Dr. Xu: A Chinese Medicine Novel

Evan’s pulse examination leaves the doctors struggling to agree on a diagnosis.

The Chinese medicine doctors were just as dumbfounded.

It wasn’t Evan’s conclusion that stunned them. It was the way he’d examined the pulse.

He had followed the pulse along the hand-yangming Large Intestine channel and detected signs of disease as it descended to the bowel? What the hell was that?

Alex was bewildered too. “Dr. Zhong,” he asked quietly, “what method is he using?”

Henry looked both startled and doubtful. “Could it be the method recorded in the Nanjing?

“With one exhalation and one inhalation, the pulse travels six cun. Wherever it passes through a diseased area, signs of the illness will show. But… does anyone still know how to do that?”[1]

Alex still didn’t understand.

Neither did Leo.

No one practiced that method anymore. How did doctors examine a pulse these days? First, they identified its qualities, then matched them to the descriptions in the old medical texts.

Take a wiry pulse. At the left cun position: palpitations, headaches, night sweats. At the left guan: fullness and pain in the flanks, abdominal masses of cold or heat type. At the left chi: pain in the lower abdomen, lower back, and knees…

Many doctors didn’t even examine the cun, guan, and chi positions carefully. They gave the wrist a quick press. Straight, long, and taut, like a drawn bowstring? A wiry pulse. Then they counted the beats. Ninety-odd a minute—a rapid pulse. So, wiry and rapid.[2]

A rapid pulse indicated a heat pattern; a wiry one could indicate a Liver disorder. Too much Liver fire, then. A look at the patient’s test results, and they wrote a prescription. That was why their pulse examinations took so little time.

The stubborn old man, for instance, had a wiry, slippery pulse. Whenever illness involved deficiency and depletion, that combination would appear. It could also indicate excess heat, phlegm-fluid retention, or phlegm-heat, and was often seen in Liver disorders or wind stroke. But the pulse alone didn’t tell you the precise disease or pattern. You still needed other diagnostic methods.

Add a Western medical diagnosis of acute cholecystitis, a shaoyang pattern, and a wiry, slippery pulse that could point to the Liver. The Liver and Gallbladder were an interior-exterior pair. Surely the diagnosis had to be right.[3]

Yet the Nanjing’s method of pulse diagnosis remained the most orthodox and effective. The Liang method had developed from it. Evan had built his foundation by learning the normal pulses of the four seasons. Only by knowing the normal seasonal pulses could he recognize diseased ones.

He had also learned to gauge the pulse by the breath, allowing him to judge its position in a complete circuit. Wherever there was illness, he could detect it in the pulse.

But he had only learned the basics, and he wasn’t entirely certain. An intestinal abscess caused pain in the lower abdomen, not the upper abdomen.

Henry thought for a moment. “Dr. Xu, the patient’s pain is in the upper right abdomen.”

Evan frowned. “That’s what puzzles me too.”

“Even I know appendicitis hurts in the lower right abdomen, not the upper abdomen, and I’m not a doctor,” Ms. He said coldly. “And you call yourselves doctors of Chinese medicine? You don’t even know basic medicine.”

The Chinese medicine doctors’ expressions darkened.

Evan rose. “I’m puzzled, yes. But when the pulse reached the Gallbladder, the signs of disease weren’t very pronounced. So it shouldn’t be cholecystitis.”

Everyone paused.

“The ultrasound showed cholecystitis,” Ms. He sneered. “Your hands are better than an ultrasound machine?”

The Chinese medicine doctors looked embarrassed.

Alex didn’t know how to answer. She had a point. How could a person be as accurate as a machine?

Henry looked grim too.

Dr. Qi didn’t know what to say either. Henry had insisted on making a fight of it. And now look.

“Could it be appendicitis with the appendix in an unusual position?” a young woman behind Dr. Qi ventured.[4]

Everyone turned to her. She was only a resident. Faced with so many department heads staring at her, she flushed and instinctively covered her mouth, unsure whether she’d said something wrong.

Leo clapped his hands. “Of course! It could be appendicitis in an unusual position. Appendicitis is misdiagnosed quite often!”

“But… the appendix isn’t part of the large intestine,” another young Western medicine doctor said quietly. “Didn’t he say the problem was in the large intestine?”[5]

“In Chinese medicine, the Heart, Liver, Spleen, Lung, and Kidney aren’t the same concepts as the organs in your anatomy textbooks,” Leo explained. “In pattern differentiation, acute appendicitis comes under the category of intestinal abscess. We classify it differently. When we treat appendicitis, we treat it as an intestinal abscess.”

