A chance to learn under Dr. Qian is more than Evan dared hope for. Now the lessons begin.
Back in Evan's own time, Professor Oliver Liu had once come to give a lecture at his university of Chinese medicine.
What a crowd. The auditorium seated two thousand, and the Chinese medicine students had filled every seat. Even the aisles were packed. Evan had sat in an aisle himself, with no chance of getting up to ask the professor a question.
Still, he'd learned an enormous amount from that one lecture.
Most experts in Chinese medicine with that many official titles were researchers in Chinese medicine or pharmacology. That didn't necessarily mean they knew how to treat patients. Professor Liu was different. He was a true master of clinical practice.
People in the field said age was the only thing holding him back. For now, he could only receive the honor of Nationally Renowned Physician of Chinese Medicine.
Give him a few more years, and he was certain to receive the government's highest honor in the field: National Master of Chinese Medicine. Three ministries awarded it jointly, selecting only thirty people every four years.[1]
How could someone that extraordinary be sitting right beside Evan—and belong to the same group of new doctors?
What Evan hadn't realized was that he'd just pulled off something even more incredible.
Oliver was baffled too. He had no idea why Evan kept staring at him.
“Comrade Evan Xu, come with me,” Dr. Qian said. “It's time we began seeing patients.”
“Yes.” Evan hurried after him. Before leaving the meeting room, he glanced back at Oliver, still shaken.
Wait. Why shaken?
Dr. Qian walked ahead, Evan following with a hand in his pocket, constantly pinching himself. If the pain hadn't registered each time, he would have thought he was hallucinating.
But everything before his eyes told him it was real!
Everything his senses registered told him it was real!
His heart slowly settled. Excitement and delight rushed in.
Dr. Qian was 82 now. His health wasn't what it had been, and he walked slowly. After a moment's thought, he stopped and asked, “Evan, how is your grounding in theory?”
“It's… all right…” Evan hesitated. Theory was about the only thing he was all right at.
Dr. Qian nodded slightly. “Then let me test you. Do you know how menstruation arises?”
Evan quickly pulled himself together. “The ‘Shanggu Tianzhen Lun’ chapter of the Suwen says: ‘At seven, a girl's Kidney qi flourishes; her teeth change and her hair grows. At twice seven, tiangui arrives, the Ren Vessel opens, and the Taichong Vessel flourishes. Her periods come at their appointed times, and so she can bear children.’[2]
“So menstruation arises when Kidney qi flourishes, tiangui arrives, the Ren Vessel opens, and the Taichong Vessel flourishes. The zang-fu organ systems, qi and blood, and the channels act together upon the womb, which stores and releases at regular intervals. That is how menstruation occurs.”[3]
“What are the Taichong Vessel and the Ren Vessel?” Dr. Qian asked.
“The Taichong Vessel is the Chong Vessel—the sea of blood,” Evan replied. “It begins in the womb, rises to the head, and connects with the yang channels. It descends to the feet, where it meets the three yin channels of the leg. It also intersects the Foot Yangming Stomach Channel at the Qijie point and runs alongside the Foot Shaoyin Kidney Channel. It is a meeting place for the qi and blood of the twelve channels. It gathers qi and blood from the zang-fu organ systems and sends them down into the womb, where they become menstrual blood. It is the foundation of menstruation.
“The Ren Vessel is the sea of the yin channels. It also begins in the womb and governs the body's yin, overseeing essence, blood, and the thin and thick bodily fluids. It is the basis for sustaining pregnancy and governs the fetus. Only when its qi flows freely can yin essence nourish the womb and menstruation and pregnancy proceed normally.”
Dr. Qian relaxed a little. “If a woman has a bleeding disorder—an acute case of flooding and persistent uterine bleeding—what formulas would you use?”[4]
“Common formulas include Dushen Tang, Shengmai San, Qingre Gujing Tang, Shixiao San, Juyuan San, and Jiao'ai Tang,” Evan answered. “In an emergency, decoct them quickly over high heat and give the decoction as it is prepared, to prevent collapse from blood loss. Treatment must begin with pattern differentiation. If there is qi deficiency, use substantial amounts of ginseng and astragalus to supplement qi and help it contain the blood.[5]
“For blood deficiency, add ejiao, hanliancao, and other medicines to nourish blood and stop bleeding. For blood heat, add xianhecao, qiancao, daji, and diyu to cool the blood and stop bleeding. For blood cold, add charred aiye, paojiang, and buguzhi to warm the channels and stop bleeding.
