Chapter 91 Gongdu Chengqi Tang

A mistaken assumption pleases Evan. Dr. Li has more practical matters in mind.

“What was that?” The barefoot doctor was so angry he almost laughed.

“Evan, don't talk nonsense!” Dr. Li scolded.

“All right,” was all Evan could say.

Still bristling, the barefoot doctor turned to Dr. Li. “He's your apprentice, isn't he? This apprentice of yours has no respect for his elders.”

“Er…” For a moment, Dr. Li did not know how to deny it.

“Hm?” Evan turned toward them. All at once, he found the old man much more agreeable.

The barefoot doctor looked him up and down. “What are you looking at? Your master hasn't said a word. What business does an apprentice have butting in?”

This time Evan was not angry. He answered with perfect sincerity. “Yes, yes. You're quite right.”

Dr. Li turned his head away in disgust.

“That's more like it.” The barefoot doctor nodded. “An apprentice ought to behave like an apprentice…”

“All right, all right, Shuanzhu,” Dr. Li interrupted. “Don't take a youngster's remarks so seriously.”

The barefoot doctor snorted. “If he weren't your apprentice, I'd give him a proper scolding.”

Dr. Li was speechless. Was he ever going to stop calling Evan his apprentice?

Evan was beginning to think the old man had excellent judgment.

Dr. Li glanced at him. “What are you standing there for? Get on with the acupuncture!”

“Right away.” Evan took the acupuncture case out of his bag.

The patient's sun-darkened husband blushed and stammered. “Li Ke, my friend, he… he… he…”

“He's a university student,” Dr. Li reassured him. “He's quite good at acupuncture.”

At the words “university student,” everyone looked at Evan differently. Even the barefoot doctor looked surprised.

“You're really going to treat her with Chinese medicine?” he asked Dr. Li.

“She's too ill to be carried over these rough mountain paths to the county hospital. All that jolting would be too much for her.”

The barefoot doctor fell silent, though he muttered, “Chinese medicine can't cure anything this serious, surely.”

Dr. Li merely smiled.

The husband nodded hastily. “We'll take Chinese medicine. We'll use it. Chinese medicine's good, it's good.”

“Do you have any white radishes?” Dr. Li asked.

“Yes, yes, we do.”

“Get 2.5 kg of raw white radish ready. Where can I make a phone call in the village?”

“There's one telephone, at the village committee office.”

Dr. Li nodded. “Then take me there. I'll ask the township clinic to send some medicinal ingredients over. That'll save time.”

“Of course, of course.” The husband hurried out with him.

Evan crouched down and took out a three-edged needle, ready to let blood.

Everyone in the room gathered around to watch the university student at work.

The barefoot doctor came closer too, his manner quite different now. “You really are a university student?”

Evan crouched down, opened the woman's mouth, and cleaned it a little. Then he pricked the Jinjin and Yuye points to let blood.^[1] The method treated vomiting and could also drain heat, since toxic heat was blocking the Triple Burner.^[2]

“I'm a graduate student,” he said as he pricked the points and released dark blood.^[3]

He placed a towel beside her mouth so that she could spit the dark blood onto it.

The barefoot doctor looked puzzled. “What's a graduate student?”

Evan stood up and pricked both Chize points and both Weizhong points to let blood.

“An advanced university student.”

“You're just bragging!” The barefoot doctor did not believe a word of it.

When he had finished releasing the dark blood, Evan put the three-edged needle away.

The woman on the bed let out several long breaths.

“How are you feeling? Any better?” someone beside her asked.

“Much better,” she said, still breathing hard. “Not nearly so queasy. Don't feel like throwing up so much.”

The barefoot doctor stared in astonishment.

Evan took a filiform needle from his acupuncture kit, pressed the woman's appendix point, and inserted the needle at the tender spot. An appendiceal abscess had already formed, and toxic heat had blocked the Triple Burner. She was very seriously ill.

