Reproducing Women: Medicine, Metaphor and Childbirth in Late Imperial China (review)

Historical knowledge of Chinese medicine has greatly expanded in the last generation, but its 2,000 year old textual record can still be hard to navigate for scholars from other fields. Yi-li Wu’s fine monograph uses “medicine for women” as a focus for those who want to understand learned medicine under the Qing dynasty—i.e. the 16th–19th centuries that coincide with what Europeanists think of as the “early modern” era.

Wu’s introductory chapters provide a fine overview of the earlier history of “medicine for women” (fuke) beginning with Sun Simiao’s 8th century CE doctrine that “women are ten times more difficult to cure than men.” Fuke, recognized as a specialty by the Song dynasty (960–1279) imperial medical bureau, practiced by lineages of physicians who claimed descent from Song court doctors, produced experts who articulated orthodox understandings of bodily gender difference, especially as it bore on a woman’s duty to produce heirs. However, since males never had direct access to labor and delivery, experts in “medicine for women” mostly addressed problems associated with fertility, pregnancy and postpartum recovery. Moreover, as post-Song neo-Confucian scholarly ideals increasingly shaped medical learning and practice, their stricter norms of gender segregation further increased the social distance between male healers and women patients.

By the 17th century, elite physicians in China had strengthened their position as learned experts with a claim to a scholarly “Confucian” identity (ruyi). The ancient texts were respected classics, while woodblock printing allowed physicians to add to a burgeoning corpus through commentary, case histories, formularies and monographs on medical specialties. Although there were no formal educational institutions or qualifying credentials, lineages of learning (xuepai), based on real and fictive kinship networks, allowed physicians to claim affiliations with known masters of past and present, and to develop often conflicting signature therapeutic strategies. Even more than in earlier centuries, prescription pharmacy dominated as the most respected medical skill, while doctors claimed epistemological authority based on philosophical doctrines. A studied rationalism, in the sense of the application of known principles to different situations, thus motivated many of the writings that serve as Wu’s sources.

In this setting, Wu identifies specific shifts in both doctrines and practice that emerged between the l7th and l9th centuries.

Concerning gender, there was a “de-exoticization of female bodies” (44): a tendency to argue (against Sun Simiao) that male and female are largely similar. Here a decline in the prestige of ritual medicine may have undercut beliefs in the pollution of female blood, and allowed elite physicians to approach their therapeutic task with greater confidence. Concerning the body, there was a shift away from a highly functionalist approach based on yin yang cosmology as the key to bodily dynamics, in favor of more attention to structure—in this case the womb, visible in metaphor as vessel, container or soil. In keeping with doctrines minimizing female difference, some experts claimed that males also have wombs. This “anatomical turn,” visible in other fields of medicine as well, may be connected with Qing era philosophical critiques of speculative cosmologies in general in favor of a more concrete, evidentiary, epistemology.

Most important, after almost a thousand years of neglect, the management of childbirth reemerged as an arena of concern, not by male healers crowding into the birthing room as in northern Europe, but by amateurs—fathers, in fact—who sought to protect their wives from what they saw as the interventionist excesses of midwives. One such, Ye Feng, in 1707 penned a straightforward self-help tract, “On Easy Childbirth” which was widely reprinted and imitated in the 18th and 19th centuries. Opposed to both manual and pharmaceutical interventions, Ye Feng evokes what today we call “natural childbirth”; but Wu labels it “cosmologically resonant” birth, in keeping with Ye’s metaphors of ripening fruit expressing a Daoist natural philosophy of spontaneous action.

Amateurs concerned for female reproductive health followed a...