Chapter 49 What Has Oliver Liu Been Teaching Him?

A difficult case turns into an unexpected lesson at the clinic.

Leo Cao's face darkened.

Ben looked sheepish too. The others might not know, but he did. All that talk of being Professor Oliver Liu's disciple was bullshit!

Oliver Liu was a university professor. Leo had merely attended his lectures. At most, that made him one of the professor's students, yet he insisted on calling himself a disciple to make himself look important.^[1]

Luckily, this was a small town and no one had checked. Otherwise, he'd have been a laughingstock.

Leo wanted to argue, but found he couldn't. What Evan said suddenly made a great deal of sense. He almost felt as though something had fallen into place. No wonder his medicine hadn't worked!

He swallowed. He was looking at Evan differently now.

The others looked from Leo to Evan and back. They couldn't follow the argument, but Evan seemed to have won.

He'd beaten the expert?

Everyone in the Octopus family was stunned.

Little Octopus was so excited she almost jumped up and down. She'd known Evan would win!

Even Her Majesty stared at him in surprise…

Clara shook her head.

Leo wished he could disappear.

Evan sighed and spoke earnestly. “When we practice medicine, especially Chinese medicine, we have no other diagnostic methods to fall back on. Inspection, listening and smelling, inquiry, and palpation all depend on us. The moment we stop paying attention, it's very easy to misdiagnose someone.

“We have to bring all four methods together, work through the confusion, and get to the underlying mechanism. None of that is possible without care. Remember that.”^[2]

During his years in the system, Evan had trained plenty of new doctors. He had always taken great care in teaching them.

Besides, Leo was his nephew in the teaching lineage. All the more reason to teach him properly.

Evan looked at Leo's flushed face. The young doctors he'd reprimanded used to look just like that.

His tone softened further. “The underlying mechanism in this case is particularly hard to find. Both the pulse and the tongue can mislead you. The pulse, especially, shows no very typical signs of cold.

“If the pulse at her right guan position were wiry, it would be easier to judge. But hers is wiry on the left. If I were prescribing for her for the first time, I could easily get it wrong too. Still, once cooling medicine has failed, you should consider whether the problem is Stomach cold.”^[3]

“Comrade, do you usually prefer hot drinks or cold ones?” Evan asked Second Sis.

“I… mostly drink things hot. They make my stomach feel warm. It's more comfortable.”

Evan nodded. That was another sign that this wasn't a heat pattern.

Leo looked worse than ever.

“If you aren't quite sure at the first consultation, what do you do?” Evan asked him.

Leo's face was red. Answering would be embarrassing. So would staying silent.

God, this was awkward!

“We could try Banxia Shumi Tang first,” Evan answered himself. “We've established that turbid phlegm is obstructing the middle. She's vomiting, so Stomach qi is certainly flowing upward. If she still vomits after taking it, we can be fairly sure it's deficiency in the middle with Stomach cold.^[4]

“Why? Banxia transforms phlegm, brings turbidity downward, harmonizes the Stomach, and directs counterflow down. Shumi nourishes yin and the Stomach. But with deficiency in the middle and Stomach cold, the qi of the middle is weak, cold obstructs the Stomach, and yang qi can't circulate freely.

“With phlegm-dampness obstructing the middle and cold obstructing the Stomach, banxia alone can't bring that turbidity down. We need to warm the middle and supplement qi while also transforming phlegm and directing turbidity downward. Once yang qi can circulate freely, the phlegm-dampness clears. Qi movement is no longer disordered. Rising and descending return to their proper order, and the vomiting stops.^[5]

“What medicine should we use at that point?” he asked Leo.

Leo was ready to cry.

Evan shook his head slightly. “Ganjiang Renshen Banxia Wan. It warms the middle, supplements qi, directs counterflow downward, and transforms phlegm.”^[6]

Then he muttered, “What's Oliver Liu doing? Is this how he teaches his disciples?”