“For blood stasis, add puhuang, xuejie, yimucao, and sanqi to dispel stasis and stop bleeding. If the bleeding is heavy, add calcined longgu, calcined muli, haipiaoxiao, and chishizhi to astringe and check the bleeding.
“And for emergency treatment, nothing is faster than acupuncture. One can needle Zigong, Sanyinjiao, Duanhong, Zhongji, Xuehai, Taixi, Guanyuan, and Yinlingquan to stop bleeding. For ear acupuncture, use the uterus, ovary, adrenal gland, Heart, Liver, and Spleen points, retaining the needles for 15–20 minutes.”[6]
Evan slowly breathed out. He knew his theory very well. In practice, though, he could manage only a simple, clearly defined condition. Give him a complicated case with concurrent patterns, and he'd drop to his knees right there.
Dr. Qian nodded slightly. He'd thought Evan's foundations would be terribly weak, but they seemed quite decent. Was this really the bucket's shortest stave? Had the boy been modest?
He nodded with a smile. “Your grounding in theory is reasonably solid.”
“Mm… a little better than Oliver Liu's,” he added.
Evan stopped walking.
Dr. Qian took another two steps. When Evan didn't follow, he turned, puzzled. Evan stood rooted to the spot, drawing in breath after breath.
“Evan, what are you doing?” Dr. Qian asked, thoroughly confused.
“Give me a second. I think it's going to my head…”
“Huh?” Dr. Qian paused, then shook his head. “Come along.”
“Yes.”
This new young doctor was rather strange. Dr. Qian shook his head and led Evan into the consultation room.
He sat in a chair. “Bring a stool over and sit beside me. You'll examine the patient first.”
“Yes.” Evan obediently fetched a stool and sat beside him.
Soon a patient knocked at the door.
“Come in.”
A woman entered, holding her abdomen.
“When diagnosing and treating women's conditions,” Dr. Qian reminded Evan, “you must understand how the Heart, Spleen, Liver, and Kidney relate to the Chong and Ren Vessels and the womb. Along with using the four diagnostic methods to differentiate patterns, you must consider menstruation, vaginal discharge, the breasts, childbirth, and pregnancy. Above all, weigh the findings from all four methods together. You cannot neglect any one of them. Sit down. Let's begin.”[7]
The woman sat across the old wooden desk.
Evan was a little nervous.
She had come for treatment of menstrual pain.
As he questioned her, he recorded her condition:
21 years old, unmarried. Agitation and irritability, nausea with an urge to vomit, dry mouth. Lower abdominal distension and pain before menstruation, with aching in the lower back. Sluggish menstrual flow with purplish-black clots; pain eases slightly after clots pass. Breast distension and pain; fullness, oppression, and pain in the chest and flanks.
“Stick out your tongue,” Evan told her. “Lift it up so I can see.”
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Puzzled, he frowned and wrote in the case record:
Tongue body red?
He nodded and felt relieved. Luckily, it was a single, straightforward condition.
“It should be qi stagnation and blood stasis,” he told Dr. Qian. “The tongue should be red. The signs indicate Liver qi constraint, which leads to qi stagnation. That is also what causes the distension and pain in the lower abdomen. Pain before menstruation usually indicates an excess pattern. Her agitation and irritability suggest Liver constraint transforming into fire and disturbing the mind. Liver fire also attacks the Stomach, causing disharmony between the Liver and Stomach. Stomach qi rises instead of descending, which is why she feels nauseated and wants to vomit.[8]
“The nipple is linked to the Liver, and the body of the breast to the Stomach. The distension and pain in her breasts and chest during menstruation also arise from Liver qi constraint and stagnation. Stagnant qi leads to blood stasis; obstruction causes pain. Stasis blocks the Chong and Ren Vessels, so menstrual blood doesn't flow freely, producing sluggish flow and purplish-black clots. It also causes distension and pain in the lower abdomen, extending to an aching lower back. Once the clots pass, the pain eases.
