Translating Ancient Chinese Wisdom into Medicine for Today
tendershootsgrowing.jpg

Q&A Forum

Q&A Forum for Imperial Mentorship members

Please send me your questions through this form, and let me know whether you are okay with me sharing the answer (and perhaps your name) on this forum for the Imperial Mentees…

Women's Emotionality

An excerpt from my work on Qi Zhongfu’s Hundred Questions on Gynecology, to be published as Part Two hopefully not too far into the future, although progress has been slow…

第二十問

婦人之病多因氣生者,何也?

答曰:氣以形載,形以氣充。惟氣與形,兩者相待,氣和則生,氣戾則病。

結為積聚,氣不舒也。逆為狂厥,氣不降也。宜通而塞則為痛,氣不達也。宜消而息則為痟。嬰之為癭,留之為瘤,亦氣之凝耳。

內經曰:「怒則氣上,喜則氣緩,悲則氣消,恐則氣下,寒則氣收,熱則氣泄,勞則氣耗,思則氣結,驚則氣亂。」九氣不同,故婦人之病,多因氣之所生也。

Question Twenty

What is the Reason for Women’s Diseases Being Predominantly Engendered Due to Qì?

Answer: Qì is carried about by the physical body, and the physical body is made plentiful by Qì. As we ponder Qì in relationship to the physical body, these two depend on each other. When Qì is harmonious, life results; when Qì is in rebellion, disease results.

Binding and forming masses, this means that Qì is not relaxed. Moving countercurrent and forming mania and reversal, this means that Qì fails to descend. When it should flow through but is congested instead, the result is pain and failure of Qì to reach. When it should dissolve but halts in one place instead, the result is Dissolution Disease. When it encircles like a necklace, this constitutes goiters. When it lodges, this constitutes tumors, which likewise means congealing of Qì.

The Nèi Jīng states: “Anger results in ascent of Qì, elation in laxness of Qì, grief in the dissolution of Qì, fear in descent of Qì, cold in constriction of Qì, heat in leakage of Qì, taxation in exhaustion of Qì, pondering in binding of Qì, and panic in Qì chaos.” These nine [forms of] Qì are different from each other, and as such women’s diseases are predominantly engendered due to Qì.


Discussion

The term 形 xíng, which I have translated above as “physical body,” literally means shape or form, in the sense of the outside contour that throws a shadow 彡. It is essential that we do not read the contrast between Qì and xíng in the sense of our Western Cartesian dualism between the immaterial mind and the material body or between “energy” and “matter,” as beginning students and popular accounts of Chinese medicine often do. There is a very good reason why well-trained professionals of Chinese medicine tend to carefully avoid the term “energy” at all costs and use the Chinese term Qì instead. Yes, energy is one aspect of Qì, but the Chinese concept includes so much more, as suggested by its etymology of steam rising up from cooked rice. Depending on context, Qì might more narrowly refer also to the breath that we inhale and exhale, or the basic “stuff” that the universe is made off, which is condensed into an infinite number of constantly changing gaseous, fluid, or solid forms. Qì is what animates the xíng, which has led some translators to use the phrase “vital stuff” to render it in English. While more accurate than “energy,” that translation is so general and devoid of the powerful associations of Qì especially in a medical context as to be almost meaningless.

The third paragraph of the answer contains four plays on words that are impossible to reflect in a literal translation: First, the two terms 通 “flow through” and 痛 “pain” are closely related etymologically, only differing by the semantic aspect or “radical” of the character. The intimate relationship between pain and lack of flow is one of the most basic concepts in the Chinese understanding of how the body works and how pain is generated and treated. It is eloquently expressed in the famous saying:

 通則不痛;痛則不通

tōng zé bú tòng; tòng zé bù tōng

Flow-through means absence of pain; pain means absence of flow-through.

