SŪN SĪMIǍO 孫思邈
Bèi Jí Qīan Jīn Yào Fāng 備急千金要方
Volume Two, Methods for Women, Part One 卷二，婦人方上
Chapter One, Seeking Children 求子第一
(1) Essay: The reason why women have separate methods is that they are different because of pregnancy, childbirth, and flooding damage.1 Therefore, women’s diseases are ten times more difficult to treat than men’s.
(2) It is a classic saying that “women are copious accumulations of yin and are constantly inhabited by dampness.”3 From the age of fourteen on, [a woman’s] 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 pathways4 are interrupted and cut off.
(3) It is impossible to discuss the entirety of damages and losses5 among these [conditions]. The raw and the cooked are deposited together,6 vacuity and repletion intermingle with each other in confusion, malign blood7 leaks internally, and the qi and vessels are injured and exhausted. Her intake of food and drink might have been intemperate, causing not just a single injury. Or she may have had sexual intercourse before [vaginal] sores have healed. Or she may have squatted over the privy without proper care, [allowing] wind to enter from below and thereby giving rise to the twelve intractable diseases. For these reasons, special methods have been established for women.
1. 崩傷 bēng shāng: Literally referring to the collapse of earth, as in a landslide, the term bēng had by early Táng times become a technical medical term indicating a flood-like loss of blood and other varieties of vaginal discharge, caused by the collapse of the internal organs. As such, it denotes the most serious type of vaginal discharge, more severe than 賁 bēn (gushing) and 漏 lòu (spotting). In its modern TCM usage, the condition is explained as “heavy menstrual flow or abnormal bleeding via the vagina” (Wiseman and Féng, Practical Dictionary, p. 212; see also 謝觀《中華醫學大辭典》 p. 1288). By contrast, medieval medical writers associated the term also with a collapse of the internal organs. According to the Zhū Bìng Yuán Hòu Lùn 諸病源候論 for example, the etiology of bēng involves the collapse of any or all of the five internal organs, thereby causing discharge in the corresponding colors (《病源論》38:40-44). This usage is also employed by Sūn Sīmiǎo in such expressions as 五崩 wǔ bēng (five-colored flooding), which refers to vaginal discharge in the five colors, or 崩中 bēng zhōng (center flooding). In the introductory statement above, the term is used in its broadest sense to refer to the variety of conditions related to vaginal discharge, which are also often summarized as 婦人三十六病 fù rén sān shí liù bìng (women’s thirty-six diseases), as in 《千金方》4:3, 《病源論》38:50, and 《金匭要略》1.
3. The origin of this statement is unclear but could quite possibly stem from an originally Sanskrit source because of its closeness to humoral theory. Sūn Sīmiǎo’s familiarity with Indian medicine is obvious from numerous references throughout the Qiān Jīn Fāng.
4. 中道 zhōng dào: While this is not a standard medical term, it most likely refers to the pathways in the central region of the body, related to the spleen and stomach and more commonly known as 水穀之道 shuǐ gǔ zhī dào (pathways of water and grains), which together comprise the center burner and govern the decomposition of water and grains. See for example 《難 經》31, translated in Paul U. Unschuld, Nanching, p. 347.
5. In a gynecological context, the character 墮 duò has the strong connotation of “miscarriage,” as in the compound 墮胎 duò tāi. In the phrase above, however, it can be understood in the more general sense of “losing” or “falling,” or even in the sense of “breakdown,” in which case it is pronounced huì.
6. 生熟二藏 shēng shú èr cáng: Based on the parallel construction of the next phrase, 虛實交錯, I read 藏 as a verb. Alternatively, 二藏 could denote the two organs of spleen and stomach since this section is concerned with the digestion of food in the central region of the body. In an interpretation less likely but more elegant perhaps for the modern reader, the Rénmín Wèishēng edition has altered the entire sentence, based on the quotation of this sentence in the Wài Tái Mì Yào 外臺秘要: 生 shēng is read as 矣 yǐ, a sentence end particle of the preceding phrase (《外台秘要》 33). The following phrase then reads: 然五臟虛實交錯 ("Then vacuity and repletion in the five viscera alternate with each other in confusion"). But since most other editions, such as the Sūn Zhēn Rén 孫真人 edition, the Huá Xià 華夏 edition, as well as the Dào Zāng 道臧 and Sì Kù Quán Shū 四庫全書 editions, contain the first version, I see no reason to simplify the text in such a manner.
7. 惡血 è xuè: This is a common technical term referring to the blood that remains in a woman’s body after childbirth. Also called 惡露 è lù (malign dew), it is considered a highly pathogenic substance, which must be discharged completely or it will cause permanent and serious health problems for the rest of the woman’s life.
(1) In cases where the nodal qi over the four seasons1 has caused illness and where xū emptiness, shí fullness, cold, or heat cause trouble, then [women are treated] the same as men, the only exception being that if they fall ill while carrying a fetus in pregnancy, you must avoid toxic medicines! In cases where their miscellaneous diseases are identical to men’s, [the treatments] are dispersed throughout the various volumes [of the Qiān Jīn Fāng] and can be known from there.
(2) 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.
1. 四時節氣 sì shí jié qì: According to the solar calendar, the Chinese year is divided into four seasons (四時 sì shí) and twenty-four nodes (二十四節 èr shí sì jié). “Nodal qì” refers here to a certain type of qì that causes illness because it appears out of its proper season.
(1) Therefore, specialists in nurturing life1 should particularly instruct their sons and daughters2 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?3
(2) Now, the Four Virtues4 are the pivot around which daughters set up their life. Bearing children is the adult role in women’s destiny and fate. If you do not understand this clearly, how could you prevent premature and wrongful death? Neither, for this reason, can servants engaged in childrearing5 afford not to study it.6 Thus, they should routinely write out a copy and carry it on their person, clutched to their bosom, in order to guard against the unexpected.
1. 養生之家 yǎng shēng zhī jiā: A person engaged in longevity and good health practices, including breathing exercises, sexual cultivation, gymnastics, and diet. For a detailed discussion of the origin and extent of these practices in the early Hàn period, see Harper, Early Chinese Medical Literature, pp. 110-147.
2. 子女 zǐ nǚ: This expression is ambiguous and could be interpret either as “sons and daughters” or as “female offspring” (see 諸橋轍次, 主編《大漢和辭典》 #6930-637, which gives both definitions).
3. 倉卒之秋 cāng zú zhī qiū: The Sūn Zhēn Rén edition has 際 jì “occasion” instead of 秋.
4. 四德 sì dé: A reference to the four womanly virtues, i.e., proper behavior (德 dé), words (言 yán), demeanor (容 róng), and work (功 gōng).
5. 傅母之徒 fù mǔ zhī tú: The Rén Mín edition (p. 36, n. 2) explains this expression as古代保育，輔導í女的老年男女 “elderly men and women charged with rearing and guiding the sons and daughters in elite households in ancient times.” It paraphrases the compound as 傅，傅父；母，保姆 “tutors and nannies.” See also 《辭源》 p. 247 for a similar reading.
6. While the connection between maternal health and the survival and welfare of children is fairly obvious (especially in the context of infertility), the importance of this text for child-rearing personnel is less clear. In my opinion, this does not only imply that the servants were supposed to educate children in the content of these methods. More significantly, this sentence points to the close links and overlapping responsibilities in elite households between mothers, their own healthcare providers, and their children’s wet-nurses, nannies, and tutors. See 李貞德《漢唐之間的女性醫療照顧者》.