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Herbal Medicine, Plants and Herbs, Series: Early Modern Chinese Studies, Series: Fertility, Series: Hot and Cold, Series: Imperial Chinese Studies, Series: Sexuality

Cold Wombs and Cold Semen: Explaining Sonlessness in Sixteenth-century China

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By Yi-Li Wu

Figure 1. Depictions of boys at play were a popular Chinese decorative motif during the sixteenth century, imbued with auspicious meaning and conveying hopes for male offspring. This porcelain bowl was made in Jindezhen during the Jiajing reign period (1522–66). From the collection of the Metropolitan Museum of Art, New York, NY. Gift of Denise and Andrew Saul, 2001. Accession number 2001.738. On-line at https://www.metmuseum.org/art/collection/search/64484

Throughout imperial China, a family’s well-being and longevity required the birth of sons. [Fig. 1]  Sons performed the ancestral rites, inherited land, and were responsible for supporting aged parents. And only men could take the examinations for government office which conferred elite socio-economic status. But at age 40, Liu Xiaoting was still sonless (wu zi). He appealed to the physician Gong Tingxian (15`38-1635), promising him rich recompense if he could help. As Gong recorded in his influential treatise, Curing the Myriad Diseases (Wanbing huichun, preface dated 1587), Liu’s “male member was weak, and his semen was icy cold.” Furthermore, his pulses were flooding when felt at the first position (cun) at the wrist, but deep and faint at the third position (chi). Gong’s diagnosis: a profound deficiency of primordial qi (yuan qi), the source of all the body’s vitalities and material manifestations. This was caused, he explained, by excessive drinking and sexual indulgence.

Depletion from debauchery was a common diagnosis for upper-class men of the time, those who had the means to own concubines and patronize courtesans. Doctors agreed that such carousing exhausted the body’s vitalities, not least because male semen was produced from “essence” (jing), the vitality that enabled growth, generation, and reproduction. Besides depleting the body, excessive outflows of semen harmed the kidneys, the organs that produced, stored, and transformed essence.  To cure Liu, Gong prescribed a 16-ingredient formula called “Elixir to Solidify the Root and Strengthen Yang” (Guben jianyang dan) (see below).  After taking one recipe’s worth, Liu felt that his nether parts were warm again.  After an additional half-recipe, he felt recovered. To his great joy, he then begat a son. Liu subsequently shared the formula with a Liu Boting and a Liu Min’an (probably kinsmen) who also used it successfully. [Figs. 2 and 3]

Figs. 2 and 3: The recto and verso of a page from a seventeenth-century edition of Gong Tingxian’s Curing the Myriad Diseases, showing his recipe for Elixir to Solidify the Root and Strengthen Yang (Fig. 2, recto) and explaining how he used it to cure Liu Xiaoting (Fig. 3, verso). Note that Chinese books were read from right to left. From Expanded edition of “A Collection on Curing the Myriad Diseases” by Mr. Gong Yunlin, Confucian doctor (Zengbu ruyi Gong Yunlin xianshen Wanbing huichun ji), Renren shushe woodblock edition, 1641. Yulin was Gong Tingxian’s sobriquet (hao). In the collection of the Berlin State Library, Germany. Digitized and on-line at the Staatsbibliothek zu Berlin-PK digitalisierte Sammlungen, permanent URL: http://resolver.staatsbibliothek-berlin.de/SBB000160F000000000.

Gong Tingxian placed Liu Xiaoting’s case in his discussion of “seeking descendants” (qiu si), which was part of a larger section on “women’s diseases” (fu ke).  “Descendants” here referred specifically to sons.  Although Chinese medical writings on childbearing focused primarily on the female body, people had also long recognized that male ailments could impede conception. These concerns were especially salient in Gong and Liu’s time, when population pressure, urbanization, and commercialization were creating new forms of socio-economic mobility and instability.  As Charlotte Furth has shown, this inspired a proliferation of writings on male self-cultivation and producing sons. Such material appeared in various textual genres, and it was not uncommon to find the reproductive illnesses of men discussed in chapters on women. These discussions assumed, furthermore, that a deficient man might still be able to father daughters, but that only a properly regulated male body would create sons. The question was how best to achieve that regulation.

