Chapter 104 A Little

A grandmother brings her grandson to the specialist’s crowded consulting room.

Professor He looked uncomfortable. Half a year wasted, and now Evan wanted to hand in homework? What was he boasting about?

But with so many people sitting there, he said nothing. He wanted to spare Evan's pride.

Soon, a woman came in with a child.

She was taken aback by the gathering. She had never seen so many doctors together before.

“What's wrong? Where do you feel unwell?” Professor He asked.

The woman looked around at the doctors. “It's not me. It's my little grandson. He keeps coughing.”

Everyone's heart sank a little. Pediatrics had always been one of the most difficult specialties in Chinese medicine. In the old days, it was called the “mute specialty,” because children had trouble describing their symptoms and how they felt.

In other words, that already made inquiry—one of the four diagnostic methods—half as useful.^[1]

And the child had a cough. As the saying went, a cough was a doctor's adversary. In Chinese medicine, any of the five zang and six fu organ systems could give rise to coughing. Finding the underlying mechanism was difficult enough; with such a young patient, it was harder still.^[2]

Professor He had clearly thought of this too. He hesitated. He didn't believe Evan's clinical skills were up to a case like this. He didn't want the young man to embarrass himself in public, but he also wanted Evan to realize his limitations and return to the provincial capital with him.

For a moment, he couldn't decide.

Evan simply said, “Come and sit down.”

The woman sat down with her grandson.

She was confused. “Who's going to see him? I thought a specialist from the provincial capital was coming?”

“This is Professor He, the specialist,” Evan explained. “I'm his student. The other doctors are here to learn from him too.

“I'll examine your grandson first, and then Professor He will examine him again. He's using the opportunity to teach us younger doctors.”

“Oh, all right. All right.” Now she understood.

Professor He glanced at Evan. Why was the boy so determined to save face? Would nothing make him give up? He was even volunteering to tackle this difficult case.

The professor shook his head slightly.

Evan had already begun. “What's wrong? Where does he feel unwell?”

“He's coughing,” the woman repeated.

“Is there any phlegm?”

“Yes. Sometimes he spits out white saliva.”

Evan looked at the child. The boy leaned against his grandmother without speaking, his face flushed and his expression weary. Yet he hadn't coughed once since coming in.

“Does he cough badly? He hasn't coughed at all since he got here.”

“Not now. It starts when he goes to sleep. It's terrible. The poor thing can't even sleep properly.”

“How long has he had it?”

“Three days. The medicine he took didn't help. Then we heard a Chinese medicine specialist from the provincial capital would be here today, so we bought a… registered for a specialist consultation.”

The doctors exchanged wry smiles. At their little hospital, specialist registration and the resale of consultation slots only became an issue when someone like Professor He came from the provincial capital.

Evan nodded and turned to the boy. “Give me your hand. Let Grandpa—Uncle feel your pulse. Sit still for me, all right?”

“Okay, Doctor Uncle,” the boy said obediently.^[3]

Listening to him, Evan noticed that his voice was a little hoarse.

The child held out his hand and rested it on the pulse cushion.

Professor He looked at Evan doubtfully. “You know how to examine the pulse now?”

Evan smiled. “A little.”

“Oh.” Professor He nodded. More than half a year, and still only a little. No progress after all.

Behind them, the young doctors looked at one another, suddenly wary. That “little”…

Evan touched the child's palm and found it hot. “Do your palms and the soles of your feet feel hot?”

The boy thought for a moment. “I think so…”

Evan nodded slightly and stopped asking questions. He placed three fingers over the cun, guan, and chi positions at the boy's wrist. The child looked six or seven, old enough for the three-finger method of wrist pulse examination.^[4]

Evan examined the pulse carefully.

Professor He watched his technique. It looked convincing enough. He asked the grandmother, “What medicine has he taken?”

“We got medicine at a hospital. Here's the prescription they gave us. It didn't work. He's still coughing.”

