Obstetrics and Gynecology in Chinese

Medicine 2nd Edition

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 Contents vii

CHAPTER 48 CHAPTER 60
URINARY DIFFICULTY AFTER CHILDBIRTH 615 ABDOMINAL MASSES 793

CHAPTER 49 CHAPTER 61
SWEATING AFTER CHILDBIRTH 625 EXCESSIVE VAGINAL DISCHARGE 813

CHAPTER 50 CHAPTER 62
CONSTIPATION AND HAEMORRHOIDS AFTER VAGINAL ITCHING (AND TRICHOMONAS AND CANDIDA
CHILDBIRTH 629 INFECTIONS AND GENITAL ECZEMA) 827

CHAPTER 51 CHAPTER 63
FEVER AFTER CHILDBIRTH 639 PROLAPSE OF THE UTERUS 835

CHAPTER 52 CHAPTER 64
JOINT PAIN AFTER CHILDBIRTH 651 VULVAR SORES 841

CHAPTER 53 CHAPTER 65
BREAST MILK NOT FLOWING (AND ACUTE ENDOMETRIOSIS 849
MASTITIS) 657
CHAPTER 66
CHAPTER 54 POLYCYSTIC OVARY SYNDROME 889
SPONTANEOUS FLOW OF MILK 669
CHAPTER 67
CHAPTER 55 MYOMA 923
COLLAPSE AFTER CHILDBIRTH 673
APPENDIX 1: HERBAL PRESCRIPTIONS 935
CHAPTER 56 APPENDIX 2: SUGGESTED SUBSTITUTIONS OF
CONVULSIONS AFTER CHILDBIRTH 679 CHINESE HERBS 1009
PINYIN–ENGLISH GLOSSARY OF CHINESE TERMS 1011
ENGLISH–PINYIN GLOSSARY OF CHINESE TERMS 1021
SECTION 8 CROSS-REFERENCE OF CHINESE DISEASE-SYMPTOMS
WITH WESTERN DISEASES 1031
MISCELLANEOUS DISEASES 683
CROSS-REFERENCE OF WESTERN DISEASES WITH
CHINESE DISEASE-SYMPTOMS 1033
CHRONOLOGY OF CHINESE DYNASTIES 1035
CHAPTER 57
BIBLIOGRAPHY 1037
INFERTILITY 685
INDEX 1039
CHAPTER 58
MENOPAUSAL SYNDROME 735

CHAPTER 59
BREAST LUMPS 769
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 FOREWORD TO THE FIRST
EDITION
East Asian medicine must always negotiate a peculiar
tension between revered point of departure and
thousands of years of experience. If the ancients are
overvalued, the clinical application could be interpreted
as a decline. If the accumulated experience is praised
too highly, the original sources can seem to have been
a bit too flawed. Each practitioner must also embody
this tension; to what extent does one follow strictly the
established authority and to what extent do unique
cultural and personal exigencies supersede ‘standard’
perspectives? Successfully navigating this polarity has
been a key component of the vitality of the entire East
Asian medical tradition and a hallmark of a sensitive
and masterly practitioner.
Excellence in the tradition of East Asian medicine
has always been defined by the ability to be simul-
taneously immersed in the past while also respond-
ing meaningfully and practically to the present. To
be a great teacher for any generation of the tradition
requires the rare ability to summarize contemporary
experience and then integrate these insights into the
perennial dialogue of the archaic. Time and timeless-
ness. New insights and revered knowledge. Change
and reverence. Movement and stillness. These two
poles must balance upon a single fulcrum, becoming
a unified body of knowledge in an unbroken transmis-
sion. An almost impossible goal, this enterprise is also
an absolutely necessary task for every generation. The
history of East Asian medicine is a remarkable chain
of transmission and modulation from one generation,
dynasty, and even country, to the next.
Our generation seems especially significant in this
transmission and transformation of East Asian med-
icine. We are participants in a huge leap: health
expectations, disease burdens, linguistic barriers
and complex cultural obstacles must be bridged. The
ancient traditions must not only co-habit and interact
with modern biomedicine and a host of other comple-
mentary therapies, but also graft themselves upon a
very different civilization. Clarity, sensitivity, knowl-
edge and wisdom must all be brought to bear lest the
authenticity of age-old theory and techniques weaken
into shallow semblance. Under what circumstances
should modern clinical experience suggest modifica-
tion in ancient approaches? How would such altera-
tion fit comfortably into the tradition? How can such
an adjustment become the very link to preserving the
continuity with the past? These are serious questions
needing thoughtful responses.
Giovanni Maciocia is a respected guide in this tran-
sitional period of East Asian medicine to the Western
arena. His accomplishments as a teacher and writer
have made him a major force in this successful move-
ment from one world to another. The Foundations of
Chinese Medicine, The Practice of Chinese Medicine and
Tongue Diagnosis in Chinese Medicine are all outstand-
ing contributions of scholarship and clinical acumen,
and this present volume, Obstetrics and Gynecology
in Chinese Medicine, adds significantly to his accom-
plishments. Indeed, one begins to see the outlines of a
Maciocia transmission or tradition existing within our
very own generation.
This volume is simultaneously an encounter with
the classics of Chinese medicine, this morning’s patient
and the insights of a seasoned practitioner. It is a won-
derful example of balancing old and new in order to
fulfil the mandate of ‘accurate’ transmission. The con-
temporary clinical insights in Obstetrics and Gynecology
in Chinese Medicine are deep, while its references to clas-
sical sources are precise and relevant. Classical cita-
tions are balanced with contemporary case histories
to provoke understanding and clinical guidance while
x Foreword
eschewing mere pedantry. Giovanni Maciocia is won-
derful in exhuming details of the archaic knowledge
that has been neglected in Asia itself. This is apparent
throughout the text and two important examples are
his discussions of the Extraordinary Vessels and of
post-natal melancholy. Giovanni Maciocia is com-
fortable acknowledging the divergence of his clini-
cal experience with that of his mentors in China.
This textbook is unafraid to present the details of pat-
terns of disharmony that are relatively infrequent in
China, and therefore not mentioned in typical books
or lectures, but which actually appear frequently in
Western societies. The text extensively addresses a
simultaneous deficiency of Kidney-Yin and Kidney-
Yang in women which is rarely mentioned in Chinese
sources. Giovanni Maciocia is also unafraid to quote
contradictory authoritative sources. The ancients were
physicians, not a ‘health cult’ with all the answers, and
their multiple voices in this text help to give them depth
and allow our modern voice to embrace diversity.
Obstetrics and Gynecology in Chinese Medicine is a
paradigmatic work. It is tempered with reverence and
innovation, meticulous archival attention and detailed
modern clinical insight. When future generations
look back at this work and other books by Giovanni
Maciocia, they will find not only knowledge and wis-
dom but also reasons for inspiration and awe. As a
community of practitioners, we are fortunate to bene-
fit from the efforts of giants such as Giovanni Maciocia.
Because of his efforts and also our entire community’s
dedication, our ‘generation’ will probably succeed in
its critical destiny and responsibility for bringing East
Asian medicine to the centre of a new cosmopolitan
healthcare agenda.
Ted J Kaptchuk
1997
 PREFACE TO THE SECOND
EDITION
I finished writing the first edition of Obstetrics and
Gynecology in Chinese Medicine in 1997. Now, 13 years
later, I have had the chance to treat many more women
and to appreciate even more how effective Chinese
medicine is in treating gynecological problems.
The main features of the second edition of this text
compared to the first are as follows:
1. The text has been thoroughly revised throughout.
2. I have added more patterns and new prescriptions
to many diseases.
3. I have added three chapters on important
biomedically defined diseases, i.e. endometriosis,
polycystic ovary syndrome and myomas.
4. The chapter on obstetrics (Ch. 44) has been
completely revised and expanded by Sarah Budd,
a midwife/acupuncturist at the forefront of the
integration of acupuncture in a biomedical setting
for labour and pre- and post-natal care.
As for the first edition, I have chosen to name the gyne-
cological conditions in the traditional Chinese way, for
example ‘Painful Periods’ rather than ‘Dysmenorrhoea’,
‘Flooding and Trickling’ rather than ‘Metrorrhagia’,
‘Heavy Periods’ rather than ‘Menorrhagia’, ‘No Periods’
rather than ‘Amenorrhoea’, etc. Please note that these
are disease entities (which I call ‘disease-symptoms’) in
Chinese medicine although not in Western medicine.
For example, in Western medicine, ‘painful periods’ is
not a disease but a symptom; endometriosis is a ‘disease’
which could cause the symptom of painful periods.
A Chinese gynecologist would always diagnose the
disease before diagnosing the pattern. Diagnosing the
disease (e.g. Flooding and Trickling) is called bian bing
while diagnosing the pattern is called bian zheng. It
may be argued by some that diagnosis of the (Chinese)
disease is not that important because we treat accord-
ing to patterns. This is not so for two main reasons.
The first is that one should be clear about the disease
being treated. For example, a woman might complain
of ‘heavy periods’ and we might diagnose ‘Flooding
and Trickling’ when, on close observation, she suffers
from ‘Mid-Cycle Bleeding’. Second, simply treating
according to pattern is not enough. For example, the
Blood stasis occurring in ‘Flooding and Trickling’
is treated differently (and therefore with different
formulae) than the Blood stasis in ‘Painful Periods’.
Even more so, the Blood stasis in ‘Abdominal Masses’
is treated very differently than the Blood stasis in
‘Painful Periods’.
As in all my other texts, the acupuncture points given
under each pattern are not combinations of points
(with a few exceptions) but a range of points from
which the practitioner can choose. Whenever points do
form a combination, it is called ‘Ancient Prescription’.
The principles of combination of points is discussed at
length in The Channels of Acupuncture.
The reader should be alerted to the fact that some
of the formulae contained in this book may contain
substances that are illegal in certain countries, either
because they are protected species of plants or animals
or because the substance is deemed to be toxic (in some
cases wrongly so). The reader is therefore urged to
familiarize himself or herself with the laws governing
the use of herbs (and minerals and animal products)
of their particular country. The prescriptions contain-
ing potentially illegal substances have been retained in
this book for two reasons. First, since the book is sold
all over the world, laws governing the use of such sub-
stances vary from country to country; for example, the
use of Fu Zi Radix Aconiti lateralis preparata is illegal in
Europe but not in the USA. Second, the formulae have
been given as they appear in old and modern Chinese
books to highlight the thinking and treatment strat-
egy behind a particular formula. Once we under-
stand the rationale of a formula’s composition, we are
in a position to modify it by making substitutions for
some of its ingredients. If we did not know the original
ingredients, we could not make a rational substitution.
xii Preface to the Second Edition
For example, if a formula contains Fu Zi Radix Aconiti
lateralis preparata we know that it is meant to heat the
body strongly and expel Cold and so, should we decide
to eliminate Fu Zi from the formula, we need to substi-
tute another herb (or possibly more than one) in a dose
that is high enough to mimic the action of Fu Zi. In this
example, Rou Gui Cortex Cinnamomi would be a possi-
ble substitution. Another example is that of Quan Xie
Buthus Martensi (scorpion): a formula that contains
this animal product is meant to have a strong Wind-
extinguishing action and, if we want to replace it, we
know that we need to use a herb (or possibly more than
one) that has a similar strong action.
On the subject of toxicity and the law regula-
tions, I would like particularly to draw attention to
Mu Tong and Aristolochia. There are several species
that are called ‘Mu Tong’ in Chinese (and some of
them are not Aristolochia, e.g. Akebia) and the use of
Aristolochia is not allowed in Europe due to its alleged
renal toxicity. As there has been an exceptional level
of attention dedicated to this herb following cases of
renal toxicity, I strongly advise practitioners against
using this herb (in any country). Indeed, authorities
are so strict on this that they do not allow the use of
any herb called ‘Mu Tong’ even if it not Aristolochia
(e.g. Caulis Akebiae) due to the possibility of mistaken
identification. Again, the reason this herb has been
retained in the old formulae is to allow the practi-
tioner to make a rational substitution. In particu-
lar, a frequent substitution for Mu Tong is Tong Cao
Medulla Tetrapanacis.
The material in this book is gathered from many
old and modern Chinese texts, from the teaching of
various Chinese teachers and from my own experi-
ence. Whenever I write something that reflects my
experience, I make that clear by saying ‘according to
my experience’. The two main texts used as sources
are Gynaecology in Chinese Medicine by Cong Chun Yu
(Zhong Yi Fu Ke Xue) 1989 Ancient Chinese Medicine
Texts Publishing House, Beijing, and Luo Yuan Kai’s
Gynaecology in Chinese Medicine (Zhong Yi Fu Ke
Xue) 1986 Shanghai Science and Technology Press,
Shanghai.
Please note that the dosages indicated in the herbal
prescriptions are those from the original texts. In my
practice, I generally use low dosages and certainly
lower than those used in modern China. For example,
my dosages for a decoction range generally from 3 to
9 grams per herb daily whereas doctors in China tend
to use 10 grams or usually more. Thus, whenever a
source does not specify the dosages within a prescrip-
tion, I have indicated the dosages that I would use.
Compared to the first edition, I have removed all
Chinese patent remedies due to the unverifiable quality
controls of Chinese patent remedies.
Finally, each chapter includes the differentiation of the
disease-symptom discussed in Western medicine: e.g. the
possible causes of painful periods in Western medicine.
Of course, this is not intended to replace a good book on
Western gynecology (some are mentioned in the bibli-
ography): it is simply meant to provide the practitioner
in a clinical setting with a quick check list of the pos-
sible Western causes of that particular symptom. This
is important because we should know when to refer a
patient to a Western gynecologist for a further diagnosis.
For example, a patient may come to us presenting
with post-menopausal uterine bleeding and we should
know when to suspect uterine carcinoma. Another rea-
son for familiarizing ourselves with the Western differ-
entiation of symptoms is prognosis. Although Chinese
medicine is excellent at providing not only a diagnosis
but also a reasonable prognosis by carefully examin-
ing symptoms, signs, tongue and pulse, in many cases
the prognosis depends also on the Western diagnosis; it
makes a considerable difference to prognosis, for exam-
ple, if excessive uterine bleeding is merely functional or
is caused by a large myoma.
The last 13 years of practice (since the publication
of the first edition) have confirmed to me even more
the importance of a Western diagnosis in many
gynecological conditions, e.g. breast lumps (possible
breast cancer), uterine bleeding (possible myoma),
painful periods (possible endometriosis), amenorrhoea
(possible polycystic ovary), etc.
Giovanni Maciocia
2011
 ACKNOWLEDGEMENTS
I acknowledge with sincere thanks the many people
who, in one way or another, have helped me to write
this book.
The most important period in my professional train-
ing was spent at the Nanjing University of Traditional
Chinese Medicine and I am deeply indebted to its direc-
tors, teachers and other members of staff for the care
and patience in sharing their profound knowledge
with me. I am also grateful to the teaching staff of
the Jiangsu Province Hospital for Traditional Chinese
Medicine where my clinical training took place.
The late Dr J H F Shen was an inspiration for me. I
owe him a debt of gratitude for communicating his
diagnostic skills to me.
Dr Ted Kaptchuk provided my first introduction to
Chinese herbs and for that I am very grateful.
I am indebted to Fi Lyburn for editing and proofread-
ing my manuscript with great care and for providing
useful suggestions.
I was fortunate to obtain the collaboration of Sarah
Budd, a midwife/acupuncturist who has been practising
midwifery at Derriford Hospital, Plymouth, England
since 1988 using acupuncture for ante-natal, intra- and
post-partum care within the National Health Service:
her knowledge and long experience in the use of Chinese
medicine in obstetrics is a great bonus to my book.
I am also indebted to Debra Betts for her contribu-
tion and suggestions regarding the chapter on labour
(Ch. 44).
I am indebted to Dr Xia Gui Cheng, director of the
Gynaecology Department of the Nanjing Province
Hospital of Chinese Medicine (affiliated to the Nanjing
University of Traditional Chinese Medicine) for
communicating his experiences to me during my study
period in Nanjing.
Dr Serena Selva read the sections on the Western
differentiation in each chapter and gave me her invalu-
able comments and criticism: for this I am very grateful.
I would like to thank the staff of Elsevier for their
expertise, efficiency and courtesy: in particular, I am
grateful to Veronika Watkins and Claire Wilson for
their help and support with this project.
This page intentionally left blank
 NOTE ON THE TRANSLATION
OF CHINESE MEDICAL TERMS
The terminology used in this book generally follows
that used in The Foundations of Chinese Medicine (2nd
edn) and The Practice of Chinese Medicine (2nd edn). In
my books, I have opted for translating all Chinese medi-
cal terms with the exception of ‘Yin’, ‘Yang’, ‘Qi’ and
‘cun’ (unit of measurement).
I have also continued to use initial capitals for the
terms which are specific to Chinese medicine. For
example, ‘Blood’ indicates one of the vital substances
of Chinese medicine, whereas ‘blood’ denotes the liquid
flowing in the blood vessels; e.g. ‘In Blood deficiency
the menstrual blood may be pale’. I use initial capitals
also for all pulse qualities and for pathological colours
and shapes of the tongue body.
This system has served readers of my books well. As
most teachers (including myself) use Chinese terms
when lecturing (e.g. Yuan Qi rather than ‘Original Qi’),
I have given each term in Pinyin whenever it is intro-
duced for the first time. One change I have introduced
recently (as in the second edition of The Foundations of
Chinese Medicine) is to use the Pinyin terms more often
throughout the text and at least once in each chapter
when the Chinese term is first introduced. I have done
this to reduce the frequency with which the reader may
need to consult the glossary.
I made the choice of translating all Chinese terms
(with the exceptions indicated above) mostly for rea-
sons of style: I believe that a well-written English text
reads better than one peppered with Chinese terms in
Pinyin. Leaving Chinese terms in Pinyin is probably the
easiest option but this is not ideal also because a single
Pinyin word can often have more than one mean-
ing; for example, jing can mean ‘channels’, ‘periods’,
‘Essence’ or ‘shock’, while shen can mean ‘Kidneys’,
‘Mind’ or ‘Spirit’.
I am conscious of the fact that there is no such thing
as a ‘right’ translation of a Chinese medicine term and
my terminology is not proposed in this spirit; in fact,
Chinese medicine terms are essentially impossible to
translate. The greatest difficulty in translating Chinese
terms is probably that a term has many facets and
different meanings in different contexts: thus, it would
be impossible for one translation to be ‘right’ in every
situation and every context. For example, the term
jue ( ) has many different meanings; a translation
can illustrate only one aspect of a multi-faceted term.
In fact, jue can mean a state of collapse with uncon-
sciousness; coldness of hands and feet; or a critical sit-
uation of retention of urine. In other contexts it has
other meanings: e.g. jue qi ( ), a condition of cha-
otic Qi; jue xin tong ( ), a condition of violent
chest pain with cold hands; and jue yin zheng ( ),
the Terminal-Yin pattern within the Six-Stage
Identification of Patterns characterized by Heat above
and Cold below.
Many sinologists concur that Chinese philosophi-
cal terms are essentially impossible to translate and
that, the moment we translate them, we distort them
with a world view that is not Chinese. Ames is partic-
ularly clear about the intrinsic distortion of Chinese
concepts when they are translated. He gives examples
of Chinese terms that are distorted when translated,
such as Tian (‘Heaven’), You-Wu (‘Being’ and
‘Non-Being’), Dao (‘Way’), Xing (‘human nature’),
Ren (‘benevolence’), Li (‘Principle’), Qi (‘primal
substance’), etc.1
Ames is particularly forceful in rejecting a single,
one-to-one translation of a Chinese term into a
Western one in the introduction of his book Focusing
the Familiar (a translation of the Confucian text Zhong
Yong).2 Ames says:
Our Western languages are substance-oriented and are
therefore most relevant to the descriptions of a world
defined by discreteness, objectivity and permanence. Such
languages are ill disposed to describe and interpret a world,
such as that of the Chinese, that is primarily characterized
by continuity, process and becoming.3
xvi Note on the Translation of Chinese Medical Terms
Ames then gives some examples of what he considers
to be serious mis-translations of Chinese philosophi-
cal terms. The important thing is that these are not
‘mis-translations’ because the terms are ‘wrong’ but
because of the intrinsic difference between Chinese and
Western thinking and therefore the inherent inability
of Western terms to convey Chinese philosophical
ideas. Ames says:
For example, ‘You’ and ‘Wu’ have often been uncriti-
cally rendered as ‘Being’ and ‘Non-Being’. Influential
translators, until quite recently, have rendered ‘wu xing’
as ‘Five Elements’. ‘Xing’ is still most often trans-
lated as ‘nature’. All these translations promote the fixed
and univocal characterizations of objects or essences emer-
gent from a language rooted in a substantialist perspective
[our Western languages].4
Ames stresses that the use of a ‘substances language’
(i.e. a Western language) to translate Chinese insights
into a world of process and change has led to seriously
inappropriate interpretations of the Chinese sensibility.
Ames asserts that it is the very difference between
Chinese and Western philosophy that makes translation
of Chinese terms virtually impossible. He says:
In the classical traditions of the West, being takes pre-
cedence over becoming and thus becoming is ultimately
unreal. Whatever becomes is realized by achieving its end –
that is, coming into being. In the Chinese world, becoming
takes precedence over being. ‘Being’ is interpreted as a
transitory state marked by further transition.5
Ames then says:
The Chinese world is a phenomenal world of continuity,
becoming and change. In such a world there is no final
discreteness. Things cannot be understood as objects.
Without this notion of objectivity, there can only be the
flux of passing circumstances in which things dissolve
into the flux and flow. A processive language precludes
the assumption that objects serve as references of
linguistic expressions. The precise referential language
of denotation and description is to be replaced by a lan-
guage of ‘deference’ in which meanings both allude to
and defer to one another in a shifting field of significance.
A referential language [Western language] character-
izes an event, object, or state of affairs through an act of
naming meant to indicate a particular thing. On the other
hand, the language of deference [Chinese] does not employ
proper names simply as indicators of particular individuals
or things, but invokes hints, suggestions, or allusions to
indicate foci in a field of meanings.6
As an example of this intrinsic impossibility of trans-
lating a Chinese philosophical term into a Western
language, Ames then cites Steve Owen’s reluctance in
translating shi as ‘poem’. Owen says:
If we translate ‘shi’ as ‘poem’, it is merely for the sake of
convenience. ‘Shi’ is not a ‘poem’: ‘shi’ is not a thing made
in the same way one makes a bed, a painting or a shoe.
A ‘shi’ can be worked on, polished and crafted; but that has
nothing to do with what a ‘shi’ fundamentally ‘is’ … ‘Shi’
is not the ‘object’ of its writer: it is the writer, the outside
of an inside.7
Ames gives various translations of Li (a Confucian
concept) as an example of how a multiplicity of terms
may apply to a single Chinese term and how none of
them is ‘wrong’. He says that Li has been variously
translated as ‘ritual’, ‘rites’, ‘customs’, ‘etiquette’,
‘propriety’, ‘morals’, ‘rules of proper behaviour’ and
‘worship’. Ames says:
Properly contextualized, each of these English terms can
render li on occasion. In classical Chinese, however, the
character carries all of these meanings on every occasion
of its use.8
This confirms clearly how, by the very translation, we
limit a Chinese term that is rich with multiple mean-
ings to a single meaning in Chinese.
Ames says that in classical Chinese philosophical
texts, allusive and connotatively rich language is more
highly prized than clarity, precision and argumentative
rigor. This rather dramatic contrast between Chinese
and Western languages with respect to the issue of
clarity presents the translator of Chinese philosophical
texts with a peculiar burden.
For the Chinese, the opposite of clarity is not
confusion, but something like vagueness. Vague ideas
are really determinable in the sense that a variety of
meanings are associated with them. Each Chinese term
constitutes a field of meanings which may be focused
by any of a number of its meanings. Ames says that
in the translation of Chinese texts we must avoid what
Whitehead called ‘the Fallacy of the Perfect Dictionary’.

