Chapter 150: Adam on His Best Behavior

For once, Adam has very little to say.

Evan gave Adam his medicine, and Adam went to sleep. Whether he was actually asleep or just pretending was anyone's guess.

Everyone else was in the living room.

“Is Dad going to be all right?” Clara asked Evan anxiously.

The young Chinese medicine doctors had quieted down too. Their discussion hadn't gotten them anywhere, and they all turned to Evan.

“It's nothing too serious,” Evan said. “There's some Liver wind stirring internally. We just need to calm the Liver and extinguish wind. Nothing to worry about.”^[1]

Clara felt a little easier. “Why did this happen so suddenly? Was it because he insisted on going out today?”

“That probably had something to do with it. The residual pathogenic factors haven't entirely cleared, so he needs to be careful about exposure to wind and cold. There's an old saying: ‘The old fear cold damage; the young fear wasting disease.’^[2]

“Your father isn't all that old, but he is middle-aged. As the Neijing says, ‘At forty, yin qi has already dwindled by half.’ His bodily functions are starting to decline.^[3]

“‘Where pathogenic factors gather, healthy qi must be deficient.’ He's let himself go in the years since your mother died. He hasn't maintained healthy habits, and emotional strain—the ‘seven emotions’—also depletes healthy qi.^[4]

“That's part of why he had the stroke. We've supported his healthy qi and expelled pathogenic factors, but there's still more to do. Some setbacks are normal. Think of all the people who have a second or third stroke soon after recovering from the first.

“Don't worry. I'm keeping an eye on him. He won't deteriorate the way he did before. Once we've calmed the Liver and extinguished wind, he should recover. Then we'll keep supporting healthy qi and expelling pathogenic factors. He'll need medicine for a while longer. And keep him at home for the next few days.”

That reassured Clara a great deal. Her greatest fear was that her father would be paralyzed down one side again.

Having finished giving Clara instructions, Evan turned to the young doctors.

“When you go downstairs in a little while, take a look at his case record. I treated him with Xiao Xuming Tang before.^[5]

“In Chinese medicine, there's a longstanding saying about treating wind stroke: ‘To treat wind, first treat the blood; when blood moves, wind dies down of its own accord.’^[6] But you have to analyze each case on its own merits. Observe the pulse and symptoms, understand what has gone wrong, then treat according to the pattern.

“You can't just go by what the books say. This patient had already taken plenty of medicines to replenish qi and invigorate blood, with poor results. In your own clinical work, you mustn't see cerebral thrombosis and think only of invigorating blood and resolving stasis.

“In Chinese medicine, the pulse and symptoms have to guide treatment. Don't approach them with even the slightest preconception. A few days ago, I prescribed Xiao Xuming Tang. Now I've prescribed medicines to calm the Liver and extinguish wind. Why? Because the pulse and symptoms have changed.”

The young doctors nodded earnestly. This was the reasoning behind treatment in Chinese medicine, and the experience it required. It sounded simple, but many practitioners were misled by their own experience in clinical work. They had to keep Zhang Zhongjing's twelve-character principle in mind whenever they treated a patient.^[7]

Evan took the others downstairs to get back to work.

Clara opened her father's bedroom door and looked at him lying in bed.

“You stubborn old man! You never listen. Now do you see how good Evan is?” she said crossly.

Adam slept all the more soundly. There was just a little redness at the base of his ears.

Evan spent the afternoon downstairs, teaching his apprentices and seeing patients.

Toward evening, he went back upstairs to examine Adam and have dinner while he was there.

Adam was tired and sleepy. He slept soundly and didn't want anything to eat.

The next morning, Evan went to a meeting at the county Chinese medicine hospital. Professor He was there too.

Evan also signed the agreement appointing him to the hospital's specialists' clinic. He would go there to see patients for a few days each month, but his main task was to get the academic working group on treating critical illness with Chinese medicine up and running.

Professor He was the group's nominal academic leader, but everyone knew he was there to lend it standing. Evan was the real driving force.

Evan was still too young and had too little seniority to give it the public standing it needed. He needed an established figure in Chinese medicine to stand behind him. Professor He had been his first teacher and had the necessary credentials. He was the best choice.

After a small inauguration ceremony and lunch at the hospital, Evan came back.

That evening, he went to Clara's home for dinner.

He wasn't sure when it had become a habit. Only in the last few days, it seemed, but as soon as he finished work, he headed over to the Zhangs' as if he'd been doing it forever. Before, he'd mainly gone there to treat Adam.

