Chapter 78 Xiao Qinglong Tang

Evan explains a disputed pulse reading, but his choice of prescription draws another objection.

“Five pulse qualities?” Alex asked in astonishment.

Evan nodded. “That's right.”

“You're making that up. You must be.” Alex didn't believe it. He could accept that Evan had found an abnormal pulse. But five different qualities at the right cun alone? That was absurd.

Henry was doubtful too. He remembered how intently Evan had examined the pulse. Could the young man be an expert at pulse diagnosis? Impossible. An expert that young?

The people without medical training looked completely lost.

Lily turned to Clara. “Is that a really impressive skill?”

Clara never worried about going too far with her boasting. “Top of the profession. Seriously badass. Keep filming. This is the best footage we could ask for.”

Lily nodded, thoroughly convinced, and went on filming, careful not to be noticed.

Evan felt a little relieved himself. Thank goodness Dr. Liang had put him through such rigorous training. Without that foundation, he would have been lost. Just yesterday, he wouldn't have known what to make of the pulse beneath his fingers. With no other symptoms to guide him, he would have been completely baffled.

That was why all those hospitals and specialists had failed to cure the man. This really was a difficult pattern to identify.

Evan nodded. “Yes. That's what I'm basing it on. The right cun is slightly tight, and his eyes water when he coughs. That tells me wind-cold is binding the Lung. The large pulse indicates fire in the Lung.

“The slippery quality indicates retained phlegm-fluid. Taken together with the dry cough and lack of sputum, that tells us cold is enclosing fire. The phlegm can't get out, so he coughs violently. The pulse is also floating and slightly rapid, and his throat itches, so there are some mild signs of wind-heat as well.”^[1]

The Chinese medicine doctors were stunned. If Evan was right, the man's pattern was perfectly clear. But was he right?

Evan paused, then offered Alex some guidance. “Take the cough from dryness you mentioned. You still have to distinguish warm-dryness from cool-dryness. When warm-dryness causes illness, the pulse must be floating and rapid. There will also be headache and fever, a dry cough without sputum or with a little sticky sputum, and a red tongue with a thin white coating. You can use a formula such as Sangxing Tang.”

Alex was taken aback.

Henry frowned. He too had diagnosed warm-dryness. The pulse he had felt was floating and rapid, and the symptoms fit.

But he had read the previous treatment records. An earlier doctor had already prescribed Sangxing Tang, without any effect. That was what had left him unsure.

“With cool-dryness,” Evan continued, “the pulse is floating and wiry. You can use something like Xingsu San.^[2]

“But remember, a dry cough isn't necessarily a cough caused by dryness. Identify the pattern and treat it. Don't be so rigid about it. Got that?”

Alex looked awkward and embarrassed. Got that, my ass!

Leo's eyes lit up. Here it was! That familiar “Got that?” Damn. First he put you down, then he gave you pointers. It really was manipulation!

Henry was still uncertain. “Then write the prescription, Dr. Xu.”

Evan nodded. “All right. A modified Xiao Qinglong Tang.”^[3]

“Xiao Qinglong Tang? How can that treat a dry cough with no sputum?” Alex couldn't stop himself from objecting again.

Leo was speechless. Did this idiot never learn? Still challenging Evan? Did he think he could beat the master of mind games?

Evan sighed. “I just told you not to be rigid, and now you're doing it again.”

Leo spread his hands. There. Another put-down. If he wasn't mistaken, reassurance would come right after it.

Alex looked even more displeased.

“The classical indications for Xiao Qinglong Tang are,” Evan went on, “‘Cold damage with an unresolved exterior condition, retained fluid beneath the heart, dry retching, fever and cough; there may be thirst, diarrhea, a choking sensation, difficult urination with fullness in the lower abdomen, or wheezing. Xiao Qinglong Tang governs.’ It doesn't mention a dry cough without sputum. That's true.

“But you should know that Xiao Qinglong Tang evolved from Da Qinglong Tang. Both belong to taiyang patterns. ‘In a taiyang wind-strike pattern, with a floating, tight pulse, fever, aversion to cold, body pain, no sweating, and agitation, Da Qinglong Tang governs.’ His pulse is floating and tight—and specifically at the right cun.^[4]

“I've been telling you all this time: cold has enclosed the fire. And I said at the very start that cold water was surging against the Lung. What formula treats cold water surging against the Lung? Xiao Qinglong Tang!”

