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A Flourishing Yin opens a new and important chapter in the history of medicine and gender in China between the Song and the Ming dynasties. Charlotte Furth's account traces the shifts in medical and gender discourses from the 'androgynous' medical narratives and the yin-yang harmony of the legendary Yellow Emperor to the late imperial literature on health and medicine circulating among medical practitioners and the literary public. Based on analysis of medical texts, popular handbooks, recorded teachings of doctors and case histories, it gives particular attention to the development of fuke (medicine for women) as learned discourse between the Song and the Ming. It shows how the changing language of the body between social and medical discourses appears as a rich source for reflecting on the cultural construction of gender. In doing this, it also gives a sophisticated critique of the 'orientalising' view of a single holistic body informing the principles of Chinese medicine.
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Furth's narrative follows three major lines of enquiry. The first interrogates the cultural assumptions of medical practitioners and professionals which led to the recognition of fuke as a branch of medicine. It examines the characterisation of the female body that emerges from medical texts, and links this with the role of the body in the natural and social construction of gender and social/kinship relations. The second, focussing on gender, challenges the stereotype of the endlessly oppressed woman of Confucian patriarchy through revisiting the ways in which nei/wai [inner/outer] boundaries were negotiated in medical practice. Drawing on Dorothy Ko's and Francesca Bray's arguments concerning the overlapping spheres of nei and wai, Furth argues that medical discourse constructed women by bodily and spatial location as much as by biology. Finally, Furth's historicisation of bodily gender challenges both the oppositional notion of a fixed gender binary and the orientalisation of the Chinese body based on the 'idealised reading of a polysemic field of meanings' (p. 11). In this, she offers some finely nuanced arguments about the ways in which gender difference was configured in Chinese medical history.
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Furth's discussion starts with an analysis of the normative standard of 'androgyny' represented by the symbolic notion of the 'Yellow Emperor's body'. Yin and yang posited gender as an attribute of nature itself both within the body and outside it, present in the qualities of all natural phenomena. Yin and yang were relational qualities and functions diffused throughout all bodies as well as the cosmos at large. However, the Inner Canon echoed social understandings of male superiority in imaging the body as 'polity' and health as 'kingly'. Furthermore, its emphasis on the generative capacities of the Yellow Emperor's body and the near invisibility of the female gestational body suggested a gender imbalance not acknowledged in the ideal of the naturally androgynous body.
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The recognition of fuke in the Song period as a particular branch of medicine was premised on the axiom that in women 'Blood is the leader'. Women's gestational functions were seen to weaken their generational capacity. The 'gestational body' of pregnancy and delivery 'resisted the symmetries of homologous gender difference and brought doctors into contact with an essentialist model of the female body as impure' (p. 130). Ritual obstetrics marked out birth as a dangerous and polluting event that should be managed within the domestic space of the home. Menstruation and the leadership of blood were now seen as the key to women's general health and fertility. Their equivalent in the male was semen. The new approach to menstruation emerged with Zhu Zhenheng's 'yang is always in excess; yin is always deficient' (p. 146). His body of fire and water signified a refiguration of the meaning of gender in the androgynous body rather than an explicit construction of bodily difference between the sexes. His terms became the categories of analysis for internal pathologies, including menstrual irregularities and internal depletions of blood triggered by negative emotions.
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Medicine during the Song was largely a domestic system, organised around rituals of practice. Encouraged by the new print culture sponsored by the state, literati physicians appeared who changed the shape of medical practice and discourse in combining literate medicine with oral traditions of healing. However, while print in the Song came to shape the contours of 'tradition' in medicine, it did not overcome the primacy of oral and informal learning in fuke. Fuke was not one of the main branches of medicine, and female healers continued to practice without negative comment by literate practitioners. Attempts by learned men to minimise the importance of women healers took the form of assuming the role of ritual advisor, not by rejecting it. Medical practice in fuke thus was a negotiated site between women healers and literate medicine (p. 115).
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Under the extension of print culture during the Ming dynasty, popular medical texts enjoyed a wide readership, and medical authors became known for their individual contributions. An early seventeenth century collection of case histories, entitled To Benefit Yin for the first time brought together in a single collection the different voices of doctors, healers and patients.
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Other changes and shifts also took place. At a time when smallpox was a big killer of children, the pollution beliefs and birth rituals of the Song gave way to a concern with 'fetal poison' and paediatric disease. This was accompanied by reduced medical attention to the mother's body and gestational blood and a new focus on men's sexual heat in explaining the origin of foetal poison. Increasing interest in internal alchemy, and attention to male gender through new narratives about longevity contrasted with the move to the medical sidelines of female disorders and the concentration of medical interest in women on their role as child bearers. Gender differences also emerged in Ming discourse on 'nourishing life' and internal alchemy, emphasizing male sexual functions as powers of a body of generation in which erotic pleasure, reproduction and longevity came together in a 'master narrative' of male bodily identity. Menstruation was not the equivalent in the female, because fertility rather than longevity was the anticipated achievement. For women, therefore, alchemical cultivation would involve a breach of reproductive functions, and would as such be socially transgressive.
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Increasing sexual segregation in the Ming produced further shifts in the gendered meanings of medical practice. Clinical limits on expert knowledge of the 'gestational' body were established by social and gender constraints on contact between male doctors and female patients. Hierarchical distinctions also emerged from the thirteenth century onwards. Relationships between male healers and the female sick became more distant, and as literati medical skills became more privileged, so did the lesser educated women healers' status fall. Medical accounts were often negative about women healers-'grannies' as they often were labelled-in a convergence of class and gender bias.
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However, case histories of patients and healers revealed a flexibility of boundaries between inner and outer in contrast to the cultural norms of segregation often associated with the period. While women often guarded their own seclusion, sometimes attended by female healers, the male householder with authority over them might challenge this seclusion by revealing to literati doctors the details of a complaint and inviting the doctor's support in curing it. Women from medical families sometime attained the status of literati doctor. Whether as medical workers who crossed the boundaries that kept women in the domestic sphere or as literati doctors practising in a sphere dominated by male public expertise, women's practices suggested that the boundaries between outer and inner were not fixed, even if the distinction between them ultimately depended on the guidance of the patriarchal authority.
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New approaches to gender difference and changes in fuke in the Ming period, did not alter the foundations of medical understanding. The androgynous body of medical knowledge was not replaced, any more than were the impurities associated with the female body's gestational function dissolved. These earlier ideas were now complicated by medical notions of gender hierarchy (blood and qi) as well as gender harmony (yin and yang), and by social and cultural practices signifying the subordination and interdependence of women. Through this complex of configurations, both gender difference and gender harmony were naturalised as the basis of family life. The idea that gender difference might be rooted in biological essentialism clearly had little place in this arrangement.
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In charting the contours of these changing constructions of gender, Furth makes a number of challenging observations. One draws out key differences between Chinese and Christian notions of the generative body. Yin and yang suggested the concentration of reproductive and erotic desires in generative bodies seen as creative capacities to assure human life. Chinese medical discourse made no separation between generation and gestation in its view of eros. The separation between the functional reproductive body and erotic performance (inscribed in the Christian view of the sin of sex when separated from reproduction) only emerged later, under the influence of western theories of medicine, the body and sex.
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A review of this length cannot, of course, do justice to the wealth of description, analysis and argument in this book. Its rich scholarship, its fluent- though often demanding-narrative style and its theoretical engagement with a range of feminist and postmodern perspectives all make it an original and learned account of gender and medicine in late imperial China. The book will be a 'must' for students of China's medical and gender history, as well as for those interested in comparative cultural studies of the history of the body.
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