At a small neighborhood clinic, Evan Xu sees his first patient of the month.
My name is Evan Xu.
I practice Chinese medicine.
I have a postgraduate degree. Top of my department, recognized by the province as an outstanding graduate. The city hospital of Chinese medicine hired me straight out of school. Two months later, they fired me.
Today marks six months and seventeen days since I was fired.
Weather: sunny.
Mood: still bad.
I now work at Mingxin Clinic, a small private Chinese medicine clinic on the ground floor of the Sunshine Residential Community in Wen County. The pay is 2,500 yuan a month. No allowances, no meal subsidy, no housing. There is social insurance, though.
Sitting across from me is a patient. My first this month. Her name is Lily Li, and she's here for menstrual cramps.
“Patient reports fatigue and little desire to speak. Irregular menstruation, arriving six or seven days early or late. Distending lower abdominal pain before and after menstruation, with nausea. Menses last three days; scanty flow, black in color, with clots. Warmth provides slight relief; pain eases after clots pass. Stools dry and hard, bowel movements once every two to three days…” Evan finished entering the case notes on his computer.
Lily held one hand over her lower belly and propped her chin on the other, studying him. Why did this handsome young man always look as though he had something weighing on him?
Evan looked at her face. Her makeup was too thick for him to learn anything from inspecting her complexion. “Stick out your tongue. Let me have a look.” She did.
“Lift the tip. I need to see underneath.” Frowning, he hesitated before typing: Tongue pale red; coating thin and white. “Hold out your hand. I'll check your pulse.” Lily obediently placed her wrist on the pulse cushion.
He located the guan position with his middle finger, using the bony prominence on the thumb side of her wrist—the radial styloid—as a landmark. Then he placed his index and ring fingers at the cun and chi positions. With all three fingers in place, Evan closed his eyes and carefully felt her pulse.
Lily kept her eyes fixed on the melancholy young doctor. The thing to do when you had cramps was look at handsome men. A perfectly good home remedy!
He soon released her right wrist. “Your left hand.” She offered it, and he spent just as little time checking that pulse. After he let go, he should have entered his findings in the case notes. His hands rested on the keyboard, but he couldn't type a thing.
Lily tilted her head. “Dr. Xu? What's wrong?”
“Nothing.” He shook his head and frowned in thought. Her cramps ought to be a case of cold causing blood stasis. In Chinese medicine, menstrual pain came down to two causes: a lack of nourishment, or an obstruction. The first was a deficiency pattern; the second, an excess pattern.
Distending pain in the lower abdomen, relief with warmth, clots: cold must have lodged in the lower burner, the lower region of the body in this framework. It caused blood stasis, blocking the flow of qi and blood.[1] Obstruction caused pain. Once the clots passed, qi and blood could flow freely, and the pain eased.
Pain before a period was usually an excess pattern: qi and blood moved downward, met an obstruction, and caused pain. Pain afterward was usually a deficiency pattern. Menstruation depleted qi and blood; there wasn't enough left to nourish the womb, and that lack of nourishment caused pain.
But she had pain both before and after her period. Could she have both deficiency and excess?
The dominant pattern should still be excess cold. Reduce excess; warm cold. The formula to use was Shaofu Zhuyu Tang. It warmed the channels and dispersed cold, invigorated blood and resolved stasis. It ought to fit her pattern.
In theory, that should be right.
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Watching him think so seriously, with that sad, attractive face, Lily felt a flutter. Her cramps immediately eased quite a bit. “Dr. Xu, what do you think?”
“I'll write you a prescription.”
“All right.”
At the mention of a prescription, a girl with a ponytail standing by the counter turned to watch Evan.
He put both hands on the keyboard, ready to enter it. But his hands trembled. His lips pressed together, and anxiety flashed in his eyes.
But what about her other symptoms?
He still hadn't done anything. “Dr. Xu?” Lily prompted.
“Huh?” He turned toward her, looking lost, then came back to himself. He swallowed. “I… I'll prescribe some Siwu Tang for you to drink.”
Siwu Tang again. The girl by the counter rolled her eyes.
Lily looked taken aback too. “Siwu Tang? I've tried that. It didn't do much.”
