gender and medicine in tang china

1 gender and medicine jen-der lee Gender and Medicine in Tang China I N T R O D U C T I O N The relationship between gender and medicine has attracted histo-rians’ attention for decades. Inquiries into the role of women in the development of medical sciences, whether as alternative healers or as physicians, have generated numerous works driven by intellectual and political concerns. Historians working on European midwifery, for instance, have analyzed the struggles for and against professionalism since the Middle Ages.1 Apart from women healers, the conceptions, or misconceptions, and experiences of women as patients have drawn even closer scrutiny, inspired in part by a recent fascination with the history of the body.2 Scholars have examined medical discourses from Soranus to Freud to demonstrate how conceptions of the male and female body changed according to socio-economic as well as politi- cal factors.3 One work uses women’s life stories in eighteenth-century medical cases not only to uncover attitudes towards women’s bodies This article was first presented for “New Perspectives on the Tang: An International Con- ference,” held at Princeton University, April 18–20, 2002. My thanks go to Yang Lu for his invitation to such a lively intellectual gathering and to Valerie Hansen for her valuable cri- tique. I also want to express my gratitude to the anonymous reviewers of Asia Major for their comments and John Kieschnick for directing me to important materials during the process of revising the article for publication. 1 For midwifery as a women’s profession in early modern Europe, see Merry E. Wiesner, “Early Modern Midwifery: A Case Study,” in Barbara A. Hanawalt, ed., Women and Work in Preindustrial Europe (Bloomington: Indiana U.P., 1986), pp. 94–114. For its professionaliza- tion in the modern era, see Ornella Moscucci, The Science of Women: Gynaecology and Gender in England 1800–1929 (Cambridge: Cambridge U.P., 1990), esp. chap. 2, “Men-Midwives and Medicine: The Origins of a Profession,” pp. 42–74. 2 For the impact that the history of the body has exerted on studies of women and medi- cine in recent scholarship, see Charlotte Furth, “Doing Research on the History of the Body: Representation and Experience,” Research on Women in Modern Chinese History 8 (Taipei: In- stitute of Modern History, Academia Sinica, 2000), pp. 179–94. 3 Thomas Laquer, Making Sex: Body and Gender from the Greeks to Freud (Cambridge, Mass.: Harvard U.P., 1990). For the Middle Ages, see Joan Cadden, The Meanings of Sex Dif- ference in the Middle Ages: Medicine, Natural Philosophy, and Culture (Cambridge: Cambridge U.P., 1993). 2 jen-der lee at that time, but also to challenge scientific accounts of the body since the eighteenth century.4 For China, conventional wisdom dates the establishment of gy- necology to the reunified Song dynasty, that is, about middle of the tenth century. Recent research has disclosed the interactions between political agents and cultural factors not only in the development of a gendered medical view, but also in women’s experiences in the rela- tionship between patients and healers.5 Although important and fruit- ful discoveries, these contributions concern mostly late-imperial China and do not address earlier developments. Moreover, influenced con- sciously or not by our modern conceptions of what defines the work of a doctor, scholars have often examined women’s healing activities only when women applied herbal medicine, or earned a living by doing so. Domestic health care, which dominated women’s time and energy, has been largely overlooked.6 Yet the study of this realm of everyday life provides an excellent opportunity for understanding the experience of women and medical practice in a preprofessionalized society. The position of women in the time of the Tang dynasty (618–907) has long grabbed the interest of students and scholars alike. As em- presses or as poets, Tang women have occupied a prominent place in our imaginations. The utilization of traditional encyclopedias as well as newly excavated inscriptions has also resulted in productive research concerning the daily life of Tang women.7 Despite these successful ex- plorations, one aspect, namely, health care, and one kind of source, medical texts, seem to have escaped historians’ eyes. All agree that our understanding of Tang women’s lives will not be complete if their roles as wives and mothers are passed over. Because both of those roles entail 4 Barbara Duden, The Woman Beneath the Skin: A Doctor’s Patients in Eighteenth-Century Germany, trans. Thomas Dunlap (Cambridge, Mass.: Harvard U.P., 1991). 5 Charlotte Furth, A Flourishing Yin: Gender in China’s Medical History, 960–1665 (Berke- ley: U of California P, 1999). Francesca Bray, Technology and Gender: Fabrics of Power in Late Imperial China (Berkeley: U. of California P., 1997). 