Chapter 155: Follow-up Visits

Evan returns to the ward, with the young doctors close behind.

At university, none of it had seemed particularly strange. Once they graduated, they were bewildered. That was especially true of doctors like them, with no exceptional talent and no option but to return to the county's Chinese medicine hospital.

Hardly anyone came to see a doctor of Chinese medicine these days. Even those who did wouldn't choose youngsters like them, and most only wanted something to improve their general health. They didn't know where to go from here, let alone what future they had.

Someone who knew how to work the system, like Leo Cao, had long since started cultivating connections, pursuing professional titles, and securing his future. Dr. Simon Liu, meanwhile, had confused himself trying to combine Chinese and Western medicine and ended up withdrawing into himself.

Even Dr. Henry Zhong, the best clinician at the county's Chinese medicine hospital, was still only a department head. And, to be honest, his position wasn't as desirable as the equivalent job elsewhere in the hospital. The Chinese medicine department was the poorest of them all.^[1]

They were all at a loss.

But now Evan had shown them a way forward. So this was what Chinese medicine could be! This was a path they could take! There was so much it could do!

Evan had appeared when these young doctors felt most lost. How could they not be excited?

How could they not be eager? He gave them a direction to follow, and he was so willing to teach them, too!

Never mind coming back after work. They would happily sleep here if they had to.

“Dr. Xu.”

“Hello, Dr. Xu.”

The young doctors greeted him.

Evan nodded to them. “Hello. Come on, let's see how the patient is doing.”

They went back to the ward together.

The man had now completely stopped vomiting blood. He looked much more settled, had managed a nap earlier, and finally felt hungry again. He had even passed gas.

“His gastrointestinal function is starting to recover,” Evan told the doctors behind him. “Stomach qi should move downward. If it goes upward instead, a mild case produces belching; a severe case produces vomiting. When it moves down, the gas comes out the other end. He's beginning to recover. It's a good sign.”^[2]

The young doctors nodded.

Evan checked the man's tongue again. “The tongue looks the same as it did this morning. Pale, with no coating.”

They wrote down the findings.

Evan began taking the pulse. After a little while, he said, “The pulse is faint at both cun positions, and deep and weak at the guan and chi positions.^[3] A faint pulse can indicate collapse of yang or deficiency of qi and blood. As the Maijing says, ‘The pulse reflects blood and qi. When qi and blood are faint, the pulse is faint as well.’^[4]

“A faint pulse at the left cun indicates insufficient Heart qi, Lung deficiency, and weak qi. At the right cun, it indicates cold in the chest with fullness and pain, and cold phlegm congealing.

“Be thorough when you examine a pulse. Check all three positions—cun, guan, and chi—one by one.

“Don't try to save yourself trouble by making a rough assessment of the pulse as a whole and leaving it at that. You can easily misdiagnose a patient that way. I'll say it again: you can't be too thorough with pulse examination. It can tell you a great deal.

“For instance, a faint pulse indicates deficiency of both qi and blood. That means three of the eight methods of internal treatment are ruled out: inducing sweating, inducing vomiting, and purging. You mustn't be careless. Use them wrongly, and complications can easily follow.^[5]

“The guan and chi pulses are deep and weak. A weak pulse also indicates insufficient qi and blood. Taken together, the findings point to Spleen and Stomach deficiency.

“The patient's symptoms agree with his pulse findings. He's been vomiting blood for two days and has lost too much blood. Naturally, his qi is weak and his blood deficient. His tongue and pulse both confirm that. When the pulse and symptoms agree, it's a favorable sign. It shows there hasn't been a new change in his condition.

“If a pulse suddenly appears that contradicts the symptoms, be careful. There may have been a new development. At a time like that, you need to be very, very thorough. Don't get caught out.”

The young doctors carefully wrote it all down. This was clinical experience, and Dr. Xu shared it without holding anything back. They couldn't afford to miss a word.

Evan continued, “The pulse and symptoms are clear now. Our treatment should warm and activate Spleen yang while nourishing the blood, with support to dispel blood stasis. Use Lizhong Tang as the main formula. Add danggui and shaoyao to replenish blood, and continue sanqi to dispel stasis. Write the prescription.”^[6]

After writing out the prescription for them, Evan went home.

The other young doctors came over and lined up to examine the patient's pulse again…

By now, the man and his wife were quite used to this routine.

The next day, Evan went to work.

At lunchtime, he went over to the Chinese medicine hospital to check on the patient again. Clara had stayed home all morning and hadn't come to Mingxin Clinic.

When Evan arrived, the young doctors hurriedly shoveled down a couple more mouthfuls and rushed after him. It was becoming a regular sight.

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“Dr. Xu, after taking the medicine, the patient says he feels a little dizzy today, and his ears are ringing,” Alex reported.

“Have you examined him?” Evan asked.

“We have, but we're not quite sure what to make of it.”

Evan led them toward the inpatient ward.

The patient's wife was still eating. She hadn't expected Evan to come back right at mealtime. Well, he was squeezing a visit into his own lunch break to treat her husband. She could hardly complain.

Evan examined the man again.

“Dr. Xu, has his condition changed again?” the wife asked. “His stomach isn't bothering him anymore, but now his head's giving him trouble. Why is that?”

The patient, too, looked at Evan curiously.

Instead of answering them, Evan turned to the young doctors. “You examined his pulse earlier, didn't you? Tell me what you found.”

“We discussed it just now,” Alex said. “We think it's thready and rapid.”

Evan gave a slight nod. “Then tell me why he's dizzy and his ears are ringing.”

