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Objects, Processes, and Female Infertility in Chinese Medicine Author(s): Judith Farquhar Source: Medical Anthropology Quarterly, New
Series, Vol. 5, No. 4 (Dec., 1991), pp. 370-399 Published by: Wiley on behalf of the American Anthropological Association Stable URL: http://www.jstor.org/stable/649292 . Accessed: 30/09/2013 05:38
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JUDITH FARQUHAR
of Anthropology Department Universityof NorthCarolinaat ChapelHill
Objects, Processes, and Female Infertility in Chinese Medicine

Focusing on the diagnosis and treatment of female infertility in traditional Chinese medicine's "women's specialty" (fu ke), I examine the relationship between anatomical objects or substances and physiological processes in Chinese medical analysis. After considering the significance of gender in medical perception, I citefield observations, textbook explanations, and published cases to illustrate a bias toward the temporal and the processual in Chinese medicine. Continuities between illness experiences and understandings of women's bodies are explored in relation to these clinical modes of knowing.
o one would deny that the body is an object. Yet scholars have asserted the objecthoodof bodies to many differentends in the service of widely varyingprojects(Kuriyama1987:64-65; O'Neill 1986; Turner1984). In biomedicine, for example, the gross anatomyupon which clinical contemporary practiceshave long been groundedhas been supplemented by refinedtechnologies for visualizingbodily structure.Even such relativelygentle developmentsas computerizedtomography(CT) and ultrasound imaging continueto troublethose patients and medical critics who complain of a radicalobjectificationof the person in clinical practice. In using (often invasive) laboratorytests to discover conditions of the body which are outside the experience of the patient yet exist deep withinhim, the body is separated fromthe lived discomfortsof the ill person(Cassell 1982;Saunders1988). However "humanistic"biomedicalpracticesbecome, howeverkind the bedside mannerof doctors, their mode of knowing and serving often rendersthe body a foreignterrainof visualized structures,an object thatcan ultimatelybe knownonly throughtechnologiesover which the patienthas no control (Taussig 1980). In the discussion that follows, I will consider similar problems of objecthood, experience, knowledge, and time in the clinical practiceof Chinese medicine as a way of assessing the extent to which all medical analysis requiressome formof objectification a structural state from the ongoing exthroughabstracting perienceof illness. As a way of approachingthe category of "the body" (Scheper-Hughesand Lock 1987), I will inquire into the natureof objects in "tradiof the bodily objects tional" Chinese medicine.' Perhapsa clearerunderstanding and substancesrecognized in Chinese medicine (e.g., visceral systems, Blood andQi, circulationtracts),2as well as of its more abstract objects (i.e., the entities thatresultfromextensive analysis such as syndromesandprescriptions),can lead 370
IN CHINESE MEDICINE FEMALE INFERTILITY
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us to a view of Chinese bodiliness that need make few concessions to Cartesianism and "the medicalgaze" (Foucault1973).3 It may also suggest ways in which styles of knowingcan color clinical encountersindependentof the social skills of individualdoctors. The anthropologicalinvestigationof styles of Chinese medical knowing is aided by a vast contemporary literaturein the Peoples Republic of China. Textbook knowledge, the sortsof things thatcontemporary Chinese doctorsaretaught in modem schools and on which they draw in doing clinical work, is readily accessible and admirablyclear. It should be noted, however, that medical knowledge is nowhere pure (Farquhar1987). Even where textbooks systematize and legislate the accumulatedtechnical wisdom of a healing discipline and where a professionof expertsis reproduced throughformaltrainingin well-supervisedinstitutions,the complex politics of the clinic diverge from expectationsfosteredby the printedpage. Furthermore, the illness experiencesof patientsarticulatemore or less awkwardlywith the language and manipulationsof their doctors. At the same time, both doctors and patientsare subjectto the structuring economic and politicalexigencies of "health care delivery," the limitationsof which they have difficultyescaping. These differing registers of reality crisscross the field of illness and healing, making every statementsignificant in several different ways (Allan Young, personalcommunication). The statement,for example, that the Kidney visceral system governs reproductive functionsinvokes for the doctor a literaturerangingfrom Taoist meditaanddialysis; for the patientit invokes a mundane tive disciplinesto transplantation but continuousexperience of urination,lower back pain, menstrualcramps, and vaginaldischarges.For both, a (possibly highly charged)historyof personalclinical experienceconnects to many such items of knowledge. Moreover, both doctor and patientrespond in practice to the institutionalfact that kidney disorders are treateddifferentlyin the "Western medicine" and "Chinese medicine" departmentsof hospitals. These are considerationsthat have no obvious place in "the professionalliterature"of textbooks and researchreports,but they do surface in the clinic and are implicit in publishedcases. An anthropological study of a style of knowing must thereforedraw from all these sources. I will focus this study on the clinical problemof infertilityas it is treatedin fu ke, women's medicine.4 Recalling how often American women complain of being treatedlike objects in gynecological practice, and perhapsbecause we are led to believe thatcertainobjects (e.g., uterusesand vaginas) must be significant to any medicine that makes a specialty of women, I bring motives and commonsense expectationsfrom the life-world of female patients in the United States to an interrogation Chinese women's of the literatureand practiceof contemporary medicine.In any such procedure thereis a dangerof findingorientalist"answers" to our own culturalquestions, producingan idealizedChinese medicine as we go. Obviously, I wish to avoid such cross-culturalromanticismwhile still finding a pathto specific Chineseversions of what ShigehisaKuriyamahas called the "unknownrealm" that is the body (1987:64). The foil for this comparisonis not the systematizedand constantlyreexamined knowledge of cosmopolitanbiomedicine;ratherit is a certainlumpy, takenthat still clings to our concept of "body." Anatomymay be disfor-grantedness integratingfast as a foundationof biomedical knowledge and practice (Haraway
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1989), but it still serves as the chief metaphorthroughwhich nonspecialistWesternersthink about their bodies. The persistentanalysis of materialexistence in termsof visible structural featuresof discretethings has been both a triumphand a limitationof the Westernmedical worldview. I hope in this articleto show that Chinese medical analyticsare radicallydifferent. Afterdiscussingthe clinical contextof women's medicineas I have observed it in the course of fieldwork5and reportingexplanationsof infertility gathered Chinese fromfu ke textbooks(Anonymous 1983; ChengduCollege of Traditional Medicine 1985; Hu 1990; Shanghai College of TraditionalChinese Medicine, Gynecology Researchand TrainingUnit 1983; Sheng, Yang, and Sheng 1990), I review 19 publishedcases of infertility, analyzingtwo of them in some detail. I havechosenthese cases neitherat randomnorvery systematically; they aresimply all the cases of infertilityappearing in the Chinese medicalcase anthologiesI have been collecting since 1982 (see Appendix). The two I have chosen to discuss in detail cannotbe consideredto be typical, but they do sharecertainfeatureswith all othercase reportsin Chinese medicine. Few cases that fail to result in a cure or significantalleviation of symptoms are published, for example, and all have didactic points to make about clinical practice and medical analysis (Farquhar 1991). The readingthatI shall attempthere could be done with any of the 19 cases summarizedin the Appendix and would lead to diverse insights about contemporaryChinesemedicaldiscourse. Publishedcases mix manyformsof experience and knowledge, and they can be unpacked and analyzed in endless ways. My focus in this article will be on physiological knowledge-in-practice and its relationshipsto the life-worlds of patients;other dimensions of medical experience will also be addressedin orderto renderthe case histories intelligible. Chinese Clinics of Fu Ke In 1983 I spentone afternoonobservingthe practiceof a doctorof traditional medicine, a man just above middle age who was famous for treatinginfertility. Marriedcouples desperateto have childrencame to him, many from a greatdistance, most of them veteransof many differenttreatmentsfor infertility. All the men had undergonefertilitytests, and some of them were being treatedwith herbal prescriptions to remedy a low sperm count or low motility. If husbandshad tested normal,their wives were treatedfor variousdepletions and deficiencies (a few examplesof which I will analyzebelow). The clinic was crowded, tense, and orientedto the technicalitiesof prescriptiondesign. Many of the couples would keep in touch with the doctor by mail, reportingchanges in the patient's symptoms and receiving writtenalterationsin the prescription. In strong contrastto this scene, I observed on several occasions (1983-84 and 1988), the regular gynecology clinic of my friend Liu Jufang in the same Guangzhouhospital. Liu practicedwith anotherexperienced woman gynecologist, Dr. Ma, in a small room with a large table in the center. Each senior doctor sat on one side of the table, withjunior associates, also women, at her side. With the help of their associates they were able to interview and examine several patientsat once, which was often necessarysince they were usuallyvery busy. Most of theirpatientswere women; the occasional husbandor fatherwho attendedthe clinic seemed reluctantto enter a room so full of females. Many kinds of female
FEMALE INFERTILITY IN CHINESE MEDICINE
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disorders,as well as male infertility,were treatedhere. Pelvic examinationswere conductedas needed in the room next door. Doctors often had whisperedconsultationswith patientswho didn't want to be overheardby the many bystanders;at the same time there were frequentjoking exchanges among the doctors and paof women's lives and illnesses. Adtients, often involvingcomplicatednarratives vice aboutsexual practices, hygiene, and self-care was given and discussed with little embarrassment. The atmospherewas one of both intimacyand openness. In its relativeexclusion of men, however, it was almost conspiratorial. The last scenariodiffers fromboth these urbanclinics. In a subsidizedvillage clinic neara Shandongcounty town, a locally well-known seniorChinese doctor, retiredfrom the county hospital of traditionalmedicine, ran a thriving general medicine andfu ke practice. Patients came to see Zheng Chengfeng when they could sparetime from their work in the fields or get away from theirjobs in local factories. Though there were times when he was very busy (just after the wheat harvestandat the heightof the winterupperrespiratory infectionseason), he often had the leisure to write lavish case histories, which he filed by surnameand kept on manyclipboardshangingin rows on the wall.6 When a patientcame in, Zheng would first find her case recordand study it before collecting informationon her currentcondition. The patientdid most of the talking, and many producedlong narrativeswhile Zheng jotted down a few notes and asked a few clinical questions. In the cases of women who had been coming to see him for a long time and broughtrelativesto see him as well, he knew much more about their family and social situationsthanthe overworkedurbandoctors I have describedabove. I have also observed three other doctors offu ke at work in Beijing clinics, as well as numerousclinics of otherChinese medical specialties. The social styles of these various doctors were highly diverse: some, like Liu, were sympathetic and attentivein a sisterly or fatherly way; others were taciturn,abrupt,or even harsh with patients. All, however, shared a commitmentto the use of clinical methodsand therapieswhich are uniqueto Chinese medicine. All contemporary Chinese doctors work in a complicatedrelationshipto the forms of practicetypical of Western medicine. In all thefu ke clinics described above, for example, the results of pelvic examinations derived from Western medicalpracticesmay be noted and considered, but pelvics are very seldom performed.Most infertilitypatientsarriveat clinics of traditional medicine afterhaving been treatedin Western medical clinics; they often can reportthe results of such examinationsor providethem in a previouscase record. In such cases treatment proceeds with referenceto these earlierfindings. In the two urbanclinics I have described,it was very rarefor an infertilitypatientto be given a pelvic exam; in Zheng's ruralclinic he sometimes asked a female associate to do an examination if none had ever been done before. In Liu's clinic pelvic examinationswere done to confirmpregnancy,to determinefetal development,or if the patientcomplained of lesions or localized pain. Patients removed or pushed aside only the parts of their clothing necessary for the examination, and were never asked to fully disrobe. In contrastto the centralityof the pelvic examinationin the Western of drapesover a disrobed practiceof gynecology, with its fetishized arrangement body and assymetricalplacement of doctor and patient, the prototypicalspatial of Chinese medical actors (their disposition in Bourdieu's sense of arrangement the word) is seated face to face at a comer of the table, talking.