By this, he means the assumption that there exists a
complete semantic repository of terms of which we
may adequately characterize the variety and depth of
our experience and that, ideally, one may seek a one-to-
one correspondence between word and meaning.
With this ‘fallacy’ in mind, Ames and Hall say:
We challenge the wisdom and accuracy of proposing
‘one-to-one’ equivalencies in translating terms from one
language to another. We introduce the notion of ‘linguistic
clustering’ as an alternative strategy to ‘literal translation’
that allows us to put the semantic value of a term first by
parsing [describe grammatically] its range of meaning
according to context, with the assumption that a range
of meaning with a different configuration of emphasis is
present on each appearance of the term.9
These ideas could not be more apt to illustrate the
problems in translating Chinese medicine terms. Of
course we must strive for precision and consistency but
to think that there is a one-to-one, ‘right’ correspon-
dence between a Chinese medicine idea and a Western
term is a misunderstanding of the very essence of
Chinese medicine.
For example, to say that the only ‘right’ translation
of Chong Mai is ‘Thoroughfare Vessel’ makes us fall into
the trap of what Whitehead calls the ‘Fallacy of the
Perfect Dictionary’. Of course, Chong Mai can be trans-
lated as ‘Thoroughfare Vessel’ but that is only one of
its meanings and it is absolutely impossible for a single
Western term to convey the richness of ideas behind
the word Chong Mai (which I translate as ‘Penetrating
Vessel’): to think that we can reduce a rich Chinese
medicine idea to a single, one-to-one term in a Western
language reveals, in my opinion, a misunderstanding
of the very essence of Chinese medicine.
Ames makes this point very forcefully. He says:
The Fallacy of the Perfect Dictionary is largely a
consequence of our analytical bias towards univocity.
We would suggest that this bias does not serve us well
when approaching Chinese texts. Not only is there the
continued possibility of novel experiences requiring
appeal to novel terminologies, but also there is seldom, if
ever, a simple, one-to-one translation of Chinese terms
into Western languages. The allusiveness of the classical
Chinese language is hardly conducive to univocal transla-
tions. We would contend that, in translating Chinese texts
into Western languages, it is most unproductive to seek
Note on the Translation of Chinese Medical Terms xvii
a single equivalent for a Chinese character. In fact, rather
than trying to avoid ambiguity by a dogged use of formally
stipulated terms, the translator might have to concede that
characters often require a cluster of words to do justice to
their range of meanings – all of which are suggested in
any given rendering of the character. In fact, any attempt
to employ univocal translations of Chinese terms justi-
fied by appeal to the criteria of clarity or univocity often
reduces philosophical insight to nonsense and poetry to
doggerel. Such an approach to translation serves only to
numb Western readers to the provocative significance har-
boured within the richly vague and allusive language of the
Chinese texts.10
As an example of the multiplicity of meanings of a
Chinese term and therefore of the fact that it is perfectly
legitimate to translate a single Chinese idea into more
than one term according to different contexts, Ames
says that he translates the term zhong (‘centre’ or
‘central’) in the title of the Confucian text sometimes
as ‘focus’, sometimes as ‘focusing’ and other times as
‘equilibrium’. Other times, he even translates it as ‘cen-
tre’ or ‘impartiality’. He says strongly:
The Chinese language is not logocentric. Words do not
name essences. Rather, they indicate always-transitory
processes and events. It is important therefore to stress the
gerundative character of the language. The language of
process is vague, allusive and suggestive.11
According to Ames, in the field of philosophy, two
terms particularly stand out as being influenced by
a Western thinking when translated, namely Tian
(‘Heaven’) and Ren (‘benevolence’). Ames says:
When we translate Tian as ‘Heaven’, like it or not, we
invoke in the Western reader a notion of transcendent
creator Deity, along with the language of soul, sin and
afterlife … When we translate Ren as ‘benevolence’, we
psychologize and make altruistic a term which originally
had a radically different range of sociological connotations.
Being altruistic, for example, implies being selfless in the
service of others. But this ‘self-sacrifice’ implicitly entails
a notion of ‘self” which exists independently of others
and that can be surrendered – a notion of self which we
believe is alien to the world of the Analects [of Confucius]:
indeed, such a reading [of the term ‘ren’] transforms what
is fundamentally a strategy for self-realization into one of
self-abnegation.12
xviii Note on the Translation of Chinese Medical Terms
With regard to Chinese medicine, the term Xue
(‘Blood’) is a good example of the above-mentioned
problem reported by Ames. When we translate the
word Xue as ‘Blood’ we immediately alter its essential
character and give it a Western medical connotation; in
fact, in Chinese medicine, Xue is itself actually a form of
Qi and one that is closely bound with Nutritive Qi (Ying
Qi). Indeed, the term mai appearing in the Yellow
Emperor’s Classic of Internal Medicine is often ambigu-
ous as it sometimes clearly refers to the acupuncture
channels and other times to the blood vessels.
After highlighting the problems in translating
Chinese terms, Ames confirms that a single Chinese
term may have different meaning in different contexts.
For example, the term shen in some cases means
‘human spirituality’, in others it means ‘divinity’.13
As he considers only the philosophical meanings of
the word shen, we could actually add many others in
the context of Chinese medicine, for example ‘mind’,
‘spirit’, ‘lustre’ (in the context of diagnosis).
Graham says:
Every Western sinologist knows that there is no exact
equivalent in his own language for such a word as ren
or de , and that as long as he thinks of it as synonymous
with ‘benevolence’ or ‘virtue’ he will impose Western pre-
conceptions on the thought he is studying.14
Ames then surveys the options that are presented
to a translator and seems to favour simply transliter-
ating the Chinese terms and leave them untranslated.
He says:
To some, this approach may appear to be simply the laziest
way out of a difficult problem. But ‘ritual’ has a narrowly
circumscribed set of meanings in English, and Li an
importantly different and less circumscribed set. Just as
no Indological scholar would look for English equivalent
for ‘karma’, ‘dharma’ and so on, perhaps it is time to do
the same for classical Chinese, the homonymity of the
language notwithstanding.15
Hall confirms that a single Chinese term may have a
plurality of meanings. He says:
The Chinese have traditionally affirmed as the ground of
their intellectual and institutional harmony the recogni-
tion of the co-presence of a plurality of significances with
which any given term might easily resonate.16
Finally, another sinologist, Yung Sik Kim, discusses
the difficulty presented by the plurality of meanings of
a single Chinese term. He says:
I have adopted the policy of sticking to one English
translation for a particular Chinese word whenever possible
… Of course, exceptions cannot be avoided altogether. I have
had to resort to different translations for such characters as
‘xin’ which means both ‘heart’ and ‘mind’; ‘tian’ , both
‘heaven’ and ‘sky’.17
In another passage, Yung Sik Kim affirms that trans-
literation of a Chinese term with a plurality of mean-
ings is the only alternative:
The term ‘li’ is difficult to define. It is difficult even to
translate because there is no single word in Western lan-
guages that covers all facets of what ‘li’ meant to the tra-
ditional Chinese mind. The existence of many translations
for the term, which often leaves transliteration as the only
viable option, bespeaks the difficulty.18
Although a diversity of translation of Chinese
terms may present its problems, these are easily over-
come if an author explains the translation in a glos-
sary and, most importantly, explains the meaning of a
given Chinese term in its context (in our case, Chinese
medicine).
In my books, I have chosen to translate all Chinese
medicine terms rather than using Pinyin purely for
reasons of style as a sentence written half in English
and half in Pinyin is often awkward. Moreover, if we
use Pinyin terms in writing, it could be argued that
we should be consistent and use Pinyin terms for all
Chinese medicine terms and this would not make for
very clear reading. Consider the following sentence:
“To treat Pi-Yang Xu we adopt the zhi fa of bu pi and wen
Yang” (“To treat Spleen-Yang deficiency we adopt the
treatment principle of tonifying the Spleen and warm-
ing Yang”).
Moreover, the problem arises only in the written
form as, in my experience, most lecturers in colleges
throughout the Western world normally prefer using
Pinyin terms rather than their counterparts in English
(or any other Western languages). Thus, a lecturer
will refer to Kidney-Jing rather than ‘Kidney-Essence’.
Indeed, when I myself lecture, I generally use the Pinyin
terms rather than their English translation. Again,
most lecturers use a pragmatic approach translating

