Chapter 112 I'll Take Responsibility

Professor He has signed the prescription. The pharmacy still has to agree to dispense it.

After signing his name, Professor He examined the prescription carefully once more.

Evan was certainly bold with his medicines, but he wasn't reckless. The Fire Spirit school had many admirers among independent practitioners these days. Many of them, however, were reckless: increasing doses indiscriminately, neglecting how the ingredients worked together, and failing to consider the patient's condition carefully.^[1]

Every dose on Evan's prescription followed the actual amounts in Zhongjing's classical formulas: chuanwu, fuzi, mahuang, and especially xixin.

The current pharmacopoeia limited xixin to just 1–3 g, echoing the old rule that it must not exceed one qian. The same rule appeared in Li Shizhen's Bencao Gangmu, the Compendium of Materia Medica. That was why so many people in Chinese medicine cursed Li Shizhen.^[2]

The excavation of an Eastern Han tomb had also established the actual xixin doses in Zhongjing's formulas.

The calculation took one Han liang as equivalent to 16 g today.

Of the sixteen classical decoction formulas containing xixin, eight used three liang and five used two; Zhenwu Tang used one liang. Among the pill formulas, Zhongjing used a full six liang in Wumei Wan. Only in the powder Houshi Heisan did he use just three fen.^[3]

Many later physicians therefore speculated that, because people in the Song dynasty favored powdered medicines, xixin's toxicity in that form might have required very small doses. It had not been broken down by high-temperature decocting.

Others said that Chen Cheng of the Song dynasty had heard of prisoners suddenly dying, possibly after taking a medicine containing powdered xixin. When writing Bencao Bieshuo, he had not verified the story, but had simply concluded that xixin taken alone must not exceed one qian.

Then Li Shizhen, without checking carefully, had simply cited Chen Cheng's view and included the one-qian limit in Bencao Gangmu, disregarding both the Shennong Bencao Jing and the doses in Zhongjing's formulas.

And so xixin had been wrongly condemned for centuries, right up to the present…

There were still many independent practitioners who followed Zhongjing's formulas. After all, the Shennong Bencao Jing—the Divine Farmer's Materia Medica—listed xixin among its upper-grade, nontoxic medicines.

Only the powdered form had to be used sparingly; Zhongjing himself had used just three fen in a powder. In a decoction, the high heat made a larger dose safe.^[4]

The renowned Hebei physician Liu Peiran had even used as much as 120 g of xixin, more than seven Han liang. Compared with the pharmacopoeia's 3 g, the difference was enormous. Yet it was this practice that had made the older physician's name, and he had never had a mishap.

Bencao Zhengyi described xixin this way:

“Xixin is intensely aromatic, and so excels at opening knotted qi and releasing constraint and stagnation. It can rise to the crown of the head, clear the ears and eyes, and reach every part of the body, leaving no corner untouched. Within, it opens the collateral vessels and frees the joints; without, it moves through the orifices and penetrates the skin.”

It was a powerful general in a Chinese medicine physician's hands. For stubborn illnesses caused by deep cold lodged in the three yin divisions, chronic conditions that had resisted treatment, it could draw pathogenic factors outward and bring a cure almost as soon as the cup was set down.^[5]

Yet centuries of unjust condemnation had left no one willing to use it.

This time, though, Evan hadn't used a particularly large dose. He had prescribed 15 g, the same as the mahuang and guizhi.

Taken as a whole, his prescription unquestionably exceeded the pharmacopoeia's doses. He might even have to bear responsibility for a medical accident.

But measured against the actual doses in Zhongjing's formulas, he had made no exceptional departure. He had kept to their original amounts and combinations.

To the Chinese medicine doctors, Evan had done nothing wrong. A forensic medical assessment, however, might leave him facing a serious lawsuit. That was why Professor He had signed his own name, to help shoulder the responsibility.^[6]

Holding the prescription, Professor He addressed the room.

“This prescription… I wrote it…”

Everyone froze.

Evan was deeply moved. He hadn't expected Professor He to take all the responsibility upon himself.

The other Chinese medicine doctors were moved by what they saw between teacher and student, too.

Professor He was an older physician with a reputation and standing. Men in his position usually guarded their good names all the more carefully. Yet he was willing to take all of this on for Evan.

It touched everyone there.

“Professor, you really don't need to do this,” Evan said. “I'm the one who insisted on prescribing it this way.”

Professor He looked at him and smiled gently.

“You're a doctor. So am I.”

“Professor…”

All the things Evan wanted to say caught in his chest.

Professor He shook his head slightly and gave him a reassuring smile.

“It's all right. I know you're right, and Zhongjing is right too. But you must understand: this is my patient. Of course the responsibility is mine.”

The other Chinese medicine doctors felt tears stinging their eyes.

…

Dr. Patrick Shi, the ICU director, frowned deeply.

“But the pharmacy won't dispense a prescription like this.”

Leo Cao had his head lowered. He let out a long breath, then looked up and stepped forward, his gaze growing steadily firmer. He snatched the prescription from the desk and signed his name.