Ben could barely watch. Somehow his brother-in-law seemed to be getting an even worse time of it than he had.

Leo suddenly felt this was rather unfair.

Ben's wife still wouldn't give in. “What is all this nonsense you're spouting? If you're so clever, make her better!”

Evan had been planning to use acupuncture. He considered for a moment, then put his needle case away again.

“All right. We'll use medicine. With the right pattern differentiation and treatment to match, it can work very quickly.”

He wrote the prescription. “Dried ginger, 6 g; renshen, 6 g; processed banxia, 9 g. Grind all three together into a fine powder. Take 1.8 g of each per dose, adding four or five drops of fresh ginger juice before taking it.”^[7]

“Clara, make out the prescription and dispense the medicine.”

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Clara answered and hurried off to gather the ingredients and grind them into powder.

Evan went on explaining to Leo. “Ganjiang Renshen Banxia Wan comes from the Jinkui Yaolue. It's a pill formula. But if a patient is vomiting severely, we can turn it into a powder and mix it with warm boiled water. That way it's absorbed more quickly and works faster.

“The dose needn't be large. When treating vomiting in pregnancy, keep the prescription simple and avoid rich, cloying medicines, so the patient won't vomit it back up. Otherwise, if she throws up as soon as she takes it, what was the point?

“This formula contains banxia. The ancients said it could harm the fetus, but earlier practitioners found that small doses weren't too much of a problem.

“But remember: if a woman has had a miscarriage, or has recurrent miscarriages, use banxia cautiously or leave it out. You can substitute 6 g of fresh ginger.”^[8]

Evan let out a small breath. Wasn't Oliver Liu supposed to have taught him all this? Somehow Evan had ended up having to give him the lesson himself.

The medicine didn't need decocting, so it was ready quickly. As soon as Second Sis took it, she felt more comfortable, and the nausea eased.

In Chinese medicine, boiling prepared medicinal pieces in water produces a decoction. There are also four more portable forms: pills, powders, pastes, and dan preparations. Pills are generally absorbed more slowly, but their effects last longer, so they are usually used for chronic illnesses. There are emergency medicines in pill form too, though, such as Angong Niuhuang Wan.^[9]

Powders are finely ground medicine, absorbed quickly and quick to act. Evan had changed a pill formula into a powder because the patient's retching was making her miserable and he wanted it to work sooner.

And it clearly had.

Having seen the result for himself, Leo finally had nothing more to say.

Results were what counted. He hadn't made her better. Evan had. That settled it.

Leo looked thoroughly embarrassed.

He nodded to Evan and looked at him seriously. “I've learned something today,” he said in a low voice. “Very good. Very good. I'll be going.”

Behind the counter, Clara grew anxious. If they left, what was she going to do about this family?

“Don't go! Didn't you say you had something urgent to discuss? Hey…”

Evan was annoyed too. After all the trouble he'd taken to teach the man, he was just leaving?

Ben's wife wasn't ready to go. “That's right. We have something to discuss!”

Clara's eyes lit up. “Good! Well, we're having a staff meeting. Evan, come on…”

Ben felt like punching his wife. How could she be so clueless? He grabbed her and hurried toward the door.

“But we haven't told them what we came for!” she cried.

“To hell with it!” Ben dragged her outside.

Clara could have cried.

