Chapter 608: Nurturing the Gu

When the timeline returned to the days just after Geng Yan collapsed, Diwu Lun and his assembled officials were utterly shocked the moment they learned the name of this illness from the physicians.

"Cold Damage!?"

Whether civil and military officials or the imperial physicians Diwu Lun had brought along, everyone was plainly terrified of this term. Feng Yan, the Director of Guests, even lost his composure in the hall in front of everyone and nearly fell over!

Afterwards, he told Diwu Lun of his own family's history with this disease: "Since the time of Emperor Wu of Han, epidemics have frequently swept the realm. Especially after the Yuandi and Chengdi reigns, famine and pestilence have come hand in hand."

"Over twenty years ago, a plague broke out in Guanzhong. The Feng clan was originally very populous, numbering over two hundred members. After the great pestilence passed, only a bit over seventy remained. Of the dead, the greater half perished from Cold Damage."

That was why Feng Yan felt such terror. Diwu Lun also recalled that his grandfather had told him before his death that Diwu Lun's own birth father and mother had died in a Cold Damage epidemic.

At first, Diwu Lun interpreted the term literally and thought it referred to "typhoid bacillus," a gastrointestinal and digestive tract disease spread mainly through the fecal-oral route, with symptoms similar to dysentery, its sufferers invariably turning into projectile warriors...

But from what he had seen and heard over more than ten years in the Xin Dynasty, and from the symptoms reported by the army physicians, Diwu Lun realized he had been mistaken. This Cold Damage and that other Cold Damage were probably just a coincidental name clash — in fact, they were two completely different diseases.

The most senior physician in the army came to report to Diwu Lun: "Your Majesty, this Cold Damage — whether fever has already set in or not — invariably involves aversion to cold, body aches, retching, and a pulse that is tight in both yin and yang..."

Diwu Lun nodded elegantly, but signaled to Zhang Yu at his side. The Embroidered Uniform Commandant urgently said, "Physician, speak in terms we can understand."

Only then did the physician put it simply: "At onset, the illness mostly involves runny nose, headache, fever, weakness in the limbs, sore throat, and prolonged coughing."

According to him, although this Cold Damage spread with extreme speed, some people recovered quickly too. A headache lasting seven days or more would heal on its own, costing at most a little over a week of work. After recovery, they could still go to the fields as before — that was the mild form. As for the severe cases... those corpses being carried out of the camp one after another — the physician said they had "the disease entering the marrow, the whole body violently burning, beyond saving."

Looking at these familiar-seeming symptoms, Diwu Lun suddenly understood: "This so-called Cold Damage — could it simply be an influenza epidemic?"

He couldn't say he was intimately familiar with this illness, only that he dealt with it physically once or twice a year. Although influenza pandemics that caused millions or tens of millions of deaths were not rare, for some reason, Diwu Lun's heart settled with inexplicable calm.

The others, however, were quite panicked. Feng Yan, drawing on his own family's bitter experience, urgently advised Diwu Lun: "Your Majesty, there are five great epidemics: Cold Damage, Miasma, Corpse Transmission, Leprosy, and Barbarian Sores. Among them, Cold Damage is foremost. Over these past decades, the realm's population has drastically declined, and Cold Damage has killed the most people."

Muttering these words, Feng Yan forcefully urged Diwu Lun: "It is said that in the Xiapi camp, at least one in three soldiers has contracted the disease. To safeguard the Sacred Body's health, Your Majesty must not remain long in Xiapi. It would be best to leave as soon as possible!"

Diwu Lun, however, had a grave expression and said to Feng Yan, "The Cold Damage epidemic that the Director of Guests suffered — I too experienced it when I was an infant."

"In that great pestilence, the Diwu clan also suffered many deaths. My imperial father and imperial mother passed away at that time, leaving only me, orphaned and alone."

As he said this, Diwu Lun's voice already carried a few sobs, which greatly moved his assembled officials. They all offered consolation: "This is Heaven's protection of Your Majesty."

"Yes, it was indeed Heaven's protection." Diwu Lun knew that for a frail infant to survive a terrible epidemic truly depended on luck.

Everyone assumed that Diwu Lun was using his family's tragic experience to build a pretext for his own panicked flight from the plague god — and to take them all with him.

Unexpectedly, Diwu Lun instead seized the opportunity and said, "Since Heaven has begotten virtue in me, what can a mere Cold Damage do to me?"

Huh?

From Feng Yan to Zhang Yu and Fu Long, all the officials stood frozen in place. And Diwu Lun took the chance to declare his resolve.

"I will not abandon my soldiers, still less flee in the face of battle. I vow to remain in Xiapi and resist the plague god together with you all!"

