Apparatus XY

16      The young official's reaction gives us a clue to how to read the story. He was at first stunned at the fact that the woman he had been living with was a ghost, but soon after the shock, he turned to a mundane conversation with the lady regarding the prescription that she offered. Why the lady would know so much about medicine did not bother him. It is almost impossible to precisely estimate how common it was for women in the Song to know medicine, but for this story to make sense to its contemporary audience women had access to medical knowledge.

17      Another even more intriguing story in Yijian zhi tells about a sick woman claiming to be possessed by an ancestor's spirit and arguing with the doctor:

The wife of the literatus Li San from Raozhou, née Yang, was the daughter of a government clerk. When she caught an epidemic disease in the spring of the fifth year of Shouxi (1194), the village doctor Zheng Zhuang was summoned to her house, yet her disease did not respond to his treatment. A few days later she suddenly rose up and talked and behaved like a man. She called Li San and said: "I am the spirit of the ancestor whom you enshrine in the main hall. Since you have been sincerely preparing the offerings and worship, I came to help with your wife's disease. You can summon the doctor again." After a while the doctor came, and Yang scolded him by name. Doctor Zhuang said: "How come you suddenly despise me like this!" Yang responded: "I am a god. Why can I not call you by your name! You constantly use the monkshood (fuzi) in prescriptions and cause harm to people's lives. Don't you dare to do that again!" Zhuang denied having used monkshood. Yang said: "It was in the prescription you gave the other day. Why do you lie to me?" Zhuang began to be scared. Yang continued: "Fetch me the Bamboo Leaves and Gypsum Infusion (zhuye shigao tang) so that at least it neutralizes [the toxicity of monkshood] and eases [my symptoms.]" Zhuang tried to get out of it by saying: "I do not know the ingredients of this recipe." Yang was infuriated and scolded: "How ridiculous that a doctor does not know this recipe!" She then listed the ingredients and dosage without the slightest deviation [from the standard prescription.] Zhuang then prepared one dose for her. She drank it and fell asleep. When awake she took another dose. The next day her symptoms were gone. (952-53)

Again, this prescription, Bamboo Leaves and Gypsum Infusion, has an orthodox source-it first appeared in an Eastern Han medical classic Treatises on Cold Damage Disorders and was included in the Song book Prescriptions of the Medical Bureau (2.45). It should not be surprising that members of a gentry family would have a chance to look at the book or have heard of some of the prescriptions. But the main problem is the voice and the gender of the patient, Lady Yang. There are different ways to interpret this story. Should we follow the storyteller's logic, simply regard Yang as a woman possessed by a male spirit? Or are there other possibilities? For example, the woman behaved extraordinarily because of her trance during her illness, and that behavior was interpreted as being possessed when the story was told. Or, one may say, knowing those herbs and prescriptions struck others as being strange, so they readily believed she was not herself-this would be less possible if, as shown in the previous story, people were not surprised at women with medical knowledge. Still another possibility is that she consciously spoke by making use of the ancestor's voice in order to give weight to her opinion on her own treatment-this interpretation offers the possibility of resisting the storyteller's logic and reading women's agency between the lines. In any case, first of all, this story echoes what we have seen earlier, that both old medical classics and new Song compilations are readily accessible for at least the gentry class in the Song dynasty. Men and women are all able to participate in diagnostic discussions and to search for and to choose prescriptions for themselves. Second, although we can never know for sure, there is a chance that Lady Yang in this story was wide awake and speaking out of her own medical knowledge. In that case, the patient can not only resist certain treatment but also give her own opinion on the choice of remedies. She knows medicine better than the doctor does.

18      Aside from anecdotal stories from Yijian zhi, we also have a complaint from a doctor's perspective. The Northern Song imperial doctor Kou Zongshi, in the preface of his book Expanded Commentaries of Materia Medica, showed his frustration when treating female patients:

Although treatment for women has been developed into a specific medical specialty, there are cases where the principles of the sages cannot be fully carried out. Women of distinguished families live in the inner quarters. [When consulting with a doctor,] they hide behind the curtain and cover their wrists with a piece of silk. In this way, the doctors can neither observe their complexion nor completely assess the pulse. Two out of the four [crucial elements for diagnosis] are thus unavailable. […] In cases where the pulse of the patient does not quite correspond to her disease and the doctor cannot see her body and complexion, he can only prescribe according to the pulse. Then how can he give the right prescription? How can he wield his medical skill to the best extent? This is a common complaint among doctors, which they have not been able to solve. [When encountering such a situation,] the doctor unavoidably asks for more details about the symptoms, yet the patient and her family regard his questions as a sign of the doctor's incompetence and are unwilling to take the medicine. There are numerous cases like this. [. . .] This is how difficult it is to treat female patients. (3.1a-b)

As this passage indicates, the doctor did not seem to be able to put much pressure on the patient. Meanwhile the patient's family, rather than pushing her to follow the doctor's instructions, sided with her and mistrusted the doctor's competence-even though the doctor was someone who, like the author of the book, worked in the imperial medical bureau and taught in the medical academy. The doctor in this case put all the blame on the ignorance of the patients and their families. However as we have seen from previous stories, what weakened the physician's authority might not simply be the different expectations between doctors and patients but also the increased accessibility of medical knowledge to the populace. Furthermore, here we see the conflict between two authorities that both attempted to situate women under their own system: the doctor wanted professional access, while the family insisted on protecting their women from inappropriate contact. The two parties that both tended to control (if not "protect") women's body did not work hand in hand but contradicted each other. And the reason that women's treatment was considered "ten times more difficult than men's" (Beiji qianjin yaofang 2.16a), at least according to this doctor, was not simply that women's bodies were more complicated or alien to men's, but also the conflict between the two systems, the professional doctor and the gentry, the specialist and the non-specialist.

Concluding Remarks

19      Taking into consideration the nature of the sources and how they were used and discussed in historical context changes the way that we analyze gender from Song medical texts. Several conclusions can be drawn here: First, there is gender differentiation/discourse in Song medical books, but it is by no means a coherent or systematic set of ideas. Song medical books are open and multi-vocal resources that provide patients with more choices. Second, the state-sponsored compilation and publication of medical books, instead of strengthening the authority of the medical profession, actually increased the accessibility of medical knowledge and exposed it to public discussion, in which women also participated. Last but not least, it seems to me that patients in the Song, including women, instead of listening to everything the doctor says, appealed to written sources, did research by themselves, made choices among all the alternatives, and constantly challenged the doctor's authority. As we see in the last story, the patriarchal and the medical systems seemed to contradict and compete with each other in terms of how they deal with women's bodies. How women responded to those two systems and found their own ways between them is a question I hope to pursue in my future studies.