Chapter 93 Materia Medica

Dr. Li's outburst opens a larger argument about the books and doses Chinese medicine has inherited.

Evan, too, shook his head with a rueful smile.

He had come from a later time, so he naturally knew that an Eastern Han tomb had been excavated this year, confirming the weights used in that period. He also knew the two ancient physicians Dr. Li cursed most often: Li Shizhen and Zhu Danxi.

In the public imagination, Li Shizhen ranked behind only Hua Tuo and Bian Que among the great Chinese physicians. Ask people to name a book on Chinese medicines, and the only one they could come up with was the Bencao Gangmu, the Compendium of Materia Medica.^[1]

But to be honest, the original Compendium had serious problems.

Why?

Because it contained a great deal of speculation and superstition. A pregnant woman mustn't eat a rabbit's head, for instance, or her child would be born with a cleft lip. If a fish bone lodged in your throat, you could burn a fishing net to ash, mix it with water, and drink it to dissolve the bone.

Steal a lamp from a rich household during the Lantern Festival and put it under your bed, and it would cure infertility. All sorts of absurdities like that—human shit, pig shit, even souls and spirits used as medicines!^[2]

His Compendium had done little more than organize the materia medica of his predecessors.

Of course, it contained much that was valuable. But it had also taken in a great deal of hearsay, and even outright speculation.

Gold mixed with silt. There was gold in it, but plenty of silt too.

There had been many materia medica works over the centuries. For practitioners of Chinese medicine, the Shennong Bencao Jing, the Divine Farmer's Materia Medica, would certainly come first.

Why, then, did ordinary people know only the Compendium?

Largely because Darwin had praised it.^[3]

That was why, during China's Republican era, many progressive thinkers said that although they opposed Chinese medicine, they still considered its medicinal knowledge a treasure house, with particularly great riches hidden in the Compendium.

Didn't that argument sound familiar? It was exactly the same today. Look through the comments of people attacking Chinese medicine online: they all said the same thing.

Modern editions, however, had gone through a series of corrections, weeding out falsehoods and retaining what was sound. The Compendium had thus become a work of considerable value.

Still, Li Shizhen's greatest contribution wasn't the Compendium. It was his work on the pulse. Both the Binhu Maixue, his study of the pulse, and the Qijing Bamai Kao, his examination of the eight extraordinary vessels, were excellent.^[4]

Another major problem with the Compendium was its investigation of ancient doses. For most medicines, Li Shizhen had simply recorded what others said without examining it, let alone spending time researching ancient quantities.

So he had simply stipulated that one ancient liang should count as one contemporary qian.

Just like that, the doses in Zhongjing's classical formulas had been cut severalfold—to one-fifth of the original amounts in theory, and only one-tenth in actual use.^[5]

Of course, Li Shizhen hadn't been alone in thinking this. The other physicians of his generation in the Ming dynasty had thought the same. Why did Dr. Li curse him, then? Because he was the most famous.

After the Ming dynasty, Chinese prescribing had suddenly become much lighter. That might avoid serious mistakes, but it could no longer treat critical illness.

By the late Ming, epidemics broke out. To their sorrow, physicians found that the formulas in the Shanghan Lun, the Treatise on Cold Damage, couldn't save people. The formulas handed down by the Sage of Medicine had become utterly useless.

At this apparent dead end, physicians had opened a new path through sheer determination. They developed and modified Zhongjing's classical formulas and devised new theories. From this arose the shibing school, concerned with seasonal illnesses.^[6]

But the Sage of Medicine's finest teachings had long since gathered dust!

In the modern conflict between Chinese and Western medicine, Chinese medicine had lost the entire field of acute and critical care. It had become synonymous with slow treatment. Now it was almost reduced to wellness medicine.

That was why true practitioners of Chinese medicine disliked being told to keep up with the times and embrace modern science. Behind them lay a vast mountain of gold. It was merely covered in dust.

Chinese medicine ought to look to the past rather than the future.

Dr. Li had barely taken a few swings of his hoe at that mountain, and he was already this formidable. In acute and critical cases, his treatments worked faster than modern medicine, and the prognosis was far better too.

He was a staunch adherent of the ancient Chinese medical tradition: rooted in the Shanghan Lun, following Zhongjing, and relying exclusively on pattern differentiation by the six channels and the eight principles. Only by resolving the question of dosage had he reached his present level.^[7]

Who said Chinese medicine on its own couldn't match Western medicine? Who said it had to keep up with the times and combine Chinese and Western methods?

…

After cursing Li Shizhen, Dr. Li gradually calmed down. Suddenly he turned to Evan.

“Now that the ancient doses have been corrected, the pharmacopoeia…”

He stopped before finishing.

Evan sighed too.

The ancient doses might have been corrected, but in Chinese medicine today… there had long been few true practitioners left. And true practitioners had long since ceased to have the final say.

