Chapter 81 You Misdiagnosed Him

Evan arrives for a consultation as tension rises around a hospital bed.

“What's the patient's condition?” Evan asked as he hurried up to the Chinese medicine hospital.

Henry Zhong, Alex Xu, and Leo Cao were waiting for him at the main entrance.

Leo looked at Henry. He didn't know the details either. Strictly speaking, he had only acted as the messenger: his job had been to call Evan.

Henry and Alex both looked awkward. Only yesterday they had gone to Evan's clinic looking for trouble; today they were asking for his help. Henry was an old hand, though, and soon got his embarrassment under control.

He held out his hand. “Dr. Xu, thank you for coming to help.”

Evan shook it. “Of course. Dr. Cao said the patient has acute cholecystitis. How is he now? Tell me about his condition first.”

“All right.” Henry wasted no more time. He gestured for Evan to go ahead, and they talked as they walked.

Alex opened his mouth, wanting to say a few words to Evan, but never got the chance. With a small sigh, he hurried after them.

“The patient's surname is He. He's 65,” Henry said. “He came to our hospital after a day of abdominal pain. The emergency department found pain in the upper right abdomen. The ultrasound report showed an inflammatory mass near the gallbladder and an irregular gallbladder wall. He was diagnosed with acute cholecystitis and admitted.

“Surgery was planned, but he's afraid of it and insists on Chinese medicine. They asked me to consult. I found a temperature of 38.5°C, pain and distension in the upper right abdomen, a dry throat, a bitter taste, and nausea with the urge to vomit. His stools were dry. His tongue was red with a yellow coating, and his pulse was wiry and slippery.^[1]

“That matched the pattern for Da Chaihu Tang, so I gave him one dose. He felt a little better, but the pain remained. The improvement was limited. The Western medicine doctors also gave him antibiotics, without much effect either. We urged him to have surgery again, but he still insists on Chinese medicine. That's why we asked you to consult, Dr. Xu.”^[2]

Evan nodded to show he understood.

Clause 165 of the Shanghan Lun read: “In cold damage with fever that does not resolve with sweating, fullness and hardness beneath the heart, vomiting, and diarrhea, Da Chaihu Tang is indicated.”

From Henry's account, the patient's symptoms did fit the formula's pattern. He had a fever. “Fullness and hardness beneath the heart” meant distension and pain in the upper abdomen. “Vomiting” did not refer only to actually vomiting: nausea, dry retching, hiccups, and belching were all signs of Stomach qi rising against its normal flow. The term xiali, used for the bowel symptom, included both diarrhea and constipation.^[3]

His other symptoms also indicated illness in the shaoyang channel. Da Chaihu Tang should have matched the pattern. Chinese medicine doctors did use it for cholecystitis, though generally for chronic cases. Acute cases rarely reached them.

Why, then, had the response been so limited?

Evan, too, began to think.

The Lingshu's chapter “On Distension” said: “In Gallbladder distension, there is pain and distension beneath the ribs, a bitter taste in the mouth, and frequent sighing.” Its chapter “The Five Pathogenic Factors” said: “When a pathogenic factor is in the Liver, there is pain along both flanks.” These were early accounts of pattern differentiation for cholecystitis. Nowadays, though, Chinese medicine doctors seldom got to treat an acute abdomen like this.^[4]

As they talked, they reached the inpatient ward. The patient was still lying in bed, groaning softly, but his daughter, the Abbess, was nowhere to be seen.

“This is the patient,” Henry told Evan.

Evan nodded.

“Edmund, this is Dr. Evan Xu,” Henry said to the patient. “He's going to examine you. Will you cooperate?”

The stubborn old man turned his head away. “No. I only want Chinese medicine.”

The others didn't know whether to laugh or cry.

“Dr. Xu practices Chinese medicine,” Henry said. “Will you let him examine you?”

“All right. As long as it's Chinese medicine.”

Evan went over and began examining him. Whatever Evan asked, the old man answered. He cooperated fully, with no sign of distrusting Evan because he was young.

