Chapter 125 Alex Makes Progress

Alex is called to the desk to examine two patients himself.

Evan beckoned. “Come here. See these two patients.”

Alex panicked. Apparently, the teacher wasn't satisfied with letting the struggling student work quietly at his desk. He had to call him up to the blackboard to do it in front of everyone.

“What are you standing there for? Come on,” Evan urged.

Alex braced himself and went over.

“There are two patients here,” Evan said. “You examine them.”

“Ah… uh… yes. All right.” Alex could only agree.

Evan had already explained things to the patients, and they were willing to cooperate.

Alex hurriedly pushed down his nerves and began asking questions. “Hello. What's troubling you?”

The two patients were a cheerful, middle-aged couple. The husband laughed. “Nothing much, really. It's just that for the past four or five years, whenever I get chilled, I start coughing. Nothing else wrong. Just the cough.

“It happens five or six times a year. Sometimes medicine helps; sometimes it doesn't. After a while it goes away, then it comes back. Everyone says the Chinese medicine doctors here are good, so my wife told me to come.”

Alex's heart sank. A cough—the doctor's old enemy.

Ben, sitting farther back, looked up, thoughtful.

“Have you had any tests before?” Alex asked. “Did you bring the reports?”

From his seat, Evan cast him a sideways look.

“Uh…” Alex immediately changed course. “Even if you brought them, there's no need to take them out. Let's carry on…”

He asked more questions about the man's condition, growing less certain with every answer. He also looked over the medicines the previous doctor had prescribed, but he still couldn't work out the pathomechanism.

“Let me see your tongue,” he told the patient.

The man stuck out his tongue.

Alex frowned as he examined it. A pale-red tongue with a thin white coating. Nothing very distinctive there, either.

“Let me take your pulse.” This time, Alex examined it with particular care.

No new patients had arrived just then. Evan used the lull to read a medical book.

After quite a while, Alex hesitantly wrote his pattern assessment in his notebook. Then he turned to the man's wife, his other patient. “Hello. What's troubling you?”

“Oh, it's my periods. They're late every month, and there's very little flow. I heard you're very good at treating women's conditions here, so I came to have it treated.”

Alex nodded. Scanty and late. Was it weakness of qi and blood? Or cold congealing?

“Don't you keep saying your back feels cold, too?” her husband added.

She nodded. “Yes. My back always feels ice-cold.”

Alex frowned. Aversion to cold in the back. He thought of the Shanghan Lun, the Treatise on Cold Damage.

“In a shaoyin pattern of one or two days' duration, if the mouth feels normal but there is aversion to cold in the back, apply moxibustion. Fuzi Tang is indicated.”

“In cold damage without great heat, with a dry mouth, thirst, vexation, and slight aversion to cold in the back, Baihu Jia Renshen Tang is indicated.”^[1]

Alex asked further questions, examined her pulse and tongue, and finally wrote down his conclusion about the pattern.

“Dr. Xu, I'm done,” he told Evan, still uncertain.

Evan didn't even look at his note. “Tell me about the patients.”

Alex swallowed. “Well, the man coughs when he gets chilled. It's a dry cough, with no other obvious symptoms. The tongue findings aren't very distinctive either. His pulse has four beats per breath, calm and unhurried, neither fast nor slow. It should be a relaxed pulse.

“Um… a relaxed pulse generally indicates wind or dampness, as in externally contracted wind or painful wind-damp obstruction. It can also indicate Spleen deficiency, hiccups, regurgitation… Only, healthy people can have a relaxed pulse too… Hmm…”^[2]

He couldn't quite go on.

The couple looked at each other. Was it really that complicated?

Ben looked just as bewildered.

Evan smiled faintly. He had spent a long time studying the normal pulses of the four seasons with Dr. Liang in the clinical training room. You had to learn to feel a healthy person's pulse before you could learn to recognize a diseased one.

“The Jingyue Quanshu says, ‘The relaxed pulse may be yin or yang, and has three meanings. When it is calm and unhurried, appropriately balanced between floating and deep, it is the normal pulse of a healthy person.’ There are three depths at which we examine the pulse: superficial, middle, and deep. Only a relaxed pulse at the middle depth can be a healthy person's normal pulse.”

Alex pondered this.

“Besides the overall pulse,” Evan reminded him, “pay closer attention to the individual qualities at the cun, guan, and chi positions. Pulse examination requires care.”^[3]

“Oh!” Alex suddenly cried.

The man gave a startled jerk. “Whoa! You made me jump!”

