Chapter 99 Too Bold a Prescription

Evan expects a familiar response to his advice. The room has gone very quiet.

Evan thought he had been polite.

Everyone else was stunned.

You could have heard a pin drop in the office.

Now Evan looked puzzled too. Where were the familiar sounds of admiration, sudden understanding, and gratitude that usually followed his advice?

He raised his head and found himself looking at one blank, embarrassed face after another.

He froze. Only then did it dawn on him: he was back in the real world. He was no longer a clinical authority with decades of practice behind him. He was just a young doctor from a small private clinic.

Evan tapped his forehead in dismay. How had he let that slip? He had gone and told the truth. He might have been offering Dr. Zhong guidance, but he no longer had the standing he used to have.

Had he offended him?

Now he was embarrassed too.

Leo gave a couple of strained laughs and forced himself to smooth things over. For years, he had been far more diligent about studying people than studying medicine. If anyone could steady a situation like this, it was him.

“Ha… ha…” After a few more awkward laughs, Leo clapped his hands. “Dr. Xu, hindsight is a wonderful thing. Of course this prescription hasn't worked. If it had, wouldn't the patient be better by now?^[1]

“By that logic, Dr. Qi's conservative treatment hasn't worked either. It's been 20 days, hasn't it? Right? Ha… ha…” He laughed again.

Leo wasn't singling anyone out. He was only pointing to the problem they could all see.

“That's why a difficult patient like this needs Chinese and Western medicine working together. That's encouraged these days too. Each side plays to its strengths and makes up for the other's weaknesses. Right?” He laughed again.

“Exactly,” Dr. Qi said. “That's why I asked you all to help. Let me buy everyone dinner after work, to thank you.”

“Now there's an idea,” Leo said at once. “We haven't had many chances to get a meal out of you. This time we'll make it an expensive one. No excuses, anyone. You're all coming.”

Dr. Qi smiled. “All right. I'll risk my life to keep you company.”

The atmosphere eased a little.

Dr. Zhong, though, still looked distinctly embarrassed and displeased.

Evan didn't know what else to say. He could only put the prescription down.

Dr. Zhong let out a breath and shook his head without speaking.

“Well… Dr. Xu,” Leo said, “what prescription would you use?”

“His Stomach fluids are depleted, and qi in the middle burner is in disorder. It rises but doesn't descend. Naturally, we need to replenish qi and direct its counterflow downward, restore fluids, and get qi moving.”^[2]

Evan had already explained the underlying pattern while critiquing Dr. Zhong's prescription. Once the pattern was correctly identified, the treatment approach was clear. But choosing a formula and prescribing its medicines mattered just as much.

Evan took a pen and paper and wrote a prescription.

When he finished, he handed it to Leo.

Leo took one look and began with a compliment. “Beautiful handwriting, Dr. Xu!”

Then he examined the combination of medicines and their doses. He went still.

The others looked on in puzzlement.

Alex moved behind Leo to look over his shoulder. He froze too.

Dr. Zhong was curious now. Why were those two looking like that?

Without changing his expression, Leo folded the paper and held it in his palm. “A very fine prescription, Dr. Xu.”

“The patient's qi movement is completely disordered. It rises but doesn't descend. Nothing can enter above or pass out below, resulting in guange. A serious case of guange like this calls for a formula that can break through a stubborn blockage, with qi-regulating medicines leading the way.^[3]

“In my experience, all his symptoms should subside after one batch. Another batch tomorrow should take care of it. After a short observation period, he can be discharged.”

Everyone stared.

A partial bowel obstruction from adhesions, serious enough that 20 days in the hospital hadn't resolved it—and two batches of herbs would put him right? He could go home?

Go home? Look at the man. He couldn't even sit up without panting. That was some boast!

Dr. Qi looked deeply skeptical.

Hannah looked astonished too.

Even the Chinese medicine doctors in the room didn't believe it.

Evan had sometimes cured patients with a single batch. But those had been excess patterns. The patients themselves weren't deficient; once the pathogenic influence was driven out, they could naturally go home.

This patient had a deficiency pattern. He was terribly depleted: 25 days without food, vomiting every day, too weak for the slightest movement.^[4]

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Evan was promising far too much.

Leo smiled and nodded, his expression unchanged. “Yes, yes. Thank you for your trouble, Dr. Xu.”

Evan could tell that something was wrong with the atmosphere. He stood. “All right, I'll be going. Contact me anytime if there's a problem.”

The others hurried to their feet.

“Thank you, Dr. Xu,” Dr. Qi said. “Hannah, would you see him out?”

“Of course,” Hannah said.

Evan said goodbye and left the office.

The people still in the room looked troubled.

Dr. Zhong looked particularly displeased.

“What's wrong, Leo?” Dr. Qi asked. “Is there a problem with Dr. Xu's prescription?”

Leo unfolded the paper in his hand. “Not a problem, exactly. The combination is quite reasonable. It's just that the doses are rather large, and the patient is too weak.

“He's been in the hospital for 20 days and hasn't eaten for 25. Look how thin he's become. The slightest movement leaves him breathless. He's breathless even sitting down. His middle qi is badly deficient. Someone that depleted shouldn't be subjected to heavy tonification or heavy draining.

