Female Medical Workers in Ancient China
ZHENG Jin-sheng 郑金生
The China Institute for the History of Medicine and Medical Literature, China Academy of Traditional Chinese Medicine, Beijing
Little represented in history, records are found of less than one hundred female workers in China. The inferior social status of women may account for their scant representation in history, but the need for female medical workers in care of women themselves proved great. The relative lack of formal training (except in the royal palace of the Ming Dynasty , to be discussed later) limited the quality of their service, yet the few records collected reveal an active involvement of women in ancient Chinese medicine.
Judging form existing documents, there appears to have been no apparent discrimination against, female physicians in ancient times. In the early stages of medical development in China, the classes were often presented under the names of deities, and female deities were included among them. A famous example was Su Nu素女(Plain Girl); the two classics of Pulse Diagnosis of Su Nu素女脉诀 and Classic of Su Nu素女经 were known under her name, the latter being a book on chamber technique (sexology).1
Many stories passed from dynasty to dynasty with approbation for the successful treatment of queens by female doctors who were then conferred with titles of honor. A certain Madam Feng in the Song dynasty, for instance, was conferred the title of An Guo Lady安国夫人 (the Lady Who Brought Relief to the Nation ) after she cured the suffering of the Empress Dowager. Her descendants used to boast of their skills by citing this story.2 Also recorded in history were clinics and drugstores owner by female doctors. One of the reasons that competent female doctors earned respect was simply because they were female." How could a female be working as unless she had some unique life-saving skill?" Taking advantage of such psychology, two famous families in the Ming dynasty ,the Jins 金 and the Tangs 汤, fabricated myths of prominent female physicians in their families. Among their ancestors, "two girls were born capable of writing such books as Gynecological Prescriptions (NuKe yifang 女科医方)，" they said ,and this easily won them respect.3
As indicated by many historical documents, outstanding female doctors enjoyed respect equal to their male counterparts. For example, a detailed account was engraved on a stone tablet of a certain Madam Han 韩医妇 in the Ming dynasty who cured cases of dysphagia.4 Theories based on the treatment of three cases of gynecological disorders by the famous female doctor, Li Guiyuan 李闺媛 ,were recorded in detail in literary sketches of the Qing dynasty.5 Despite all these, however, the female doctors were far less represented compared with their male counterparts.
The cause of this exclusion should be sought in the social institution prevailing at that time assigning women a certain social role. The "three obediences and four virtues"(三从四德) were the standards expected of women in ancient China .In the past, the labor was divided in such a way that "men are in charge of external affairs while women are in charge of internal affairs." As a result, the social roles of the female were always supporting ones, roles subordinate to the male roles. And that is why women were never able to give full play to their talents in the fields of science and technology, with medicine being no exception.
Nevertheless, unlike astronomy and geography, medicine has a much greater social dimension and, owing to social demand , female doctors have always been indispensable. To protect the integrity of the imperial harem, specialized female doctors were appointed at least as early as the Han dynasty .6 As decreed by the Ming government , "(male) doctors are not allowed to enter the palace of imperial concubines and, in case of disease, the concubines shall be given herbs as considered appropriate based on their complaints." 7 In view of cases of adultery between imperial concubines and external officals in late Yuan dynasty, the first emperor of the Ming dynasty issued thisdecree, prohibiting male doctors to edter the palace of the imperial concubines . From then on, Selected maids and eunuchs were trained to take care of the concubines and, sometimes, midwives were called in from outside as the need arose.
Feucal ethics came to their peak during the Song dynasty, when the apologists went so far as to say :"A woman should rather die of Hunger than lose her chastity." Male doctors found it more and more Difficult dealing with female patients. According to the Bencao yanyi本草衍义，a book written during the Song dynasty, female patients were required to wrap their wrists with cloth so that male doctors might not make contact with their skin while feeling their pulse." 8 Later a myth was made up in novels that an able doctor could feel a pulse by putting his fingers at one end of a thread while the other end was connected to the wrist of the female patient, The feudal shackles, however , fell more heavily on widows, who were expected to be
faithful to their dead husbands to their own end. In Yuan dynasty, for example, a widow had a "mammary sore"( rutong乳痛，mastitis or more probably carcinoma) and others advised her to go to see doctors. " I am a widow. How can I let males see me," she replied. Finally she died of the illness . 9 Another example was a certain Madam Hu, who was paised as a "chaste widow." Sticken with disease and when her family was about to send for a doctor, she said to her father "A widow's hand should not be inspected by males." Again she died without taking any treatment.10 They would not even let themselves be examined, let alone have their babies born with male's assistance. Such being the case, the presence of female doctors was a blessing for
The average woman at the time . Thirty one cases were recorded in Medical Cases with Annotation by a Female Doctor (Nuyi zayan女医杂言), a book written by Tan Yunxian 谈允贤 in the Ming dynasty. All the patients were females and, according to Tan, most of them were "her acquaintances who were unwilling to be treated by male doctors."11 It is thus clear that social demand was the primary cause for the Continual existence of female doctors.