Professor He and Evan were both taken aback.

Leo looked at them and gave an easy smile.

“I've spent all these years chasing money and status. I almost forgot I'm a doctor too. Professor He, you're not quite right. This isn't just your patient. He's our Chinese Medicine Department's patient as well.

“I'll get Director Du to sign. I'm determined to prescribe this medicine today. I refuse to believe Zhongjing's classical formulas are wrong. We're going to save this patient. Count me in for a share of the responsibility!”

Everyone was startled.

Even Marcus Cao was stunned. He had never expected such spirit from his older brother, who spent all his time cultivating connections.

The patient's wife's eyes reddened again.

Dr. Qi and Patrick, the ICU director, also stared at Leo in astonishment.

Henry Zhong stepped forward to Leo's side, took the prescription from his hand, and added his own name.

“Leo, who made you the hero? You talk as if the rest of us aren't doctors.”

“Henry, you…” Leo was taken aback too.

Henry sighed softly and looked down at the prescription, a little ashamed.

“I've known the actual doses in Zhongjing's formulas all along. But I never dared use them, even for serious, critical illnesses.

This chapter was published by its author on the NovelPhoenix site, then copied here without consent.

“It wasn't that I thought Zhongjing's formulas were wrong. I was afraid of being held responsible. I'm ashamed when I think about it now. ‘The Great Physician's Skill and Sincerity’ is carved into our hospital walls. Yet instead of giving myself wholly to saving a patient, I've worried about what might happen to me.^[7]

“Ordinary doctors like us have little influence. We can't change what happens at the top. But when a patient is in front of us, we should do everything we can to save him, whatever the cost. Isn't that our responsibility as doctors? So count me in, too. Our Chinese Medicine Department is going to save this patient today!”

Evan stared at the two men.

Professor He looked dazed as well.

So did Dr. Qi and Patrick.

Alex Xu stood up too.

“My mentor gave up everything and went to Beijing to start again because he's a real doctor. As his apprentice, I can't fall behind. So… if you'll have me, I'd like to sign my name too.”

Now Leo and Henry were taken aback.

“Count me in.” Another young Chinese medicine doctor stood up.

“Me too. I don't believe Zhongjing was wrong, and I certainly don't believe a thousand years of clinical experience can be wrong!” Another young practitioner rose.

“Count me in.”

“And me.”

…

Everyone was stunned. No one had imagined a scene like this taking place in the Chinese medicine hospital.

This was plainly against the rules, yet every Chinese medicine doctor there was willing to take responsibility for it.

The patient's wife covered her face and wept. This time she wasn't crying hopelessly, like a lifeless puppet. She was moved to tears.

Evan's and Professor He's eyes reddened too.

Evan remembered what Dr. Li had said to him before his death: If great physicians will not come forward, what are the people to do?

For a moment, Evan felt he was truly seeing great physicians. Seeing hope for Chinese medicine.

The doctors at the county hospital seemed almost possessed, showing an extraordinary stubbornness over this dangerous prescription.

In the end, Director Du, who oversaw Chinese medicine, signed it.

The patient also signed a liability waiver.^[8]

A group of Chinese medicine doctors rushed downstairs to get the pharmacy to dispense the medicines.

At last, the medicines were dispensed. They followed Evan's method, decocting the herbs in 2,500 mL of cold water until 500 mL remained, then mixing in 500 mL of huangjiu, Chinese yellow wine.

They gave the medicine to the patient in divided portions, three during the day and one at night. Evan was following Zhongjing's preparation and administration method too. Each batch of herbs was decocted only once, then taken in several portions to keep its medicinal effect unchanged.^[9]

Once the patient had finished the batch, everyone watched his condition closely.

It was already evening, but none of the Chinese medicine doctors would go home. They stayed at the hospital, outside the ICU, doing a doctor's duty.

Until the patient was out of danger, they would not leave.

That night, staff from the ICU came to report that, after taking one batch of the medicine, his symptoms had eased and he had fallen peacefully asleep.

In seven months of hospitalization, he had never been as comfortable as he was today.

Evan's medicine had worked!

The Chinese medicine doctors' cheers rang through the hospital.

Leo and Henry laughed heartily too.

Marcus looked at his older brother with sincere respect for the first time.

The patient's wife sobbed uncontrollably. At last she was crying aloud, with hope and gratitude in her tears.

That night, “The Great Physician's Skill and Sincerity,” carved into the hospital wall, seemed to shine with a new light.