“I've got it!” Alex said delightedly. “The Jingui Yaolüe says, ‘When the pulse at the wrist is slow and relaxed, slowness indicates cold, and relaxation indicates deficiency.’ His pulse is relaxed, with particular weakness at the chi position of the right wrist. The right chi corresponds to the Life Gate. This is a cough caused by declining Life Gate fire—Kidney yang deficiency.”^[4]

The corners of Evan's mouth lifted slightly, and he gave a small nod.

Ben listened in surprise. It looked as though the young man really had found the pathomechanism!

The husband was stunned. “What? I've got Kidney deficiency?”

His wife nodded as if that explained a great deal, and cast him a glance.

“Don't always equate Kidney deficiency with trouble in that department,” Evan said. “They're not quite the same thing. Even children can have Kidney deficiency.”^[5]

The husband immediately straightened his back. Exactly. Not the same thing!

Encouraged by Evan's approval, Alex grew excited. “Then… Guifu Dihuang Wan would be the treatment, wouldn't it?”^[6]

NovelPhoenix is the chapter's publishing home for its author, not the source of permission for this copy; reading there supports the creator.

Evan nodded. “Correct. And what about the lady here?”

Alex sank back into thought, muttering, “Menstrual trouble. Scanty flow, late periods, aversion to cold in the back. Fuzi Tang? Or Baihu Jia Renshen Tang? A yin pattern or a yang pattern…?”

Evan watched him. This patient presented a subtle problem too. Aversion to cold in the back appeared in the Shanghan Lun, but the treatments were entirely different. Fuzi Tang treated cold; Baihu Jia Renshen Tang treated heat.

The two pathomechanisms could be complete opposites. Cold belonged to yin, heat to yang. Opposite mechanisms could produce the very same symptom, misleading the doctor.

Now it remained to be seen whether Alex could find his way through the fog.

“Hmm…” He was still puzzling over it.

“Dr. Xu,” the husband asked, “could you write my prescription first?”

Alex instinctively lifted his head to look at him. Something flashed into place.

“Oh!”

“Whoa! You made me jump again!” The man was getting exasperated.

Alex was too excited to worry about that. “I've got it! Her pulse is relaxed too, and it's weak at the right chi as well. It's the same decline of Life Gate fire, the same Kidney yang deficiency. Guifu Dihuang Wan is the treatment for her too.”

At last, Evan smiled.

The woman was baffled. “I take that medicine too?”

“We've got completely different illnesses,” her husband said. “We take the same medicine?”

Evan smiled. “That's Chinese medicine. Your symptoms are completely different, and so are the names of your illnesses. But the pathomechanism is the same. That's what we mean by a pattern. Different symptoms, the same pattern. Naturally, we follow the pattern rather than the symptoms.

“So sometimes we use one medicine for two entirely different illnesses. And sometimes we use two different medicines for exactly the same symptom. That's pattern differentiation and treatment.

“Symptoms can mislead you. You can't simply treat each symptom as it appears. You have to find your way through the fog to the underlying pathomechanism. Find it, and you can resolve it. When the outward symptoms and the other diagnostic findings aren't clear, the pulse can provide the evidence.

“That's why you can never be too careful when examining a pulse. As doctors, we must do everything we can to reduce misdiagnosis and earn our patients' trust through real results.”^[7]

Alex nodded deeply. He knew those words were meant for him. “I'll remember that, Dr. Xu.”

“The Zhangshi Yitong also has an account and summary of aversion to cold in the back,” Evan added. “Read it when you get back.”^[8]

“Yes,” Alex answered earnestly.

So much homework. As if copying out two books wasn't enough, he had reading to do as well. Still, he was excited. At least he had identified these two patients' patterns using Chinese medicine alone.

And the pathomechanism had been so well hidden in both cases! He had found his way through all that fog and caught it anyway.

That sense of achievement felt fantastic.

Evan stood and pointed at his computer. “Go through the earlier cases one by one. Compare them with your assessments. Check whether you got the patterns right, and mark every place you went wrong.”

“Huh?” Alex's delighted expression collapsed. Right. The struggling student still couldn't escape checking his answers.

Watching from the back, Ben felt his mouth go a little dry. Ever since Evan had suddenly become so good, he had even stopped playing Dou Dizhu. Before, he'd played the card game without a trace of guilt. Now his conscience bothered him.

And now Evan was taking on students from the Chinese medicine hospital. Even his student was this good. Ben felt more uncomfortable than ever…

After thinking it over for quite a while, he finally picked out a few regular customers and quietly messaged them on WeChat.

