Chapter 138: High-Dose Poge Jiuxin Tang

Evan returns with a treatment proposal that leaves the hospital’s doctors facing a difficult decision.

Evan rose, looking a little more hopeful. “Let's go,” he told Alex.

Alex was startled. “Huh? We're leaving already?”

Evan nodded, and the two of them went out.

Everyone was watching them.

“Dr. Xu, how is she?” Marcus asked quickly.

“It's not completely hopeless. There's still a chance.”

Everyone was startled.

Even the doctor who had led the resuscitation was taken aback.

“Really?” Marcus asked, delighted.

Leo spoke up at once. “Dr. Xu, you… you have to make sure you've examined her carefully.”

Evan nodded. “I've examined her thoroughly,” he said gravely. “She has sparrow-pecking and roof-leak pulse qualities, among the seven strange pulses. Her limbs are icy cold and she's barely breathing, down to her last breath. But I can still feel her Fuyang, Taixi, and Taichong pulses beneath my fingers. She isn't completely beyond saving!”^[1]

The people outside looked bewildered.

Even the Chinese medicine doctors standing there were a little lost.

Marcus had no idea what Evan meant, but immediately chose to back him. “Then hurry and give it a try!”

“What formula are you planning to use, Dr. Xu?” Du asked.

“She is clearly in heart failure and respiratory failure. Layer upon layer of yin cold has her trapped. We need a large dose of Poge Jiuxin Tang to break through that cold and restore yang. Saving her yang and preventing collapse must come first. If her yang returns, she lives. If it goes, she dies.”^[2]

“Then Shen Ge San to draw qi back to the Kidneys, and shexiang—musk—to dispel foul turbidity, transform turbid phlegm, and open the upper orifices, to save her from respiratory failure.”^[3]

Guo looked at Du. His background wasn't in Chinese medicine, and he didn't quite understand what this meant.

The Chinese medicine doctors all felt a chill. Who among them hadn't heard of Dr. Li's Poge Jiuxin Tang? But how many dared to use it on a patient? Even if they did, the pharmacy wouldn't dispense it.

Du's expression tightened a little. “How much fuzi are you planning to use?”

“Fuzi is our leading general for strengthening the heart—a fierce warrior of pure yang that can travel through all twelve channels, inside and out. She's in extreme danger. Only a large dose can save her life. We need to use 200 g.”^[4]

Everyone drew in a sharp breath. Two hundred grams, right from the start.

This time Guo understood too. His eyes widened.

Du, at least, could still keep his composure.

“Three batches in succession over one day and night,” Evan continued.

That shook even Du. Three batches in twenty-four hours—that would be 600 g of fuzi? He remembered that the formula also contained a substantial amount of raw banxia. Three batches would mean over a hundred grams of that too.

Good God!

Guo was even more speechless.

Everyone looked at one another.

Leo, Alex, and the others no longer dared to say anything.

“What's wrong?” Marcus asked urgently. “Why isn't anyone saying anything? Aren't you going to write the prescription?”

Evan looked directly at Du. “Director Du, this is our last chance. If we keep delaying until those three pulses disappear, there won't be the slightest hope left.”

A troubled look crossed Du's face. He immediately turned to Guo. “What do you think, sir?”

Guo shook his head slightly, his expression dark. “That's far beyond the pharmacopoeia's limits. It isn't appropriate, and there's no telling what the consequences might be.”

Evan's voice rose. “Desperate times call for drastic measures. With a patient this close to death, how can we break through and bring her back without large doses of heart-strengthening medicines? Ask him whether he exceeded the usual dose of those medicines just now.”

He pointed at the doctor who had led the resuscitation.

The doctor froze. How had he been dragged into this?

He had indeed used heart-strengthening medicines above the usual dose. But his use was permitted: the pharmacopoeia allowed certain medicines to be given above the usual dose in an emergency.

There were no corresponding provisions for Chinese medicine or Chinese medicinal drugs at present.^[5]

Marcus hurried to speak again. “What's wrong with exceeding the dose? Dr. Xu exceeded it when he treated my mentor, and now my mentor can get out of bed. Why can't he do it now?”

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Du frowned and asked Evan, “What chance do you have of saving her?”

“Less than sixty percent.”

Once again, everyone was stunned. With a patient in this state, he still dared to claim a sixty-percent chance?

In fact, he could only say that because of his relentless practice in the treatment training room. Before that, he had given himself only a forty-percent chance. Now he put it at nearly sixty. That was already a remarkable achievement.

The emergency doctor looked utterly unconvinced.

Even the young Chinese medicine doctors who had always admired Evan were wavering. They, too, thought it impossible.

Marcus, however, brightened immediately. “Really? Then hurry and try!”

Evan looked at Du as well. “If you don't decide now, there really won't be another chance!”

Du slowly exhaled. He stamped his foot and, very unusually for him, swore.

“Damn it. I'll go along with this madness. I'll sign. But the police have to sign too. If we fail to save her, we can't bear the consequences alone.”

“All right. I'll sign!” Marcus said at once.

Everyone stared at Du in astonishment. What nerve the director had!