some terms into English (such as ‘treatment principle’
instead of ‘zhi fa’) and leaving others in Pinyin such as
‘Yuan Qi’ or ‘Chong Mai’.
When I lecture I always try to give the participants
an idea of the meaning of a particular Chinese charac-
ter and its significance and application in Chinese med-
icine. Indeed, the use of Pinyin when lecturing renders
Chinese medicine truly international as I can lecture in
the Czech Republic and mention Jing, Yang Qiao Mai, Wei
Qi, etc., knowing that I will be understood by everyone.
A diversity of translation of Chinese terms may even
have a positive aspect as each author may highlight
a particular facet of a Chinese term so that diversity
actually enriches our understanding of Chinese medi-
cine. If someone translates Zong Qi ( ) as ‘Initial Qi’,
for example, we learn something about that author’s
view and understanding of Zong Qi; the translation
cannot be branded as ‘wrong’ (I translate this term as
‘Gathering Qi’). Another example: if someone trans-
lates yang qiao mai as ‘Yang Motility Vessel’, the transla-
tion captures one aspect of this vessel’s nature; again,
this could not be defined as wrong (I translate the name
of this vessel as ‘Yang Stepping Vessel’).
Trying to impose a standard, ‘right’ translation of
Chinese medicine terms may lead to suppression of
healthy debate; I therefore hope that readers will con-
tinue to benefit from the diversity of translation of
Chinese medicine terms and draw inspiration from the
rich heritage of Chinese medicine that it represents.
I firmly believe that the future lies not in trying to
establish a rigid, embalmed, fossilized, ‘right’ terminol-
ogy based on single, one-to-one translations of Chinese
ideas. Indeed, I believe this is a potentially dangerous
trend as it would, in my opinion, lead students and prac-
titioners away from the richness of Chinese language
and richness of meanings of Chinese medicine ideas.
The adoption of a standardized, ‘approved’ terminol-
ogy of Chinese medicine terms may indeed, in time,
divorce students and practitioners from the essence of
Chinese medicine. If an ‘official’, standardized transla-
tion of Chinese terms took hold, then students would
be less inclined to study the Chinese terms to explore
their meaning.
Ames and Hall make the same point:
Such translations have been ‘legitimized’ by their gradual
insinuation into the standard Chinese–English dictionaries
and glosses. By encouraging the uncritical assumption
in those who consult these reference works that this
Note on the Translation of Chinese Medical Terms xix
formula of translations provides the student with a
‘literal’ rendering of the terms, these lexicons have become
complicit in an entrenched cultural equivocation that we
strive to avoid.19
They then further make the point that using a one-
to-one translation of Chinese terms ignores the cultural
background where they came from:
Our argument is that it is in fact these formulaic
usages that are radical interpretations. To our mind, to
consciously or unconsciously transplant a text from its
own historical and intellectual soil and replant it in one
that has decidedly different philosophical landscape is to
take liberties with the text and is radical in the sense it
tampers with its very roots.20
As I said above, an ‘official’, standardized translation
of Chinese terms may make students and practitioners
less inclined to study the Chinese terms to explore their
meaning with their own interpretation. Ames and Hall
say:
Our goal is not to replace one inadequate formula with
another. Our translations are intended as no more than
suggestive ‘placeholders’ that refer readers back to this
glossary to negotiate their own meaning, and, we hope, to
appropriate the Chinese terms for themselves.21
Moreover, imposing an ‘approved’ terminology in
English betrays an Anglo-centric world view: to be con-
sistent, we should then have an ‘approved’ terminology
in every major language of the world. It seems to me
much better to try and understand the spirit and the
essence of Chinese medicine by studying its characters
and their clinical significance and using Pinyin translit-
eration whenever appropriate.
Trying to fossilize Chinese medicine terms into an
imposed terminology goes against the very essence of the
Chinese language which, as Ames says, is not logocentric
and in which words do not name essences: rather, they
indicate always-transitory processes and events. The
language of process is vague, allusive and suggestive.
Because Chinese language is a language of process,
the question arises also whether practising Chinese
medicine actually helps the understanding of Chinese
medicine terminology: in my opinion, in many cases it
does. For example, I feel that clinical experience helps us
to understand the nature of the Chong Mai (Penetrating
xx Note on the Translation of Chinese Medical Terms
Vessel) and therefore helps us to understand the term
Chong in a ‘knowing practice’ way (as Farquhar defines
it)22 rather than a theoretical way.
Of course, a translator of Chinese books should strive
for precision and consistency, but we must accept that
there is a rich multiplicity of meanings for any give idea
of Chinese medicine. The Chong Mai is a good example
of this multiplicity as the term chong could be trans-
lated as ‘thoroughfare’, ‘strategic cross-roads’, ‘to pene-
trate’, ‘to rush’, ‘to rush upwards’, ‘to charge’, ‘activity’,
‘movement’ and ‘free passage’. Which of these transla-
tions is ‘correct’? They are all correct as they all convey
an idea of the nature and function of the Chong Mai.
I therefore think that the future of teaching Chinese
medicine lies not in trying to impose the straight-jacket
of a rigid terminology of the rich ideas of Chinese
medicine, but in teaching students more and more
Chinese characters explaining the richness of mean-
ings associated with them in the context of Chinese
medicine. I myself would not like my own terminology
to be ‘adopted’ as the ‘correct’ or ‘official’ one: I would
rather see colleges teaching more and more Chinese
to their students by illustrating the rich meanings of
Chinese medicine terms. As mentioned above, my main
motive for translating all terms is purely for reasons of
style in an English-language textbook; when I lecture
I generally use Pinyin terms but, most of all, I show the
students the Chinese characters and try to convey their
meaning in the context of Chinese medicine.
Finally, I would like to explain my continued trans-
lation of Wu Xing as ‘Five Elements’. The term ‘Five
Elements’ has been used by most Western practi-
tioners of Chinese Medicine for a long time (also
in French and other European languages). Some
authors consider this to be a misunderstanding of the
meaning of the Chinese term ‘Wu Xing’, perpetuated
over the years. ‘Wu’ means ‘five’ and ‘Xing’ means
‘movement’, ‘process’, ‘to go’, ‘conduct’ or ‘behav-
iour’. Most authors therefore think that the word
‘Xing’ cannot indicate ‘element’ as a basic constitu-
ent of Nature, as was supposedly intended in ancient
Greek philosophy.
This is, in my opinion, only partly true as the ele-
ments, as they were conceived by various Greek philos-
ophers over the centuries, were not always considered
‘basic constituents’ of Nature or ‘passive motionless
fundamental substances’.23 Some Greek philosophers
conceived the elements as dynamic qualities of Nature,
in a way similar to Chinese philosophy.
For example, Aristotle gave a definite dynamic inter-
pretation to the four elements and called them ‘primary
form’ (prota somata). He said:
Earth and Fire are opposites also due to the opposition of
the respective qualities with which they are revealed to our
senses: Fire is hot, Earth is cold. Besides the fundamental
opposition of hot and cold, there is another one, i.e. that
of dry and wet: hence the four possible combinations of
hot–dry [Fire], hot–wet [Air], cold–dry [Earth] and cold–
wet [Water] … the elements can mix with each other and
can even transform into one another … thus Earth, which
is cold and dry, can generate Water if wetness replaces
dryness.24
To Aristotle, therefore, the four elements became
the four basic qualities of natural phenomena, clas-
sified as combinations of four qualities: hot, cold, dry
and wet. As is apparent from the above statement, the
Aristotelian elements could even transform into one
another and generate each other.
This interpretation is very similar to the Chinese
one, in which the elements are qualities of Nature.
Furthermore, it is interesting to note the similar-
ity with the Chinese theory of Yin–Yang: the four
Aristotelian elements derive from the interaction
of the basic Yin–Yang qualities of cold–hot and
dry–wet.
Thus, it is not entirely true to say that the Greek ele-
ments were conceived only as the basic constituents of
matter, the ‘building blocks’ of Nature which would
make the use of the word ‘element’ wrong to indicate
xing. Furthermore, the word ‘element’ does not neces-
sarily imply that: it does so only in its modern chemical
interpretation.
In conclusion, for the above reasons I have kept the
word ‘element’ as a translation of the Chinese word
‘xing’. According to Wang, the term ‘Five Elements’
could be translated in a number of ways, e.g. ‘agents’,
‘entities’, ‘goings’, ‘conduct’, ‘doings’, ‘forces’, ‘activities’
and ‘stages of change’.25
Recently, the term ‘Five Phases’ is gaining accep-
tance but some sinologists disagree with this transla-
tion and propose returning to ‘Five Elements’. Friedrich
and Lackner, for example, suggest restoring the term
‘elements’.26 Graham uses the term ‘Five Processes’.27
I would probably agree that ‘processes’ is the best trans-
lation of Wu Xing. In fact, the book Shang Shu written
during the Western Zhou dynasty (1000–771 BC) said:
 Note on the Translation of Chinese Medical Terms xxi

The Five Elements are Water, Fire, Wood, Metal and Earth. 10. Ibid., p. 16.
11. Ibid., p. 16.
Water moistens downwards; Fire flares upwards; Wood 12. The Analects of Confucius, p. 312.
can be bent and straightened; Metal can be moulded and 13. Ibid., p. 313.
14. Hall D L, Ames R T 1998 Thinking from the Han – Self, Truth and
can harden; Earth allows sowing, growing and reaping.28 Transcendence in Chinese and Western Culture, State University of
New York Press, New York, p. 238.
Some sinologists (e.g. Needham and Fung Yu Lan) 15. The Analects of Confucius, p. 314.
16. Thinking from the Han, p. 4.
still use the term ‘element’. Fung Yu Lan suggests that a 17. Yung Sik Kim 2000 The Natural Philosophy of Chu Hsi, American
possible translation of wu xing could be ‘Five Activities’ Philosophical Society, Philadelphia, p. 11.
18. Ibid., p. 19.
or ‘Five Agents’.29 Although the term ‘five phases’ has 19. Daodejing, p. 55.
gained some acceptance as a translation of ‘wu xing’, I 20. Ibid., pp 55–56.
find this term restrictive as it clearly refers to only one 21. Ibid., p. 56.
22. Farquhar J 1994 Knowing Practice – The Clinical Encounter of
aspect of the Five Elements, i.e. phases of a (seasonal) Chinese Medicine, Westview Press, Boulder, USA.
cycle. 23. Needham J 1977 Science and Civilization in China, Vol. 2, Cambridge
University Press, Cambridge, p. 244.
24. Lamanna E P 1967 Storia della Filosofia (History of Philosophy), Vol.
1, Le Monnier, Florence, pp 220–221.
END NOTES 25. Wang Ai He 1999 Cosmology and Political Culture in Early China,
Cambridge University Press, Cambridge, p. 3.
1. Ames R T, Rosemont H 1998 The Analects of Confucius – A Philosophical 26. Friedrich M, Lackner M 1986 Once Again: the Concept of Wu Xing,
Translation, Ballantine Publishing Group, New York, p. 311. Early China 9–10: 218–219.
2. Ames R T, Hall D L 2001 Focusing the Familiar – A Translation and 27. Graham A C 1986 Yin–Yang and the Nature of Correlative
Philosophical Interpretation of the Zhong Yong, University of Hawaii Thinking, Institute of East Asian Philosophies, Singapore, pp 42–66
Press, Honolulu, pp 6–16. and 70–92.
3. Ibid., p. 6. 28. Shang Shu (c. 659 BC) cited in Practical Chinese Medicine (Shi Yong
4. Ibid., p. 6. Zhong Yi Xue ) 1975 Beijing Publishing House,
5. Ibid., p. 10. Beijing, p. 32. The book Shang Shu is placed by some in the early
6. Ibid., p. 10. Zhou dynasty (hence c. 1000 BC), but the prevalent opinion is that it
7. Ibid., p. 13. was written sometime between 659 BC and 627 BC.
8. Ibid., p. 69. 29. Fung Yu Lan 1966 A Short History of Chinese Philosophy, Free
9. Ames R T, Hall D L 2003 Daodejing – Making This Life Significant, Press, New York, p. 131.
A Philosophical Translation, Ballantine Books, New York, p. 56.
This page intentionally left blank
SECTION 1
PHYSIOLOGY AND
PATHOLOGY
1. HISTORY OF GYNECOLOGY IN CHINESE MEDICINE 3