Dr. Li sighed as well. Looking defeated, he stood, his back a little more bent.

“Come on. The medicine's ready.”

Evan stood and went to pour the medicine from the two pots together, making about 1,000 mL in all.

It was six in the evening.

First Evan had the patient drink 300 mL. Two hours later, at around eight, she suddenly developed wrenching abdominal pain. After three days without passing gas, she began passing it repeatedly. This meant that qi was now flowing freely through the Triple Burner.^[8]

Following Dr. Li's instructions, Evan pressed on and had her drink about 500 mL. She wanted to move her bowels but couldn't. Her belly, previously swollen like a huge jar, had gone down considerably, however. The distension eased greatly, and she felt much more comfortable.

At eleven that night, Evan gave her the rest of the medicine.

At two in the morning, she passed stool as black as sludge and terribly foul-smelling, mixed with hard lengths and lumps of feces and material resembling pus and blood. It filled a large bedpan.

At last she felt comfortable. She hadn't eaten for two days, and suddenly she was hungry. She even ate a small bowl of noodles.

She had taken the first dose at six in the evening. By two in the morning, this severe case of appendicitis with an abscess and five days of intestinal obstruction was declared cured. Eight hours in all. Just one batch of medicine.^[9]

The author's official page supplied this unapproved copy, and reading the chapter there supports the person who publishes it.

Yet faced with an outcome that would have astonished any medical worker, neither Evan nor Dr. Li could manage a smile.

It was already two in the morning. They went out into the farmhouse's small courtyard and sat beneath a sky full of stars.

Dr. Li lit another cigarette. He loved smoking; he almost always had one in his mouth. Slowly exhaling smoke, he said, “If there's one thing my experience can teach you, it's how to master potent, toxic medicines.”

Evan turned toward him.

In the darkness, a red point glowed at Dr. Li's lips.

“Every Chinese medicine has properties that tend in a particular direction,” he said. “From that point of view, no medicine is neutral, and none is without toxicity.

“Some lean only a little. Almost anyone can use them, like huangqi and renshen—astragalus root and ginseng. Others lean much more strongly, so their range of use is much narrower. Toxic medicines are the clearest examples.

“Fuzi is only one of them. Do you remember that dying cor pulmonale patient I treated? I boiled the medicine quickly over high heat and gave it as it brewed. That was when the fuzi was at its most toxic. Even a healthy person couldn't have withstood it.

“Yet that patient, with barely a breath left, didn't die. He was saved. A dying heart failure patient is trapped in layer upon layer of yin cold. Fuzi's great heat and great toxicity are precisely the secret of bringing him back from death's door.

“Give it to a healthy person and you'll have a serious problem. That's why a physician must learn to master potent, toxic medicines. Once you really can, you'll find that they work wonders.

“To learn to master poisons, you first have to taste them yourself, and keep increasing the dose. Only after drinking them yourself will you know how to use them. Don't be afraid of poisoning yourself. If you're poisoned, you can deal with the poison afterward. A practitioner of Chinese medicine should follow Shennong's example and taste the hundred herbs.”^[10][11]

Evan nodded earnestly.

Dr. Li lowered his cigarette and turned to him.

“That time you used my formula and failed to save the patient—what happened? I know you were sent down from the provincial capital to work at the local level. Ordinarily, a young doctor like you wouldn't qualify to take part in a resuscitation.”

Evan's expression froze.

