Chapter 100 Brilliant! Absolutely Brilliant!

A visiting professor turns a difficult consultation into an impromptu lesson.

Early the next morning, Dr. Zhong and Leo drove to the station to pick up Professor He.

“Ha! Professor He, welcome back. Thank you for coming to help us again.” Both men went forward to greet him.

Professor Martin He was a leading specialist at the provincial hospital of Chinese medicine and a professor at Nanzhongyi, a university of Chinese medicine. Through a partnership with their hospital, he came to see patients for a few days each month.

He was in his sixties, still vigorous, with a refined, scholarly manner. He smiled and shook their hands. “It's no trouble.”

“This way, please. Please,” Leo said quickly.

They ushered him into the car and drove toward the hospital.

On the way, they explained the patient's condition and asked him to join consultations on several other difficult cases. Professor He readily agreed.

When they reached the hospital, Dr. Qi was waiting too. A group of Chinese medicine doctors had gathered at the main entrance.

Applause broke out as Professor He arrived.

The doctors crowded behind him and swept toward the inpatient building in an impressive procession. A leading specialist from the provincial hospital certainly made an entrance.

The patient and his family were delighted. They had never expected a specialist from the provincial hospital to come and treat him.

Professor He went to the bedside. His manner was gentle as he asked about the illness and examined the patient's tongue.

“His tongue is red, and it's dry through the middle and toward the root. What does that tell us?” he asked the doctors following him. “His Stomach fluids are depleted, so Stomach qi fails to descend, and he keeps vomiting. You must pay attention to that when diagnosing and treating him.”

The doctors around him wrote it all down as earnestly as grade-school children.

Professor He felt the patient's pulse next.

“The pulse is broad but disperses under pressure. In this patient, qi deficiency has led to the bowel obstruction. You can't treat every case as excess heat. You must learn to differentiate the pattern.^[1]

“After surgery in conventional medicine, a patient's qi and blood are bound to be weak. Remember that. When working with surgeons, make sure to replenish qi and blood both before and after the operation. Patients will recover much faster, with fewer complications and a much better prognosis.”

The others hurried to write that down too.

Dr. Qi nodded seriously. For experienced clinicians like them, the improvement in prognosis when Chinese medicine was involved before and after surgery was plain to see.

Professor He stood with his hands behind his back and continued.

“Now, treating any fullness or blockage comes down to treating qi. What is the hub of qi movement in the Triple Burner? The Spleen and Stomach. The Spleen functions well when its qi ascends; the Stomach is in harmony when its qi descends. The key to treating qi is to raise Spleen qi and lower Stomach qi.

“This patient is a typical case of disordered qi movement. Nothing can enter above or pass out below, resulting in guange. That's what has led to his bowel obstruction. How should we treat him?”^[2]

He looked at the young doctors behind him.

No one quite dared to answer. They looked at one another.

Professor He was a university teacher, and he encouraged them. “It's all right. Speak up.”

Alex summoned his courage. “We should replenish qi and direct counterflow downward, restore fluids, and get qi moving.”

“Good! This young man has worked out the treatment approach already.”

Dr. Zhong glanced at Alex. Weren't those Evan's exact words yesterday?

Alex felt rather pleased with himself. Answering questions was a lot more fun when you'd already seen the answers!

The other young doctors looked at him too.

“Then what approach should we take in choosing the medicines?” Professor He asked.

The young doctors looked at one another again.

Professor He called on Alex again. “Come on, young man. Tell us more.”

Alex said hesitantly, “A serious case of guange like this calls for medicines that can break through a stubborn blockage, with qi-regulating medicines leading the way.”

“Yes! Very good.” Professor He's eyes filled with appreciation.

Dr. Zhong and Leo gave Alex distinctly unimpressed looks.

Dr. Qi had an odd expression too.

“Young man, what's your name?” Professor He asked.

Alex's heart began to pound. “I… I'm Alex Xu.”

Professor He nodded. “Alex Xu. Good. If you were writing the prescription, what would you use?”

“Uh…” Alex looked embarrassed.

Leo looked at him. Surely the kid wasn't going to recite Evan's prescription?

Seeing Alex hesitate, Professor He encouraged him as if they were in class.

