Lily's questions keep Evan talking.
Lily glanced at April's expression and changed the subject. “Dr. Xu, why does a cold womb make it hard to get pregnant?”[1]
Evan also looked at April's face. “You're this cold even in summer. Winter must be worse. Where the ground stays frozen all year, even grass and trees struggle to grow, let alone a human life.”
April was a little surprised. She had been married for more than three years. Her mother-in-law kept urging her to have a baby, but she simply couldn't conceive.
She and her husband had both been examined at a hospital. All the tests of their reproductive health had come back normal, yet she still had trouble conceiving. She had assumed it was simply the way her body was.
“Then… why am I so cold?” April asked, still doubtful. “My hands and feet are like ice in winter.”
“From the examination I just did, your main problem is Kidney yang deficiency,” Evan explained. “The Kidney is the foundation of what we're born with, the root of qi and blood, the basis of the Chong and Ren Vessels, and the root of yin and yang in all five zang organs. It contains primordial yang and primordial yin. In a healthy person, yin is balanced and yang secure—bearing yin and embracing yang.[2]
“Kidney yin and Kidney yang nourish and warm the yin and yang of the other organ systems. Kidney yin is the foundation of the body's yin fluids, nourishing and moistening all the organ systems. Kidney yang is the foundation of the body's yang qi, warming them.
“When Kidney yin is insufficient, the organs don't receive enough nourishing fluids, and a pattern of yin deficiency with exuberant heat can develop. When Kidney yang is insufficient, you get a situation like yours. It can't warm the organs, and a deficiency-cold pattern results. That's why your hands and feet are icy and your lower abdomen feels cold and painful. Kidney yang deficiency can also make your lower back ache as though it's breaking.
“The Kidney is linked to the womb through the Chong, Ren, and Du Vessels. If your Kidney is so deficient and cold, like a block of ice, how can the womb connected to it stay warm?[3]
“And insufficient Kidney yang can't rise to warm Heart yang, leading to yang deficiency in both the Heart and Kidney. In the five phases, the Heart belongs to fire. It is the great sun within yang. If even that sun isn't warm… And the womb is connected to the Heart above and the Kidney below. If neither end is warm, how can the womb be warm?
“Deficiency cold in the womb means a lack of nourishment, which causes pain. Without warmth, blood stasis obstructs the channels. How could it not hurt when the menstrual blood flows down? You also have Spleen yang deficiency, so not enough qi and blood are produced. After your period, they're even more depleted, which is why it hurts afterward too. Most importantly, a cold womb means you can't conceive.”[4]
There was something else Evan didn't say. A normally healthy person's Kidney yang was unlikely to become this depleted. The Kidney was the congenital foundation; either that foundation had been insufficient from birth, or something had depleted it later.
For women, apart from their living conditions, the likeliest explanation was a previous pregnancy loss that had badly depleted Kidney qi. Without proper care afterward, Kidney yang could become deficient.[5]
Lily hadn't understood much of it.
Ben and Clara had some grounding in Chinese medicine. Both began to feel that Evan might actually know what he was talking about. Ben couldn't understand it. How had the King of Siwu Tang suddenly become so good?
April listened, bewildered. Then she asked cautiously, “So… can it be treated?”
“It's not especially serious. I'll prescribe a formula. Take it for a while, and then I'll examine you again.”
“What should I take?”
Evan smiled a little, looking much more confident. “There's a formula in the ‘Seeking Conception’ section of Fu Qingzhu Nüke that fits your pattern exactly.”[6]
“Which one?” Lily asked curiously.
“Wenbao Yin.”
“Wenbao Yin?” They all looked blank.
Evan recited in a clear voice. “There are women whose lower bodies are icy cold and cannot be warmed without fire. During intercourse, there is no warmth at all within the vagina. People think this is a weakness they were born with. Who realizes that the womb is cold in the extreme? In frozen ground, grass and trees do not grow. In depths of heavy yin, neither fish nor dragons flourish. With the womb so cold, how can conception occur?
