A patient's anger leaves Mingxin Clinic in a difficult position. Evan tries to bring the conversation back to the illness.
Clara stood up. “Sir, you'd better be able to stand by that accusation!”
“What have I said that's irresponsible?” the driver shouted. “What did I say that wasn't true? You didn't cure me! You just prescribed whatever you felt like!”
“That other doctor didn't cure you either,” Ben protested. “Why aren't you giving him a hard time?”
“Shut up! All you know is process of elimination. You don't know shit!”
Ben was livid.
Evan shook his head. He'd suspected all along that something was wrong with Ben's prescription. His own skills had been too limited then to work out the underlying pattern.
But he was no longer the doctor he'd been.
He got to his feet. “Sir, please calm down. Getting angry won't help.”
“Won't help? You people treat patients any way you like, and now I'm not even allowed to say anything?”
“What exactly do you want?” Clara asked.
The driver pointed at Ben. “Money! Compensation for my losses. And a public apology from you!”
Several expressions crossed Ben's face in quick succession.
Clara was overwhelmed.
Evan sighed. “Sir, no amount of money or apologies will cure your mouth ulcers. You've had them for some time, haven't you? They keep coming back, and treatment hasn't cleared them up.”
The driver had been ready to keep swearing, but he turned, startled. “How did you know?”
Evan paused. Before he could answer, the driver demanded of Ben, “Did you tell him?”
“I don't even know how long you've had them!” Ben said indignantly.
“Didn't I tell you?”
Ben hesitated. “Did you?”
“Didn't I?” the driver snapped.
“All right, all right,” Evan cut in. “Dr. Song hasn't told me about your case. Mouth sores can belong to either a deficiency or an excess pattern. The ‘Mouth and Tongue’ section of the Shoushi Baoyuan says, ‘Mouth sores that persist without healing are due to deficiency heat.’”[1]
“Dr. Song gave you medicine to clear excess heat, and it didn't work. That makes deficiency heat a strong possibility. But I still need to examine you again to see exactly what's going on.”
For a moment, the driver was taken aback.
Evan continued patiently. “However angry you get, however much you shout, isn't it all because you're still ill? These sores must have been tormenting you for a long time. Getting them treated matters more than anything else, wouldn't you say?”
“Can you cure me?”
“No doctor can guarantee a cure. But if we identify the pattern correctly and use the right medicine, there will certainly be a response.”[2]
The driver was moved by Evan's sincerity. There was also that bit of old writing the young man had just recited. He hadn't understood it, but it had sounded reasonable.
And this doctor had spotted that his mouth ulcers were a longstanding problem. Perhaps he did know what he was doing.
In fact, ordinary circumstances alone made that fairly easy to work out. These days, hardly anyone went to a Chinese medicine practitioner to have an illness treated. They went for tuina, massage, or to improve their general health.[3]
Mouth ulcers were an illness, however minor. When the pain became unbearable, people went to a conventional doctor. For this man to seek Chinese medicine, especially at a small place like Mingxin Clinic…
There could only be one reason: conventional treatment hadn't cured him, so he'd come to try his luck. He must have had the ulcers for some time.
“Fine. You can have another look.” The driver pointed at Ben. “I'll settle with you later.”
Ben didn't know whether to laugh or cry. Why was the man still blaming him?
The driver sat opposite Evan. “Let me tell you all now: if you don't cure me, don't expect a cent. And I'll be coming after you too.”
Evan looked at Clara. She was the owner, after all.
Clara let out a breath and nodded to him.
The woman who'd come to see Ben was watching Evan in admiration too. Somehow, he looked even more handsome now.
Ben still wasn't entirely reassured. “Evan, can you really handle this? Heat patterns in the upper and lower burners were both wrong, so this time it has to be the middle burner. I'm telling you, it's definitely hidden fire in the Spleen and Stomach. Remember to use Xiehuang San.”[4]
“Will you shut up!” the driver shouted.
Ben swallowed his frustration.
“All right, no more arguing,” Evan said. “And try to calm down. Getting angry isn't good for you. Open your mouth. Let me have a look.”
The driver opened his mouth.
Evan frowned as soon as he looked inside. The ulcers really were severe. There were more than a dozen on the side of the tongue and elsewhere inside the mouth.
With that many sores, neither eating nor drinking could be comfortable. The man couldn't get a moment's relief all day. No wonder he was so irritable.
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Evan examined them more closely. The smallest were the size of millet grains; the largest, soybeans. They were pale, not red.
With a slight frown, he said, “Stick out your tongue. Let me see.”
The driver did.
The tongue coating was white and greasy. Phlegm-dampness! Most often caused by Spleen deficiency.[5]
“Give me your hand. I'll take your pulse,” Evan said.
The driver held it out, still making a sour face at Ben.
Ben was utterly speechless.
Everyone watched Evan anxiously. Whether they could resolve this mess today depended on him.
That was one of the difficulties of running a private clinic. Whether at a large hospital or a small practice, whether a celebrated physician or an ordinary doctor, nobody could guarantee a cure every time. Not even for the simplest minor illness.
If a treatment failed, most patients changed medicines or doctors. Few came back to make a scene. A large hospital could handle such a dispute more easily. At a small clinic, it was much more troublesome.
And today Ben was in the wrong over one thing: he'd insisted that the man have tuina.
Still, Ben was seething. He wanted to know which doctor had been talking nonsense and making these accusations against him!