Several of the Western medicine doctors frowned.

Appendicitis was indeed misdiagnosed fairly often. That was why, when asking family members to sign the consent form, doctors usually included a clause allowing them to change the surgical plan if they found that the condition wasn’t appendicitis.

Dr. Qi considered it with a frown. “There is an inflammatory mass near the gallbladder. We can’t completely rule out appendicitis, but an appendix in an unusual position is very rare.”

“We could open him up and explore the abdomen,” said a young Western medicine doctor behind him. “Then we’d know, wouldn’t we?”

Many misdiagnosed cases of appendicitis, especially those with an unusually placed appendix, were only discovered during surgery. They were difficult to identify in the examinations beforehand.

With this patient, for instance, if they opened him up and found appendicitis rather than cholecystitis, they could simply remove the appendix.

But that sounded rather harsh to a patient’s family.

“Is that how you doctors operate?” Ms. He asked. “By trial and error?”

“No,” the young doctor hurried to explain. “If his appendix is in an unusual position, it’s in that same area. The incision would still be appropriate. Besides, those cases are only discovered during surgery anyway. It wouldn’t affect his treatment.”

NovelPhoenix has the chapter published by its author, while this page displays text copied without their approval.

“Then operate. Why bring Chinese medicine doctors in to get in the way?”

“I’m not having surgery. I only want Chinese medicine,” the old man insisted from the bed.

No one had an answer. There they were, back where they’d started.

Ms. He was too angry to speak.

“I think we could try it,” Evan said.

Everyone stared.

“You agree to surgery too?” Dr. Qi asked, surprised.

“At least you’ve got some sense,” Ms. He said.

“Traitor!” the old man cried furiously.

Evan didn’t know whether to laugh or cry. “I meant we could try Chinese medicine.”

Chinese medicine?

They were all taken aback. What could Chinese medicine do? Even if it was appendicitis, that was an acute abdomen. They still needed Western medicine to diagnose it. What method could Chinese medicine offer?[6]

Even the Chinese medicine doctors standing there were startled.

Evan moved to the foot of the patient’s bed, reached out, and pressed his lower leg. “Does it hurt here?”

“Yes,” the old man said miserably.

The Western medicine doctors watched, bewildered. What was he doing?

Henry clapped his hands in frustration. “The appendix point! How could I have forgotten?”

Alex and Leo immediately understood.

“Of course—the appendix point!” Leo said, delighted. “It’s used for appendicitis or intestinal inflammation. In acute appendicitis, it’s often tender when pressed!”[7]

Ms. He looked surprised.

“Could his appendix really be in an unusual position?” the young woman resident murmured.

Everyone was astonished. Could this man really diagnose with three fingers what modern instruments couldn’t establish?

Dr. Qi’s brow remained furrowed. The Chinese medicine doctors all thought it was appendicitis now, but he didn’t accept their conclusion. Western medicine didn’t recognize acupuncture points and pulse qualities as scientifically established.

You said his pulse showed appendicitis? They didn’t regard pulse diagnosis as scientific. You said the appendix point hurt when pressed? Perhaps he’d simply knocked or injured his leg there.

Besides, even if it was acute appendicitis, he still needed surgery. If it got worse, it could kill him.

Evan paid little attention to all that. He took an acupuncture case from his bag.

Ms. He stared at him. “What are you doing?”

“Treating him,” Evan said simply. He opened the case and took out a filiform acupuncture needle.

“You…” Too angry to finish, Ms. He turned to Dr. Qi. “If something goes wrong, who’s responsible?”

“I am!” the stubborn old man shouted from the bed. “I’m the one who asked him to treat me. It’s nothing to do with anyone else!”

Dr. Qi had no reply.

Ms. He flung out a hand in fury. “Fine. Go ahead. Go ahead and treat him. Wasn’t harming one person enough? Fine—let your Chinese medicine kill you too!”

“I wasn’t wrong!” the old man shouted. “I want Chinese medicine to treat me! I’m going to prove I wasn’t wrong!”

“You… You’re ignorant! Backward! Superstitious!” Ms. He grew angrier with every word. “There’s something seriously wrong with your head. Even if it’s appendicitis, it’s still an acute abdomen. Can Chinese medicine treat that? Do you want to put off treatment until you’re seriously ill too?”

The stubborn old man said nothing.