Professor He took the prescription, glanced over it, and passed it to the doctors behind him.

The child had taken cough syrup and other medicines without much improvement. Then he had seen a conventional doctor at a hospital, who prescribed expectorants and cough suppressants. Those hadn't helped much either.

By the time the sheet had made the rounds, the young doctors were all looking thoughtful.

Dr. Zhong and Leo were thinking too. From a Chinese medicine perspective, the cause of a cough was not easily found.

Evan was still examining the pulse.

The chapter is available on the author's official publication, but this copy was made without permission; reading their posting helps fund the writing.

Professor He was a little surprised at how long he was taking.

He picked up the boy's other hand and began his own examination.

After a while, each doctor switched to the opposite wrist.

The child was well behaved and sat still throughout.

After another while, they finished.

“What pulse qualities?” Professor He asked.

“Slippery and rapid.”^[5]

Professor He was mildly surprised. Evan had actually identified it correctly. “Not bad!”

“Slippery and rapid?” The other doctors began thinking again.

“Stick out your tongue for me,” Evan told the boy.

The child did.

Both doctors looked.

A red tongue with a yellow coating.

Professor He considered this, then asked the doctors behind him, “How would you differentiate the pattern in this case? What would you prescribe?”

This time, they were eager to try. All the diagnostic findings had been given to them, after all.

Professor He called on one of them. “You… Alex, was it? Tell us.”

Alex was delighted. He hadn't expected the professor to remember his name.

“Well, a slippery, rapid pulse can indicate phlegm-heat,” he began at once. “A red tongue with a yellow coating also points to an interior heat pattern.

“The fact that he feels hot and has a flushed face supports that too. So the cough should be due to phlegm-heat obstructing the Lung. We should restore the Lung's dispersing function, clear heat, transform phlegm, and relieve the cough.”^[6]

The others nodded slightly.

Only Dr. Zhong looked puzzled as he studied the prescription in his hand.

Professor He frowned too. “Where's that prescription?”

“Here.” Dr. Zhong handed it over.

The professor took it and studied it.

Evan went on questioning the boy. “Does your tummy feel bloated?”

The child nodded. “Yes.”

“What about when you poop? Can't get it out? Or is it very runny, like water?”

Everyone froze.

Professor He also looked at Evan in surprise.

“Very runny, like water,” the boy said.

Evan nodded, then asked the grandmother, “Did he eat a lot more than usual in the days before the cough started?”

She paused, then thought back. “Oh, yes! Yes, he did. I even told him he'd upset his stomach. But what's that got to do with his cough?”

She wasn't the only one. The young doctors behind them were just as bewildered.

Evan nodded. “There's retained food. The watery stools are overflow diarrhea from heat-bound stool—a yangming bowel excess pattern.”^[7]

They were still confused. A slippery, rapid pulse could indicate phlegm and retained food, but it could also indicate phlegm-fire. It could even occur during pregnancy.

Evan's questions had all concerned phlegm and food retention. The answers had indeed confirmed retained food and a yangming bowel excess pattern. But they still didn't understand what that had to do with coughing.

Dr. Zhong thought it over. Understanding dawned on his face, though some uncertainty remained.

Professor He looked over the prescription once more and nodded slightly. Yes, retained food had caused yangming bowel excess, which in turn had caused the cough. He looked at Evan with renewed appreciation.

He knew Evan had grasped the reasoning. The others hadn't understood, but Evan had. The professor was pleased. Evan was still outstanding among the younger doctors. His foundations had always been so solid.

No wonder he was the student Professor He was proudest of!

The professor smiled in satisfaction.

Wait. No!

Professor He was suddenly startled. Evan had finished examining the pulse and gone straight to questions about yangming bowel excess. He hadn't even looked at the prescription. He didn't know what medicines the child had already taken!

He had identified the underlying mechanism from the pulse alone! But how had he known the cough came from retained food, rather than phlegm-heat obstructing the Lung?

