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A Response From a Classical Chinese Medicine Perspective to a Lecture on Early Greek Gynecology

Response from a Chinese medicine perspective to Helen King, “Ancient Greek Gynecology for Beginners: Wine, Women, and Pongs”

Lecture presented at Reed College on March 9, 2015

 

Last night, I was fortunate to enjoy a highly entertaining and informative lecture by Dr. Helen King, Professor of Classical Studies at the Open University in the UK, presented at Reed College in Portland, Oregon. As the leading authority on medicine for (and by) women in ancient Greece and early Europe, she managed to provide a survey of early gynecology that was impressive in its comprehensiveness in spite of the unfortunate time limitations of her presentation. I was elated to have her touch on many subjects that I often discuss in the context of classical Chinese gynecology:

  • medical explanations for the difference between male and female bodies;
  • related to this, the concept of the androgynous body and sex differences not as absolute but on a spectrum ranging from extreme male to extreme female, with people falling anywhere in between these poles;
  • menstruation, most notably the interpretation and treatment of absent menstrual flow; 
  • the significance of the womb in pathology and physiology, and the image of the wandering womb ravenously looking for moisture;
  • the politics of gynecology: is the medical recognition of female difference paternalizing, debilitating, empowering, an excuse by men for oppressing and disrespecting women, a recognition of their equal value and contribution to society, or all of the above? 
  • the female body, and female flesh in particular, as more moist and “spongy” than the male body;
  • infertility and its relation to blocked menstruation and lack of moisture;
  • the issue of female healthcare providers and power relationships between midwives (female and later also male) and doctors (mostly male, but with notable exceptions);
  • the limitations of our knowledge about women’s actual experiences of healthcare, based on the absence of female voices in the written sources; and lastly,
  • potential contributions of ancient medicine to the practice of modern medicine, most notably the experience of “holism” by avoiding dissecting dead bodies and encouraging empathy for the living body instead.

Given Professor King's historical background and the limitations of time in a lecture of less than two hours, I left with more questions than I had arrived with, as should be expected, and I hope to continue a conversation with this outstanding scholar in the future. Nevertheless, two things struck me as significant enough to share them in a short blog post: First, there are several similarities in both etiological conceptions of women’s disorders and their treatments that raised so many questions for me as a clinically oriented scholar but that were unfortunately only mentioned in passing in this lecture. Second, the way the material was presented and received by the audience: As a teacher at a clinical school of “Classical Chinese Medicine,” I get to transmit insights from the ancient writings in a framework where they are revered as “Classics” and read and explored with respect for clinical truths still useful today. Instead, Dr. King presented her material, at least in this lecture, as exotic, crude, entertaining for its absurdity from a modern biomedical standpoint, and important primarily as a contribution to historical research into early European culture and the role of women.

1. Similarities Between Early Greek and Chinese Gynecology

Most significant to me personally were Dr. King’s repeated references to female bodies, and female flesh in particular, as more “moist” and “spongy” than male bodies!  This immediately reminded me of Sun Simiao’s strange statement that “women are copious accumulations of yīn and constantly inhabited by dampness” (婦人者,眾陰所集,常與濕居). This isolated quotation from a “classic” has always seemed a bit odd to me in that particular context, and smelled of foreign influence. Now I may have found my answer to this mystery. How this Greek notion made it via India into Sun Simiao’s writings requires future research, but the thought is enticing.

To return to ancient Greek ideas as presented by Dr. King, female bodies accumulate “moisture,” which they have to eliminate regularly through the physiological process of menstruation. If the menses are suppressed, this is a serious sign of pathology in need of treatment and the primary cause for infertility. As a result, symptoms like vomiting blood or nosebleeds are interpreted not as pathological symptoms but actually as a healthy elimination of menstrual blood, just from the upper body instead of the lower body, so presumably a much smaller problem than no menses at all. Unfortunately, Dr. King did not have time to go into the clinical details on how menstrual blood was believed to move to the upper body and what precisely the clinical causes for this abnormality were.

Eliciting many chuckles from the audience, Dr. King presented an illustration by Leonardo da Vinci from the 1490s depicting the significant aspects of a male and a female body engaged in sexual intercourse. She explained several features that I was the only member in the audience not to laugh at: The connection between the womb and breast in the female body was depicted because menstrual blood was seen as transforming into breast milk for lactation. In the male body, by contrast, a substantial pathway led from the brain down the spine into the penis, since semen was believed to be produced in the brain. In another context, she explained that men, being more “hot” than women, were able to “cook” their blood into semen while women, being more “moist” and “cold,” had to eliminate theirs through menstruation. Both of these pathways obviously make perfect sense from a Chinese medicine perspective and are definitely not something to make fun of but essential aspects of the healthy functioning of the body.

Concerning the treatment of stopped menstruation, Dr. King only mentioned three modes, possibly chosen for their entertainment value.

