Editing Traditional Chinese medicine (section)

== Gender in traditional medicine ==
''Fuke'' ({{lang-zh|t=婦科 |s=妇科 |p=Fùkē |labels=no}}) is the traditional Chinese term for women's medicine (it means [[gynecology]] and [[obstetrics]] in modern medicine). However, there are few or no ancient works on it except for Fu Qingzhu's ''Fu Qingzhu Nu Ke'' (Fu Qingzhu's ''Gynecology'').<ref name="PyYtM">{{Cite book|title=Fu Qingzhu's gynecology| vauthors = Fu S |date=1995 |publisher=Blue Poppy Press|isbn=093618535X|oclc=46812372}}</ref> In traditional China, as in many other cultures, the health and medicine of female bodies was less understood than that of male bodies. Women's bodies were often secondary to male bodies, since women were thought of as the weaker, sicklier sex.<ref name="yzdrXFB">Furth, Charlotte. ''A Flourishing Yin: Gender in China's Medical History, 960–1665''. Berkeley: University of California Press, 1999. [http://hdl.handle.net/2027/HEB.04218.0001.001 hdl.handle.net] {{Webarchive|url=https://web.archive.org/web/20221215092227/https://www.fulcrum.org/concern/monographs/9s161641g |date=15 December 2022 }}</ref>

In clinical encounters, women and men were treated differently. Diagnosing women was not as simple as diagnosing men. First, when a woman fell ill, an appropriate adult man was to call the doctor and remain present during the examination, for the woman could not be left alone with the doctor.<ref name="nzFZzH">{{Cite book|title=A flourishing yin: gender in Chinaʼs medical history| vauthors = Furth C |publisher=University of California Press|year=1999|isbn=0520208293|pages=245, 250, 255|oclc=955120174}}</ref> The physician would discuss the female's problems and diagnosis only through the male. However, in certain cases, when a woman dealt with complications of pregnancy or birth, older women assumed the role of the formal authority. Men in these situations would not have much power to interfere.<ref name="54E8O5" />  Second, women were often silent about their issues with doctors due to the societal expectation of female modesty when a male figure was in the room.<ref name="nzFZzH" /> Third, patriarchal society also caused doctors to call women and children patients "the anonymous category of family members (''Jia Ren'') or household (''Ju Jia'')"<ref name="nzFZzH" /> in their journals. This anonymity and lack of conversation between the doctor and woman patient led to the inquiry diagnosis of the Four Diagnostic Methods<ref name="jBODo">{{Cite book|title=Diagnostic of Traditional Chinese Medicine – A newly compiled practical English-Chinese library of Traditional Chinese medicine| vauthors = Wang LF |publisher=Shanghai university of TCM press|year=2002|isbn=7810106805}}</ref> being the most challenging. Doctors used a medical doll known as a [[Doctor's lady]], on which female patients could indicate the location of their symptoms.<ref name="Byouo">{{cite book | url=https://books.google.com/books?id=xtgVBAAAQBAJ&pg=PA66 | title=You and Your Doctor: A Guide to a Healing Relationship, with Physicians' Insights | publisher=McFarland & Company | vauthors = Heller T | year=2012 | pages=66| isbn=9780786462933}}</ref>

Cheng Maoxian (b. 1581), who practiced medicine in Yangzhou, described the difficulties doctors had with the norm of female modesty. One of his case studies was that of Fan Jisuo's teenage daughter, who could not be diagnosed because she was unwilling to speak about her symptoms, since the illness involved discharge from her intimate areas.<ref name="54E8O5">{{cite book|title=A Flourishing Yin: Gender in China's Medical History| vauthors = Furth C |date=March 1999| publisher = University of California Press |isbn=9780520208292}}</ref> As Cheng describes, there were four standard methods of diagnosis – looking, asking, listening and smelling and touching (for pulse-taking). To maintain some form of modesty, women would often stay hidden behind curtains and screens. The doctor was allowed to touch enough of her body to complete his examination, often just the pulse taking. This would lead to situations where the symptoms and the doctor's diagnosis did not agree and the doctor would have to ask to view more of the patient.<ref name="VtvP4C">{{cite book|title=A Flourishing Yin: Gender in China's Medical History: 960–1665| vauthors = Furth C |date=March 1999|isbn=9780520208292|page=248| publisher = University of California Press }}</ref>