Professor He stared at Evan in astonishment.

Reader Notes

Reader Notes

1. ↩︎ The “mute specialty” and the four examinations. The traditional nickname refers to the difficulty children may have in explaining their symptoms, not to an inability to speak. Inquiry is one of Chinese medicine's four diagnostic methods, alongside inspection, listening and smelling, and palpation. A caregiver can supply part of the history, as the grandmother does here. The narration's remark about losing much of inquiry expresses the difficulty of the case; it is not a literal rule that this examination cannot be used with children. Sources: Hong Kong Department of Health — Diagnostic methods; China National Healthcare Security Administration — Pediatric services, “mute specialty” paragraph (in Chinese).
2. ↩︎ Cough and the organ systems. The Suwen's chapter on coughing describes cough as potentially involving all five zang and six fu systems, rather than the Lung alone. These are categories in traditional medical theory, combining bodily functions and relationships; they are not simply a list of anatomical organs. The passage recalls that framework without yet identifying this child's pattern. Source: Suwen — Treatise on Cough, chapter 38, Chinese transcription.
3. ↩︎ “Grandpa—Uncle.” Chinese kinship terms can also serve as familiar forms of address outside a family. Shu, “uncle,” can address a man of the father's generation; “Doctor Uncle” does not make Evan the boy's relative. Evan nearly gives himself a much older title before correcting it. The slip continues the story's contrast between his youthful appearance and his long experience; it does not mean his body has aged. Source: Taiwan Ministry of Education — shu, noun 1(3) (in Chinese).
4. ↩︎ Three wrist positions. Cun, guan, and chi are adjacent examination sites over the radial pulse near the wrist, not three separate arteries. The index, middle, and ring fingers are used to examine them. Finger spacing is adjusted to the patient's proportions; a single finger can also assess the three positions in children. The novel specifically presents this six- or seven-year-old as large enough for three fingers. The cited standard describes technique, not a universal age cutoff of six. Source: GB/T 40665.4—2021 — Pulse palpation, sections 3.2–3.3 and 4.3.2 (in Chinese; PDF).
5. ↩︎ Slippery and rapid. “Slippery” describes a smooth, rolling sensation under the fingers, while “rapid” describes speed. They are two qualities felt together, rather than two separate pulses. Such terms describe the practitioner's tactile findings within traditional pulse examination, which assesses more than the heart rate. They do not, by themselves, name a unique diagnosis. The doctors' interpretation of the finding is still to come at this point. Source: WHO — International standard terminologies on traditional Chinese medicine, entries 892, 900, and 929.
6. ↩︎ Phlegm-heat obstructing the Lung. This traditional pattern associates cough with phlegm and heat affecting the Lung's functions. “Interior” identifies a traditional pattern category, rather than an imaging finding. Alex's proposed treatment lists aims—restore the Lung's dispersing function, clear heat, transform phlegm, and relieve cough—without naming a formula. Capitalized Lung follows this edition's convention for a Chinese medicine functional system. His interpretation remains a character's judgment at this point in the consultation. Sources: WHO — International standard terminologies on traditional Chinese medicine, entry 1173; Hong Kong Department of Health — Pattern differentiation and treatment.
7. ↩︎ Retained food, bowel excess, and overflow diarrhea. In this traditional framework, yangming bowel excess involves an internal accumulation associated with heat and intestinal contents. “Heat-bound” describes that pattern, not an actual temperature measurement. Rejie pangliu describes watery discharge passing around retained stool, which explains why loose stools do not automatically rule out an excess pattern in Evan's reasoning. These terms describe the traditional interpretation used in the scene; they do not independently establish the child's diagnosis. How Evan distinguishes the cause of the cough remains the chapter's unanswered question. Sources: WHO — International standard terminologies on traditional Chinese medicine, entry 1404; Hong Kong Baptist University — Da Cheng Qi Tang, pattern explanation and explanatory question 1 (in Chinese).