Now… well, Adam still wasn't quite better, was he?

This time, Adam was finally awake for dinner. He sat with his head bowed, looking at the tabletop, his hands hanging obediently at his sides. He didn't look up. He was the picture of good behavior.

Evan wasn't sitting around doing nothing either. He'd been helping Clara in the kitchen.

Outside the kitchen, Adam kept twisting his mouth in disgust. Sickening!

Dinner was served.

Adam ate quietly, taking food with his chopsticks and behaving himself impeccably.

“How did things go over there?” Clara asked Evan. “Did you sign?”

“Yes.”

“How many days a week do you have to see patients there?”

“Just two.”

Clara was relieved. That wouldn't interfere with his work here. She ate a mouthful of food and asked, “Weren't they going to put some safeguards in place for you Chinese medicine doctors treating critically ill patients?”

Evan nodded. “Yes. If I prescribe certain medicines above the specified dose limits, I need the hospital director's signature. The patient also has to sign a release from liability. We have to fully explain the possible risks of the medication and provide the relevant pharmacological research reports on the Chinese medicines involved. We can only use them after getting consent.

An aside on sources: NovelPhoenix hosts this chapter, while this copy was reproduced without the author's approval.

“We also have to retain samples of the medicines for later examination. And especially with critically ill patients, we have to monitor all the relevant clinical data after administering them, so there's a record to account for what happened if anything goes wrong. Finally, we've bought insurance!”

Clara smiled. “Director Du really has thought it through.”

“Yes. Mainly, though, it depends on support from the health authorities.”

“Does that mean you'll often be treating critically ill patients at the hospital?”

Evan gave a wry smile. “It isn't that easy. The academic center is established, but the Chinese medicine department still hasn't been allowed to admit critically ill patients.

“The leadership wants to feel its way across the river, one stone at a time. For now, they've only set up a system for us to assist conventional medicine in treating those patients, and addressed our worries about using the medicines.

“Whether the Chinese medicine department can actually take charge of those patients later will need more evaluation. It'll also depend on how we do. One step at a time. At least it's a good start.”

“That's fine,” Clara said with a smile. “Saves you spending all your time working for them and neglecting the patients at the clinic.”

Evan lowered his head and smiled.

Clara tapped her chopsticks and raised an eyebrow. “Hey, how much are they paying you a month as an outside specialist?”

“Oh! Right!” Only then did Evan remember. He picked up the bag beside him and took out the agreement.

Clara snatched it from him and quickly leafed through it. “Let me see how much!”

Adam, who had been eating so obediently, quietly raised his eyes too.

“Whoa!” Clara looked astonished. “For just eight days a month, they're paying you more than ten times what I pay you here! And when they call you in for consultations, they pay your fee at the full senior specialist rate. They're certainly generous with you. Won't you be making tens of thousands of yuan a month?”^[8]

“Really?” Evan looked delighted too.

“Ugh. Look at you, all excited about the money.” Clara gave him a disdainful look.

Evan looked over the agreement. They really were paying him quite a lot.

“Well, now that you're making big money,” Clara urged, “how about taking the management of Mingxin Clinic out to dinner?”

Still eating on his best behavior, Adam secretly twisted his mouth. He didn't want a meal paid for by Evan! Even if the boy invited him, he wouldn't go!

Unless he invited him several times. Hmph!

“I have another use for this money,” Evan said. “I need to save it.”

Adam's mouth twisted even further. Stingy little brat!

“Save it?” Clara asked, puzzled. “For what? Getting married?”

Evan shook his head. “No. To pay off a debt. A little over two years of saving should be enough, I think.”

“Whoa. You owe that much?”

Evan nodded.

Clara gave him another disapproving look. “Look at you. You're not even that old, and you're already up to your neck in debt. What kind of habits have you got? How did you end up owing so much, anyway? What did you do?”

Evan just smiled and didn't explain.

Clara didn't press him.

After dinner, Evan left.

Adam sat on the sofa, watching the palace drama Story of Yanxi Palace and behaving himself.

Once Clara had washed the dishes, she began rummaging through cupboards and drawers.

Adam turned to look at her. “What are you looking for?”

“Our ICBC bank card.” Clara scratched her head. “I'm sure I left it in this drawer last time. Where did I put it after that? Why can't I find it?”^[9]

At that, Adam kept rolling his eyes and put a hand over his chest.

He was doomed!