“Fu Qingzhu Nüke says: ‘When menstruation is about to begin and the Liver fails to respond, its qi is checked and pain arises.’ Patterns can be deficient or excessive. Qi stagnation is an excess pattern; excess must be drained. We should soothe the Liver and relieve its constraint. Once qi can move freely, all her symptoms will naturally disappear…”[9]
Dr. Qian looked at him and frowned. “Finished?”
Evan felt uneasy. “I… think so?”
“What about the pulse? Is the condition in the exterior or the interior? Good heavens. I told you to bring all four diagnostic methods together, and you've forgotten the most important one—the pulse examination. You really aren't afraid of getting the pattern wrong!”[10]
“I didn't forget…” Evan murmured.
“Then examine her pulse.”
Looking sheepish, Evan forced himself to say to the woman, “Hold out your hand. I'll take your pulse.”
She held it out.
Evan located the cun, guan, and chi positions and began examining her pulse.[11]
After a while, Dr. Qian asked, “Well?”
Evan drew in a breath and forced out an answer. “It beats quite strongly.”
Dr. Qian nearly lost his balance in his chair. He couldn't help saying, “Who taught you to take a pulse—a cotton-beater?”[12]
Reader Notes
↩︎ National honors. “Nationally Renowned Physician of Chinese Medicine” and “National Master of Chinese Medicine” are distinct state honors. This passage recalls Oliver's standing in Evan's own time; the young Oliver in 1978 does not yet possess those titles. The novel describes a four-year cycle for the higher honor. The China Academy of Chinese Medical Sciences gives a five-year cycle, with thirty recipients per selection. These distinctions establish why Evan finds meeting the young doctor so extraordinary. Source: China Academy of Chinese Medical Sciences — 2022 honors (in Chinese).
↩︎ The Suwen and tiangui. The Suwen, or Basic Questions, is part of the Huangdi Neijing, a foundational work of Chinese medicine. Evan quotes its opening chapter's account of female development in seven-year stages. Tiangui names the reproductive capacity or substance associated in this tradition with the maturation of Kidney essence and the onset of reproductive function. It is not the name of a particular modern hormone. The ages in the quotation belong to the classical account Evan is reciting, rather than a universal timetable supplied by the translator. Sources: Chinese Text Project — Suwen, opening chapter (in Chinese); Xia and Tan — Heart–Kidney theory in gynecology, pp. 541–542 (in Chinese).
↩︎ Channels, Chong, and Ren. Chinese medicine describes channels as a network linking functional organ systems and carrying qi and blood. Here “Vessel” names a channel in that framework, not an anatomical blood vessel. Chong is the “sea of blood” and Ren the “sea of yin channels”: images of gathering and regulating. “Essence” is a traditional nourishing category. Jin and ye distinguish the body's thinner and thicker fluids, whose functions include moistening and nourishment. Evan connects these categories to the womb. His “Taichong Vessel” means Chong, not the acupuncture point also called Taichong. Sources: Hong Kong Health Bureau — meridian theory; Xia and Tan — Chong and Ren in menstrual theory, p. 542 (in Chinese); WHO — Chinese medicine terminology, essence and body fluids.
↩︎ Bleeding and pattern differentiation. Benglou is a traditional gynecological category spanning sudden profuse bleeding and prolonged or irregular bleeding; “flooding” and “leaking” are its literal images. Dr. Qian is posing a theoretical emergency, not describing the patient who appears later. Evan distinguishes qi deficiency, blood deficiency, blood heat, blood cold, and blood stasis as different patterns that would change the treatment approach. “Blood deficiency” is a traditional failure of nourishment, not a confirmed diagnosis of anemia; “heat” and “cold” do not simply report body temperature. Sources: WHO — Chinese medicine terminology, 2022; WHO — traditional medicine terminology, 2007, blood-related terms, p. 55.
↩︎ Formula and medicine names. The capitalized names are named formulas; the lower-case names are individual medicinal materials. Tang ordinarily means a decoction and san a powder, although Evan's answer explicitly describes preparing a decoction. The lists include plant, animal, and mineral materials: longgu is fossilized bone, muli oyster shell, and haipiaoxiao cuttlebone. “Calcined” and “charred” preserve preparation details in the source. Sources: WHO — Chinese medicine terminology, pharmaceutical preparations; Taiwan's National Research Institute of Chinese Medicine — materia medica catalogue, NHM-00030 and NHA-00010 (in Chinese); Hong Kong Baptist University — cuttlebone specimen D00518.