Alex looked worse still.

Leo shook his head. Just as he'd expected.

Evan began writing the prescription. “Since there are signs of constrained heat in the Lung, add raw gypsum and sangbaipi. The gypsum clears fire from the Lung and Stomach. Its pungent quality also helps the pathogenic influence pass outward. Sangbaipi drains the fluid held in the Lung with the constrained heat, directing it out through urination.

“Then add houpo and xingren. Houpo directs Spleen and Stomach qi downward. When that qi descends, Lung qi follows. When qi descends, phlegm resolves. Xingren is the quickest at diffusing Lung qi and directing it downward. The Lung governs the qi of the whole body; once Lung qi descends, the rest follows.”

He addressed Alex again. “The Shanghan Lun says, ‘When preparing Guizhi Tang for someone prone to wheezing, it is good to add houpo and apricot kernels.’ But those two aren't only for wheezing with phlegm. A cough is also Lung qi flowing upward against its proper direction. So you can use them to direct qi downward and move phlegm too. Learn to apply what you know!”

Alex turned his face away. Why keep telling him? Did he look as though he wanted to listen? The more Evan taught him, the more embarrassed he felt. It only made him look stupid.

The official page where the author publishes the story has this chapter, while this copy was reproduced without approval.

“And add ziwan and kuandonghua,” Evan said. “Those are two important medicines for stopping cough and resolving phlegm. They reinforce each other as supporting ingredients, to get a quick effect.”^[5]

He finished listing the ingredients and called to Clara. “Clara, fill this prescription.”

“On it!” Clara answered eagerly and went off happily to dispense the herbs.

Henry watched Evan, uncertain what to think. He still couldn't tell whether the earlier pulse diagnosis had been genuine, whether Evan really was that skilled. But the way Evan had explained the Shanghan Lun had astonished him. To understand the classics so thoroughly at his age was no small achievement.

“Dr. Xu,” he asked, “how much of this medicine will he need before we see an effect?”

“If it matches the pattern, one or two batches should be enough to show a change.”

Henry nodded slightly.

“That fast?” the patient's wife asked in surprise. “I thought Chinese medicine needed a long time to get your body back into balance.”

Evan gave a derisive laugh. “Chinese medicine treats disease. Treats it! The response should be as immediate as a drum answering a strike. It should bring stubborn illnesses to an end on the spot!”

The three Chinese medicine doctors standing there all went still. People thought Chinese medicine was only for keeping the body healthy, that it could no longer treat disease. How long had it been since anyone had spoken with such confidence?

“Oh?” The wife was startled too. “Oh, yes, yes, of course…”

The three doctors stayed. They all wanted to see what the medicine would do.

After a while, Clara brought the decoction over.

The man drank it while everyone watched.

A good while later, he rubbed his chest. “Hey. My throat doesn't itch anymore.”

“Oh!” his wife said delightedly. “You haven't coughed once since you drank it!”

Henry and the others felt another jolt. Could this be another cure with a single batch?

The result proved that Evan had got both the diagnosis and the prescription right. The treatment's effect was the best evidence!

“Dr. Xu, you're incredible!” the wife said delightedly. “All those specialists couldn't cure him. If only we'd come to you first! All that money, all those doctors, all those trips…”

She was off again.

Alex looked thoroughly miserable. He had come to settle a score with Evan, to see him make a fool of himself. Evan hadn't. Alex had made a fool of himself instead.

Too ashamed to stay, he turned to leave.

“Wait a moment,” Evan called.

Everyone looked at Evan. Even the wife stopped talking.

Alex stopped but didn't turn around. “What is it, Dr. Xu? Want to humiliate me some more?”

Evan sighed. “I wanted to tell you that I didn't trick your teacher into leaving, or force him out. He made that decision himself. How many doctors today know perfectly well what's going on and pretend they don't? None of them wants to give up the benefits and reputation they already have. Your teacher is different. He's a true physician. I respect him from the bottom of my heart.”^[6]

Alex turned back in disbelief. He hadn't expected Evan to say that.

