Chapter 68 The Fever Breaks

Evan explains his diagnosis while Evie’s family and doctors wait to see what the first prescription will do.

Simon hurried to fetch paper and a pen.

“Dr. Xu, what exactly is wrong with Evie?”

Evan glanced at him. “She has a taiyang wind-strike pattern. Her nutritive and defensive qi are out of harmony, and her Lung qi isn’t dispersing properly. She has a high fever, but her feet are cold. Her tongue is pale too. This isn’t a heat pattern.”^[1]

Simon’s expression immediately darkened.

Leo stole a cautious look at him.

“Her pulse is floating and slippery,” Evan continued. “A floating pulse points to an exterior pattern. Wind-cold has constrained the exterior, and yang qi has moved outward to contend with it. The nutritive and defensive qi are out of balance, which is why she has a floating pulse and a fever.

“She contracted wind-cold. She needed pungent, warming medicines to release the exterior, but she was given pungent, cooling ones instead. The exterior remained constrained, the pathogenic influence sank inward, and the Lung’s defensive function couldn’t operate freely. That’s why she’s coughing, with labored breathing and fullness in her chest. She also has wind-phlegm and jingfeng. Write this down.”^[2]

Simon’s expression grew grimmer. He let out a shaky breath and picked up the pen.

Evan stood. “We need to release the muscle layer and dispel wind, harmonize the nutritive and defensive qi, direct qi downward to ease her breathing, and drive the pathogenic influence out through the exterior. We’ll combine bitter-warming with pungent-warming treatment. A modified Guizhi Jia Houpo Xingzi Tang.”

“Guizhi, 1.5 g. Baishao, 1.8 g. Zhigancao, 1.5 g. Two slices of fresh ginger. Two jujubes. Houpo, 1.8 g. Ten xingren kernels. Jiangcan, 3 g. Qianhu, 1.5 g.”^[3]

Simon took the prescription and ran out.

Evie’s parents were rather bewildered.

Evan said nothing.

Leo looked awkward.

Some time later, Simon returned with the medicine he had decocted for Evie. A senior physician from the conventional medicine team arrived as well and looked curiously at Evan. With the mask covering Evan’s face, he could not make out his age.

This was now a joint Chinese and conventional medicine consultation. Any medication required the senior physician’s agreement. Simon had gone to see him and personally vouched for Evan before obtaining his consent. Naturally, he had come to watch when the medicine was administered.

Evie took the medicine.

Everyone watched.

Her parents were tense. Would she improve this time?

The doctors outside were nervous too.

The senior physician kept looking at Evan. Without Simon’s assurance, he might never have agreed. With so many people present, however, he said nothing.

A little while after that first dose, Evie began to sweat.

Evan had stayed inside to observe her. “A light sweat.”

“The exterior has been released!” Leo looked delighted.

Chinese medicine used the particular properties of medicines to correct imbalances in the body. Deficiency called for supplementation, excess for draining; cold called for warming, heat for cooling. An exterior pattern required releasing the exterior—in other words, resolving it through sweating. Once the sweat came, the exterior would be released.

Exterior patterns could involve either wind-cold or wind-heat. In wind-cold, an external wind-cold influence constrained the exterior. Cold called for warmth, hence pungent-warming treatment. Pungency dispersed; once sweating resolved the exterior, the problem was gone.

Wind-heat, by contrast, called for pungent-cooling treatment to release the exterior. Simon had misjudged it. Both Ma Xing Shi Gan Tang and Yinqiao San, which he had combined, released the exterior with pungent-cooling medicines. Evie had a wind-cold exterior pattern. The medicines did not match it, so instead of helping, they had made her worse.

Simon let out a long breath of relief too.

The senior physician looked surprised.

Evie’s parents knew little about medicine, but she did seem a little better.

They watched a while longer. Evie opened her eyes on her own and turned her head, looking this way and that. She was much more alert.

A nurse was quickly called to take her temperature.

“38.2°C.”

Everyone brightened at the reading. The high fever was beginning to come down.

Her parents were so excited that tears came to their eyes. They had been frantic with worry. It broke their hearts to see their little girl, barely over a year old, so ill. At last there was a glimmer of hope.

The senior physician was astonished.

Leo walked one way, then back again, beaming. He could hardly have been happier if he had just been promoted to deputy director.

Simon looked pleased as well, though he could not hide his dejection.

It was past noon. None of them had eaten.

They had forgotten all about it until a nurse came to remind them.