But he had already examined her pulse. Though she had been ill for five days, with fever and intestinal obstruction, and had passed neither stool nor gas for three days, the pulse showed no deficiency. Her constitution was still reasonably strong.

So he went straight to the Toutianliang technique—Heaven-Piercing Coolness—with strong stimulation.^[4]

The people beside him watched with fascination.

“What technique is that?” the barefoot doctor asked curiously.

“For graduate students only.”

The barefoot doctor was baffled. What was that supposed to mean?

Evan used a strong draining method at Zusanli, Neiguan, and other points.

Dr. Li and the husband returned. Seeing Evan at work, Dr. Li paused in surprise. “Oh? Heaven-Piercing Coolness?”

“What?” the barefoot doctor asked. “Isn't that only for graduate students?”

Dr. Li was left speechless again.

After a while, Evan finished the acupuncture. “Ma'am, does it still hurt?”

“Much better,” she said from the bed. “Hardly hurts now.”

The barefoot doctor was dumbfounded. “Is a graduate student's technique really that good?” he murmured.

Dr. Li looked at the barefoot doctor, who had swallowed Evan's nonsense whole, and shook his head slightly. After a pause, he asked, “Evan, if you were treating her, what would you prescribe?”

Evan was taken aback. This was a test.

He gave it careful thought. This was no time to be careless. “Toxic heat is blocking the Triple Burner. This is a severe case of guange, with yangming bowel excess.”^[5]

The barefoot doctor, who claimed to have studied Chinese medicine, was lost the moment he heard this. What did it mean?

“She hasn't passed stool or gas for three days,” Evan continued. “That tells us there is yangming bowel excess, with severe dryness and heat in the Large Intestine. That's also what has caused the intestinal obstruction. Zhang Xichun's Xiaofu Tongjie Tang would be appropriate.

“It's excellent at softening hardness, moistening and moving the bowels, without injuring the body's healthy qi. It's particularly suitable for weak patients and the elderly. And since she has an intestinal abscess with pus formed, naturally it should be combined with Dahuang Mudanpi Tang.”^[6]

The barefoot doctor looked from one to the other. He still had no idea what they were talking about.

His so-called study of Chinese medicine amounted to knowing that one herb could bring down fire and another could reduce inflammation.

Chinese medicine required an understanding of theory, treatment principles, formulas, and medicinal ingredients. He knew a little about the properties of a few ingredients at most. He did not even understand formulas, much less the reasoning behind treatment.

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Wisely, he kept quiet. Still, he was beginning to think Evan was rather capable. An advanced university student indeed.

Dr. Li nodded slightly. “Write down the prescription and the doses. Let me see.”

“All right.” Evan immediately took out paper and a pen and leaned over the table to write.

The barefoot doctor leaned in to look too. After studying it for a few moments, he walked back, still puzzled.

Evan handed the prescription to Dr. Li. Dr. Li read it, made no comment, and simply told him to put it away.

That left Evan uncertain where he stood.

Before long, people from the township clinic arrived with the medicinal ingredients.

The radishes were ready too.

Evan and Dr. Li went to prepare the decoctions.

Evan sliced the 2.5 kg of radish and divided it into three portions. He poured 5 L of water into a pot, added 120 g of yuanmingfen and one-third of the radish, and began boiling it.^[7]

This was Zhang Xichun's Xiaofu Tongjie Tang, which worked extremely well for stubborn dry constipation or intestinal obstruction.

Zhang Xichun had used puxiao, but mangxiao would also do. Mangxiao had a somewhat stronger purgative action. They shared the same salty flavor and cold nature.

Too little of this medicine would be ineffective; too much would injure the body's healthy qi. That was why the radish was needed. Many people thought radish was cold in nature, but that was incorrect: it was slightly warm. Its slight warmth counteracted mangxiao's excessive coldness, while it also absorbed the saltiness so that an excess of salt would not injure the Kidneys.^[8]

Although the formula contained only two ingredients, they were very well matched. It worked well, especially for elderly or weak patients.