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The results of pelvic examinationsand other Western medical procedures (ultrasound,for example) are recordedand considered within the larger framework of the clinical encounter, which is guided by the "four examinations" of traditional medicine. These are "looking" (at the tongue and featuresof the patient's general appearance), "asking" (the history of the disorder), "hearing/ smelling" (for alteredvoice, coughs, foul odors) and "palpating" (the pulse). It has been clear in all my observationsof clinical encountersin the institutionsof Chinese medicinethatdoctors subsumethe results of "objective" Western-style tests andexaminationswithinthe more impressionisticand subjectivemethodsof traditionalmedicine. The "four examinations" focus on the patient's own account of her symptoms and on signs that are perceptibleon the body's surface (e.g., tongue color, pulse quality). Together, doctor and patientproducean understandingof the illness from the ingredientsof her memory and noninvasive not only supersedesinformationde"readings"of her body. This understanding rived from Westernmedical methods but also replaces a Westernmedical diagnosis with a (theoretically, at least) more treatableChinese medical syndrome (zheng). Doctors neitherstrive to achieve "objectivity" nor dwell upon objects. Their subjective grasp of pathologicalprocess builds largely upon the patient's reportof her history, treatingboth signs observed in the clinic (pulse, tongue images) and Westernmedical test results as moments that are of little significance in themselves.7 This process of privileging the methods and entities of Chinese medicine is clear in both of the cases analyzedbelow. Thoughhospitalcase recordsand published cases are phrasedin a somewhatspecialized medical language, I will try to show how the Chinese medical syndrome-a summaryof pathologicalprocessis arguably more consonant with the patient's experience of her illness than "Westernmedical" diseases of hiddenanatomicalirregularities and microscopic pathogens. Chinese Medicine and Female Infertility "Failureto become pregnant"(buyunzheng) as a disorderis invariablydiscussed nearthe end of contemporary textbooks and collections offu ke case histories.8 It is preceded by all the disorders that can afflict "menstruation,discharges, pregnancy,and childbirth."9Infertilityis often not presentas a pathology at all, at least accordingto the usual means of detecting disorderin Chinese medicine;it is a failure to achieve a desired bodily change, ratherthan an undesiredchangethatmust be broughtundercontrol. Further,like most Chinese medical syndromes,it resultsnot from a permanent structural of the body abnormality but ratherfrom an (often subtle) deficiency of normal physiological functions. (The cases discussed below will illustratethis.) Failureto become pregnantmay be one of the most frequentlytreateddisordersin contemporary Chinese medicine, and it is certainlyone thatevokes desperateanxietyon the partof its sufferers.Much of this anxiety is due to the "one child policy," which an Americanfriendof mine in South Chinahas bitterlydescribedas "the policy thatevery woman musthave one child." He was referring to the pressuresthat working women in China face to put motherhoodfirst while combininghouseholdmanagementwith wage-earningand, in some cases, career
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is required advancement.In manyadministrative jurisdictions,priorauthorization for plannedpregnancies;clearanceto reproduceis awardedon the basis of complex rules designed to give everybody their chance at one healthy child.' It is often strategicallynecessary to become pregnantwith split-second timing: birth control in this case actually means minute control of when there will be a birth, and "family planning" is no euphemism. of infertility, I will attemptto locate the subBefore turningto the treatment within traditionalmedicine as a whole. Textof women's medicine discipline books both argueanddemonstrate thatfu ke is basically the same as Chinese medicine's centraldiscipline of internalmedicine (nei ke), a body of knowledge and practicesthat concerns itself with all physiological and pathological processes. Until the very recententryof numbersof women into the professionof traditional who were known for skill infu ke seldom confined medicine, male practitioners theirworkto this area.Male doctorswho aredevelopingthe infantfield of "men's speciality" (nan ke) usually also have other specialties as well. Subdisciplinary institutionsof Chinese medidivisions tend to be very fluid in the contemporary cine. One textbookpoints out thatWesternmedical obstetricsand gynecology differ fromfu ke in that their origins are in surgery, a set of practices that never developed in premodernChina (ChengduCollege of TraditionalChinese Medicine 1985:1). This distinction is made in the context of a long critiqueof traditional Chinese medical approachesto childbirth,which are seen as endlessly reproducingerrorsfrom an early classic, with only a few worthwhileinsights scatthe historyof the field. Classical discussions of the disordersof teredthroughout "menstruation, discharges, and pregnancy," on the other hand, are said to have a morenoble historyby virtueof being partof the rich internalmedicinetradition. The 7th-centuryscholar Sun Simiao is often cited to the effect that "those who have prescriptionsfor women's distinctiveness(bie) take the differences of pregnancy, childbirth, and [internal]bursting injuries as their basis" (cited in is typical ChineseMedicine 1985:2). This remark ChengduCollege of Traditional of manydistinctionsmade in classical medicine:a small set of characteristic physiological and pathological processes rather than anatomical structures mark "women's distinctiveness" within the general run of medical concerns. These processestake theirplace alongsidea host of otherphysiological andpathological processes, all of them implicating each other in the functional relations of the in visceral systems. Sun's emphasison reproductivefunctionsremainsimportant fu ke; recently published texts focus on maintainingnormalmencontemporary struation,pregnancy,and childbirth,devoting almost no attentionto sexuality or menopause. Though there is a parallel interest in reproductivehealth for men within internalmedicine, until very recently no separatespecialty has been concernedwith such problems(Zhang 1990:i). It appearsthatfu ke as medical subdiscipline is clearly all about assuringthe wholesome productionof babies. The disordersof "women's distinctiveness" that it treatsare those that interferewith success. reproductive It would be a mistake, however, to infer from this bias of a traditionalmedical specialtythat "women," unlike "men," are uniquely significantas producers of babies. For both men and women, reproductivephysiology is stronglyassociatedwith the roots andorigins of many processes necessaryto normalhealth.
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Male and female seminal essence (jing)'2 and the congenitally endowed "source Qi" of both sexes are governed by the Kidney visceral system. (See Table 1 for a summary of the functions and characteristics of the five yin visceral systems of function.) 3 When an external heteropathy invades the body and initiates a pathological process, it most often affects the higher and more "outer" visceral systems first, especially the Lung system (which is hardly mentioned infu ke) and the SpleenStomach system. As an external pathology ramifies through the five linked visceral systems and the circulation tract system, it may eventually begin to affect Kidney system functions. This is a sign of a long-standing and deep-seated pathology, hard to cure and implying permanent damage. Pathological processes that extend to the Kidney system attack the seat of irreplaceable "source Qi." This form of Qi, which is necessary to healthful respiration and circulation, may be slowly depleted through sexual activity, menstruation, and childbirth. Women are advised to rest for a month after childbirth lest they incur skeletal injuries from premature activity, and a wide array of therapies are available to men who suffer from the serious symptoms of premature ejaculation or nocturnal emissions. Pathological attacks on the center of source Qi are thus very serious indeed. TABLE 1 Thefive visceral systems offunction. System Heart Acts on Blood Stores Manifestations Affiliated with Small intestine
Unfolds in vessels; Shen (vitality) manifestsin face; vents at tongue Unfolds in skin and body hair;regulates the "watercourse"; vents at nose Unfolds in flesh, four limbs; vents at mouth; manifestsin lips
Lung
Qi; breathing; clears away, carriesdownward transmissionand transformation; elevates clear fluids; in chargeof blood flow dispersion upwardand downward fluids; Bladder; marrow; accepts Qi Blood
Large intestine
Spleen
Stomach
Liver
Unfolds in sinews; vents at eyes; manifestsin nails Unfolds in bones, source Qi, "Blood reservoir";manifests in hair;vents at ear, genitals, anus
Gall bladder
Kidney
Jing (semen)
Urinarybladder
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It appears,then, thatChinese medicine, in placingthe reproductive functions for bothsexes at the terminusof a sequenceof increasinglyseriousvulnerabilities, a strongtelos of reproduction.A person with an impairedability to incorporates have a child is very ill indeed, at least in theory. Chinese medical knowledge has its long history been used in the service of continuing "Confucian" throughout lineages throughthe productionof children. In medicine reproductivefunctions are centralto healthjust as in social life having childrenis centralto selfhood.14 Genderdifference ("women's distinctiveness") appearsto count for medicine mainly with regardto problemsthat arise in one momentof a dual-genderedprocess of reproduction.
Textbook Knowledge about Infertility
Thereare a few main types of female infertility.Textbooksdiffer somewhat on theirnumber,some subdividing"Kidney Depletions" into two or three types and some lumpingall Kidney Depletions together. But the usual explanationsfor failure to conceive are quite standardand can be summarizedas six syndrome types (Table 2). Given the complexity of Chinese medical physiology, it is interestingthat infertilitysyndromesshould be so few. Practitioners,who are well aware of the manifoldways in which disorderin any one system can ramifyto all others, tend to explain the relative simplicity of short lists like this in terms of accumulated clinical experience. These are the "often seen" (changjian) syndromes, whose perceived redundancyover centuries of observationhas allowed them to be included in handbooksas lists which link typical symptoms (importantfor differentialdiagnosis)with recommendedtreatment principlesandeffective drugs. Clinicians are likely to considerthese syndromesfirst as explanationsfor the symptoms presentedby patients,but in practiceinfertilitycan have causes thatdeviate from such standardlists. Of the cases appendedhere, only one, #17, is a syndromemarkedlydifferentfrom those listed.15Infu ke, as in traditionalmedicine as a whole, syndromesare patternsof disorderratherthan fixed disease entities; the list of possible disorders is thus theoretically infinite, as the one exception remindsus. The standard list of infertilitysyndromesundoubtedlyarises from historical experienceof some kind, but certain featuresof these "often seen" syndromes are easily rememberedbecause they are reasonablein terms of normalphysiology. It appearsfrom the "illness mechanisms" summarizedin Table 2 that the irregularitymost proximate to symptomaticexpression is of the Highway and Conceptioncirculationtracts. These are tractsof the "extraordinary" (qijing batreatment of variousdisordersin both men and mai) class, usable for acupuncture women but especially crucial to female reproductivefunctions. In other words, thougha visceral system (Kidney, Spleen, Liver), a bodily substance(Qi, Blood, Jing), or a form of heteropathicQi (Phlegm, Damp, Heat) is held to be chiefly responsible("taken as the root," doctors would say), the Highway and Conception tracts"downstream"from such sources invariablymalfunctionand produce the characteristic and infertility. In keeping symptoms of irregularmenstruation with a strongdiagnosticbias towardmore systemic disorders(i.e., toward"seeking the root"), all drugs for regulatingthe Highway and Conception tracts are
