Chapter 9: The First Free Clinic

The next morning, upon waking, Miaozhen noticed a round fan on the table, a gift from Lin Xiaoxiao. It had a brown bamboo handle and a double-sided silk surface embroidered with a butterfly and flower pattern in the shape of a begonia. She was momentarily lost in thought. She instructed someone to carefully put it away before heading to Madam Mei’s place, telling her she would accompany Madam Ru to the free clinic that day.

Madam Mei brought over a plate of willow leaf dumplings. “Since that’s the case, eat more to fill your stomach,” she said, then ordered a bowl of lamb noodles with two eggs on the side.

Miaozhen pressed her palm to her forehead. “You’re trying to burst my belly.”

“Eat more to stave off hunger. There are also two packs of snacks at home; I’ve had someone prepare them.” Madam Mei wished she could go with her daughter herself, but this was her daughter’s first time dealing with strangers.

After hastily wiping her mouth with a handkerchief, Miaozhen left with a maid in a carriage, first arriving at the Tao residence. Madam Ru then took her and Ru Xiniang together to the Xuanmiao Temple.

Here, Madam Ru had borrowed a few rooms to set up the clinic, draping curtains inside for privacy. She instructed Miaozhen, “Light the protective incense.”

In ancient times, without modern disinfectants, they burned herbs like cangzhu or protective incense to cleanse the air. When treating patients, one had to avoid being affected by their aura, lest one fall ill oneself. Many doctors in acupuncture and massage practiced morning exercises like running and the Eight Brocade Qigong to maintain health.

Aside from burning incense, Madam Ru ordered water boiled with salt to sterilize needles and knives.

“Before healing others, we must first protect ourselves.”

Both Miaozhen and Ru Xiniang nodded in agreement.

At the sound of a gong, the first to enter was a woman supported by her sister, said to have fainted after excessive bleeding. Miaozhen instinctively began recording the medical case.

“Madam Tao, shouldn’t we stop the bleeding first?” her sister asked.

Madam Ru felt her pulse but shook her head. “Though there is abundant fire stirring the blood, it is not true fire. Using only hemostatic agents may stop it temporarily but it will likely relapse.”

The patient might not understand, but Miaozhen recognized the meaning from the Yellow Emperor’s Classic of Medicine: “Collapse caused by yin deficiency and excessive yang.” This woman’s bleeding was from yin-deficiency fire disturbing the blood chamber, so simply stopping the bleeding was not enough; nourishing yin was necessary.

The woman’s sister inquired, “What medicine will the doctor prescribe?”

Madam Ru said, “Use the ‘Stabilize the Root and Stop Collapse Decoction’: one tael of well-steamed Rehmannia glutinosa, one tael of white atractylodes roasted in clay, three qian of astragalus, five qian of angelica soaked in wine, two qian of black ginger, and three qian of ginseng. All decocted in water. Usually, one dose stops the bleeding; after ten doses, it won’t recur.”

Miaozhen dutifully wrote down the prescription and gave it to the woman’s sister.

After they left, Madam Ru explained, “Excessive bleeding causes a loss of qi and blood, so we must first tonify qi before replenishing blood. Note that black ginger helps guide blood back to its channels.”

Miaozhen asked, “If the bleeding is unstoppable and all six pulses vanish, more severe than this woman, what then?”

“Then we cannot start with the Stabilize the Root and Stop Collapse Decoction. Instead, decoct three qian of ginseng with the root of Ardisia crenata and mix in one qian of powdered ardisia charcoal. The patient takes this first to revive her qi slightly, then the previous formula is given with an additional qian of ardisia charcoal,” Madam Ru replied.

“What if her condition remains weak and unimproved?” Miaozhen pressed.

“Then use three qian of ardisia charcoal mixed with ash-free yellow wine. When she fully regains consciousness, administer the original decoction, but replace ginseng with codonopsis and still add one qian of ardisia charcoal,” Madam Ru explained in detail.

Miaozhen finally understood that ardisia charcoal is prepared for its cooling, detoxifying, blood-cooling, and hemostatic properties.

Next came a pale-faced woman, hesitant to speak, especially upon seeing Miaozhen and Ru Xiniang. Madam Ru reassured her, “They are doctors and women as well; you need not be afraid.”

The woman said, “I am pregnant, but one day the child miscarried, and the bleeding wouldn’t stop.”

“Have you done the postpartum confinement?” Madam Ru asked.

The woman nodded, “Even after confinement, it’s still the same. Many hemostatic medicines have no effect.”

Madam Ru took her pulse herself and then had Miaozhen do so. Miaozhen observed the hollow lower eyelids, indicating deficiency in the reproductive palace. This was her first real clinical experience; she carefully felt the pulse and said, “The middle is empty and soft, the sides are solid, a hollow and tight pulse.”

A hollow pulse is usually seen in acute blood loss, severe vomiting, or serious diarrhea. Miaozhen checked both wrists—the left corresponds to heart, liver, and kidney; the right to lung, spleen, and kidney.

“I feel there is vigorous deficiency fire,” she said.

Madam Ru told them, “Miscarriage bleeding is often caused by sexual intercourse, which differs from the previous case. You must be careful. The last case was yin-deficiency fire disturbing the blood chamber; this one is caused by qi deficiency and blood loss.”

Ru Xiniang blushed slightly, but Miaozhen, not yet eleven, remained composed as if hearing about something ordinary like eating or drinking.