“Boss, fancy a wellness treatment today? I've got a discount for you.”^[9]

Reader Notes

Reader Notes

1. ↩︎ Two classical passages. The Shanghan Lun uses a traditional system of six divisions, including shaoyin, to classify patterns of illness; its “cold damage” is not simply modern typhoid fever. The passages recalled here are conventionally numbered 304 and 169. Their contrasting mouth and thirst findings matter to Alex's uncertainty. Moxibustion is treatment using the heat of burning moxa, usually mugwort. These are remembered passages, not procedures performed on this woman. Sources: Shanghan Lun — clauses 304 and 169, Chinese transcription; WHO — TCM terminology, entry 3138.
2. ↩︎ Relaxed is not the same as slow. This translation keeps huan, “relaxed,” distinct from chi, “slow.” Alex counts four beats over a breathing cycle, then struggles to interpret the quality. The WHO standard calls huan a “slowdown” or “moderate” pulse; the chapter retains the established translation “relaxed.” No beats-per-minute measurement is supplied. His “wind” and “dampness” are traditional explanatory categories, and the externally contracted “wind” here does not mean a diagnosed stroke. Source: WHO — TCM terminology, entries 867, 891, and 907.
3. ↩︎ Positions and depths. Cun, guan, and chi are three neighboring positions at each wrist's radial pulse. Superficial, middle, and deep describe levels of pressure at those positions, not three separate arteries. Evan is asking Alex to distinguish the overall impression from individual findings. The quoted Jingyue Quanshu describes a healthy relaxed pulse as balanced in depth; Evan then gives his own more specific explanation about the middle depth. The quotation alone does not establish that any middle-depth pulse is normal. Sources: WHO — TCM terminology, entries 856–857; Jingyue Quanshu — volume 5, “Relaxed pulse” (in Chinese).
4. ↩︎ The Life Gate and the right chi. The Life Gate, or mingmen, is a functional concept here. Its “fire” refers to the warming and activating functions attributed to Kidney yang, rather than literal fire or an acupuncture procedure. The Jingyue Quanshu associates the right chi with the Kidney, Life Gate, and other traditional functions. Alex combines that mapping with a short Jingui Yaolüe quotation. His conclusion about this cough is the character's interpretation; the cited texts establish the vocabulary and historical reasoning, not this patient's clinical diagnosis. Sources: WHO — TCM terminology, entries 179–180 and 1276; Jingyue Quanshu — volume 5, pulse positions (in Chinese); Jingui Yaolüe — “Wind stroke and joint disorders,” Chinese transcription.
5. ↩︎ Kidney deficiency. The capitalized Kidney denotes a traditional functional system. Its deficiency patterns can involve warming, fluids, growth, or reproduction. The husband's embarrassment and his wife's glance rely on a narrower popular association with sexual performance. The term itself neither establishes sexual dysfunction nor means that a laboratory test has diagnosed kidney failure. Source: WHO — TCM terminology, entries 154–159, 162, and 1276.
6. ↩︎ Guifu Dihuang Wan. This is a named compound formula, traditionally associated with warming and supporting Kidney yang. Gui and fu refer to cinnamon bark and processed aconite; wan identifies a pill formula, while tang in the other formula names denotes a decoction. A formula name does not supply this consultation's dose, preparation instructions, or treatment outcome. Guifu Dihuang Wan, Fuzi Tang, and Baihu Jia Renshen Tang remain distinct names throughout the chapter. Sources: Xinjiang Medical Products Administration — Dihuang formulas, section 6 (in Chinese); WHO — TCM terminology, entries 2777–2778.
7. ↩︎ Different symptoms, the same pattern. A symptom is a reported or observed manifestation; a pattern is the traditional interpretation of a set of findings. “Pattern differentiation and treatment” connects that interpretation to a treatment choice. Evan's teaching contrasts different illnesses sharing a pattern with similar symptoms arising from different patterns. The couple's diagnoses and proposed shared formula belong to the story. No later response to treatment is shown here, and a terminology definition does not verify the accuracy or effectiveness of this consultation. Source: WHO — TCM terminology, entries 546, 548, 550, and 552–553.
8. ↩︎ The additional reading. The Zhangshi Yitong is a medical work by Zhang Lu. Its third volume discusses aversion to cold, including cold sensations in the back, under several traditional explanations. Evan assigns further reading rather than saying that every cold back has one cause. Alex has not yet read the assigned passage in this scene. Source: Zhangshi Yitong — volume 3, “Aversion to cold,” Chinese transcription.
9. ↩︎ A game and a sales message. Dou Dizhu is a Chinese card game whose usual three-player form pits two players against the “landlord.” WeChat is a messaging and social platform. Ben sends private messages to existing customers here, rather than publishing an article to followers. “Boss” is a friendly sales address, not a statement that each recipient employs him; his wellness offer concerns the clinic's services. Sources: General Administration of Sport of China — Dou Dizhu tournament and standard format (in Chinese); Tencent — Weixin & WeChat.