  1. Succussion on a ladder, admittedly quite crude from a modern perspective, to shake an unwanted fetus or gathering blood out of the womb and thereby restore the menstrual flow;
  2. fumigation with (unfortunately unidentified) sweet-scented substances, especially when stuffed inside a puppy, by suspending the woman over a hole and exposing her uterus to the heat and smoke from the burning substances, for the purpose of enticing the wandering womb to return to its proper location in the lower abdomen; and lastly
  3. beetle pessaries, most notably the insertion of Cantharides (Spanish fly or “blister beetle”) into the womb to make the woman bleed vaginally.

As Dr. King quoted several times, an important treatment mode was “when in doubt, get it out.” While the insertion of vaginal suppositories with Blister Beetles is indeed shockingly drastic from almost any perspective, the connections to the internal use of strong blood-moving insects like méngchóng (Tabanus bivittatus), zhèchóng (wingless cockroach), and especially géshàngtíngcháng (Epicauta Gorhami, a close relative of Cantharides) in classical Chinese medicinal decoctions for infertility has much potential for future research. Similarly, the use of heat and aromatic herbs to break up bound blood makes a whole lot of clinical sense from a classical Chinese perspective. As both the ancient Chinese and the ancient Greek doctors agreed, stopped menstruation was, after all, a sign of infertility, and childbearing was the most essential function of women. Also, the need for moisture and the increasing lack thereof in the aging female body, which caused stopped menstruation and infertility, is an obvious connection.

2. Differences Between a Historian's and a Clinic-Oriented Approach

Concerning my second observation about the difference in approach between my own presentations and Dr. King’s lecture, I am not sure how much of this was due to the admittedly very limiting context of this particular lecture. I would have loved to hear Dr. King go into more detail on the effects of dissection (or lack thereof) on the medical approach to the human body and the doctor’s empathy, a topic that she mentioned only in passing. Of course I wanted to learn more details about herbal and other, more subtle forms of treatments and their intended effect on the female body, but that obviously transcended the limitations of this occasion. What was the significance of the wandering uterus with its multiple "mouths," how was it treated and what were its specific causes, besides the obvious answers of pregnancy and lack thereof, respectively. Where and when did this concept first appear and when did it become obsolete, and how could it be related to cultural norms, threats, or ideals? How much moisture in the female body was physiological, how could you determine this, and when was it interpreted as a pathology instead? If female bodies dry out with age, how do male bodies differ in their response to aging? If women could grow beards when deprived of their husbands, did men start to menstruate and lactate? What about nuns, widows, and other celibate women who did not fall ill and die from a ravenous wandering uterus? What was the relationship between midwives, presumably female until the arrrival of William Smellie in 1752, and male doctors and what was their role in the production of knowledge about the female body?

Besides all these hanging questions, which Dr. King could well have answered in a different lecture to a different audience, I wonder how this lecture would have turned out if both the presenter and the audience had approached the information in the texts from a clinical angle instead of as historical curiosities with no relevance to modern practice. As a result, maybe the discussion would not have focused on those aspects of the texts that strike us modern “rational” and “scientific” researchers as absurd and laughable, but on information that might expand, supplement, or even challenge our current medical paradigms? And in reverse, for a moment, I imagined somebody giving a very similar lecture in front of this kind of audience on classical Chinese treatments like burning the husband’s pubic hair to induce labor or consuming pulverized cockroaches for stopped menstruation, and receiving the exact same response, ranging from derision to hysterical (no pun intended) laughter, disgust, and condescension. While this could easily be done with a roaring effect, the resulting loss of clinically useful information and disrespect for the insights of the ancient masters causes me deep discomfort.

More than anything, this lecture makes me want to brush up on my Greek and Latin, and study Arabic, so that I can study the writings of the Hippocratic corpus, Galen, Soranus, and Avicenna myself. It also makes me feel profoundly proud of the sophistication of our understanding of the medical treatment of the female body in classical Chinese medicine, where we would never be forced to construct a single image on the basis of texts, legends, and illustrations ranging over almost 2000 years (500 BCE to 1490 CE) and brushing over the Chinese equivalent of cultural and religious differences between Greek, Roman, and Islamic medical traditions, to name just a few. An equivalent might be the difference between Confucian virtue literature, Daoist self-cultivation (whether for men or for women), and Buddhist treatises clearly influenced by Indian notions of female pollution and "mind over matter." Or even in the context of medical literature, where we have long recognized the different outlook and intention of theoretical treatises like the Yellow Emperor's Inner Classic compared to formularies like Zhang Zhongjing's Essentials of the Golden Cabinet and Sun Simiao's Prescriptions to Prepare for Emergencies Worth a Thousand in Gold. Once again, I am left admiring the subtlety of the Chinese medical approach to the female body and count myself fortunate for the field and environment I work in, where the result of my research is not object of laughter but of heated clinical discussions.

Sabine Wilms5 Comments