Dr. Xu: A Chinese Medicine Novel

Questions about a stubborn cough bring some unexpected compliments.

Evan considered the question. “We might as well discuss it. It’ll help put the patient at ease too.”

The man and his wife both nodded quickly.

“Then please enlighten us,” Henry said evenly.

“The patient’s only symptom is a cough,” Evan said. “The other signs give us too little to identify a pattern. So I followed the practice of earlier physicians and relied on the pulse alone. My examination indicated cold water surging against the Lung—”[1]

Alex couldn’t wait for him to finish. “Cold water surging against the Lung?”

Henry frowned too.

Evan paused at the interruption. “That’s right.”

Alex gave a derisive laugh. “Doesn’t that mean thin, watery phlegm, shortness of breath, and a tight chest? In severe cases, you can’t even lie flat? This patient has a dry cough. No phlegm. How can you call it cold water surging against the Lung? Where’s the phlegm?”

The wife looked puzzled. “You can cough this cold right out of your body?”

“Coughing is the body’s way of protecting itself,” Alex explained. “It detects something wrong inside and tries to cough out the pathogenic influence. With cold water surging against the Lung, it’s usually someone who already has retained phlegm-fluid or edema. Then they catch an external cold influence. The cold stirs up the retained fluid, which surges upward and interferes with the Lung’s dispersing and defensive functions.

“So the body coughs to try to drive out the fluid and the cold and get itself healthy again. That’s why patients with this pattern generally have phlegm. It’s thin and watery, sometimes foamy. They usually aren’t thirsty, and their tongue coating is white and moist.”

“Oh.” The couple understood. They looked back at Evan to hear his response.

Evan nodded to Alex. “You’ve learned that well.”

Alex rolled his eyes. “Who asked you to praise me?”

Unbothered, Evan went on. “How do you know he hasn’t coughed out any fluid?”

Everyone in the room was taken aback.

“Dr. Xu,” Leo prompted, “did you… get your words mixed up? Talking too fast?”

“Bullshit,” Alex said at once. “He doesn’t understand, and his hearing’s no good either. The patient’s been telling him all this time: dry cough, no phlegm. Can’t he hear?”

“I think it’s your eyesight that’s the problem,” Evan said. “The patient makes a little movement every time he coughs. Didn’t you notice?”

“What?” Alex was startled.

So were Leo and Henry.

Even the patient looked confused. “What movement?”

“What do you think?” his wife said. “Every time you cough, I give you a tissue to wipe your eyes. I have to bring tissues whenever we go out now.”

“Oh, right, right.” He remembered. “But isn’t it normal to cough until your eyes water? It just means I’m coughing hard.”

He thought it was normal. To the Chinese medicine doctors, it sounded rather less ordinary.

They all turned to look at him.

Startled, he felt that unbearable itch in his throat again and immediately began to cough. “Cough, cough, cough… Cough, cough, cough…”

His wife deftly pulled a tissue from her bag. These days she kept a large pack in there: easy to pull from, plenty of tissues, and cheaper too.

The man took it and wiped away his tears. This time, everyone saw.

Henry caught hold of the patient’s hand. He studied the man’s tears and eyes, his brow furrowing further.

He released the man. “If this is cold water surging against the Lung, the coughing could certainly expel the cold and fluid as tears or nasal discharge. But most of it should come out as phlegm through the mouth. Why does he have a dry cough with no phlegm?”

Evan nodded and offered another compliment. “Just what I’d expect from a department head. You’ve put your finger on the key point.”

Henry looked uncomfortable too. He, too, wanted to say: Who the hell asked you to praise me? But he kept it to himself. He had the dignity of a department head to maintain.

Still, the discomfort was real. He had never imagined being praised could feel so awkward. What the hell was this?

Leo didn’t know whether to laugh or cry. That damned habit of Evan’s left him speechless. If someone came looking for trouble, he could understand arguing back, falling out with them, even getting into a fight. That would be normal.

But why compliment them? What sort of approach was that? Leo remembered coming to challenge him last time. Evan had praised him, criticized him, and given him pointers, all at once.

Was this manipulation?[2]

A reader’s note on origin: this passage was taken from the author’s page without permission. The official story supports the writer.

The thought gave Leo a fright. He looked at Evan differently. Was the kid going to play mind games with Henry? Damn. The young really did know no fear.

Leo was burning with curiosity.

Henry suppressed his discomfort. “Get on with your explanation. Don’t change the subject.”

Evan smiled slightly. “Why isn’t it coming out through the mouth? Because there’s pent-up heat in the Lung. Then he contracts an external cold influence, and wind-cold binds the Lung. In everyday terms, cold has wrapped up the heat. With cold and heat constrained together, the phlegm-fluid in the Lung can’t come out. Instead, it finds another outlet as tears or nasal discharge.”[3]

The others were taken aback.

“That sounds… a bit far-fetched,” Alex said doubtfully.

Evan turned the question to Henry. “I hear you’ve examined him too, Dr. Zhong. Shall we compare our findings?”

Henry was briefly taken aback.

Leo stole a cautious look at him. Henry hadn’t worked out the underlying mechanism.

Henry’s expression didn’t change. “I’m not the doctor treating him. Alex, tell us what you think.”

Leo’s expression changed at once. Damn. Neat way to pass the question on.

