Chapter 64 Deficiency in the Middle, Sinking Qi

Evan’s blunt warning leaves Simon determined to settle the matter with another round of tests.

Everyone in the consulting room froze.

Leo was taken aback too. Ever since he had met Evan, he had found him unfailingly polite. There might have been some manipulation involved, but at least Evan was always pleasant about it.

And when they had gone to Mr. Xie’s house, Evan had been careful to let Dr. Raymond Liu save face. Surely that proved he was good-tempered and generous enough to let things go.

So why was he angry now?

The atmosphere in the room suddenly grew oppressive.

Simon’s expression stiffened. He had not expected Evan to say anything like that either.

The patient was stunned. He was getting worse?

Simon’s courtesy vanished. “What do you mean by that?”

“You’ll know once the tests are done,” Evan said. “You wanted him to have another urinalysis and a complete blood count, didn’t you? Then get them done!”

Simon stared at him for a long moment. “Fine. Fine. We’ll do the tests.”

He wrote the orders and took two hundred yuan from his pocket. “I’ll cover the cost. Come on, I’ll take you to have your blood drawn. I’ll ask the lab to process it quickly.”

“Come on, Simon, don’t get worked up. There’s no need, no need,” Leo said, hurrying to smooth things over.

“I think there’s every need,” Simon said angrily. “I’d very much like to know what evidence Dr. Xu has for saying the patient is worse after taking my medicine.”

“Come on.” He pulled the patient along to pay and have the tests done.

The patient was completely bewildered.

Only Evan and Leo remained in the consulting room.

“Well, this has turned into a bit of a… Look, don’t get so worked up. We can talk about it calmly,” Leo said awkwardly.

Evan let out several heavy breaths. He was irritated too.

After a while, Simon brought the patient back. He looked troubled. They had just taken the man’s temperature: 38°C. He had a fever.

Back in the consulting room, Simon told the patient to stay there rather than go anywhere else.

Both Simon and Evan looked grave.

The patient was confused too. What was going on?

Leo even went over to examine his pulse. When he finished, he looked puzzled as well.

He came back but did not dare ask anything. The atmosphere grew more awkward still.

The patient had wanted a cigarette. He had already taken one out, but then he felt awkward and put it away again.

Thanks to Simon’s request, the results came back quickly. They soon appeared on his computer.

Simon hurried to open them, and Leo leaned over to look. Evan had no desire to look at all.

Simon’s face fell further as he read.

Leo was dismayed too.

The urine test showed more white blood cells and pus cells than before. The white blood cell count in his blood had risen too. Neutrophils were at 91%, higher than before.

Lymphocytes had fallen to 9%. Together with his temperature of 38°C, the results showed that the patient really was worse!^[1]

“How can that be?” Simon was flustered. He could scarcely believe it.

Leo gave him a worried look.

Evan shook his head slightly.

“That shouldn’t happen,” Simon murmured. “I gave him an antibiotic to fight the inflammation and kill the bacteria. And I gave him Bazheng San. It clears heat and relieves painful urination. It works very well. He has heat strangury—an acute infection of the urethra. That’s right. Burning urine and a fever. It shouldn’t happen.”^[2]

Seeing him like this, Leo sighed. Under their hospital’s rules, if the patient still did not improve this time, the Chinese medicine doctors could not keep treating him. He would have to be transferred to the Western medicine side.

That was why the Western medicine doctors were always grumbling in private about having to clean up after the Chinese medicine doctors. No wonder they looked down on them. If you couldn’t cure the patient, didn’t you still have to rely on them?

“Why?” Simon turned to Evan.

“Shall I be frank?” Evan asked again.

Leo hurried to interrupt. “Er… sir, perhaps you could wait outside for a moment while we discuss your case?”

“No. Stay here and listen!” Simon stopped him.

Leo was left speechless. Why did the man have to be so stubborn?

“What is the mechanism behind his illness?” Evan asked. “Yin or yang, exterior or interior, deficiency or excess—which category does it fall under?”^[3]

Simon paused before answering. “He has frequent urination with burning and pain. Obviously there’s heat in the lower burner. It’s heat strangury, a damp-heat pattern. That’s why I used Bazheng San to clear heat, drain fire, dispel dampness, and relieve the painful urination.

