Chapter 121 One More Book

Alex’s lesson continues as Evan explains what must accompany the prescription.

Alex was miserable. The last time he'd been made to copy out a book as punishment had been in middle school. If he remembered right, it had been for dating, and he'd had to copy the entire school rulebook.

He'd been out of college for years, and here he was, copying books for punishment again. What a life.

Clara was enjoying his misfortune. “Better get started. And don't forget to hand in your homework. Give it to me when you're done. I'll check for mistakes. If I find any, you can copy it again.”

“I…” Alex's lips trembled. It wasn't fair.

Evan smiled and shook his head too. “Clara, take your father back to his bedroom. Decoct each batch of herbs just once, so the strength stays the same. Then give him three doses during the day and one at night, to maintain the level of medicine in his blood and drive the pathogenic influence out in one sustained effort.

“Remember what I told you? Cover him with a thick quilt first. After his first dose, once he starts sweating, replace it with a thin one. He doesn't need to sweat heavily. Is the congee cooking?”

“It's in the rice cooker. I've got a piece of lamb simmering in plain broth too.”

Evan nodded. “He needs to eat between doses. We mustn't let him grow weak and become even more depleted. Sun Simiao stressed this: while taking the decoction, eat congee once the medicine has been digested, then take the medicine once the congee has been digested. Give a little lamb as nourishment too.”^[1]

Clara nodded earnestly.

Alex dutifully wrote down these instructions as well.

Adam raised his eyes and looked at Evan again.

“Why congee?” Evan asked Alex.

Alex paused. Another test. He thought for a moment. “Because congee warms the middle and dispels cold. It replenishes the middle too. Right now we need to drive the pathogenic influence out in one sustained effort. We can't let hunger or sweating weaken him.”

Evan nodded. “Nothing wrong with that reasoning. But why give congee after he sweats?”

“To replenish him promptly.”

“There are plenty of nourishing foods, and plenty of warm foods. Why congee in particular?”

“Um…” Alex didn't know what to say.

“The Suwen, in its ‘Yujizhenzang Lun’ chapter, says, ‘When grain liquid and congee enter the Stomach and the diarrhea stops, those with deficiency survive; when the body sweats and the bowels open, those with excess survive.’

“Jiang means grain liquid. Congee is beneficial. It's all about protecting Stomach qi. Whether we're dealing with deficiency after diarrhea or releasing an exterior excess through sweating, we need to replenish the middle, support qi, and protect Stomach qi. Once Stomach qi becomes deficient, all kinds of illness follow.”^[2]

Evan shook his head. “You young doctors of Chinese medicine really haven't studied the classics properly.”

Alex was taken aback. You young doctors? Wasn't Dr. Xu about his own age?

“You should understand why the classics became classics,” Evan said. “They express profound ideas in very few words. Every word is a gem. There isn't a wasted sentence or a single unnecessary word.

“The four great classics in particular should be read over and over. Ten thousand readings wouldn't be too many. Every time you read them, you'll understand something new. The principles of treating illness are all in there.”^[3]

Alex nodded earnestly.

Adam and Clara both paused. Clara's mother had often said the same thing when she was alive.

“Take the way Xuming Tang is administered,” Evan continued. “Sun Simiao stated clearly that it must be taken in a closed room: ‘If the person has no closed room, wind cannot be treated. Even a strong person in a room that is not properly enclosed can be struck by wind. How much more so someone taking medicine?’^[4]

“Yet hardly anyone has used this closed-room method all these years. That's one reason Xiao Xuming Tang sometimes gives poor results. The old theories of internal wind and ‘non-wind’ already had a powerful influence. Then Western medicine added to it.

“Your generation has gone off course. You all see stroke in cardiovascular and cerebrovascular terms, caused entirely by internal factors. Even the lasting effects are treated in terms of qi deficiency and blood stasis. By now, you think stroke has little to do with pathogenic wind, don't you?”^[5]

“Well…” Alex was embarrassed. Hardly any doctors of Chinese medicine these days believed stroke was caused by external wind. They thought the old physicians had imagined it. Shutting the doors and windows and taking medicine in a closed room made even less sense to them.

Evan sighed softly. “Pathogenic wind in Chinese medicine doesn't simply mean a strong wind blowing outside. It's a category of disease-causing influence. Wind comes first among the six external pathogenic influences.^[6]

“The Jinkui Yaolue also says, ‘Human beings receive the five constant influences and grow through wind qi. Wind can bring all things into being, and it can harm all things, just as water can float a boat or overturn it.’

“Sun Simiao's Qianjin Yaofang says, ‘The texts speak of earth, water, fire, and wind combining to form a human being. When a person's wind qi is disordered, the whole body becomes rigid and all the pores close.’^[7]

“The ancient sages made it perfectly clear in the classics. How can you understand the principles of treating illness without studying the depth of those few words? The right course is to return to the classics, to Chinese medicine itself.

Heads up: this text was scraped from its original home, and the author never agreed to it appearing here.

“I'm not saying Western medicine is bad. But its theories and those of Chinese medicine are entirely different. The more deeply it influences you, the harder it becomes for you to grasp the pathomechanism. That's also why the previous doctors couldn't cure him.

“Because the theories differ, Western medicine can cure some illnesses we can't. And Chinese medicine can cure some it can't. Those are complementary strengths. Of course, there are plenty of illnesses neither can cure.

“But if Western medicine influences you too much, you'll fail wherever it fails. And wherever you succeed, its results will be better than yours. Then Chinese medicine will disappear.

“The frightening thing isn't Chinese medicine disappearing in itself. It's losing a large piece of the shield that protects our people's health. There are illnesses for which we originally had the advantage. That's why you must return to Chinese medicine itself!”

