A second arrival keeps Clara on edge while Evan returns to his interrupted consultation.
Clara was close to breaking out in a cold sweat. This whole business was nerve-racking. Almost too exciting.
Two queens, face to face. It was happening right in front of her.
Meanwhile, Comrade Evan, an unwitting player, was perfectly calm, without a trace of fear. Ignorance was bliss.
He was still baffled. What was wrong with this patient? Why had she scratched his palm?
Was she ill?
What could be causing that symptom?
The woman who had just arrived looked much more mature than a girl like Little Octopus. Standing in the doorway, she gave Evan a brief once-over, then looked around the clinic.
Evan turned toward her voice. “I'm Evan Xu. Can I help you?”
She smiled. “I've come because of your reputation.”
Before Evan could react, Ben began to lose patience. He raised his head, took a few heavy breaths, and looked at the woman. Now they were showing up in groups to pose as patients?
She was quite pretty too. Why would she do something like this?
The woman glanced at Ben and paused in surprise. That middle-aged doctor really was rather annoying!
Ben turned toward Clara.
Clara was frantically scrolling through the chat history. Who was this woman?
Evan nodded to the newcomer. “Please have a seat. I'll see to her first.”
“All right.”
She stepped inside on long legs. At 173 centimeters, she was as tall as a man.
“That tall?” Clara was surprised when the woman came in. Then something occurred to her, and she immediately searched the chats again.
Found her!
Sunward Heart. Height: 173 centimeters.
“She's pretty distant!” Clara scrolled through the conversation. This woman had only asked a few brief questions about the clinic. They hadn't chatted about anything else.
Clara had thought she wouldn't come. None of those cute, enthusiastic younger girls had arrived, yet this cool, distant woman had come before them.
The reserved woman sat down to one side, her brow tightly furrowed, as though something was on her mind.
Little Octopus glanced back at her, then whispered to Evan, “You're pretty busy here.”
He nodded. “Not bad. No more talking. Let me take your pulse first.”
“Okay.” Little Octopus obediently agreed, then added, “I'll tell you a secret. My periods have actually been very light these past few months. And they're really short. Only two days.”
Evan frowned.
The others were taken aback too.
This girl was quite something. Coming to a doctor and withholding her symptoms, then presenting a scanty period as a secret! What was wrong with young people these days?
Ben was puzzled. Some shill she was. Was this part in the script too?
Clara was surprised for a different reason. This was supposed to be about treating period pain. Where had scanty periods come from? Was that even on the syllabus?
The woman waiting nearby glanced over a couple of times but said nothing.
“Did the amount decrease gradually, or did it drop all at once?” Evan asked.
“It's been getting less over the past few months. Less than half what it used to be, I think.”
Evan gave a small nod. A gradual reduction usually meant deficient qi and blood; a sudden drop usually meant some obstruction.
“All right. Settle down and don't talk. It distracts me. Let me finish taking your pulse first.”
“Okay,” Little Octopus said obediently.
Evan located the cun, guan, and chi positions on her wrist and began examining her pulse carefully. This time he had her stay seated rather than lie down. He was quite practiced at pulse examination now.[1]
Ben kept staring at Little Octopus. In a moment of inattention, he lost his game of Dou Dizhu. He didn't care at all; he was looking thoughtful instead.
Little Octopus noticed him watching her. She turned her head away with a quiet “Hmph.”
Evan continued examining her for a long time, steady and unhurried, with something of a master's composure.
Little Octopus tilted her head and watched him for a good while.
The reserved woman seated nearby also glanced at him from time to time.
Ben kept curling his lip. Quite a detailed performance. Did Evan even know how to take a pulse? Since when had the King of Siwu Tang learned that?
After a while, Evan finished examining the pulses at both wrists and nodded slightly. The pulse felt slightly small. The main pattern was qi and blood deficiency.
“Ms. Zhang, your periods are early and scanty because your qi and blood are deficient. I'll prescribe something to replenish them in a moment.”
Little Octopus's real name was Emily Zhang, and she was still in college. Evan had learned that when registering her earlier, which was why he addressed her that way.[2]
The story has been illicitly taken; should you find it on Amazon, report the infringement.
“Okay.” Little Octopus grinned.
Ben's eyes shifted. Suddenly he spoke up. “Dr. Xu, how can you be sure it's qi and blood deficiency? It could be blood stasis.”
There were many possible causes of early, scanty periods. Evan had said nothing about differentiating the patterns; he was going straight to a prescription.
Ben knew at once: the kid had barely prepared. Well, of course. Once you'd hired a shill, all that mattered was her acting. Why bother studying the medicine?
So he challenged Evan on the spot. He would expose the whole scheme and let that stupid woman Clara see this fraud for what he was!
Trying to use fake patients to take his place as Mingxin Clinic's best doctor. The nerve of him.
Evan paused in surprise at the question, then answered.
“With scanty menstruation, dark purple blood with clots and abdominal pain that gets worse with pressure indicate blood stasis… Her menstrual blood is pale, and pressure relieves her pain. There's no distending pain. This is a deficiency pattern.”[3]
“Oh.” Ben faltered, then hurried on. “But… pale red… pale red blood… that could also be phlegm-dampness obstruction.”
“Pale red blood with a sticky, phlegm-like consistency indicates phlegm-dampness,” Evan said. “But people with phlegm-dampness tend to be overweight. This girl is thin and frail. And her pulse is neither soggy nor slippery. It's small, which indicates qi and blood deficiency.”[4]
Ben was taken aback. Damn. Now he was bringing pulse qualities into it!
