Chapter 40 Acupuncture for Childbirth

At the county hospital, a difficult delivery puts the doctors' judgment under pressure.

Dr. Zhao was getting angry at the director's silence. Patients might not know any better, but now the Chinese-medicine doctors were joining in the nonsense. And the hospital director was just going to stand there and watch?

“Director Liu, aren't you going to say something?” he demanded.

“Well…” Director Liu looked awkwardly at Dr. Qian. “Dr. Qian… I think we ought to persuade the family to agree to a cesarean. If we keep delaying, something really could go wrong.”

“If you can persuade the mother and her family, I have no objection,” Dr. Qian replied.

Director Liu had no answer to that.

The dark-complexioned man lowered his head. “We don't have the money for an operation,” he said quietly.

That made Dr. Zhao angrier still. “Which matters more, money or a life? If you can't pay, you can owe it for now. Go home, raise the money, and pay us later. But your wife cannot wait any longer. Keep putting this off and the baby could be in danger. What kind of husband are you, being so irresponsible?”

The man kept his head down, afraid to speak. All he did was tug at the hem of his jacket, where the cloth had a hole…

Dr. Zhao shook his head. He had nothing left to say.

Dr. Qian sighed softly. “I've just examined her. Her condition isn't too serious. The baby is doing well and is in the right position. Her qi and blood are simply too depleted. She hasn't the strength to give birth, and labor has stalled.”^[1]

He addressed the husband. “Since you want Chinese medicine, we'll try it first. But if it doesn't work, there is nothing more we can do. She'll have to have a cesarean. We really cannot delay any longer.”

“You heard him!” Dr. Zhao said loudly. “No more stalling afterward. If something goes wrong, it'll be too late for regrets!”

Looking aggrieved, the man reluctantly nodded.

Dr. Zhao spoke quickly to the nurse beside him. “What are you standing there for? Go and get ready for surgery!”

“Now, now!” Director Liu hastily rebuked him again.

Dr. Zhao looked back at the displeased Chinese-medicine doctors. In his haste, he had offended them again.

Meanwhile, Evan arrived with his acupuncture kit. He came into the consultation room and told Dr. Qian, “Chief, I'm ready.”

Dr. Qian nodded. “Go ahead.”

Everyone froze. He was letting the young man do it?

Dr. Zhao's eyes widened. What the hell?

Director Liu was stunned too.

So were the county hospital's Chinese-medicine doctors. A young fellow like this, handling an emergency like that?

The husband stared. “No… no… no…” he said hurriedly. “Doctor, aren't you going to treat her yourself?”

Dr. Qian smiled. “He's better at acupuncture than I am.”

Everyone was astonished. That was an extraordinary endorsement.

Even Evan was taken aback.

“I'm old,” Dr. Qian continued. “My control of force and precision aren't what they were. Better to let someone young do the needling.”

The husband was still unhappy. Patients had little faith in young doctors, especially young doctors of Chinese medicine. He pointed to the others behind them and stammered, “But… but there are so many other specialists here!”

Some were specialists from Evan's hospital; others were Chinese-medicine specialists at the county hospital. Being pointed out like this left them visibly embarrassed.

It wasn't that they couldn't do acupuncture. They didn't dare try it now.

Medicine depended on practice. You became an expert clinician by treating patients, over and over.

Deliveries hadn't been left to Chinese-medicine doctors for years. None of these doctors had ever handled one.

There were accounts of diagnosis and treatment handed down by their predecessors. But without practical experience, who would dare?

Especially in a situation like this. Suppose they stepped forward and achieved nothing—wouldn't they be laughed out of the room? This was obstetrics' business in the first place. Why get involved?

No one wanted a difficult, thankless job.

Dr. Qian looked at them, disappointment in his eyes.

Holding his needle case, Evan told the husband, “Acupuncture is something I'm fairly good at. I can't promise to cure her with a needle, but it will certainly have some effect. You don't want your wife to keep lying here like this, do you?”

The man still looked hopefully at the other Chinese-medicine doctors. Every one of them avoided his eyes. No one would respond.

Dr. Qian sighed softly. “Let him try. He's a… real doctor of Chinese medicine.”

Evan turned to look at him.

The specialists behind them didn't quite know how to take that.

