Chapter 143: Truly Out of Danger

Evan explains the next step while the hospital waits for a response.

Evan looked at Alex with approval. The young doctor was learning fast.

“Exactly,” Evan said. “When a pathogenic factor attacks someone, it starts at the exterior. If it isn't treated, it moves from the exterior into the interior. The weaker the person's healthy qi, the deeper it penetrates. Since the pathogenic factor enters from the outside, the exterior is both its way in and its way out.

“In Chinese medicine, we don't set out to destroy the pathogenic factor. We drive it out. Trying to destroy it by force is bound to harm the body. We support healthy qi and expel the pathogenic factor.

“Since it came in through the Taiyang channel, we use whatever methods are needed to help it out along that same route. Don't just treat whatever illness you see in front of you. You have to understand where the pathogenic factor came from and where it's gone.

“Yu Chang once said, ‘Even when a pathogenic factor has sunk into the interior for as long as a hundred days, it should still be guided out from the interior to the exterior. If you try to remove it only through the interior, you will not stop until the patient is dead.’ He was discussing dysentery with an exterior component and dampness that had sunk inward, but the same principle applies to treating any illness.^[1]

“You must pay close attention to this in clinical practice, or sooner or later you'll make a serious mistake.

“Remember: with these symptoms, we need to release the exterior. Whenever there's exterior excess, release the exterior first.

“If you fail to release it and mistakenly use tonifying treatment instead, you'll be shutting the door with the thief still inside. There'll be no end of trouble. If you mistakenly use an attacking treatment, you'll drive the pathogenic factor deeper into the interior, which is even more dangerous. Those are all failures on the doctor's part.”^[2]

Alex nodded earnestly.

Leo nodded along too.

Marcus thought for a moment. “So if we want to get the ice out of her, we have to lift off the quilt? Otherwise it can't get out. If we start messing around inside instead, the ice stays there and absorbs even more heat. Then the patient's in danger.”

Evan's eyes brightened. “That's a good analogy, Captain Cao. You've got the makings of a Chinese medicine doctor yourself.”

Marcus waved the idea away. “No, no. I'll stick to catching thieves. Being a doctor takes more skill than I've got.”

Leo laughed too.

Evan shook his head with a smile, then turned to Alex. “This patient is a classic case of deep, entrenched cold. The external pathogen has sunk far into the interior. Once that ice is lodged inside, it's very hard to get out. With a patient like this, we can only use the sweating method and help the cold move outward, so it can be released through the exterior.

“That's why the Neijing says, ‘The most skilled treat at the level of the skin and body hair.’ Physicians have long dismissed the sweating method as a minor trick. They've been badly mistaken. Used well, it has countless applications. Even in everyday life, getting some exercise and working up a sweat can be beneficial.”^[3]

“All right. Let's write the prescription.”

Alex took out a pen and paper and began taking it down.

Evan's prescription was much the same as yesterday's. He again used a large quantity of fuzi, 200 g. The cold inside the patient had not been resolved, so her yang still needed support. He also used 120 g of shanyurou to prevent collapse.^[4]

He modified yesterday's combination of Poge Jiuxin Tang and Shen Ge San, removing several ingredients and adding mahuang and xixin. Mahuang would open the closed exterior; xixin was the force that would help bring the deep, entrenched cold outward to be released. The mahuang decoction was boiled separately.^[5]

When Evan finished dictating, he said, “Go and get your hospital director's signature.”

“Yes.” Alex headed for the director's office. He knew the way by now.

Evan turned to Marcus. “Come on. Let's see how your mentor's doing.”

“All right.” Marcus nodded at once.

Leo went back as well.

The ward was in the same building, so Evan and Marcus went straight downstairs.

This was Evan's third visit to Gordon Gao, and the first time Gordon had really seen what he looked like. He was astonished.

His wife had told him the doctor was young. He hadn't expected him to be this young.

Evan examined him again. The gangrene on his toes had largely healed, and the electric-shock pain in both legs had long since stopped. He had recovered so well that he could even get out of bed and walk a few steps.

After checking his pulse again, Evan told him to take a few more batches of medicine. He should be ready for discharge by then. Evan would examine him once more and prescribe follow-up treatment, though he would probably need that medicine for quite some time.

Husband and wife thanked him over and over.

His wife, especially, had been a frightening sight in those earlier days. Despair had left her numb, like a wooden doll. Now she could smile again. Some life had returned to her face.

Evan felt a deep sense of relief. This was why doctors mattered. He wasn't only saving patients' lives and health. He was protecting the happiness of whole families, too.

After examining Gordon, Evan went back upstairs.

Alex had finished boiling the medicine and brought it over.

The three of them went into the room.

