Chapter 57 Three Mistakes in a Row

Outside the Xies’ villa, Iris asks Evan what the other doctors missed.

Evan had already left.

He would have left much earlier if not for his sense of responsibility toward the patient. He had passed the key findings for pattern differentiation on to Dr. Liu. Hearing the questions that followed, he knew the man had understood.

The difficult part of Chinese medicine was identifying the pattern. Once that was right, the choice of medicines was unlikely to go far wrong. And with Dr. Liu's ability as a city specialist, Evan trusted that it wouldn't.

“Dr. Xu.” A voice came from behind him.

He looked back. Iris had followed him out.

She jogged a few steps to catch up, looking thoroughly apologetic. “I'm so sorry, Dr. Xu. I didn't know they'd invited another doctor. It put you in an awkward position.”

Evan waved it aside. “It doesn't matter. We're all here to treat the patient.”

Iris nodded and fell into step beside him. “I could tell. You were the one who got Dr. Liu out of trouble, weren't you?”

Evan smiled. “I wouldn't put it that way. When a patient withholds treatment records, it makes the doctor's job harder. Besides, we have ties. Of course I should help.”

“Ties?” Iris thought for a moment. “Oh, you and that Ethan Yang were classmates, weren't you?”

Evan gave a small nod. His connection with them went much further back than that. He had already known Wang, their teacher's teacher.

“Dr. Xu, what actually made Mrs. Xie ill?” Iris asked.

“Summerheat and dampness accumulated as heat, severely disrupting the Stomach and Intestines and causing diarrhea. Over time, Earth became obstructed and Wood constrained. She also took a lot of warming tonics, and she's hot-tempered. Anger injures the Liver and feeds its heat. That heat scorches yin, so the diarrhea persists.”^[1]

“What?” Iris hadn't understood a word.

Evan explained. “Didn't she say she'd traveled abroad over Lunar New Year? She went somewhere hot, where it was summer. External damp-heat invaded her body and caused diarrhea.

“It never cleared up after she came home. The damp-heat stayed inside her. She's also quick to anger. The Liver is naturally exuberant in women, and being so irritable makes Liver constraint more likely.

“When Wood is too strong, it overacts on Earth. Excessive Liver fire damages Spleen Earth. The Spleen raises the clear, nourishing part of food. If it's deficient, the normal ascending and descending movements are disrupted. It can't properly send nutrients upward to the Heart and Lung and distribute them throughout the body. That's why she feels weak all over. Liver Wood is overacting too strongly on Earth, disturbing the rise and fall of qi and keeping the diarrhea going.”^[2]

“Oh.” Iris finally understood. “Then what's this dawn diarrhea they were talking about?”

“Dawn diarrhea is also called cockcrow diarrhea. Every morning at cockcrow, the bowels rumble and there's pain around the navel. The pain eases after a bowel movement. It's most common in middle-aged and older people, especially men.

“In most cases, Kidney qi isn't firm enough to hold things in, and Kidney yang is deficient. That's why it's also called Kidney diarrhea. In more severe cases, Spleen yang is affected too, leaving both Spleen and Kidney yang deficient.

“The yin and mao hours are the transition between yin and yang. If Kidney yang is insufficient, yin cold flourishes inside. At that time, yang qi hasn't yet arrived and yin qi is at its peak. Fire fails to generate Earth. Spleen yang doesn't receive the warmth it needs, so its work of transforming and transporting nourishment is disrupted, causing diarrhea.^[3]

“These patients pass plenty of clear urine and get up frequently at night to urinate. Their stools are loose and unformed, their lower back and spine feel cold and sore, and their abdomen likes warmth and dislikes cold. The tongue body is pale, with a white coating.

“Sishen Wan works very well for this kind of dawn diarrhea caused by Kidney yang deficiency. If Spleen yang is deficient too, you can add medicines that warm the Spleen.”^[4]

Iris looked puzzled. “Then why didn't Sishen Wan cure Mrs. Xie?”

“Because Kidney yang deficiency isn't the cause in her case. She has no signs of yang deficiency. Instead, she has a heat pattern. The yin and mao hours belong to Wood. That's when shaoyang, the lesser yang, holds sway.

“Liver Wood is already liable to become exuberant then. Add the damp-heat trapped inside her and her bad temper, and the Liver fire becomes even stronger. Its attack on the Spleen grows worse at that time, so she gets diarrhea in those early-morning hours.

“And during the yin and mao hours, shaoyang loosens Earth too much, which accounts for the abdominal pain. A lot of hot-tempered people suffer frequent diarrhea. Keeping your emotions steady is the most important thing.”