The husband had no choice. He gritted his teeth. “All… all right!”

Evan said no more. He hurried forward, pulled up a stool, and sat facing the woman.

She was still conscious, just utterly exhausted.

Evan opened the needle case to take out a needle. At the sight of the woman lying on the bed, those images suddenly came back into his mind.

For a moment, he looked deeply distressed. His hands remained still.

The Chinese-medicine doctors behind him craned for a look, exchanged glances, and began whispering.

What was he thinking? All these specialists had refused to try, yet a youngster had to show off. Was this any time to seek the limelight? One mistake, and he'd make a complete fool of himself.

Look at him now. He didn't even dare move. Had he been scared witless?

This had nothing to do with Chinese medicine in the first place. He was trying to show off, without even the skill to back it up!

And Dr. Qian was indulging them!

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If Dr. Qian hadn't been there, the specialists would probably have started scolding him outright.

Dr. Zhao shook his head too. Utter nonsense.

Director Liu gave a slight shake of his head as well.

Only Dr. Qian kept his eyes fixed on Evan.

“Those who are unhurried in speech and calm in manner, deft of hand and careful in judgment, may be entrusted with needles and moxa.” Evan murmured the words and clenched his right hand into a tight fist.^[2]

Not every doctor of Chinese medicine was suited to acupuncture and moxibustion. The first requirement was a sufficiently calm mind.

Evan slowly let out several breaths. After all the rigorous drilling he had undergone with Instructor Cheng in the acupuncture practice room, he quickly suppressed the images and calmed himself.

“Ma'am, can you hear me?” he asked the woman. “I know you're exhausted. Rest a little first. Try not to worry or get upset. You'll be able to give birth soon.”

“I'm going to give you acupuncture now. If you feel anything, tell me, all right? It's all right. Don't worry. In a little while, we'll work together, and you'll be able to take your baby home.”

The woman looked at his face. Surprisingly, she showed no irritation. “All right.”

Evan took her hand and disinfected the web between thumb and index finger with an alcohol swab. He took out a filiform needle. Pressing the skin at Hegu with his left thumb, he held the needle by its handle in his right hand, set the shaft against his left thumbnail, and slipped it swiftly beneath the skin without twisting or rotating it.^[3]

The specialists' eyes lit up.

One move was enough to show whether someone had skill.

This was called rapid nail-pressing insertion. It allowed quick entry, brought on deqi—obtaining qi—quickly, and caused no pain. But it was difficult to master. In unpracticed hands, it could easily hurt the patient or bend the needle.^[4]

For someone less skilled at acupuncture, slowly inserting the needle with gentle rotation was the more reliable choice.

Holding the handle in his right hand, Evan rolled and rotated the needle, lifting and pressing it. Soon he felt a heavy, tightening resistance through it. He had obtained qi.

“How does that feel? Does it ache, or feel full, numb, or heavy?” he asked.

“Yes… it aches, and feels full,” the woman answered weakly.

As the Lingshu, in “Pathogenic Qi and the Forms of Disease in the Zang and Fu,” put it: “Strike the qi point, and the needle travels as through a lane.” The needle had found the channel point. Evan did not hesitate; he immediately began a tonifying technique.^[5]

He felt encouraged. Her response to the needle was strong.

“Listen to me. Breathe in through your mouth and out through your nose. Just breathe naturally. That's it.”

Matching her breathing, Evan used a single finger to press the point and advanced the needle to the heaven level as she exhaled. He worked the handle with five forward strokes of his right thumb, using the flying manipulation. When he felt the needle tighten, he lifted it gently to release the binding.^[6]

He then advanced to the human level and repeated the flying manipulation four or five times. Once the needle tightened again, he thrust it quickly to the earth level and repeated the same movements.

Setting the Mountain on Fire divided the point into heaven, human, and earth: the shallow, middle, and deep levels.^[7]

After completing the flying movements, Evan kept the needle tip engaged with the responsive area and made three quick thrusts and slow lifts over a range of about one fen.^[8]

The Chinese-medicine doctors watching him were dumbfounded.

The younger ones had no idea what he was doing. All they could see was the needle being lifted and thrust again and again. Did he really need to do it so often?