“Besides, modern pharmacological research shows that Bazheng San has very effective anti-inflammatory and antibacterial effects on the urinary system. That’s why it’s commonly used for urinary tract infections, cystitis, and so on. Is there a problem with that?”

“Judging by his symptoms, it really does look like damp-heat pouring downward,” Leo said, equally puzzled. “That isn’t wrong, is it?”

“It isn’t wrong,” Evan said. “There is damp-heat pouring downward. But why is it pouring downward?”

The question stopped both of them.

Stolen story; please report.

A trace of bewilderment crossed Simon’s eyes.

“As I’ve said before, Chinese medicine has never been about treating a disease just because you see a disease, or a symptom just because you see a symptom.

“It requires pattern differentiation and treatment. What does that mean?

“Zhang Zhongjing, the Sage of Medicine, left us twelve Chinese characters: ‘Observe the pulse and symptoms, understand what has gone wrong, and treat according to the pattern.’^[4] You neither examine the pulse and symptoms nor look into what has gone wrong. You go entirely by Western medical test reports.

“Why study Chinese medicine? Wouldn’t you be better off studying Western medicine? If you’d used Western drugs alone, he might already be better!”

Evan was making himself angry as he spoke.

Simon’s face darkened.

“That’s a bit harsh. A bit harsh,” Leo said, trying to smooth things over.

Simon stared at Evan. “Then tell me what caused his illness.”

“Didn’t you hear him? He leaks urine when he coughs. He’s weak all over. And look—he has to stop for breath after saying just a few words. That’s clearly shortness of breath on exertion. Isn’t that a pattern of deficiency in the middle with sinking qi?^[5]

“His middle qi is too weak to hold things in place and lift them. That’s why he leaks urine when he coughs. Middle qi is the qi of the Spleen and Stomach, where qi and blood are generated. When the Spleen and Stomach are deficient, naturally he feels weak all over. Weak middle qi also leaves him short of breath on exertion.

“You see a fever, a red face, frequent burning urination, and you dare conclude that it must be an excess-heat pattern?

“His middle qi is so deficient, his original qi so depleted, that yin fire surges upward. That’s why he has a fever and a red face.^[6]

“Again, his middle qi is too weak to keep things in place, so damp-heat pours downward. Food tasting bland, nausea, wanting to vomit—those are also signs of Spleen and Stomach deficiency! And that last part—the Spleen and Stomach deficiency—is your doing!

“His Spleen and Stomach were already deficient, his middle qi already too weak and sinking, and you gave him bitter, cold medicines. The bitter, cold action of Bazheng San damages the Spleen and Stomach. With further damage, his middle qi becomes even weaker. Of course his symptoms get worse!”^[7]

Simon listened, dumbfounded.

Leo was grimacing as he listened. Evan was frightening when he got like this!

Evan grew angrier with every word. “All those symptoms right in front of you, and instead of studying them, you go looking at lab reports? One look at his tongue would tell you whether there’s damp-heat. Never mind. You don’t know how to read it anyway.

“At least the earlier doctors who tried to bring Chinese and Western medicine together stayed rooted in Chinese medicine and drew on Western medicine. You’ve turned that around—rooted in Western medicine and drawing on Chinese medicine! Why practice Chinese medicine, then? Wouldn’t you be better off practicing Western medicine? You’d still be treating patients and saving lives!”^[8]

To hell with the System’s task. To hell with getting Simon to study Chinese medicine again.

Bullshit!

Evan was furious!

He was done with the task!

