Chapter 59: Beyond the Medical Books

Measles was a very common childhood illness in ancient times, and many physicians knew how to treat it. Zuo Gui had treated children with it before. After a careful examination, he said, “Yes, measles. The eruption’s toxins have sunk inwards, lung qi is closed and constrained, and phlegm-heat is disturbing the heart. This is critical. We must bring the eruption out and free the lungs at once.”

He wrote a prescription and handed it to Shaoyang.

Shaoyang did not recognise it. It was probably an empirical formula from the early Tang. Examining its basic composition, he found ephedra and notopterygium, both acrid, warming medicines that dispersed cold. Measles was a yang-toxin illness and ordinarily should not be treated with such medicines, but these two dispersed powerfully—the very action needed to open the body’s surface.

To prescribe against the usual rule in this way required courage. If his father dared use it, the formula must have proved itself in practice.

He examined their quantities more closely: slightly under one coin-measure of ephedra and slightly under two of notopterygium.

A coin-measure was a way to measure powdered medicine with a copper coin, preferably a Han five-zhu piece. Hold it flat and heap powder over its surface: that was one coin-measure. Scoop half as much with the coin: half a measure. “Slightly under” meant a little less than the full amount.

Measured this way, the amounts were naturally small. Ephedra and notopterygium released the exterior and dispersed upwards so forcefully that reducing their quantity restrained that action.

Further down came mulberry leaf, mint, burdock fruit, prepared soybean and kudzu root—acrid, cooling medicines to disperse wind-heat and encourage the eruption. Fresh reed rhizome and dyer’s woad leaf, both cold, cleared heat and drained fire. The fresh reed rhizome also generated fluids, relieved thirst and eased agitation. At five qian, it was the largest ingredient.

Zhejiang fritillaria bulb and bamboo secretion cleared hot phlegm; bitter apricot kernel relieved cough and wheezing.

The combination clearly aimed to bring out the eruption, open the lungs, transform phlegm and stop cough. It fitted the symptoms well. But it did not address the child’s convulsions and clouded consciousness.

Shaoyang decided to add medicines to extinguish wind, relieve spasms and open the orifices. After consideration, he chose stiff silkworm, uncaria and sweetflag. Uncaria with the mint already in the formula was a common pairing for convulsions; sweetflag with bamboo secretion strengthened the action of opening the orifices, clearing phlegm and extinguishing wind. Finally, he added lotus seed heart to clear heat, ease agitation and calm the spirit.

He decocted the medicine at once and gave it to the boy.

It was his first time treating measles. Though he believed his father’s formula sound and his additions appropriate, he remained anxious. Zuo Gui, by contrast, had become confident once he knew measles was responsible. Seeing his son’s tension, he smiled into his beard.

“Don’t worry. Go to bed. When the fever drops tomorrow morning, he’ll improve.”

Hands behind him, he strolled back to his room.

His assurance reassured Master Jia, who smiled at Shaoyang.

“You should rest too. The maids and serving women are here. If anything is wrong, we’ll call you immediately.”

Shaoyang nodded and felt the boy’s forehead. Still very hot. But he had only just taken the medicine. Illness struck like a collapsing mountain and retreated like silk being drawn from a cocoon; it could not vanish so quickly. They must wait.

He took his leave and returned to his room.

The Jia family was comfortable enough to provide quilts thickly padded with silk floss, soft and pleasant to the touch. Since his arrival, Shaoyang had slept in his lined jacket under hemp-cloth quilts stuffed with straw. They were uncomfortable and so poor at keeping out the cold that he woke several times a night. At last he could sleep warm.

A maid prepared a large wooden tub of hot water and offered to attend him while he bathed. He was naturally unaccustomed to that and declined. Only after she had giggled and gone out, closing the door, did he strip and settle into the tub for a thoroughly enjoyable soak.

Then, in his underclothes, he climbed beneath the silk-floss quilt. Warmth surrounded him as though he had returned to modern life. He stretched out his limbs, drew a long breath and let it go. Such comfort! If only he could always sleep in a bed like this.

It was no extravagant wish. A silk-floss quilt cost only a few hundred wen. One day he would certainly afford it.

He closed his eyes, but despite the warmth could not immediately sleep. Both difficult cases now had prescriptions that seemed appropriate. Reviewing the patterns and treatments, he believed they would work. Yet he had not seen the results. He tossed and turned for a long time before falling asleep wrapped in the quilt.

He slept wonderfully, waking only when it was broad daylight. No one had disturbed him overnight. The patients must have remained stable. Pleased, he got up and dressed.

A young maid in the covered walkway came to meet him as he opened the door.

“You’re awake, young physician!”

“How is your young master?”

“Much better! His fever’s down a great deal, his breathing is easier, and he’s coughing much less. He’s clear-headed too.”

“That’s good. Is my father up?”

“Long ago. He examined the young master, had breakfast and has just gone to Auntie Li’s. Let me show you where to eat.”

“No hurry. I’ll see the boy first. Take me to him.”

“He’s in the front hall with Master and Madam. Master Huang from Three Willows Village has come to offer New Year greetings. Perhaps wait a little? The young master is much better, after all. Master said you’d worked hard and told us not to wake you early.”

If the boy could join his parents in receiving holiday visitors, he must indeed be improving. Otherwise the couple would not be so relaxed.

“I’ll go to Auntie Li’s too.”

He ran back for the medicine chest, then out through the rear gate without needing the maid’s guidance, and hurried to the house.

The door stood open. Voices and laughter came from within. His heart eased at once. That suggested Auntie Li had improved as well.

A man at the entrance saw him coming.

“The young physician!”

Her son hurried out and bowed.

“Please, come in!”

“How is she?”

“Much better!” The man grinned. “She opened her eyes before dawn and can say a word or two. Not clearly yet, and she still can’t move her right side. But Physician Zuo says that now she can speak, we needn’t worry. With gradual treatment, she’ll certainly return to normal.”

Shaoyang entered.

“Mother, the young physician from Guizhi Hall is here. He came himself with your medicine last night and gave it to you.”

Her lips moved.

“Thank… you…”

The sounds were indistinct, but intelligible. Shaoyang was delighted that his change of treatment had worked. He examined her pulse and tongue and found she had indeed improved greatly.

“With a greatly toxic drug, remove six parts in ten.” He had once been able to recite that backwards, yet at the bedside had forgotten it entirely. He had not truly grasped its importance in practice or given it the weight it deserved. His failure to apply it had led to mistreatment and nearly a disaster. Remembering it, he felt ashamed.

Knowledge gained on paper was shallow until tested through personal practice. However often he read a medical text, however familiar its classical sayings, without experience they remained words on a page.

He might possess knowledge far beyond Tang physicians, but turning that knowledge into clinical results would still require long practice.

Zuo Gui had arrived early and been overjoyed at the improvement. He had studied the medicine dregs for ages without understanding them. Nevertheless, father and son had successfully treated two difficult cases, and he was delighted. Whether Auntie Li could speak clearly or not, he sat by her bed chatting about anything and everything, giving voice to his pleasure.

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