Medical Writings on Childbirth in Imperial China
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Male Brushstrokes and Female Touch: Medical Writings on Childbirth in Imperial China Margaret Wee Siang Ng Department of History, Faculty of Arts McGill University, Montreal May, 2013 A thesis submitted to McGill University in partial fulfillment of the requirements of the degree of Doctorate of Philosophy in History © Margaret Wee Siang Ng, 2013 TABLE OF CONTENTS Abstract i Résumé ii Acknowledgements iii INTRODUCTION 1 Writing about Birth 3 Methods 8 Sources 10 Contemporary Scholarship 11 The Life of Shichan lun 14 CHAPTER ONE 20 Female Hands and Male Brushstrokes: A Translation and Analysis of Shichan lun 十產論 (Ten Topics on Birth) Part One: Introduction 20 Authorship, Structure, Language and Tone 21 Part Two: The Pain of Childbirth 29 Topic One: Zhengchan 正產 29 The quality of pain in Shichan lun 30 Topic Two: Shangchan 傷產 35 Talking About Pain 42 Pain in Medicine 48 Painful Birth in Chinese Culture 58 Topic Three: Cuichan 催產 66 A Season to Birth: Topics Four and Five: Season and Climate 67 Part Three: Female Hands: Shoufa 手法 (Hand Techniques) 72 Fa 法 – Method, Technique and Skill 73 Topic Six: Hengchan 橫產 74 Topic Seven: Daochan 倒產 77 Topic Eight: Pianchan 偏產 78 Topic Nine: Aichan 礙產 81 Touch of the Practitioner 82 Healing Hands in Chinese Medicine 84 Part Four: 93 Topic Ten: Zuochan 坐產 93 Topic Eleven: Panchang chan 盤腸產 95 Conclusion 96 CHAPTER TWO Male Brushstrokes: The Life of a Text: 101 The Transmission of Shichan lun from Song to the Qing Introduction 101 The Northern Song (960-1126) 104 The Intellectual Milieu 107 Yang Zijian, the Literatus from Qingshen 112 Writings of Yang Zijian 126 Yang and His Contemporaries 140 Shen Gua 143 Scholarly Learning and Medicine 149 Medical Governance 152 Elites and Medicine 155 Who was Yang Zijian? 160 CHAPTER THREE 164 Envisioning Women's Medicine: Chen Ziming Introduction 164 The End of the Southern Song 169 Chen Ziming's Unique and Ambitious Undertaking 174 Chen Ziming's Vision/ Revision of Fuke 176 Preservation of Non-Extant Works 179 Female Difference in Song Medical Texts 183 Aspirations to Become a Literatus-Physician 194 Organization of Furen daquan liangfang 199 Teaching Materials 208 Childbirth 215 Preparing the Woman about to Give Birth 220 Aligning the Birthing Woman with the Stars 226 Conclusion 234 CHAPTER FOUR 236 Xue Ji: A Successful Physician and the Charlatan? Introduction 236 Xue Ji's Role as Editor 238 Editorial Style 243 The Untalented Doctor 246 Major Milestones 249 Social, Cultural and Political Background of Xue Ji's Period 255 Medicine in Mid-Ming China 257 Contemporaries of Xue Ji 264 Changes in the Description of Childbirth 265 Preliminary Observations 266 Analysis of the Changes Xue Ji Made to Shichan lun 268 Topic One to Topic Four 269 Xue and Qi (Blood and Qi) 275 Topic Five to Topic Six 278 Topic Seven to Topic Nine 284 Techniques of Delivery 285 Topic Ten to Topic Eleven 288 Conclusion 290 CONCLUSION 293 APPENDIX 297 BIBLIOGRAPHY 310 Abstract This dissertation is a study of Shichan lun (Ten Topics on Birth), a widely disseminated medical treatise produced in the Northern Song dynasty (960-1127), around the early twelfth century. Shichan lun records how childbirth progressed and it also contains detailed descriptions of hand techniques deployed by women practitioners during birth complications. I examine its composition, incorporation into a larger work (in the thirteenth century), and redaction (ca. early to mid- sixteenth century). In Chapter One, I translate and analyze the earliest extant edition of Shichan lun, collected in Chen Ziming’s Furen daquan liangfang (All Inclusive Good Prescriptions for Women, pub. 1238). I highlight the use of childbirth pain descriptions as a diagnostic “tool” during delivery and the hand techniques women practitioners used to manage birth complications. In Chapter Two, I provide a composite biography of the author of Shichan lun, Yang Zijian (fl. 1100), and analyze the reasons why a literatus came to write about childbirth in the early twelfth century and his literary network. Chapter Three is devoted to the study of Chen Ziming (fl. 1237-1271), who incorporated Shichan lun into his work. I examine Chen’s authorial impulse and evaluate his involvement in re- defining women’s medicine. Chapter Four is a study of the changes introduced by Xue Ji (1487-1558), the sixteenth century medical author, to Chen Ziming’s work and Shichan lun. My conclusion addresses how Shichan lun, a work of a technical and practical nature, resisted theoretical incorporation, and the problems of using male-authored sources to study women’s medicine and women practitioners. i Résumé Cette thèse de doctorat est une étude biographique du Shichan Lun (Dix discours sur la naissance), un traité médical rédigé dans la dynastie des Song du Nord (960-1127) autour du début du XIIe siècle et largement diffusé jusqu'aujourd'hui. Shichan lun