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TABLE 2 Main causes and treatmentsof infertility. Illness Mechanism Body depletedand weak Kidney Qi inadequate Highway and Conception tractscannotcontrolJing to conceive Same as above Treatment Build up Spleen WarmKidney NourishBlood Regulatemenstrualperiods Nourish and replenish Liver and Kidney NourishBlood Regulatemenses Nourish Blood to harmonize with ConstructiveQi Supplement and replenish Liver and Kidney
Syndrome Type Spleen and Kidney yang depletion
Liverand Kidney yin depletion
Blood depletion
Withering or hemorrhage of blood induces vacuity, Depletion of Highway and Conception tracts, which cannot controlJing to conceive
PhlegmDamp
Obese constitutionor indulg- Transform Phlegm and dry up ence in fatty and sticky Damp Build up Spleen to regulate foods produces Phlegm menses Damp internallyso that Qi mechanisms don't flow smoothly, Highway and Conception tracts develop obstructions and produceinfertility. Negative feelings lead to tensing and knotting in Liver system Qi and Blood go out of synch Highway and Conception tractslose regularity Conceptionis affected. Damp Heat accumulates and obstructs the lower processing locus, so the Qi and Blood of the Uterus channels are blocked in their flow, inducinginfertility Relax Liverto resolve oppression and clear out sluggishness
Liver oppression
DampHeat
ClearHeat and drainDamp Relax Liver to open tracts
Source: ShanghaiCollege of TraditionalChinese Medicine (1983:164-167).
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specifics for one or anothervisceral system and act on the Qi-Blood relationship. Their efficacy on the tracts of the reproductivesystem is not mentioned in the materiaemedicaeexcept in termsof theirresults, regulationof menstrual periods. All six infertility syndromes are characterizedby irregularor absent menstruation.The importanceaccordedto regulatingmenstrualperiods in curing infertilityis evident in the treatmentprincipleslisted: three specify menstrualregulationandthe otherthreeimply it in theiremphasison eliminatingblockages and Qi and Blood. In publishedcases like the two sluggishnessand on reharmonizing of regular discussedbelow, pregnancyoften follows quickly upon the attainment monthlyperiods. Medical textbooks are organized to make symptom complexes associated with each of the syndromes listed in Table 2 easy to find. In fu ke, menstrual are focused on most attentively;not only the timing but also the volirregularities ume, color, consistency, and odor of menstrualflow are carefully noted. The patient is relied upon to reportthese symptomsaccurately,along with a great many manifestations that are more widely significant within traditional medicine: moods, digestion, elimination functions, sleep patterns, aches and pains, local swellings, fevers or unusualfeelings of cold, and degree of interestin sex. The only symptomsthatcan be correctlyperceived by doctors exclusively are alterations in the pulse andqualityandappearance of the tongue. These technicalsymptoms are very importantbut seldom meaningfulapartfrom their relationshipto reportedsymptoms. schools of Syndromedifferentiation,at least as it is taughtin contemporary Chinese medicine, proceeds from these symptoms, classifying them with ever morerefinedmodes of analysis until many closely relatedpossibilities have been eliminatedand one useful characterization has been achieved. To illustratethis process with an overly simple example of just one symptom, a large volume of brightred menstrualblood indicatespathologicalHeat arising from a state of repletion;small amountsof brightred blood suggest pathologicalHeat due to a depletion. Repletion and depletion refer less to the physical amountof blood than to complex dysfunctionsof the visceral systems. Afterthese generalruleshave been combinedwith analyseswhich targetspecific visceral systems and spatiotemporal sectors of the body,16the information can be used to design an intervention.For example, once it has been determined thatthe problemis one of depletionof Cold of an internalsector, no drugs which eitherfurther chill or deplete (e.g., throughdraining)the affectedvisceral systems will be chosen. The syndromenames in column one of Table 2 suggest the various dimensions focused on in conventionaldiagnosis. Of the cases in the Appendix, six (1, 6, 7, 10, 11, and 18) areclear cases of Spleen and Kidney Yang Depletion. Cases 2, 4, 12, 13, and 15 are simultaneousdepletions of Kidney and Liver. Cases 3, 5, and 9 are simply seen as Kidney Depletion. Three of the 19 cases (8, 14, 19) are analyzedin Qi-Blood termsand would requirea close readingof the prescriptions used to determine what visceral systems were primarilytreated, though Spleen and Liver systems are the usual targetsof such therapy. And in addition to the exception to all rules mentionedabove (Case 17), Case 16 focuses rather on the Highway and Conceptiontractsthemselves, naming no unconventionally more systemic root to the disorder.17
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Severalgeneralobservationscan be made on the basis of this review of textbook knowledge and publishedcases. First, doctors' own explanationsof illness etiology are consistent with textbook generalizations, though they may depart fromthemwhen concretesymptomswarrant.This is truenot only in formaltexts, such as publishedcases, but also in the explanationsdoctorshave providedto me aboutcases I have observed in clinics. Second, these explanationsfocus on disordered processes which ramifythroughthe whole body. They do not localize the disorderwithinthe body, ratherthey distinguishit from otherpossible patternsof pathologicalprocess affecting the whole body. Even the notion of depletion, an translationof the Chinese word xu, refers not so much to inadequate inadequate amountsof substanceas it does to weakenedforces of bodily flow. Wherehealthy processesflag or transgressusual limits, substanceswill not be producedwith the propertiming and in the propervolume. The diagnosis and regulationof menstrualdisorders(and the closely relatedcondition of infertility)infu ke thus typifies the relationsbetween processes and objects in Chinese medicine. Two Cases of Infertility in Women Of the 19 cases appendedhere, cases 2 and 7 aretranslated in full for a closer reading;in what follows 1 will refer to them ratherthan paraphrase.In the view of Chinese doctors, Case 2 is useful mainly to make a very clear point: a chronically ill woman is diagnosed in a Westernmedicine clinic to be infertilebecause of obstructedfallopian tubes. An experienceddoctor of Chinese medicine, perceiving long-standingfunctional disordersof many systems, ignores the reproductive organs per se. Instead he restores strengthand regularityto functional systems which are more basic than any specific abnormalitiesof reproductive function. As a result, a healthierpatient is able to conceive and bear a healthy child. In the published case, the fallopian tubes and whatever was obstructing them are apparently irrelevantto the case. The narrativeof this case takes a familiar form for contemporaryChinese medicalcase histories. It notes the anatomicallyfounded "diagnosis" of Western medicine, then demonstratesthe superiorityof Chinese medical "dynamic and holistic" methods of analysis with the considerablepolemic force of an actual cureand, in this case, a healthybaby. The discretetransplantable objectsof Western medicine, characterizedwith such loving care in pathological anatomy and perceived at the cost of such expensive imaging technology, are seen as mere productsof powerfulprocesses that govern the life of the body. I can make this point clearerby explicatingthe treatmentprinciplesused in this case. They fall into three categories. First, with respect to visceral systems, the planis to "warmthe Kidney system and nourishthe Liver system." The Kidney system tends towardbeing "Cold" (i.e., more yin than yang), and this patient's symptomsare stronglysuggestive of a state of chronicInteriorCold. Conceptionand fetal developmentrely upon a balanceof yin and yang in the Kidney system; thereforedrugs which "Warm" or "yang" the Kidney will tend to restorethis system to normal. Turningto the Liver system aspect of Case 2, we should note that the relationshipof the Liver system to conception and pregnancyhas to do both with its Blood storagefunction and with its characteristic activity of Qi dispersion. With
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respectto Blood, the most generalclassical principlegoverningconceptionis that "[male] Semen and [female] Blood join to become [fetal] form." For women, Blood supply to the Highway tract(also called the Blood resthen, an inadequate ervoir, of which more below) because of reduced Liver function renders menstruation scant and infrequentand conception unlikely. If the Qi dispersionfunctions of the Liver system become disordered,there are immediateconsequences for Blood flow, since Qi drives Blood. Menstrualirregularities are thereforealmost as often blamedon Qi disordersas on Blood. Mrs. Sun, the patient, may grasp almost nothing about the activities of the Kidneyand Liver visceral systems, or she may be the sortof sophisticatedpatient who has elaborateand well-informedideas on the subject. But given her symptoms of cold and weakness, pain and scant menstrualflow, it seems likely that she would see the sense of a therapyidentifiedas "warming" and "nourishing." The Kidney and Liver each "rule" (zhu)'8complex systems of functionand usually are seen to have priorityover the functionsof the circulationtracts. Thus thoughthe Highway and Conceptiontractsare often implicatedin menstrualdysare functionandinfertility,their "regulationandreplenishment"in this treatment mentionedafter the more basic treatmentof visceral systems. Though they have other functions, both tracts are crucial to reproduction.The Highway tract, or Blood reservoir,fills and drainsmonthly, supplyingregularmenstrualflow. The Conceptiontractcontrols this periodicity, and its flow (of Qi, presumably)must be smooth and even. Thus both tractsdepend especially on the Liver system as not only a sourceof Blood but also a primaryagent in the dispersionof Qi through of the yin-yang the tractsystem. The two tractsalso have a close interdependency type: the Conception tract plays the role of "active" yang Qi to the Highway tract's "structive" yin Blood. ' They must be "regulated and replenished" together. The chief means of doing so in this prescriptionis to foster Liver system functions. The thirddimensionof interventionin this case directlyaddressesBlood and Qi, the closely interdependent yin-yang couple that crosscuts both visceral systems and circulationtractfunctions. In other words, the yin-yang relationshipof Blood and Qi (Qi drives Blood while dependingon Blood as its fluid medium) is the most generaldynamic of the body, the fluid and mobile resourceof all body substanceandactivity. The symptomsreportedin Case 2 betraydepletionsof both Qi andBlood andgive a clearpictureof Blood stasis, a conditionthatoften results from simultaneousQi and Blood depletions. Because Qi drives Blood, Blood stasis is often treatedby stimulatingQi movement. In this case, four of the 15 eitherreplenishor regulateQi, and four of them enliven drugsin the prescription or replenish Blood (see Table 3). Treatmentdirected at the Liver system will eventuallyaddressproblemsof Blood stasis as the Qi dispersionfunctionsof the
Liver improve.
