Chapter 42: Ginseng

Shaoyang took the prescription and recognised the Life-Prolonging Decoction, Xu Ming Tang, cited from *Ancient and Modern Recorded Prescriptions* in the supplementary formulas of *Essentials from the Golden Cabinet*. It opened the channels, harmonised nutritive and defensive qi, released the exterior and expelled pathogenic influences. Its indications included wind stroke and paralysis of one side of the body.

For a moment, he was puzzled. *Essentials from the Golden Cabinet* had been compiled in the Song dynasty. How could a physician in the early Tang know this prescription?

Then he understood. Although the book had taken its present form in the Song, it had been assembled from the miscellaneous-disease section of the Eastern Han medical sage Zhang Zhongjing’s *Treatise on Cold Damage and Miscellaneous Diseases*. Zhang’s work itself drew together the medical achievements of earlier times. Many of its classical formulas had already circulated widely among physicians.

The original treatise had been scattered and lost for centuries, but its prescriptions had survived in handwritten copies among ordinary practitioners. Early Tang physicians might never have heard of *Essentials from the Golden Cabinet* and still know some of the formulas later recorded in it. That was probably how this one had reached his father.

He scanned the ingredients. They were indeed those of Life-Prolonging Powder, except that one crucial ingredient—three liang of ginseng—had been replaced with three liang of astragalus.

Now he understood why Huimin Hall and the other clinics had refused the patient.

Before the Tang and Song, physicians had understood wind stroke chiefly as an external pathogenic attack on an internally deficient body. Treatment therefore centred on dispersing wind, expelling the pathogen and strengthening healthy qi. And among qi-supplementing medicines, ginseng stood foremost. For powerfully replenishing original qi, restoring the pulse and rescuing collapse, it was the principal emergency drug.

It was also extraordinarily expensive. The best ginseng was worth more than gold or silver. This prescription required three liang at a time: at least three taels of silver for a single dose, equivalent to fifteen thousand yuan in modern money.

How could these ragged people afford it? And if a clinic offered treatment and medicine free, how could it bear that cost?

Guizhi Hall stocked no ginseng precisely because it was so expensive. If they had possessed even a few liang to sell, their rent would have ceased to be a problem.

His father had substituted astragalus. It too supplemented qi, but in its ability to restore original qi it was worlds apart from ginseng. If one could replace the other without greatly affecting the result, someone would have done it long ago.

Tang physicians could do little about this. Shaoyang faced no such difficulty. Understanding and treatment of wind stroke had advanced considerably after the Tang and Song. From the Jin and Yuan onwards, many physicians had approached it through the theory of internal wind. Through the work of Liu Hejian, Zhu Danxi, Zhang Jingyue, Li Zhongzi, Ye Tianshi and the great physicians of successive dynasties—particularly with modern medical research—a complete set of treatment principles had developed, far beyond those of the Tang and Song. Methods had multiplied and results improved. This illness could be treated effectively without ginseng.

For this patient, he decided on a modified Antelope Horn and Uncaria Decoction, Ling Jiao Gou Teng Tang, together with Purple Snow.

The decoction dated from the Qing dynasty. It chiefly cooled the liver and extinguished wind, combining medicines to nourish yin, transform phlegm and calm the spirit. Addressing both root and manifestation, it was a representative formula of the liver-cooling, wind-extinguishing method.

Antelope horn was difficult to obtain in modern times because antelopes were protected animals. In this age it was an ordinary medicinal material. Their shop had it, and the other ingredients were common too.

Since pathogenic heat was sealed inside and the patient’s consciousness clouded, he also needed medicine to open the orifices and restore awareness. He had prepared Purple Snow, one of the Three Cooling Treasures, and used it with striking effect on the child with acute convulsions in Laohuai Village the day before. He had not expected to need it again so soon.

“Would you like us to decoct the medicine here,” he asked the man, “or will you take it home and do it yourselves?”

“Please do it here, young brother.” The man looked miserable. “I’m afraid Mother can’t wait that long. The sooner she takes it, the better.”

“Very well. We’ll prepare one dose first and see how she responds. If it helps, we can dispense more. Is that all right?”

“Yes, yes!” The man glanced at those behind him, hesitated, then lowered his voice. “May I ask… how much?”