2. WOMEN’S PHYSIOLOGY 7

3. WOMEN’S PATHOLOGY 49
This page intentionally left blank
 CHAPTER 1
HISTORY OF GYNECOLOGY
IN CHINESE MEDICINE
Like all branches of Chinese medicine, traditional
gynecology has a long history. The earliest records of
gynecological medical writings date from the Shang
dynasty (1500–1000 BC): bones and tortoise shells
have been found with inscriptions dealing with child-
birth problems. The text Book of Mountains and Seas
from the Warring States period (476–221 BC) describes
medicinal plants to treat infertility.
The Yellow Emperor’s Classic of Internal Medicine –
Simple Questions (Huang Di Nei Jing Su Wen) has many
references to women’s physiology, anatomy, diagnosis
and treatment of gynecological problems. It describes
the function of the Uterus and states its connection to
the Heart and Kidneys via the Bao Mai (Uterus Vessel)
and Bao Luo (Uterus Channel) respectively. For exam-
ple, the Simple Questions in Chapter 33 says:
In amenorrhoea, the Uterus Vessel is shut. The Uterus
Vessel pertains to the Heart and communicates with the
Uterus; when Qi rebels upwards to press towards the
Lungs, Heart-Qi cannot flow downwards and
amenorrhoea results.1
In Chapter 47 it says: “The Uterus Channel connects
with the Kidneys; the Kidney channel reaches the root of
the tongue.”2
The very first chapter of the Simple Questions describes
the hormonal changes occurring in women at 7-year
intervals and attributes these to the waning and wax-
ing of the Directing and Penetrating Vessels. The Simple
Questions also describes the aetiology and treatment of
amenorrhoea and menorrhagia.
The first chapter of the Simple Questions mentions for
the first time the important substance Tian Gui. Tian Gui
is a transformation of Kidney-Essence that occurs at
puberty. In men, it is sperm; in women, it is menstrual
blood and ova. Chapter 1 of the Simple Questions says:
“When a girl is 14, the Tian Gui arrives, the Directing
Vessel is open and the Penetrating Vessel flourishing, the
period arrives and she can conceive.”3
That gynecology already existed as a speciality during
the Warring States period is recorded in the Historical
Annals (Shi Ji) which refers to the famous doctor Bian
Que as one who ‘treats diseases under the skirt belt’
(Dai Xia Yi), i.e. a gynecologist. During the Han dynasty
(206 BC–AD 220), a gynecologist was called a ‘breast
doctor’ (Ru Yi) or ‘women’s doctor’ (Nu Yi). The earliest
recorded gynecologists under that name were two doc-
tors called Yi Xu and Chun Yu Yan who treated one of
the empresses during the Western Han dynasty (206
BC–AD 24).
The famous doctor Zhang Zhong Jing refers in his
work Discussion on Cold-induced Diseases (Shang Han
Lun) to a previous book entitled Series of Herbs for
Obstetrics (Tai Lu Yao Lu) which proves that even before
the Han dynasty there were books dealing exclusively
with gynecology, but all of these have been lost. The
Discussion of Prescriptions of the Golden Cabinet (Jin Gui
Yao Lue Fang Lun) by the same author has three chap-
ters on gynecology, i.e. ‘On pregnancy’, ‘Post-partum
diseases’ and ‘Women’s miscellaneous diseases’.
These chapters discuss disorders of menstruation, leu-
corrhoea, pregnancy, miscellaneous diseases and post-
partum problems. Over thirty gynecological formulae
are discussed, e.g. Wen Jing Tang Warming the Menses
Decoction, Jiao Ai Tang Donkey’s Hide Glue-Artemisia
Decoction, Dang Gui San Angelica Powder, Gan Jiang
Ren Shen Ban Xia Wan Zingiber-Ginseng-Pinellia Pill,
Gui Zhi Fu Ling Wan Ramulus Cinnamomi-Poria Pill,
etc. All these formulae are still widely used nowadays.
These three chapters on gynecology represent one of
the earliest gynecological treatises and they formed the
model upon which subsequent books were based.
The Pulse Classic (Mai Jing, AD 280) by Wang Shu
He, a famous doctor of the Jin dynasty (265–420),
describes pulse pictures and differentiation of women’s
4 Section 1: Physiology and Pathology
diseases in Volume 9. This book constitutes an assimila-
tion and systematization of the gynecological material
from earlier texts, notably the Yellow Emperor’s Classic
of Internal Medicine, the Classic of Difficulties and the
Synopsis of Prescriptions from the Golden Cabinet. Wang
Shu He also added a wealth of comment from his per-
sonal experience in the gynecological field. For exam-
ple, he says that “The Kidneys govern the Uterus, and its
condition is reflected at the Rear position of the pulse. If the
pulse at this region does not fade on pressure, it indicates
pregnancy.”4 In another passage he says that “A super-
ficial pulse accompanied by abdominal pain referred to the
midline of the lower back, indicates impending labour.”5
The book also describes the qualities of the pulse before
an imminent miscarriage, normal and abnormal pulses
during the post-partum stage and pulses in women
with abdominal masses in relation to prognosis.
During the Sui dynasty (581–618), Chao Yuan
Fang wrote the General Treatise on the Symptomatology
and Aetiology of Diseases (Zhu Bing Yuan Hou Zong Lun,
AD 610) which deals with gynecology and obstetrics in
Volumes 37 to 44. The book describes 283 syndromes
covering diseases of menstruation, leucorrhoea, preg-
nancy and post-partum diseases.
The Thousand Golden Ducat Prescriptions (Qian Jin Yao
Fang, AD 652) written by Sun Si Miao during the Tang
dynasty (618–907) has three volumes dealing with
gynecology, including the differentiation and treat-
ment of infertility, diseases of pregnancy, menstrua-
tion, leucorrhoea, etc., with hundreds of formulae for
these diseases. Sun Si Miao made the interesting obser-
vation that a metal knife should never be used to cut
the umbilical cord: from a modern perspective, this
was an important recommendation as, if dirty, a metal
instrument could easily provoke a tetanus infection.
The Treasure of Obstetrics (Jing Xiao Chan Bao), writ-
ten during the Tang dynasty, is the earliest obstetrics
book. The book contains 12 chapters on diseases of
pregnancy, 4 chapters on difficult labour and 25 chap-
ters on post-partum diseases. Diseases of pregnancy
discussed include morning sickness, bleeding, threat-
ened miscarriage, miscarriage, urinary problems and
oedema. The discussion on labour problems includes
formulae for promoting labour, and on dealing with a
dead fetus, prolonged labour or retention of placenta.
The discussion on post-partum diseases includes teta-
nus, puerperal infections, abdominal pain, persistent
bleeding, retention of urine, insufficient lactation and
mastitis.
During the Song dynasty (960–1279), the impe-
rial medical college was staffed by 300 people; there
were nine departments, one of which was obstetrics
and gynecology. This was probably the earliest medi-
cal school department dedicated entirely to gynecol-
ogy and obstetrics. The specialization fostered by the
division of the imperial medical college into different
departments stimulated the development of the vari-
ous specialties, among which was gynecology. This led
to the publication of many books specializing in obstet-
rics and gynecology, an important one being the Great
Treatise of Useful Prescriptions for Women (Fu Ren Liang
Fang Da Quan, 1237) written by Chen Zi Ming during
the Southern Song dynasty. The book comprises 24
volumes including 20 chapters on menstrual diseases,
91 on miscellaneous diseases, 10 on infertility, 8 on
‘fetal education’, 9 on pregnancy problems, 70 on post-
partum diseases and 10 on boils and ulcers. More than
260 diseases are discussed in all with various formu-
lae for each. This book exerted a profound influence on
the development of obstetrics and gynecology in sub-
sequent dynasties.
During the Jin and Yuan dynasties (1115–1368)
many different medical schools of thought flourished,
among which the main ones were those headed by Liu
Wan Su, Li Dong Yuan, Zhu Dan Xi and Zhang Zi He.
Liu Wan Su (1120–1200) maintained that Fire is the
primary cause of disease and he therefore advocated
the use of cold herbs in gynecological problems. For
example, he attributed amenorrhoea to Heart-Fire.
He also advocated treating the Kidney channel in girls
before puberty, the Liver channel in young women and
the Spleen channel in post-menopausal women. He
also paid attention to modifying gynecological formu-
lae according to the seasons. Recognizing the influence
of the seasons on medical conditions, he advocated
doubling the dosage of Chuan Xiong Radix Chuanxiong
within the formula Si Wu Tang Four Substances Decoction
during springtime, doubling Bai Shao Radix Paeoniae
alba in summertime, doubling Shu Di Huang Radix
Rehmanniae preparata during the autumn and doubling
Dang Gui Radix Angelicae sinensis in wintertime. He
also suggested adding Fang Feng Radix Saposhnikoviae
in springtime, Huang Qin Radix Scutellariae in summer-
time, Mai Men Dong Radix Ophiopogonis in the autumn
and Gui Zhi Ramulus Cinnamomi in winter.
Li Dong Yuan (1180–1251) was the founder of the
‘School of Stomach and Spleen’ which emphasized a
disharmony of these two organs as the main aetiology

and pathology of diseases. He therefore advocated toni-
fying the Stomach and Spleen as the main method of
treatment in gynecology too. In his book Secret Record
of the Orchid Chamber (Lan Shi Mi Cang), he says that
prolonged deficiency of the Stomach and Spleen leads
to amenorrhoea, and that to treat this, one needs to
clear Stomach-Heat, generate Stomach fluids and ton-
ify Qi and Blood. He says that uterine bleeding is due
to deficiency of the Stomach and Spleen, arousing
Minister Fire of the Kidneys and causing Damp-Heat to
infuse downwards: to treat this he advocates tonifying
the Stomach and Spleen and raising Qi.
Zhu Dan Xi (1281–1358) maintained that “Yang is
often in excess and Yin is often deficient” and therefore
advocated nourishing Yin as one of the most important
treatment principles. For example, for problems before
childbirth he advised clearing Heat and nourishing
Blood. He also indicated Huang Qin Radix Scutellariae
and Bai Zhu Rhizoma Atractylodis macrocephalae as two
important herbs to prevent miscarriage.
Zhang Zi He (1156–1228) treated diseases by the
three methods of sweating, vomiting and moving
downwards. He used tonics only after first using herbs
that eliminate pathogenic factors, since one cannot
tonify when these are present. He applied this method
to gynecological diseases as well, often advocating that
the patient be made to vomit and using downward-
moving methods of treatment to eliminate Phlegm and
Water in menstrual problems.
The doctors of the Ming dynasty (1368–1644) con-
solidated and integrated the theories of these four great
schools of medical thought. Many important gyneco-
logical books were written during the Ming dynasty,
e.g. Standards of Diagnosis and Treatment of Women’s
Diseases (Zheng Zhi Zhun Sheng – Nu Ke, 1602) by Wang
Ken Tang, Summary of Gynecology and Obstetrics (Nu Ke
She Yao, 1548) by Xue Ji, Summary of Fertility (Guang Si
Ji Yao) and Women’s Secrets (Fu Ren Mi Ke) by Wan Quan.
He said that, in order to conceive, the man should clear
his Heart and control his sexual desire to nourish the
Essence, while a woman should calm her Mind and set-
tle Qi to nourish Blood. The above-mentioned Standards
of Diagnosis and Treatment by Wang Ken Tang summa-
rized the experience of doctors of previous generations
in the treatment of gynecological diseases. His book
dealt with menstrual problems, miscellaneous dis-
eases, pregnancy problems and post-partum diseases.
Wu Zhi Wang adopted this book as a chief source to
write his Compendium of Therapy of Women’s Diseases
History of Gynecology in Chinese Medicine 5
(Ji Yin Gang Mu, 1620) which became an authoritative
text for subsequent generations of gynecologists.
The Complete Works of Jing Yue (Jing Yue Quan Shu,
1624), by Zhang Jing Yue, has an extensive section on
gynecology and obstetrics discussing the treatment of
problems of pregnancy and labour, leucorrhoea, breast
diseases, fertility, abdominal masses and menstruation.
Zhang Jing Yue recommended paying particular atten-
tion to regulating menstruation in gynecological dis-
eases. He said that the key to regulate menstruation is
to nourish Blood by tonifying the Stomach and Spleen
and calming the chamber of Blood by tonifying the
Kidneys. On the question of whether the Spleen or the
Kidneys was the more important organ, he decided in
favour of the latter.
During the Qing dynasty (1644–1911) many gyne-
cological treatises were written. The three most impor-
tant ones were Fu Qing Zhu’s Gynecology (Fu Qing Zhu
Nu Ke) by Fu Qing Zhu (1607–1684), the Golden Mirror
of Medicine (Yi Zong Jin Jian, Vol. 3, 1742) by Wu Qian
and the Treatise on Obstetrics (Da Sheng Bian, 1715) by
Ji Zhai Ju Shi (a pseudonym meaning ‘the Buddhist of
Ji House’).
Fu Qing Zhu’s Gynecology is unlike any other gynecol-
ogy book insofar as the author proposes his own per-
sonal, and often unorthodox, ideas on the pathogenesis
and treatment of gynecological diseases and his formu-
lae are unlike any of those from previous gynecologi-
cal books. One of the central theses of Fu Qing Zhu’s
book is that the Kidneys are the most important organ
for the menstrual function as they are the origin of
menstrual blood. According to him, menstrual blood
is unlike normal ‘Blood’: it is a precious fluid derived
from the Kidney-Essence. His book discusses the differ-
entiation and treatment of menstrual problems, preg-
nancy, post-partum diseases, infertility, leucorrhoea
and labour, with the different patterns and formulae
for each.
The gynecology volume of the Golden Mirror of
Medicine by Wu Qian discusses the pathology and treat-
ment of menstrual problems, leucorrhoea, pregnancy,
labour, post-partum diseases, abdominal masses and
miscellaneous diseases. One particular feature of this
book is that it is written in a style that is easy to read.
The Treatise on Obstetrics focuses on diseases of preg-
nancy, management of normal and difficult labour,
and post-partum diseases.
During the late Qing dynasty, Western medicine
was introduced to China and integrated with Chinese
6 Section 1: Physiology and Pathology
medicine. The two principal doctors who advocated
the integration of Chinese and Western medicine were
Tang Zong Hai (1862–1918) and Zhang Xi Chun
(1860–1933). These doctors did not write specialized
books on gynecology but they did discuss gynecological
and obstetric problems in their works. For example, in
his book Discussion on Blood Syndromes (Xue Zheng Lun,
1885), Tang Zong Hai discusses the treatment of men-
strual problems, uterine bleeding, stasis of Blood, accu-
mulation of Blood, amenorrhoea, etc. Zhang Xi Chun
paid special attention to regulating Spleen and Kidneys
and invigorating Blood in treating gynecological dis-
eases. He formulated several important prescriptions
such as Li Chong Tang Regulating the Penetrating Vessel
Decoction, An Chong Tang Calming the Penetrating Vessel
Decoction, Gu Chong Tang Consolidating the Penetrating
Vessel Decoction and Shou Tai Wan Fetus Longevity Pill
in his book Records of Combined Chinese and Western
Medicine (Yi Xue Zhong Zhong Can Xi Lu, 1918).
Since 1949, the combination of Western and
Chinese medicine has been emphasized and many
innovative treatments have been devised. For exam-
ple, ectopic pregnancy is often treated with acu-
puncture and Chinese herbs without recourse to
surgery; acupuncture is used in breech presenta-
tion of the fetus; Chinese herbs are used in the treat-
ment of myomas and cervical carcinoma, etc. Since
the major colleges of traditional Chinese medicine
were established in 1956, many modern gynecology
textbooks have been published and the ancient ones
reprinted.
END NOTES
1. 1979 The Yellow Emperor’s Classic of Internal Medicine – Simple
Questions (Huang Ti Nei Jing Su Wen ), People’s Health
Publishing House, Beijing, p. 197. First published c. 100 BC.
2. Ibid., p. 259.
3. Ibid., p. 4.
4. Wang Shu He 1988 A Revised Explanation of the Pulse Classic (Mai
Jing Jiao Shi ), with commentary by the Fuzhou City People’s
Hospital, People’s Health Publishing House, Beijing, p. 585. First pub-
lished in AD 280.
5. Ibid., p. 588.
 CHAPTER 2
WOMEN’S PHYSIOLOGY

THE UTERUS 8
PHYSIOLOGY OF MENSTRUATION AND THE
FOUR PHASES 10
The origin, nature and function of Tian Gui 10
The four phases of the menstrual cycle 12
Menstruation in Western medicine 14
Hypothalamus–pituitary–ovarian axis 17
Chinese medicine view of the four phases in detail 19
The four phases and treatment principles 23
MENSTRUATION AND THE INTERNAL ORGANS 24
Kidneys 24
Liver 28
Spleen 30
Heart 31
Lungs 32
Stomach 32
MENSTRUATION AND THE EXTRAORDINARY
VESSELS 33
Penetrating Vessel (Chong Mai) 33
Directing Vessel (Ren Mai) 36
Governing Vessel (Du Mai) 38
Girdle Vessel (Dai Mai) 40
Yin Stepping Vessel (Yin Qiao Mai) 42
The Kidneys play a huge role in gynecology as they
are the origin of Tian Gui, i.e. menstrual blood, and the
ova from the ovaries. Without Tian Gui, there would be
no menstrual cycle and no fertility. The origin, nature
and function of Tian Gui are discussed at length
below.
In women, Blood plays a role in menstruation, fer-
tility, conception, pregnancy and childbirth. Although
Tian Gui is not equivalent to Blood, the Blood stored by
the Liver and the Uterus does play a role in women’s
physiology. Moreover, although menstrual blood is Tian
Gui (and therefore ‘Water’), the Post-Natal Qi and Blood
produced by Stomach and Spleen do play a (secondary)
role in producing menstrual blood.
CLINICAL NOTE
Although menstrual blood is Tian Gui (and therefore
‘Water’), the Post-Natal Blood of Stomach and
Spleen does play a secondary role in producing
menstrual blood. For this reason, in order to tonify
Blood in women, we can reinforce BL-20 Pishu and
BL-23 Shenshu to nourish the Post-Natal Blood
and the Tian Gui respectively.