Henry looked at Evan, then at the patient, then out through the doorway into the distance. He felt ashamed of how far he fell short. He, too, let out a long sigh.

“Ah…”

Reader Notes

Reader Notes

1. ↩︎ Pulse qualities and mixed patterns. The right cun is a pulse-taking position at the patient's right wrist, introduced in the preceding chapter. A pulse can combine qualities describing depth, breadth, movement, rate, and tension. Wind-cold, wind-heat, retained fluid, and “cold enveloping fire” belong to a traditional diagnostic vocabulary; cold and heat here are not simply thermometer readings. Evan combines that vocabulary with the tears and itchy throat to interpret this case. The terminology source defines the concepts rather than verifying his findings. Source: WHO — International standard terminologies, entries 889, 892, 894, 900, 906, 929 and 936.
2. ↩︎ Warm-dryness and cool-dryness. These are two traditional patterns involving dryness, distinguished by their accompanying signs and treatment principles. Sangxing Tang is associated with warm-dryness affecting the Lung; Xingsu San is associated with cool-dryness. The names identify different formulas, not warmer and cooler servings of one drink. “Wiry” describes a tense, stringlike pulse sensation. Evan's symptom lists describe the patterns in general; they do not establish that this patient has every listed symptom, or that all coughs without sputum arise from dryness. Sources: HKBU — Sang Xing Tang; Shanghai University of Traditional Chinese Medicine — Warm and cool autumn dryness (in Chinese).
3. ↩︎ Xiao Qinglong Tang. This classical decoction is associated with an external cold pattern and retained fluid within. Tang denotes a decoction; it does not mean a culinary soup. The familiar description includes cough with thin sputum, which explains Alex's objection. Evan chooses a modified version for the different pattern he has identified. The university reference distinguishes this from dry cough due to yin deficiency or internal phlegm-heat; the story's choice is not a general rule for dry cough. A ji is a batch of medicinal ingredients prepared together; the term itself does not specify a number of days or servings. Source: HKBU — Xiao Qing Long Tang.
4. ↩︎ Reading the classical indications. The Shanghan Lun, or Treatise on Cold Damage, uses taiyang as a traditional diagnostic division; “wind-strike” here does not mean a cerebrovascular stroke. The quoted alternatives are possible features in a formula's indication, not additional findings in this patient. “Beneath the heart” is a classical regional expression for the upper central abdomen. Xiao and da mean “small” and “large,” but Xiao Qinglong Tang and Da Qinglong Tang are distinct formulas. Evan's statement that one evolved from the other remains his account; the cited passages establish their indications, not that historical sequence. Sources: CUHK — Shanghan Lun Zhu, sections 2.4–2.5 (in Chinese); Tianjin TCM journal — Xinxia region, section 1.1 (in Chinese).
5. ↩︎ The added medicinal materials. Raw gypsum means the uncalcined mineral used medicinally. Sangbaipi is mulberry root bark; houpo is magnolia bark; xingren means medicinal apricot kernels, not ordinary almonds. Ziwan is aster root and rhizome, while kuandonghua is coltsfoot flower buds. Their supporting role describes how Evan combines them within the prescription. “Directing qi downward” and “resolving phlegm” are traditional functional descriptions, not a picture of literal substances falling through the body. The stated functions and expected speed belong to Evan's explanation. No quantities are supplied here. Sources: HKBU — Gypsum, Ziwan, Kuandonghua; Chinese Medicine Council of Hong Kong — Medicinal-material names.
6. ↩︎ Teacher and disciple. Alex's “teacher” is his medical mentor within a tradition of direct clinical instruction, rather than necessarily a university lecturer. Such relationships transmit practical skills and ways of interpreting cases alongside formal study. That background explains why his teacher's departure matters personally to him. Evan's reply concerns the teacher's own decision and professional integrity; it does not supply a new account of where he has gone. The modern document linked here explains the educational relationship, not the novel's particular events or date. Source: National Administration of Traditional Chinese Medicine — Mentorship education, articles 3 and 6 (in Chinese).