Iris smiled faintly. She lengthened her stride on her long legs and turned to look at him. “You really are good, Dr. Xu. People say the real masters of Chinese medicine are outside the big institutions. Today I've seen it for myself.”

“You're too kind. Anyone who takes treating patients seriously is a real doctor of Chinese medicine.”

Iris paused, then smiled again. She was usually cool and reserved, and she didn't often smile.

Evan glanced back at the villa and sighed softly. Dr. Liu was actually a capable physician. He had simply let his past experience dictate his conclusions.

On seeing that Mrs. Xie had suffered diarrhea for six months and lost fifteen kilograms, he had decided that prolonged diarrhea had depleted her healthy qi. On hearing that it occurred at dawn, he had decided it must be Kidney yang deficiency.

Evan glanced at Iris beside him. She had played a part in it too. As soon as they came in, her husband had brought up her case of heat entering the blood chamber.

Dr. Liu had begun looking down on them even then. People in a backwater like this knew so little. Heat entering the blood chamber was something even an apprentice could treat, yet they thought it was a difficult case.

So when he examined Mrs. Xie, he had appeared cautious, but in fact he had already let his guard down.

That was something a physician must never do!

His questioning had been haphazard. When Mrs. Xie interrupted, he hadn't continued.

During the tongue examination, Evan had known he was going astray as soon as he heard him describe the coating as white and greasy without distinguishing whether it was moist or dry.

That was why Evan had immediately reminded him to look at the tongue body. Dr. Liu had noticed that something about its color wasn't right, but his preconceptions and overconfidence had made him insist it was pale red.

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Then he made another mistake with the pulse. He had insisted on reading a wiry pulse as thready. The two qualities were very similar and easy to confuse. He hadn't spent long enough examining it, and he already had a fixed idea in his head.^[5]

One mistake after another. Three in a row.

It wasn't a lack of medical ability. He had broken a fundamental rule of being a doctor.

If the Xies had told him about the earlier Chinese medicine treatments, he would have recognized his mistake. But they had deliberately concealed them.

Dr. Liu had been on the verge of making a fool of himself.

Mrs. Xie already had internal heat. More warming tonics and astringent medicines would only trap the dampness and worsen Wood constraint. Her condition would get worse. That was where the earlier doctors had gone wrong too. Prolonged diarrhea didn't necessarily mean her healthy qi was depleted. Evan had examined her carefully. She showed no signs of deficiency.

He couldn't help shaking his head with a sigh. Chinese medicine was different from Western medicine. A diagnosis produced by medical instruments was objective and factual.

The four examinations of Chinese medicine were all subjective. A doctor needed sufficient clinical experience and skill, but above all an absolutely calm mind, free from preconceptions.^[6]

That single requirement—to be still—had defeated countless doctors of Chinese medicine.

At the Xies' villa.

Dr. Liu and the others had come outside. They had collected the consultation fee, but there was little satisfaction in it this time.

Dr. Liu sighed.

Ethan and Leo followed behind him, neither daring to say much.

Dr. Liu looked up at the sky and slowly let out a breath, still shaken by how close he'd come. “One lapse, and I nearly made a complete fool of myself.”

He turned to Ethan. “That young man was your classmate?”

“Yes.” Ethan nodded quickly.

“The younger generation is something to reckon with,” Dr. Liu said admiringly.

Leo looked thoroughly put out too.

Ethan had nothing to say. Evan really did deserve his old nickname, the Great Xu. Ethan had thought Evan's life was over after he was fired. He'd even thought Evan's medical skills were now worse than his own. Instead, he was better than Ethan's teacher. Damn, he was good!

Dr. Liu considered for a moment. “Does he come from a family of Chinese medicine doctors? Has he inherited their skills?”

Leo glanced at him. Hadn't he asked the very same question that morning?

“No,” Ethan said. “His father's a barefoot doctor in their village, not a doctor of Chinese medicine.”^[7]

“Oh,” Dr. Liu said. “Then who's his teacher?”

Leo gave him another look. Hadn't he asked that too?

“He doesn't have one. He's working in a little clinic now.”

“Can he really be a genius?” Dr. Liu was beginning to question everything he knew. “So young, with such skill. And what's rare is that he's neither arrogant nor impatient. If he hadn't had you pass me that message today and let me save face, I'd have made a terrible spectacle of myself.”

Leo was taken aback as well.

“What's someone so talented doing in a little clinic?” Dr. Liu said. “I think you should talk to him. See if we can bring him to our hospital. If he's willing to come, I'll speak to the hospital leadership.”