These social and cultural beliefs were often barriers to learning more about female health, with women themselves often being the most formidable barrier. Women were often uncomfortable talking about their illnesses, especially in front of the male chaperones that attended medical examinations.<ref name="yzdrXFB" /> Women would choose to omit certain symptoms as a means of upholding their chastity and honor. One such example is the case in which a teenage girl was unable to be diagnosed because she failed to mention her symptom of vaginal discharge.<ref name="yzdrXFB" /> Silence was their way of maintaining control in these situations, but it often came at the expense of their health and the advancement of female health and medicine. This silence and control were most obviously seen when the health problem was related to the core of Ming ''fuke'', or the sexual body.<ref name="yzdrXFB" /> It was often in these diagnostic settings that women would choose silence. In addition, there would be a conflict between patient and doctor on the probability of her diagnosis. For example, a woman who thought herself to be past the point of child-bearing age, might not believe a doctor who diagnoses her as pregnant.<ref name="yzdrXFB" /> This only resulted in more conflict.

=== Yin yang and gender ===
Yin and yang were critical to the understanding of women's bodies, but understood only in conjunction with male bodies.<ref name="uHbrTu">{{cite journal |last1=Farquhar |first1=Judith |title=Objects, Processes, and Female Infertility in Chinese Medicine |journal=Medical Anthropology Quarterly |date=1991 |volume=5 |issue=4 |pages=370–399 |doi=10.1525/maq.1991.5.4.02a00040 |jstor=649292 }}</ref> Yin and yang ruled the body, the body being a microcosm of the universe and the earth. In addition, gender in the body was understood as homologous, the two genders operating in synchronization.<ref name="yzdrXFB" /> Gender was presumed to influence the movement of energy and a well-trained physician would be expected to read the pulse and be able to identify two dozen or more energy flows.<ref name="GFgKi">{{Cite book|title=Canon of the Pulse (Maijing)}}</ref> Yin and yang concepts were applied to the feminine and masculine aspects of all bodies, implying that the differences between men and women begin at the level of this energy flow. According to ''Bequeathed Writings of Master Chu'' the male's yang pulse movement follows an ascending path in "compliance [with cosmic direction] so that the cycle of circulation in the body and the Vital Gate are felt...The female's yin pulse movement follows a defending path against the direction of cosmic influences, so that the nadir and the Gate of Life are felt at the inch position of the left hand".<ref name="Z7q7v">{{Cite book|title=Bequeathed Writings of Master Chu}}</ref> In sum, classical medicine marked yin and yang as high and low on bodies which in turn would be labeled normal or abnormal and gendered either male or female.<ref name="54E8O5" />

Bodily functions could be categorized through systems, not organs. In many drawings and diagrams, the twelve channels and their visceral systems were organized by yin and yang, an organization that was identical in female and male bodies. Female and male bodies were no different on the plane of yin and yang. Their gendered differences were not acknowledged in diagrams of the human body. Medical texts such as the ''[[Yuzuan yizong jinjian]]'' were filled with illustrations of male bodies or androgynous bodies that did not display gendered characteristics.<ref name="dsK5E">Wu, Yi-Li, and {{lang|zh|吳一立}}. "The Gendered Medical Iconography of the Golden Mirror, Yuzuan Yizong Jinjian {{lang|zh|御纂醫宗金鑑}}, 1742." In ''Imagining Chinese Medicine'', edited by Lo Vivienne, {{lang|zh|羅維前}}, Barrett Penelope, Dear David, Di Lu, {{lang|zh|蘆笛}}, Reynolds Lois, Yang Dolly, and {{lang|zh|楊德秀}}, 111–32. Leiden; Boston: Brill, 2018. {{JSTOR|10.1163/j.ctvbqs6ph.12}}.</ref>

As in other cultures, fertility and menstruation dominate female health concerns.<ref name="yzdrXFB" />  Since male and female bodies were governed by the same forces, traditional Chinese medicine did not recognize the womb as the place of reproduction. The abdominal cavity presented pathologies that were similar in both men and women, which included tumors, growths, hernias, and swellings of the genitals. The "master system", as Charlotte Furth calls it, is the kidney visceral system, which governed reproductive functions. Therefore, it was not the anatomical structures that allowed for pregnancy, but the difference in processes that allowed for the condition of pregnancy to occur.<ref name="yzdrXFB" />

