This topic is perhaps the one area in my research where my personal and professional interests intersect more vividly than anywhere else.
Experiencing my own pregnancy and then giving birth to my daughter is what led me to the study of medieval Chinese gynecology as my dissertation topic many years ago. The more I learn about how classical Chinese medicine cared for and about the female body, the more strongly I feel about the need to share this knowledge with not just Chinese medicine practitioners but also patients and practitioners of other healing arts. I would love for this knowledge to ripple out there to the general public because no culture or family can ever be truly healthy until all of its mothers (in the literal and figurative sense) are respected and nurtured and supported on all levels.
As you can see from the length of this page, I tend to get carried away a bit. I consciously have chosen the broad "nurturing the feminine" as the title for this page, rather than something more traditional like "classical Chinese gynecology," because what Chinese medicine and philosophy have to offer far transcends the medical treatment of gender-specific diseases like menstrual irregularities, obstetrical complications, menopausal hot flashes, or infertility. My thinking on this topic continues to evolve, ever since I first chose to translate Sun Simiao's volumes on gynecology (Bei Ji Qian Jin Yao Fang 備急千金要方 II-IV) for my doctoral dissertation decades ago. As a woman, daughter, mother of a girl who is now on her own road to womanhood, and friend and teacher and student of women from all over the world, I have witnessed countless ways in which women experience their womanhood, with countless stories of powerlessness, abuse, and suffering, balanced only by equally heart-opening stories of beauty, love, empowerment, and healing. Which way you see the scale tip is a matter of perspective and choice.
In popular Western imagination, especially since the arrival of modern feminism, traditional Chinese culture is often judged harshly for its oppression of women.
This situation is associated in particular with Confucianism, which is held responsible for the Chinese system of strict social organization on the basis of a patriarchal and patrilineal hierarchy. The Chinese language is full of traditional sayings like this: "Before marriage, obey your father; after marriage, obey your husband; after the husband's death, obey your son." One commonly expressed notion holds that the woman, being associated with yīn and the earth, is subject to (because physically located below) the man who is associated with yáng and the sky/heaven. Above all, women's lives in historical China are generally seen as defined by their ability to produce male offspring for their husband's family, to ensure the continuation of ancestral sacrifices for the husband's clan. This perspective is often compounded in the popular imagination by details specific to late imperial period, such as evocative, horrifying images of footbinding and gripping accounts of concubinage and female enslavement and infanticide, such as in many mainstream movies or fiction. All this is most certainly worthy of our attention and emotional responses, and discussed in great detail in numerous Women's Studies classes and academic and popular publications.
Nevertheless, the position of women in traditional China, just like in medieval Europe or any other culture, time, or place in the world, is much more complex than the popular image suggests.
Regional, chronological, social, economic, and even personal differences, to name just the most obvious, make it a great challenge to draw meaningful conclusions that do not oversimplify the subject. This complexity is the reason why I am not a Woman's Studies scholar. My personal research focus on the Tang dynasty has led me to look at the position of women in China from a slightly different perspective, suggested perhaps in the slides below.
While women's lives were undoubtedly shaped by the above-mentioned aspects of Chinese culture in general, and societal structure in particular, stories abound from the Tang dynasty also of powerful women. To name just two examples, the two most illustrious ladies are:
- Wu Zetian 武則天: the only true empress in China, who founded and successfully ruled her own dynasty from 690-701 CE.
- Yang Guifei 楊貴妃: the "Precious Consort Yang," the deeply beloved consort of emperor Xuanzong, one of the most celebrated emperors in the history of China. So enamored was he by this powerful lady that only her death prevented the loss of the dynasty during the An Lushan rebellion of 756 CE.
Similar to the ambiguity suggested by the brief introduction above, it is impossible to summarize the treatment of women's bodies in Chinese medicine in a simple statement. Three excellent books on the topic of women in Chinese medicine are the following:
Charlotte Furth, A Flourishing Yin. Gender in China's Medical History, 960-1665 (University of California Press, 1999)
Yi-Li Wu, Reproducing Women. Medicine, Metaphor, and Childbirth in Late Imperial China (University of California Press, 2010).
