Chapter 58: A Few Small Spots

Zuo Gui’s True Warrior Decoction was divided into three portions.

“Only one portion left?” Shaoyang said. “That won’t be enough tonight. She is seriously ill and must take medicine through the night. I’ll dispense another dose, divided into three: one now, one at midnight and one at dawn.”

“All right. What about the medicine left from this afternoon?”

“It’s cold. Don’t give her that. She needs it warm.”

Afraid they would be reluctant to waste it and give it anyway, Shaoyang carried the pot outside and poured the decoction away. He selected fresh ingredients from the chest, put them in the pot and handed it to the man.

This was no longer True Warrior Decoction. He had substituted a modified Phlegm-Cleansing Decoction, Di Tan Tang, with Storax Pills, Su He Xiang Wan.

The decoction came from the Ming work *Wondrously Effective Prescriptions*. An acrid, warming, aromatic formula, it was commonly used for wind stroke in which phlegm obscured the heart’s orifices. Storax Pills came from the Tang *Arcane Essentials from the Imperial Library*. Unlike Purple Snow, they represented the warming method of opening the orifices: dispelling foul turbidity, restoring awareness, moving qi, warming the middle and relieving pain, chiefly for cold-closure patterns.

Suspecting nothing, the man took the pot and put it on the stove.

When it was ready, Shaoyang crushed the Storax pill into the decoction and personally administered it through the duck-spouted pot. Then he sat beside the bed to wait.

Nearly an hour passed without a response. Auntie Li remained unconscious. Uneasy, he took her pulse. It showed no further deterioration, which reassured him a little. He reviewed his reasoning and believed his pattern differentiation was sound this time. He resolved to continue.

Her son was touched by the young physician’s constant vigil. Seeing how late it was, he spoke softly.

“Why don’t you go back and rest? If anything changes, I’ll come and tell you at once.”

Shaoyang had no desire to sleep before seeing a result. Even if he lay down, worry would probably keep him awake.

“Let’s wait a little longer. There’s no hurry.”

As they spoke, hurried footsteps sounded outside, followed by knocking.

“Is the young physician here?”

“Yes!”

Auntie Li’s son opened the door.

“Oh, Steward Jia. He’s here.”

The old steward came in, drenched in sweat and panting.

“At last! Hurry, your father wants you!”

“What’s happened?” Shaoyang rose.

“Our young master… another attack. Twitching all over, hardly able to breathe. Physician Zuo sent us to find you. We didn’t know where you’d gone, and the medicine chest was missing too. We’ve searched everywhere. Come quickly!”

Before he had finished, Shaoyang was out of the house with the chest on his back.

He ran straight to the Jia family’s rear courtyard. Lights blazed. A maid at the entrance cried with relief, “The young physician’s back!”

“Where is he?”

“Inside, with Physician Zuo.”

He rushed in. Several maids stood in the main room. Through the raised curtain to the inner chamber, he heard the mother weeping and calling her son.

A large brazier burned brightly beside the bed, making the room warm. The young woman sat on its edge with the child in her arms. Phlegm rattled in his throat; his eyes rolled upwards and his limbs jerked continuously. Master Jia and his father stood nearby, wringing their hands. Their faces brightened when Shaoyang entered.

Zuo Gui turned and snorted.

“Where have you been?”

“To see Auntie Li. What happened to the boy?”

The mother only shook her head and wept, clutching her son.

“He became feverish again in the night, terribly hot,” Master Jia said miserably. “I sent for your father. While he was examining him, the boy suddenly began convulsing. There was phlegm in his throat that he couldn’t cough up; he could scarcely breathe. Your father used the old method, having him swallow a threaded croton seed and drawing it back out. His breathing eased a little.”

“Has he taken the pill we gave you?”

“Yes, just now.”

“It should help. Let’s wait.”

After a while, the fever fell slightly and the convulsions eased. Yet he continued coughing, nostrils flaring, breath rapid, face grey and lips purple. The signs of respiratory distress were unmistakable.