In medical discussions of infertility, cold could refer to somatic sensations of chillness, as well as to a sense of deficiency and absence of vitality.  Writings on women were primarily concerned with ensuring the ample and free flow of female blood, which constituted the female seed, nourished the fetus, and later transformed into breast milk.  But doctors also worried about coldness in the womb, whether from an invading wind, or arising from internal depletion. Cold would cause female blood to stagnate and become corrupt.  But concerns about female cold were also expressed in terms of agricultural metaphors which portrayed the womb as a field that needed to be warm and nurturing to receive the male seed.

Women with cold wombs would simply not produce children. But when couples produced only girls, this suggested deficiencies in the man, who played a key role in determining the child’s sex. The various theories of sex selection might differ as to details, but they agreed that a man could produce boys by shooting (she) his seed into the woman on certain days, in a certain manner, at a certain point in the copulatory act.  Particularly important was the belief that both men and women released reproductive seed during orgasm, and that the fetus’ sex was determined by the seed that came last.  A man who wanted sons thus needed to bring his female partner to climax before releasing his own seminal essence. His semen also needed to be sufficiently “dense” (mi), lest it dribble uselessly out of the womb.

Coldness in men was thus associated with impaired copulatory function, manifesting as cold and watery seed and as a weak penis unable to control its emissions. Gong Tingxian’s fertility formula echoed this understanding, relying heavily on substances that were classified as “principal drugs for treating spermatorrhea” and/or as “principal drugs for treating impotence” in Li Shizhen’s authoritative  and encyclopedic Compendium of Materia Medica (Bencao gangmu,preface dated 1590).  At the same time, Gong’s formula implicitly rebuked those who would treat male coldness with heating drugs.  This objection was rooted in a particular understanding of how cosmological yin and yang forces expressed themselves in the male body.

To simplify enormously: yang referred to things that were external, active, and hot, while yin was internal, receptive, and cool. Men were the yang of humankind, and male potency and fertility were understood as expressions of bodily yang. As a result, people routinely tried to treat sonlessness with heating drugs. But some doctors warned that too much heat would damage and consume yin, harming the kidneys (yin) and consuming its essence (yin). Excessive heat would sicken the man, and even if he managed to conceive a son, the heat would remain as a latent poison in the fetal body and the boy would die young. Instead, they argued that the proper way to regulate yang was to address the underlying deficiency of yin.  Gong Tingxian shared this viewpoint, and the key drugs in his prescription acted by nourishing bodily yin and the kidneys.  As Liu Xiaoting swallowed the dozens of pills that Gong prescribed, he may have had initial doubts about their efficacy. But the birth of his son would have convinced him that, at least in this instance, Gong’s approach to male coldness was the correct one.

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Elixir to Solidify the Root and Build Yang (Guben jianyang dan)
Dodder seed (tu si zi) cooked in wine, one and a half taels[1]

White poria, root end (bai fu shen), skin and woody bits removed
Dioscorea (shan yao), steamed with wine
Achyranthes root (niu xi), stems removed, washed in wine
Eucommia bark (du zhong), washed in wine, skin removed, roasted until crisp
Angelica root, main body (dang gui shen), washed in wine
Cistanche (rou cong rong), soaked in wine
Schisandra fruit (wu wei zi), washed in wine
Black cardamom (yi zhi ren), stir-fried in salt water
Tender deer antler (nen lu rong), roasted until crisp
One tael each of the above

Prepared rehmannia (shu di), steamed in wine
Dogwood fruit (shan zhu yu), steamed in wine, the pit removed
Three taels each of the above

Sichuanese morinda (chuan ba ji), soaked in wine, the heart removed, two taels

Teasel (xu duan), soaked in wine
Milkwort (yuan zhi), processed
Cnidium seeds (she chuang zi), stir fried, the husks removed
One and a half taels each of the above

Add:
Ginseng (ren shen), two taels
Goji berries (go ji zi), two taels

Grind the above into a fine powder, and mix with honey to form pills as large as the seeds of the parasol tree. For each dose, take 50 to 70 pills on an empty stomach, washed down with salt water. With wine is also fine. Before bedtime, take another dose. If the woman’s monthly affair is already concluded, then this is the time for planting sons, and if one takes three doses a day, that is no problem.  If essence is not stable, then add dragon bone (long gu) and oyster shell (mu li), heated in fire and quenched in salted wine three to five times. Use one tael, three mace of each. Moreover, add five taels of tender deer horn.