The burly young doctor who had held Alex by the neck earlier answered in a booming voice.

“Dr. Xu, a thready pulse usually indicates qi and blood deficiency, yang deficiency, and cold in the Stomach. A rapid pulse indicates heat, but I think this patient's pulse is rapid without strength. That would mean deficiency heat.^[7]

“I think the heavy bleeding has left his qi and blood so depleted, and his Spleen and Stomach so weak, that they've lost their ability to control and contain. The earlier medicine then caused deficiency heat to rise, producing the ringing in his ears and the dizziness.”

Evan nodded. “Very good. That's right. This is exactly why we so rarely use one prescription unchanged from start to finish, especially for a serious illness or an acute, severe condition.

“A patient's condition changes, whether he's improving or getting worse. There will be new changes after he takes medicine, too. You must keep watching, especially with inpatients.

“And never forget to observe the pulse and symptoms. You've all seen it these past two days. His pulse has already changed three times, so our medicines have to change accordingly.

“Since we've established that this is deficiency heat surging upward, we'll keep the previous formula, but add digupi and oujie. Digupi cools the blood without impeding its movement; oujie frees the channels and dispels stasis. Then we just need one more medicine, salty and cold in nature, to bring down the fire…”^[8]

With that, Evan prepared to lead them away.

Reader Notes

Reader Notes

1. ↩︎ Professional rank and hospital office. As in earlier chapters, a medical professional title, or zhicheng, concerns clinical rank. Being a department head is a hospital leadership role. The two can overlap, but they are not interchangeable. Here, the narrator connects the young doctors' frustration with their limited prospects and their department's resources. Source: Hubei Department of Human Resources and Social Security — Medical Professional Titles, article 2 (in Chinese).
2. ↩︎ Stomach qi and downward movement. In traditional Chinese medicine, Stomach qi refers to the Stomach's functional activity, not to gas inside the organ. Its normal direction is described as downward, carrying partially digested food onward; movement in the opposite direction is associated with symptoms such as belching and vomiting. Evan interprets the return of hunger and passage of gas within that framework. His explanation remains a character's assessment of this patient. Source: WHO — Traditional Chinese Medicine Terminologies, entries 188, 193–194, and 1214.
3. ↩︎ Pulse positions and qualities. Cun, guan, and chi are three examination positions along the radial pulse at each wrist. They are not three different arteries. Faint, or wei, describes a pulse that is barely perceptible; weak, or ruo, describes a deep, soft pulse lacking strength. Thready describes narrowness, while rapid describes speed. The distinctions matter here because Evan follows changes in both position and quality. These traditional descriptions do not supply laboratory measurements of blood loss. Source: WHO — Traditional Chinese Medicine Terminologies, entries 856–862, 890, 892, 895–896, and 910.
4. ↩︎ The Pulse Classic. Maijing is a classical work on pulse diagnosis. Its opening section describes a faint pulse as extremely fine, soft, and sometimes barely detectable. A similar link between diminished qi and blood and a faint pulse appears in the later Binhu Maixue. The exact sentence quoted in the novel was not located in the Maijing transcription checked here; Evan's attribution is retained. Sources: Maijing — opening section (Chinese primary-text transcription); Binhu Maixue — Faint Pulse (Chinese primary-text transcription).
5. ↩︎ The eight methods. This traditional classification groups treatment under sweating, vomiting, purging, harmonizing, warming, clearing, dispersing, and supplementing. They are categories, not eight steps that every patient must undergo. The Yixue Xinwu discusses their selection and the consequences of inappropriate sweating, including in depleted patients. Evan's warning concerns avoiding further depletion in this case. The historical framework explains his reasoning without establishing a modern treatment protocol. Source: Yixue Xinwu — The Eight Methods and On Sweating (Chinese primary-text transcription).
6. ↩︎ Lizhong Tang and the additions. Lizhong is traditionally used to warm and support the Spleen and Stomach. The formula database lists both pill and decoction preparations; tang here identifies the decoction. Danggui is Chinese angelica root, while shaoyao means peony root. The novel abbreviates the latter without specifying white or red peony, so neither is silently selected. Sanqi continues from the preceding visit. No ingredient amounts are supplied here. Sources: Hong Kong Baptist University — Li Zhong Wan, preparation and actions; Hong Kong Polytechnic University — Chinese Angelica (in Chinese); White Peony Root, a specifically named preparation (in Chinese).
7. ↩︎ Deficiency heat. Heat in this vocabulary is a traditional pattern category, not necessarily a measured fever. A rapid pulse can be interpreted differently depending on its strength: rapid and forceful suggests excess heat, while rapid and weak suggests deficiency heat. The young doctor connects that distinction with the patient's blood loss, weakness, and new symptoms. The suggested causal role of the earlier medicine is his clinical interpretation, which Evan accepts in the story. Source: WHO — Traditional Chinese Medicine Terminologies, entry 892.
8. ↩︎ Root bark, lotus nodes, and medicinal properties. Digupi is wolfberry root bark, traditionally classified as clearing deficiency heat and cooling blood. Oujie is the dried node of the lotus rhizome; its traditional uses include stopping bleeding and dispelling stasis. These identify the two named additions. The remaining medicine is described only by its salty flavor and cold medicinal nature; cold is a traditional property rather than serving temperature. Its identity is left unstated here. Sources: Hong Kong Polytechnic University — Digupi (in Chinese); Lotus Rhizome Node (in Chinese); WHO — Traditional Chinese Medicine Terminologies, entry 2639.