The second instance of a play on words is much more challenging to translate and involves the character that I have translated as “dissolve”: 消 xiāo. It is the etymological source for the character 痟 xiāo, which I have translated a bit awkwardly as “Dissolution Disease.” Most readers who are familiar with Nigel Wiseman’s terminology in his Practical Dictionary of Chinese Medicine should recognize the meaning of this term, which he translates slightly differently as “dispersion,” in the context of pathology from the compound “dispersion thirst” (消渴 xiāokě), usually rendered in English TCM literature as “diabetes.” In traditional Chinese dictionaries, the character is explained with two groups of meanings as “soreness and headache” or as “diabetes.” The Zhōngyī Dàcídiǎn 《中醫大辭典》 (Great Dictionary of Chinese Medicine), for example, offers two different meanings: First, as a symptom that is related to the notion of dissolution or dissipation, of melting away, in the sense of “dissolution emaciation” (痟瘦), as in the compounds “dissolution thirst” 消渴 and “dissolution of the center” 痟中. Second, this dictionary defines 痟 xiāo as a disease name characterized by headache.

The third and fourth instances of a play on words work in a similar fashion: Both are disease names that are etymologically related to the state of the Qì described by the source character. First there is the relationship between the character 嬰 yīng, which means “necklace” or “to wear around the neck,” and 癭 yǐng, literally “encircling-the-neck disease,” or in other words, goiters. And then we find the character 留 liú “to lodge” that is used inside the character for “tumor,” which is a combination of “to lodge” with the disease radical: 瘤, also pronounced liú. In all of these cases, it is obvious how knowledge of the character’s etymology provides important insights into the etiology of the disease.

The quotation from the Nèi Jīng at the end of this Question is from Sù Wèn chapter 39, which is the famous treatise on pain. In that chapter, no reference is made to women being more prone to these diseases than men, and even after the explanation in the present answer above, it is not clear to me how these nine types of Qì explain why women are more prone to disease engendered by Qì. A much more convincing answer to that question is offered by Sūn Sī miǎo in his famous introductory essay on his gynecological formulas:

然而女人嗜欲多於丈夫,感病倍於男子,加以慈戀,愛憎,嫉妒,憂恚,染著堅牢,情不自抑,所以為病根深,療之難瘥。

This being so, women’s predilections and desires exceed those of men and they contract diseases at twice the rate of men. In addition, when they are affected by compassion and attachment, love and hatred, envy and jealousy, and worry and rancor, these become firmly lodged and deep-seated. Since they are unable to control their emotions by themselves, the roots of their diseases are deep and it is difficult to obtain a cure in their treatment.

It is up to the individual reader to decide how to interpret this statement: My feminist students tend to view it as an offensive and patronizing attempt by an elite man to explain women’s frustrations that were due to their difficult lives in a time, society, and culture that did not allow them to express themselves fully. I tend to be reluctant to pass judgment on the supposed misogyny of early Táng society because it is simply too difficult, in my opinion, to get a true sense of the lived experiences of women, varied as they were by class, region, individual circumstances, and even the meaning of male-female hierarchical relationships in such a distant time. In the context of that essay, I read it as part of Sūn Sīmiǎo’s effort to convince his contemporaries of the importance of taking care of women as the true foundation of “nurturing life” by creating and maintaining healthy families, in all meanings of that word.

To return to the question here and Qí Zhòngfǔ’s answer, his explanation on the basis of the Sù Wèn quote makes sense when we assume that the connection between women and emotionality was something so self-evident to medical authors of the Sòng period that it did not need to be spelled out. Since, in their minds, women were obviously much more strongly affected by emotional upheaval then men, the answer here merely explains the specific effects of these emotions, subdivided into nine different kinds to emphasize the comprehensiveness of this emotional profile and all the various ways in which the flow of Qì could be disrupted. With its reference to the “Seven Qì,” which should probably be interpreted here as identical to the “Seven Emotions,” the first formula following the present answer also supports this emphasis on the emotions as the link between women and Qì disorders.

Sabine WilmsComment