Few patientsknow much about the functionalroles of the herbalmedicines includedin theirprescriptions.But they have little difficulty in correlatingsomeand general thingcalled "Blood stasis" with symptomsof menstrualirregularity coldness and weakness. Most people also know that in Chinese medicine Qi drives Blood; patientscan see the logic of remedyinga condition manifestingin Blood inadequacywith a methodthatsimultaneouslyregulatesQi. With the doctor, they can feel thathe is "seeking the root."
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MEDICAL ANTHROPOLOGY QUARTERLY
TABLE 3 of Analysis prescriptionfor case 2. Treatment Principlesa Enliven Blood, expel stasis Regulate Qi to stop pain
Drug name Foxglove Dodderseed Deer horn glue Placenta
Tracts affected Liver Kidney Liver Kidney Liver Kidney Lung Liver Kidney Heart Liver Spleen Liver Stomach Heart Liver Liver Kidney Liver Liver Gall Bladder Heart Liver Spleen Liver Kidney Large Intestine Spleen Lung
Warm Kidney X X
Nourish Liver X
x
X X
Angelica
Sweetgum fruit Jiazhu Sage Epimedium Nut-grass Hare'sear root Frankincense
X (not found in materiamedica)
x x x x x
Myrrh Broomrape
Ginseng
"Treatment principlesare specified in the publishedcase. No drugs were specific for "regulatingand replenishingthe Highway and Conceptiontracts."
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The therapyfor Case 2, then, is very broad. No effort is made to isolate the single most crucial system or substance, least of all something as trivial as tube blockage. Instead,every aspectof Sun's chronicillness is addressedat once, with In a sense, a reproduca strongemphasison drugsthat strengthenand nourish.20 tive anatomythat is capable of conceiving and bringing a pregnancyto term is built almost ab initio by replenishing the productive functions of three crosscutting bodily processes (visceral systems of function, circulation tracts, and Blood andQi).2' This is not to say thatthe relevantstructures,such as the ovaries, tubes, and uterus,are denied;they are simply local and contingentphenomenain a medicine in which fetuses are conceived and nurtured by global (i.e., wholebody) processes. Case 7 appearsto be a good deal more complicated,even thoughthe patient, herself a doctor, presentsmuch less evidence of chronic illness than had Sun. In this case Luo Yuankai'seditors have helpfully provideda syndromedifferentiation (i.e., a Chinese medical diagnosis) of "Spleen and Kidney systems both depleted, accompaniedby Liver system Qi stasis." This is a combinationof two of the categorieslisted in Table 2 and yields eventually to the standardstrategyreferredto in the commentary attachedto the publishedcase: "This makesthe menstrualperiodshave a regulartiming-then it's easy to become pregnant." The case narrative makesthe usualpolemic point:the patienthadlong sought a cure for her infertilityfrom institutionsof Western medicine but without success. Their final gesture was to performan invasive procedureunimaginatively focused on one partof one organ (a biopsy of endometrialtissue) which enabled them to diagnose only a very subtle dysfunction. Luo's editors wish us to note that he saw the problemin diametricallyopposed terms:by readingthe manifest signs of the illness, he analyzedfunctionaldebility in three of the five majorvisceral systems governing the health of the whole body. His herbal prescription reflectsthis wide-ranginganalysis (Table4). Since he was able to producefirst a and then a pregnancyin less thana year, his significantalterationin menstruation readingof the problem(the case reportsuggests) was vindicatedin practice. Case 7 is one of those interestingChinese medical documents in which the whole sequenceof the clinical encounteris indicated.Luo saw this patientover a periodof more than a year; he not only recordedher changing symptoms during this time but also his tinkeringswith the prescription,down to the amountof each drug in each formula. Though four prescriptionsare recorded, there are in fact only three formulaeinvolved, and all are variationsof one masterformula. The fourthprescriptionis an exact duplicate of the first, which (the wording of the treatmentprinciple notwithstanding)takes replenishing and nourishing Kidney and Liver functions to be primaryand invigoratingSpleen functions to be secondary.The deviationsfrom this masterformulain the second and thirdprescriptions emphasize invigoratingSpleen function;this is interpretable as a response to the fact thatKidney and Liver symptomscleared up sooner than Spleen symptoms did. Once the various symptomshad been broughtundercontrol and menstrualperiodswere beginningto regularize(fourthexamination),Luo was able to returnto his original prescription.Apparentlythe patient's condition had progressed satisfactorilythroughout,and no serious revision of the initial syndrome differentiation was required.
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TABLE 4 Actions ofprecriptionsfor case 7. Treatment Principlesa Replenish Kidney X X Build Spleen Relax Liver to resolve oppression X X
Drug Name Dodderseed Cherokeerose
Tracts Affected Kidney, Liver Kidney, Urinary Bladder,Large Intestine Kidney, Liver Spleen, Lung Kidney, Liver Heart, Liver, Spleen Kidney, Liver Liver Liver, Gall Bladder, Pericardium
Cornbind Dangshen Matrimony vine Angelica Raspberry Nut-grass Lovage
X X X X X
X X X
X X
aTreatment principlesare specified in the publishedcase. The fact that no pelvic examination was considered necessary until a cure had almost certainly been achieved, and then only to confirm pregnancy, is interesting. This form of case management invites us to conceive of Chinese medical diagnosis as a different mode of apprehending illness from that which has characterized Western medicine. What are Luo (and possibly Rao, his patient) imagining on the basis of the phenomena they observe and record? Given that most of the pertinent phenomena are aspects of the illness's "history" (i.e., the patient's perceptions of events prior to her clinic visit, collected in the course of the "asking" examination), it appears that an illness process is more centrally at issue than a stable disease lesion or local functional defect. The field in which such manifestations of illness process are significant is not so much a body, seen as a stable structure that can suffer from "substandard glandular secretion," as it is a lived life of irregular periods, lower back pain, cold extremities, etc. In Luo's approach to the illness, the diachrony of symptom history almost completely overwhelms the synchrony of an internal bodily defect, and the patient's knowledge of her symptoms outweighs the results of the endometrial biopsy in diagnostic importance. The fu ke conceptualization of illness is not idealistic. All the symptoms noted, including those derived from examinations performed in the clinic (primarily pulse and tongue images) are quite concrete and material. But they do not lead to the perception of an abnormal bodily structure. Consider the symptoms listed in Case 2:
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tendto be delayed,volumeof flow Menarche was at age 15, menstrual periods bloodclots. Between herbodyis cold, smallandcolorpale,containing periods lowerbackpainandweaklegs, painandswelling[of] lowerabdomen, large her mentalstate is exvolumeof discharge.Breastsswell premenstrually, in sex. Urination andhas littleinterest clearand she lacksstrength, hausted, fecesnotfirm. prolonged, These symptoms reportedby the patient are supplementedby pulse and tongue test imagesobservedby the doctorand, in this case, by the resultsof a laboratory from anotherclinic. Togetherthey form a patternof disorderin which no single phenomenonis significantin itself. For the doctor all the symptomstogetherbetraya pathologicalprocess with a trajectoryand key points at which intervention will be efficacious. He understands the normalactivities and standard pathologies of visceral systems, circulationtracts, and body substances(Blood and Qi) and thinksaboutthis illness historyin those terms. For the patientthe process in question perhapsnever departsfar from the vicissitudes of her general debility and in her failure to conceive. Chinese medical analysis, continuingdisappointment however, by findingthe significanceof her symptomsin a temporaldimension, a weakenedprocess ratherthanan invisible structural defect, may resonatewith the No lived of wonder the confidenceof these doctors patient's experience debility.22 is not shakenwhen it takes monthsor years to bring about a majorchange in the patient's condition: where therapy seeks to influence naturaltrajectoriesof the whole body so that a reliable continuationof general health and strengthcan be achieved, a certainamountof time is required.As both patients and doctors of Chinesemedicineconstantlypoint out, traditional medicine is slow but thorough. Conclusion In this reflectionon two publishedcases I have devoted considerablespace to a mode of medical analysis that is difficult to understandand foreign to our "Western"common sense, while pointingout that it may have important continuities with the experience of Chinese patients. If we fail to come to terms with these complex analytics, field observationsof the type included at the beginning of this articlecan only be misleading.In Chinesemedicine, the illness experiences women confide in the clinic are the basic ingredientsfrom which a treatablesyndromebecomes perceptible.Both doctor and patientwork in the mediumof time and experience, attendingto the objective manifestationsof disease as signs of a process. Seated not opposite from each other, but differentlyorientedaroundthe corer of the table, they can bringtheirdifferingexpertiseto bear on one illness. There may be struggles over many things in this relationship(e.g., the expense of the drugs, the timing of returnvisits, the need for a work excuse or a hospital stay), but there does not seem to be much disagreementover the natureof the illness. One could arguethat Westernmedical thinkinghas traditionallybeen most clear when anatomicalobjects and intellectualobjects are the same thing. An obstructionof the fallopian tubes, for example, is an explanation for a failure to conceive which posits both a thing with a structureand a notion that can rationalize eitheran interventionor a practicaldecision not to intervene. Chinese medical thinkingis not naturallymurky,it just gets thatway when one attemptsto fill
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its intellectualobjects (patternsof pathological function) with anatomicalcontent.23 This kindof translation is a shift of a particularly sweeping kind, an attempt to translate the diachronicinto the synchronicand processes into structures. Othershave made this point before aboutChinese medicine (Porkert1974), but our commonsensecommitmentto a materialismwhich must reducephenomena to synchronicallyobservablecollections of objects is difficult to overcome. The visceralsystems of functionwhich organizeso muchof Chinese medical perception need not be thoughtof as primitiveanatomy, with the Kidney organs as the "materialsubstrate"of (immaterial?)reproductivefunctions.24Ratherit is signs and symptoms, experiences and perceptions, which are the materialfoundationof medical perception.They are not less concretethananatomicalorgans, but they are not conceivable outside of lived time. The materialityof the synchronicbody, its contentsand its boundaries,can be unproblematic as long as we acknowledgethat these things are trivial from the point of view of diachronic Chinesemedical analysis. Many attemptsto demystify Chinese medicine have founderedon this particularconfusion, I think. Translators have failed to distinguishbetween the realities of space, which are most powerfullyapprehended throughvision and depiction, and the equally concrete realities of time, which must be remembered,inscribed, and embodied. In popularworks on Chinese medicine we have seen too of Chinese medicalknowledge into a failed anatomyor a vague manytranslations and over-general"holism." To give both Chinese medicine and Westernmedicine theirdue requiresfiner discriminations of the specific relationsbetween objects and processes, productsand relations of production, spatial and temporal materialities. To conclude with a question that has motivatedsome of this discussion:are women made to feel like objects in Chinese medicine? Are they alienated from theirown experiencein clinical practice?ThoughI have talkedwith some Chinese women aboutthis, I cannotclaim to know how they "really" feel when they visit doctors of traditional medicine. The evidence here suggests, however, that Chinesemedicineaccordsa certainimportance to quotidianself-perception; while never denying the object-nature of bodies, it privileges processes of change that takeplace in personaltime, which can only be enteredinto medicalconsideration via the patient'sown narrative. All this has takenus far from Chinese medical gynecology and infertilityas specific topics. Let me close then, with an observationmade some time ago by Jack Potteron the basis of his fieldworkin the New Territoriesof Hong Kong: "When a woman conceives a child, a heavenly flower is planted in one of the smallgardens,anda seed is sent down fromHeaven into the uterusof the woman. The villagers liken the uterus to a flower that begins to enlarge and open after conception"(Potter1974:214). Reportedas a quaintfolk belief, this image of the fragile, contingent,and short-livedwomb has long fascinatedme. As metaphor, it sums up in the relationshipof flowers to seeds (zi, the same word as for sons), the most general yin-yang of reproduction.Families are a temporalcontinuity foundednot on the permanenceof any one thing or personbut on a well-nurtured generativityand a wholesome alternationof potential and actual. Where reproducing endows life with much of its meaning, especially for women (as Potter's othermaterialsuggests), the bodily things neededto have a child come into being