Angela Ki Che Leung, ed., Medicine for Women in Imperial China (Brill, 2006).
Focusing on the writings of the great Sun Simiao 孫思邈 in the Bei Ji Qian Jin Yao Fang 備急千金要方 ("Essential Formulas Worth a Thousand in Gold to Prepare for Emergencies") as a key turning point in the history of Chinese gynecology, the following points stand out in his writing:
1. Women's Health: The Root of Family Health
In the Bei Ji Qian Jin Yao Fang, the treatments for women, comprising roughly ten percent of his entire work, are placed at the very beginning of the text, right after the introduction and before pediatrics and then the bulk of the text on general medicine. This stands in marked contrast to other medical compendiums from classical China, and, one may add, to the historical and modern conventions of Western medicine as well, where information on women's gender-specific care is placed at the very end, often with the explanation that any other disorders in women are to be treated just like those of men and are covered under the general section.
As many historians have stated, in the history of Western medicine this attitude is the logical outcome of the early Greek medical model of a "one-sex body" based on the male as the norm and centering on anatomy rather than of function. As a result, the female body is in this model seen as a deviation from the norm, due to the presence of the uterus, which makes women prone to physical and psychological disorders and weaknesses, most notably "hysteria" (etymologically derived from the Greek word for "uterus"), and consequently often treated by removing the uterus through hysterectomy.
The medical historian Charlotte Furth has contrasted this convincingly with what she has termed the "androgynous" body in Chinese medicine, one that is neither exclusively male nor female and is marked by functional equivalents along a yin-yang continuum. While yin and yang are associated with female and male respectively, they are also affected by a multitude of other correlated pairs, such as old/young, moist/dry, active/passive, blood/essence, earth/heaven, inner/outer, lower/upper, etc. As a result, several medical historians have asserted that classical Chinese medicine before the Song period did not recognize a categorical difference between male and female bodies, a claim supported also by the fact that early specialists in women's care were referred to as dai xia yi 帶下醫 "physician of what is below the girdle." Similarly, the Jin Gui Yao Lüe 金匱要略 asserts: "“Women’s disorders in the upper and middle sections of the body should be treated with general formulas. Only diseases “below the girdle” (i.e., digestive and reproductive conditions) are specific to women and mentioned in the section at end.” An analysis of all relevant literature on women's conditions is obviously beyond the scope of this webpage, so you will have to take my word or do your own research, but my research in the clinical literature of the pre-Song period (most notably formularies and Chao Yuanfang's Zhu Bing Yuan Hou Lun 諸病源侯論 (Treatise on the Origins and Signs of the Various Diseases) leads me to disagree with this view.
But let us return to Sun Simiao to prove my point with perhaps the most obvious example. In my eyes at least, the structure of the Bei Ji Qian Jin Yao Fang as a whole demonstrates Master Sun's attitude to the female body as worthy of special attention and central to the health of the entire family and to the grand project of "nurturing life" more vividly than any written statement could. Whether initiated by Sun Simiao or merely brought to light by him, this appreciation for women's health and the recognition that "nurturing life" extends beyond the sphere of individual cultivation led to the development of gynecology as a full-fledged and greatly respected professional medical specialization with its own literature, celebrated specialists, and imperially-sponsored department of medical training during the Song period (960-1279 CE). There is no doubt in my mind that one reason for this development can be found in Sun Simiao's exposure to and historically documented involvement with Mahayana Buddhism, a set of religious concepts and practices that had been imported from India to China only a few centuries earlier and advocated altruistic practices aimed at relieving the suffering of all sentient beings. Sun Simiao's chapter on medical ethics expresses this view clearly.