“One moment, please.”

Shaoyang quickly selected the ingredients for Antelope Horn and Uncaria Decoction.

“Twelve wen for one dose.”

He had, of course, charged for his father’s Life-Prolonging Powder without ginseng. The medicine he was actually dispensing, together with Purple Snow, cost rather more, but he could not explain that.

The man murmured an acknowledgement, took out his purse and emptied it. There were only five copper coins. Before he could speak, the others brought out their purses too and poured out their money. Between them, they just managed twelve wen, which they laid carefully on Zuo Gui’s table.

Zuo Gui glanced at the coins, his hands tucked in his sleeves, but made no move to take them. Clearly he believed his prescription would be ineffective and did not wish to accept payment. Unaware that Shaoyang had substituted another medicine, he lowered his head and seemed to wait for failure.

When the decoction was ready, Shaoyang concealed a Purple Snow pill in his palm and carried the bowl to the little bed. With his back to his father, he prised open the old woman’s mouth and gave her the pill. Unconscious, she could not swallow by herself. He had to use a special crane-spouted medicine pot, extending its spout towards her throat and slowly forcing the decoction down.

Then there was nothing to do but wait.

Guizhi Hall had little business, so the family’s vigil in the main room inconvenienced no one. Passers-by peered in, however, and on hearing that a gravely ill patient was being treated, a few idlers lingered by the door.

With Peilan’s help, Huixiang and Madam Liang had brought the seats in from the cart and offered one to the patient’s son. He thanked them repeatedly but would not sit. Hands tucked away, he stared anxiously at his unconscious mother. The other men squatted on the floor beside the bed with their hands in their sleeves. None spoke.

Peilan helped the softly sobbing woman up from the corner, and they stood together, watching the patient sadly. Shaoyang brought Peilan a chair. She gave him a strained smile but shook her head. With the room full of people and a critically ill patient before them, he could hardly chat to her. He returned behind the counter and stood there with his hands tucked away, lost in thought.

The room was very quiet. Finding nothing to watch but the same gloomy vigil, many of the spectators drifted away.

The sun set and darkness finally gathered. The first watch was approaching. Huixiang lit the oil lamp, but could not bring herself to urge the visitors to leave. She would wait until the watch sounded.

Just then, the man beside the bed cried out in delighted disbelief.

“Mother! You’re awake? Mother! My mother’s awake!”

The squatting men looked at one another, hardly daring to believe it. Then they sprang up and crowded round the bed, calling “Mother!”, “Sister-in-law!”, “Auntie!”—their voices tumbling over one another.

The woman Peilan was supporting had cried until her eyes were swollen. At the shout, she jerked up her head, pulled free and rushed to the bedside. Pushing past a man, she bent over the old woman.

“Mother!” Her voice trembled. “How do you feel? Mother, I was wrong. Please forgive your daughter-in-law!”

She dropped to her knees and knocked her forehead against the floor.

A cloudy tear slowly welled at the old woman’s eye and dragged its way down through the wrinkles.

With tears in her own eyes, Peilan came over and helped the woman up.

Shaoyang emerged from behind the medicine cabinet, made his way through the group and looked down. The old woman’s eyes were indeed slightly open. They moved slowly from face to face.

“Father!” He turned, delighted. “Your medicine worked! She’s regained consciousness!”

Zuo Gui’s mouth fell open. Slowly he stood, drawing his hands from his sleeves.

“She’s… awake?”

“Yes, Father! She seems to recognise people!”

His small eyes widened.

“Astragalus… can have the effect of ginseng?”

The mutter was too quiet for anyone to hear.

Huixiang had opposed accepting the patient only because the family could not afford to subsidise her medicines. Now that they had taken the case and the treatment was working, she was genuinely pleased. She and Madam Liang hurried over. The old woman’s eyes were moving as she looked at everyone, though the stroke had left her unable to speak.

“She really is awake, Father!” Huixiang said joyfully. “Come and see!”

Only then did Zuo Gui hurry forward. The men made way, and he approached the bed and bent to examine her.

“I am the physician treating you,” he told her. “Can you hear me? If you can, blink.”

The old woman blinked.

The men around her broke into tearful smiles.

“She’s better! She really is! What a miraculous physician!”

“Yes! Indeed he is!”

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