Dr. Xu: A Chinese Medicine Novel

Evan takes the patient’s other wrist. The pulse beneath his fingers is unlike any he has felt before.

Almost simultaneously, Evan and Dr. Li each took one of the patient’s hands and began examining his pulse.

Dr. Li glanced at Evan in mild surprise, then quickly focused on the pulse.

Evan had become quite good at pulse examination himself. This time, though, his brow furrowed as soon as his fingers touched the wrist. This pulse was unlike any he had felt before.

It was like a sparrow pecking at grains of rice: three to five beats, then a sudden stop. A long time passed before it beat again.

A sparrow-pecking pulse!

Evan’s heart sank. This was one of the seven strange pulses.

He had never encountered it before. When he had studied pulse examination with Dr. Liang in the clinical training room, they had worked only on normal pulses through the four seasons, never pathological ones.

This was his first encounter with a terminal pulse, a sign that the patient’s chances were all but gone.

The sparrow-pecking pulse signified exhaustion of Spleen qi and was most often seen in severe structural heart disease.

Examining it further, Evan found a roof-leak pulse as well.

Another of the seven strange pulses.

Like water dripping from a leaking roof, a single drop after a long wait. The intervals were uneven, the pulse extremely slow.[1]

This was bad. Sparrow-pecking and roof-leak pulses together—could the patient’s Stomach qi already be exhausted? With Stomach qi, a person lived. Without it, a person died.

But the pulse was so slow and so chaotic that Evan could not make a judgment straightaway.

Dr. Li’s voice suddenly broke in. He seemed to be speaking to himself.

“When the wrist pulse cannot be relied on, follow the experience of our predecessors. Examine the three lower pulse sites: Fuyang, Taixi, and Taichong.”[2]

Evan paused. Was Dr. Li giving him guidance?

Dr. Li moved to the patient’s feet and began his examination, still apparently talking to himself.

“Examine Fuyang to assess Stomach qi, Taixi to assess Kidney qi, and Taichong to assess Liver qi.

“The Kidney is the innate foundation; the Spleen and Stomach are the foundation of life after birth. When life hangs in the balance, saving yang comes first. Preserve even a thread of yang qi, and a thread of hope remains. In severe threefold failure, layer upon layer of yin cold hems the patient in. When death may come at any moment, restoring yang is urgent.”[3]

Dr. Li straightened, his expression solemn.

“At such a moment, we must use a large dose of Poge Jiuxin Tang to break through the barriers, drive back yin cold, and restore yang—to save a life on the point of extinction. Take down the prescription!”

Evan gave a start and immediately got up to fetch paper and a pen.

“A large dose of Poge Jiuxin Tang to recover the yang that is slipping away and prevent collapse,” Dr. Li dictated. “Add Sansheng Yin to clear phlegm, and shexiang to dispel foulness, open the sensory orifices, and restore consciousness, to rescue him from respiratory failure. Fuzi, 150 g. Dried ginger and prepared licorice root, 60 g each. Korean ginseng, 30 g, stewed separately into a concentrated extract and mixed in for administration. Raw banxia, 30 g…”[4]

Just as he finished, Evan’s gossiping roommate arrived with the hospital director.

Well, the director signed without a word.

The pharmacy immediately gathered the herbs and put them on to boil.

“Add 1.5 kilograms of boiling water,” Dr. Li instructed. “Boil over high heat and give it as it brews. Day and night, keep feeding it to him without stopping.”

The young doctor hurried off to do it.

Evan crouched at the patient’s feet and examined the three pulses Dr. Li had mentioned.

Dr. Li glanced at him a few times but said nothing.

Normally, Chinese herbs were started in cold water, brought to a boil, then simmered over gentle heat. The boiling time also varied according to the herbs.

With fuzi, for instance, its toxicity only broke down substantially after an hour of boiling. During that first hour, it was at its most toxic.

Yet Dr. Li had prescribed 150 g of it, boiling it hard and administering it as it brewed. There had been no preliminary hour of boiling. This was when the fuzi was at its most poisonous![5]

The prescription was already boiling fiercely. The young doctor kept bringing portions over and feeding them to the patient.

After watching for a while, Dr. Li left the treatment room and went into the dark courtyard. He leaned against the wall by the hospital gate, lit a cigarette, and smoked.

“Director… are you confident about this patient?” Evan had come out too and stood behind him.

Without turning, Dr. Li said quietly, “You examined his pulse too. Tell me what you found.”

“Sparrow-pecking and roof-leak pulses, both among the seven strange pulses. Terminal pulses, with almost no hope of survival. The wrist pulse was too unreliable, so I examined Fuyang, Taixi, and Taichong. They were very fine and weak, but still discernible. So his chances aren’t entirely gone!”