6 One recent work on the role of American women in home-care also addresses this issue. See Emily K. Abel, Hearts of Wisdom: American Women Caring for Kin 1850–1940 (Cam- bridge, Mass.: Harvard U.P., 2000). 7 The political accomplishment of China’s only female emperor, the fascinating life and poems of Daoist nuns, and the lively depictions of Tang women’s social activities that appear in archeological excavations have all received scholarly attention. Deng Xiaonan ᔥ՛ত, ed., Tang-Song nüxing yü shehui ାݚՖࢤፖषᄎ (Shanghai: Cishu chubanshe, 2003), deals not only with empresses and poets but also women’s religious, economic, artistic, and medical activities, using a huge variety of materials. This publication arose from Beijing University’s international conference meant to broaden and deepen the field of Tang women’s history. 3 gender and medicine health care activities, medical texts provide some of the best material for understanding the day-to-day life of Tang women. In order to examine how women both cared for others and were cared for, the childbirth story recorded in Wang Tao’s ׆ះ (ca. 670– 755) Waitai miyao ؆ፕఽ૞ʳis a good point of departure. This story is the earliest detailed description of childbirth in China. It relates the birthing method of a sixth-century Buddhist monk, Tan Luan ᖣᦚ, and is told by a certain Mr. Cui, whose work is extensively excerpted by Wang Tao. The story goes like this. I (Mr. Cui) was going through Master Luan’s Methods to Regulate the Breath and read the following: A certain Yangdao Qing ၺሐᐜ of Beiping קؓ told me that one of his sisters and two of his daughters died from complica- tions during childbirth. When his daughter-in-law was in the last month of pregnancy, he was so concerned that he came into the mountains to visit me for a recipe for easy-delivery… I searched my memory and wondered why I have not heard of childbirth death among cattle, nor when fornicating girls or debased maids give birth. This is because no one is around to pressure them; therefore they can go through the whole natural process. Those who die of complications are mostly from wealthy families with many women gathering around. Once [the expectant mother] starts to feel the pain caused by the baby’s turn, these women speak among themselves. Bystanders annoy and scare her. Her fear accumulates and her physical condition deteriorates. Once she physically deteriorates, pain sharpens even further. When these bystanders see her sharp pain, they conclude that the time has come. Some of them grab her hair, another massages her abdomen, and another pours cold water on her face. [They] push hard and the baby comes out all of a sudden. The accu- mulated breath thus drops abruptly and unceasingly, causing her to pass out. This is the reason and nothing else. When Qing came, I told him my thoughts. Qing listened si- lently but still insisted on inviting me to his home. Therefore I went. I stayed there more than ten days when one evening we were told that, “the daughter-in-law feels pain in her abdomen; it seems to be the time for delivery.” I then asked them to re- move the beds and tables to make an open space, spread grass in three or four places, hang down a rope and tie it to a piece of wood to make a horizontal bar. I had them measure the height 4 jen-der lee to her armpits when squatting so that she could lean against it like a crossbeam, and spread out animal skins and furs for fear that the baby might drop on the straw and injure itself. After all these preparations, I told the woman to assume her position, sit or lie at will. I then explained my methods to her. “Each method has its reason. She who follows it will live while she who goes against it will die. Calm yourself and have no fear.” The woman in labor understood my words pretty well. Having given my instructions, I closed the door, set up a bed outside the room and I sat with Qing, not letting a single person enter. Once in a while, I asked her through the window what her condition was. She answered that the pain was endurable. When it reached the first watch of the night,8 I ordered them to make some chicken broth porridge out of the hens that had died naturally. Once the porridge was cooked, I stirred it quickly with my hands so that the temperature was right, and advised the woman to take three sheng ֒. She gave birth on her own in the fifth watch of the night. Once I heard the cry of the baby, I allowed people to go in. The woman behaved in a natural and comfortable man- ner, exhibiting nothing out of the ordinary. She said, “When it hurt a little bit, I relaxed my body and exhaled a long breath, and the pain went away.” This is the result of flowing with the breath. Qing inquired as to the reason for taking chicken broth porridge. I answered, “Hens have a slippery nature that will smooth the breath.” He asked the reason for not eating chicken. I answered, “When the breath is about to come