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

In this thoroughly researched and lucidly written book, Yi-li Wu examines Chinese medical views of childbearing and women's reproductive health from the seventeenth through the nineteenth centuries. Her principle aim is to delineate how Ming-Qing fuke (婦科), the branch of scholarly medicine that dealt with disorders defined as distinctively female, differed from that of earlier dynasties. In keeping with recent scholarship, she stresses innovation over continuity, challenging the still prevalent notion that Chinese medicine was a constant and unchanging tradition bounded by ancient canons.¹ Utilizing medical texts produced in different periods, some dating as far back as the Han dynasty, she demonstrates that Ming-Qing authors, like their predecessors, drew upon a rich corpus of classical works to generate new ideas or to combine old ideas in novel ways. With its wide-ranging primary sources and its well-structured synthesis of relevant secondary literature, Reproducing Women: Medicine, Metaphor, and Childbirth in Late Imperial China both introduces and advances the history of Chinese medicine.

Wu's principle thesis is that late imperial scholar-physicians (ruyi 儒醫) held a markedly benign view of the female body. Whereas Song-Yuan medical authors regarded female bodily functions as uniquely debilitating and childbirth as dangerous, Ming-Qing medical theorists depicted women's ailments as fundamentally the same as men's. Moreover, they saw childbirth as inherently trouble-free, requiring no intervention except in rare cases of prolonged labor. The "de-exoticization" of female difference that began in the seventeenth century (pp. 42-51) and the construction of what Wu terms the discourse of "cosmologically resonant childbirth" (p. 148) profoundly shaped gendered patterns of childbirth practice. In contrast to Europe, where male surgeons took over obstetrics from female midwives and devised techniques for forcibly extracting babies, often with horrible results, the non-interventionist doctrine that emerged in the late imperial period meant that labor and delivery were left largely to female midwives. Rather than supervising parturition directly, Qing doctors involved themselves instead in other aspects of reproductive medicine, such as regulating menstrual health, enabling conception, ensuring healthy pregnancies, and managing postpartum recovery.

In making this central argument, Wu weaves together several closely related thematic strands, each of which illuminates important issues in Chinese medical history. In addition to documenting the dynamism of Ming-Qing fuke, she reexamines Chinese medical ideas about the relationship of anatomical structures to bodily functions, the role popular print culture played in shaping medical knowledge, and the means by which Confucian scholar-physicians competed with other healers in a highly pluralistic medical marketplace. Eschewing the social constructionist perspective that informs much scholarship on the subject in European history, Wu underscores the intersections between the biological reality of disease and its cultural framing. She argues persuasively that the seemingly esoteric medical debates she analyzes were focused above all on easing the suffering of real women. Behind the rhetoric, she argues, there was a singular material reality: women died in childbirth, whereas men did not.

Reproducing Women is divided into three sections, each of which pursues one of the lines of inquiry reflected in the book's subtitle. The first section, entitled "Medicine," sets Ming-Qing fuke in historical and cultural context in order to show how text-based knowledge about women's bodies was created, negotiated, and legitimated over time. Chapter 1 chronicles the historical development of fuke as a distinct subfield of scholarly medicine from its origins in the fifth century into the late imperial period. Building upon Charlotte Furth's pioneering analysis of shifting medical conceptions of the female body,² Wu argues that the concern about gender difference decreased in the late imperial period at least partially because of competition between two types of healers: hereditary doctors (shiyi 世醫), whose legitimacy was based on proprietary knowledge handed down over generations; and scholar-physicians, who increasingly dominated the medical landscape from the Song-Yuan period. As entry into government service became difficult, men of scholarly...