As Evan boiled the medicine, he added the radish in three batches, removing each batch once it was cooked and replacing it with the next. He had to keep boiling until the liquid had reduced to 500 mL.

Evan set about preparing the other formula.

Dr. Li handed him a sheet of paper.

Evan took it.

“Those are the ingredients and doses for the second formula,” Dr. Li said.

Evan hurried to read it.

“In my sixth year of teaching myself Chinese medicine, I developed two formulas,” Dr. Li said unhurriedly. “One was Poge Jiuxin Tang, for critical cases of heart failure of all kinds. It uses large doses of fuzi to break through layer upon layer of yin cold and restore yang, saving the patient's life. That one treats yin patterns.^[9]

“The other is this Gongdu Chengqi Tang. I developed it by adding ingredients to Dahuang Mudanpi Tang from the Jinkui Yaolue—the Essentials from the Golden Cabinet—specifically for yang patterns.

“I often use it for critical acute abdomen cases. Acute abdomen is actually very common in the countryside. I've treated more cases than I can count. This formula has served me countless times. Every patient has been cured. I've never failed.”

“Holy shit!” Evan exclaimed in admiration.

Dr. Li slowly lit a cigarette and let out a ring of smoke.

“Getting medicines together in the countryside is inconvenient, so I increase the doses. In all my years of practice, more than 90 percent of my acute abdomen patients—severe cases included—have been cured by a single batch. Mild cases are cured before they've even finished it.

“A dozen or so hours at most, and it costs only a few yuan! Only a few of the gravest cases—severe appendicitis with peritonitis and other life-threatening conditions—have needed two batches.”^[10]

“Holy shit!” said Evan, the advanced university student, offering another thoroughly uneducated expression of admiration.