Reader Notes

Reader Notes

1. ↩︎ The Fire Spirit school. This is a school of Chinese medicine associated with an emphasis on yang qi and warming medicines, notably fuzi, an aconite material. “Fire Spirit” names a medical approach, rather than a religious order. The paragraph distinguishes Evan's prescribing from the indiscriminate dose increases it criticizes. The label does not establish that he belongs to a particular lineage, or that every practitioner associated with the school follows the same approach. Source: Nanjing University of Chinese Medicine — Lecture on the Fire Spirit school's origins (in Chinese).
2. ↩︎ Xixin and the quoted dose limit. Xixin refers to an Asarum medicinal material. A 2004 Hong Kong Department of Health notice cites the 2000 Chinese Pharmacopoeia's 1–3 g range while also distinguishing plant parts and preparations. That supports the existence of the quoted range; the novel does not identify its pharmacopoeia edition or year. The old one-qian maxim is a separate historical expression, not a precise conversion of every qian into 3 g. The source also records safety concerns, rather than treating decocting as a blanket guarantee of safety. Source: Hong Kong Government — Measures concerning Aristolochia and Asarum medicinal materials, June 8, 2004 (in Chinese).
3. ↩︎ Old weights and formula forms. Liang and fen are historical weight or proportional terms; tang, wan, and san commonly distinguish decoctions, pills, and powders. The passage uses 16 g per Han liang, although historical reconstructions differ. Its eight, five, and one formula groups account for fourteen of the stated sixteen. The standard base Zhenwu Tang listed by HKBU does not contain xixin, differing from the formula named here. The classical Houshi Heisan text does list three fen of xixin in its mixed powder, rather than specifying three fen as a separate modern dose. Sources: Cui et al. — Original classical formula doses, §4.1 (in Chinese); HKBU — Zhenwu Tang; Jinkui Yaolue — Houshi Heisan, chapter 5 (Chinese transcription).
4. ↩︎ Historical classifications and the powder warning. The Shennong Bencao Jing places xixin among its upper-grade medicines, a category described there as nontoxic. This is an old materia medica classification, not a modern toxicological finding. Bencao Zhengyi later discusses a warning attributed to Chen Cheng about xixin taken alone as powder, and itself cautions against excessive use. Those texts help explain why preparation matters in the debate. They do not establish the novel's account of the prisoners, its judgment about Li Shizhen's research, or its assurance that higher decocted doses are harmless. Sources: Shennong Bencao Jing — Upper Canon (Chinese transcription); Bencao Zhengyi — Xixin, especially the correction and cautions sections (Chinese transcription).
5. ↩︎ The materia medica quotation. Bencao Zhengyi is rendered here as “Correct Meanings of the Materia Medica.” The quoted account of xixin's penetrating aroma and movement through the body uses traditional therapeutic language. The three yin divisions are Taiyin, Shaoyin, and Jueyin, already part of Evan's explanation; they are not three kinds of yin deficiency. The cup being set down is an expression for a rapid result. Liu Peiran's reported 120 g use and the rapid-cure claim remain the novel's accounts; the cited classical description does not establish their clinical safety or effectiveness. Sources: Bencao Zhengyi — Xixin, “Correct Meaning” section (Chinese transcription); WHO — TCM Terminologies, entry 26.
6. ↩︎ Signing and professional responsibility. A doctor's signature identifies responsibility for a prescription; it does not by itself settle whether a treatment is appropriate or how a later dispute would be decided. China's 2007 Prescription Administrative Measures state that exceptional doses require a reason and a further signature. That provision supplies context for the doctors' concern, rather than authorizing this particular prescription. The assertions about the pharmacopoeia and a possible lawsuit remain the scene's own judgments; the story has not specified an applicable edition, case, or formal assessment. Source: National Health Commission — Prescription Administrative Measures, article 6(9), PDF p. 4 (in Chinese).
7. ↩︎ “The Great Physician's Skill and Sincerity.” Dayi Jingcheng is an essay in Sun Simiao's Beiji Qianjin Yaofang. It combines exacting medical skill with compassion and a commitment to helping the sick. Henry's words about giving himself to saving a patient and worrying about his own prospects echo its wording. The essay also insists on careful judgment and warns against displaying cleverness at the expense of a life. Its presence on the hospital wall gives Henry's confession a concrete point of reference; it does not certify the prescription he has signed. Source: Beiji Qianjin Yaofang — Volume 1, second essay (Chinese transcription).
8. ↩︎ The liability waiver. The patient signs here, whereas the earlier offer to sign came from his wife; the distinction is retained. A liability waiver is not the same thing as informed consent or guaranteed legal immunity. For comparison, China's Civil Code treats clauses excluding liability for personal injury as invalid and addresses medical fault and consent separately. This provides a modern distinction between the concepts, not a ruling on the fictional document. The novel does not specify the document's wording or the year in which this consultation takes place. Source: Supreme People's Court — Civil Code, articles 506 and 1218–1219 (in Chinese).
9. ↩︎ A batch, its portions, and huangjiu. Huangjiu, literally “yellow wine,” is a fermented grain wine, commonly made from rice or millet; no brand, grain, or alcohol percentage is specified here. One batch of herbs is distinct from the separate portions of liquid taken from it. The passage describes one decoction divided across three daytime administrations and one at night, without giving equal portion sizes or a timetable. The water quantities, wine addition, and claimed preservation of effect are the novel's procedure and explanation; the source below identifies the wine category only. Source: Ministry of Environmental Protection — Beverage alcohol manufacturing policy, §1(2), huangjiu definition (in Chinese).