Alex was taken aback too. He had no idea, but his department head had called on him. He could hardly say he didn’t know, especially with his sworn enemy Evan right there. He couldn’t back down.

He gathered his thoughts. “Well… a dry cough without phlegm is most likely a cough caused by dryness. If dryness has caused the trouble, you moisten it. Gentle warming and moistening, nourishing yin and relieving dryness—that shouldn’t be far wrong.”[4]

“Wrong,” Evan said.

“What?” Alex was startled.

Evan pointed to the stack of treatment records. “Didn’t you look at what the previous doctors prescribed? Most of it was intended to nourish yin and moisten dryness too. It didn’t work at all.”

“What?” Alex’s face reddened. He really hadn’t looked. He’d been too busy arguing.

The wife immediately looked displeased. “See? I told you these young doctors don’t take responsibility. They won’t even look properly. All they know is ordering tests and making us spend more money.”

Alex’s face grew redder. “Then… perhaps there was something wrong with the formula, or the doses.”

Even he wasn’t convinced. If the pattern had been correctly identified, the formula would usually not be far wrong. A small mistake in the dose shouldn’t leave it completely ineffective. But the patient had taken the medicine without any improvement. His cough had even become worse.

Henry came to Alex’s rescue. “Dr. Xu, perhaps you’d explain the basis for your diagnosis.”

“That’s what I was trying to do earlier,” Evan said. “He interrupted me before I could finish.”

Alex was so angry he could barely think. So he’d done this to himself!

Henry’s face was expressionless. “Then please enlighten us, Dr. Xu.”

“As I said, the patient’s symptoms offered no clear pattern,” Evan replied. “I identified it from the pulse.”

“The pulse.” Henry frowned. He had examined it himself, without finding an answer.

Evan nodded. “Yes. And this patient’s pulse is particularly hard to read. It’s perfectly balanced throughout. There’s an abnormal pulse only at the right cun position.”

Henry gave a slight nod. He had noticed that much. He was, after all, the best clinician at the county Chinese medicine hospital. He had that much ability. But he hadn’t been able to make sense of the right cun either. That was why he couldn’t be sure.

“At the right cun,” Evan continued, “the pulse is floating, large, slippery, rapid, and slightly tight.”[5]

Those who knew nothing of Chinese medicine looked blank. Those who did know were dumbfounded.

The cunkou pulse-taking site had three positions: cun, guan, and chi. The right cun was the cun position on the right wrist. That one position had room for just one finger.

And Evan claimed to have distinguished five pulse qualities at that single spot. Was he making this shit up?

Even Henry was stunned.

Leo began to wonder. Was this bluffing, or manipulation?

Reader Notes

Reader Notes

↩︎ Cold fluid and the Lung. “Cold water surging against the Lung” renders shui han she fei, a traditional description of cold driving retained fluid upward. The capitalized Lung denotes the traditional functional system. “Phlegm” and the thinner retained “fluids” are pathological fluid categories, broader than coughed-up sputum. The related cold-fluid Lung pattern includes watery phlegm and difficult breathing, explaining Alex’s objection. The terminology provides background; his account does not establish that this patient has every feature he lists. Source: WHO — International standard terminologies, entries 342–347 and 1177.↩︎ The joke about manipulation. Leo uses PUA, an English acronym whose meaning has broadened in Chinese beyond “pick-up artist” to include psychological or emotional manipulation in relationships, work, and other settings. “Manipulation” and “mind games” preserve that sense here. Leo is wondering whether Evan’s mixture of praise and criticism is a way to gain control over people; the narration has not established that Evan is deliberately doing so. This is a suspicious colleague’s comic interpretation, not a psychological diagnosis. Source: University of Pennsylvania Language Log — “PUA, part 2”.↩︎ Cold enclosing heat. In this traditional model, an external cold influence can restrict the Lung’s activity while heat is already present inside. “Cold” and “heat” name different aspects of a pattern and need not cancel each other out or describe measured temperatures. The WHO terminology includes the related phrase “cold enveloping fire.” Evan applies this framework to explain the dry cough despite retained fluid. The further claim that fluid is diverted into tears or nasal discharge belongs to his reasoning in the novel; the terminology source does not establish that mechanism in this patient. Source: WHO — International standard terminologies, entries 936 and 1176.↩︎ Nourishing yin and moistening dryness. Yin includes the body’s nourishing and moistening aspects in Chinese medicine. This treatment principle replenishes them when internal dryness is attributed to yin deficiency. “Dryness” is a traditional category, rather than a synonym for every cough without sputum. Alex proposes it from the dry cough; Evan objects that earlier treatments using this approach did not help. That failure belongs to the case narrative. The source does not establish that a correctly chosen pattern must always produce a treatment response, and this chapter gives no formula or dose. Source: WHO — International standard terminologies, entry 2422.↩︎ One position, several qualities. Cun, guan, and chi are three adjoining pulse-taking positions at the radial artery of each wrist; cun is nearest the hand. Qualities describe different aspects of what the examiner feels. “Floating” concerns depth, “large” breadth, “slippery” smooth movement, “rapid” rate, and “tight” tension. They are not five separate arteries or five heartbeats. The standard recognizes combined pulse qualities; the characters are astonished at Evan’s ability to distinguish this particular five-part combination in one finger-width position. The source defines the terms, rather than verifying his examination. Source: WHO — International standard terminologies, entries 856–857, 862, 889, 892, 894, 900, 906 and 929.