Dr. Li still did not turn. He slowly exhaled smoke, the corner of his mouth lifting in the darkness.

“Then do you think he still has a chance?”

“I…”

Evan did not know how to answer. He had never treated a case like this.

Hearing no more from him, Dr. Li raised his head toward the stars filling the sky. Again, he seemed to be talking to himself.

“Another two hours, and it’ll be dawn.”

Evan paused, then suddenly understood. “I see!”

“What do you see?”

“He has severe threefold failure. His body is hemmed in by layers of yin cold. The zi hour, around midnight, is when yin qi is strongest. That was when this attack began, and he nearly died.

“But although yin is at its height then, that’s also when the first yang returns. After the zi hour, yang qi grows stronger and stronger. And the patient didn’t die. He held on until now! That’s his thread of hope!”

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Still facing away, Dr. Li smiled a little more in the darkness.

“It’s four in the morning.”

Evan’s eyes immediately lit up.

“At four, in the circulation of nutritive and defensive qi through the twelve channels, the Lung channel is in ascendancy. This is when that channel’s qi is strongest. Despite this patient’s threefold failure, he’s held on until now without deteriorating to the point of death. This is the last chance to save him!”[6]

Dr. Li chuckled, dropped his cigarette butt, and ground it out underfoot.

“You know something of classical Chinese medicine. That’s rare.”

“Because that’s where Chinese medicine has its roots,” Evan said earnestly.

Dr. Li neither agreed nor disagreed. He simply turned and came toward him.

“Come on. Let’s see the patient.”

“Director.”

Evan stopped him.

Dr. Li halted and turned his head.

“Director, I want to study medicine under you.”

A little taken aback, Dr. Li shook his head and smiled. “Under me?”

Evan nodded seriously.

“What I do goes against all the rules,” Dr. Li said. “You want to learn from me? I can teach you everything, hold nothing back. But if I dare teach you, do you dare use it?”

Evan froze.

“The pharmacopoeia says fuzi must not exceed 9 g. I start with 150 g. Often I use more than 500 g in a day and a night. Its toxicity only begins to break down after an hour of boiling. But I give it as it brews. Right now, it’s at its most poisonous.

“And the man lying in that bed has only his last breath left. I’m giving a dying man a violently poisonous decoction that even a healthy person would struggle to withstand. If I teach you, do you dare use it?”

Evan froze again. His breathing suddenly grew heavy.

Dr. Li smiled once more.

“There’s only one last thread of hope for this patient. Even Zhang Zhongjing couldn’t promise he’d live. I can’t be certain either.

“If I fail to save him, what if his family takes my prescription and makes trouble? What if they take it to the authorities? The pharmacopoeia is the law. With this sort of use beyond its limits, I might end up in prison!”[7]

Evan was utterly stunned. For a few seconds, he stopped breathing.

Dr. Li looked into his eyes.

“If I dare teach you, do you dare use it? Treat a patient this ill and save him, and you might lose your license. Fail to save him, and you might go to prison. Would you still dare?”

He studied Evan’s blank expression, then shook his head with a smile. He did not seem disappointed. Over the years, he had grown used to this. He turned to leave.

Behind him, Evan spoke solemnly.

“When a great physician treats illness, he must not hang back, calculating his own fortunes or protecting his life. He must see another’s suffering as his own and feel it deeply. He must not shrink from danger, day or night, heat or cold, hunger, thirst, or exhaustion. He must give himself wholly to saving the patient, without any thought of making a show of his efforts.”[8]

With his back to Evan, Dr. Li chuckled.

“Words. Anyone can say them.”

He started to leave again.

“I’ve used your prescriptions,” Evan said. “I’ve treated a dying patient!”

Only then did Dr. Li turn to look at him.

Evan gave a bleak smile.

“I had ten thousand reasons not to try to save him. If I’d stayed out of it, no one would have blamed me. But I went anyway. And so… I lost everything…”