“Though the man musters his courage and strives with all his strength, though his semen is very hot and enters the womb directly, the icy cold presses against it. It may be received for a moment, yet nothing can last. But this woman is human like any other. Why should her womb be so cold? Is it not a weakness she was born with?[7]
“No. The womb lies between the Heart and Kidney, connected above to the Heart and below to the Kidney. Its coldness comes from the decline of the fires of both. To treat the womb, one must first replenish the fires of the Heart and Kidney.
“Therefore… the formula is Wenbao Yin.”
They listened in a daze, impressed without quite understanding. Even Ben was much the same; his medical skills were nothing special.
Clara noticed how different Evan had become. Before, he had been melancholy and timid, as though he wanted to shut himself away in a little dark room where no one could see him.
The melancholy was still there, but now he was much more confident. He seemed to have become a different person overnight.
A spark lit Clara's eyes. Looking at him, she murmured, “The old you… you're finally back.”
Evan recited a formula mnemonic:[8]
“Wenbao Yin warms the cold womb;
Ginseng, baizhu, rougui, fuzi, bajitian;
Shanyao, duzhong, qianshi, buguzhi;
When Heart and Kidney fires decline, take it and recover.”
Then he explained, “Ginseng replenishes qi. Baizhu supports the Spleen and secures qi, benefiting the lower back and the area around the navel. Bajitian and buguzhi warm the Kidney and womb. Duzhong, shanyao, qianshi, and tusizi replenish the Kidney and essence, and also treat the aching lower back. Fuzi and rougui are medicines with intensely hot properties. They replenish your primordial yang, the true fire of the Life Gate.[9]
“The key to this formula is that it replenishes both the Heart and Kidney, warming the Kidney and the Heart together. Once their fires are restored, the cold in the womb naturally disperses. Once the womb is warm, the menstrual pain will naturally stop. A warm womb also gives you a better chance of conceiving. After a month, it should be warm. I'll adjust a few ingredients for you in a moment to make it work better.”
“I don't really understand,” April said blankly, “but it sounds impressive.”
“Would taking this improve anyone's chances of getting pregnant?” Lily asked.
“Of course not. This formula treats deficiency cold in the womb. If there's heat in the womb, you absolutely mustn't take it. In Chinese medicine, treatment has to follow the pattern. You can't just take medicines indiscriminately.”[10]
“Oh,” Lily said quietly.
“Then please write the prescription for me,” April said.
Evan wrote her a prescription for ten batches of herbs. She would drink the first at the clinic; the rest would be packed for her to take home after work.
While they waited for the herbs to decoct, Lily asked, “Dr. Xu, how serious is April's menstrual pain? How long will she have to take the medicine before she's better?”
April looked at him too.
“When the formula matches the pattern, it should work as promptly as a drum answers a strike,” Evan said.
“But I took Chinese medicine for ages before,” Lily said. “Why didn't it do anything?”
Evan froze.
Lily and April looked at him in puzzlement.
Suddenly, an idea came to him. Right—he had been struggling to think of something to post on Weibo to promote Chinese medicine. Wasn't this a perfect topic?
This story has been unlawfully obtained without the author's consent. Report any appearances on Amazon.
Everyone thought Chinese medicine worked slowly. That was its reputation, but it wasn't true. He really ought to explain this to the public.
“Dr. Xu?” Lily prompted again.
Evan came back to himself. “Oh, it's nothing. If it works slowly, that just means the doctor isn't good enough!”
“You're that blunt about it?” Lily asked, surprised.
“It's the truth.”
Ben, playing Dou Dizhu nearby, couldn't help rubbing his chin. Why did that sound as though it was aimed at someone in particular?
Soon, April drank her medicine and left.
By afternoon, Ben couldn't enjoy Dou Dizhu no matter how he played. He felt that his position as Mingxin Clinic's best doctor was under threat.
Clara kept watching Evan thoughtfully. After a long while, she came over and asked, “Are you… particularly good at treating menstrual pain?”
Evan thought about it. “I can treat a bit of everything when it comes to women's conditions.”