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only as a resultof the reproductive process itself. Whateverthe official attitudeof existence of modem Chinese doctors might be towardthe independentstructural internal organs, such as the uterus,in theirway of analyzingandtreatingwomen's illnesses they can be agnosticon the subjectof anatomy.Doctors and theirclients can focus together on manifestationsof disturbedprocesses, supplementingor relaxing, dissolving or draining,to build a physiology that can have a child. Appendix The 19 cases summarizedbelow are drawnfrom four collections of clinical cases publishedin the Peoples Republic of China between 1980 and 1987. Two of these volumes collect the cases of well-known senior doctors and two are devoted tofu ke cases. I used my own collection of case anthologies (20 volumes, most published in the 1980s) and simply chose every case of infertility for this analysis. Cases 1, 3-6, and 8-19 are summarizedbelow with a brief list of key charin full.25Certaintechnicalterms(e.g., for acteristics;Cases 2 and 7 are translated pulse qualities)have been renderedfollowing Sivin (1987) and capitalized. Syndromenames are also capitalized.
Case 1
Sourco:He and Liu (1987:166). WangX X, F-29. Marriedsix years withouta pregnancy.Uterusabnormally small, delayed menses, volume of menstrualblood small, color pale. Abdominal pain during menses, excessive discharge, lower-back pain. Poor appetite, cold extremities,clear and excessive urination,loose stools. Facial color dark, tongue pale with sticky white coating, pulse Subtle and Small. Syndrome:Spleen and Kidney Yang Depletion with downwardconcentration of Cold-Damp, infertilitydue to UterineCold. Therapeutic principlenot stated. After about three months of treatmentthere was a normal pregnancy and delivery.
Case 2
Source: He and Liu (1987:166-167). Sun X X, F-31. ExaminedDecember4, 1980. Menarchewas at age 15, menstrualperiods tend to be delayed, volume of flow small and color pale, containing blood clots. Between periods her body is cold, lower backpain and weak legs, pain and swelling on both sides of the lower abdomen, large volume of discharge. Breasts swell premenstrually,her mental stateis exhausted, she lacks strengthand has little interestin sex. Urinationclear and prolonged, feces not firm. Tongue pale with thin coating, pulse Sunken and Small. Marriedeight years without a pregnancy. In 1978 at anotherhospital iodized oil radiography (iodolography)was done of the uterusand fallopian tubes andthe reportwas: "obstructionof both Fallopiantubes." Therapeutic plan is to warmthe Kidney visceral system and nourishthe Liver visceral system, regulate and replenish the Highway and Conception tracts, enliven Blood to eliminate stasis, regulateQi to stop the pain.
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ginseng, 6 gm; Chinese foxglove (steam-dried),30 gm; dodder Prescription: seed, 15 gm; deer horn glue, 10 gm (scalded);humanplacenta, 10 gm (scalded); Chineseangelica, 10 gm; Chinese sweetgum fruit, 10 gm; roastedjiazhu, 10 gm; red-rooted sage, 10 gm; epimedium, 10 gm; nut-grass, 10 gm; hare's ear root, 10 gm; frankincense,10 gm; myrrh, 10 gm; broomrape,10 gm. After 18 doses of this prescriptionhad been administered,all the various symptomshad improved.The prescriptionwas made up into pills, each dose 10 gm; two doses daily. After it had been taken for three months, she got pregnant. Pregnancyand delivery normal;motherand child both well. Case 3 Source: He and Liu (1987:167). Guo X X, F-32. Constitutionweak, spirits low, vertigo. Irregular menses, volumeof menstrual blood small andcolor pale. Dizziness andringingin the ears, severe lower back pain, abdominalpain. Tongue pale with fine coating, pulse Sunkenand Weak. Has been married10 years withouta pregnancy. Syndrome:Kidney Qi Depleted and Weak, Highway and ConceptionTracts Irregular. principle:bolsterKidney Qi and regulatethe Highway andConTherapeutic ceptiontracts. Treatment period50 weeks, whereuponpatientbecame pregnant. Case 4 Source: He and Liu (1987:167). Sun X X, F-32. Marriedeight years withouta pregnancy.Delayed menses, blood small;color pale, consistencythin. Vertigo, heartpalvolumeof menstrual color facial greenishwhite. Diagnosedat a Westernmedicalhospitalas pitations, congenitalinfertilitydue to nonovulation.Pulse Sunken and Small, tongue pale with white coating. No syndromeor treatmentprinciplestated, probablyKidney and Liver Depletion. Menstruation regularizedaftereight treatments.Pregnancyoccurredafter 12 carriedto term, normaldelivery. treatments, Case 5 Source: He and Liu (1987:167-168). Zhang X X, F-29. Chronic menstrualpain. Marriedeight years without a pregnancy.Delayed menses, volume of blood small and color pale, intense menstrualpain which can be lessened with heat and massage. Facial color greenish white. Discharge yellow. Lips pale. Vertigo. Skin and flesh dry and flaccid. Lower back pain and generalizedweakness, little interestin sex. Urinationclear and prolonged, stools loose. Tongue coating sticky white, pulse Small and Retarded.Patienthas been treatedwith both Chinese andWesternmedicine without obvious improvement. Syndrome:Kidney Depletion brought on by Lack of Nourishmentto the Highwayand ConceptionTracts.
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Treatment principle:Strengthenyang to warmthe Uterus. Treatment period three months, pregnancyoccurredbefore treatmentcomplete. Normalpregnancyand delivery. Case 6 Source: GuangzhouCollege of TraditionalChinese Medicine, Gynecology and ObstetricsResearchand TrainingSection (1980:217-218). Hu X X, F-31, factory medical services worker. Marriedsix years without a pregnancy.Menses slightly irregular,color light red, volume normal. Western medicaltests reporthormonalinsufficiencybut unobstructed fallopiantubes. Last threeyears patienthas suffered from lower back pain, dizziness, weakness, and hairloss, chills, andinsomnia. Urination poorappetite; recentlyhas hadabnormal anddefecationnormal, facial color greenish white, lips pale, tongue mottled and swollen with white coating, pulse Sunkenand Small. Syndrome:Spleen and Kidney Yang Depletion. Treatment Principle:warmKidney, invigorateSpleen, bolster Blood. Treatmentperiod 14 months showing steady improvement,followed by a normalpregnancy. Case 7 Source: GuangzhouCollege of TraditionalChinese Medicine, Gynecology and ObstetricsResearchand TrainingSection (1980:218-220). Rao X X, F-36, a physician, firstexamined April 15, 1978. Patientmarriedand living together [with her husband]more than five years but still has no children. Husbandhas been examined and is normal. Patienthas undergonea thoroughexaminationand is largely normal;she has sought out doctors in four places, still withoutthe desired result. At the beginningof this year, at another hospitalin Guangzhou,she had an endometrial biopsy (threehoursafter onset of menses), and the pathology report was "during endometrialsecretion period, substandard glandularsecretion." Menarcheat 15 years, periodsapproximatelymonthly. But from the time of her marriagein 1973 the onset and length of her periods has not been predictable,onset being frequentlydelayed, sometimes having only one period in two or three months;volume of menstrualflow is small, even to the extent that [the period will amountto] one day of spotting then be clear;color darkred;breastsswell premenstrually. She has used artificial means to induce periods several months, which were effective when used, but afterceasing this medicationthe situationwas as before. Frequentdizziness, fatigue andlassitude,markedpain in the lower back, urinationclear andprolonged, cold extremities, normaldigestion, somewhat excessive white discharge. Facial color darkishyellow, with blackheads,tongue pale and spotted with white coating, pulse Sunkenand Small, Weak at the foot sections. [Westernmedical]diagnosis: (1) delayed periods with small volume, (2) infertility(buyunzheng). [Chinese medical] syndrome differentiation:Spleen and Kidney systems both depleted, accompaniedby Liver system Qi stasis. Treatment principle:primarilyreplenishKidney and strengthenSpleen, secondarilyrelax Liver to resolve Qi stasis.
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dodder seed, 25 gm; Chinese raspberry,10 gm; Chinese maPrescription: trimony-vine(fruit), 15 gm; Cherokeerose (fruit), 25 gm; Chinese angelica, 12 gm; Sichuan lovage, 6 gm; Chinese cornbind, 25 gm; dangshen, 20 gm; nutgrass, 10 gm. Take once a day. Second examination, April 26: After administeringthe above prescription with some modificationsmore than 10 times, the lower back pain had lessened but the othersymptomswere as before. Prescription:dodder seed, 25 gm; epimedium, 10 gm; dangshen 20 gm; baishu, 15 gm; millettia, 30 gm; Chinese angelica, 6 gm; nut-grass, 10 gm. Take once a day. commenced Thirdexamination,May 3: After this medicationmenstruation withoutswollen breasts;spiritsmarkedlyimprovedfrom before. Continueto use [principlesof] replenishingKidney, strengthening Spleen, and nourishingBlood to treatthe condition. dodderseed, 25 gm; epimedium, 10 gm; Sichuanteasel, 20 gm; Prescription: chain fern, 20 gm; dangshen, 20 gm; baishu, 15 gm; Chinese cornbind, 30 gm; Chineseangelica, 10 gm. Fourthexamination,June 25: returned to the hospital to informus that, takthe above after her meals, ing prescription periodshad become more regular,the last one having startedon June 23 and cleared afterone day, the volume being a bit more than before; dizziness and back pain improved, extremities warmer, digestionokay; tongue pink with white coating, pulse Small and Sunken. dodderseed, 25 gm; Chinese raspberry,10 gm; dangshen, 20 Prescription: gm; Chinese matrimony-vine (fruit), 15 gm; Cherokee rose (fruit), 25 gm; Chinese cornbind,25 gm; Sichuan lovage, 6 gm; Chinese angelica, 12 gm; nutgrass, 10 gm. Advised to take fourdoses each monthafterthe periodclears, reusing the sediment. Returnfor a check-up aftertwo or three monthsof use. Fifth examination, September23: Having taken the above prescriptionaccordingto our advice, all the varioussymptomsappearedto be improved,timing of menstrual periodsnormal, [one having]begun on July 23 and lasted fourdays, with increasedvolume. Afterthis periodshe continuedto take the above prescription in the same manneruntil August 20. Now there has been no period for two months. She is dizzy and nauseous, digestion is not good, there is fatigue, and a urinetest for pregnancyin her home unit was positive. Tongue pink with white, slightly oily coating, pulse Sunken, Small, and Smooth. Externalgenitaliaandvagina normal,cervix soft with Physicalexamination: changedcolor [Chadwick'ssign?], uterustilted forwardand soft, enlargedconsistentwith second monthof pregnancy,bilateralattachments normal,diagnosed is to replenishKidney, strengthenSpleen, and staas earlypregnancy.Treatment bilize the fetus; plan is to use Fetal Longevity Pills and modifiedFour LordsDecoction. At this writing patient has been pregnant six months. [Editor: Zhang Baozhen]
Case 8
Source:GuangzhouCollege of TraditionalChinese Medicine (1980:220-222). Li X X, F-29, worker. Marriedthree years without a pregnancy,diagnosed at a Westernmedical clinic with "congenital uterineinsufficiency." Since onset