CONCEPTION 43
Women’s physiology is, of course, also dominated
PREGNANCY 44 by the fact that their lower Dan Tian houses the Uterus
which, in turn, stores Blood. This is of huge clinical sig-
MENOPAUSE 45 nificance: because women’s lower abdomen contains
the Uterus which stores Blood, women are much more
prone to Blood stasis than men are.
Women’s physiology and gynecological systems are
influenced particularly by one organ, one vital sub-
CLINICAL NOTE
stance and one structure:
Women are very prone to Blood stasis. In
• The Kidneys. complicated, chronic gynecological problems,
• Blood. always suspect Blood stasis.
• The Uterus.
8 Section 1: Physiology and Pathology
In order to understand women’s physiology, it may
be helpful to compare and contrast it with men’s physi-
ology. Women pertain to Yin but some aspects of their
physiology are Yang; men pertain to Yang but some
aspects of their physiology are Yin. Women’s physio-
logy is rooted in Blood, men’s in Qi; men store Essence,
women store the Uterus, Blood and fetus.
The book Elementary Medicine (1575) says:
Men store Essence, women the Uterus and the fetus. Men
take Qi as their foundation, they are Yang constitutionally
but Yin functionally; the sperm is white but can be red if
there is Fire. Women take Blood as their foundation; they
are Yin constitutionally but Yang functionally; menstrual
blood is red but it can be white if there is Phlegm.1
The Secret Records of Master Feng’s Brocade Bag says:
Man pertains to Yang but there is Yin within Yang. The Yin
number is 8 so man’s Yang essence rises at the age of 8 and is
abundant at the age of 16. Woman pertains to Yin but there
is Yang within Yin. The Yang number is 7 so woman’s essence
rises at the age of 7 and is abundant at the age of 14.2
This passage of course makes reference to the life
cycles of men (8 years) and women (7 years) first intro-
duced by Chapter 1 of the Simple Questions.
The discussion of women’s physiology will consist of
the following parts:
• The Uterus
• Physiology of menstruation and the Four Phases
• Menstruation and the internal organs
• Menstruation and Extraordinary Vessels
• Conception
• Pregnancy
• Menopause
THE UTERUS
The Uterus received many different names during the
development of Chinese medicine: Zi Bao, Bao Gong, Zi
Zang, Zi Chu, Xue Zang (Baby’s Bao, Bao Palace, Baby’s
Zang, Baby’s Abode, Blood Zang). The Chinese word Bao
conveys the idea of a ‘container’ and for this reason the
Uterus is called Zi Bao, i.e. the contained or the baby (in
pregnancy). However, please note that Bao by itself is a
structure that is common to both women and men; it is
only the Zi Bao (‘baby’s container’) that is exclusive to
women. As indicated below, in men, Bao is the Jing Shi
which can be translated either as ‘Room of Sperm’ or
‘Room of Essence’.
In women, the Uterus corresponds to the Lower Field of
Elixir (Dan Tian) which in men houses the ‘Room of Sperm’.
The Golden Mirror of Medicine (Yi Zong Jin Jian, 1742) says:
The Governing Vessel [Du Mai] arises within the lower
abdomen, externally in the abdomen, internally in the Bao …
also called Dan Tian in both men and women: in women it
is the Uterus, in men it is the Room of Sperm.3
This passage clearly shows that Bao is a structure
common to both men and women, being the Uterus in
women and the ‘Room of Sperm’ in men. As we shall see,
the Extraordinary Vessels arise from this area (Fig. 2.1).
The Uterus is one of the six ‘extra Yang organs’.
These organs have the shape of a Yang organ (i.e. hol-
low) and the function of a Yin organ (i.e. storage). The
Uterus’s shape is hollow and menstruation and labour
are an expression of its function of discharging (as a
Yang organ). On the other hand, the Uterus stores
Blood and nourishes the fetus during pregnancy (an
expression of its function as a Yin organ; see Fig. 2.2).
The Uterus is related to the Kidneys via a channel
called the Uterus Channel (Bao Luo). Chapter 47 of the
Simple Questions says: “The Uterus Channel extends to the
Kidneys.”4 The Uterus is also physiologically related to
the Heart via a channel called the Uterus Vessel (Bao
Mai). Chapter 33 of the Simple Questions says: “The
Uterus Vessel pertains to the Heart and extends to the
Uterus” and “When the period does not come it means that
the Uterus Vessel is obstructed”5 (Fig. 2.3).
BAO LOWER DAN TIAN
In men ROOM OF JING UTERUS – In women
ZI BAO
SPERM MENSTRUAL
BLOOD
TIAN GUI
Figure 2.1 The Bao in men and women.

Stores fetus
Shape of a Zang
Stores Blood
Discharges Blood
Function of Fu
Discharges baby
Figure 2.2 The Uterus as one of the six Extraordinary Yang organs.
HEART
Uterus Vessel
(Bao Mai )
UTERUS
Uterus Channel
(Bao Luo)
KIDNEYS
Figure 2.3 The Uterus connection with Kidneys and Heart.
CLINICAL NOTE
The Uterus is functionally related to the Kidneys
via the Uterus Channel (Bao Luo) and to the Heart
via the Uterus Vessel (Bao Mai). The latter connection
with the Heart explains the strong influence of
emotional stress on menstruation. In order to
influence the Uterus through the Heart channel I
use mostly HE-5 Tongli.
Hence normal menstruation and fertility depend on
the state of the Kidney-Essence and of Heart-Qi and
Heart-Blood. The Kidney-Essence and Tian Gui are the
primary factors in menstruation and fertility: if the
Kidney-Essence is deficient, there may be amenorrhoea
and/or infertility. However, the Heart also plays a role.
If Heart-Qi does not descend to the Uterus, this may
also cause amenorrhoea. Figure 2.4 shows the connec-
tion between the Uterus and the internal organs.
‘Uterus’ has a broad definition in Chinese medi-
cine, encompassing structures beyond the uterus itself,
Women’s Physiology 9
including the fallopian tubes and the ovaries. Thus, the
‘Uterus’ and, in particular, the Kidneys are responsible
for all the functions that in Western medicine are related
to uterus, tubes and ovaries, and indeed including the
hypothalamus–pituitary–ovarian axis. For this reason,
too, Tian Gui has a broader meaning than simply men-
strual blood as it must include the ova from the ovaries.
!
The ‘Uterus’ of Chinese medicine includes the ovaries
and Tian Gui includes the ova.
Interestingly, in Western medicine too there is a con-
nection between the uterus and ovaries. There is evi-
dence that hysterectomy with conservation of the
ovaries is associated with earlier ovarian failure and this
may be due to a reduction in the blood supply to the ova-
ries following surgical clamping of the uterine arteries.
Animal studies have shown that uterine tissue is neces-
sary to ensure the development of ovarian follicles.6
SUMMARY
Uterus
• The Uterus was variously called Baby’s Bao, Bao
Palace, Baby’s Zang, Baby’s Abode, Blood Zang
• Bao by itself is a structure that is common to both
women and men: in men, Bao is the Jing Shi
which can be translated either as ‘Room of Sperm’
or ‘Room of Essence’
• The Uterus is one of the six ‘extra Yang organs’
with the shape of a Yang organ (i.e. hollow) and
the function of a Yin organ (i.e. storage)
• Menstruation and labour are an expression of its
function of discharging (as a Yang organ). On the
other hand, the Uterus stores Blood and nourishes
the fetus during pregnancy (an expression of its
function as a Yin organ)
• The Uterus is related to the Kidneys via a channel
called the Uterus Channel (Bao Luo) and to the Heart
via a channel called the Uterus Vessel (Bao Mai)
• Normal menstruation and fertility depend on the
state of the Kidney-Essence and of Heart-Qi and
Heart-Blood
• ‘Uterus’ has a broad definition in Chinese medicine,
encompassing structures beyond the uterus itself,
including the fallopian tubes and the ovaries
10 Section 1: Physiology and Pathology

HEART

down to Uterus
HE-Blood goes

HE-Yang goes down

to Uterus Vessel
LIVER PENETRATING
VESSEL

Pr

s B and
ov
mo

ide Bloo

d
s
loo
ve

sa d

mo vide
s

nd
d

o
an d

Pr
ve
k es Bloo
Ma lds
ho
Keeps Uterus Provides Essence, DIRECTING
SPLEEN UTERUS
in place Yin VESSEL
Pro
ng
trati Mi
vid
e
ne el nis s Ya
Pe ss ter n
via Ve Fir g,
e
Provides
Essence GOVERNING
STOMACH VESSEL
Uterus
Channel

KIDNEYS

Figure 2.4 The Uterus and internal organs.

PHYSIOLOGY OF MENSTRUATION
AND THE FOUR PHASES
Menarche (the onset of the first menstrual period) sta-
tistically starts at 12.8 years of age in industrialized
countries, with a range of 10 to 16 years. In the United
Kingdom, menarche occurs between the ages of 11 and
15 in 95% of girls and the median age is 13.7 In the USA,
90% of girls experience menarche between the ages of
11 and 13.75 and the median age is 12.43.8 In China,
menarche occurs within the 13 to 15 age range in the
overwhelming majority of girls.9 Menarche occurring
before the age of 10 is considered premature, and menar-
che is delayed if it has not occurred by the age of 16.
The mean age of menopause is 50: if it occurs before the
age of 35 it is termed premature, and if it has not occurred
by the age of 55, delayed. From a Western medical per-
spective, the menstrual cycle occurs every 21 to 36 days
and lasts 3 to 7 days, with the woman losing an aver-
age amount of 30–80 ml. The colour is usually dark red,
lighter at the beginning, deep in the middle and pinkish at
the end of the period. The normal flow does not coagulate
and there are no clots; the blood is neither dilute nor thick.
A study of 321 women showed that the commonest bleed-
ing lengths were 5 and 6 days, found in 49% of women.10
The range of the above ‘normal’ values from a
Western medical perspective is somewhat broader
than what Chinese medicine would consider ‘nor-
mal’. For example, Chinese medicine would consider
a range of 26 to 32 days more normal for the length
of the menstrual cycle than a range of 21 to 36 days.
It should be stressed here that regularity of the cycle
is all-important: if the cycle length varies from month
to month, this would be considered abnormal even
if it fell within the 26 to 32 days range. On the other
hand, were the period to occur regularly every 33 days,
this would be considered normal. Similarly, Chinese
medicine would consider a duration of 4 to 6 days for
menstruation as more ‘normal’ than that of 3 to 7 days.
The origin, nature and function of
Tian Gui
Tian Gui is mentioned in the first chapter of the Simple
Questions in connection with the life cycles of men and
women. Chapter 1 of the Simple Questions says: “At 14

the Tian Gui arrives, the Directing Vessel [Ren Mai] is open
and the Penetrating Vessel [Chong Mai] flourishing, the
period arrives and the girl can conceive.”11 Tian Gui is the
ancient Chinese equivalent of hormonal development
in modern medicine.
In men, Tian Gui is sperm, while in women, it is men-
strual blood and the ova. The root of Tian Gui is in the
Kidney-Essence and the Minister Fire which are pres-
ent from conception. They need 14 years in girls and 16
years in boys to mature into ova and sperm respectively.
The Post-Natal Qi and Blood of the Stomach and Spleen
play a role (albeit a secondary one) in the formation of
menstrual blood and the maturation of eggs at puberty.
The term Tian Gui is impossible to translate because Tian
means ‘heaven’ or ‘heavenly’ but Gui refers to the 10th
Heavenly stem of the Chinese calendar: thus the word
‘Gui’ must remain untranslated. The fact that the term
for Tian Gui refers to ‘Heaven’ is significant: it refers to the
fact that women’s menstrual cycle is influenced by cosmic
cycles. Indeed, the term Tian Gui refers to ‘Heaven’ twice:
once in the term ‘heavenly’ itself and once because Gui is
a Heavenly stem, i.e. representing the heavenly influence
of a particular year. Each year is denoted by one of the 10
Heavenly stems and one of the 12 Earthly Branches.
Moreover, it is significant that the Heavenly stem Gui
pertains to Water: in fact there are 10 stems divided
into 5 couples, each couple pertaining to one of the Five
Elements. The fact that the stem Gui pertains to Water
indicates that Tian Gui is a form of Water, a transforma-
tion of Kidney-Water.
What exactly is Tian Gui? All Chinese books say that
Tian Gui is menstrual blood and that, for this reason,
menstrual blood is not the same as Liver-Blood, i.e. the
‘Blood’ that nourishes the sinews, eyes, hair and skin.
Menstrual Blood is a precious fluid that originates from
Kidney-Water and Kidney-Essence.
Thus menstrual Blood is called ‘Heavenly Gui’
because it represents the descending of Heavenly Gui
materializing into Water (the 10th stem Gui pertains
to Water). The Great Treatise of Beneficial Formulae for
Women (1237) explains:
When the girl is 14 the Heavenly Gui arrives, the
Directing Vessel is open, the Penetrating Vessel is
flourishing and the period arrives. “Heavenly” indicates
the descending of the True Qi of Heaven; “Gui” indicates
Water [as this stem pertains to Water]: [menstrual
blood is therefore] like heavenly clouds generating
water.12
Women’s Physiology 11
The famous Qing dynasty gynecologist Fu Qing
Zhu (1607–1684) stressed forcefully that menstrual
blood is not ‘Blood’ but ‘Water’. Fu Qing Zhu holds
that menstrual blood is not Blood but Tian Gui which
originates from the Kidneys. He says it is formed
from Kidney-Yin but with the participation of Heart-
Yang (another way in which the Heart influences
menstruation) and that despite being blood-red in
colour it is not Blood; hence its name of Tian Gui.13
He also says that the generation of Tian Gui has noth-
ing to do with Heart, Liver or Spleen; these organs
only help its transformation into Blood. His original
passage says:
Menstrual blood is not Blood but Heavenly Water,
originating within the Kidneys, it is the essence of extreme
Yin and Qi of extreme Yang. It is red like blood but it is
not blood. That is why it is called Heavenly Gui. People
nowadays regard menstrual blood as Blood, a mistake
perpetuated for 1000 years … in fact it is not called blood-
water [Xue Shui] but menstrual water [Jing Shui] … the
generation of Kidney Water [and therefore menstrual
blood] has nothing to do with Heart, Liver and Spleen, but
the transformation of Kidney Water is helped by Heart,
Liver or Spleen.14
It should be emphasized that while menstrual blood
is a form of Tian Gui, this is not only menstrual blood as
it is also the origin of sperm in men (Fig. 2.5).
However, in women, in my opinion Tian Gui is not
simply menstrual blood but it must include the ova.
The first chapter of the Simple Questions obviously
refers to the ova when it says that “Tian Gui arrives and
the girl can conceive”. It is the maturation of the ova
occurring at puberty, not menstrual blood, that allows
conception.
KIDNEY-WATER TIAN GUI
HEART LIVER SPLEEN
Help transformation of Water into Tian Gui
Figure 2.5 Generation and transformation of Tian Gui
according to Fu Qing Zhu.
12 Section 1: Physiology and Pathology