down, the meat is hard to digest and may cause trouble.” He asked the reason for giving porridge. I answered, “The breath goes up when one is hungry, but the descending breath is better for delivery. Naturally we do not want the breath to go up.” Qing considered this childbirth technique a marvel. Wherever it is taught there will not be anxiety. Therefore I (Mr. Cui) know that the hidden ideas of Master Luan are wonderfully accordant with the finest reasoning. Why then are there still taboos of days and deities (riyoufanzhi ֲሏ֭֘)? This is because women are fearful and they are subject to panic during delivery. If they are not guided by various methods, I am afraid that they will be anxious. Therefore I simplify many methods and 8 The first watch (geng ޓ) is 11 p.m. to 1 a.m. 5 gender and medicine place them on the left (that is, “below”) for reference so that people can choose based on their own decisions.9 According to this story, the reason Qing went into the mountains to ask for help was his previous experience of having lost female relatives in childbirth. Delivery was a dangerous task, and looking for medical support was, for the people of early-imperial China, an important way to ensure a safe delivery. The assistance a doctor provided ranged from easy-birth recipes to house visits and guidance. Once the doctor arrived, he instructed the family to prepare a delivery chamber. Space was made so that a crossbeam could be arranged for the laboring woman to lean on while squatting. Straw and furs were spread to save the dropping baby from injury. Both suggest that women took vertical instead of horizon- tal position in delivery.10 The doctor forbade anybody to go into the room, apparently owing to his earlier interpretation of the chief cause of complications: too many women around. From Mr. Cui’s comments, we know that contemporary childbirth techniques were not limited to regulating the breath. Rather, deities considered bad and days subject to taboos, such as riyoufanzhi, were also avoided to protect the laboring mother. However, to the doctors’ eyes, this only existed to calm women, whose natures were anxious and fearful. It seems that whether as heal- ers or as patients, women were regarded as simply too incompetent to carry out birthing duties without the help of a male doctor. Male doctors, however, do not seem to have had many real ex- periences in midwifery. When he was first approached, all our doctor could think of was hearsay about animals and lascivious girls. On the contrary, his criticism of female attendants reveals exactly the tech- niques a midwife may have utilized to enhance the delivery. She would massage the abdomen of the laboring woman both to sooth her pain and to help the baby turn. She would also try to revive her senses by 9 Wang Tao ׆ះ, Waitai miyao ؆ፕఽ૞ (Taipei: Guoli zhongyi yanjiusuo, 1964) 33, p. 924. The way Wang Tao recorded the story makes it difficult to decide the original narrator. A detailed textual analysis suggests that the first “I” who mentioned the reading of Master Luan’s work was actually Mr. Cui, while the second “I” that was embedded in the birthing story should have been Master Luan. Mr. Cui resumed his voice when he praised the “hidden ideas of Master Luan” and commented on the functions of birthing taboos. 10 The vertical position is probably a cross-cultural phenomenon in traditional societies. For the European case, see Jacques Gélis, History of Childbirth: Fertility, Pregnancy and Birth in Early Modern Europe (Cambridge: Polity Press, 1991), pp. 121–32. For Japanese studies on the subject, see Nakayama Tar± խ՞֜૴, “Kodai no bunmenh± to minzoku” ײז圸։୦ऄ圲اঋʿ in Rekishi to Minzoku ᖵ׾圲اঋ (Tokyo: Parutosusha, 1941), pp. 272–94. For the Chinese case, see Lee Jen-der ޕૣᐚ, “Han Tang zhi jian yishu zhong de shengchan zhi dao” ዧାհၴ᠔஼ խऱسขհሐ, ZY Y Y 67.3 (1996), pp. 533–654 (English trans. forthcoming). See Jen-der Lee, “Childbirth in Early Imperial China,” Nan Nü: Men, Women and Gender in Early and Imperial China (Leiden: Brill; special issue on medicine and women, forthcoming). 6 jen-der lee grabbing her hair and pouring water on her face.11 One other point is that the expectant mother may have already gained child-birth infor- mation from various sources before delivery. Granted that the woman in the story was praised by the doctor for quickly understanding his advice, the description of her self-possessed appearance and smooth delivery suggests that she may have had earlier knowledge instead of relying totally on the instructions on-site. Wang Tao’s Waitai miyao collected all kinds of recipes dating from antiquity to his own time. This specific story was quoted from Cuishi ാ ּ, a book probably written by the Tang high official Cui Zhiti ാव஘ (d. 681), who may be credited with having written at least two medical texts.12 Cui’s story is drawn, in turn, from his reading about a success- ful childbirth event