Evan checked the time. Nine in the morning.

“There's 600 mL of decoction,” he told Alex. “Give it to her in three portions. Choose the wu hour, when yang is strongest, to help her healthy qi. Mix 50 mL of the separately boiled mahuang liquid into each portion. Stop once she starts sweating.”^[6]

“All right.” Alex began feeding the medicine to the patient.

The first portion was given.

“Dr. Xu, when will she really be out of danger and able to answer questions?” Marcus asked.

Evan considered it. “It depends on how she responds. If everything goes well, she should be more alert by this evening or tomorrow morning.”

“Good.” Marcus nodded firmly.

They all watched her closely.

Some of the younger Chinese medicine doctors came to learn whenever they had a moment free. This was the first critically ill patient their department had taken on.

In the past, they would never have accepted a patient like this. Other departments might ask them to consult on a severe case, but that was as far as it went.

This reproduction was taken from the author's official publication without consent; reading the chapter at that publication supports them.

They were all rather excited.

Out in the corridor, Evan went over the key points of treating such a patient. Every one of the young doctors dutifully took notes.

Marcus and another detective stood listening for quite a while. They didn't understand much, but it sounded impressive.

At ten, an hour after the medicine, Alex came to report that the patient still hadn't sweated.

Everyone frowned.

Another half hour passed. Still no sweat.

Marcus's heart sank.

Alex was starting to panic a little too. “Dr. Xu, what do we do now?”

Evan checked the time. Ten thirty.

“Shorten the interval. Give her another portion now. Then we'll write another prescription.”

“Dr. Xu, the pharmacy's gone to buy more fuzi,” another young doctor said. “We're running short.”

Evan paused, unsure whether to laugh or sigh. “We don't need it this time. Just find a kitchen.

“Finely chop some fresh ginger, add brown sugar and ground white pepper, and boil a bowl of soup. It'll support the medicine's action—pungent and warming, to disperse outward.”

“Got it.” The young doctor hurried off.

Marcus looked surprised. “Isn't that a soup to make you sweat?”

“That's right,” Evan said with a nod. “This is Chinese medicine thinking too. It happens to be just what we need now.”

The younger detective beside him asked, “Could I use it next time I catch a cold?”

“If it's wind-cold, yes. Right at the beginning, when wind-cold is constraining the exterior, working up a light sweat this way can help. But if the exterior still hasn't been released, come to the hospital and see a doctor.”^[7]

“All right. Understood.”

Both detectives made a note of the little remedy. Convenient, they thought. Everything they needed was in the kitchen at home.

The ginger, pepper, and brown sugar soup soon arrived and was fed to the patient as well.

By noon, it was time for lunch.

Alex came out to report that sweat had appeared on the patient's head.

Everyone outside brightened.

A little later he returned. Her neck, chest, and back were sweating too.

They were even more encouraged.

Evan kept nodding. The closed exterior had opened; the hidden cold was making its way out.

“The sweating method is useful,” he reminded them, “but you mustn't let the patient sweat too heavily. Excessive sweating can cause problems too. Now that she's started sweating, we must stop releasing the exterior.

“Alex, throw away the remaining mahuang decoction. Keep giving her the rest of the main prescription.”

“All right.” Encouraged, Alex went back to work.

Toward evening, Evan examined the patient again. She had slept for a while that afternoon.

Her exterior was open now, her Lung qi spreading outward, the hidden cold released, and her true yang distributed through the body again. The icy cold in her back had gone. Her upper limbs were no longer cold, and the phlegm no longer rattled in her throat. Her lips and nails had turned pale pink.

Her breathing had settled completely, and the violent spasms of coughing had almost stopped. She had coughed only once or twice all afternoon. The Lung was the gateway of the voice, and it also regulated the waterways.^[8]

Now that she had sweated and the hidden cold had found its way out, she could finally speak normally. Before, she hadn't even been able to do that. She was also passing more urine, and the swelling in her feet had gone down considerably. Her legs and feet had previously been swollen and badly broken down.

With the exterior qi flowing freely, nutritive and defensive qi were in harmony again. She was still bringing up a great deal of phlegm, but the tightness in her chest had eased considerably. Once again, the sweating method had done its work. Her healthy qi was beginning to recover.

Only now did Evan dare say that she was truly out of danger.

It was evening, but none of the young doctors had left. Senior Chinese medicine doctors, including Henry Zhong and Leo Cao, had come too. Several department chiefs from conventional medicine were waiting outside, along with David Du.

Evan came out and gave them a slight smile. “After two days of fighting for her, we've finally… got her completely out of danger!”

“Yes!” Cheers went up outside the door.

Several of the conventional medicine doctors went in to check her vital signs. She had indeed recovered enough to be out of danger.