fluctuates like a tide during the month in a determined

SUMMARY pattern. The pattern is that Yang decreases when the
period starts and reaches a minimum at mid-cycle; Yin
The origin, nature and function of Tian Gui
increases when the period starts and reaches a maximum
• Tian Gui is mentioned in the first chapter of the
at mid-cycle. Thus, Yang reaches its maximum level just
Simple Questions in connection with the life cycles
before the period starts and then begins to decrease rap-
of men and women
idly as soon as the period starts (this rapid decline of Yang
• When a girl is 14, the Tian Gui arrives, the
explains the disappearance of pre-menstrual symptoms
Directing Vessel (Ren Mai) is open and the
when the period starts). Yang reaches its minimum level
Penetrating Vessel (Chong Mai) flourishing, the
at mid-cycle after which it starts to rise again. It rises rap-
period arrives and the girl can conceive
idly in the few days before the period. As for Yin, it is at its
• In men, Tian Gui is sperm, while in women it is
minimum level at the beginning of the period after which
menstrual blood and the ova
it starts to rise, reaching its maximum at mid-cycle. After
• The root of Tian Gui is in the Kidney-Essence and
that, it starts to decline until the next period starts. Thus,
the Minister Fire which are present from conception
at mid-cycle, there is a maximum of Yin and minimum
• The Post-Natal Qi and Blood of the Stomach and
of Yang; when the period starts, there is a maximum of
Spleen play a role (albeit a secondary one) in the
Yang and minimum of Yin.
formation of menstrual blood and the maturation
Note that there are two crucial times of transforma-
of eggs at puberty
tion from Yin to Yang and Yang to Yin. In fact, when the
• Tian Gui is menstrual blood and, for this reason,
period starts, Yang decreases from its maximum level
menstrual blood is not the same as Liver-Blood, i.e.
and Yin increases from its minimum level: thus, there is
the ‘Blood’ that nourishes the sinews, eyes, hair
a switch, a transformation from Yang to Yin. The oppo-
and skin. Menstrual blood is a precious fluid that
site happens at mid-cycle (around ovulation time). At
originates from Kidney-Water and Kidney-Essence
this time, Yin has reached its maximum and starts to
• The famous Qing dynasty gynecologist Fu
decline while Yang has reached its minimum level and
Qing Zhu (1607–1684) stressed forcefully that
starts to increase: thus, there is a switch, a transforma-
menstrual blood is not ‘Blood’ but ‘Water’
tion from Yin to Yang, the opposite of what happened
• Fu Qing Zhu holds that menstrual blood is not
at the beginning of the period.
Blood but Tian Gui which originates from the
This transformation of Yang to Yin and vice versa is
Kidneys. He says it is formed from Kidney-Yin with
under the control of the Heart: it relies on the descending
the participation of Heart-Yang
of Heart-Qi and Heart-Blood. If for any reason Heart-Qi
• He also says that the generation of Tian Gui is
does not descend to the Uterus (via the Bao Mai, Uterus
from the Kidneys while the Heart, Liver and Spleen
Vessel), then the period or ovulation might be delayed:
help its transformation into menstrual blood
conversely, should Heart-Qi descend too soon, the period
• In women, in my opinion, Tian Gui is not simply
or ovulation might come early. The times of transforma-
menstrual blood but it must include the ova
tion of Yang to Yin and vice versa are marked by discharge
and downward movement. In fact, when the period starts
(transformation from Yang to Yin), there is a discharge
The four phases of the menstrual cycle and downward movement of blood. During mid-cycle
The theory of the four phases of the menstrual cycle is not (transformation from Yin to Yang), there is a discharge
an ancient, traditional theory but a modern one. However, and downward movement of the ovum (or ova).
it is a modern theory that is based on the integration of Figure 2.6 illustrates the ebb and tide of Yin and
the ancient concepts of Yin-Yang and Kidney-Yin and Yang in the four phases of the menstrual cycle. Please
Kidney-Yang with modern hormonal knowledge. note that the diagram of the four phases is rather
This theory was developed largely by Professor Xia Gui theoretical, i.e. it shows the ebb and flow of Yin and
Cheng of the Nanjing University of Traditional Chinese Yang as perfectly symmetrical during the month. In
Medicine. According to this theory, the menstrual cycle practice, it is not so. In practice, the diagram repre-
is determined by the ebb and flow of two tides: one of senting the ebb and flow of Yin and Yang would be
Kidney-Yin, the other of Kidney-Yang. The amount of Yin rather different. One difference is, for example, that
and Yang (and specifically Kidney-Yin and Kidney-Yang) the Yin is at its minimum level not at the beginning
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 DANCE ON STILTS AT THE GIRLS’ UNYAGO, NIUCHI

Newala, too, suffers from the distance of its water-supply—at least

the Newala of to-day does; there was once another Newala in a lovely
valley at the foot of the plateau. I visited it and found scarcely a trace
of houses, only a Christian cemetery, with the graves of several
missionaries and their converts, remaining as a monument of its
former glories. But the surroundings are wonderfully beautiful. A
thick grove of splendid mango-trees closes in the weather-worn
crosses and headstones; behind them, combining the useful and the
agreeable, is a whole plantation of lemon-trees covered with ripe
fruit; not the small African kind, but a much larger and also juicier
imported variety, which drops into the hands of the passing traveller,
without calling for any exertion on his part. Old Newala is now under
the jurisdiction of the native pastor, Daudi, at Chingulungulu, who,
as I am on very friendly terms with him, allows me, as a matter of
course, the use of this lemon-grove during my stay at Newala.
 FEET MUTILATED BY THE RAVAGES OF THE “JIGGER”
(Sarcopsylla penetrans)

The water-supply of New Newala is in the bottom of the valley,

some 1,600 feet lower down. The way is not only long and fatiguing,
but the water, when we get it, is thoroughly bad. We are suffering not
only from this, but from the fact that the arrangements at Newala are
nothing short of luxurious. We have a separate kitchen—a hut built
against the boma palisade on the right of the baraza, the interior of
which is not visible from our usual position. Our two cooks were not
long in finding this out, and they consequently do—or rather neglect
to do—what they please. In any case they do not seem to be very
particular about the boiling of our drinking-water—at least I can
attribute to no other cause certain attacks of a dysenteric nature,
from which both Knudsen and I have suffered for some time. If a
man like Omari has to be left unwatched for a moment, he is capable
of anything. Besides this complaint, we are inconvenienced by the
state of our nails, which have become as hard as glass, and crack on
the slightest provocation, and I have the additional infliction of
pimples all over me. As if all this were not enough, we have also, for
the last week been waging war against the jigger, who has found his
Eldorado in the hot sand of the Makonde plateau. Our men are seen
all day long—whenever their chronic colds and the dysentery likewise
raging among them permit—occupied in removing this scourge of
Africa from their feet and trying to prevent the disastrous
consequences of its presence. It is quite common to see natives of
this place with one or two toes missing; many have lost all their toes,
or even the whole front part of the foot, so that a well-formed leg
ends in a shapeless stump. These ravages are caused by the female of
Sarcopsylla penetrans, which bores its way under the skin and there
develops an egg-sac the size of a pea. In all books on the subject, it is
stated that one’s attention is called to the presence of this parasite by
an intolerable itching. This agrees very well with my experience, so
far as the softer parts of the sole, the spaces between and under the
toes, and the side of the foot are concerned, but if the creature
penetrates through the harder parts of the heel or ball of the foot, it
may escape even the most careful search till it has reached maturity.
Then there is no time to be lost, if the horrible ulceration, of which
we see cases by the dozen every day, is to be prevented. It is much
easier, by the way, to discover the insect on the white skin of a
European than on that of a native, on which the dark speck scarcely
shows. The four or five jiggers which, in spite of the fact that I
constantly wore high laced boots, chose my feet to settle in, were
taken out for me by the all-accomplished Knudsen, after which I
thought it advisable to wash out the cavities with corrosive
sublimate. The natives have a different sort of disinfectant—they fill
the hole with scraped roots. In a tiny Makua village on the slope of
the plateau south of Newala, we saw an old woman who had filled all
the spaces under her toe-nails with powdered roots by way of
prophylactic treatment. What will be the result, if any, who can say?
The rest of the many trifling ills which trouble our existence are
really more comic than serious. In the absence of anything else to
smoke, Knudsen and I at last opened a box of cigars procured from
the Indian store-keeper at Lindi, and tried them, with the most
distressing results. Whether they contain opium or some other
narcotic, neither of us can say, but after the tenth puff we were both
“off,” three-quarters stupefied and unspeakably wretched. Slowly we
recovered—and what happened next? Half-an-hour later we were
once more smoking these poisonous concoctions—so insatiable is the
craving for tobacco in the tropics.
Even my present attacks of fever scarcely deserve to be taken
seriously. I have had no less than three here at Newala, all of which
have run their course in an incredibly short time. In the early
afternoon, I am busy with my old natives, asking questions and
making notes. The strong midday coffee has stimulated my spirits to
an extraordinary degree, the brain is active and vigorous, and work
progresses rapidly, while a pleasant warmth pervades the whole
body. Suddenly this gives place to a violent chill, forcing me to put on
my overcoat, though it is only half-past three and the afternoon sun
is at its hottest. Now the brain no longer works with such acuteness
and logical precision; more especially does it fail me in trying to
establish the syntax of the difficult Makua language on which I have
ventured, as if I had not enough to do without it. Under the
circumstances it seems advisable to take my temperature, and I do
so, to save trouble, without leaving my seat, and while going on with
my work. On examination, I find it to be 101·48°. My tutors are
abruptly dismissed and my bed set up in the baraza; a few minutes
later I am in it and treating myself internally with hot water and
lemon-juice.
Three hours later, the thermometer marks nearly 104°, and I make
them carry me back into the tent, bed and all, as I am now perspiring
heavily, and exposure to the cold wind just beginning to blow might
mean a fatal chill. I lie still for a little while, and then find, to my
great relief, that the temperature is not rising, but rather falling. This
is about 7.30 p.m. At 8 p.m. I find, to my unbounded astonishment,
that it has fallen below 98·6°, and I feel perfectly well. I read for an
hour or two, and could very well enjoy a smoke, if I had the
wherewithal—Indian cigars being out of the question.
Having no medical training, I am at a loss to account for this state
of things. It is impossible that these transitory attacks of high fever
should be malarial; it seems more probable that they are due to a
kind of sunstroke. On consulting my note-book, I become more and
more inclined to think this is the case, for these attacks regularly
follow extreme fatigue and long exposure to strong sunshine. They at
least have the advantage of being only short interruptions to my
work, as on the following morning I am always quite fresh and fit.
My treasure of a cook is suffering from an enormous hydrocele which
makes it difficult for him to get up, and Moritz is obliged to keep in
the dark on account of his inflamed eyes. Knudsen’s cook, a raw boy
from somewhere in the bush, knows still less of cooking than Omari;
consequently Nils Knudsen himself has been promoted to the vacant
post. Finding that we had come to the end of our supplies, he began
by sending to Chingulungulu for the four sucking-pigs which we had
bought from Matola and temporarily left in his charge; and when
they came up, neatly packed in a large crate, he callously slaughtered
the biggest of them. The first joint we were thoughtless enough to
entrust for roasting to Knudsen’s mshenzi cook, and it was
consequently uneatable; but we made the rest of the animal into a
jelly which we ate with great relish after weeks of underfeeding,
consuming incredible helpings of it at both midday and evening
meals. The only drawback is a certain want of variety in the tinned
vegetables. Dr. Jäger, to whom the Geographical Commission
entrusted the provisioning of the expeditions—mine as well as his
own—because he had more time on his hands than the rest of us,
seems to have laid in a huge stock of Teltow turnips,[46] an article of
food which is all very well for occasional use, but which quickly palls
when set before one every day; and we seem to have no other tins
left. There is no help for it—we must put up with the turnips; but I
am certain that, once I am home again, I shall not touch them for ten
years to come.
Amid all these minor evils, which, after all, go to make up the
genuine flavour of Africa, there is at least one cheering touch:
Knudsen has, with the dexterity of a skilled mechanic, repaired my 9
× 12 cm. camera, at least so far that I can use it with a little care.
How, in the absence of finger-nails, he was able to accomplish such a
ticklish piece of work, having no tool but a clumsy screw-driver for
taking to pieces and putting together again the complicated
mechanism of the instantaneous shutter, is still a mystery to me; but
he did it successfully. The loss of his finger-nails shows him in a light
contrasting curiously enough with the intelligence evinced by the
above operation; though, after all, it is scarcely surprising after his
ten years’ residence in the bush. One day, at Lindi, he had occasion
to wash a dog, which must have been in need of very thorough
cleansing, for the bottle handed to our friend for the purpose had an
extremely strong smell. Having performed his task in the most
conscientious manner, he perceived with some surprise that the dog
did not appear much the better for it, and was further surprised by
finding his own nails ulcerating away in the course of the next few
days. “How was I to know that carbolic acid has to be diluted?” he
mutters indignantly, from time to time, with a troubled gaze at his
mutilated finger-tips.
 Since we came to Newala we have been making excursions in all
directions through the surrounding country, in accordance with old
habit, and also because the akida Sefu did not get together the tribal
elders from whom I wanted information so speedily as he had
promised. There is, however, no harm done, as, even if seen only
from the outside, the country and people are interesting enough.
The Makonde plateau is like a large rectangular table rounded off
at the corners. Measured from the Indian Ocean to Newala, it is
about seventy-five miles long, and between the Rovuma and the
Lukuledi it averages fifty miles in breadth, so that its superficial area
is about two-thirds of that of the kingdom of Saxony. The surface,
however, is not level, but uniformly inclined from its south-western
edge to the ocean. From the upper edge, on which Newala lies, the
eye ranges for many miles east and north-east, without encountering
any obstacle, over the Makonde bush. It is a green sea, from which
here and there thick clouds of smoke rise, to show that it, too, is
inhabited by men who carry on their tillage like so many other
primitive peoples, by cutting down and burning the bush, and
manuring with the ashes. Even in the radiant light of a tropical day
such a fire is a grand sight.
Much less effective is the impression produced just now by the
great western plain as seen from the edge of the plateau. As often as
time permits, I stroll along this edge, sometimes in one direction,
sometimes in another, in the hope of finding the air clear enough to
let me enjoy the view; but I have always been disappointed.
Wherever one looks, clouds of smoke rise from the burning bush,
and the air is full of smoke and vapour. It is a pity, for under more
favourable circumstances the panorama of the whole country up to
the distant Majeje hills must be truly magnificent. It is of little use
taking photographs now, and an outline sketch gives a very poor idea
of the scenery. In one of these excursions I went out of my way to
make a personal attempt on the Makonde bush. The present edge of
the plateau is the result of a far-reaching process of destruction
through erosion and denudation. The Makonde strata are
everywhere cut into by ravines, which, though short, are hundreds of
yards in depth. In consequence of the loose stratification of these
beds, not only are the walls of these ravines nearly vertical, but their
upper end is closed by an equally steep escarpment, so that the
western edge of the Makonde plateau is hemmed in by a series of
deep, basin-like valleys. In order to get from one side of such a ravine
to the other, I cut my way through the bush with a dozen of my men.
It was a very open part, with more grass than scrub, but even so the
short stretch of less than two hundred yards was very hard work; at
the end of it the men’s calicoes were in rags and they themselves
bleeding from hundreds of scratches, while even our strong khaki
suits had not escaped scatheless.