[1] The weight of the tael (Ch. liang) has varied over time, but during Gong Tingxian’s lifetime would have been equivalent to approximately 37 grams.  A mace (Ch. qian) is one-tenth of a tael.

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Yi-Li Wu is a Center Associate of the Lieberthal-Rogel Center for Chinese Studies at the University of Michigan, Ann Arbor (US).  She earned a Ph.D. in history from Yale University and was previously a history professor at Albion College (USA) for 13 years.  Her publications include Reproducing Women: Medicine, Metaphor, and Childbirth in Late Imperial China (University of California Press, 2010) and articles on gender and the body; medical illustration; forensic medicine, and Chinese views of Western anatomical science.  She is currently completing a book manuscript on the history of wound medicine in China.

Antiquity, Remedies, Series: Fertility, Series: Women's Health

I smell a rat! Fumigation in Mesopotamian and Hippocratic recipes for women’s ailments – Part 1

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By Ulrike Steinert

In my first post on the blog, I described some of the difficulties in studying Mesopotamian medical texts from 2nd and 1st millennium BCE Babylonia and Assyria. In the following two contributions, I would like to discuss similarities between Babylonian and Hippocratic recipes applying “fumigation from below” as a therapy for gynaecological disorders. In this part I will present the recipes themselves with some comments on fumigation in general. In the next post I will compare Mesopotamian and Hippocratic concepts of women’s ailments and their treatment gleaned from the fumigation recipes.

The specific treatment form of fumigation from below is so far attested only a few times within the Mesopotamian gynaecological corpus, but fumigation of the (whole body of the) patient or of specific body parts (e.g. the ears) is more commonly found as a treatment type in other areas of Mesopotamian therapy. Surprisingly, the situation is reversed in the Hippocratic texts: most attestations within the Hippocratic corpus are found in the gynaecological treatises, while fumigation is otherwise rare (Goltz 1974, 232). Here, I would like to point out some similarities and differences between the Babylonian and Hippocratic sources with regard to the therapeutic procedure itself, and with regard to the female ailments treated by fumigation from below in each tradition.

Before comparing the recipes, the term “fumigation” should be clarified. In fumigation, hot and dry vapours or smoke are led to a body part, while in the cognate procedure of “fomentation”, hot water vapours are used to lead medicinal substances to a body part (Totelin 2009, 52; Goltz 1974). The differentiation between both techniques was not very strict in Greek medicine, except in the gynaecological treatises (Goltz 1974, 235). The main difference between both procedures is the apparatus: in fomentation, a vessel containing the drugs and some water is heated over a fire and the vapours are led to a body opening through a reed, while in fumigation substances are directly thrown into the fire or onto glowing charcoals or ashes. In Mesopotamian medical texts, fumigation consists of burning aromatic substances on a fire or on charcoals (usually a brazier is used), exposing the patient (or specific body parts) to the fumes (Goltz 1974).

It may come as a surprise that in both Mesopotamian and Hippocratic gynaecology fumigation from below was applied for some identical purposes and ailments. In Hippocratic gynaecology, fumigation was used to treat infertility, with the incentive to open or soften the uterus for conception.[i] Interestingly, fumigation was regarded as a patent method both to stop fluxes and to expel retained fluids from the womb.[ii] More often however, fumigation was applied to return the womb to its correct position, if it had moved elsewhere in the body.[iii]

By contrast, the theory that the womb could move within the body and cause illness is unknown to Mesopotamian medicine. But one prescription applies fumigation from below to stop bleeding during pregnancy (naḫšātu), comparable to the Hippocratic use of fumigation for fluxes. Further, both in Hippocratic and Mesopotamian gynaecology fumigation from below was prescribed when fluids were retained or blocked in the womb. While the Hippocratic texts speak of blocked menstrual or postpartum blood (lochia), the Babylonian texts describe a similar condition called “(b)locked fluids” (lit. “water”). Because this condition is sometimes mentioned in the context of postpartum complications, it is possible that the word “fluids” here refers to the lochia, but this is far from certain, since the word “fluids” can stand for several things in different contexts, e.g. for the amniotic fluid or for vaginal discharge other than blood. Yet, Mesopotamian texts describe very similar symptoms in connection with the condition “(b)locked fluids” as the Hippocratic texts do in connection with disease conditions caused by retained menses (see Steinert 2013 for discussion). Should the Akkadian expression “(b)locked fluids” be a euphemistic term for the retained menses?