“Why don’t we get some lunch?” Leo suggested. “We can keep observing and treating her afterward.”

Evie’s mother hesitated. She did not want the doctors to leave, but she could hardly stop them from eating.

“Yes, yes, lunch first,” her father said at once. “It’s already past lunchtime. Why don’t I treat everyone? We could go out somewhere.”

Evan waved it off. “It’s all right. I’m not hungry. I’ll skip it.”

Simon was still watching Evie. “I’ll skip it too.”

Leo swallowed. He could hardly admit that he was the only one who wanted to eat.

“I… I’m not hungry either. I’ll skip it.”

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Evie’s father turned to the senior physician. “Dr. Ma, would you…”

Dr. Ma smiled and waved a hand. “I ate before I came.”

Well, then. Nobody was going to lunch.

Evan played with Evie a little and noticed a sound in her throat like a water hen’s call.

The Shengji Zonglu stated: “The Lung governs qi and connects upward to the throat. When cold lodges in the Lung channel, the throat becomes obstructed and phlegm and saliva congeal. Qi surges through the airways, and breathing grows labored and noisy, like the call of a water hen.”^[4]

The Lung was still obstructed. Its qi was not dispersing freely, hence the water-hen sound.

Evan continued his examination. Her abdomen was still full, the cough and labored breathing persisted, and her tongue was pale with a grayish-white coating. The first dose had brought the nutritive and defensive qi back into harmony, but the Lung qi remained blocked by phlegm-dampness. He needed to warm and open the Lung, redirect the counterflow downward, and transform phlegm.

“Write this down,” he called again.

Simon brought over the paper and pen.

Dr. Ma gave him a puzzled look. How had Simon ended up as an apprentice taking down prescriptions? Who was this man? A Chinese medicine specialist from some major hospital?

“Wind-phlegm is disturbing the upper body,” Evan said. “There’s coughing with qi surging upward, and a water-hen sound in the throat. Shegan Mahuang Tang is indicated.”^[5]

He modified the formula. Simon took the prescription and sent someone to have it filled.

“Where is this Chinese medicine specialist from?” Dr. Ma asked Leo curiously.

“Uh…” Leo did not know how to answer.

Dr. Ma studied his reaction. “Don’t tell me he’s one of the top specialists from the province?”

“Uh…” Leo was even more at a loss.

Evie’s father chimed in. “Dr. Xu is the disciple of one of the country’s great physicians of Chinese medicine!”

“Oh? The disciple of a National Master of Chinese Medicine?” Dr. Ma looked at Evan with new respect.^[6]

What the hell? Leo had no words. How did the story keep getting bigger? Now there was a National Master involved? How come he had never heard that this kid had such an illustrious background?

But he could hardly explain now. Keeping quiet was killing him.

After some time, the decoction was ready and brought in.

Evie took the second decoction.

They continued watching her. The afternoon shift should have started by now, but Dr. Ma stayed instead of going out to see patients in the clinic. He was far too curious himself.

Some time passed after she took the medicine.

Evie became much livelier. She began babbling and squirming in her mother’s arms, unable to lie still. She was nothing like the child Evan had found when he came in.

“Evie! Evie! Do you still feel bad?” Her father hurried over anxiously.

“Hee-hee…” Evie thumped her father’s face playfully with her little fists. Mischievous again, and looking very well indeed.

Evan and the others were heartened too.

“Nurse Yang, come and take her temperature,” Dr. Ma called.

They watched the nurse anxiously. This would tell them whether her condition had improved.

Her parents waited with their hearts in their mouths.

The doctors were nervous too.

“36.4°C.” The nurse sounded delighted. “Oh! The fever’s gone!”

“Yes!” Leo, a man in his forties, jumped up like an excited child.

Evan let out a great breath of relief. As soon as he relaxed, deep exhaustion washed over him. Yet he felt exhilarated. The child was going to be all right.

“Evie… Evie…” Her mother held her and sobbed so hard she could barely speak.

Her father’s eyes filled with tears too. Who knew how they had made it through the past few days? Who could imagine the pain and torment they had endured?

They had thought she might have to go into intensive care. They had already signed a notice warning that she was seriously ill. Now their precious daughter’s condition was finally under control. Even a grown man like him could no longer hold back.

Evie looked from one parent to the other in bewilderment, with no idea what either of them was doing.

“Thank you… Thank you…” Her father came over and gripped Evan’s hand tightly. Tears in his eyes, he thanked him and bowed again and again.

Evan’s own nose stung with emotion. So much went through his mind. Perhaps this was what being a doctor was for.