↩︎ Acupuncture point names. Zigong and the other names identify acupuncture points in Evan's answer. They do not mean that he is proposing to insert needles into the anatomical organs named by some of them. Ear acupuncture uses its own named locations on the ear; its “uterus,” “ovary,” and “adrenal gland” labels refer to those locations. No needling is performed in this chapter. Evan's claims about speed and control of bleeding remain his statements in a theoretical examination. Sources: Hong Kong Health Bureau — acupuncture and meridian theory; WHO — Chinese medicine terminology, ear acupuncture and ear points, entries 3068–3069.
↩︎ The four diagnostic methods. These are inspection, listening and smelling, inquiry, and palpation. Tongue inspection is part of looking; pulse examination is part of palpation. They are sources of information to be considered together when identifying a Chinese-medicine pattern, rather than four separate modern laboratory tests. Dr. Qian emphasizes integrating them because a fluent explanation alone does not complete the examination. His additional list asks Evan to consider the patient's menstrual, discharge, breast, childbirth, and pregnancy history. Source: Hong Kong Polytechnic University — Four Diagnostic Methods.
↩︎ Liver constraint, fire, and blood stasis. Earlier chapters introduced Liver qi stagnation and Liver–Stomach disharmony. Here Evan adds a new connection: constrained qi can turn into “fire,” while impeded qi movement can hinder blood and produce “blood stasis.” These are traditional pattern relationships, not test results establishing liver damage, a blood clot, or a psychiatric diagnosis. Capitalized Liver and Stomach indicate functional systems in this edition. Evan uses this framework to connect irritability, nausea, breast and abdominal discomfort, and the menstrual clots; the pulse examination is still to come. Sources: WHO — Chinese medicine terminology, blood stasis due to qi stagnation, entry 440; The Chinese Medicine Hospital of Hong Kong — zang-xiang theory.
↩︎ Fu Qingzhu and deficiency or excess.Fu Qingzhu Nüke is a Chinese gynecological classic traditionally attributed to Fu Qingzhu; the title is kept in romanization. Evan quotes its account of menstrual pain and uses it to justify relieving Liver constraint. “Deficiency” describes insufficient nourishing or supporting functions, while “excess” describes a predominance or obstruction to be reduced. “Drain” therefore names a treatment principle, not draining menstrual blood out of the patient. The promise that all symptoms will disappear is Evan's conclusion, which Dr. Qian immediately questions. Sources: Shidian Guji — Fu Qingzhu Nüke, upper volume (in Chinese); WHO — Chinese medicine terminology.
↩︎ Exterior and interior. In Chinese-medicine pattern differentiation, exterior and interior describe a pattern's location or depth within the traditional diagnostic framework. “Exterior” is associated with the body's outer layers, whereas “interior” concerns deeper or internal systems. The distinction does not ask whether the pain can be seen from outside. Dr. Qian's question challenges Evan to complete the examination before settling on a pattern; it does not establish either answer for this patient. Source: WHO — Chinese medicine terminology, pattern differentiation.
↩︎ Cun, guan, and chi. These are three adjacent positions used to examine the radial pulse at the wrist, not three separate arteries. Chinese-medicine pulse examination attends to qualities of the pulse as well as its rate, and findings are interpreted within a pattern framework. The positions explain what Evan is attempting to assess; the novel has not yet supplied a named pulse quality or a completed diagnosis. His reply reports only that the beating feels strong. Source: Liu Yuan — a discussion of cun, guan, and chi positions, Shandong Journal of Traditional Chinese Medicine, abstract (in Chinese).
↩︎ Cotton beating. Traditional cotton workers loosened compacted cotton for bedding by striking the taut string of a large bow, making it vibrate through the fibers. The rhythmic thumping and plucking made this a distinctive, noisy craft. Dr. Qian's joke compares Evan's crude report of forceful beating with a cotton worker's handling of that vibrating string. It mocks the limits of Evan's answer without yet naming the medical quality of the patient's pulse. Source: Yingtan People's Procuratorate — My Father's Large Wooden Bow (in Chinese).