“But he's prescribed large doses throughout, especially of the medicines that break up qi stagnation.

“Personally, I think it's a little risky. What do you think, Dr. Zhong?”

Dr. Zhong held out his hand. “Let me see.”

Leo passed him the prescription.

Dr. Zhong read it. “The combination is certainly appropriate. Restore fluids to float the boat, replenish qi, and direct counterflow downward. But those doses really are bold. If he'd just been admitted, I'd dare to use it. After all this time, though…”^[5]

He pressed his lips together, still sounding aggrieved. “I'm not an idiot. The patient clearly has severe guange: nothing can enter above or pass out below. Do you think I don't know to guide qi downward and break up the stagnation?

“The point is that he's too weak now. Deficiency was his main problem to begin with. Forcing the blockage open could cause complications, especially at doses like these. That's why I used small doses to tonify the middle and replenish qi—build him up first and regulate his qi movement.

“Chinese medicine isn't just about attacking whatever illness you see. Treating without directly attacking the illness—that's the higher art. Once he's stronger and his qi movement has recovered a little, we can support him and break up the stagnation at the same time. There's nothing wrong with my approach, is there?”

That was why Dr. Zhong hadn't asked Evan to critique his prescription. If he hadn't done anything wrong, what was there to criticize?

Alex glanced at the senior doctors. He kept his head down, not daring to speak, and studied Evan's prescription from behind them.

Leo gave a helpless smile. “Dr. Zhong, he didn't mean anything by it. Don't hold it against him.”

Dr. Zhong waved a hand. “Forget it. He's young, and a young man with that much ability is bound to be headstrong. He's helped me a few times too. I'm not that petty. But he really is too bold. Not cautious enough. Still young—getting a little carried away.”

Dr. Qi couldn't hold back any longer. “Wait. If there's a problem with the prescription, why didn't you ask him about it while he was still here?”

Both men looked embarrassed.

If Evan hadn't started by instructing Dr. Zhong on his prescription, they certainly would have asked. But the atmosphere had already been so awkward. If they'd immediately started questioning Evan's prescription in return, what would that have looked like? You criticize mine, I criticize yours.

An argument for the sake of arguing?

Dr. Qi gave them an irritated glance. “So what do we do? Are we using it or not?”

Neither man could quite decide.

“How about this?” Leo said. “Isn't tomorrow the day Professor He comes to see patients here?

“Why don't we ask him to examine the patient? Another day won't make much difference, will it? I'd feel more confident that way.”

Dr. Qi considered it and nodded. “All right.”

That settled it.

Hannah walked Evan to the main gate. She watched him climb onto the pink electric scooter, put on his pink helmet, and ride off in style.

“Why do all the good-looking men have to be like this?”

The young resident had already imagined several elaborate dramas. Her girlish heart was broken.

Reader Notes

Reader Notes

1. ↩︎ The wisdom of hindsight. The Chinese expression calls someone “a Zhuge Liang after the event”: clever once the outcome is already known. Zhuge Liang is a historical figure associated with resourcefulness. Leo uses the saying lightly to turn Evan's criticism into something everyone can agree on—the treatment has not worked yet. The English keeps that conversational function rather than inserting an unexplained historical name into his joke. Sources: Ministry of Education — The idiom “a Zhuge Liang after the event” (in Chinese); Ministry of Education — Zhuge Liang (in Chinese).
2. ↩︎ Restoring fluids and directing qi downward. The middle burner is a traditional functional region associated here with digestion. Stomach qi normally descends; counterflow describes movement in the wrong direction. Evan links restoring Stomach fluids with regulating qi. The capitalized Stomach marks traditional functional usage. His description does not report a gastric-acid measurement or identify qi with gas inside the bowel. Source: WHO — International standard terminologies on traditional Chinese medicine, entries 193, 195, 209, 231 and 2366.
3. ↩︎ Guange. This traditional term commonly describes a grave combination of persistent vomiting and urinary retention. The novel uses it here for blockage “above and below,” in a patient with vomiting and a partial bowel obstruction. No urinary retention is stated in this case. The translation retains the term without adding that symptom or substituting a kidney diagnosis. Evan's prediction of recovery after two batches remains his own assessment. Source: WHO — International standard terminologies on traditional Chinese medicine, entry 1701.
4. ↩︎ Deficiency, excess, and treatment strength. These are traditional pattern distinctions. Tonifying supports deficient functions or resources; draining counters an excess or obstruction. Here the doctors agree that weakness matters but disagree about treatment strength and timing. Dr. Zhong's later “treating without directly attacking” means first supporting the patient, not withholding all treatment. The dialogue supplies no ingredients or quantities for Evan's prescription. Source: WHO — International standard terminologies on traditional Chinese medicine, entries 994–995 and 2428–2429.
5. ↩︎ Restoring fluids to float the boat. This is a traditional treatment metaphor: when a channel lacks water, the boat cannot move. Increasing fluids and moistening the intestines is compared to raising the water so passage becomes possible. Dr. Zhong uses the image to acknowledge the logic of Evan's combination while questioning its strength. The metaphor names an approach, not the specific formula prescribed here; the chapter does not identify that formula's ingredients. Source: Anhui University of Chinese Medicine — Formula studies syllabus, purgative formulas section (in Chinese).