He patted Evie’s father on the shoulder. “It’s all right. No need to thank me. Go and give your wife and daughter a hug.”

The man stopped trying to contain himself. He hurried back and wrapped his arms around his wife and child. Both parents cried, letting out all the grief, anger, and misery of the past few days.

Leo rubbed his eyes. “Ah, this is getting to me.”

The nurse’s eyes had been red for some time already.

Simon was elated too, yet he also looked forlorn. His expression was complicated.

Dr. Ma clapped vigorously. “Remarkable. Just remarkable! Chinese medicine really does have its wonders. I’m deeply impressed. No wonder you’re the disciple of one of the country’s great physicians. Remarkable!”

Leo looked at him in exasperation and rubbed his nose.

“Ma, don’t ruin the moment.”

Reader Notes

Reader Notes

1. ↩︎ Taiyang and nutritive–defensive harmony. Taiyang is one of the six divisions used in cold-damage pattern differentiation. “Wind-strike” here names a traditional pattern, not a cerebrovascular stroke. Nutritive qi is associated with nourishment within the vessels; defensive qi with protection outside them. Their coordination is part of Evan’s explanation of the fever and exterior signs. WHO’s corresponding “Taiyang wind attack” entry includes sweating, whereas Evie had no sweat before treatment in the preceding chapter. That difference is retained from the novel. Source: WHO — Traditional Chinese Medicine Terminologies, entries 237, 240, 1397 and 1399–1400.
2. ↩︎ Warming and cooling the exterior. In this framework, “pungent,” “warm,” and “cool” describe medicinal properties and treatment strategies; they do not specify the drink’s temperature. Pungent-warming exterior treatment is traditionally associated with wind-cold, and pungent-cooling treatment with wind-heat. A measured fever does not by itself make a pattern “heat.” The account of sweating resolving the exterior, and the judgment that Simon’s previous prescription worsened this child’s illness, belong to the novel’s clinical reasoning. Source: WHO — Traditional Chinese Medicine Terminologies, entries 2282–2284.
3. ↩︎ The first prescription. Guizhi Jia Houpo Xingzi Tang is a Guizhi Tang variant with magnolia bark and apricot kernels, associated with the Shanghan Lun. Guizhi is cinnamon twig; baishao, white peony root; zhigancao, prepared licorice root; houpo, magnolia bark; and xingren, apricot kernels rather than ordinary almonds. Qianhu is a medicinal root. Jiangcan is animal material: dried silkworm larvae killed by a fungal infection. Evan’s additions and quantities are those of this fictional case, distinct from the reference formula. Sources: HKBU — Guizhi Tang, additional formula 2, Jiangcan, and Qianhu.
4. ↩︎ The “water-hen” sound. The Shengji Zonglu is a historical Chinese medical compendium. The quoted passage appears in volume 67 under “Upward qi with a water-hen sound in the throat.” Shuiji, literally “water chicken,” supplies an animal-call comparison for noisy breathing. “Water hen” preserves that comparison without identifying a particular species or equating the sound with one precisely established modern respiratory sign. The Lung channel, cold, and congealing phlegm are the passage’s traditional explanation. This translation is made directly from the Chinese quotation. Source: Shengji Zonglu — electronic transcription, volume 67 (in Chinese).
5. ↩︎ Shegan Mahuang Tang. This is a distinct classical formula associated with the Jingui Yaolue, often translated as Essentials from the Golden Cabinet. Shegan and mahuang are its naming ingredients, rendered as belamcanda and ephedra in the university database. The traditional indication links cough and difficult breathing with obstructing phlegm and fluid, including a rattling sound in the throat. “Directing qi downward” refers to correcting an upward counterflow within that theory. The novel says Evan modifies the formula but gives no second ingredient list or quantities, so none have been supplied here. Source: HKBU — Xiao Qing Long Tang, additional formula: She Gan Ma Huang Tang.
6. ↩︎ A compliment becomes a title. Guoshou, used in the father’s praise, means a physician of exceptional national standing. Guoyi Dashi, rendered here as “National Master of Chinese Medicine,” is also the name of a formal national honor. Dr. Ma turns the father’s broad compliment into the specific title, which explains Leo’s dismay. Earlier chapters have introduced the honor; this exchange does not establish that Evan’s teacher holds it. The report below documents the formal honor; the misunderstanding comes from the novel. Source: China Academy of Chinese Medical Sciences — National Master and Nationally Renowned Physician honors (in Chinese).