Du looked at Guo again. “Sir, I know you've always opposed our establishing a policy that lets Chinese medicine take part in resuscitating patients with severe or critical illnesses. I know Dr. Xu may still fail to save this patient. If he does, you'll have even more reason to oppose it.

“But I'm going to support him anyway. Even if there's only one chance in ten thousand, we can't give up. All we've ever wanted to do is treat illness and save lives. That's all.”

Guo's face tightened. He turned his head and found everyone looking at him. At last, his gaze settled on Du, and he stared at him, stunned.

Du turned away from Guo and spoke directly to Evan. “Dr. Xu, write the prescription.”

“Alex, take this down,” Evan called.

Alex hurriedly took out paper and a pen.

“Fuzi, 200 g. Dried ginger, 25 g. Prepared licorice root, 60 g. Shanyurou, 120 g. Raw banxia, yunling, and fresh ginger, 45 g each…”

Evan dictated the ingredients and their amounts one by one. Then he said, “Use 2,000 mL of boiling water. Decoct it quickly over high heat, and give it as it brews. Hurry.”^[6]

Without a word, Alex took the prescription and ran over to Du.

Du signed it for him.

After Du had signed, Guo suddenly said, “I'll add my signature too.”

Du was visibly taken aback.

Guo took the pen and signed his name as well.

Marcus came over. “I'll sign too.”

All three had signed. A name was never something to sign lightly. It meant responsibility.

Du immediately handed the notebook to Alex. “Hurry to the pharmacy and get the medicines.”

Alex said nothing. He took the notebook and ran as fast as he could.

Du gave Guo a long look, then took out his phone. He needed to speak to the pharmacy first.

Reader Notes

Reader Notes

1. ↩︎ Pulse qualities and pulse sites. Sparrow-pecking and roof-leak are traditional tactile comparisons, included among the “seven strange pulses” associated with grave illness. They describe the examiner's impression of the pulse rather than named ECG rhythms. Fuyang, Taixi, and Taichong here are the lower pulse sites examined in the preceding chapter, not three acupuncture procedures. Evan's inference that a chance remains belongs to his assessment in the story. Sources: Classical text — Maijue Kanwu, section on strange pulses (in Chinese); WHO — TCM terminology, entries 855–856, 919 and 926.
2. ↩︎ Restoring yang and preventing collapse. In this traditional account, yin cold constrains the body's warming and sustaining functions. “Restoring yang” and “preventing collapse” name the proposed treatment's purpose. The twelve channels are traditional pathways, not twelve blood vessels. Poge Jiuxin Tang is retained as a formula name; a university journal describes its origin in treating heart failure within this framework. That background explains Evan's choice without establishing its effectiveness in this emergency or implying that the patient has already recovered. Sources: WHO — TCM terminology, entries 2562, 2845 and 2909; Journal of Tianjin University of Traditional Chinese Medicine — clinical-experience article, section 2.1.3 (in Chinese).
3. ↩︎ Receiving qi and opening the orifices. Traditional theory assigns the Kidneys a role in receiving and holding inhaled qi, alongside the Lungs' work in breathing. This explains “draw qi back”; it does not describe air entering the anatomical kidneys. Opening the orifices is a medicinal treatment concept involving awareness and obstruction, not a surgical opening. Evan names Shen Ge San and musk within that reasoning. The novel does not give the powder's composition or dose, or identify natural versus synthetic musk. Source: WHO — TCM terminology, entries 164 and 2507–2514.
4. ↩︎ Fuzi, raw banxia, and the dose dispute. Fuzi is an aconite lateral-root medicinal material. Raw banxia is unprocessed pinellia tuber, distinct from its processed forms. Preparation, dose and combinations matter to their use. Hong Kong's Department of Health identifies potentially fatal aconite toxicity and cautions about combining aconite materials with banxia. Those cautions help explain the alarm in this scene; the fictional prescription does not establish a safe dose or combination. Sources: Hong Kong Department of Health — aconite-containing medicines (in Chinese); HKBU — Raw Banxia, specimen D00190.
5. ↩︎ The pharmacopoeia and emergency prescribing. A pharmacopoeia is an authoritative collection of medicine standards and quality specifications. Here it is also the reference invoked in a dispute over prescribing limits. The precise edition, the unnamed emergency medicines and the claimed difference in emergency exceptions are not identified in the novel. This scene's account therefore should not be read as a statement of current prescribing law. The signatures show the characters accepting responsibility; they do not by themselves establish legal immunity. Source: WHO — International Meetings of World Pharmacopoeias, definition.
6. ↩︎ Medicinal names and preparation. Shanyurou is the medicinal cornel-fruit flesh, also called shanzhuyu; yunling names poria associated with Yunnan. Fresh and dried ginger remain separate entries, as do prepared licorice and raw banxia. A batch means one full set of prescribed materials, not one mouthful. The ellipsis leaves part of the formula unspecified. The rapid preparation order is Evan's instruction in this emergency, distinct from the health department's general decoction method. Sources: HKBU — Cornel fruit, B00234; Anan, Guangdong drug-safety portal — cornel-fruit names (in Chinese); China Medical Information Platform — Poria, opening definition (in Chinese); Hong Kong Department of Health — Preparing Herbal Decoctions.