“Tell us. Be bold. Medicine is about exchanging ideas. Don't be afraid to get something wrong. Make a mistake and correct it—that's how you improve. Go on.”

Everyone was looking at Alex.

The young doctors watched him. He'd already shown off twice in the space of a few minutes. Could he keep it up?

Alex swallowed, looked to either side, and ventured, “Raw huangqi, 90 g; red ginseng, 20 g, simmered separately; shengdi, 30 g; yuanshen, 60 g; maidong, 90 g; houpo, 30 g; chenxiang and muxiang, 5 g each, ground with liquid and mixed in; powdered zheshi, 50 g; laifuzi, 30 g, half raw and half prepared; ginger juice, 10 mL, mixed in.”^[3]

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Leo rolled his eyes. The guy really had recited Evan's prescription.

The doctors exchanged looks. Weren't those doses rather large? The patient was so weak. Could he withstand medicines that broke up qi stagnation like that?

Dr. Zhong looked thoroughly fed up too.

Professor He had begun with the same kindly smile. As he listened, however, his brows drew together. By the time Alex finished, he was silent and looked rather grave.

After a moment, he looked up. “Write the prescription down. Let me have another look.”

Before Alex could do anything, Dr. Zhong handed Professor He the piece of paper he was holding.

“You've written it out already?”

Professor He took it and studied it carefully. The longer he looked, the more surprised he became.

“Brilliant!” he said to Dr. Zhong beside him. “This is an exceptionally well-judged combination. Very clever. Every part fits perfectly.

“Look. It's qi deficiency and impaired transport that have caused the blockage. That's why we should treat the apparent obstruction by tonifying, using large doses of ginseng and huangqi to replenish primordial qi. The approach is absolutely right.^[4]

“And the clever touch is the small amounts of muxiang and chenxiang, ground with liquid and mixed in, to help qi circulate. We don't just want to replenish qi. His qi movement is disordered. Once qi circulates properly, the effect will come quickly.

“And here—his Stomach qi isn't descending, so zheshi and houpo have been added to direct counterflow downward. But his Stomach fluids are depleted. Trying to force qi downward won't work without restoring those fluids. There's a large-dose Zengye Tang hidden in this prescription too, to restore fluids and float the boat!^[5]

“He has a partial bowel obstruction from adhesions. Nothing can enter above, and nothing can pass below. A serious case of guange. We certainly need to break through stagnation and open the blockage. Simply replenishing qi won't do enough.

“Look, there's laifuzi too. What is laifuzi? The mature seeds of white radish. Eat white radish raw and it makes you belch. It raises qi and eases the chest, opening the upper burner first. Cook it, and you pass wind instead, with your bowels rumbling. It sends qi downward very quickly and helps the passage of both urine and stool, clearing qi in the middle and lower burners.

“Radish seeds have the same properties as the radish itself. Using half raw and half prepared is a clever way to restore qi movement quickly throughout the Triple Burner. After all, this patient has trouble both above and below. Brilliant! Absolutely brilliant!”^[6]

Alex's face had gone red at all the praise.

“Wow.” The others stared at Alex.

“But Professor He,” Dr. Zhong asked, puzzled, “aren't the doses too large? The patient is extremely weak. Any movement leaves him breathless. He's breathless even sitting up.

“We shouldn't use heavy tonification or heavy draining at a time like this, especially at such large doses. I'm afraid he won't withstand the force with which laifuzi breaks through the blockage. Shouldn't we proceed gradually?”

Professor He waved a hand.

“Yes, laifuzi clears the lower burner extremely quickly. It can knock walls down. But remember, laifuzi itself is unlikely to damage healthy qi. It's suitable for elderly or physically weak patients.

“This patient has been ill for a long time and is very weak. Forcing the blockage open could indeed cause complications. But look at the quantities of ginseng and huangqi. Do you think those doses are only there to replenish qi?

“No. The beauty of this formula is that it uses a relatively large dose of laifuzi, but even larger doses of ginseng and huangqi to keep it under control. That preserves its ability to knock walls down while restraining the harm its forceful action could do. Very clever indeed!”

Dr. Zhong and Leo finally understood. Now they both felt rather embarrassed.

Still holding the prescription, Professor He went on praising it.