The older, more knowledgeable doctors could scarcely believe their eyes.

“That… could it be…?” Dr. Qian said the name slowly. “Setting the Mountain on Fire!”

Reader Notes

1. ↩︎ Qi, blood, and stalled labor. As in the preceding chapter, qi and blood deficiency is a traditional pattern describing depleted function and nourishment. Here, inadequate strength to deliver is Dr. Qian's assessment. “Stalled labor” does not specify a mechanical obstruction. Sources: WHO — Chinese medicine terminology, entries 224–225 and 1122; WHO — Maternal and newborn care standards, quality statement 1.4.
2. ↩︎ A classical description of the practitioner. Evan's words come from “Guan Neng,” chapter 73 of the Lingshu (Spiritual Pivot), the acupuncture text within the Huangdi Neijing. The passage assigns different medical tasks according to a practitioner's abilities and temperament. Here, measured speech, composure, dexterity, and careful judgment qualify someone to use needles and moxa. Moxa refers to the material used in moxibustion; its presence in the quotation does not mean Evan uses it in this scene. Source: Lingshu — “Guan Neng,” chapter 73 (in Chinese).
3. ↩︎ Hegu and the needle. Hegu, also designated LI4, names an acupuncture point on the back of the hand, between the thumb and index finger. “The tiger's mouth,” the Chinese expression behind the preceding description, refers to that thumb–finger web. A filiform needle is a slender acupuncture needle, rather than a hollow needle for an injection. The source does not identify which of the woman's hands Evan treats. Sources: Memorial Sloan Kettering — LI4 (Hegu), location section; NCCIH — What is acupuncture?.
4. ↩︎ Insertion and obtaining qi. Nail-pressing insertion uses one hand to steady the skin beside the point while the other guides the needle alongside the nail. “Rapid” preserves the novel's emphasis on Evan's speed. Deqi names the associated needle response: the patient's aching, fullness, numbness, or heaviness, and the practitioner's sense of resistance. Chapter 36 distinguished obtaining qi from the further arrival of qi; that distinction is retained here, although terminology sources may use the expressions together. Sources: Beijing University of Chinese Medicine — Needle insertion (in Chinese); WHO — Chinese medicine terminology, entries 3016 and 3040–3041.
5. ↩︎ The needle and the lane. The novel invokes a classical image of the needle moving through a passage when it reaches the intended point. Zang and fu refer to organ systems in the traditional framework. A tonifying technique aims to supplement deficiency, as opposed to reducing excess; nothing is being injected. The quotation supplies the passage's traditional reference, rather than a modern measurement of needle placement. The English quotation is translated here from the wording in the novel. Sources: Lingshu — “Xie Qi Zang Fu Bing Xing,” chapter 4 (in Chinese); Beijing University of Chinese Medicine — Reinforcing and reducing methods (in Chinese).
6. ↩︎ The flying manipulation. This is a name for working the needle handle with repeated finger movements, not for lifting the needle out of the patient. It belongs to a vocabulary that distinguishes rotation, lifting and thrusting, and other manipulations. The accompanying breathing and the slight lift to release binding are separate details in the novel's sequence. They are retained without adding movements or counts from a textbook version. Source: WHO — Chinese medicine terminology, entries 3038, 3050, and 3061.
7. ↩︎ Setting the Mountain on Fire. Shaoshanhuo is a named compound needling manipulation traditionally associated with producing warmth. Heaven, human, and earth designate relative shallow, middle, and deep levels within the intended needling depth, using a familiar three-part cosmological vocabulary. They are not three separate organs. “Fire” names the method; no flame or burning moxa is applied here. Accounts differ in their detailed sequences, so the narrative retains the source's particular counts. Source: Beijing University of Chinese Medicine — Compound reinforcing methods, Shaoshanhuo (in Chinese).
8. ↩︎ A small traditional measure. A fen is one tenth of a cun in the traditional length hierarchy. The term is retained here rather than converted into a precise number of millimeters: the novel supplies no fixed modern scale for this movement. In this sentence, it describes the small range of lifting and thrusting, rather than the entire insertion depth. “About” preserves the approximation in the Chinese. Source: Taiwan Ministry of Education — Historical length hierarchy, entry “Si” (in Chinese).