enregistre l'évolution des méthodes d'accouchement et contient également des descriptions détaillées des techniques manuelles déployés par les praticiens femmes pendant les complications de l'accouchement. J'examine la composition de l’oeuvre, l’intégration de l’oeuvre à un ouvrage plus large (au XIIIe siècle) ainsi que sa rédaction (ca. début au milieu du XVIe siècle). Dans le premier chapitre, je traduis et j’analyse la première édition existante du Shichan lun, recueillie dans le Furen daquan Liangfang de Chen Ziming (prescriptions inclusives et bonnes pour les femmes, pub. 1238). Je souligne l'utilisation des descriptions de la douleur de l'accouchement comme un «outil» de diagnostic pendant l'accouchement et les techniques manuelles utilisées par les praticiens femmes pour gérer les complications de l'accouchement. Dans le deuxième chapitre, je fournis une biographie composite de l'auteur du Shichan lun, Yang Zijian, en analysant les raisons pour lesquelles un lettré se mit à écrire au sujet de l'accouchement au début du XIIe siècle ainsi que son réseau littéraire. Le troisième chapitre est consacré à l'étude de Chen Ziming qui a incorporé le Shichan lun dans son oeuvre. J'examine impulsion d’authorial de Chen et j’évalue son implication dans la redéfinition de la médecine des femmes. Le chapitre quatre est une étude au sujet des changements introduits par Xue Ji, auteur médical du XVIe siècle, dans l’oeuvre de Chen Ziming et dans le Shichan Lun. En conclusion, je constate la façon dont le Shichan lun, un oeuvre de caractère technique et pratique, a résisté l’incorporation théorique ainsi que les problèmes de l'utilisation de sources d'auteurs masculins quant à l‘étude de la médecine des femmes et des praticiens femmes. ii Acknowledgements This journey has been meaningful, unexpected and rewarding, and I have incurred much debt during the long gestation period of this project. First, I would like to express my gratitude to my supervisor, Robin D.S. Yates, who has supported me throughout my PhD career. His good cheer and sound advice were important ingredients in the completion of this dissertation. Griet Vankeerberghen taught me classical Chinese and the importance of being a meticulous thinker. Much credit is due to Faith Wallis who taught me everything I know about the history of medicine in the West. She has been most generous with her time and good advice. I would also like to thank Kenneth Dean, Grace Fong, Brian Lewis, Leonard Moore and Nancy Partner for their time and counsel. I would like to thank Yi-Li Wu, the external examiner for this dissertation. I much appreciate the valuable suggestions she made for its improvement. My time at McGill was made much easier by the assistance and goodwill of Georgii Mikula, Colleen Parish, Mitali Das, Sylvia Crawford and Jody Anderson of the History Department. My appreciation is also extended to Livia Nardini and Angela Lapenna of the East Asian Studies Department, who have been most supportive. In Montreal, I was fortunate to receive much intellectual stimulation and support from Afra Tucker, Lin Fan, Rongdao, Chloe Sondervorst, Paola Carozza, Alvin Chung, Sara Neswald, Hasan Karrar, Jessica Main, Melissa Curley, Gyewon Kim, Zheng Lee, Sarah Gibson, Brian Lander, Elizabeth Lord, Chris Bryne, Tracy Zhang and Grace Lin. A fellowship from the Princeton University Library Research Grant allowed me to use the collection of rare Chinese medical works held at the Seeley G. Mudd Manuscript Library. I am much indebted to the staff of the Princeton University East Asian Library and Gest Collection. They provided me with much assistance, and I especially benefitted from the guidance of Martin Heijdra. I would like to express my appreciation for the welcome offered by the East Asian Studies Department. During my tenure in Princeton, I was fortunate to meet Lucille Chia and received good counsel. I also had the opportunity to meet Charlotte Furth, whose work inspired me to start this project many years ago. She was most generous with her time and advice. My thinking on practice was enriched by discussions with Pamela Smith and Dieter Kuhn. I had stimulating conversations with Brigid Vance, April Hughes, Wayne Soon, Ye Minlei, Zuo Ya, Christine Dunbar, Erin Brightwell, Margaret Schotte, Nurfadzilah Yahaya, Yulia Frumer, and Pey-Yi Chu. Thank you for camaraderie, encouragement, and good food. I dearly miss the dessert club. A Center for Chinese Studies Fellowship made possible my research in Asia, and the opportunity for me to use the resources at the National Library, the National Palace Museum Library, and the Academia Sinica in Taiwan. I am grateful to the staff of the CCS, especially Keng Li-chun, Jane Liau, Mister Tsai, iii and Luo Jinmei, who were excellent hosts. In Taiwan, I also benefitted from discussions with Annika Pissin, Uffe Bergeton, Hsieh Mei-yu, Eli Alberts, Stephan Schmidt, Quinn and Sophie Javers, David Wright, Cho Sungwu, Wang Cheng-hua, and Chang Che-chia.