Reader Notes

1. ↩︎ Student and disciple. Attending a professor's classes makes someone a student; calling oneself a disciple claims a more personal place in a teaching lineage. Relationships within that lineage also matter: a teacher's fellow disciple can be addressed as an uncle, regardless of biological kinship. Here Ben's knowledge of Leo's classroom attendance is distinct from Evan's understanding of his own seniority. The novel keeps those two perspectives in play. Source: Ministry of Education — Shixiong, first definition, on disciples of the same teacher (in Chinese).
2. ↩︎ The four diagnostic methods. These are inspection, listening and smelling, inquiry, and palpation. Tongue observation belongs to inspection and pulse examination to palpation; inquiry covers symptoms and medical history. Evan insists on considering the findings together. His statement about having no other diagnostic methods is part of his speech in this scene. Source: Hong Kong Polytechnic University — Four Diagnostic Methods.
3. ↩︎ A position and a quality. Guan is one of the three adjacent positions used to examine the radial pulse at each wrist. Wiry describes a taut, stringlike feel. Evan distinguishes a wiry quality at the right guan position from wiriness on the left; he does not specify a left-side position here. His inference about cold depends on the wider case, including the failed cooling prescription, rather than this quality alone. Source: WHO — International Standard Terminologies on Traditional Chinese Medicine, entries 883, 885 and 904.
4. ↩︎ Banxia Shumi Tang. The formula's name identifies banxia and shumi, a traditional term for sticky grain; tang denotes a decoction. Shumi has not always designated one unambiguous modern crop, so the Chinese name is retained rather than specifying a species. Evan proposes the formula as a trial within his own pattern reasoning. The conclusion he says he would draw from continued vomiting belongs to that reasoning, rather than to the grain's definition. Source: China Grain Museum, Henan University of Technology — Shumi and its historical names (in Chinese).
5. ↩︎ Cold, deficiency, and obstructed movement. The “middle” is the digestive functional region associated with the Spleen and Stomach. Qi and yang qi describe traditional functions, including movement and warming; phlegm-dampness can mean disordered retained fluids, beyond ordinary respiratory mucus. Evan argues that restoring downward movement requires addressing cold and weakness as well as phlegm. These are his linked treatment principles. They do not describe a measured stomach temperature or a visible substance moving through the body. Source: WHO — International Standard Terminologies on Traditional Chinese Medicine, entries 7, 193–195, 209 and 1234.
6. ↩︎ Ganjiang Renshen Banxia Wan. The name identifies dried ginger, renshen (ginseng), and banxia; wan denotes pills. The Jinkui Yaolue, often translated as Essentials from the Golden Cabinet, contains this formula in its chapter on pregnancy disorders. The consulted text describes the three ingredients being powdered and made into pills with fresh ginger juice. That historical preparation explains the name. Its traditional units have not been converted into modern grams in this translation. Source: Guangxi University of Chinese Medicine — 2020 classics examination syllabus, Jinkui Yaolue chapter 20, clause 6, printed pp. 67–68 (in Chinese).
7. ↩︎ The prescription's wording. The Chinese says to grind the three ingredients together, then uses a phrase literally meaning “1.8 g of each per dose.” It leaves unclear how “each” relates to the combined powder. That wording is retained here rather than silently changing it to 1.8 g of the mixture. The figures reproduce the fictional prescription; the historical formula cited above does not resolve this modern wording.
8. ↩︎ Processing and pregnancy. The prescription specifies processed banxia, while Evan's explanation uses the shorter herb name. Processing is a meaningful distinction: the Hong Kong terminology guide lists several processed forms under banxia, without making them interchangeable. The novel does not identify which form he uses. His claim about small doses in pregnancy and his proposed ginger substitution remain character statements; the sources cited here do not establish their safety. Sources: Hong Kong eHealth — Chinese medicines terminology guide, table 8 (in Chinese); Hong Kong Department of Health — Adverse Reactions of Chinese Medicines, sections 3, 5 and 6.
9. ↩︎ Names and dosage forms. Tang, wan, and san usually indicate decoctions, pills, and powders. Gao includes paste preparations; the novel also lists the traditional category dan, which is retained by name here. Neither is prescribed in this scene. “Prepared medicinal pieces” refers to ingredients prepared for dispensing, rather than tablets. Evan changes a pill formula into a powder without changing its name. The surrounding claims about speed and duration follow the novel; the terminology source defines forms, rather than establishing a universal absorption rule. Source: WHO — International Standard Terminologies on Traditional Chinese Medicine, entries 2610 and 2776–2787.