Seeing this, Madam Ru nodded inwardly and prescribed the ‘Qi-Strengthening and Essence-Filling Decoction.’

After the woman left, Miaozhen realized the reason for her hesitation: miscarriage due to sexual intercourse. During pregnancy, the fetus relies heavily on kidney essence, so treatment must not only stop bleeding but also strongly nourish kidney essence; otherwise, kidney water is depleted and deficiency fire intensifies.

Madam Ru further explained, “If miscarriage is caused by a fall or shock, with heavy bleeding mixed with black-purple clots and dizziness, then the ‘Qi-Regulating and Blood-Dispersing Decoction’ is needed.”

Miaozhen meticulously recorded Madam Ru’s words, sensing that she was particularly skilled in gynecology—fluency in treating female hemorrhage and postpartum care was clear—though perhaps less so in other fields.

Recalling that Lin Xiaoxiao and her mother both suffered from lung ailments, it made sense why some said Madam Ru’s medical skills were average; it was not her fault.

Miaozhen resolved to master gynecology thoroughly, no longer wavering.

Several more women arrived, mostly with gynecological disorders. The last was a woman with a crooked mouth and eyes, drooling, suffering chills after being exposed to wind.

This was wind-cold facial paralysis. In her previous life, Miaozhen had treated this condition with acupuncture and was familiar with it. Madam Ru, however, did not fully trust her to handle it alone, only teaching her which acupoints to needle. When extracting needles, she let Miaozhen do it.

“Madam, two young ladies, the meals have arrived,” a Taoist nun announced, bringing food.

Everyone washed their hands and ate in a side room. Miaozhen, having eaten too much earlier, was not very hungry and only nibbled a little.

Madam Ru did not insist. “Take a walk nearby. I need to speak with a certain Taoist priestess.”

After Miaozhen left, Madam Ru indeed took her niece to meet a female Taoist priestess. These priestesses often mingled with wealthy families and officials, thus well-informed.

Ru Xiniang was now of marriageable age. Orphaned, Madam Ru treated her niece as her own daughter, bringing her along to the homes of the wealthy in hopes of a good marriage. Unfortunately, suitors often demanded substantial dowries and disapproved of her lacking parents, making proposals unsatisfactory.

There was, however, a way: if her niece could be recommended to the palace, it would be ideal.

Coincidentally, Madam Ru had taken in a young girl from the Xu family as an apprentice. In less than two years, this girl’s knowledge nearly matched Ru Xiniang’s five years of study. The Empress Dowager Jiang, mother of Emperor Jiajing, was said to be suffering from sores and ulcers. The palace often sourced doctors from civilian offices; Madam Ru planned to use this priestess’s connections to send her niece into the palace.

Naturally, they first needed to seek out a renowned doctor specializing in ulcers, which required social connections.

They spoke for an hour. Miaozhen strolled outside briefly, then returned to rest before seeing Madam Ru and her niece return. Their faces were bright with joy. Miaozhen said nothing; she knew mastery lay in depth, not breadth. She had heard from her father’s colleagues at the government office that Emperor Jiajing was searching for doctors in the common folk to treat Empress Dowager Jiang’s ulcers. Suzhou had many famous doctors, each with specialties. Following the example from above, their family’s bookstore’s books on ulcer treatment were kept as treasured volumes, though a few copies still sold.

Just as in her past life she had studied acupuncture because her parents chose it, gynecology was her own strength and choice in this life. She had no intention of changing her path.

To devote one’s life to perfecting a single pursuit was enough.

That afternoon, Miaozhen studied diligently.

Madam Qiu from the women’s school taught them to cook abalone with bones; she prepared two boxes to send to Madam Ru. Though Madam Ru favored her niece, she appreciated talent and noticed Miaozhen’s youth but kind nature and dedication, giving her extra care.

After the summer solstice, the weather grew hot. Returning from outside, they were often drenched in sweat. Madam Qiu allowed them over a month’s rest, planning to resume lessons after the start of autumn.

Thus, Miaozhen could study with Madam Ru from morning till night. Her acupuncture advanced rapidly—already familiar with acupoints, she adapted quickly to ancient needles and techniques, having pricked her own legs countless times and frequently practicing moxibustion.

One day, returning drenched in sweat, Madam Mei suggested, “Why not rest for a couple of days?”

“Everything must be done in one go. Now that she’s only taken her daughter out two or three times a month, it’s already very good. The daughter has eaten two bowls of iced sorbet on the road and feels more comfortable,” Madam Ru replied.

Worried about her daughter’s cold stomach, Madam Mei advised eating less. Miaozhen thought that in such heat, avoiding cold foods might cause heatstroke.

Meanwhile, her father had ordered a cartload of ice from a fresh ice boat. Over the past two years, their family had repaid two hundred taels of silver and still had two hundred taels in savings, surpassing their debts, so there was no longer such financial strictness.

Though they had not used all the ice, a heavy rain began. Their house was on high ground and did not flood, but the main and third branches’ houses leaked badly, flooding halfway up.

Fortunately, the eldest aunt’s home was fine. She borrowed a room from her uncle to stay, though her eldest uncle was reluctant, feeling inferior to the Yue family. Since he came alone to borrow lodging, the eldest aunt had no choice but to bring Miaoyun and others along.

The third uncle and aunt’s home had water soaking the floor near the beds. Master Xu and Madam Xu stayed upstairs, but Xu Siniang could not stay and was drenched, so they sent her over.

Suddenly, the house had four more people, and Miaozhen knew trouble was coming with so many around.