Chapter 55 Quack

A thorough consultation tests the patient's patience.

He had already recognized the cause, but he couldn't simply announce it.

It was like hiring a locksmith. He could open your front door in ten seconds, but instead he had to make it look difficult, huffing and puffing over the lock and wiping sweat from his forehead. Only then could he feel comfortable charging you a hundred yuan, right?

If he opened it in ten seconds, who wouldn't feel they'd wasted their money?

A house call was much the same.

There was no need to pretend the illness was complicated. That would frighten the patient, and it would be unethical. But you did have to show that you were careful and responsible. You couldn't treat it like an ordinary hospital outpatient visit.

If you rattled off a diagnosis, took the money, and left, of course the patient would feel cheated. They'd brought you out to see them, arranged transport both ways, put you up in a five-star hotel, and paid such a generous fee. Surely they hadn't done all that just to get the same treatment as an ordinary outpatient?

A hospital outpatient visit and the medicine cost only a few yuan, and insurance could cover them!^[1]

If you accepted that much money, you had to give the patient their money's worth.

Although he already knew the cause, Dr. Liu kept asking questions. Where had she gone abroad? What had she eaten? What medicines had the hospital given her, and how had she felt after taking them?

Ethan's case record grew longer and more detailed. The patient grew more and more annoyed.

At last Mrs. Xie couldn't bear it. “Are you finished? Do you really need all that detail?”

Dr. Liu was momentarily lost for words.

“Come on,” Mr. Xie said quickly. “Dr. Liu is being responsible. An irresponsible doctor would have asked a few casual questions, prescribed whatever came to mind, and left long ago.”

“Exactly,” Leo chimed in. “Dr. Liu is known for his integrity. He's exceptionally thorough and responsible.”

Mrs. Xie let out a heavy breath, looking impatient.

Her husband gave Dr. Liu an apologetic smile.

Evan looked at her complexion and thought about her irritable, explosive temper. His brow creased slightly.

Iris and her husband looked disgruntled too. Mr. Xie's wife had a foul temper. She blew up at the slightest thing. Where did all that anger come from?

Dr. Liu also looked displeased, but he said nothing about it. “That's nearly all the questions, Mrs. Xie. Would you please stick out your tongue?”

Frowning, she did so.

The doctors all looked.

Dr. Liu examined it closely. “The coating is white, greasy, and thick, especially at the back.”

Ethan took a look and wrote it down.

“That's not right.” Evan's gaze sharpened. After a pause, he reminded Ethan, “You haven't recorded the tongue itself.”^[2]

“Hm?” Ethan turned, puzzled. Had he forgotten? His teacher hadn't mentioned it yet.

The others looked over too.

Leo's face darkened at once. Evan had already criticized him for failing to distinguish between the tongue body and its coating.

Now that Evan had brought up the tongue body again, those unpleasant memories immediately returned.

“Dr. Liu hasn't got to that yet,” Leo said darkly. “You weren't listening properly, and now you're blaming someone else!”

Evan glanced at his nephew in the teaching lineage and said nothing.

Mr. Xie looked Evan over again, his frown deepening.

Dr. Liu turned his attention to Mrs. Xie's tongue body. He too looked puzzled. “Hm?”

But she pulled her tongue back in. “You've finished looking, haven't you?”

He frowned, a little uncertain, but said, “Tongue body… pale red.”

Ethan wrote it down.

Evan shook his head slightly.

“Let's take your pulse now,” Dr. Liu said.

Mrs. Xie heaved another sigh and held out her hand.

Dr. Liu spent several minutes examining both wrists. “A thready, slippery pulse,” he told Ethan.^[3]

Ethan noted it down and nodded. The underlying pattern was clear to him.

Leo nodded too.

Still intent on being thorough, Dr. Liu turned to her husband. “Mr. Xie, could I see the reports from your wife's hospital tests?”

“Of course.” Mr. Xie had someone bring them all over.

A thick stack.

Dr. Liu settled into his seat and began reading carefully. After turning over two sheets, he said, “Ethan, you should take her pulse too. Examine her yourself.”

“All right,” Ethan said happily. Learning under a master meant more than copying prescriptions. You had to learn how to examine and treat patients too. Taking a pulse after your teacher had taken it was another way to learn.