Professional Specialties of Female Doctors
As revealed by the statistics on female doctors I have collected, most of them were concentrated in obstetrics, gynecology, pediatrics and minor surgery. Being females themselves, they were privileged in obstetrical, gynecological and pediatric practice. Just as Zhu En朱恩 said in his preface to Medical Cases with Annotation by a Female Doctor,
As I heard from male doctors, they would rather treat ten men than a woman. It is not because they can learn very little from women as a result of the ethical barrier between men and women, but rather because the nature differs between the two sexes. The female doctor, based on her understanding of her own nature, can easily understand the female patient's nature, and they are bound to succeed.12
From the cases reported in the above book, one can see that the patients who visited Tan Yunxian were willing to reveal their privacy so that she was well-informed and could easily offer correct diagnoses and good advice. For example, one woman became ill out of anger when her husband took a concubine after he rose in social position. Another woman became ill with anxiety because she had not yet born a son and she was afraid that her husband might take a concubine using this as an excuse. Of course, they would not reveal such social-psychological precipitating factors to male doctors. On the other hand, Tan Yunxian herself had "menstrual disorders" and other common gynecological diseases. She had also giver birth to four children and thus she knew much more than her male counterparts how to treat female patients. Besides, as a mother herself, she had good experience in caring for children. One day, a rich woman brought an eight-year old girl to her, saying the girl had protracted diarrhea and it persisted for a long time. When Tan learned that the girl was the mother's only daughter, she thought "spoiling would lead to excessive eating and improper diet which was likely to result in dyspepsia." She prescribed Baohe pill保和丸 (a prescription indicated especially for indigestion) and moxibustion, and the girl was promptly cured.
Although female doctors were privileged in gynecology, obstetrics and pediatrics, they were limited in other fields and in their practices. Tan Yunxian, for example, practiced Medicine only in the country among her acquaintances. After she completed the book, she was not in a position to publish it. As she wrote in her book, "I do hope to solicit comments on my writing but, being a woman I cannot go out myself, so I have to ask my son to have blocks cut for printing." Thus the limitation imposed upon women (their being prohibited from contacting males outside their home) confined their practices to women and children
Medical Education and Social Status of Female Doctors in Ancient China
Many types may be distinguished among female doctors in ancient China and various levels of education were available to each type of them. A good many of them did not receive any systematic education and they earned their living simple by suing the few prescriptions or skills they picked up form other and the little experience they acquired form the few cases they happened to treat. Yet there were a few who received formal training. This training was not, however, on a par with what male doctors received. No female student ever attend official medical school in any dynasty. Most of the female doctors received their training form their families.
Those professional female doctors who received systematic training were the best of then and most women received their training form their "medical families"-usually form her husband's family but occasionally form her own family. To monopolize their skills, most medical families kept their knowledge secret and only passed it on to sons and daughters-in-law but not t their daughters married into other families. This is the reason why there were so many cases where both mother-in-law and daughter-in-law were doctors . For example, in the medical family of the Guos郭氏 -which had earned a reputation in gynecology since the Song dynasty-, female doctors of several generations (respectively nee Feng冯, Wu吴, and Mao毛") enjoyed good fame. In the medical family specialized in pediatrics in the Ming dynasty, Madam Cheng程 nee Fang方 was the daughter-in-law of Madam Cheng程 nee Jiang蒋 . There were a few female doctors, however, who received their training from their own parent's family. In families that had no son or whose son(s) would follow other professions, it was possible for the daughter to inherit the shills. The above mentioned Tan Yunxian learned from her grandfather and grandmother, for her father's generation changed to an official career and no one except her would be able to carry forward medical tradition.