Evan worked through the examination. The symptoms were just as Henry had described. After thinking for a moment, he began taking the patient's pulse.

“What are you doing?”

The icy voice came suddenly from the doorway.

They turned. It was the old man's daughter, Ms. He.

“Treating a patient. What else?” Alex had little patience for her either.

Ms. He glanced at Evan, who was examining her father's pulse. “Who gave you Chinese medicine doctors permission to treat him?”

“The patient did,” Alex said, entirely unrepentant.

Her expression grew colder. Too angry for a reply, she pointed at Evan. “And who is this?”

“A Chinese medicine specialist. Didn't you tell us to cure this Chinese medicine fanatic?”

Her face went icy.

Alex was secretly delighted. Talking back to someone felt wonderful.

Henry's lips curved with a hint of satisfaction too, though he said, “That's enough. Stop arguing. Don't disturb Dr. Xu while he's examining the patient.”

This copy was made without the author's approval; their official page carries the chapter they publish for readers.

Alex fell silent.

Ms. He's cold gaze swept over them. “Fine. I'll find the doctor in charge of him. I want to know who authorized you to examine and treat him.”

“Go ahead,” Henry said, refusing to give ground.

Ms. He turned and stalked off.

Evan continued his careful pulse examination.

A little later, Dr. Qi arrived with the others.

“It's them,” Ms. He said angrily. “Tell me, who exactly is the doctor in charge of my father? Why have you called in some Chinese medicine doctor for a consultation without telling his family?”

Dr. Qi hurried forward and leaned close to Henry. “Henry, what's going on?”

“I've asked a friend to consult.”

Dr. Qi frowned. He was in a difficult position now. “Henry, don't do this out of spite.”

They were supposed to be doing everything they could to persuade the patient to accept surgery. Instead, Henry had brought in yet another Chinese medicine doctor. Wasn't that just being spiteful?

“This isn't spite. It's what I want to do,” Henry said.

Dr. Qi had no reply.

“Dr. Qi, what are you going to do about this?” Ms. He demanded.

He thought for a moment, then forced himself to answer. “Well, the hospital does have rules and procedures. But if a patient insists on bringing someone in, it puts us in a difficult position.”

The stubborn old man spoke up from the bed. “I'm the one who asked this Chinese medicine doctor to treat me. It's nothing to do with anyone else. You won't look after me—can't I even find my own doctor?”

Ms. He was furious, her chest heaving.

“Don't talk. Stay calm,” Evan reminded the patient as he carefully examined his pulse.

The patient shut his mouth.

Evan continued taking his pulse.

Only now did the people by the doorway get a proper look at Evan. They stared.

He was so young!

Dr. Qi was speechless for some time. Henry had invited someone this young for a Chinese medicine consultation? What was he thinking? This wasn't just spite. He was making trouble!

Leo explained, “Dr. Qi, he's the doctor who cured that postpartum patient who couldn't pass urine or stool, and the eighteen-month-old with severe adenovirus pneumonia.”

Dr. Qi paused. “The one who talked Simon Liu into going to Beijing?”

For a moment, Leo didn't know how to answer. So that was Evan's most famous achievement!

He could only nod. “Yes.”

Dr. Qi and the young Western medicine doctors behind him looked at Evan again. They had heard the stories about him. They simply hadn't expected him to be so young.

Ms. He kept her face set. She no longer even wanted to speak.

Evan spent a full half hour examining the pulses at both wrists. Only then did he finish. His brow furrowed in puzzlement. He reached out and pressed the patient's lower abdomen. “Does it hurt here?”

“A little,” the patient replied.

Evan frowned again.

“What do you think, Dr. Xu?” Henry asked.

“Judging by the symptoms, a red tongue with a yellow coating usually points to an interior excess-heat pattern,” Evan said. “The bitter taste, dry throat, and urge to vomit also point to a shaoyang pattern.

“But during the pulse examination, I found signs of pathogenic heat in the hand-yangming Large Intestine channel, in its course down to the large intestine. That makes me suspect an intestinal abscess pattern. Yet the pain in his lower abdomen isn't very pronounced.”^[5]

The Chinese medicine doctors were dumbfounded.