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of menses at age 15 has sufferedfrom premenstrual abdominalswelling, as well as nausea, cold sweats, dizziness, cold extremities, and severe abdominalpain duringmenstruation.After a therapeuticdilation and curettagetwo months ago her periods regularizedsomewhat. Tongue dark red with fine yellowish-white coating, pulse Strung, Small, and Rapid. Syndrome:Blood Stasis with Qi Congestion Therapeutic Principle:enliven Blood to transformstasis, mobilize Qi. for six months. Pregnancyachieved ten months after Treatmentinterrupted firstclinic visit, two months after resumptionof treatment.Carriedto term with normaldelivery. Commentary (by Zhang Baozhen) on Cases 6, 7, and 8: Althoughthe basic cause in the above listed few cases of infertility disordersis Kidney Depletion such that it cannot controlJing (seminal essence) and produce a pregnancy, the "branch"illnesses are differentin each case; if the branchillnesses are not eliminatedit is difficult to settle on the root. . . . Case [7] was one in which Spleen and Kidney were both depleted, along with premenstrualtension disorders of Liver system Qi stasis, so it was appropriateto take replenishing Kidney and strengthening Spleen as the main [therapeutic principles],secondarilyrelaxingthe Liver to resolve Qi stasis; when Liver Qi ramifiesoutwardwholesomely [tiaoda] Blood and Qi are harmoniouslyregulated, and when Kidney, Spleen, and Liver are all properlysynchronized, this makes the menstrualperiods have a regular timing-then it's easy to become pregnant. . . . When Chinese medicine treats illnesses it alwaysemphasizescombiningillness differentiation and syndromedifthus it can get immediateresults. [Editor:Zhang Boazhen] ferentiation; Case 9 Source: GuangzhouCollege of TraditionalChinese Medicine (1980:222-224). He X X, F-29, worker. Married3/2 years without a pregnancy. Irregular menses, menstrualpain, volume of blood normal, dizziness and lower back pain when fatigued, little interestin sex, light sleep with frequentdreams. Diagnosed at anotherhospital as "immatureuterus." A recent test reported"proliferation of endometrialtissue." Body weak and wasted, facial color darkyellow, tongue pink with normalcoating, pulse Sunkenand Small. Syndrome:Insufficiencyof "PriorHeaven' Kidney Qi, Depleted Highway and ConceptionTracts. TreatmentPrinciple:moisten and bolster Kidney Qi, invigorate Spleen to regulateBlood and menstruation. Afterfive monthsof treatment,patientbecamepregnant anddelivereda baby girl normally. Case 10 Source: GuangzhouCollege of TraditionalChinese Medicine (1980:224-225). WangX X, F-32, doctor. Marriedmorethanfouryears withouta pregnancy. Delayed menses, variable volume of blood, abdominalswelling and pain, and lower back pain during menstruation.Pelvic examinationnormal. Tongue has small red lesions and little coating, pulse is Sunken and Small. menstruation. Syndrome:Infertilitydue to irregular
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Treatment principle:bolster Kidney, nourishBlood, mobilize Qi and regulate menstruation. Treatment period: 10 months, whereupontherewas a normalpregnancyand deliveryof a baby girl. Case 11 Source: Wang (1986:215-216). morethanten years Zeng X X, F-36. Teacherat SichuanUniversity.Married withouta pregnancy.Diagnosed at anotherhospital as "blocked fallopiantubes, one side has an accumulationof fluid due to inflammation."Obese, spirits low, lower back pain and ringing in ears, cold extremities, feelings of congestion in chest, swollen breasts,poor appetiteanddiarrhea,dischargeclear andthin in consistency, menstrualperiods very irregular,blood scanty and discolored. Pulse Sunkenand Weak, tongue pale with moist and slipperycoating. Syndrome:Spleen and Kidney Yang Depleted Treatment principle:warmKidney andstimulateSpleen transformation, regulatethe Highway tractand transformDamp to drive out local stasis. Treatment periodfive months, followed by pregnancyresultingin birthof 8poundbaby. Case 12
Source. Wang (1986:216-217).
DuanX X, F-42. Design technician. Married17 years withouta pregnancy. Volume of menstrualblood small, discharge yellow and foul-smelling. Diagnosed at another hospital as "endometrial inflammation, fallopian tubes blocked." Surgeryfailed to open tubes effectively. Has chest pain and insomnia, dizziness and ringing in ears, sweaty palms, low-grade fever in afternoon, thin and weak body, dry throatand bittertaste in mouth, constipation.Pulse Strung, Small, and Rapid. Tongue red with dry yellow coating. Syndrome:Liver and Kidney Yin Depleted. Treatment principle:drive out stasis. Treatmentperiod:six months, followed by normalpregnancyand delivery of a 7 /2 poundbaby.
Case 13
Source: Wang (1986:217-218). Feng X X, F-32. Military. Marriedfive years without a pregnancy. Diagnosed at anotherhospitalas blockedfallopiantubes. Dizziness andringingin ears, sweaty palms, low fever and periodic sweating, excessive sexual desire, and irritability.Headachesandinsomnia,feelings of chest congestion andpain in sides, bittertaste in mouth, dry throat, constipation, irregularmenstruation with small volume of blood. Pulse Strungand Rapid, tongue red and withoutcoating. Syndrome:Yin Depletion with Yang Excess. Treatment principle:regulateLiver and moisten Kidney, nourishYin to restore fluids. Treatment period:seven months, followed by normalpregnancyand delivery of a baby girl.
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Case 14
Source: Wang (1986:218-219). Zhou X X, F-42. Staff person at Sichuan Engineering College. Married many years without a pregnancy. Diagnosed at anotherhospital as "severe anemia, proliferationof endometrialtissue." Suffers cold extremities, cold lower abdomen,sallow facial color, weak body, poor appetite, insomnia, shortnessof breath,slow speech, lower back pain, poor bladdercontrol, long menstrualperiods with high volume of blood, and excessive white discharge. Pulse Retarded and Moderate,tongue pale with thin white coating. Syndrome:Qi and Blood both Depleted. Treatment principle:bolster Qi and Blood, moisten Liver and Kidney, regulatemenstruation to transformstasis. Treatment period:threemonths, afterwhich she became pregnantand delivered normally.Latershe became pregnantagain. Case 15
Source: Liu (1986:240-241).
Wang X X, F-28, a relative. Marriedseven years without a pregnancy, recently menstrualperiods five to ten days premature,with swollen breasts. Previously periods were normal. Volume of blood small, color dark;pain with menstruation.Obese. Tongue normal, pulse Sunken and Slippery. Syndrome:Kidney Qi Inadequate,Liver TractCongested and Sluggish. Treatment principle:moisten Kidney and relax Liver, enliven Blood to mobilize stasis. After four monthsof treatmentthere was a normalpregnancyand delivery.
Case 16
Source: Liu (1986:241-242). Zhang X X, F-25, a relative. Irregularmenstruation,marriedfour years without a pregnancy. Menstrualsymptoms:volume of blood small, color dark. Premenstrualback and abdominal pain and generalized weakness. Frequent swelling of lower abdomen, reduced appetite. Tongue dark red with fine white coating, pulse Strungand Small. Syndrome:Highway and ConceptionTracts Inadequate,Depletion Cold of the Uterus. Treatment principle:warmUterusandexpel Cold, regulateandbolsterHighway and Conceptiontracts. Pregnantaftertwo monthsof treatment. Case 17 Source: Liu (1986:242-244). Wang X X, F-29, a cadre. Marriedthree years without a pregnancy. Menstruation every 40 + days, volume of darkblood very great. Recently has experiencedagitation,pimples on face and lips, and constipation.Tongue coating dry and yellow, pulse Sunkenand Slippery.
394
Syndrome: Fire Excess of Stomach and Heart, Highway and Conception Tracts Irregular. Treatment principle: clear Heart and drain Stomach, moisten and bolster Highway and Conception tracts. After seven months of treatment she became pregnant. Case 18 Source: Liu (1986:244-245). Chen X X, F-29, worker. Menstruation had ceased for 40 days on patient's first visit to clinic, and she displayed other signs of early pregnancy. But pregnancy was ruled out upon examination. She had been married six years without a pregnancy. Syndrome: Depletion Cold of Spleen and Kidney, Infertility Due to Uterine Cold. Treatment principle: assist yang and supplement Qi, warm and bolster Spleen and Kidney. After six months of treatment she attained a normal pregnancy and full-term delivery. Case 19 Source: Liu (1986:245-247). Lu X X, F-35, farmer. Married 12 years without a pregnancy. Diagnosed as uterine insufficiency at another hospital. Menstrual symptoms: periods short and volume small; color of blood dark; pain in abdomen, lower back, and extremities. Tongue mottled, pulse Tardy and Moderate. Syndrome: Cold Depletion of Uterus, Irregularity of Highway and Conception Tracts. Treatment principle: supplement Qi and nourish Blood, warm Uterus to drive out Cold. Pregnancy achieved after 18 months of treatment. NOTES The fieldworkon which this study partlydraws was funded by a Acknowledgments. series of generousgrantsfrom the Committeeon ScholarlyCommunicationwith the Peoples Republicof Chinaof the NationalAcademy of Sciences. Versionsof this articlehave in the following meetings:SouthernCalifornia benefitedfromthe commentsof participants of Humanitiesand Social Studies of MedChinaColloquium,January1990; Department icine Colloquium,McGill University, January1990; and the annualmeeting of the American EthnologicalSociety, Atlanta, April 1990. Special thanks are due to Tani Barlow, Jean Comaroff, CharlotteFurth, James Hevia, MargaretLock, Allan Young, and two anonymousreadersfor MAQwho made helpful suggestions based on carefulreadings. of Anthropology, may be addressedto the authorat the Department Correspondence Universityof NorthCarolinaat Chapel Hill, 301 Alumni Building, CB3115, ChapelHill, NC 27599-3115. 'Inthe Peoples Republicof China, "traditional' medicine is called Chinese medicine (zhongyi),andbiomedicine(whatCharlesLeslie [ 1975] has called cosmopolitanmedicine) is referredto as Western medicine (xiyi). My use of the term Western medicine in this
395
articleis meantto recall this indigenouspractice, which constantlycontraststhe two medical systems. Though the standardtranslationfor zhongyi is "traditionalChinese medicine" (TCM), the traditionalismof this rapidly modernizing field in the contemporary P.R.C. is arguable. 2Qi(ch'i) is translated by NathanSivin as vitalitiesor energies, dependingon medical context (1987:46-53). See his useful historical discussion of this fundamentalmedical force and substancefor a clarificationof its many contexts and connotations.For purposes of this article it is especially importantto note the intimate interdependenceof Qi and Blood. Qi drivesBlood; Blood is the conditionof existence for certaintypes of physiological Qi. In this article I use many of Sivin's standardtranslationsof medical terms (Circulation tracts is an example) and capitalize technical terms that could be misleading, especially those referringto complex entities such as Blood and Qi and the five yin and six yang visceralsystems of function(Spleen, Kidney, etc.). I hope in capitalizingthese terms to remindreadersthatthese entities do not correspondin any simple way to the anatomical objects described by the English words. Where an otherwise capitalized word such as Blood appearsuncapitalized,it can be taken to refer to the red fluid of our commonsense experience. 3Ido not mean to separateobjects into two types, one real (bodily) and the other anof this alytic (mental).Ratherthe intentionhere is to considerthem together,one argument articlebeing thatobjects given in Chinese medicine, such as visceral systems, are as much the resultof intellectualactivity as aredisease categories. The converse also holds: another aim of this article is to show that categories such as the syndrome in Chinese medicine (zheng), thoughunrecognizedin biomedicine, are not purely ideal or vapid. 4Theobstetricsand gynecology specialties of Westernmedicine in China are usually calledfuchanke. Because there is almost no scholarly organizedtogetherin departments traditionof obstetrics in traditionalChinese medicine, fu ke (women's specialty) is the usualtermwhich bothorganizestextbookknowledge andprovidesthe namefor clinics and medicine. All the materialin this unitsof this subdisciplineof traditional teaching-research article,from both field observationsand writtenworks in Chinese, is drawnfrom this speChinese medicine. cialty withintraditional 5Thefield observationswhich follow were made in the course of threeresearchvisits to the P.R.C. in 1982-84, the summer of 1988, and 1990-91, totalling more than two years of fieldwork. In all cases I was invited to sit in the clinics concerned, listening to conversations among doctors, patients, andbystandersin Cantoneseand more or less standardMandarin Chinese. I kept notes and occasionally tape-recorded what transpired. I also readand sometimescopied the case historiesof patientsvisiting the clinics. In some cases I was able to follow the managementof a case over a periodof several weeks throughboth clinic observationsand the writtencase history. This work was done withoutthe help of a In the Guangzhouclinics the doctors and their assistantssometimes translated translator. the remarksof Cantonese-speaking patientsinto standardMandarinfor me, and in Shantapes I had made, using Mandarin dongfor a briefperiodlocal associateskindlytranscribed to explain unclaritiesof local language as needed. For this latterassistance I am indebted to Li Zhongyongand Wang Jun. 6Inthe outpatientclinics of the Guangzhouhospital, where the scenes previously describedtook place, patientskept theirown case-recordbooklets with them, bringingthem every time they visited the clinic. Dated notes were addeduntil it was full (or became lost), whereupona new one was started.The clinics collected these booklets only if they had a researchprojectunderway and needed to code them for analysis. 7Mostof the senior doctors I have interviewedaboutphilosophicalissues in Chinese medicinespontaneouslyinsist upon the essential "subjectivity" (zhuguanxing)of Chinese medicine. Their feelings on this issue are mixed, as they fear that the futurelies with the "objective" sciences, especially in a socialist Chinawhere official policy has recentlyemphasized"seeking truthfrom facts."