Reader Notes

Reader Notes

1. ↩︎ Materia medica and the two classics. Bencao names the tradition of writing about medicinal substances, including animal and mineral materials as well as plants. It is not an abbreviation that always means the Compendium. Li Shizhen's Ming compilation and the much earlier Shennong Bencao Jing, the Divine Farmer's Materia Medica, are separate works. The latter bears the name of a legendary cultural ancestor rather than an identifiable sole author. The rankings and judgments in this passage belong to the novel's commentary. Sources: UNESCO — Compendium nomination dossier, summary; National Museum of Traditional Chinese Medicine — Shennong and the herbal classic (in Chinese).
2. ↩︎ Old beliefs in a collected work. The Lantern Festival falls on the fifteenth day of the first lunar month. The novel lists beliefs to criticize the Compendium's mixed contents. Its rabbit entry transmits a pregnancy taboo about rabbit meat, rather than specifically the head; the English retains the novel's wording. Its renpo entry describes a supposed material residue of a dead person's po, a traditional aspect of the soul. Preserving such accounts in a historical compilation is distinct from demonstrating their effects. Source: Li Shizhen — Bencao Gangmu, rabbit and renpo entries (in Chinese).
3. ↩︎ Darwin and the later debate. In On the Origin of Species, Darwin credits an old Chinese encyclopedia with stating the principle of selective breeding. That reference concerns natural history; it does not endorse all remedies in a medical compilation. Nor does it establish the narrator's larger claim that Darwin's praise chiefly explains the Compendium's popular standing or the views of Republican-era intellectuals. The online comparison is a contemporary narrator's aside, not internet use by the characters in 1981. Source: Charles Darwin — On the Origin of Species, Chapter 1, discussion of methodical selection.
4. ↩︎ Li Shizhen's other works. Binhu Maixue concerns pulse examination; Binhu was a name Li Shizhen used. Qijing Bamai Kao examines the eight extraordinary vessels, channels discussed within traditional Chinese medicine. Mai can refer to a pulse or a vessel according to context. Although the novel groups these books under Li's work on the pulse, the second is not simply another manual of wrist-pulse diagnosis. Calling these his greatest contributions is the narrator's evaluation. Sources: Binhu Maixue, preface (in Chinese); Qijing Bamai Kao, opening discussion (in Chinese).
5. ↩︎ Historical weights and prescribing quantities. Liang and qian are weight units, but their values and their application to prescriptions changed over time. The Compendium does allow one contemporary qian to stand for an ancient liang. A modern scholarly discussion distinguishes that prescribing convention from reconstructions based on ancient objects, and notes disagreement between conversions. The novel's one-fifth and one-tenth figures, its excavation chronology, and its sweeping attribution of later medical failures are retained without being independently established by these sources. Sources: Bencao Gangmu, section on compounding quantities (in Chinese); Shi et al., 2019 — classical-prescription research, §4, printed p. 368 (in Chinese).
6. ↩︎ Cold damage, epidemics, and seasonal illness. Shanghan, “cold damage,” is a traditional category, not simply the modern diagnosis of typhoid fever. Shibing refers to seasonal illnesses; related discussions of warm and epidemic diseases developed their own distinctions. In the preface to his Wenyi Lun, Wu Youxing describes the 1641 epidemic and argues that epidemic illness differs from cold damage. That historical argument helps explain the controversy here, but does not establish reduced doses as its sole cause. The English retains the source's school name and chronology. Source: Wu Youxing — Wenyi Lun, author's preface (in Chinese).
7. ↩︎ Six channels and eight principles. These are frameworks for identifying traditional patterns, rather than six anatomical tubes or eight separate diseases. The six-channel framework organizes presentations as Taiyang, Yangming, Shaoyang, Taiyin, Shaoyin, and Jueyin. The eight principles distinguish exterior/interior, cold/heat, deficiency/excess, and yin/yang. Here they describe Dr. Li's allegiance to Zhongjing's approach. The terminology source defines the frameworks; it does not establish the narrator's comparison between his outcomes and those of modern medicine. Source: WHO — TCM terminologies, entries 931 and 969.
8. ↩︎ Qi and the Triple Burner. Sanjiao, translated here as the Triple Burner, groups the upper, middle, and lower regions of the body in a traditional account of qi transformation and fluid circulation. It does not designate a single anatomical organ. The passage interprets renewed passage of gas as freer movement of qi within that framework. This is the novel's traditional explanation of the observed change, rather than an additional test result. Source: WHO — TCM terminologies, entries 207–210.
9. ↩︎ The reported recovery. An appendiceal abscess is a collection of pus associated with inflammation of the appendix. Intestinal obstruction is the accompanying bowel condition named in the story. The narrator declares the woman cured after eight hours and one batch; the English preserves that declaration. Passing stool and feeling hungry are the events narrated here. The chapter supplies no subsequent examination or longer follow-up, and the background source does not verify this fictional outcome. Source: NIDDK — Appendicitis, definition and complications.
10. ↩︎ Properties, potency, and toxicity. Dr. Li's language about a medicine's “direction,” great heat, and yin cold belongs to traditional theory. Fuzi is an aconite-root medicine; huangqi is astragalus root and renshen is ginseng. Aconitum alkaloids can cause serious, sometimes fatal poisoning. Official toxicology information identifies inadequate preparation and short decoction among the risks. His claim that a dying patient can withstand what a healthy person cannot, and his advice to increase doses by tasting poisons, remain his teachings in the story. These sources do not establish that self-poisoning can simply be reversed. Sources: Hong Kong Department of Health — aconitum-containing medicines (in Chinese); Department of Health — documented aconitum poisoning alert, 16 August 2021.
11. ↩︎ Shennong tasting the hundred herbs. Shennong, the Divine Farmer, is a legendary ancestor associated with agriculture and medicine. Stories describe him tasting plants to discover their qualities and poisons. “The hundred herbs” evokes the multitude of medicinal plants, without setting an exact curriculum of one hundred specimens. Dr. Li invokes that cultural model of learning through personal experience. The legend explains the allusion; it is separate from evidence about the safety of the practice he recommends. Source: National Museum of Traditional Chinese Medicine — Shennong tastes the herbs (in Chinese).