“The doses look large, and the patient seems too weak to withstand a forceful attack on the blockage. But every part of this combination fits. Nothing can be added or taken away. The doses are exceptionally well judged too.

“Replenish qi and direct counterflow downward. Restore fluids to float the boat. Break through without damaging healthy qi, supporting it and regulating its movement instead. Remarkable! Once this prescription is given, qi in the Triple Burner should recover quickly and break through the obstruction. The effect should be as prompt as a drum responding to a strike. All the symptoms should resolve at once.”

The young doctors stared at Alex in shock. Holy shit, when had he become this good? Professor He was heaping praise on him!

Professor He looked up at Alex, astonished and full of admiration.

“Your name is Alex Xu, isn't it? A young man to be reckoned with! To have such a command of formulas and medicines at your age—I'm amazed. Who did you train under? Do you come from a family of Chinese medicine doctors?”

Alex's face went redder still.

Reader Notes

Reader Notes

1. ↩︎ Pulse findings and patterns. A broad pulse and what happens under firmer finger pressure are separate observations. In traditional pattern differentiation, a broad pulse does not by itself establish excess heat; its strength and other findings also matter. Qi deficiency and blood deficiency are traditional functional descriptions, not laboratory results such as anemia. The postoperative benefits Professor He describes, and the clinicians' agreement, belong to the story's clinical outlook. A terminology standard does not establish those benefits. Source: WHO — International standard terminologies on traditional Chinese medicine, entries 894–897 and 994–995.
2. ↩︎ The Spleen, Stomach, and Triple Burner. Capitalized organ names mark traditional functional usage. The Triple Burner divides functions into upper, middle, and lower regions; the professor locates their coordinating hub in the Spleen and Stomach. Ascent and descent describe qi movement, not simply gas moving through the bowel. Guange conventionally includes persistent vomiting and urinary retention. Here the novel uses it for blockage above and below without stating urinary retention; none has been added to the case. Source: WHO — International standard terminologies on traditional Chinese medicine, entries 188–195, 207–210, 231 and 1701.
3. ↩︎ The prescription's names and preparations. These names refer to medicinal materials. Shengdi is unprepared rehmannia root; yuanshen is another name for xuanshen, figwort root; maidong is ophiopogon root. Zheshi is hematite, a mineral, so the prescription is not entirely botanical. “Simmered separately” applies to red ginseng. “Ground with liquid and mixed in” preserves the instruction for chenxiang and muxiang without specifying a liquid or quantity the novel does not supply. The ginger juice is also mixed in. The amounts are the particular prescription Alex recites; no complete brewing schedule is given. Sources: HKBU — Zengye Tang, constituent materials; HKBU — Xuanshen and its alternative name yuanshen (in Chinese); HKBU — Zheshi.
4. ↩︎ Treating apparent obstruction by tonifying. Sai yin sai yong is a traditional treatment principle for an obstructed appearance attributed to underlying deficiency: support the deficient function so movement can resume. It does not mean making a mechanical blockage tighter. Here Professor He argues that ginseng and huangqi both support the patient's foundational, or primordial, qi and govern the stronger moving action of other ingredients. His judgment about these doses remains his assessment of this case. Source: Jiangxi University of Chinese Medicine — He Xiaohui on sai yin sai yong (in Chinese).
5. ↩︎ Zengye Tang and the boat metaphor. Zengye Tang is a fluid-restoring decoction built from xuanshen, maidong, and shengdi. Professor He recognizes those three materials within the larger prescription, at the quantities already recited. He is not giving a second prescription. “Restoring fluids to float the boat” compares intestinal passage to moving a boat that has too little water beneath it: moistening is part of the traditional treatment logic. The formula reference explains that logic; it does not verify the outcome predicted here. Source: HKBU — Zengye Tang, composition and explanation.
6. ↩︎ Laifuzi and “raw” versus “prepared.” Laifuzi is the dried mature seed of the radish, used as a medicinal material. The formula specifies half raw and half prepared; it does not name the preparation method. Professor He compares raw and cooked radish to explain his reasoning about upward and downward movement, then applies that comparison to the seeds. His claims about speed, suitability for weak patients, and protection from harm remain his own. The material reference establishes the seed's identity and describes its traditional functions. Source: HKBU — Laifuzi, garden radish seed.