2. Ten Times More Difficult to Treat
In direct contradiction to some information found on the internet and taught by self-identified "specialists" in the field of "traditional Chinese medicine" in the West, Sun Simiao did NOT say that he would rather treat ten men that one woman. Far from it! He did say that women were ten times more difficult to treat (比之男子十倍難療) and required separate formulas because of their "difference due to pregnancy, childbirth, and flooding damage." Given their central role for the continuation of the family, "specialists in nurturing life should particularly instruct their sons and daughters to study these three volumes of methods for women until they comprehend them thoroughly. Then what would there be to worry or fear even in the face of a harvest of unexpected surprises?" In other words, Sun states that it is precisely because of women's reproductive functions, their affinity with yīn, the menstrual cycle, and their complicated emotional states that their bodies required extra care and present a greater medical challenge than men's. We can choose to take offense to such an attitude as patronizing and patriarchal, as encoding women's weaknesses and potentially justifying their oppression by men, or appreciate it as an expression of tender care and respect for the challenges experienced by the female body as the result of the burden of childbearing. Regardless of our personal attitude, the fact remains that as due to this attitude, classical Chinese medicine developed highly sophisticated medical tools for the diagnosis and therapy of women's diseases that, in my eyes at least, remain unmatched by any other medical system to this day.
3. Causes of Women's Vulnerability
What were the causes that made women's bodies so much more challenging in the eyes of male medical authors? Sun Simiao answers this question indirectly by offering a surprisingly comprehensive overview in his brief introduction (read the literal translation of the full introduction here!):
- The initial explanation states in concise terms that women are "different because of pregnancy, childbirth, and flooding damage" (beng 崩, a technical term that refers to flood-like vaginal bleeding, with a character that is etymologically derived from the notion of landslide). I read this short statement as saying plainly that women's bodies differ from men's because they go through pregnancies, give birth, and suffer from profuse vaginal hemorrhages, in the present context most likely referring to heavy bleeding in connection with childbearing, i.e., during pregnancy, birth, and postpartum.
- Sun then quotes an unidentified classic: "Women are copious accumulations of yīn and are constantly inhabited by dampness." The origin of this statement is unclear but could even derive from a Chinese translation of an Indian medical text.
- Menstruation is listed as the next factor: "From the age of fourteen on, yin qi floats up and spills over, [causing] a hundred thoughts to pass through her heart. Internally, it damages the five viscera; externally, it injures the outward appearance. The discharge and retention of menstrual fluid is alternatingly early or delayed, stagnant blood lodges and congeals, and the central pathways are interrupted and cut off."
- Presumably linked to menstruation because of its position in the essay, Master Sun now presents a long and varied list of etiological factors: incomplete digestion, an imbalance of xu 虛 (emptiness, vacuity, deficiency) and shi 實 (fullness, repletion, excess) in the five zang organs, internal leaking of pathogenic blood, injury to the flow of qi in the vessels, irregular diet, sexual intercourse with unhealed vaginal sores, and wind entering the body from outside during a visit to the outhouse. The list concludes with the statement that these are the reasons why special treatments have been established for women.
- After confirming that any other conditions in women are to be treated exactly the same as in men, with the exception of avoiding toxic medicinals during pregnancy, Sun Simiao concludes this discussion with a fascinating comment: "Nevertheless, women’s predilections and desires exceed those of men and they contract diseases at twice the rate of men. In addition, when they are affected by compassion and attachment, love and hatred, envy and jealousy, and worry and rancor, these become firmly lodged and deep-seated. Since they are unable to control their emotions by themselves, the roots of their diseases are deep and it is difficult to obtain a cure in their treatment."
4. Gender-Specific Treatments
For obvious physiological and cultural reasons, the medical care of the female body has in most cultures and times focused on women's reproductive functions, by preparing for pregnancy with fertility treatments, by ensuring a healthy pregnancy to provide the environment for ideal fetal development, and by managing a smooth labor and delivery. In most traditional medical systems, including Chinese medicine, postpartum recovery has also received considerable attention. This is one area where the contrast to current biomedical attitudes and practices could not be starker, especially when we also include recovery after abortions and miscarriages in this category, as has traditionally been done in China and most other cultures. In my opinion, postpartum care is a key area of gynecological practice where Chinese medicine offers the a huge potential for real contributions to patients' well-being in the West, simply because biomedicine has so woefully little to say or do for women during this fragile time. According to Chinese medicine theory, the results of inadequate postpartum care will affect a woman for the rest of her life.