Reader Notes

Reader Notes

1. ↩︎ Internal wind. “Liver wind” belongs to Chinese medicine's account of disturbed movement within the body. It differs from the external wind and cold Evan mentions next. The capitalized Liver denotes a traditional functional system. “Calm the Liver and extinguish wind” is a treatment aim, not the name of a particular prescription. Evan's explanation continues his assessment in the previous chapter. Source: World Health Organization — Traditional Chinese Medicine Terminologies, entries 1258–1259 and 2485.
2. ↩︎ Cold damage and wasting disease. Shanghan, translated “cold damage,” has a broad historical meaning in Chinese medicine: illness attributed to externally contracted wind and cold. It should not automatically be read as the modern diagnosis of typhoid. Lao means a wasting illness, particularly consumption or tuberculosis. The saying pairs illnesses traditionally feared at different ages; it does not identify Adam's current illness as an infection. Sources: WHO — Traditional Chinese Medicine Terminologies, entry 1450; Jiaonan County Gazetteer — Infectious Disease Prevention, tuberculosis section (in Chinese).
3. ↩︎ The Neijing on aging. Neijing is the shortened title of the Huangdi Neijing, the Yellow Emperor's Inner Classic. Its Suwen, chapter 5, discusses aging through the relationship of yin and yang and includes the line Evan quotes. Yin qi here belongs to that traditional account of bodily nourishment and maintenance. The statement about halving is a classical formulation, not a laboratory measurement. Evan invokes forty as a general threshold; the passage does not give his patient's exact age. Source: Suwen — chapter 5, Yin Yang Ying Xiang Da Lun, electronic transcription (in Chinese).
4. ↩︎ Healthy qi and emotional strain. Healthy qi means the body's normal sustaining, defensive, and recuperative functions in traditional theory. “Supporting” it and expelling pathogenic factors are linked treatment aims. The seven emotions are joy, anger, anxiety, overthinking, grief, fear, and fright; the theory concerns excessive or prolonged emotional disturbance, not a claim that ordinary feelings are illnesses. Evan also quotes Suwen, chapter 33, on weakness where pathogenic factors gather. Sources: WHO — Traditional Chinese Medicine Terminologies, entries 284, 365 and 2258; Chinese Medicine Regulatory Office — Maintaining a Healthy Mental State (in Chinese); Suwen — chapter 33, Ping Re Bing Lun (in Chinese).
5. ↩︎ Xiao Xuming Tang. This is the “minor” form within the Xuming formula family; tang denotes a decoction. Sun Simiao's Beiji Qianjin Yaofang, book 8, records it among prescriptions for wind disorders. Those historical categories overlap with, but are not identical to, modern stroke diagnoses. Evan is naming his earlier prescription. He does not say that today's medicines constitute that same formula, or provide a new recipe here. Source: Beiji Qianjin Yaofang — book 8, Xiao Xuming Tang sections, electronic transcription (in Chinese).
6. ↩︎ Treating blood to treat wind. The maxim links traditional wind disorders with the condition and movement of blood. “Treat the blood” is broader than removing a clot: older discussions also consider nourishing deficient blood. Li Zhongzi's Yizong Bidu uses the saying in its discussion of migrating painful obstruction. Evan quotes it while insisting that a general maxim cannot replace assessment of the present case. Source: Yizong Bidu — book 10, Bi, electronic transcription (in Chinese).
7. ↩︎ The twelve characters. Zhang Zhongjing's principle is “观其脉证，知犯何逆，随证治之”: three groups of four Chinese characters, rather than twelve English words. The Shanghan Lun passage concerns reassessing a disorder after previous treatment has gone wrong. Here Evan uses it more broadly to emphasize treatment guided by the patient's current pulse and presentation. His quotation does not establish that Adam has suffered the particular treatment errors discussed in the classical passage. Source: Shanghan Lun — treatment maxim and cited classical location (in Chinese).
8. ↩︎ An appointment and a fee scale. Chinese physicians' professional titles are distinct from administrative posts such as hospital director. Zheng gaoji means the full senior level; for physicians, the corresponding title is chief physician, zhuren yishi. Clara says Evan's consultation fees are calculated at that level. That describes his negotiated treatment as an outside specialist, not a statement that he has now been awarded the professional title. Source: Hubei Department of Human Resources and Social Security — medical professional titles, article 2 (in Chinese).
9. ↩︎ ICBC. The initials stand for Industrial and Commercial Bank of China. Gonghang is the everyday Chinese abbreviation Clara uses for the bank. She is looking for the family's bank card; this exchange supplies no account balance and does not say what she intends to do with it. Source: ICBC — Introduction.