NATIVE PATH THROUGH THE MAKONDE BUSH, NEAR

MAHUTA

I see increasing reason to believe that the view formed some time
back as to the origin of the Makonde bush is the correct one. I have
no doubt that it is not a natural product, but the result of human
occupation. Those parts of the high country where man—as a very
slight amount of practice enables the eye to perceive at once—has not
yet penetrated with axe and hoe, are still occupied by a splendid
timber forest quite able to sustain a comparison with our mixed
forests in Germany. But wherever man has once built his hut or tilled
his field, this horrible bush springs up. Every phase of this process
may be seen in the course of a couple of hours’ walk along the main
road. From the bush to right or left, one hears the sound of the axe—
not from one spot only, but from several directions at once. A few
steps further on, we can see what is taking place. The brush has been
cut down and piled up in heaps to the height of a yard or more,
between which the trunks of the large trees stand up like the last
pillars of a magnificent ruined building. These, too, present a
melancholy spectacle: the destructive Makonde have ringed them—
cut a broad strip of bark all round to ensure their dying off—and also
piled up pyramids of brush round them. Father and son, mother and
son-in-law, are chopping away perseveringly in the background—too
busy, almost, to look round at the white stranger, who usually excites
so much interest. If you pass by the same place a week later, the piles
of brushwood have disappeared and a thick layer of ashes has taken
the place of the green forest. The large trees stretch their
smouldering trunks and branches in dumb accusation to heaven—if
they have not already fallen and been more or less reduced to ashes,
perhaps only showing as a white stripe on the dark ground.
This work of destruction is carried out by the Makonde alike on the
virgin forest and on the bush which has sprung up on sites already
cultivated and deserted. In the second case they are saved the trouble
of burning the large trees, these being entirely absent in the
secondary bush.
After burning this piece of forest ground and loosening it with the
hoe, the native sows his corn and plants his vegetables. All over the
country, he goes in for bed-culture, which requires, and, in fact,
receives, the most careful attention. Weeds are nowhere tolerated in
the south of German East Africa. The crops may fail on the plains,
where droughts are frequent, but never on the plateau with its
abundant rains and heavy dews. Its fortunate inhabitants even have
the satisfaction of seeing the proud Wayao and Wamakua working
for them as labourers, driven by hunger to serve where they were
accustomed to rule.
But the light, sandy soil is soon exhausted, and would yield no
harvest the second year if cultivated twice running. This fact has
been familiar to the native for ages; consequently he provides in
time, and, while his crop is growing, prepares the next plot with axe
and firebrand. Next year he plants this with his various crops and
lets the first piece lie fallow. For a short time it remains waste and
desolate; then nature steps in to repair the destruction wrought by
man; a thousand new growths spring out of the exhausted soil, and
even the old stumps put forth fresh shoots. Next year the new growth
is up to one’s knees, and in a few years more it is that terrible,
impenetrable bush, which maintains its position till the black
occupier of the land has made the round of all the available sites and
come back to his starting point.
The Makonde are, body and soul, so to speak, one with this bush.
According to my Yao informants, indeed, their name means nothing
else but “bush people.” Their own tradition says that they have been
settled up here for a very long time, but to my surprise they laid great
stress on an original immigration. Their old homes were in the
south-east, near Mikindani and the mouth of the Rovuma, whence
their peaceful forefathers were driven by the continual raids of the
Sakalavas from Madagascar and the warlike Shirazis[47] of the coast,
to take refuge on the almost inaccessible plateau. I have studied
African ethnology for twenty years, but the fact that changes of
population in this apparently quiet and peaceable corner of the earth
could have been occasioned by outside enterprises taking place on
the high seas, was completely new to me. It is, no doubt, however,
correct.
The charming tribal legend of the Makonde—besides informing us
of other interesting matters—explains why they have to live in the
thickest of the bush and a long way from the edge of the plateau,
instead of making their permanent homes beside the purling brooks
and springs of the low country.
“The place where the tribe originated is Mahuta, on the southern
side of the plateau towards the Rovuma, where of old time there was
nothing but thick bush. Out of this bush came a man who never
washed himself or shaved his head, and who ate and drank but little.
He went out and made a human figure from the wood of a tree
growing in the open country, which he took home to his abode in the
bush and there set it upright. In the night this image came to life and
was a woman. The man and woman went down together to the
Rovuma to wash themselves. Here the woman gave birth to a still-
born child. They left that place and passed over the high land into the
valley of the Mbemkuru, where the woman had another child, which
was also born dead. Then they returned to the high bush country of
Mahuta, where the third child was born, which lived and grew up. In
course of time, the couple had many more children, and called
themselves Wamatanda. These were the ancestral stock of the
Makonde, also called Wamakonde,[48] i.e., aborigines. Their
forefather, the man from the bush, gave his children the command to
bury their dead upright, in memory of the mother of their race who
was cut out of wood and awoke to life when standing upright. He also
warned them against settling in the valleys and near large streams,
for sickness and death dwelt there. They were to make it a rule to
have their huts at least an hour’s walk from the nearest watering-
place; then their children would thrive and escape illness.”
The explanation of the name Makonde given by my informants is
somewhat different from that contained in the above legend, which I
extract from a little book (small, but packed with information), by
Pater Adams, entitled Lindi und sein Hinterland. Otherwise, my
results agree exactly with the statements of the legend. Washing?
Hapana—there is no such thing. Why should they do so? As it is, the
supply of water scarcely suffices for cooking and drinking; other
people do not wash, so why should the Makonde distinguish himself
by such needless eccentricity? As for shaving the head, the short,
woolly crop scarcely needs it,[49] so the second ancestral precept is
likewise easy enough to follow. Beyond this, however, there is
nothing ridiculous in the ancestor’s advice. I have obtained from
various local artists a fairly large number of figures carved in wood,
ranging from fifteen to twenty-three inches in height, and
representing women belonging to the great group of the Mavia,
Makonde, and Matambwe tribes. The carving is remarkably well
done and renders the female type with great accuracy, especially the
keloid ornamentation, to be described later on. As to the object and
meaning of their works the sculptors either could or (more probably)
would tell me nothing, and I was forced to content myself with the
scanty information vouchsafed by one man, who said that the figures
were merely intended to represent the nembo—the artificial
deformations of pelele, ear-discs, and keloids. The legend recorded
by Pater Adams places these figures in a new light. They must surely
be more than mere dolls; and we may even venture to assume that
they are—though the majority of present-day Makonde are probably
unaware of the fact—representations of the tribal ancestress.
 The references in the legend to the descent from Mahuta to the
Rovuma, and to a journey across the highlands into the Mbekuru
valley, undoubtedly indicate the previous history of the tribe, the
travels of the ancestral pair typifying the migrations of their
descendants. The descent to the neighbouring Rovuma valley, with
its extraordinary fertility and great abundance of game, is intelligible
at a glance—but the crossing of the Lukuledi depression, the ascent
to the Rondo Plateau and the descent to the Mbemkuru, also lie
within the bounds of probability, for all these districts have exactly
the same character as the extreme south. Now, however, comes a
point of especial interest for our bacteriological age. The primitive
Makonde did not enjoy their lives in the marshy river-valleys.
Disease raged among them, and many died. It was only after they
had returned to their original home near Mahuta, that the health
conditions of these people improved. We are very apt to think of the
African as a stupid person whose ignorance of nature is only equalled
by his fear of it, and who looks on all mishaps as caused by evil
spirits and malignant natural powers. It is much more correct to
assume in this case that the people very early learnt to distinguish
districts infested with malaria from those where it is absent.
This knowledge is crystallized in the
ancestral warning against settling in the
valleys and near the great waters, the
dwelling-places of disease and death. At the
same time, for security against the hostile
Mavia south of the Rovuma, it was enacted
that every settlement must be not less than a
certain distance from the southern edge of the
plateau. Such in fact is their mode of life at the
present day. It is not such a bad one, and
certainly they are both safer and more
comfortable than the Makua, the recent
intruders from the south, who have made USUAL METHOD OF
good their footing on the western edge of the CLOSING HUT-DOOR
plateau, extending over a fairly wide belt of
country. Neither Makua nor Makonde show in their dwellings
anything of the size and comeliness of the Yao houses in the plain,
especially at Masasi, Chingulungulu and Zuza’s. Jumbe Chauro, a
Makonde hamlet not far from Newala, on the road to Mahuta, is the
most important settlement of the tribe I have yet seen, and has fairly
spacious huts. But how slovenly is their construction compared with
the palatial residences of the elephant-hunters living in the plain.
The roofs are still more untidy than in the general run of huts during
the dry season, the walls show here and there the scanty beginnings
or the lamentable remains of the mud plastering, and the interior is a
veritable dog-kennel; dirt, dust and disorder everywhere. A few huts
only show any attempt at division into rooms, and this consists
merely of very roughly-made bamboo partitions. In one point alone
have I noticed any indication of progress—in the method of fastening
the door. Houses all over the south are secured in a simple but
ingenious manner. The door consists of a set of stout pieces of wood
or bamboo, tied with bark-string to two cross-pieces, and moving in
two grooves round one of the door-posts, so as to open inwards. If
the owner wishes to leave home, he takes two logs as thick as a man’s
upper arm and about a yard long. One of these is placed obliquely
against the middle of the door from the inside, so as to form an angle
of from 60° to 75° with the ground. He then places the second piece
horizontally across the first, pressing it downward with all his might.
It is kept in place by two strong posts planted in the ground a few
inches inside the door. This fastening is absolutely safe, but of course
cannot be applied to both doors at once, otherwise how could the
owner leave or enter his house? I have not yet succeeded in finding
out how the back door is fastened.

MAKONDE LOCK AND KEY AT JUMBE CHAURO

 This is the general way of closing a house. The Makonde at Jumbe
Chauro, however, have a much more complicated, solid and original
one. Here, too, the door is as already described, except that there is
only one post on the inside, standing by itself about six inches from
one side of the doorway. Opposite this post is a hole in the wall just
large enough to admit a man’s arm. The door is closed inside by a
large wooden bolt passing through a hole in this post and pressing
with its free end against the door. The other end has three holes into
which fit three pegs running in vertical grooves inside the post. The
door is opened with a wooden key about a foot long, somewhat
curved and sloped off at the butt; the other end has three pegs
corresponding to the holes, in the bolt, so that, when it is thrust
through the hole in the wall and inserted into the rectangular
opening in the post, the pegs can be lifted and the bolt drawn out.[50]

MODE OF INSERTING THE KEY

With no small pride first one householder and then a second

showed me on the spot the action of this greatest invention of the
Makonde Highlands. To both with an admiring exclamation of
“Vizuri sana!” (“Very fine!”). I expressed the wish to take back these
marvels with me to Ulaya, to show the Wazungu what clever fellows
the Makonde are. Scarcely five minutes after my return to camp at
Newala, the two men came up sweating under the weight of two
heavy logs which they laid down at my feet, handing over at the same
time the keys of the fallen fortress. Arguing, logically enough, that if
the key was wanted, the lock would be wanted with it, they had taken
their axes and chopped down the posts—as it never occurred to them
to dig them out of the ground and so bring them intact. Thus I have
two badly damaged specimens, and the owners, instead of praise,
come in for a blowing-up.
The Makua huts in the environs of Newala are especially
miserable; their more than slovenly construction reminds one of the
temporary erections of the Makua at Hatia’s, though the people here
have not been concerned in a war. It must therefore be due to
congenital idleness, or else to the absence of a powerful chief. Even
the baraza at Mlipa’s, a short hour’s walk south-east of Newala,
shares in this general neglect. While public buildings in this country
are usually looked after more or less carefully, this is in evident
danger of being blown over by the first strong easterly gale. The only
attractive object in this whole district is the grave of the late chief
Mlipa. I visited it in the morning, while the sun was still trying with
partial success to break through the rolling mists, and the circular
grove of tall euphorbias, which, with a broken pot, is all that marks
the old king’s resting-place, impressed one with a touch of pathos.
Even my very materially-minded carriers seemed to feel something
of the sort, for instead of their usual ribald songs, they chanted
solemnly, as we marched on through the dense green of the Makonde
bush:—
 “We shall arrive with the great master; we stand in a row and have
no fear about getting our food and our money from the Serkali (the
Government). We are not afraid; we are going along with the great
master, the lion; we are going down to the coast and back.”
With regard to the characteristic features of the various tribes here
on the western edge of the plateau, I can arrive at no other
conclusion than the one already come to in the plain, viz., that it is
impossible for anyone but a trained anthropologist to assign any
given individual at once to his proper tribe. In fact, I think that even
an anthropological specialist, after the most careful examination,
might find it a difficult task to decide. The whole congeries of peoples
collected in the region bounded on the west by the great Central
African rift, Tanganyika and Nyasa, and on the east by the Indian
Ocean, are closely related to each other—some of their languages are
only distinguished from one another as dialects of the same speech,
and no doubt all the tribes present the same shape of skull and
structure of skeleton. Thus, surely, there can be no very striking
differences in outward appearance.
 Even did such exist, I should have no time
to concern myself with them, for day after day,
I have to see or hear, as the case may be—in
any case to grasp and record—an
extraordinary number of ethnographic
phenomena. I am almost disposed to think it
fortunate that some departments of inquiry, at
least, are barred by external circumstances.
Chief among these is the subject of iron-
working. We are apt to think of Africa as a
country where iron ore is everywhere, so to
speak, to be picked up by the roadside, and
where it would be quite surprising if the
inhabitants had not learnt to smelt the
material ready to their hand. In fact, the
knowledge of this art ranges all over the
continent, from the Kabyles in the north to the
Kafirs in the south. Here between the Rovuma
and the Lukuledi the conditions are not so
favourable. According to the statements of the
Makonde, neither ironstone nor any other
form of iron ore is known to them. They have
not therefore advanced to the art of smelting
the metal, but have hitherto bought all their
THE ANCESTRESS OF
THE MAKONDE
iron implements from neighbouring tribes.
Even in the plain the inhabitants are not much
better off. Only one man now living is said to
understand the art of smelting iron. This old fundi lives close to
Huwe, that isolated, steep-sided block of granite which rises out of
the green solitude between Masasi and Chingulungulu, and whose
jagged and splintered top meets the traveller’s eye everywhere. While
still at Masasi I wished to see this man at work, but was told that,
frightened by the rising, he had retired across the Rovuma, though
he would soon return. All subsequent inquiries as to whether the
fundi had come back met with the genuine African answer, “Bado”
(“Not yet”).
 BRAZIER