The other two areas of gynecology in which I see the greatest potential for Chinese medicine practitioners are
- "Menstrual attunement" (yue tiao 月調)
- Fertility and pregnancy care, far beyond a successful conception.
The subject of creating and then nurturing the fetus (yang tai 養胎) deserves its own page, which will be created for this website sooner rather than later. Suffice it to say here, the focus in classical Chinese medicine not on treating disease but on preventing it -- and hence on continuously fine-tuning the fluid and ever-changing equilibrium that is the defining characteristic of the human body in all its manifestations,-- has led to the accumulation of millennia of wisdom and clinical expertise on how to maximize health and minimize pathogenic influences. As such, any expert practitioner of this art should be eminently capable of bringing the female body into a state of optimal health, with dramatic results in the area of fertility. Whether in preparation for or assistance to biomedical treatments, or as an effective treatment in its own right, fertility is an area of practice that is bound to grow rapidly in the next few decades.
The Chinese medical view of menstruation as an essential function of the female body and a sign of cyclical health, balance, and abundance can serve as an effective counterweight to the negative associations with female blood in our modern popular culture, which depicts menstruation as dirty, shameful, debilitating, as something that must be hidden or even avoided as much as possible. By contrast, Chinese medicine views female blood from different angles.
- It nurtures the fetus during pregnancy
- After the child is born, the blood transforms into breast milk, in which form it continues to feed the baby.
- Immediately after childbirth, uterine bleeding is also essential for eliminating stale blood and highly pathogenic residual substances (e lu 惡露 "malign dew") from the uterus by flushing and cleansing it.
- It's cyclical appearance in accordance with the cycles of the moon in a healthy, free flow with the right color, consistency, timing, duration, and accompanying signs symbolizes abundance, balance (especially between blood and qi), absence of blockage, and harmony with cosmic cycles.
- Any pathologies surrounding menstruation are evocative and illuminating windows into ever more subtle layers of otherwise hidden processes within the female body that can be addressed effectively by means of "attuning the menses."
To read the full text of the introduction to Sun Simiao's three volumes on gynecology in the Bei Ji Qian Jin Yao Fang, see here.
For more information on Sun Simiao and the Bei Ji Qian Jin Yao Fang, see the page on Sun Simiao on this website.
You can also find more articles published by me on this topic in my List of Publications.
For more information on nurturing the fetus, see my chapter “Worth a Thousand in Gold: The Quest for Perfect Children in Early China.” in Andreas Noll and Sabine Wilms eds., Chinese Medicine in Fertility Disorders (Thieme International, 2010) and my article “The Transmission of Medical Knowledge on ‘Nurturing the Fetus’ in Early China” in Asian Medicine: Tradition and Modernity 2, 2005.
You can purchase the online version of a course on "Nurturing the Fetus" that Debra Betts and I have taught together many times over the years, but most recently in 2016 at the IFS Symposium in Vancouver. I highly recommend this because Debra's clinical advice is such a great compliment to my own knowledge. Visit the course page at healthyseminars.com.
For a rare chance to listen in on a conversation between myself, Debra Betts and Laurie Regan, visit Laurie's show on "Ancient Wisdom Can Deliver a Healthy, Happy Pregnancy" here.
For more information on menstruation, see in particular my article “The Art and Science of Menstrual Balancing in Medieval China” in Andrew Shail and Gillian Howie, eds., Menstruation: A Cultural History (Palgrave, 2005), or in German, “Die Kunst der ‘Regulierung der Menstruation’ im frühmittelalterlichen China” in Chinesische Medizin (2010 issue).