His mother held him very tightly. He already wore thick clothes, and the heavy silk-floss quilt covered more than half his little face. That must be hindering his breathing. With such a large brazier warming the room, there was no need to wrap him so heavily.

“Madam, loosen the quilt,” Shaoyang said. “It’s too tight. He can’t breathe properly.”

Distraught, she did not hear and continued clutching him. He repeated himself, with no result.

“The young physician told you to loosen it!” Master Jia snapped. “Didn’t you hear?”

“What?”

She looked up at her husband.

He reached to take the child. Not understanding, she instinctively held on tighter. Unable to pull him free and seeing the boy’s face turning purple, Master Jia thrust his hands inside the quilt and lifted his son out.

“Will this do?”

The child’s clothes were still thick enough to restrict him. Shaoyang stepped forward, undid the fastenings at his throat, pulled the sides apart and adjusted the collar around his neck.

“That’s better… What is this?”

Behind the boy’s ear were several rose-purple spots. He rubbed them, but they did not come off.

Something stirred in his mind. He took a tongue depressor from the chest and opened the boy’s mouth. On the inner cheeks, near the teeth, he saw several similar spots.

At the sight of them, everything fell into place.

Measles!

The child had measles complicated by pneumonia, causing the high fever that brought on acute convulsions.

Measles was one of the commonest infectious childhood diseases. Its early symptoms resembled an externally contracted illness. At first, the boy had fever, cough and a clear nasal discharge. Huimin Hall had failed to identify it and treated it as an external febrile disease, repeatedly using Ephedra, Apricot Kernel, Liquorice and Gypsum Decoction, Ox-Bezoar Powder, Heart-Clearing Pills and antelope horn powder—all cooling medicines. Shaoyang’s Purple Snow, one of the Three Cooling Treasures, was more powerfully cold still.

Measles was a yang-toxin illness, so cooling rather than warming treatment was indicated. The ephedra formula could itself treat measles that failed to erupt, with body heat, agitation and toxins sinking inwards. It was particularly suitable when pneumonia accompanied measles and heat congested the lungs.

But nothing should be carried to excess. Too much cooling could seal toxic heat inside and produce complications.

The situation resembled Auntie Li’s. Strong cooling medicines had been used as the rash began, followed by his Purple Snow, suppressing it too far and trapping toxic heat within. Of course, without Purple Snow to reduce the fever and restore awareness, the boy might not have survived this long.

The rose-coloured rash was evidence that the eruption’s toxins could not escape, with warm pathogens constrained in the superficial tissues and blood level.

The pneumonia accompanying measles kept the fever high. Unable to disperse, extreme heat stirred wind, producing convulsions. Toxic heat entered nutritive qi and blood and passed counterflow into the pericardium, clouding the child’s consciousness and preventing the eruption from emerging in its proper course.

Spoiled and frail, the boy lacked the strength to push the toxins out. They lay concealed within, bringing pneumonia and the resulting difficulty in breathing.

After all this, measles had been the culprit behind the pneumonia and fever.

From the beginning, the child had been wrapped in a thick quilt that covered much of his face. Measles first appeared behind the ears and along the hairline before spreading elsewhere. The strong cooling medicines given at the outset had trapped the toxic heat, preventing the rash from showing on the face and elsewhere.

Earlier, Shaoyang had asked the mother to unwrap and undress the child, but she had refused. He had not suspected measles then. Otherwise he should have insisted on examining the rest of the body and would probably have found it.

The discovery heartened him. Yet in modern times, widespread vaccination had greatly reduced measles and made it uncommon. During his studies he had paid little attention to treating it. Now that he had identified it, he felt flustered and could not immediately think how to proceed.

He would see whether his father had a suitable prescription.

“Father!” He pointed urgently behind the boy’s ear. “Look at this!”

Zuo Gui rose, came over and bent to inspect the spots. His body gave a start.

“Give me the child.”

Master Jia hastily handed him over. Zuo Gui opened the boy’s clothes and examined him, then, just as Shaoyang had done, used the tongue depressor to look carefully inside his mouth.

A moment later, he said gravely, “Measles.”

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