Evan looked a little panicked. “You have to keep taking it. Try it a little longer… Well…”
“All right.” Lily discreetly pursed her lips. She was disappointed. She should have gone to an older Chinese medicine doctor. This pretty boy was good to look at and useless for anything else. All that promise, and nothing to back it up. His looks might ease her cramps, but that treated the symptoms, not the cause!
Evan quickly completed the prescription, unable to hide his dejection. He knew his own limitations. Postgraduate degree or not, he was full of theory and short on clinical skill. He could treat a simple pattern, up to a point, but several patterns occurring together were beyond him. More than that, he was afraid to treat patients at all. That incident had left him too shaken.
He looked behind him at Ben Song, Mingxin Clinic's other doctor. Ben was thirty-five, had a bachelor's degree and had practiced for ten years. He… couldn't treat patients either. But he was better than Evan at one thing: talking people into believing him.
Ben was seeing a patient too. The middle-aged man across from him puffed out his cheeks. “Dr. Song, the medicine you gave me last time didn't work. My mouth is still full of ulcers. They haven't improved at all.”
Compared with Evan's caution, Ben was utterly casual. “What did I give you last time? Oh, Zhibai Dihuang Wan. I suspected your Kidney yin was depleted. Yin couldn't restrain yang, so you had yin deficiency with excessive heat. That was causing the ulcers. Men always have a bit of trouble with their Kidneys.”
“Hey, I don't! Don't go saying that.” The patient immediately grew agitated.
Ben waved a hand. “I'm talking about your condition. Yin deficiency with excessive heat. That's why I gave you Zhibai Dihuang Wan. The Dihuang Wan formula nourishes Kidney yin, and the zhi and bai herbs clear deficiency heat. But now it looks as though that wasn't it. If it isn't Kidney fire, it has to be Heart fire.”
“Yes, that's right.” Ben nodded, certain of it. “Definitely Heart fire. The Heart opens into the tongue; the tongue is the Heart's sprout. Sores in the mouth and on the tongue must mean Heart fire rising. It also burns up body fluids. You must have felt thirsty?”
“No.” The patient shook his head.
“Huh?” Ben paused, then immediately said, “You must have had some water, then.”
“Oh, right!” The patient considered this. It seemed to make sense.
“The Heart and Small Intestine are linked as an interior–exterior pair,” Ben went on. “And the Small Intestine governs fluids. If your Heart fire moves to the Small Intestine, it'll burn up the fluids there, so you'd be passing very little urine, dark yellow in color. Right?”
“No.” Another shake of the head.
“Huh?” Ben paused again. “Then… the Heart fire hasn't reached your Small Intestine yet. You're lucky. And you like drinking water, so that's diluted your urine. Your first pee in the morning must be very yellow.”
“It is.” Again, the patient thought this seemed to make sense.
“All right. I'll prescribe some Daochi San. It clears heat and nourishes yin, and it's indicated for mouth ulcers.”
“Okay.” The patient nodded.
Once he'd finished the prescription, Ben said, “Come on. Let's go to the treatment room for some tuina massage.”
The patient looked taken aback. “Huh? I need a massage for too much internal heat?”
“It's only thirty yuan,” Ben said impatiently. “You'd pay more than that for a massage chair at the station. And medical insurance covers it. What's there to lose?” He pulled the man into the treatment room.
Evan shook his head with a rueful smile. He knew Ben had identified the wrong pattern. It certainly wasn't excess heat, and probably wasn't yin deficiency either. But he couldn't explain why.
Ben couldn't treat patients. Neither could Evan. They were about as bad as each other.
Evan sighed softly, his expression troubled. There was something no one knew. Besides being unable to treat illness, he had an illness himself.
With his eyes open, everything was normal. But whenever he closed them, he could see a line of text:
System loading: 99%.
It had been there since the day he was fired. At first it had read 1%. It had taken half a year to reach 99%.
At first he'd been frightened and unable to sleep. Then he'd grown curious and confused. Now he and the thing could live together in peace. Much longer and he might start getting attached.
Evan shook his head. He had no idea what this system was, or why it had spent six months loading. At that speed, it was probably running some knockoff version of Android.
Reader Notes
↩︎ The medical language follows the characters' Chinese medicine framework. Qi refers to the body's vital activity; yin and yang describe interdependent aspects of its functioning. Capitalized names such as Kidney, Heart and Small Intestine refer to functional systems within that framework.