BAM 237 (VAT 8577+), a collection of gynaecological recipes from Assur. Source: Cuneiform Digital Library Initiative (http://cdli.ucla.edu/dl/ photo/P285323.jpg)
BAM 237 (VAT 8577+), a collection of gynaecological recipes from Assur. Source: Cuneiform Digital Library Initiative (http://cdli.ucla.edu/dl/photo/P285323.jpg)

One of the prescriptions for fumigation from below is contained in a Neo-Assyrian text from Assur (ca. 7th cent. BCE), devoted to treating bleeding during pregnancy:

BAM 237 i 26’-27’:
“You scatter “human bone” over charcoal, you let the woman sit down above it. If (the haemorrhage) does not stop, you repeat (it), and let her sit down (again), ditto (i.e. and it will stop).”

From a second, contemporary recipe on a Babylonian tablet found in the palace library of the Assyrian king Ashurbanipal at Nineveh, we learn a few more details about the procedure:

K. 8678+ rev. 9’-12’:
“If ditto (i.e. a woman is (b)locked regarding the fluids): you dig a hole, you make it two fingers [deep], […],
[…] you cover (it). You throw flour? into it, one tenth of a litre of ka[mūnu-spice?],
[…] solid pieces? of resin, one thirtieth of a litre of ṭūru-aromatic […],
[…] you spread on coals; you make the woman sit down above it.”

Although the text is fragmentary and presents difficulties, the procedure is quite clear and bears similarities to a few Hippocratic recipes for fumigation of the womb (presented in Part 2 of this post). The apparatus is simply a hole in the ground, which functions as a receptacle for burning charcoal and the fumigants. The woman’s pubic region is exposed to the fumes.

 

[i] E.g. Diseases of Women 1.75, L 8.164; cf. Diseases of Women 2.154, L 8.330; Sterile Women 230, L 8.438ff. describes a fomentation with a gourd for the same purpose.

[ii]DW 2.114, L 8.246; DW 2.195, L 8.376; DW 1.78, L 8.186.

[iii] For discussion see King 1998; e.g. Diseases of Women 2.123, L 8.266 movement to the head; DW 2.126, L 8.272 womb attaches itself to the hypochondria; DW 2.127, L 8.272 movement to the liver; DW 2.133, L 8.284-6 fomentations when the womb moves to the hip joint; DW 2.203, L 8.390 womb fixes itself to the loins. Sometimes, the patient is described to suffer from more than one symptom at the same time, e.g. in Diseases of Women 2.154, L 8.330 the womb is “irritated”, the menses are blocked and the woman does not conceive.

References:

Goltz, Dietlinde (1974) Studien zur altorientalischen und griechischen Heilkunde. Therapie-Arzneibereitung-Rezeptstruktur, Wiesbaden.

King, Helen (1998) Hippocrates’ Woman. Reading the Female Body in Ancient Greece, London/New York.

L = Littré, Émile (1962) Œuvres completes d’Hippocrate. Tome Huitième, Amsterdam.

Steinert, Ulrike (2013) “Fluids, rivers, and vessels: metaphors and body concepts in Mesopotamian gynaecological texts”, in: Journal des Médecines Cuneiformes 22, 1-23. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3791376/

Totelin, Laurence (2009) Hippocratic Recipes. Oral and Written Transmission of Pharmacological Knowledge in Fifth- and Fourth-Century Greece. Leiden, Boston.

Antiquity, Medical Practitioners, Records, Documents and Notes, Remedies, Series: Women's Health

Like an alien in a strange old world – Reading Mesopotamian medical texts on women’s healthcare

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By Ulrike Steinert

Decoding medical cuneiform texts often makes you feel a bit like a detective who has entered a mysterious, foreign world of words and ideas. Not few of my Assyriologist colleagues would probably favour other topics, rather than studying Mesopotamian medical texts, because they are hard to understand, full of strange disease names and unknown drugs, and because these texts have a reputation of being technical, monotonous and boring.

Not surprisingly then, Mesopotamian medical texts remain a poorly known corpus, and few scholars have worked on the subject or published books for a general audience.[i] Although the majority of the texts are still unavailable in proper editions and translations, the situation is steadily improving. Beside a growing number of publications every year, cuneiform medicine is becoming an increasingly recognised topic, and a few research projects are currently investigating these texts, preserved on thousands of fragments of clay tablets and scattered in various museums.[ii] The fragmentary nature of the corpus, consisting of diagnostic and therapeutic texts as well as handbooks on materia medica, written during the 2nd and 1st millennium BCE, and the difficulty of decoding them connected with the cuneiform writing system and the genre (especially the use of many multivalent logograms) have contributed to the lagging behind of research in this field, compared e.g. to Egyptological research on medical papyri.