“Oh.” Clara went back. “How did he get so good all of a sudden?”
She stepped behind the counter and stole a glance at Evan. A faint smile touched her lips, and she looked a little excited.
When Evan went to the restroom, Ben finally couldn't hold back. He gave a derisive snort and even stopped playing Dou Dizhu.
“Clara, don't believe him. Those women must be people he brought in to pose as patients. You know what he's like. What can he prescribe besides Siwu Tang?
“And now he's good at treating women's conditions? Who would dare say that? Would even a specialist at the Chinese medicine hospital say it? Who does he think he is—a second-generation disciple of Professor Oliver Liu?”[11]
Clara rolled her eyes at him. “What do you know? He's a genius!”
Ben laughed. “What? Him? That college graduate who couldn't even pass the exam to get a hospital job? A genius?”
“Worry about yourself,” Clara snapped. “Bring in more patients. If I can't keep this clinic open, don't think you won't be laid off.”
Ben's face changed. He had always assumed he was safe. How had he ended up facing a layoff too?
“Clara, you can't believe him!” he said urgently. “He brought them in to pose as patients! He's only doing this because he's afraid you'll lay him off. You have to look closely and see what's really going on.”
Clara rolled her eyes and ignored him completely.
Ben's face turned green. He hadn't expected Clara to be so foolish.
Women!
So easily taken in!
Reader Notes
↩︎ The continuing assessment. “Cold womb” resumes Evan's traditional deficiency-cold assessment from the previous chapter. It brings together cold limbs, menstrual findings, pain, and the pulse examination; it is not a measurement of uterine temperature. April's normal reproductive test results are a separate piece of her history. The terminology source describes difficulty conceiving among possible features of a deficiency-cold pattern, without establishing why this particular patient has not conceived. Source: WHO — Chinese medicine terminology, entry 1343, printed p. 169.
↩︎ The Kidney's two aspects. Capitalized Kidney names a functional system in Chinese medicine. Kidney yin concerns its nourishing and moistening aspect; Kidney yang concerns warming, activation, and movement. “Primordial” yin and yang are alternative names for these aspects, not two additional substances. Calling the Kidney the congenital foundation links inherited essence with growth and reproduction. The account extends the previous chapter's yin–yang explanation. The five zang are the Heart, Liver, Spleen, Lung, and Kidney; their names have a wider theoretical scope than the corresponding anatomical organs. Source: WHO — Chinese medicine terminology, entries 153–158, printed p. 14.
↩︎ Connections in the traditional model. Chong, Ren, and Du belong to the eight extraordinary meridians. They are also called the Thoroughfare, Conception, and Governor Vessels. “Vessel” here names a meridian connection, rather than an anatomical blood vessel. The passage combines these connections with a Heart–Kidney account of reproductive warmth. The Heart's association with fire belongs to the five phases. Its description as a sun is the speaker's warming metaphor here, rather than a reference to the taiyang disease category discussed in other medical contexts. Sources: WHO — Chinese medicine terminology, entries 81 and 2926–2929; Fu Qingzhu Nüke — “Lower-body cold and inability to conceive,” section 31 (in Chinese).
↩︎ Two explanations of pain. Chinese medical theory distinguishes pain associated with obstruction from pain associated with insufficient nourishment. Evan invokes both: cold and blood stasis obstruct the channels, while deficiency leaves tissues inadequately nourished. His further explanation connects Spleen yang, the production of qi and blood, and pain after menstruation. Spleen here is the traditional functional system associated with transforming food and distributing nourishment. The explanation and its application to April remain Evan's assessment. Sources: Tianjin University of Traditional Chinese Medicine journal — discussion of pelvic pain, section 1.3.1 (in Chinese); The Chinese Medicine Hospital of Hong Kong — Zang-xiang, the Spleen and Stomach's functions.