Reader Notes

Reader Notes

1. ↩︎ Bloodletting and the named points. A three-edged needle is a lancet-like acupuncture instrument, distinct from the slender filiform needle Evan uses later. Jinjin and Yuye are named points beneath the tongue; the narrative's mouth-cleaning and towel belong to that part of the scene. Chize and Weizhong are different point names, and the source explicitly has him treat both sides. The term “draining heat” expresses the traditional rationale, rather than the removal of a measured substance called heat. Sources: WHO — Standard TCM terminologies, entries 3025 and 3080; Tianjin Journal of Traditional Chinese Medicine — Tian Zhonghui, 2017, §2.1, point terminology and bloodletting description (in Chinese).
2. ↩︎ Toxic heat and the Triple Burner. Sanjiao, translated as the Triple Burner, groups the body into upper, middle, and lower functional regions and describes pathways of qi and fluids. It is not three literal furnaces or a single anatomical organ. “Toxic heat” is traditional pattern language for an intense pathogenic heat condition, not the name of a laboratory-identified toxin. Here the narrator and Evan use this framework to explain the severity and extent of the illness; the phrase itself does not establish a modern anatomical diagnosis. Source: WHO — Standard TCM terminologies, entries 207–210 and 1049.
3. ↩︎ The “advanced university student.” A graduate student studies beyond the first university degree; the Chinese term here does not specify whether Evan means a master's or doctoral program. China's postgraduate education was expanding again in this period, with degree regulations taking effect in 1981. The joke depends on this particular village doctor's unfamiliarity with the distinction. Evan's explanation, and his later claim that a needling technique is reserved for graduate students, are teasing, not names of academic qualifications or clinical methods. Source: China's Ministry of Education — historical overview of postgraduate education (in Chinese).
4. ↩︎ Heaven-Piercing Coolness. Toutianliang is a named compound needling manipulation, discussed in Chapter 83. Its cooling name expresses its intended traditional effect; it is unrelated to a graduate degree. A “draining” needle method seeks to reduce a condition classed as excess and is distinct from the purgative action of a medicinal formula. Evan chooses strong stimulation because his pulse assessment suggests no deficiency. The “appendix point” is a named acupuncture site on the lower leg, not the appendix itself. Sources: Beijing University of Chinese Medicine — reinforcing and reducing needling methods (in Chinese); China Association of Acupuncture-Moxibustion — appendix-point terminology (in Chinese).
5. ↩︎ Yangming bowel excess and guange. Yangming bowel excess is a traditional pattern involving intestinal heat, dryness, and obstructed stool; “excess” describes a pattern rather than the amount of intestine. Guange commonly denotes a critical condition involving persistent vomiting and urinary retention. Evan applies it here in a discussion of vomiting and bowel obstruction, but the chapter reports no urinary retention. The translation therefore keeps his term without adding that symptom or assigning a modern kidney disorder. His explanation of the obstruction remains his own traditional medical reasoning. Source: WHO — Standard TCM terminologies, entries 1404 and 1701.
6. ↩︎ The proposed combination. Xiaofu Tongjie Tang is a formula associated with Zhang Xichun's Yixue Zhongzhong Canxi Lu, a medical work bringing Chinese and Western learning into dialogue. Dahuang Mudanpi Tang is the fuller name used in the novel for the classical formula catalogued as Dahuang Mudan Tang, or Rhubarb and Moutan Bark Decoction. Evan proposes combining formulas to address both the blocked bowels and the intestinal abscess. These are names and traditional indications; the catalogued indications do not verify his diagnosis or establish the effectiveness of his proposed combination. Sources: Hubei University of Chinese Medicine — Zhang Xichun's work and contents (in Chinese); Hong Kong Baptist University — Dahuang Mudan Tang, F00018.
7. ↩︎ Yuanmingfen and the xiao medicines. Yuanmingfen is an alternative name for xuanmingfen, a dried sodium sulfate medicinal material. Mangxiao and puxiao are related mineral medicines, but their processing and water content need not be identical. Their shared traditional description as salty and cold does not make equal weights interchangeable. The novel first specifies yuanmingfen, then discusses puxiao and mangxiao; those names and the stated 120 g are preserved separately. The radish quantity is rendered in metric units: five modern mainland jin equals 2.5 kg. Sources: National Research Institute of Chinese Medicine — Xuanmingfen (in Chinese); China Medical University Hospital — China Pharmacy Newsletter, December 2014, p. 10 (in Chinese); Taizhou official gazetteer — unit conversion table (in Chinese).
8. ↩︎ The radish explanation. “Warm” and “cold” here classify medicinal nature, rather than the temperature of the simmering ingredients. The novel's account follows an argument found in a transcription of Zhang Xichun's formula discussion, where radish is described as slightly warm and used to temper the mineral medicine. Classifications differ: Hong Kong Baptist University's entry lists fresh radish root as cool. The translation preserves the novel's explanation and records that difference. Neither the classification nor the claim about absorbing salt establishes a measured change in sodium content or protection from kidney injury. Sources: Zhang Xichun — Xiaofu Tongjie Tang, text transcription (in Chinese); Hong Kong Baptist University — Radish, D00612.
9. ↩︎ Yin and yang patterns. In this contrast, yin patterns belong broadly to the cold and deficient side of traditional classification, while yang patterns belong broadly to the heat and excess side. These are medical pattern categories, not the patient's sex or two interchangeable names for heart failure and abdominal illness. Fuzi, encountered in the earlier rescue, is an aconite-root medicine. Dr. Li is describing the purposes of his two formulas; the distinction does not establish their safety or effectiveness for every condition within those categories. Sources: WHO — Standard TCM terminologies, entries 990–995; Hong Kong Department of Health — medicines containing aconitum alkaloids (in Chinese).
10. ↩︎ A batch and a claim of cure. Here a “batch” means one prescription's quantity of medicine prepared for administration, not a single sip. The recovery figures, timing, costs, and statement that every case was cured are Dr. Li's claims in the story. They are not results verified by the sources for these notes. This woman's reduced nausea and pain have been reported, but no cure has occurred in the chapter. Modern information on appendicitis describes treatment according to the illness and its complications. Source: NIDDK — treatment for appendicitis and complications.