He brought over the pulse cushion and gave Mrs. Xie a cheerful smile. “Would you let me take your pulse once more? Thank you, big sister.”^[4]

He certainly knew how to flatter.

Mrs. Xie was irritated, but he was so young, and so sweet-talking, that she let it pass and held out her hand.

Ethan located the cun, guan, and chi positions at her wrist and began taking her pulse, looking thoughtful and puzzled by turns. After a while he withdrew his hand and turned to Evan. “Why don't you examine her too, Evan?”

“Will this never end?” Mrs. Xie snapped.

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Everyone was taken aback.

Even Dr. Liu stopped reading the reports.

Evan's expression faltered too.

Leo looked delighted. So even you have your bad days, master manipulator.

Iris had had enough. She'd held back until now, but seeing Evan treated like this was more than she could take. She stood up at once.

Her husband hurried to stop her.

Mr. Xie noticed them. “You've misunderstood, dear. This doctor didn't come with Dr. Liu. Mr. Hu and his wife heard you were ill and went out of their way to bring him here.”

Mrs. Xie pressed her lips tightly together.

If he had been another of Dr. Liu's assistants, she would have lost her temper. What did they think she was—a practice dummy for interns?

But the couple had specially invited this doctor out of kindness. She couldn't just turn him down. Besides, she had to show them some respect. They would be doing business together soon, after all.^[5]

Leo chose that moment to speak. “Personally, I don't think we need quite so many doctors examining her. Dr. Xu is young and inexperienced. It would be better to leave the examination and treatment to Dr. Liu.”

Dr. Liu looked up from the reports at him. Why the barbed remark?

Mr. Xie frowned too. This wasn't about whether another doctor was needed. It was about the couple's kindness, and the respect they were owed.

Mrs. Xie nodded emphatically. She was very tired of all this.

Seeing her nod, Leo looked pleased with himself.

Only then did she look up at Evan. The moment she saw his face, she changed her tune. “Well… perhaps he could have a look.”

“Huh?” Leo was taken aback.

“They did mean well, after all,” she said.

Iris and her husband looked much less tense.

Mr. Xie breathed a sigh of relief too.

Without a word, Evan moved over and sat beside Mrs. Xie. He found the cun, guan, and chi positions and carefully examined her pulse.

Ethan was examining her other wrist. Seeing Evan come over, he began apologetically, “Evan…”

“Shh. Don't disturb me.” Evan frowned in concentration as he felt the pulse.

That cut Ethan short.

Mrs. Xie turned to look at this young doctor of Chinese medicine with his air of melancholy.

Leo looked puzzled too.

Dr. Liu put the reports down. “Dr. Cao, let's discuss the case.”

Since Leo was here, he might as well be kept busy. The two made a show of discussing her condition, and Ethan went over to take notes.

That left Evan alone to examine Mrs. Xie. He carefully finished taking the pulse at both wrists.

Iris came over too. She had invited Evan. If Mrs. Xie shouted at him again, she wasn't going to stand by and let him be mistreated.

Fortunately, Mrs. Xie didn't lose her temper. She just kept looking at him.

Evan put the pulse cushion away. “Do you sleep well at night? Do you dream a lot?”

“So-so. I'm always dreaming. How old are you?”

He ignored the question. “What about your urine? Plenty of it, and clear? Or scanty and reddish?”

“Scanty and reddish. Where are you from?”

“Do you sweat a lot? Mainly where?”

For once, Mrs. Xie wasn't showing any impatience. “My head sweats quite a bit. I'm asking you questions too, you know. Aren't you going to answer?”

Evan looked serious. “Comrade, please answer your doctor's questions first. What about your diet? Do you prefer cold food or hot food?”^[6]

“Comrade?” Mrs. Xie savored the word, at once old-fashioned and novel, then smiled. “All right, Comrade Doctor. In this heat, wouldn't hot food leave your head covered in sweat?”

Iris watched in surprise. That bad-tempered woman was actually smiling? She hadn't been anywhere near this patient with Dr. Liu.

Evan nodded slightly. He understood now. Dr. Liu had certainly misdiagnosed her. He got up, but before he could speak, Dr. Liu had finished writing the prescription.

Dr. Liu told Mr. Xie, “The prescription is ready. Please take a look. Your wife has dawn diarrhea. Her Kidney yang is deficient, and the Kidney's warming fire is weak. This has led to Spleen yang deficiency as well.^[7] I've combined Sishen Wan with Shenling Baizhu San, with modifications. Ten doses to start with.”^[8]

Mr. Xie's expression froze.