The Western medicine doctors looked bewildered. One of the younger doctors whispered to the person beside him, “What's an intestinal abscess?”

“I think he means acute appendicitis.”

“What?” The young doctor was stunned. “Doesn't appendicitis cause pain in the lower right abdomen? How could it be in the upper right? Besides, the appendix isn't even part of the large intestine!”^[6]

“Hah!” At those words, Ms. He's expression grew colder still.

Reader Notes

Reader Notes

1. ↩︎ Wiry and slippery pulses. These are traditional descriptions of what the examiner feels, rather than two heart-rate readings. A wiry pulse feels taut; a slippery pulse has a smooth, rolling quality. Henry combines them with the tongue and other symptoms when identifying a pattern. The terminology alone does not verify his diagnosis. Source: WHO — Standard TCM terminologies, entries 900 and 904, p. 90.
2. ↩︎ Da Chaihu Tang and shaoyang. This formula, introduced earlier, is also called Major Bupleurum Decoction. Its traditional indications combine shaoyang and yangming patterns. Shaoyang belongs to the six-division framework of Chinese medicine; it is not another name for gallbladder inflammation. The listed patterns include digestive symptoms and a bitter mouth. Matching those indications is the doctors' reasoning in this scene, distinct from establishing a biomedical diagnosis or demonstrating treatment success. Sources: Hong Kong Baptist University — Da Chai Hu Tang, Action, Indication and Pathogenesis; WHO — Standard TCM terminologies, entry 1405, p. 179.
3. ↩︎ The classical passage and xiali. The quotation is translated here from the novel's Chinese, not borrowed from a modern English edition. Xiali ordinarily refers to diarrhea. The novel explicitly extends it to constipation; that explanation is preserved, but is not a standard translation of the word. The CUHK-hosted commentary distinguishes the quoted bowel symptom from difficult defecation. HKBU lists constipation and diarrhea as alternative formula indications, a separate point. Stomach qi “rising” describes a traditional reversal of digestive function, not visible movement of a substance. Sources: CUHK — Shanghan Lun commentary, §3.9 (in Chinese); HKBU — Da Chai Hu Tang; WHO — Standard TCM terminologies, entry 1214, p. 144.
4. ↩︎ The Lingshu quotations. The Lingshu, often translated as Spiritual Pivot, forms part of the Huangdi Neijing, a foundational Chinese medical classic. “On Distension” describes a Gallbladder symptom category, while “The Five Pathogenic Factors” links the Liver with flank pain. Capitalized organ names mark traditional functional systems in this edition. The narrator connects these older descriptions with cholecystitis; the quotations themselves do not identify a modern disease or settle this patient's diagnosis. Sources: Chinese Text Project — Zhang Lun (in Chinese); Chinese Text Project — Wu Xie (in Chinese).
5. ↩︎ Pattern, channel, and intestinal abscess. “Interior,” “excess,” and “heat” describe traditional pattern categories. Hand-yangming is the Large Intestine channel in the traditional meridian system, rather than a blood vessel leading from the wrist into the bowel. Evan's detailed interpretation of the pulse belongs to the novel's clinical reasoning. Changyong, rendered “intestinal abscess,” is a traditional disorder category associated with fever and lower abdominal pain or tenderness. It does not, by itself, confirm either a modern abscess or appendicitis. The other doctor's proposed identification remains tentative. Source: WHO — Standard TCM terminologies, entries 1047, 1668 and 2911, pp. 113, 227 and 398.
6. ↩︎ The appendix and the doctor's objection. The anatomical claim in this line is preserved from the original dialogue. The appendix is a small pouch attached to the large intestine, so the doctor's categorical objection is misleading. Appendicitis commonly causes pain that begins near the navel and moves toward the lower right abdomen, though presentations vary. This background explains the terminology and the disagreement; it does not establish what is causing Mr. He's pain. Sources: NIDDK — Definition and Facts for Appendicitis; NIDDK — Symptoms and Causes of Appendicitis.