↩︎ An inference, not an answer. The narration gives Evan's unspoken reasoning. April has not answered the question at the end of Chapter 12, and this chapter does not establish that she has lost a pregnancy. The overlapping Chinese terms liuchan and xiaochan are again rendered together as “pregnancy loss”; no cause, timing, or distinction between spontaneous and induced loss has been supplied. The dictionary supports the wording overlap, rather than the medical inference about Kidney qi. Source: Ministry of Education — Xiaochan, with a cross-reference to liuchan (in Chinese).
↩︎ A book and a formula.Fu Qingzhu Nüke, or Fu Qingzhu's Gynecology, is a Chinese medical work attributed to Fu Qingzhu, also known as Fu Shan. The quoted passage and Wenbao Yin occur in section 31 of its discussion of seeking conception. The formula's name can be glossed as “Womb-Warming Decoction.” The English quotation is translated for this novel, rather than taken from an existing English edition. The historical account provides the source of Evan's recitation, not evidence of April's eventual response. Source: Fu Qingzhu Nüke — section 31, “Lower-body cold and inability to conceive” (in Chinese).
↩︎ A wording difference in the quotation. The novel's Chinese wording differs at this point from the consulted transcription of the older work: the transcription has an additional negative before the verb meaning “expel.” The English keeps the limited sense that reception is brief and nothing lasts, without supplying a definite mechanism of expulsion or silently repairing the Chinese manuscript. The icy-ground and fish-and-dragon imagery belongs to the quoted traditional argument. It describes neither an observed reproductive test nor a new event in April's history. Source: Fu Qingzhu Nüke — section 31, compare the sentence beginning “Though the man…” (in Chinese).
↩︎ Remembering the ingredients. Formula verses compress names for memorization. Here ginseng is renshen; baizhu is white atractylodes rhizome; bajitian, morinda root; buguzhi, psoralea fruit; duzhong, eucommia bark; shanyao, Chinese yam; qianshi, Euryale seed; and tusizi, dodder seed. Rougui is cinnamon bark, distinct from cinnamon twig; fuzi is aconite lateral root, listed as processed in the older formula. Tusizi appears in Evan's explanation and the historical ingredient list, although it is absent from this verse. The English preserves that difference. Sources: Fu Qingzhu Nüke — Wenbao Yin ingredient list (in Chinese); Hong Kong Department of Health — Chinese Materia Medica Standards, ingredient names; Hong Kong Baptist University — Shanyao specimen record; Taiwan Ministry of Health and Welfare — Qianshi / Euryales Semen ingredient record (in Chinese).
↩︎ The Life Gate. Mingmen, or the Life Gate, names a traditional functional concept closely associated with the Kidney. Its “fire” refers to warming, activating, and qi-transforming functions of Kidney yang. In this passage it does not identify a location where literal fire burns, nor does it indicate treatment at the acupuncture point also called Mingmen. Similarly, “hot” describes the traditional properties assigned to fuzi and rougui, rather than how hot their liquid preparation feels when swallowed. Source: WHO — Chinese medicine terminology, entries 179–180 and 2639–2640.
↩︎ Matching and modifying a formula. Pattern differentiation brings symptoms and examination findings together into a Chinese-medicine assessment; treatment is then chosen to address that pattern. Jia jian means adjusting a formula by adding or removing ingredients. Evan says he will modify the formula, but the chapter supplies neither those changes nor ingredient quantities. His restriction to deficiency cold, and his rejection of use for womb heat, are part of the dialogue and have a parallel in the older text's note. Sources: WHO — Chinese medicine terminology, entries 546–554; Fu Qingzhu Nüke — note following Wenbao Yin (in Chinese).
↩︎ A teacher's lineage. Tusun places someone two teaching links below a master: a disciple of the master's disciple. “Second-generation disciple” describes that relationship, without implying biological descent. Such relationships can carry considerable prestige in a medical tradition that transmits learning through apprenticeship. Ben invokes Professor Liu's reputation to mock Evan's confidence. His rhetorical question does not establish what he knows about Evan's training. UNESCO's account of acupuncture and moxibustion describes instruction and demonstration through master–disciple relationships alongside formal education. Source: UNESCO — 2010 inscription document, printed p. 17, transmission through master–disciple relationships.