Unlike their male counterparts who often learned skills form a certain master with the purpose of setting up their own clinics right after they completed their apprenticeship, women in the profession. Received medical training largely to assist the males in their family by doing some supporting work. One important source of male doctors was those would-be scholars who failed the official examination. This was impossible for females who were not qualified to take the official examination at all. Most male doctors were not from medical families and many officials and learned men studied medicine out of personal interest. Even after they became prominent physicians, they did not rely on medicine to make a living. No such examples were found among female doctors. Family training was the standard mode of education for them and few female doctors were known who received systematic training outside the family. While they might be very skilled in certain medical techniques, they rarely made any theoretical contributions. The extant medical works contributed by them were mostly case records or summaries of their clinical experience. This may be attributed to their limited training.
In contrast to the family-based female doctors, many itinerant female healers were active throughout the land, rendering their service to the bottom of society sometimes in the city but largely in the country, where Confucian ethics had little influence. Few of them received ant formal training. There such a variety of them that no single picture of then can be presented. Some of them were nuns or simply witches. They sold hers, which were often professed as "secret recipes," "magic drugs" or "panacea." They acted as midwives who might assist with abortions sometimes. Among them, midwifery was a stable profession throughout the dynasties. Yet they were among the most despised in the society, usually classified together with fortune-tellers, sorceresses, matchmakers, middlemen, or even procuresses. In novels written in the Ming and Qing dynasties, they were often depicted as women who earned their living by dishonest means.
Although some of them were experienced, midwives generally had little technical competence. They simply could do nothing in cases of difficult labor. There went a saying in the Han dynasty that, during delivery, there was "only one survival after ten deaths." According to Yang Kanghou杨康侯, a physician in the Song dynasty, "there are very few good midwives and death is often the outcome." As was also pointed out by Chen Zhidao 陈治道, the author of safe delivery (Baochan wanquan fang保产万全方) in the Ming dynasty, "it is precarious to risk two lives on a midwife." A steady and experienced midwife might save the life of both the mother and infant, but this is purely chance and the not the consequence of good knowledge and skill. In contrast, a rude and ignorant quack might turn an otherwise uneventful case into a difficult one and, frightened by the unexpected outcome out of her wits, she might even take the opportunity to blackmail the family though death of at least the infant was usually the case. In Supplement to the Classified Medical Records of Distinguished Physicians (Xu mingyi leian续名医类案), one can see an account of a midwife in the Yuan dynasty who broke the arm of an infant leading to its death in the womb. Much criticism was directed at midwives for their lack of technical competence and morality.
Many female healers used witchcraft to deify their skill. During the Song dynasty, a certain Madam Zhang 张 practiced witchcraft while performing acupuncture on her patients. And in the Qing dynasty, Madam Li李 , a female healer in Shunyi顺义 County, was famous for her magic arts as well as her art of healing. With the effects much tauted, she became praised as the "Old Buddha of Western Hills" (Xishan laofo西山老佛), attracting a good many to come to worship her. For fear that this might lead social instability, the authorities eventually executed her on a pretext. Such female witch-healers and common female healers of low standard did great harm to the image of female doctors in general. All these led Xiao Jing萧京, a physician in the Qing dynasty, to conclude: "It is really risky to entrust the midwife with the life of one's wife and son. They have already killed a good many."
On the basis of biographies and works of roughly eighty female medical workers in ancient China, a brief review and analysis was done of their sociocultural background. Despite their own shortcomings and the criticisms directed against them, and marking allowance for the limitations of the times, they seem to have served their social functions as well as their male counterparts. It remains, however, to find more materials (including sketches and novels as well) to study them further, especially the least represented itinerant healers, from a multidimensional perspective.
1 Ge Hong葛洪Baopuzi xialan 抱朴子 遐览juan 卷 19 (Shanghai:Guji chubanshe 古籍出版社1990)，p.148.
2 Chen Menglei 陈梦雷 et al.,Yibu quanlu, mingliu liezhuan 医部全录·医术名流列传"（Beijing Renmin weisheng chubanshe 人民卫生出版社1962)，p.168.
3 Ibid ,p. 174.
4 Ibid ,p.168.
5 Zhou Sheng周生Yangzhoumeng 扬州梦juan 4 (Shanghai: Wenming shuju 文明书局 1915).
6 Shiji史记juan 122 (Zhonghua shuju 中华书局1975).p.3144.
7 Yu Jideng余继登Dian'gu Jiwen 典故纪闻 juan 2,p.30.
8 8 Kou Zongshi寇宗奭, Bencao yanyi juan 1 (Beijing: Renmin weisheng chubanshe,
1957). P. 48b.
9 Ke shao柯绍, Xin Yuanshi 新元史， “Liezhuan" 列传", juan 244, p. 4a.