Let me describe some of the difficulties posed by the Mesopotamian medical texts, specifically those concerned with treating women, to a modern reader. These difficulties result to a considerable degree from cultural differences e.g. between ancient and modern concepts of physiology, disease and therapy.

One problem for the modern scholar is to grasp ancient disease concepts and ideas of physiology from symptom descriptions. The gynaecological texts form a small sub-corpus among the majority of medical tablets devoted to diseases which are normally not gender-specific and which use the male body as a general model. Thus, while the latter diagnostic and therapeutic texts begin with the formula “If a man (suffers from ailment X/symptoms X, Y, Z)”, the gynaecological texts begin with “If a woman …”. The gynaecological corpus, not unlike the modern medical discipline, focuses on female reproduction: (in)fertility, complications occurring during pregnancy, birth, and in childbed, but also includes treatments for abnormal vaginal bleeding and other fluxes, as well as renal, rectal and gastro-intestinal ailments in women. Yet, because the perspective of gynaecological texts was restricted to the diagnosis and treatment of abnormal phenomena, they do not contain descriptions and explanations of normal physiological functions, such as menstruation, which have to be inferred from the sparse information gleaned from the medical texts or other text genres.

A Babylonian tablet with medical prescriptions for women, ca. 7th cent. BCE. Source: Cuneiform Digital Library Initiative (http://cdli.ucla.edu/dl/ photo/P238756.jpg)
A Babylonian tablet with medical prescriptions for women, ca. 7th cent. BCE. Source: Cuneiform Digital Library Initiative (http://cdli.ucla.edu/dl/photo/P238756.jpg)

For instance, Babylonian healers collected treatments “to stop a woman’s blood” in case “a woman’s blood flows and does not stop”, leaving us at loss to decide whether this refers to unusually heavy menstrual bleeding or to abnormal haemorrhage due to other causes. Beside blood, the texts also treat discharge of “fluids” (literally “water”) from the vagina, which depending on the context, refers to phenomena which modern medicine has come to differentiate, like amniotic fluid (premature rupture of the membranes) and vaginal discharge due for instance to leucorrhea. It becomes clear that the Babylonian healers do not share our differentiations of symptoms and diseases, and that progress with the texts will only be made by investigating their system of ideas about what goes wrong in the body when disease occurs.

This undertaking is somewhat hampered by another characteristic of Mesopotamian medical texts, namely that the writers (Babylonian and Assyrian healers and scholars) rarely recorded their theories (e.g. discussions which took place in the classroom and in scholarly discourse). Yet, some of their concepts of the body, health and disease emerge, often implicitly, from disease aetiologies, names, and from metaphors found especially in the incantations that accompanied medical treatments. These characteristic traits of Mesopotamian medical texts form a contrast to Greek and Roman medical writers who often speculated in writing about physiological processes such as menstruation, conception and the nature of female illnesses based on humoral theory.

Another challenge arising from Babylonian medical texts is to understand the “logic” of ancient medical treatments and recipes even though the majority of the drugs are unidentified, and to reconstruct the cultural context in which the texts were used, e.g. how medical consultation and application of treatments actually took place. Thus, it is still debated whether Babylonian (male) healers actually examined women (and applied the prescribed remedies like tampons), or whether the symptom descriptions in the texts stem from what the patients observed themselves and told the doctor. In upcoming posts on fumigation in Mesopotamian and Hippocratic gynaecology, I will illustrate an approach to discover principles of coherence between the use of particular materia medica and specific complaints.

[i] A real primer presenting a comprehensive overview of Mesopotamian medicine is Markham J. Geller’s Ancient Babylonian Medicine. Theory and Practice. Malden / Oxford, 2010.

[ii] The most ambitious of these projects in terms of scope is “BabMed”, a project at Freie Universität Berlin, consisting of a small research team led by Markham Geller. An overview of publications about Mesopotamian medicine can be found in the regularly updated bibliographies in Le Journal des Médecines Cunéiformes (http://www.ames.cam.ac.uk/jmc/de.html).