=== Pregnancy ===
Traditional Chinese medicine's dealings with pregnancy are documented from at least the seventeenth century. According to Charlotte Furth, "a pregnancy (in the seventeenth century) as a known bodily experience emerged [...] out of the liminality of menstrual irregularity, as uneasy digestion, and a sense of fullness".<ref name="nzFZzH" /> These symptoms were common among other illness as well, so the diagnosis of pregnancy often came late in the term. The ''Canon of the Pulse'', which described the use of pulse in diagnosis, stated that pregnancy was "a condition marked by symptoms of the disorder in one whose pulse is normal" or "where the pulse and symptoms do not agree".<ref name="BddYV">{{Citation|chapter=Diagnosis for Pulse-Taking and Pulse Subtlety|date=March 2019|pages=69–77|publisher=WORLD SCIENTIFIC|isbn=9789813273573|doi=10.1142/9789813273580_0017|title=The Yellow Emperor's Classic of Medicine – Essential Questions|s2cid=241372790}}</ref> Women were often silent about suspected pregnancy, which led to many men not knowing that their wife or daughter was pregnant until complications arrived. Complications through the misdiagnosis and the woman's reluctance to speak often led to medically induced abortions. Cheng, Furth wrote, "was unapologetic about endangering a fetus when pregnancy risked a mother's well being".<ref name="nzFZzH" /> The method of abortion was the ingestion of certain herbs and foods. Disappointment at the loss of the fetus often led to family discord.<ref name="nzFZzH" />

=== Postpartum ===
If the baby and mother survived the term of the pregnancy, childbirth was then the next step. The tools provided for birth were: towels to catch the blood, a container for the placenta, a pregnancy sash to support the belly, and an infant swaddling wrap.<ref name="BTqQT">{{Cite book|title=Shinzoku kibun.| vauthors = Nakagawa T, Sun B, Muramatsu K |publisher=Tōkyō: Heibonsha.|year=1966}}</ref> With these tools, the baby was born, cleaned, and swaddled; however, the mother was then immediately the focus of the doctor to replenish her ''qi''.<ref name="nzFZzH" /> In his writings, Cheng places a large amount of emphasis on the Four Diagnostic methods to deal with postpartum issues and instructs all physicians to "not neglect any [of the four methods]".<ref name="nzFZzH" /> The process of birthing was thought to deplete a woman's blood level and ''qi'' so the most common treatments for postpartum were food (commonly garlic and ginseng), medicine, and rest.<ref name="QDRbHW">Cheng Maoxian. ''Yi'an'' (casebook). Dated 1633, but Xue Qinghu (1991) states that the original was printed in 1644</ref> This process was followed up by a month check-in with the physician, a practice known as ''zuo yuezi''.<ref name="aeNQF">{{cite journal |last1=Pillsbury |first1=Barbara L.K. |title='Doing the month': Confinement and convalescence of Chinese women after childbirth |journal=Social Science & Medicine. Part B: Medical Anthropology |date=January 1978 |volume=12 |issue=1B |pages=11–22 |doi=10.1016/0160-7987(78)90003-0 |pmid=565536 |s2cid=13414474 }}</ref>

=== Infertility ===
Infertility, not very well understood, posed serious social and cultural repercussions. The seventh-century scholar [[Sun Simiao]] is often quoted: "those who have prescriptions for women's distinctiveness take their differences of pregnancy, childbirth and [internal] bursting injuries as their basis."<ref name="uHbrTu" /> Even in contemporary ''fuke'' placing emphasis on reproductive functions, rather than the entire health of the woman, suggests that the main function of ''fuke'' is to produce children.

Once again, the kidney visceral system governs the "source ''Qi''", which governs the reproductive systems in both sexes. This source ''Qi'' was thought to "be slowly depleted through sexual activity, menstruation and childbirth."<ref name="uHbrTu" /> It was also understood that the depletion of source Qi could result from the movement of an external pathology that moved through the outer visceral systems before causing more permanent damage to the home of source Qi, the kidney system. In addition, the view that only very serious ailments ended in the damage of this system means that those who had trouble with their reproductive systems or fertility were seriously ill.

According to traditional Chinese medical texts, infertility can be summarized into different syndrome types. These were spleen and kidney depletion (yang depletion), liver and kidney depletion (yin depletion), blood depletion, phlegm damp, liver oppression, and damp heat. This is important because, while most other issues were complex in Chinese medical physiology, women's fertility issues were simple. Most syndrome types revolved around menstruation, or lack thereof. The patient was entrusted with recording not only the frequency, but also the "volume, color, consistency, and odor of menstrual flow."<ref name="uHbrTu" /> This placed responsibility of symptom recording on the patient, and was compounded by the earlier discussed issue of female chastity and honor. This meant that diagnosing female infertility was difficult, because the only symptoms that were recorded and monitored by the physician were the pulse and color of the tongue.<ref name="uHbrTu" />