Reader Notes

Reader Notes

↩︎ Sparrow-pecking and roof-leak pulses. These are traditional descriptions of how a pulse feels under the fingers. The first suggests a cluster of quick beats followed by a pause; the second suggests widely separated, irregular drops. They belong here to the classical category of ominous or “strange” pulses, associated with exhaustion of the body’s sustaining functions. Stomach qi in this context includes the pulse’s underlying vitality, not simply digestion. The chapter’s association with structural heart disease is a separate medical claim; these definitions do not establish a specific heart rhythm or an inevitable outcome. Sources: Mai Jue Kan Wu — “Strange Pulses,” classical text transcription (in Chinese); WHO — International Standard Terminologies on Traditional Chinese Medicine, entry 926, p. 93.↩︎ Pulse sites below the wrist. Cunkou, translated here as the wrist pulse, is the usual radial-artery examination area. Dr. Li turns instead to pulse sites around the foot and ankle: Fuyang, Taixi, and Taichong. These are palpation sites in this passage; no needles are being inserted. The traditional associations with Stomach, Kidney, and Liver qi belong to the functional systems of Chinese medicine. They do not mean that feeling these pulses directly measures the function of the anatomical stomach, kidneys, or liver. Source: WHO — International Standard Terminologies on Traditional Chinese Medicine, entries 855–856 and 919, pp. 84 and 92.↩︎ Foundations and restoring yang. The Kidney is called the innate foundation because traditional theory associates it with inherited essence. The Spleen and Stomach sustain life after birth through food and nourishment. Dr. Li connects these ideas to an emergency strategy of restoring yang, the warming and activating aspect of bodily function, and preventing collapse. “Threefold failure” preserves the source’s shorthand for this patient’s grave condition; it does not add a diagnosis of kidney failure. Yin cold and loss of yang describe his traditional assessment, rather than laboratory findings. Source: WHO — International Standard Terminologies on Traditional Chinese Medicine, entries 114 and 158, pp. 11 and 14.↩︎ The dictated prescription. Poge Jiuxin Tang and Sansheng Yin are formula names; the latter is added here for phlegm in Dr. Li’s explanation. Fuzi is an aconite-root medicine; banxia is pinellia tuber, explicitly raw in this prescription. Shexiang means musk, and prepared licorice is distinct from unqualified licorice root. The amounts remain the novel’s amounts of medicinal material, not isolated alkaloids. The list ends with an ellipsis in the source, so it is not a complete formula. Raw banxia’s identity and regulated toxic status are documented; that does not validate this combination or its doses. Source: Hong Kong Baptist University — Raw Banxia, specimen D00190.↩︎ Boiling time and aconite toxicity. A decoction is made by boiling medicinal materials in water; preparation methods differ between materials. Dr. Li’s rapid, repeated administration is deliberately contrasted with ordinary preparation. The “one hour” statements in the narrative and dialogue remain the source’s claims, not a universal boundary between toxic and safe medicine. Hong Kong’s Chinese Medicine Regulatory Office calls for appropriate processing, controlled dosing, and preliminary, prolonged decoction of aconite medicines. It also lists banxia among materials not normally combined with them. Those cautions highlight the exceptional practice portrayed here; they do not certify it as safe. Sources: CMRO — Preparing Herbal Decoctions; CMRO — Aconitum Alkaloids, “Precautions” (in Chinese).↩︎ Midnight, returning yang, and the Lung channel. A traditional Chinese double-hour lasts about two modern hours: zi is approximately 11 p.m. to 1 a.m.; the 3–5 a.m. period is yin, associated in this channel timetable with the Lung. This time-period name is different from yin in yin and yang. The dialogue combines the return of yang after midnight with the channel’s assigned time of ascendancy. These are related traditional frameworks, not a demonstration that clock time predicts this patient’s survival. Their use here belongs to Evan and Dr. Li’s reasoning. Sources: Beijing University of Chinese Medicine — Zhai Shuangqing on channel and double-hour correspondences (in Chinese); Academia Sinica — Taiwan Social Change Survey report, PDF p. 96, time coding table (in Chinese).↩︎ The pharmacopoeia and personal responsibility. A pharmacopoeia sets standards for medicinal substances and preparations. Dr. Li’s “9 g” limit and “the pharmacopoeia is the law” are his statements within the novel’s 1981 scene. The edition behind that exact limit has not been established here; the modern regulatory leaflet linked below lists a different range for prepared fuzi. His warning about losing a license or going to prison conveys the stakes as he sees them, rather than an automatic legal consequence. Source for the modern comparison only: CMRO — Aconitum Alkaloids, prepared-fuzi table (in Chinese).↩︎ A great physician’s sincerity. Evan returns to the passage traditionally known as Dayi Jingcheng, “The Great Physician’s Skill and Sincerity,” in Sun Simiao’s Beiji Qianjin Yaofang. It calls for compassion and wholehearted care rather than self-protection or a performance of virtue. The words here are translated afresh from the novel’s excerpt, without adding the surrounding classical text. Dr. Li’s reply challenges the gap between reciting that ideal and acting on it. Source: Beiji Qianjin Yaofang — volume 1, “On the Great Physician’s Skill and Sincerity,” classical text transcription (in Chinese).