Although Diwu Lun's slogans rang out boldly, he did not have heaven-defying abilities to conjure a panacea out of thin air, so matters had to proceed step by step.

The first thing to clarify was the origin of this illness, Cold Damage.

On this point, even the physicians most experienced with Cold Damage could not explain clearly. Unexpectedly, it was Huan Tan, accompanying the army, who had done some research.

"Cold Damage perhaps originates from the northwestern frontier fortresses of Hexi."

Huan Tan had a basis for saying this. In Chang'an, he had read a vast number of miscellaneous books, leaving nothing untouched from astronomy and geography above to insects, fish, and beasts below. When he pored over ancient texts, he discovered that the term "Cold Damage" appeared most frequently in Han bamboo slips from the northwest.

"In Hexi, Han and Rong live intermingled, and the weather is also cold. In the time of Emperor Wu of Han, three hundred thousand were relocated to garrison the northwest. Those who had just arrived often contracted Cold Damage, and no more than six or seven in ten survived."

"And with envoys traveling frequently between Hexi and Chang'an, they brought this disease into the Central Plains. Thus, before Emperor Wu, Cold Damage epidemics were rare; after Emperor Wu, they broke out almost every few years."

This illness typically peaked in autumn, winter, and early spring — quite similar to the seasonal patterns of influenza in later ages.

"But in the past, Cold Damage was mostly in the north, less so in Xu and Yang. The year before last, during the Red Eyebrows' rebellion, corpses north of the Huai were like hemp, yet there was no massive spread of Cold Damage."

Turning their gaze back to the great epidemic before them, Huan Tan and others found it strange. Diwu Lun, however, did not consider it an "exception."

Although the physicians rambled on to him about how "Cold Damage is caused by wind pathogens," Diwu Lun remained firmly convinced that, in the final analysis, it was still influenza and similar viruses at work.

Diwu Lun understood the clothing, food, shelter, and travel of people in this era. They rarely left home beyond a hundred li. This self-sufficient lifestyle of small communities and limited populations had, by a fortuitous accident, achieved a quarantine effect. Thus, when great epidemics arose, it was often large cities like Chang'an and Luoyang that suffered first, while isolated little hamlets could luckily escape.

War, however — that great activity contrary to human nature — gathered people from all corners of the realm together, initiating a grand exchange of pathogens.

Thus, since ancient times, when armies were deployed, troops often faced the worry of epidemics. It was common for those who died of disease to outnumber battle casualties several times over. Moreover, Diwu Lun's army was mostly northerners, especially troops from You and Ji, the farthest north. Having first circled around Qingzhou, they had contracted who knows how many local illnesses, and then arrived in the Huai-Si region, where the climate was utterly different from Hebei. Unaccustomed to the environment, their resistance weakened, and it was hardly surprising that Cold Damage exploited this weakness to invade.

"The two armies, each serving its own master, constantly clash and fight for territory, leaving tens of thousands of corpses and chasing the defeated north. Yet neither side realizes that both are merely nurturing a poison gu for the virus."

Thinking this way, Diwu Lun suddenly felt that his struggle with Liu Xiu for the realm seemed somewhat like "a fight over a snail's horn," and he couldn't help but mock himself a bit.

After summarizing the disease's origin, seasonality, geography, and causes, Diwu Lun discovered that he still had no particularly effective method: he lacked the ability to produce homemade antibiotics or penicillin, nor could he decree with words that the virus would one day miraculously vanish...

As for lying down to await death or herd immunity and the like, Diwu Lun was also quite averse to them. After all, he had no wish to be posthumously titled "Emperor Chuan of Wei."

After pondering, Diwu Lun decided to focus on two approaches.

The first was to rely on old traditional physicians...

Since Diwu Lun had declared himself king and taken over the Xin Dynasty palace's many imperial physicians, he had implemented a military physician system for several years. Funded by the court, physicians were to widely take on disciples, with each physician required to serve in the army for three years and leave behind at least ten apprentices. Now, this system had only reached a barely usable level.

But Diwu Lun still found it hard to break down the barriers between different medical schools. The several great physicians accompanying the army, when faced with the same disease, submitted completely different prescriptions. Even changing the patient would lead them to swap out several ingredients.

Looking them over, he found that the physicians mainly used fourteen medicinal ingredients, such as cassia twig, licorice, jujube, ephedra, fresh ginger, peony, aconite, and Sichuan pepper. Judging from the therapeutic effects of these drugs, they were mainly used to treat wind-cold, cough, headache, and fever — no major issues there.