operated by a Buddhist monk, and is followed by Cui’s understanding of the method of taboo-days. Immediately after the story, Wang Tao’s work quotes Cui’s method for deriving childbirth taboo-days based on a laboring woman’s age, and it reproduces as well Cui’s delivery charts (see figure 2, appended to this article). However, none of Mr. Cui’s or Master Luan’s works exists today despite their con- siderable fame in the eighth century. Fragments survive only through Wang Tao’s occasional quotations, as seen here. The most “marvelous technique” of childbirth was provided by a monk and praised by a male bureaucrat, with one criticizing the ability of women helpers and the other downplaying the inner strength of a laboring mother. The story Wang Tao quoted for posterity not only depicts vividly the life-and- death matter of childbirth, so prominent in most women’s lives, but also directs us to important gender issues in the history of medicine: the positions and images of women both as the recipient of care and the care-giver. The following two sections discuss these two aspects of women’s lives, first concerning childbirth and then health care. W O M E N I N C H I L D B I R T H Since antiquity, Chinese texts have remarked on the danger of childbirth. A first-century official lady once proclaimed that only one out of ten women survived such hardship.13 A fifth-century doctor con- 11 All these methods were applied in early-modern European midwifery as well. See Gélis, History of Childbirth, pp. 133–38. 12 One was a ten-chapter book Cuishi zuanyaofang ാּᤊ૞ֱʳand the other was a one-chap- ter Chantu ขቹ; see Liu Xu Ꮵᷦ (887–946), comp., Jiu Tangshu ៱ା஼ (Beijing: Zhonghua shuju, 1975; hereafter, J T S ) 47, pp. 2042, 2050. Cui Zhiti died in 681 as the minister of rev- enue (hubu shangshu ֪ຝࡸ஼). Translations of official titles are based on Charles O. Hucker, A Dictionary of Official Titles in Imperial China (Stanford: Stanford U.P., 1985). 13 This was Lady Xian ᧩ recorded in Ban Gu ఄࡐ (32–92), Hanshu ዧ஼ (Beijing: Zhong- hua shuju, 1962) 97A, p. 3966. 7 gender and medicine sidered a laboring woman’s squatting on the ground not much different from awaiting death.14 Precisely because of the danger, the renowned Tang doctor Sun Simiao ୪৸᠓ (581–682) suggested that whoever took charge of young ladies should have read his “Recipes for Women,” made a copy of it, and carried it at all times to avert any possible risk.15 Extant medical texts from early China suggest that doctors’ interven- tions into women’s reproductive function started first of all with the problems posed by maladies during gestation.16 But their observations and advice advanced steadily. By the beginning of the Tang, when Sun Simiao’s “Recipes for Women” appeared, male doctors already had a whole set of techniques to treat childbirth, from begetting a son to postpartum care, and in the meantime developed a gendered view of the body through a discourse on reproduction. The Burden of Bearing a Son and the Rationale for “Recipes for Women” “Recipes for Women” in Sun Simiao’s Beiji qianjin yaofang ໂ৺Տ८ ૞ֱʳis the earliest independent section of such discourse that is extant in our medical texts. The chapter begins with “recipes to beget a son,” followed by pregnancy care, treatments in complications and afterbirth nourishment, which would finally bring the woman back to her regular “monthly flow.”17 Sun’s text reveals important developments in gyne- 14 Chen Yanzhi ຫ࢏հ (ca. 5th c.), Xiaopinfang ՛঴ ,ֱ cited in Tanba Yasuyori կंൈ ᘸ (912–995), Ishinp± ᠔ֱ֨ (982; rpt. of 1854 edn., Taipei: Xinwenfeng chubanshe, 1982), j. 23, p. 25a. 15 Sun Simiao ୪৸᠓ (581–682), Beiji qianjin yaofang ໂ৺Տ८૞ֱ (punctuated version based on Song woodblock edn.; Jilin: Renmin chubanshe, 1994; hereafter, Q J Y F ) 2, p. 28. Sun, a Daoist hermit also well-versed in Buddhism, was known for his knowledge in medicine and life nourishment. He repeatedly declined recruitment by the Sui court (581–618) and served only briefly under the early Tang before seeking retirement; biog. J T S 191, pp. 5094–97. For a recent study on Sun’s medicine for women, see Sabine Wilms, “The Female Body in Medi- eval China: A Translation and Interpretation of the ‘Women’s Recipes’ in Sun Simiao’s Beiji Qianjin Yaofang,” Ph.D. diss. (Tucson: University of Arizona, 2002). 16 See, below, for detailed discussion, and also Lee, “Han Tang zhi jian shengchan zhi dao,” and “Childbirth.” 17 Q J Y F, j. 2–4. One of the first fertility recipes Sun provided for his women patients was a combination of decoction, suppository, and pill. The decoction was made from low-grade mirabilite (puxiao ڸ௣) and bore the name “dangbao tang” ᘒઽྏ, literally “decoction for purging the womb.” The suppository was a mixture of ten different herbs including angelica, schisandra seed, and rhubarb loaded into a silk bag and inserted into the woman’s vagina. Both were considered efficacious t