Evan smiled with relief. “Captain Cao, she can speak now, and she's fairly alert. If you want to question her, you can.”

“Good.” Marcus nodded firmly.

Reader Notes

Reader Notes

1. ↩︎ Yu Chang and the route outward. Yu Chang, also known as Yu Jiayan, was a historical Chinese physician; his name is retained rather than given an English substitute. His Yimen Falü discusses bringing an inward-sunk pathogenic influence back outward in certain dysentery cases. Evan extends that reasoning to this patient and then to illness generally. That extension belongs to his teaching here. The available transcription phrases the hundred-day argument differently; the quotation here follows the novel. Sources: Yu Chang — Yimen Falü, “Dysentery,” electronic transcription (in Chinese); Jiangxi University of Chinese Medicine — Yimen Falü (in Chinese).
2. ↩︎ Supporting the body and opening an exit. “Healthy qi” names the body's sustaining and protective functions in this framework; a “pathogenic factor” is a traditional category, not necessarily an identified microorganism. Tonifying methods supplement deficiency, while attacking methods act against an excess or accumulation. Evan's door-and-thief metaphor explains why he thinks the order matters. Taiyang is a name in the traditional channel and pattern systems. The standard's exterior-first principle has conditions; Evan's categorical statements remain his explanation of treatment. Source: WHO — TCM terminology, entries 274, 365, 1398, 2258–2264 and 2280–2286.
3. ↩︎ Treating at the surface. The Neijing quotation refers to treating at a superficial level before illness reaches deeper structures. It is found in the Suwen's fifth chapter, within a sequence running from the skin inward. Evan uses it to argue for the sweating method in this particular, already deeply ill patient. His further claim about how earlier physicians regarded sweating is broader than that passage establishes. The ice and its outward movement remain treatment metaphors. Source: Suwen — “Yin–Yang and Their Corresponding Manifestations,” chapter 5 (in Chinese).
4. ↩︎ The medicinal materials and quantities. Fuzi is the aconite material used in the earlier rescue; shanyurou names the medicinal fruit flesh also called shanzhuyu, or cornus fruit. The 200 g and 120 g here reproduce the novel's prescription, not amounts supplied by the translator. Aconite materials can cause serious poisoning, and the health authority's ordinary precautions do not establish this fictional quantity as safe. The university entry identifies the fruit material; it does not verify the patient's response. Sources: Hong Kong Department of Health — Aconitum alkaloid medicines (in Chinese); Hong Kong Baptist University — Corni Fructus.
5. ↩︎ The separate decoction. Poge Jiuxin Tang and Shen Ge San retain the formula names used earlier. Here Evan modifies their combination rather than reciting a complete fixed recipe. Mahuang is ephedra; xixin is another medicinal material. Although the Chinese calls the separate liquid “mahuang tang,” the subsequent directions call it mahuang liquid. The translation therefore uses “mahuang decoction,” without adding the other ingredients of the classical formula named Mahuang Tang. Ephedra's documented risks do not establish this prescription's safety. Sources: Tianjin University of Traditional Chinese Medicine Journal — section 2.1.3 (in Chinese); NCCIH — Ephedra.
6. ↩︎ The wu hour. Traditional Chinese timekeeping divides the day into twelve periods of about two hours. Wu corresponds to 11 a.m.–1 p.m.; it is associated here with the height of yang around midday. The chapter nevertheless explicitly places the first administration at 9 a.m., with no sweating at 10 and another portion ordered at 10:30. Both the instruction and the clock times are retained. The passage does not resolve their discrepancy or specify a corrected schedule. Source: Hong Kong Observatory — Heavenly Stems and Earthly Branches, table 3.
7. ↩︎ Wind-cold and a kitchen remedy. Wind-cold describes a traditional exterior pattern, not the name of a virus. “Pungent and warming” describes the proposed action of the ingredients in that system. Evan limits his reply to the beginning of that pattern and tells the detectives to seek medical care if it does not resolve. Their enthusiasm for a convenient home preparation is part of the conversation; it does not establish the soup as treatment for every illness called a cold. Source: WHO — TCM terminology, entries 2282–2283.
8. ↩︎ The Lung, voice, and fluids. The capitalized Lung denotes a traditional functional system as well as its association with breathing. Its outward diffusion and regulation of fluid pathways help explain why the narration links sweating, easier speech, and increased urination. Nutritive and defensive qi describe nourishing and protective functions; their renewed harmony belongs to the same account of recovery. These are the story's traditional explanations of the observations. The terminology source defines the functions; it does not independently confirm the proposed cause of this patient's improvement. Source: WHO — TCM terminology, entries 92–98 and 237–240.