The other young Western medicine doctors nodded. They felt the same way. But since Dr. Qi hadn’t spoken, they didn’t dare say so outright.

Henry and Leo looked unhappy too, but neither could find an answer.

Evan glanced at Ms. He and replied calmly, “Who told you Chinese medicine can’t treat an acute abdomen?”

She froze.

So did everyone else.

This was an acute abdomen. For years, cases like this had gone to Western medicine for surgery. Since when had Chinese medicine had a part in it?

Evan found a small stool and sat by the old man’s feet. Then he took a container of alcohol-soaked cotton from his bag.

“I’ll hold that.”

Evan looked up. It was Alex.

Reader Notes

Reader Notes

↩︎ The Nanjing and breath-based pulse diagnosis. The Nanjing, or Classic of Difficult Issues, is a Chinese medical classic discussed in earlier chapters. Its first difficulty describes three cun of circulation on exhalation and three on inhalation. Cun here is a traditional unit, not an English inch; the account belongs to classical channel theory. Evan’s ability to locate a diseased segment through the wrist pulse is part of the novel’s account, rather than something this passage of the classic establishes. Source: Nanjing Benyi — First Difficulty (in Chinese).↩︎ Positions, qualities, and context. Cun, guan, and chi are three adjacent examining positions at each wrist. “Wiry” describes a taut quality, “slippery” a smooth, rolling one, and “rapid” the rate. The narrator contrasts matching such features to a symptom list with a more detailed examination. The ninety-odd beats in this example should not be read as a universal diagnostic threshold. Seasonal normal pulses, introduced earlier, provide a traditional baseline; the novel’s claims of a uniquely effective method and specific disease associations are not validated by the terminology. Source: WHO — Standard TCM terminologies, pulse examination and pulse conditions.↩︎ Traditional organ systems. Capitalized organ names in this edition denote Chinese medicine’s functional systems. The Liver and Gallbladder form a traditional interior-exterior pair; this is not an anatomical connection that proves cholecystitis. Phlegm-fluid retention and phlegm-heat are also traditional pattern terms, not necessarily visible mucus. These classifications explain the narrator’s diagnostic associations, while “shaoyang” continues the six-division framework introduced earlier. Neither the organ pairing nor a pulse label independently establishes the cause of this patient’s pain. Source: WHO — Standard TCM terminologies, entry 58 and pulse/pattern sections.↩︎ An unusually located appendix. An appendix situated beneath the liver can cause upper right abdominal pain and resemble gallbladder disease. A published case documents that diagnostic difficulty. This background explains the resident’s suggestion; it does not establish that Mr. He has that condition. Atypical anatomy does not mean an appendix is inherently invisible to imaging. Modern assessment can include examination, laboratory tests, ultrasound, CT, or MRI, although identifying the cause may still be difficult. A case report demonstrates a possibility, rather than a general misdiagnosis rate. Sources: Case report — A Case of Right Upper Abdominal Pain Misdiagnosed on Computerized Tomography; NIDDK — Diagnosis of Appendicitis.↩︎ The anatomical objection. As in the preceding chapter, the doctor’s categorical statement is preserved from the original dialogue. The appendix is attached to the large intestine; this objection does not accurately distinguish the two systems of diagnosis. Source: NIDDK — Definition and Facts for Appendicitis.↩︎ Acute abdomen. This clinical term describes a serious, acute abdominal presentation requiring urgent assessment, rather than a single disease or a wound. Appendicitis is one possible cause. The disagreement in this scene concerns diagnosis and the choice of treatment. Contemporary treatment commonly includes appendectomy and antibiotics; selected mild cases may be treated with antibiotics alone. That distinction does not establish acupuncture as an equivalent treatment, or determine what this fictional patient needs. Sources: Cleveland Clinic — Acute Abdomen; NIDDK — Treatment for Appendicitis.↩︎ The appendix point. Wanwei is an extra acupuncture point on the lower leg, distinct from the abdominal appendix itself. Chinese acupuncture literature lists it among points used for appendicitis. That traditional use explains Henry’s recognition and Leo’s statement here. Tenderness at a named point does not, by itself, confirm appendicitis or exclude another cause of abdominal pain. The scene records the characters’ interpretation, not a validated diagnostic test. The original does not specify which leg Evan presses, and the translation leaves the side unspecified. Sources: China Association of Acupuncture-Moxibustion — Acute Appendicitis (in Chinese), Body Acupuncture, point selection; NIDDK — Diagnosis of Appendicitis.