Apparatus XY

by Hsiao-wen Cheng, University of Washington, USA

1      Scholars studying pre-modern Chinese medicine have demonstrated its tremendous development during the Tang-Song periods. The two aspects related to gender that have been well studied are the rapid increase in separate prescriptions for women and the establishment of gynecology as a distinct field. These developments coincided with large-scale state projects of compiling and publishing medical books, among which some particularly focused on "treatments for women." In past scholarship, these two phenomena are associated with a process of sex/gender differentiation, a shift in responsibility for reproduction from men to women, and the systemization of medical discourse on the female body. For example, Jen-der Lee focuses on medical innovations from the Tang, concluding that in Tang medicine, men's and women's bodies were essentially differentiated, and that the responsibility for pregnancy gradually shifted from men to women. The increased prescriptions for women's infertility, according to Lee, reflect an increasingly heavy burden and a set of physical and moral regulation of women (Li 316-17, Lee 7-11). Charlotte Furth argues that "treatments for women" had gone through a process of systemization during the Song, characterized by the use of "pattern diagnosis," that is, "a strategy for grouping the multiplicity of individual symptoms into a smaller number of broad categories that in turn could be related to each other dynamically" (65). The female body was presented as dominated by Blood, while the male body was dominated by qi. Blood and qi are in a hierarchical relationship: Blood is inferior, secondary, and dependent on the qi (70-74).

2      However, the picture would not be complete without considering the nature and use of Song medical compilations. The layout of Song medical books shows a pragmatic and all-inclusive approach that was intended for a popular use. It may be part of the male literate physicians' effort to canonize their own medical opinions, yet it also increased the accessibility of medical knowledge and exposed it to public discussion. Anecdotal stories show that men as well as women all participated in that discussion, and there are cases where female patients contended with doctors based on their understanding of the materia medica. How did the large-scale compilation and circulation of medical books which might contain certain gender ideologies actually affect men and women's lives during the Song? How was medical knowledge used and discussed when printing made both old and new ideas more accessible? What can we learn from the dynamics taking place beside the sickbeds? Taking into consideration the circulation of medical knowledge and the actual encounters between doctors and patients may change the way we read gender from medical texts during the Song. I therefore seek a contextual approach to studying gender in Song medicine, in order to highlight the unstable aspects of gender history: the alternatives, the resistance, and the maneuvers, in contrast to the fixed institutional/ideological frameworks.

3      I begin with the framework itself. Using chapters concerning fertility as an example, I analyze the all-inclusive and hybrid nature of Song medical books and the ambiguity of gender differences reflected in those chapters, in order to present those books as open and multi-vocal resources, rather than something that creates or reinforces a systematic gender discourse. Then I will turn to the other side of history-to explore the actual encounters between doctors and patients, and the circumstances where medical knowledge was used and discussed, mostly from Yijian zhi (or Record of the Listener, a twelfth-century book recording various anecdotal stories), to call attention to patients' resistance and active participation in their own treatment, as well as the ways medical knowledge provided alternatives rather than imposed authority.[1]There are various kinds of "healing" taking place in stories in Yijian zhi. Here I only focus on those concerning uses of medical knowledge which comes from what Angela Leung has called, the "scholarly tradition"-that is, materials that were written in standard medical texts, especially those that were compiled, published, and distributed under the patronage of the Song state (375). This is to highlight my point that the authority of "standard" medical knowledge was challenged not simply by the popular or shamanistic (the "non-scholarly") tradition but also by the popular use and discussion of the scholarly tradition.

The Framework

4      A major difficulty that one encounters when studying Song medical books is that they preserve a large number of texts from previous dynasties without indicating the source, and many of the sources are no longer extant. What is from an earlier tradition and what is a Song invention is not always readily apparent, except for a few cases when the compiler explicitly commented on the development of certain notions or prescriptions, such as Kou Zongshi's comment on the herb Cangzhu-which will be discussed below. This is related to the pragmatic approach of the Song state compilation projects.[2]As Angela Leung has pointed out, the Song scholarly tradition was "characterized by a highly pragmatic approach, consisting of the study of materia medica and the publication of prescription manuals, as well as an elaborate system of public dispensaries," and that the Song state's interest in publishing medical books "derived less from a philological search for historical authenticity than a desire to promote an image of state benevolence" (375-76). Such a pragmatic approach produced an all-inclusive yet not so consistent appearance of those books. It would be problematic to interpret gender from Song medical books in a systematic way without considering that those texts often contain disparate information drawn from sources of different time periods.

5      Take one of the grand projects from the Northern Song (960-1126) as an example, Prescriptions of Sacred Benevolence under the Great Peace (Taiping shenghui fang, compiled in 978-992, published in 992, Prescriptions of Sacred Benevolence hereafter). It consists of a long catalog of all kinds of illnesses, brief descriptions of the causes, and lists of all symptoms, prescriptions, and recipes under each category. When it was compiled, the edict ordered all doctors in the Imperial Medical Academy to present recipes handed down from their families. After all recipes were put into categories, the editors then inserted one passage from a Sui dynasty (581-617) book, On the Origins and Symptoms of Various Diseases (Zhubing yuanhou lun, compiled in 605-617, Origins and Symptoms hereafter), in front of each chapter as a brief introduction (Song shi 461.13507). As soon as the book was finished, copies were distributed "all under Heaven." Official copies reached at least all the prefectures, some temples, garrisons, and overseas to Koryo (Song Shi 461.13508, Song hui yao li 62.35, 36, 39).[3]One story in <em>Yijian zhi</em> tells about some supernatural incidents happening in Shuzhou (the Shu Prefecture) in 1146 when the blocks of <em>Prescriptions of Sacred Benevolence</em> were reproduced there. <em>Yijian zhi</em>, bing, 12.464. In the chapter on disorders of semen, there is a section on "Prescriptions for Depletion, Exhaustion, and Dreaming of Intercourse with Ghosts." A short passage taken directly from Origins and Symptoms

Human life comes from the essence of the Five Phases and relies on the divine energy (shenqi) of the Five Viscera. When the yin and the yang forces are ample and balanced, the viscera and bowels are strong, and vicious spirits cannot disturb a person. Yet if one does not rest and ingest regularly, the blood and the qi become depleted and weak, then the vicious influence from the Wind (fengxie) takes the opportunity to invade the depleted body, and ghost spirits disturb its regular pattern. This is why those who are exhausted, whose weak viscera are unable to guard the divine energy, are disturbed by vicious spirits and dream of intercourse with ghosts. (Taiping 30.857, Zhubing 40.2a)

However intriguingly, in the Sui book, this passage is subsumed under the category of "Miscellaneous Illnesses of Women." When it appears in this Northern Song book, it is put into the section on men's disorders. Similar passages also appear in other Song books explaining women's symptoms of this kind (Nüke baiwen 1.61a, Furen daquan 6.12a). If the same description of causes could be used rather loosely for either men's or women's disorders, it seems that some gender division that existed in earlier dynasties was not reinforced and, quite the opposite, was even blurred in Song medical books.