By Maura Elizabeth Cunningham
Yi-Li Wu is an independent scholar and a center associate at the Center for Chinese Studies, University of Michigan. She is also the author of Reproducing Women: Medicine, Metaphor, and Childbirth in Late Imperial China (UC Press, 2010).
MEC: Your book examines “medicine for women” (妇科 fuke) in Qing China. How did the practice of fuke then differ from present-day obstetrics and gynecology? What has changed in the Chinese understanding of women’s medicine?
YLW: Qing fuke was a subfield of a literate corpus of medical knowledge that formed the basis of what is now called “traditional Chinese medicine” (TCM). This medicine drew its authority from a body of ancient classical texts that explained health and illness in terms of the harmony or imbalances in the body’s “qi,” what could loosely be thought of as a vital force. Doctors explained the relationship between different types of bodily qi in terms of the cosmological concepts of yin-yang and the five phases. You can manipulate and harmonize qi through acupuncture, pharmacological formulas, and regulating your behavior and diet.
Today we think of TCM as alternative medicine, lower in status than Western medicine, and used as a complement to it. But back then, this was the medicine deployed by the social and medical elites, the educated practitioners who could read and write. It was the healing system used by the government doctors who treated the imperial family and state officials. So that’s one big change. Insofar as women’s health is concerned, an important difference with modern obstetrics is that fuke historically dwelt very little on the physical mechanics of childbirth itself. Unlike European doctors of the time, Qing doctors didn’t try to take over obstetrics, and they didn’t develop surgical techniques for extracting the baby. Chinese male doctors might be called in to administer drugs if the labor was prolonged, but otherwise everyone assumed that delivery was the job of female midwives. What doctors did was to focus on the other aspects of female fertility: menstrual health, conception, pregnancy, and postpartum recovery. As I discuss in my book, they believed that childbirth would go smoothly as long as the woman’s health was properly managed during all these other stages. Today’s TCM is still based on the same core principles and therapies as late imperial medicine, but it’s also influenced by Western medicine. TCM gynecology textbooks in China today discuss anatomical science, for example, alongside yin and yang. When I was researching this book, I got the chance to sit in on a TCM gynecology clinic, and I was interested to see that patients would bring in their blood test results and ultrasound reports and the like to show the doctor.
MEC: What are some of the topics you cover in Reproducing Women?
YLW: Childbirth is something that humans have been worrying about throughout history and across cultures. My aim in writing this book was to help readers understand how people in the Qing thought about these universal issues. The first part of the book sets fuke in its historical context, and asks, why did people write and publish texts on fuke and how did male doctors try to establish their authority as experts in fuke? The second part is structured around the key medical issues that various experts and laypeople were actively debating at the time: how to promote fertility by ensuring the health of the woman’s menses and womb; how to ensure a healthy pregnancy and avoid miscarriage; how to protect the body’s ability to give birth smoothly; and how to prevent illness after delivery. Throughout, I also explore the issue of medical change and innovation by examining the continuities and divergences between Qing views and the medical perspectives of earlier eras.
MEC: What did you find to be the most challenging part of researching and writing this book? What types of sources did you use to understand the practice and perception of fuke?
YLW: My main sources were medical texts, primarily Ming-Qing works but also sources dating as far back as the Han. To be sure, there are many other types of sources that one could use to explore late imperial Chinese medical thought, notably literature, local histories, and literati jottings, and I do bring in some of these as well. But there is a staggering amount of pre-20th century Chinese medical literature that is still extant, and scholars are still only in the early stages of parsing out this immense source base. To give you an example, there are some 300 specialized works on women’s medicine and childbearing, and that doesn’t even count all the information on fuke that is contained in general treatises on medicine, medical cases collections, and encyclopedias. So one fundamental challenge was simply to figure out what to do with all this stuff!
One thing that made it both interesting and complicated was that late imperial authors are continually altering and recombining earlier works in new ways. To understand the special characteristics of Qing medicine, therefore, I had to continuously read back and forth between late imperial writings and earlier sources. And then, after spending so much time immersed in the doctrinal minutiae, I wanted to find a way to de-wonk the book, to make it accessible and relevant to people who didn’t have a background in the subject. What I eventually did was to frame each chapter with a medical case. The point I tried to make with these cases was that even if arguments about hot vs. cold medicines seem a bit esoteric to the modern reader, these issues really matter to the man who has just lost his wife in childbirth, or to the woman who has had five miscarriages in a row. These were the ideological and technological resources they had at their disposal during the Qing, and I wanted to find a way to bring the reader into that mental universe. People tend to see Chinese medicine as mystical, and certainly it takes a while to understand the cosmology and philosophy that underlies it. But when you get past that, you have the universal story of people getting sick, and people trying to cure them.
MEC: In a previous article, you wrote about Buddhist monks who were fuke practitioners. What was the relationship between religion and medicine in women’s healthcare during the Qing dynasty?
YLW: Religious healing was a routine form of therapy, not just for women, but for everyone. The classical medicine that I am studying historically arose as a rejection of religious models of healing, and it argued that the processes of health and disease were located in the body, not in the whims of god or demon. But people continued to use prayers, incantations, and rituals of all kinds as a way to prevent or cure illnesses, ranging from eye diseases to plagues and epidemics. Women also regularly visited temples to pray that they would be granted sons. People also performed rituals during and after childbirth to protect the woman and newborn from harmful demons. While some doctors criticized these practices, others included this kind of information in their medical works. What is particularly interesting, furthermore, is the way that medical texts themselves could take on ritual meanings. For example, in the book I discuss the phenomenon of merit publishing, where people printed and distributed medical texts as a way of obtaining karmic rewards. These included a man whose wife started vomiting blood during a difficult labor. He vowed to publish 1,000 copies of a medical text on childbirth if only she could be saved, and she then safely delivered a son. So medical experts are working and writing in an environment in which the boundaries between different healing modalities are both fluid and contentious.
MEC: What are you working on now?
YLW: My current book project is a comparative study of Chinese and European medicine in the 1830s to 1860s. I first got interested in this years ago when a friend showed me the work of Benjamin Hobson, a British surgeon and medical missionary who wrote a series of texts in the 1850s to introduce Western medicine to Chinese doctors. These included a specialized work on midwifery. What I’d like to understand is the factors that influenced Chinese views of Western knowledge at a time when European therapeutics was not self-evidently superior to Chinese methods. For example, neither Chinese nor European doctors had an effective means of treating cholera, which was the major global health issue of the time. Also, caesarean sections were still very dangerous, so Western obstetricians would often resolve obstructed labor by dismembering the baby, techniques that were broadly similar to those used by Chinese midwives. And yet, there were a number of Chinese doctors and literati in the early nineteenth century who were very interested in Western medical writings. The aim of my project is to explore why.