Some consolation was afforded me by a brassfounder, whom I

came across in the bush near Akundonde’s. This man is the favourite
of women, and therefore no doubt of the gods; he welds the glittering
brass rods purchased at the coast into those massive, heavy rings
which, on the wrists and ankles of the local fair ones, continually give
me fresh food for admiration. Like every decent master-craftsman he
had all his tools with him, consisting of a pair of bellows, three
crucibles and a hammer—nothing more, apparently. He was quite
willing to show his skill, and in a twinkling had fixed his bellows on
the ground. They are simply two goat-skins, taken off whole, the four
legs being closed by knots, while the upper opening, intended to
admit the air, is kept stretched by two pieces of wood. At the lower
end of the skin a smaller opening is left into which a wooden tube is
stuck. The fundi has quickly borrowed a heap of wood-embers from
the nearest hut; he then fixes the free ends of the two tubes into an
earthen pipe, and clamps them to the ground by means of a bent
piece of wood. Now he fills one of his small clay crucibles, the dross
on which shows that they have been long in use, with the yellow
material, places it in the midst of the embers, which, at present are
only faintly glimmering, and begins his work. In quick alternation
the smith’s two hands move up and down with the open ends of the
bellows; as he raises his hand he holds the slit wide open, so as to let
the air enter the skin bag unhindered. In pressing it down he closes
the bag, and the air puffs through the bamboo tube and clay pipe into
the fire, which quickly burns up. The smith, however, does not keep
on with this work, but beckons to another man, who relieves him at
the bellows, while he takes some more tools out of a large skin pouch
carried on his back. I look on in wonder as, with a smooth round
stick about the thickness of a finger, he bores a few vertical holes into
the clean sand of the soil. This should not be difficult, yet the man
seems to be taking great pains over it. Then he fastens down to the
ground, with a couple of wooden clamps, a neat little trough made by
splitting a joint of bamboo in half, so that the ends are closed by the
two knots. At last the yellow metal has attained the right consistency,
and the fundi lifts the crucible from the fire by means of two sticks
split at the end to serve as tongs. A short swift turn to the left—a
tilting of the crucible—and the molten brass, hissing and giving forth
clouds of smoke, flows first into the bamboo mould and then into the
holes in the ground.
The technique of this backwoods craftsman may not be very far
advanced, but it cannot be denied that he knows how to obtain an
adequate result by the simplest means. The ladies of highest rank in
this country—that is to say, those who can afford it, wear two kinds
of these massive brass rings, one cylindrical, the other semicircular
in section. The latter are cast in the most ingenious way in the
bamboo mould, the former in the circular hole in the sand. It is quite
a simple matter for the fundi to fit these bars to the limbs of his fair
customers; with a few light strokes of his hammer he bends the
pliable brass round arm or ankle without further inconvenience to
the wearer.
SHAPING THE POT

SMOOTHING WITH MAIZE-COB

CUTTING THE EDGE

 FINISHING THE BOTTOM

LAST SMOOTHING BEFORE

BURNING

FIRING THE BRUSH-PILE

 LIGHTING THE FARTHER SIDE OF
THE PILE

TURNING THE RED-HOT VESSEL

NYASA WOMAN MAKING POTS AT MASASI

Pottery is an art which must always and everywhere excite the
interest of the student, just because it is so intimately connected with
the development of human culture, and because its relics are one of
the principal factors in the reconstruction of our own condition in
prehistoric times. I shall always remember with pleasure the two or
three afternoons at Masasi when Salim Matola’s mother, a slightly-
built, graceful, pleasant-looking woman, explained to me with
touching patience, by means of concrete illustrations, the ceramic art
of her people. The only implements for this primitive process were a
lump of clay in her left hand, and in the right a calabash containing
the following valuables: the fragment of a maize-cob stripped of all
its grains, a smooth, oval pebble, about the size of a pigeon’s egg, a
few chips of gourd-shell, a bamboo splinter about the length of one’s
hand, a small shell, and a bunch of some herb resembling spinach.
 Nothing more. The woman scraped with the
shell a round, shallow hole in the soft, fine
sand of the soil, and, when an active young
girl had filled the calabash with water for her,
she began to knead the clay. As if by magic it
gradually assumed the shape of a rough but
already well-shaped vessel, which only wanted
a little touching up with the instruments
before mentioned. I looked out with the
MAKUA WOMAN closest attention for any indication of the use
MAKING A POT. of the potter’s wheel, in however rudimentary
SHOWS THE a form, but no—hapana (there is none). The
BEGINNINGS OF THE embryo pot stood firmly in its little
POTTER’S WHEEL
depression, and the woman walked round it in
a stooping posture, whether she was removing
small stones or similar foreign bodies with the maize-cob, smoothing
the inner or outer surface with the splinter of bamboo, or later, after
letting it dry for a day, pricking in the ornamentation with a pointed
bit of gourd-shell, or working out the bottom, or cutting the edge
with a sharp bamboo knife, or giving the last touches to the finished
vessel. This occupation of the women is infinitely toilsome, but it is
without doubt an accurate reproduction of the process in use among
our ancestors of the Neolithic and Bronze ages.
There is no doubt that the invention of pottery, an item in human
progress whose importance cannot be over-estimated, is due to
women. Rough, coarse and unfeeling, the men of the horde range
over the countryside. When the united cunning of the hunters has
succeeded in killing the game; not one of them thinks of carrying
home the spoil. A bright fire, kindled by a vigorous wielding of the
drill, is crackling beside them; the animal has been cleaned and cut
up secundum artem, and, after a slight singeing, will soon disappear
under their sharp teeth; no one all this time giving a single thought
to wife or child.
To what shifts, on the other hand, the primitive wife, and still more
the primitive mother, was put! Not even prehistoric stomachs could
endure an unvarying diet of raw food. Something or other suggested
the beneficial effect of hot water on the majority of approved but
indigestible dishes. Perhaps a neighbour had tried holding the hard
roots or tubers over the fire in a calabash filled with water—or maybe
an ostrich-egg-shell, or a hastily improvised vessel of bark. They
became much softer and more palatable than they had previously
been; but, unfortunately, the vessel could not stand the fire and got
charred on the outside. That can be remedied, thought our
ancestress, and plastered a layer of wet clay round a similar vessel.
This is an improvement; the cooking utensil remains uninjured, but
the heat of the fire has shrunk it, so that it is loose in its shell. The
next step is to detach it, so, with a firm grip and a jerk, shell and
kernel are separated, and pottery is invented. Perhaps, however, the
discovery which led to an intelligent use of the burnt-clay shell, was
made in a slightly different way. Ostrich-eggs and calabashes are not
to be found in every part of the world, but everywhere mankind has
arrived at the art of making baskets out of pliant materials, such as
bark, bast, strips of palm-leaf, supple twigs, etc. Our inventor has no
water-tight vessel provided by nature. “Never mind, let us line the
basket with clay.” This answers the purpose, but alas! the basket gets
burnt over the blazing fire, the woman watches the process of
cooking with increasing uneasiness, fearing a leak, but no leak
appears. The food, done to a turn, is eaten with peculiar relish; and
the cooking-vessel is examined, half in curiosity, half in satisfaction
at the result. The plastic clay is now hard as stone, and at the same
time looks exceedingly well, for the neat plaiting of the burnt basket
is traced all over it in a pretty pattern. Thus, simultaneously with
pottery, its ornamentation was invented.
Primitive woman has another claim to respect. It was the man,
roving abroad, who invented the art of producing fire at will, but the
woman, unable to imitate him in this, has been a Vestal from the
earliest times. Nothing gives so much trouble as the keeping alight of
the smouldering brand, and, above all, when all the men are absent
from the camp. Heavy rain-clouds gather, already the first large
drops are falling, the first gusts of the storm rage over the plain. The
little flame, a greater anxiety to the woman than her own children,
flickers unsteadily in the blast. What is to be done? A sudden thought
occurs to her, and in an instant she has constructed a primitive hut
out of strips of bark, to protect the flame against rain and wind.
This, or something very like it, was the way in which the principle
of the house was discovered; and even the most hardened misogynist
cannot fairly refuse a woman the credit of it. The protection of the
hearth-fire from the weather is the germ from which the human
dwelling was evolved. Men had little, if any share, in this forward
step, and that only at a late stage. Even at the present day, the
plastering of the housewall with clay and the manufacture of pottery
are exclusively the women’s business. These are two very significant
survivals. Our European kitchen-garden, too, is originally a woman’s
invention, and the hoe, the primitive instrument of agriculture, is,
characteristically enough, still used in this department. But the
noblest achievement which we owe to the other sex is unquestionably
the art of cookery. Roasting alone—the oldest process—is one for
which men took the hint (a very obvious one) from nature. It must
have been suggested by the scorched carcase of some animal
overtaken by the destructive forest-fires. But boiling—the process of
improving organic substances by the help of water heated to boiling-
point—is a much later discovery. It is so recent that it has not even
yet penetrated to all parts of the world. The Polynesians understand
how to steam food, that is, to cook it, neatly wrapped in leaves, in a
hole in the earth between hot stones, the air being excluded, and
(sometimes) a few drops of water sprinkled on the stones; but they
do not understand boiling.
To come back from this digression, we find that the slender Nyasa
woman has, after once more carefully examining the finished pot,
put it aside in the shade to dry. On the following day she sends me
word by her son, Salim Matola, who is always on hand, that she is
going to do the burning, and, on coming out of my house, I find her
already hard at work. She has spread on the ground a layer of very
dry sticks, about as thick as one’s thumb, has laid the pot (now of a
yellowish-grey colour) on them, and is piling brushwood round it.
My faithful Pesa mbili, the mnyampara, who has been standing by,
most obligingly, with a lighted stick, now hands it to her. Both of
them, blowing steadily, light the pile on the lee side, and, when the
flame begins to catch, on the weather side also. Soon the whole is in a
blaze, but the dry fuel is quickly consumed and the fire dies down, so
that we see the red-hot vessel rising from the ashes. The woman
turns it continually with a long stick, sometimes one way and
sometimes another, so that it may be evenly heated all over. In
twenty minutes she rolls it out of the ash-heap, takes up the bundle
of spinach, which has been lying for two days in a jar of water, and
sprinkles the red-hot clay with it. The places where the drops fall are
marked by black spots on the uniform reddish-brown surface. With a
sigh of relief, and with visible satisfaction, the woman rises to an
erect position; she is standing just in a line between me and the fire,
from which a cloud of smoke is just rising: I press the ball of my
camera, the shutter clicks—the apotheosis is achieved! Like a
priestess, representative of her inventive sex, the graceful woman
stands: at her feet the hearth-fire she has given us beside her the
invention she has devised for us, in the background the home she has
built for us.
At Newala, also, I have had the manufacture of pottery carried on
in my presence. Technically the process is better than that already
described, for here we find the beginnings of the potter’s wheel,
which does not seem to exist in the plains; at least I have seen
nothing of the sort. The artist, a frightfully stupid Makua woman, did
not make a depression in the ground to receive the pot she was about
to shape, but used instead a large potsherd. Otherwise, she went to
work in much the same way as Salim’s mother, except that she saved
herself the trouble of walking round and round her work by squatting
at her ease and letting the pot and potsherd rotate round her; this is
surely the first step towards a machine. But it does not follow that
the pot was improved by the process. It is true that it was beautifully
rounded and presented a very creditable appearance when finished,
but the numerous large and small vessels which I have seen, and, in
part, collected, in the “less advanced” districts, are no less so. We
moderns imagine that instruments of precision are necessary to
produce excellent results. Go to the prehistoric collections of our
museums and look at the pots, urns and bowls of our ancestors in the
dim ages of the past, and you will at once perceive your error.
MAKING LONGITUDINAL CUT IN
BARK

DRAWING THE BARK OFF THE LOG

REMOVING THE OUTER BARK

 BEATING THE BARK

WORKING THE BARK-CLOTH AFTER BEATING, TO MAKE IT

SOFT

MANUFACTURE OF BARK-CLOTH AT NEWALA

To-day, nearly the whole population of German East Africa is
clothed in imported calico. This was not always the case; even now in
some parts of the north dressed skins are still the prevailing wear,
and in the north-western districts—east and north of Lake
Tanganyika—lies a zone where bark-cloth has not yet been
superseded. Probably not many generations have passed since such
bark fabrics and kilts of skins were the only clothing even in the
south. Even to-day, large quantities of this bright-red or drab
material are still to be found; but if we wish to see it, we must look in
the granaries and on the drying stages inside the native huts, where
it serves less ambitious uses as wrappings for those seeds and fruits
which require to be packed with special care. The salt produced at
Masasi, too, is packed for transport to a distance in large sheets of
bark-cloth. Wherever I found it in any degree possible, I studied the
process of making this cloth. The native requisitioned for the
purpose arrived, carrying a log between two and three yards long and
as thick as his thigh, and nothing else except a curiously-shaped
mallet and the usual long, sharp and pointed knife which all men and
boys wear in a belt at their backs without a sheath—horribile dictu!
[51]
Silently he squats down before me, and with two rapid cuts has
drawn a couple of circles round the log some two yards apart, and
slits the bark lengthwise between them with the point of his knife.
With evident care, he then scrapes off the outer rind all round the
log, so that in a quarter of an hour the inner red layer of the bark
shows up brightly-coloured between the two untouched ends. With
some trouble and much caution, he now loosens the bark at one end,
and opens the cylinder. He then stands up, takes hold of the free
edge with both hands, and turning it inside out, slowly but steadily
pulls it off in one piece. Now comes the troublesome work of
scraping all superfluous particles of outer bark from the outside of
the long, narrow piece of material, while the inner side is carefully
scrutinised for defective spots. At last it is ready for beating. Having
signalled to a friend, who immediately places a bowl of water beside
him, the artificer damps his sheet of bark all over, seizes his mallet,
lays one end of the stuff on the smoothest spot of the log, and
hammers away slowly but continuously. “Very simple!” I think to
myself. “Why, I could do that, too!”—but I am forced to change my
opinions a little later on; for the beating is quite an art, if the fabric is
not to be beaten to pieces. To prevent the breaking of the fibres, the
stuff is several times folded across, so as to interpose several
thicknesses between the mallet and the block. At last the required
state is reached, and the fundi seizes the sheet, still folded, by both
ends, and wrings it out, or calls an assistant to take one end while he
holds the other. The cloth produced in this way is not nearly so fine
and uniform in texture as the famous Uganda bark-cloth, but it is
quite soft, and, above all, cheap.
Now, too, I examine the mallet. My craftsman has been using the
simpler but better form of this implement, a conical block of some
hard wood, its base—the striking surface—being scored across and
across with more or less deeply-cut grooves, and the handle stuck
into a hole in the middle. The other and earlier form of mallet is
shaped in the same way, but the head is fastened by an ingenious
network of bark strips into the split bamboo serving as a handle. The
observation so often made, that ancient customs persist longest in
connection with religious ceremonies and in the life of children, here
finds confirmation. As we shall soon see, bark-cloth is still worn
during the unyago,[52] having been prepared with special solemn
ceremonies; and many a mother, if she has no other garment handy,
will still put her little one into a kilt of bark-cloth, which, after all,
looks better, besides being more in keeping with its African
surroundings, than the ridiculous bit of print from Ulaya.
MAKUA WOMEN