Little Octopus pursed her lips too. “I'm not fat!”
“More importantly,” Evan continued, “phlegm-dampness obstruction can indeed reduce the amount of bleeding, but it generally doesn't make a period come early. If it's blocking the flow, how is it supposed to come out ahead of time?”
“Oh, right.” Ben absently rubbed his chin.
“Hmph!” Little Octopus gave a louder snort, looking proud. Dr. Xu really knew his stuff!
Behind the counter, Comrade Clara was pleasantly surprised too.
Ben felt he had lost face. He hurriedly searched his memory.
“But… early periods aren't usually caused by qi and blood deficiency either. She hardly has any blood, does she? If there's so little that the womb isn't even full, how could it come out early? I remember that early menstruation is usually caused by blood heat forcing the blood downward. Yes. That's right.”
The others thought it over. It did seem reasonable. They all looked at Evan again, while Little Octopus silently cheered him on.
Evan explained, “The Jingyue Quanshu says: ‘Blood heat often brings menstruation early, but one must examine whether yin qi is deficient or in excess. If the flow is red, or purple and thick, or plentiful; if the pulse is surging and slippery; if cold food and drink are preferred and heat is disliked—all these belong to fire.’[5]
“She doesn't have those heat signs. Her menstrual blood is pale. I haven't seen parched lips, a dry mouth, an aversion to heat, or a preference for cold. Her pulse is neither wiry and rapid nor thready and rapid. It's faint.”[6]
“Then how do you explain it coming early when there's so little?” Ben asked.
“It can happen. Qi is the commander of blood. Her qi and blood are so deficient that qi has lost the strength to contain blood. There's very little qi and blood to begin with, and the deficient qi can't keep the blood in check. The Chong and Ren Vessels can't hold firm, so her periods come early even though the flow is scanty.”[7]
Ben was dumbfounded.
“Damn,” he muttered. “He really came prepared!”
The reserved woman gave Evan a surprised look too.
Reader Notes
↩︎ The three wrist positions. Cun, guan, and chi are adjacent positions used in Chinese pulse examination. The examiner considers the pulse's feel as well as its rate. The examination interrupted in the previous chapter now resumes, with the patient seated. Source: WHO — Chinese medicine terminology, entries 883 and 890–911.
↩︎ Little Octopus and Ms. Zhang. In the Chinese novel, her name is Zhang Yu (章瑜), which sounds like zhangyu (章鱼), “octopus.” The adapted name Emily Zhang cannot carry that sound play, so the nickname is retained separately. Her real name is revealed here, after the nickname has already appeared. Evan's original address is Zhang tongxue, a polite way to address a student by surname; “Ms. Zhang” serves that purpose in this English scene. This explanation follows the names and address in the Chinese text.
↩︎ Deficiency or obstruction? Pattern differentiation is the traditional practice of weighing a group of signs to distinguish possible explanations. Qi and blood deficiency concerns insufficient function and nourishment; blood stasis concerns impaired movement of blood. Pressure that eases pain is one of Evan's reasons for choosing deficiency, while dark clots and pain aggravated by pressure are his contrasting signs. “Blood stasis” here is a traditional category, not a diagnosis of a clot in a particular blood vessel. Source: WHO — Chinese medicine terminology, entries 428, 434, 1113, and 1122.
↩︎ Phlegm-dampness. In this traditional vocabulary, dampness and phlegm refer to categories of retained or improperly distributed fluids. Phlegm can describe a pattern without anything being coughed up. Ben proposes an obstructive explanation, and Evan weighs the flow's consistency, the patient's build, and pulse qualities against it. A “soggy” pulse is soft and superficial, becoming hard to feel under pressure; a “slippery” one feels smooth and flowing. The statement about overweight patients belongs to Evan's diagnostic argument, rather than establishing a rule about body size. Source: WHO — Chinese medicine terminology, entries 342–344, 900, 911, and 1066.
↩︎ Jingyue Quanshu. The title means approximately “The Complete Works of Jingyue,” a Ming-period medical work by Zhang Jiebin. The passage is in volume 38, “Early menstruation due to blood heat.” It asks the reader to consider the whole pattern rather than identify heat from an early period alone. Its discussion also allows for early bleeding when qi lacks the strength to hold blood. The quotation is translated from the excerpt supplied by the novel; the linked source is a Chinese transcription of the classical work. Source: Shidian Guji — Jingyue Quanshu, volume 38, “Blood heat and early menstruation” (in Chinese).
↩︎ What the pulse feels like. “Surging,” “slippery,” “wiry,” and “thready” describe different tactile qualities, not just different heart rates. “Rapid” adds a rate description. The Chinese term Evan uses for her pulse here is wei, a feeble or barely perceptible pulse; the earlier description was simply “small.” The narrative moves from that general description to a named quality. These are observations within the traditional examination, rather than an instrumental measurement of her circulation. Source: WHO — Chinese medicine terminology, entries 892–896, 900, and 904.
↩︎ Qi as commander, Chong and Ren as vessels. Calling qi the commander of blood is a metaphor for its traditional roles in moving and containing blood. Chong and Ren are functional vessels associated with menstruation. Evan argues that there is little blood to lose and too little qi to restrain it; the vessels' failure to hold firm describes that lost restraint. This continues his explanation in the previous chapter. Source: WHO — Chinese medicine terminology, entries 442, 1124, and 1968.