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8Thereare, however, numerousspecialized works devoted to the treatmentof infertility. Two recently published examples are Sheng, Yang, and Sheng (1990) and Hu (1990). 9Thisfour-character phrase,jing dai yun chan, is used repeatedlyin thefu ke literature to label the special concerns of the field. A similar phrase both labels and characterizes traditional medicine as a whole, "theory, methods, formulae, and drugs." Four-character of life phrasesare not confined to medical usage; witness the often-seen characterization in general:"birth, aging, illness, and death." '?Control over the timing of legal birthsis most fundamentally exertedby controlling the time of marriage.In most urbanand ruralareas childbearingis allowed immediately after marriageregistrationat the legal age. In many rural areas a second child may be approvedfor parentswhose first child is a girl, but this is possible only some years later, afterothershave had a chance at a firstbaby. The infertilitytreatedinfu ke clinics is often of late onset, following previoussuccessful or abortedpregnancies.Ruralwomen desiring a secondchild and who felt they hadto take advantageof an administrative clearancewhile they had it, were frequentvisitors to such clinics. "A recentinfluentialarticleby ThomasLaqueur(1986) tracesthe emergence in early moder Europeof beliefs that women are essentially differentfrom men. He describes a shift from gender seen as positions on a qualitativecontinuumto gender representedas absolute difference founded in anatomy and links this shift with problems arising from debateson equality and humannature.His work has raised interestingques18th-century tions aboutthe universalityof "natural"genderdifferenceswhich this articlein parttakes up. Hence my interestin the relationshipof a medical subdisciplinecalled "women's specialty" to the clinical concernsof generalChinese medicine. '2Thecomplex termJing can be properlytranslatedin a varietyof ways; it is perhaps morecontext sensitive thanany othercentraltermof Chinese medicine. Threemajorcommon uses of the term are transitionalQi (i.e., in a moment of transforming between two othersubstantial forms), refinedessences of food and drink,and seminalessence or semen itself. See Sivin (1987:164-165) and Porkert(1974:176-180). '3Theyin and yang visceral systems of function, each of which is named with reference to an internal organ, are very complex. Limitationsof space preventa full explanation of theircharacteristics in Table 1. See Sivin (1987) and beyond the formulaicpresentation Porkert(1974) for extensive discussions. this is an unoriginalinsightin Chinese studies, few authorshave framedthe '4Though relationshipof filiality and selfhood in just this way. John Hay (1983) and Tu Wei-ming (1985) are among the exceptions. '5Caserecordsmaintainedin hospitals and clinics often fail to specify the causes or syndromesof infertility. When they do, simply noting "Kidney depletion" or "Liver oppression"is often felt to be enough. For experiencedclinicians, diagnosticrefinements may be inferredfrom prescriptions,so thereis no need to specify the syndromemore completely. When cases are published, though, editors must identify the syndrome being treated or checking with the doctorwho wrotethe origby eitheranalyzingthe prescription inal case record. '6Thespatiotemporal sectors referredto are partof the methodsandtheoreticalframeworks of two majorschools of thought in Chinese medicine, the Warm Illnesses school andthe Six Warpsschool. In the diagnosis of exogenous illnesses one or the othermethod is almostalways used. of this case would inevitablyimplicatelarger-scaledisorders,however. As '7Analysis of therapyhas few techniquesthat addressdisorders pointedout previously, the literature of the circulationtractsdirectly. '8Zhucan also be translatedas "ramifies as," "is chief among," or "unfolds in" 1989). (Farquhar
397
'9The terms"active" and "structive" are Porkert's(1974). The yin-yang relationship has been the subject of extensive discussion in Sinology and anthropologyfrom Marcel Granetforward.For purposesof this article it is importantto note that Blood as material realizationand Qi as the active vitality driving it exist in a classic yin-yang relationship. But yin and yang logics are not confined to medicine; they still exist to some extent in ordinarylanguage and social life, and patients undoubtedlygrasp somethingof the technical significanceof terms like Qi and Blood by analogy to the yin-yang of weather, the calendar,and other mundaneconcerns. I have no way of exactly calculatingthe cost of this prescriptionin 1980, 1 20Though have the strong impressionthat it was not only symbolically evocative but also very exandMyrrh(Tantriccodes for blood and semen) to "build pensive. The use of Frankincense muscle," and of deer hornglue, humanplacenta, and ginseng, which are also expensive, implies that Sun's family was willing to pour considerablewealth into her in the hope of producingtheirown child. 2'Onecan imagine how Chinese doctors view a Western medical regimen that can problem, thus permittinga pregcontemplatesurgical interventionto correct a structural nancy in a woman whose physiology is not strong enough to carry and nourish a fetus properly.The proceduremust seem highly irresponsible. 22Insupportof this somewhat speculative point, it is worth noting that herbalmedicines and food are commonly conflatedin moder Chinese practice. Many types of food, in holiday festivities, are knownfor theirmeespeciallyexpensive "gift" foods important dicinalqualitiesanddescribedin the languageof Chinese medicine. IdeallyChinese herbal medicine is administeredin a "soup" (tang) which is cooked at home from ingredients assembledin a pharmacyaccordingto a doctor's prescription.Since so many illnesses in Chinesemedicineareconditionsof debilityanddepletion, it would not be far-fetchedto see Chinesemedicaltherapyas a mode of nurturing.Families drawupon the expertise of doctors for refined prescriptiondesign, but they remain in control of the actual therapy by preparingand administeringthe medicine. Patients' comments about their relations to Chinesedoctorsand Chinese medicine suggest a strongcontinuitybetween technicalideas about such therapiesas "warming and nurturing"and the mundaneprocesses in which people care for each other. 23This opinion is very much my own and is not sharedby most of my Chinese medical acquaintances, many of whom believe (perhapscorrectly)thateventuallyChinese medical knowledgewill become comprehensiblein Westernmedical terms. 24" 'Substrate"is Porkert'sterm. In the early 1980s there was much concern in the world of Chinese medicine with characterizing the "materialfoundations" (wuzhijichu) of manyfunctionsdescribedby Chinese medicine. Though I have not yet done substantial researchon this topic, I believe that this interesthas subsidedin recent years. 25Translations for Chinese herbalmedicine are taken from Hu (1980). Medicines for which Hu findsno suitabletranslation are renderedin the Wade-Gilesromanization system in her book. For the sake of consistency within this article I use Pinyin romanizationfor Chinesedrugnames, as for all other Chinese terms.
REFERENCES CITED
Anonymous 1983 Bailing Fuke (Dr. Han Bailing's Gynecology). Harbin: Heilongjiang Kexuc JishuChubanshe. Cassell, Eric 1982 The Natureof Suffering and the Goals of Medicine. New EnglandJournalof Medicine 36(11):345-369.
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Chinese Medicine, ed. ChengduCollege of Traditional 1985 Zhongyi Fukexue (Chinese Medical Gynecology). Chengdu: Sichuan Kexue JishuChubanshe. Judith Farquhar, 1987 Problemsof Knowledge in Contemporary Chinese Medical Discourse. Social Science and Medicine 24(12):1013-1021. 1989 Multiplicity,Pointof View, and Responsibilityin Chinese Medicine. Paperpresentedat the Meeting of the Association for Asian Studies, Washington,DC, March. 1991 Time and Text: ApproachingChinese Medicine throughAnalysis of a Case. In Pathsof Asian Medical Knowledge. CharlesLeslie and Allan Young, eds. Berkeley: Universityof CaliforniaPress. (In press.) Foucault,Michel 1973 The Birthof the Clinic:An Archaeologyof MedicalPerception.New York:Random House. GuangzhouCollege of TraditionalChinese Medicine, Gynecology and Obstetrics Researchand TeachingSection, ed. 1980 Luo YuankaiLun Yi Ji (Selected Medical Worksof Luo Yuankai).Guangzhou: GuangdongKexue Jishu Chubanshe. Haraway,Donna 1989 The Bio-politics of Post-modernBodies. Differences 1(1):3-44. Hay, John 1983 The HumanBody as a Microcosmic Source of MacrocosmicValues in Calligraphy.In Theories of the Arts in China. Susan Bush and ChristianMurck, eds. Pp. 74-102. Princeton:PrincetonUniversityPress. He Shengxiaoand Liu Changtian,eds. 1987 Nuke Linzheng Jingyan Jiyao (Collected Essentials of Clinical Experience in ChineseMedicine). Guangzhou:PopularScience Press, GuangzhouBranch. Hu Longcai 1990 BuyunzhengZhiyan(Therapeutic Experiencein InfertilitySyndromes).Beijing: Zhongyi Guji Chubanshe. Hu Shiu-ying 1980 An Enumeration of Chinese MateriaMedica. Hong Kong: Chinese University Press. Kuriyama,Shigehisa 1987 Pulse Diagnosis in the Greekand Chinese Traditions.In Historyof Diagnostics. Yosio Kawakita,ed. Pp. 43-67. Osaka:The TaniguchiFoundation. Laqueur,Thomas 1986 Orgasm,Generation,and the Politics of ReproductiveBiology. Representations 14:1-41. Leslie, Charles 1975 Pluralismand Integrationin the Indianand Chinese Medical Systems. In Medicine in Chinese Cultures:ComparativeStudies of Health Care in Chinese and Other of Health, Societies. ArthurKleinmanet al., eds. Washington,DC: U.S. Department Center. Education,and Welfare, John E. FogartyInternational Liu Hengxiang,ed. 1986 Fuke Yian (Gynecology Cases). Jinan:ShandongKexue Jishu Chubanshe. O'Neill, John 1986 Five Bodies: The Human Shape of Modern Society. Ithaca, NY: Cornell University Press. Porkert,Manfred 1974 The TheoreticalFoundationsof Chinese Medicine. Cambridge:M.I.T. Press.
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Potter,Jack 1974 Cantonese Shamanism. In Religion and Ritual in Chinese Society. ArthurP. Wolf, ed. Pp. 207-231. Stanford,CA: StanfordUniversityPress. Saunders,Barry 1988 The Undeathof the Clinic: A Pathologyof Medical Conception.Paperpresented at the Society for Health and HumanValues Conferenceon AmericanHospitals and HumanValues, 1860-1988, Tampa, FL, April 14. Scheper-Hughes,Nancy, and MargaretLock 1987 The MindfulBody: A Prolegomenonto FutureWorkin Medical Anthropology. Medical AnthropologyQuarterly(n.s.) 1(1):6-41. ShanghaiCollege of TraditionalChinese Medicine, Gynecology Research and Teaching Unit, ed. 1983 Zhongyi Fuke Linchuang Shouce (Clinical Handbook for Chinese Medical Gynecology). Shanghai:ShanghaiKexue Jishu Chubanshe. Sheng Wenyan, Yang Wenlan, and Sheng Guoguang of Infertility).Beijing:Zhon1990 Buyun Buyu Zheng Zhi (Diagnosis and Treatment gyi Guji Chubanshe. Sivin, Nathan 1987 TraditionalMedicine in Contemporary China. Ann Arbor:Universityof Michigan Centerfor Chinese Studies. Taussig, Michael 1980 Reification and the Consciousness of the Patient. Social Science & Medicine 14B:3-13. Tu Wei-ming 1985 Selfhood and Othernessin ConfucianThought. In Cultureand Self: Asian and WesternPerspectives.AnthonyJ. Marsellaet al., eds. Pp. 231-251. New York:Tavistock. Turner,BryanS. 1984 The Body and Society. Oxford:Basil Blackwell. WangWeichuan 1986 Wang Weichuan Linchuang Jingyan Xuan (Collected Clinical Experience of Wang Weichuan). Shaanxi:Renmin Chubanshe. ZhangYoujun, ed. 1990 Medical Cases of Men's Medicine in China. Tianjin:Tianjin Keji Fanyi Chubanshe.