After a while, Evan released the man's hand. The findings were clear: a deep, thready, weak pulse. A thready pulse was commonly associated with weak qi and blood, yang deficiency, and Stomach cold. The tongue findings also confirmed Spleen deficiency.[6]
The ‘Mouth’ section of the Yizong Jinjian also stated: “With deficiency heat, mouth sores are pale red, with tiny white spots throughout the mouth… With excess heat, they are vivid red, with ulcerated patches throughout the mouth…” The patient's sores were pale, not red. They probably didn't belong to an excess-heat pattern.[7]
Putting the findings together, Evan gave a small nod. He had his conclusion.
“How's your appetite? You don't feel like eating much, do you?”
The driver nodded. “Right. I'm full after a few bites.”
“Do you often feel tired? Weak all over?”
The driver nodded eagerly. “Yes, yes. I wake up with no energy. I haven't even been driving for a few hours before I'm exhausted.”
“What about your bowel movements? Often loose?”
“Yes. They're never properly formed.”
“And cold food makes your stomach uncomfortable?”
The driver became excited. “Yes! Yes, exactly! How did you know?”
Ben stared. He was almost ready to ask whether Evan had hired the driver as a shill!
The woman who'd come to see Ben exclaimed, “Wow! Brother-in-law, look! He's amazing!”
“Ahem! Ahem!” Ben hastily coughed twice, loudly.
Clara stared at her, wide-eyed. She had no words.
Ben's sister-in-law knew she'd slipped up too. She stuck out her tongue and hurried out of the way.[8]
Evan nodded slightly. Everything fit. There was no mistake.
“The cause of your mouth ulcers lies in the Spleen and Stomach.”
Ben perked up at once. “See? What did I tell you? I said it, didn't I? The Spleen and Stomach! That's what Xiehuang San is for!”
Evan rolled his eyes. Why the hell did he have to keep butting in? The fool was making it impossible to save him!
Reader Notes
↩︎ Deficiency and excess heat. These are contrasting categories in Chinese medicine. Excess refers to an overabundance of pathogenic factors, while deficiency concerns weakened bodily functions or insufficient nourishing resources. “Fire” is heat-related theoretical language, not literal burning. Deficiency heat is often discussed with yin deficiency, but Evan has not established a specific pattern here. His quotation comes from the older medical compendium Shoushi Baoyuan. The novel renders its point as persistent mouth sores suggesting deficiency heat; the linked transcription has a wording variant at the corresponding passage. Sources: WHO — Chinese medicine terminology; Shoushi Baoyuan — Volume 6, “Mouth and Tongue” (in Chinese).
↩︎ Identifying a pattern. Pattern differentiation brings together symptoms, tongue findings, pulse qualities, and other observations within Chinese medicine's diagnostic framework. A biomedical disease name and a traditional pattern are different kinds of classification. Evan's assurance about a treatment response remains his statement to the patient. Source: Hong Kong Department of Health — Diagnostic Methods and Features of Chinese Medicine Practitioners.
↩︎ Tuina. This is the manual therapy, including massage techniques, mentioned earlier in the series. The passage distinguishes visits for massage or general wellbeing from visits to treat an illness. Its account of patients' habits is the narration's framing of this setting. Source: Hong Kong Health Bureau — Chinese medicine interventions, tuina.
↩︎ The middle burner and Xiehuang San. The middle burner is the digestive region of the three-jiao framework, associated with Spleen and Stomach functions. Xiehuang San is the formula Ben proposed in the previous chapter for “hidden fire” in those systems. Naming the same functional region does not specify the same pattern or medicine. At this point it remains Ben's proposal; nobody has taken the formula in this scene. Sources: WHO — Chinese medicine terminology, entries 207–210; Beijing University of Chinese Medicine — Comparison with Xiehuang San (in Chinese).
↩︎ Phlegm-dampness and Spleen deficiency. In this vocabulary, dampness concerns disordered fluid handling; phlegm can mean a theoretical pathological accumulation, including forms that are not coughed up as sputum. The Spleen's traditional functions include transforming food and transporting nourishment and fluids. Weakness in that functional system is therefore linked with digestive symptoms and the accumulation of dampness or phlegm. Evan reads the white, greasy tongue coating through this framework. The passage describes his assessment, without identifying a microorganism or a biomedical disease. Sources: WHO — Chinese medicine terminology, entries 342–345, 682, and 1066; The Chinese Medicine Hospital of Hong Kong — Zang-xiang, Spleen and Stomach.
↩︎ Deep, thready, and weak. These words describe different tactile qualities: how much pressure is needed to feel the pulse, how fine it feels, and how strongly it meets the fingers. They are not a numerical blood-pressure result. Qi and blood deficiency, yang deficiency, and Stomach cold are traditional categories; the latter describes impaired warming and digestive function, not a measured stomach temperature. Evan combines the pulse with the tongue findings. His interpretation is retained as the novel's clinical reasoning. Source: WHO — Chinese medicine terminology, entries 890, 896, 1092, and 1122.
↩︎ Yizong Jinjian. This medical compendium distinguishes pale-red sores with small white spots from vividly red, ulcerated patches in its discussion of deficiency and excess fire. Evan uses the patient's pale sores to argue against excess heat. The quotation here follows the novel's shortened wording; it does not import the classical passage's other symptoms or prescriptions into the examination. Source: Yizong Jinjian — Volume 65, mouth sores (in Chinese).
↩︎ Brother-in-law. The Chinese address is jiefu, one's elder sister's husband. Her slip, followed by the narrator's description of her as Ben's xiaoyizi—his wife's younger sister—reveals the family connection here. “Brother-in-law” preserves the surprise in English, and the following sentence identifies her as his sister-in-law. Neither person has been given an additional name. This explanation follows the relationships stated in the Chinese scene.