Mrs. Xie gave an angry snort. “Quack!”

Reader Notes

1. ↩︎ Hospital fees and medical insurance. Chinese medical insurance can help pay for eligible care and medicines at designated institutions. Coverage depends on the service, medicine, and applicable arrangements. The narration contrasts an ordinary hospital visit with an expensive private house call, using “a few yuan” as its comparison. That amount comes from the novel; the linked policy explains the insurance framework and supplies no price for this fictional consultation. Source: National Healthcare Security Administration — Insurance support for Chinese medicine, sections II and IV (in Chinese).
2. ↩︎ The tongue and its coating. Chinese tongue examination considers the tongue's own tissue, called its “body,” separately from the material coating its surface. Color and texture can be described for each. A white coating therefore leaves the color of the underlying tongue to be recorded separately. This distinction explains Evan's interruption. Dr. Liu's later “pale red” is his assessment of that tissue; Evan's disagreement remains unexplained here. Source: WHO — Chinese medicine terminology, entries 640–644, 673, 675, 682, and 691.
3. ↩︎ Pulse qualities and positions. “Thready” describes a narrow, soft pulse; “slippery” describes a smoothly flowing sensation beneath the fingers. These are tactile qualities assessed in Chinese pulse diagnosis. Later, cun, guan, and chi name three neighboring positions along the radial pulse at each wrist. The physician places fingers over those positions to examine it. The words describe what is being felt and where; the doctor's interpretation also draws on the rest of the consultation. Source: WHO — Chinese medicine terminology, entries 856–859, 896, and 900.
4. ↩︎ “Big sister.” Jie can address an older woman of one's own generation as well as an actual elder sister. Family language can thus create a warmer tone between people who are unrelated. Here Ethan uses it while asking an irritated patient for another examination, and the narration explicitly calls him sweet-talking. The English preserves that shift from professional formality to flattering familiarity. Source: Taiwan Ministry of Education — Jie, definition 1.2 (in Chinese).
5. ↩︎ Showing respect, or “giving face.” Mianzi can mean reputation or the personal consideration owed to someone in a relationship. Here, accepting the doctor whom the couple invited acknowledges their goodwill and preserves their standing in front of the others. The pending business cooperation gives that courtesy a practical weight. The narration shows Mrs. Xie's calculation in this particular encounter; the medical question and the social obligation remain separate concerns. Source: Taiwan Ministry of Education — Mianzi, definitions 1–2 (in Chinese).
6. ↩︎ “Comrade.” Tongzhi was a familiar form of address in Chinese public and working life, and could be used for women as well as men. In this contemporary conversation, Evan's formal wording sounds old-fashioned enough to catch Mrs. Xie's attention. She answers in the same register with “Comrade Doctor.” The joke lies in that unexpected courtesy and the change in her response. Source: Laishan District Government — Customs of etiquette, forms of address (in Chinese).
7. ↩︎ Kidney yang and Spleen yang. In Chinese medical theory, yang includes warming and activating functions. Dr. Liu attributes the dawn diarrhea to weakened Kidney warming, which in his account also leaves the Spleen's digestive functions inadequately warmed. “Fire” is part of this traditional language of bodily function. The capitals mark the novel's functional organ categories. This is the pattern Dr. Liu proposes; Evan has just reached a different assessment, whose details have yet to be given. Source: WHO — Chinese medicine terminology, entries 156, 1200, 1276, and 1323.
8. ↩︎ Two named formulas. Sishen Wan is associated traditionally with Spleen–Kidney deficiency cold and dawn diarrhea. Shenling Baizhu San belongs to the qi-supporting, Spleen-strengthening formulas used in the traditional framework for digestive weakness and dampness. Wan and san indicate pill and powder forms in their names. Combining and modifying named formulas means adapting their ingredients in a prescription. The novel gives ten doses but no ingredient list, quantities, or preparation instructions, so the names alone do not specify what Mrs. Xie would receive. Sources: Taiwan Ministry of Health and Welfare — Sishen Wan license record, indications and dosage form (in Chinese); Hong Kong Baptist University — Shen Ling Bai Zhu San, classification, method, and action.