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Objects, Processes, and Female Infertility in Chinese Medicine Author(s): Judith Farquhar Source: Medical Anthropology Quarterly, New

of Anthropology Department Universityof NorthCarolinaat ChapelHill

Objects, Processes, and Female Infertility in Chinese Medicine

IN CHINESE MEDICINE FEMALE INFERTILITY

FEMALE INFERTILITY IN CHINESE MEDICINE

IN CHINESE MEDICINE FEMALE INFERTILITY

FEMALE INFERTILITY IN CHINESE MEDICINE

Syndrome Type Spleen and Kidney yang depletion

Liverand Kidney yin depletion

ClearHeat and drainDamp Relax Liver to open tracts

Source: ShanghaiCollege of TraditionalChinese Medicine (1983:164-167).

FEMALE INFERTILITY IN CHINESE MEDICINE

FEMALE INFERTILITY IN CHINESE MEDICINE

MEDICAL ANTHROPOLOGY QUARTERLY

Drug name Foxglove Dodderseed Deer horn glue Placenta

Sweetgum fruit Jiazhu Sage Epimedium Nut-grass Hare'sear root Frankincense

X (not found in materiamedica)

FEMALE INFERTILITY IN CHINESE MEDICINE

Drug Name Dodderseed Cherokeerose

Cornbind Dangshen Matrimony vine Angelica Raspberry Nut-grass Lovage

FEMALE INFERTILITY IN CHINESE MEDICINE

FEMALE INFERTILITY IN CHINESE MEDICINE

FEMALE INFERTILITY IN CHINESE MEDICINE

IN CHINESE MEDICINE FEMALE INFERTILITY

FEMALE INFERTILITY IN CHINESE MEDICINE

IN CHINESE MEDICINE FEMALE INFERTILITY

IN CHINESE MEDICINE FEMALE INFERTILITY

FEMALE INFERTILITY IN CHINESE MEDICINE

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