“I'll remember that, Dr. Xu,” Alex said earnestly.

Evan frowned. How had he managed to talk himself into getting angry?

“Go home and copy out the Suwen too.”

Alex stumbled. His vision darkened for a moment.

Adam had been watching the two of them out of the corner of his eye.

Clara let out a soft sigh and crouched in front of him. “Dad.”

He slowly turned his head toward her.

“Dad, we're going to start the treatment soon. It may take a few days. Will you cooperate?”

He tilted his head. “I… I…”

Clara took his hand.

He looked at her again.

Her voice grew subdued. “Dad, I know you've been despondent these past few years since Mom died. Especially since the stroke. You haven't even wanted treatment. Dad… I know you miss her. I miss her too. But I'm still here. Aren't you going to look after me anymore?”

Adam stared at her.

Evan felt a pang too.

Clara sighed and shook her head. “Actually… a lot has happened lately. You don't know… I… it's been so hard, keeping everything going on my own…”

Adam gazed at her, stricken. His eyes were full of pain for her… and shame.

Evan sighed silently too.

After Adam's stroke, he'd stopped taking care of anything. Clara had had to take leave from college and come home to look after him. Money was tight, and Mingxin Clinic was on the verge of closing. Every burden had fallen on her alone.

Even Evan himself had been a heavy burden to her back then. He hadn't known how to treat patients, hadn't dared to try, and couldn't talk them into spending money the way Ben did.

Yet even then, Clara had never considered firing him.

Something stirred in Evan.

Clara tightened her hold on her father's hand. “Dad, no matter how hard things got, I never intended to give up on you. Or on Mingxin Clinic. You're the only family I have left in the world.

“When Mom passed away, she had you with her. I don't want to be all alone when I go. Dad, please get better. Stay with me a few more years. Please?”

“Mm… mm…”

His head still tilted, Adam nodded hard. His eyes filled with tears.

Reader Notes

Reader Notes

1. ↩︎ Food between doses. Congee is rice cooked with enough water to become a soft porridge. Sun's historical account describes alternating decoction and congee and giving a little lamb broth for nourishment. A batch of herbs and an administration of the liquid are separate quantities: Evan specifies one decoction per batch and four administrations over the day and night. His phrase about maintaining blood levels is his own explanation here; the classical passage supplies no measured drug concentrations. Source: Qianjin Yaofang — volume 1, “Taking Medicines,” passage on sudden wind illness (Chinese transcription).
2. ↩︎ Protecting Stomach qi. Stomach qi is a traditional functional concept associated with receiving and processing food. It does not mean gas in the stomach. The “middle” concerns the Spleen and Stomach functional systems. Evan connects grain-based nourishment with supporting a depleted patient. The cited Suwen passage, in chapter 19, discusses signs of survival in severe deficiency and excess: food entering the stomach and diarrhea stopping in one case, sweating and restored bowel passage in the other. His application to congee after sweating is his interpretation of that passage. Sources: WHO — TCM terminology, entries 188 and 243; Suwen — chapter 19, concluding exchange (Chinese transcription).
3. ↩︎ Reading the classics. These are medical classics. The chapter does not name all four works Evan has in mind, so this edition does not supply a definitive list for him. The Suwen, commonly translated as Basic Questions, is part of the Huangdi Neijing, or Yellow Emperor's Inner Classic. It is the work he has just quoted. Alex's copying assignment from the previous chapter concerns a different work, Sun Simiao's Qianjin Yaofang, a compilation of prescriptions and medical discussions. Sources: Suwen — text and chapter headings (Chinese transcription); Qianjin Yaofang — title and authorship (Chinese transcription).
4. ↩︎ A room protected from drafts. This continues the historical administration method discussed in Chapter 120. “Closed room” means a room kept free of drafts, rather than a secret chamber. The corresponding passage in volume 8 of Sun's text contrasts a sheltered room with one exposed to wind. It supports the historical attribution, rather than demonstrating that closing a room improves stroke outcomes. Source: Qianjin Yaofang — volume 8, “Wind Paralysis,” discussion before “Wind Yi” (Chinese transcription).
5. ↩︎ Two explanatory frameworks. Evan is continuing a dispute within Chinese medicine over external wind, internal wind, and “non-wind” accounts. His statement about the influence of Western medicine remains his position in that dispute. Modern medicine describes stroke in terms of interrupted blood supply to the brain or bleeding in the brain. A traditional wind pattern is therefore not interchangeable with a confirmed vascular cause or stroke subtype. The chapter does not establish a new biomedical diagnosis for Adam. Source: NHLBI, NIH — What Is a Stroke?.
6. ↩︎ The six external influences. The traditional list is wind, cold, summer-heat, dampness, dryness, and fire. These are categories used to explain patterns of illness, rather than six named microbes. “Wind” can concern an external influence or, in internal-wind accounts, a bodily pathological process. The argument here is about how doctors understand that category and its place in a wind-stroke case. It does not identify a particular gust of air as the demonstrated cause of Adam's illness. Source: WHO — TCM terminology, entries 281 and 357.
7. ↩︎ Two older accounts of the body. “Five constant influences” preserves the Jinkui Yaolue's phrase wu chang in its account of human life and wind qi. Sun's separate quotation names earth, water, fire, and wind. Those four terms are not the five-phase list used elsewhere in the novel, and the translation keeps the two passages distinct. Sun's passage gives this four-term account without identifying a specific source text. The translation therefore does not add a title or religious attribution to his reference to the texts. Sources: Jinkui Yaolue — chapter 1, passage beginning “Human beings receive the five constants” (Chinese transcription); Qianjin Yaofang — volume 1, “Diagnosis,” four-term account (Chinese transcription).