As a layman, Diwu Lun could not interfere excessively. He only summoned them personally and earnestly persuaded them all to set aside their grudges and first help the Emperor survive the great epidemic. His fingertips tapped on those prescriptions. He did not demand complete uniformity, only that, at least within the camps each was responsible for, they prepare four types of medicinal formulas according to the four degrees: mild, severe, moderate, and preventative.

"As for the medicinal ingredients you all require, apart from those excessively rare, I will spare no expense, even a thousand in gold, to gather them all properly."

That said, Diwu Lun required the physicians to replace expensive ingredients like cassia twig and peony with affordable substitutes. He was not looking at individual efficacy, only at collective recovery.

The number of infected was too great, already nearing ten thousand, with several hundred new cases each day. It was impossible to diagnose and treat each one individually. The plan now was simply to have everyone drink "communal pot medicine." In the camps, large cauldrons were set up, simmered over low heat, and the medicine was ladled out in large bowls and fed to the sick. Nor could they expect recovery with a single dose — Chinese medicine had to work slowly, easing inflammation, and relying on the body's own immune system to gradually endure was already good enough.

However, for key patients like the Grand General of Chariots and Cavalry, Diwu Lun arranged for dedicated physicians to care for them. Whatever medicinal ingredients were needed, no matter how difficult to obtain, were delivered from a thousand li away by relay riders.

So now, when Geng Yan recovered, he learned from his younger brother Geng Shu just how much effort the Emperor had put into the medicines he had drunk!

After Diwu Lun finished his visit to Geng Yan and departed, Geng Shu finally told his elder brother the truth:

"The ginseng was tribute from Liaodong, stored in Luoyang. The Emperor specially ordered the Luoyang flying riders to deliver it, covering eight hundred li in five days and nights."

"The cassia twig is produced in the south. General Cen seized quite a bit in Jingzhou, sealed and stored in Wan. It was delivered covering six hundred li in four days and nights."

"Although Xu and Huai also have pepper, the physicians said Sichuan pepper is best. His Majesty thus sent a flying message to Weiyang Palace in Chang'an, ordering the immediate delivery of what Gongsun Shu had once presented. It took seven days to reach Xuzhou and enter Elder Brother's medicinal soup. I hear that when the Empress learned of the difficulties at the front, she also ordered the Pepper Room stores to successively ship the surplus goods over."

For ordinary soldiers, Diwu Lun strove for "collective effect" — the cheaper and more readily available the medicine, the better, taking cost into account. But for an important figure like General of Chariots and Cavalry Geng, he spared no expense — although Diwu Lun privately thought, how much difference could there really be in the medicinal components between this Xu-Huai pepper, whose flavor might not be so authentic, and Sichuan pepper? What he was buying was not medicinal efficacy, but this gesture of regard.

Geng Yan truly felt it. The bowl of medicine he had drunk earlier with a furrowed brow — he had found it bitter and numbing. But when the afternoon dose arrived, Geng Yan held it for a long time, staring wordlessly at the pitch-black decoction, lost in thought. In the end, a few tears fell.

There was gratitude in those tears, and also guilt. Such boyish sentiment made Geng Shu unable to suppress a smile, but his elder brother soon recovered his usual cold severity and even explained: "Just added a bit of guiding ingredient, that's all."

With that, he lifted the bowl and drank slowly. This time, the medicinal brew no longer seemed bitter and hard to swallow, but carried a warmth, mellow and sweet.

If someone in later ages were to record this in verse, it would read: "Turn back from Chang'an, embroidered heaps unfold, / A thousand gates on the hilltop open one by one. / A rider under dark dust, the General recovers — / None knows it was the cassia and pepper that came."

Geng Yan's cold-damage illness was more or less cured. But for the Wei army, the true challenge was only just beginning.

When Geng Yan finally stepped out of the convalescent courtyard, he realized the atmosphere outside was unusual. The officers and clerks who, when he was in charge, had roamed the streets and alleys of uninhabited Xiapi City had vanished. In their place were Xiapi's sealed gates, and guards at every street corner wearing cloth masks, blocking anyone without reason to pass.

When he climbed the White Gate Tower and looked out at the camp beyond the walls where the sick were housed, it was even more orderly. The camp paths, once crowded and chaotic, were now nearly empty, only small patrol squads walking slowly. At the camp's gates, barricades had been erected, abatis turned inward, and several guards sat gripping long-bladed halberds, watching vigilantly anyone who tried to come out.

This was the second measure Diwu Lun had seized upon. Though he had no specific remedy, considering the nature of cold-damage — the disease's characteristics — cutting off the source of transmission could not be wrong.

So Diwu Lun issued an order of absolute thoroughness:

"Seal the camp!"

PS: There is still debate over exactly which modern illness the Han-dynasty "cold damage" corresponds to. Here only one interpretation is used, without further elaboration.