Reader Notes

Reader Notes

1. ↩︎ White cells in urine and blood. Neutrophils and lymphocytes are types of white blood cell. The figures here are their percentages in a blood differential, distinct from the total white blood cell count. “Pus cells” in urine is a term associated with urinary white cells; the Chinese text lists both labels, and both are retained. It supplies no absolute counts or full differential. The worsening described here belongs to this fictional case; these figures alone do not establish Evan’s traditional diagnosis. Sources: MedlinePlus — Blood differential test; National Library of Medicine — Pyuria.
2. ↩︎ Heat strangury and Bazheng San. As in the previous chapter, “heat strangury” names a traditional pattern involving urinary discomfort and heat signs. Bazheng San is a multi-ingredient formula traditionally used for damp-heat strangury. Simon equates that pattern with an acute urethral infection here; the traditional category and the biomedical diagnosis use different frameworks. His statements about effectiveness and antibacterial action remain his claims. Source: Hong Kong Baptist University — Ba Zheng San, Action, Indication, and Application.
3. ↩︎ Patterns, mechanisms, and the eight principles. Pattern differentiation brings findings together into a traditional diagnostic pattern; the mechanism explains how the illness develops. The eight principles organize findings by yin/yang, exterior/interior, cold/heat, and deficiency/excess. Evan’s spoken list names six of these, leaving cold/heat unstated. “Lower burner” refers to the lower functional region of the three-burner framework, which includes urinary functions. The terms describe traditional classifications, rather than results measured by a blood or urine test. Source: WHO — International standard terminologies on traditional Chinese medicine, entries 210, 364, 548–550, and 931.
4. ↩︎ Zhongjing’s twelve characters. Zhongjing is the historical physician Zhang Zhongjing; “Sage of Medicine” is an honorific. The twelve characters are those of the Chinese maxim, not twelve words in English. In its classical context in the Shanghan Lun, the instruction follows a discussion of illness altered by earlier treatments. “What has gone wrong” preserves that context without adding a particular treatment error to the quotation. The English is translated here from the Chinese, using the wording established in Chapter 5. Source: Shidian Guji — Maxim and its source in the annotated Shanghan Lun (in Chinese).
5. ↩︎ Middle qi and sinking. “Middle qi” is the qi of the Spleen and Stomach, the traditional functional systems involved in transforming food and supplying nourishment. “Sinking” describes failure of its upward and supporting functions; it does not mean that a measurable substance has fallen inside the body. This is a new application of the middle-qi discussion in Chapter 62. Evan connects the patient’s weakness, breathlessness, and urinary leakage within that framework. His case interpretation remains distinct from the laboratory findings. Source: WHO — International standard terminologies on traditional Chinese medicine, entries 243, 1195–1196.
6. ↩︎ Yin fire and original qi. Yin fire is a traditional term for pathogenic fire associated with causes that can include qi or yang deficiency. It should not automatically be read as the heat of yin deficiency, or as literal combustion. Li Dongyuan’s Piwei Lun links weakened Spleen and Stomach qi, depleted original qi, and upward-surging yin fire. This supplies the background to Evan’s explanation, rather than independently confirming his diagnosis. “Original qi” is another traditional functional concept, not a laboratory value. Sources: WHO — Terminologies, entries 235 and 362; Piwei Lun — section on heat arising from dietary and exertional injury (in Chinese).
7. ↩︎ Bitter and cold. These are traditional medicinal properties: bitter refers to a flavor category, and cold to a cooling tendency within the theory, not the temperature at which a medicine is swallowed. The Piwei Lun passage just cited warns that bitter, cold medicines can further damage a deficient Spleen and Stomach. That explains the reasoning Evan invokes. His accusation that Bazheng San caused this patient’s deterioration is the character’s conclusion, rather than an adverse-effect determination established by these sources. Sources: WHO — Terminologies, entries 2638 and 2644; Piwei Lun — section on heat arising from dietary and exertional injury (in Chinese).
8. ↩︎ Bringing Chinese and Western medicine together. Zhongxi huitong refers to efforts to bring the two medical traditions into conversation; the physician Zhang Xichun is associated with this current. Evan’s wording plays on zhong Zhong can Xi: remaining rooted in Chinese medicine while consulting Western medicine. He reverses “Chinese” and “Western” to criticize Simon’s priorities. The exchange concerns which framework leads the treatment, rather than simply whether a doctor uses both kinds of medicine. It does not define every present-day approach to integrated care. Source: Tianjin University of Traditional Chinese Medicine — Visit to the Zhongxi Huitong Medical Society (in Chinese).