Ethan looked uncomfortable. “That might be a problem.”

“Why?”

Ethan hesitated. “He… was once involved in… a serious medical accident.”

“What?” Both men were shocked.

Reader Notes

1. ↩︎ Summerheat, dampness, and yin. These are terms within Chinese medicine's account of illness. Summerheat concerns harmful summer heat; dampness denotes a pathogenic quality associated with heaviness and impaired fluid handling. They can combine and interfere with digestion. Yin includes the body's nourishing and moistening aspects, so heat “scorching yin” describes their injury in this framework. Evan first gives Iris a compressed technical explanation, then unpacks it. The travel history comes from the story; no destination, infectious organism, or laboratory finding is specified. Source: Hong Kong Department of Health — Summerheat and summerheat-dampness; WHO — Chinese medicine terminology.
2. ↩︎ Liver Wood and Spleen Earth. These capitalized organ names denote traditional functional systems. Wood corresponds to the Liver and Earth to the Spleen; normal restraint becomes “overacting” when excessive. Here Evan connects that imbalance with disrupted digestion and the upward distribution of nourishment. His statement about women's exuberant Liver belongs to traditional gynecological theory, not a finding that women universally have diseased or overactive anatomical livers. His explanation links both directions: obstructed Earth constrains Wood, while excessive Wood then overacts on Earth. Sources: WHO — Five-phase relationships and Spleen functions; Chinese Medicine Hospital of Hong Kong — Visceral manifestation; Beijing University of Chinese Medicine journal — The Liver in traditional gynecological theory (in Chinese).
3. ↩︎ The early-morning hours. Traditional timekeeping divides the day into twelve two-hour periods. The earthly branch yin names approximately 3–5 a.m.; mao, 5–7 a.m. That time-name yin is distinct from the yin paired with yang. “Dawn diarrhea” describes a timing pattern, not a cause by itself. Evan contrasts two explanations: insufficient warming from Kidney yang, and excessive Liver Wood affecting the Spleen. Fire generating Earth is five-phase language for support and warming. His later reference to shaoyang, “lesser yang,” belongs to that traditional account of emerging yang and Wood; it does not introduce a new laboratory diagnosis. Sources: Hong Kong Observatory — Heavenly Stems and Earthly Branches, Table 3; WHO — Chinese medicine terminology.
4. ↩︎ Sishen Wan. This is the pill formula discussed during the consultation, associated in traditional prescribing with dawn diarrhea and deficiency-cold of the Spleen and Kidney. Wan denotes pills; the name does not supply the dose or establish that every case of early-morning diarrhea has the same pattern. Warming and tonifying address insufficient warmth and function; astringent treatment aims to check losses such as diarrhea. These are traditional treatment categories. Evan's assessment of the formula's effectiveness remains his clinical statement in the story. Sources: Taiwan Ministry of Health and Welfare — Sishen Wan, indications and dosage form (in Chinese); WHO — Chinese medicine terminology.
5. ↩︎ Distinctions in examination. A wiry pulse feels taut like a stretched string; a thready pulse is fine and soft. These are different qualities in the terminology, even though Evan's account here says they can be confused. Tongue examination likewise separates the tissue's color from its coating's color, texture, and moisture. Calling a coating white and greasy leaves its wetness or dryness unstated. The passage reviews how preconceptions affected Dr. Liu's interpretation; it does not describe another examination taking place outside. Source: WHO — Tongue examination and pulse qualities, entries 640–645, 682, 896, and 904.
6. ↩︎ The four examinations. These are inspection, listening and smelling, questioning, and palpation, which includes feeling the pulse. Chinese medicine brings the findings together when distinguishing a pattern. Evan's reflection emphasizes the practitioner's judgment and the danger of letting an early assumption govern later observations. The categorical contrast with instrument-based Western diagnosis is retained as part of that reflection. The source explains the traditional examination methods and their combined use; it does not establish that medical instruments always produce an infallible diagnosis. Source: Hong Kong Department of Health — Diagnostic Methods and Features of Chinese Medicine Practitioners.
7. ↩︎ A barefoot doctor. This term became well known in rural China in the 1960s for community health workers who received basic medical training, often combining farming with preventive care and treatment. The historical program could draw on both Western and Chinese medicine. It therefore does not mean a practitioner of Chinese medicine specifically, nor that a doctor literally works without shoes. Here Ethan uses the familiar rural designation while explicitly saying Evan's father is not a doctor of Chinese medicine. It does not establish his father's training dates or present credentials. Source: WHO Bulletin — China's village doctors take great strides, pp. 914–915 (PMC archive).