Yi-Li Wu. Medicine, Metaphor, and Childbirth in Late Imperial China. Berkeley, Los Angeles: University of California Press, 2010. 362 pp. ISBN 978-0-520-26068-9 (hardcover).

In this masterful study of late imperial fuke, or medicine for women, Yi-Li Wu examines the interplay between late imperial society, medical and Neo-Confucian philosophy, and the material realities of childbirth. Each chapter opens with a vivid account of a parturient or postpartum woman whose life hangs in the balance, to be nurtured back to health through the appropriate diagnosis and treatment of a skilled practitioner, or to be hastened to her death by an incompetent charlatan. These accounts, derived from physician casebooks and the editorial prefaces of fuke texts, remind us both that the stakes were high in the battles of competing medical currents, and that the potential for complications in pre-modern childbirth posed a real and immediate danger to a woman and her family.

Reproducing Women offers both a social history of women’s medicine and a sophisticated gendered analysis of the medical philosophies within fuke from the seventeenth through the early nineteenth centuries. The first two chapters of this six chapter book examine the social world of medical practitioners and medical texts, before delving into questions of medical philosophy in the remaining chapters.

Chapter One introduces us to the world of late imperial fuke, a subfield of classical medicine that focused on managing menstruation, pregnancy, and post partum health. While female midwives played an indispensible role in delivering babies, literate male doctors and amateurs drew upon their knowledge of neo-Confucian cosmology and classical medicine to claim superiority over the hands-on experience of the midwife, focusing instead on managing pregnancy and post partum recovery through behavioral and pharmaceutical means. Their chief rivals, however, were not midwives, but other male practitioners whom they derided on class, professional, and epistemological grounds.

Wu describes male literati involvement in treating and publishing on women’s reproductive health as a public demonstration of Confucian benevolence. What, after all, could be more Confucian than helping to ensure the fertility and survival of a wife, without whom no patriline could be perpetuated? Wu reveals additional motivations for publishing in Chapter Two, which focuses on popular Qing fuke texts. Men who sought karmic merit for good deeds printed numerous copies of amateur advice books on childbirth, or dosing manuals that contained secret proprietary formulas known for their efficacy in treating women’s ailments. As families feared the potential harm incurred by charlatan doctors, they turned to dosing manuals, which listed symptoms alongside corresponding pharmaceutical formulas, for self-treatment.

In the remaining four chapters Wu reveals the diversity of concepts and approaches to fuke in debates over the nature and structure of the female reproductive body, its degree of difference from men’s bodies, and the best methods for maintaining a pregnancy or promoting post partum recovery. A doctor’s underlying assumptions about the female body informed both his diagnosis and treatment, influencing whether he sought to bolster yin or prescribe heating formulas to sustain a pregnancy, and whether he prescribed purgatives to prevent stagnation or formulas to replenish blood for post partum recovery. Wu argues that late imperial fuke was marked by a move away from both popular religious views of childbirth as polluting and elite medical views “that women were inherently more sickly and harder to treat than men” (p. 42). Instead, “the intellectual vanguard of late imperial fuke was distinguished by a markedly optimistic view of female bodies, epitomized by the idea that ‘women’s ailments are fundamentally the same as men’s,’ and by the teaching that childbirth was an inherently safe process that replicated the spontaneous ease of cosmogenesis” (p. 4). The most extreme example of this concept of “cosmologically resonant childbirth” can be seen in Treatise On Easy Childbirth (Dasheng bian), which argues that without the unnecessary interventions of doctors and midwives, the child would be born without complication, “as easily as ‘a ripe melon drops from the stem’” (p. 148).

Reproducing Women expands upon the model set forth by Charlotte Furth’s ground breaking work A Flourishing Yin, in providing a gendered analysis of the Chinese medical body, and demonstrates the rich source material and research possibilities in this emerging subfield. Wu also demonstrates how fuke was connected with broader medical and philosophical discussions. In tracing the motivations for publishing and purchasing popular texts, Wu not only provides the genealogy of her research texts, she offers significant insights into the role of elite literati medicine in the broader society, a topic of recent debate among scholars of the history of Chinese medicine. For example, Wu demonstrates how the formulas recorded in popular dosing manuals contained traces of the epistemological battles between different medical currents debated in elite fuke texts, and how the popular amateur text, Treatise On Easy Childbirth represented a simplified version of elite medical and cosmological principles. Reproducing Women is a delight to read, and is recommended especially for scholars of the history of Chinese medicine and for the study of gender in Chinese society.

(Nicole Richardson, University of California, Davis)