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As revealed by the statistics on female doctors I have collected, most of them were concentrated in obstetrics, gynecology, pediatrics and minor surgery. Being females themselves, they were privileged in obstetrical, gynecological and pediatric practice. Just as Zhu En 朱恩 said in his preface to Medical Cases with Annotation by a Female Doctor,
As I heard from male doctors, they would rather treat ten men than a woman. It is not because they can learn very little from women as a result of the ethical barrier between men and women, but rather because the nature differs between the two sexes. The female doctor, based on her understanding of her own nature, can easily understand the female patient's nature, and they are bound to succeed.12
From the cases reported in the above book, one can see that the patients who visited Tan Yunxian were willing to reveal their privacy so that she was well-informed and could easily offer correct diagnoses and good advice. For example, one woman became ill out of anger when her husband took a concubine after he rose in social position. Another woman became ill with anxiety because she had not yet born a son and she was afraid that her husband might take a concubine using this as an excuse. Of course, they would not reveal such social-psychological precipitating factors to male doctors. On the other hand, Tan Yunxian herself had "menstrual disorders" and other common gynecological diseases. She had also giver birth to four children and thus she knew much more than her male counterparts how to treat female patients. Besides, as a mother herself, she had good experience in caring for children. One day, a rich woman brought an eight-year old girl to her, saying the girl had protracted diarrhea and it persisted for a long time. When Tan learned that the girl was the mother's only daughter, she thought "spoiling would lead to excessive eating and improper diet which was likely to result in dyspepsia." She prescribed Baohe pill 保和丸 (a prescription indicated especially for indigestion) and moxibustion, and the girl was promptly cured.
Although female doctors were privileged in gynecology, obstetrics and pediatrics, they were limited in other fields and in their practices. Tan Yunxian, for example, practiced Medicine only in the country among her acquaintances. After she completed the book, she was not in a position to publish it. As she wrote in her book, "I do hope to solicit comments on my writing but, being a woman I cannot go out myself, so I have to ask my son to have blocks cut for printing." Thus the limitation imposed upon women (their being prohibited from contacting males outside their home) confined their practices to women and children
Medical Education and Social Status of Female Doctors in Ancient China
Many types may be distinguished among female doctors in ancient China and various levels of education were available to each type of them. A good many of them did not receive any systematic education and they earned their living simple by suing the few prescriptions or skills they picked up form other and the little experience they acquired form the few cases they happened to treat. Yet there were a few who received formal training. This training was not, however, on a par with what male doctors received. No female student ever attend official medical school in any dynasty. Most of the female doctors received their training form their families.
Those professional female doctors who received systematic training were the best of then and most women received their training form their "medical families"-usually form her husband's family but occasionally form her own family. To monopolize their skills, most medical families kept their knowledge secret and only passed it on to sons and daughters-in-law but not t their daughters married into other families. This is the reason why there were so many cases where both mother-in-law and daughter-in-law were doctors . For example, in the medical family of the Guos 郭氏 -which had earned a reputation in gynecology since the Song dynasty-, female doctors of several generations (respectively nee Feng冯, Wu吴, and Mao毛") enjoyed good fame. In the medical family specialized in pediatrics in the Ming dynasty, Madam Cheng程 nee Fang方 was the daughter-in-law of Madam Cheng程 nee Jiang蒋 . There were a few female doctors, however, who received their training from their own parent's family. In families that had no son or whose son(s) would follow other professions, it was possible for the daughter to inherit the shills. The above mentioned Tan Yunxian learned from her grandfather and grandmother, for her father's generation changed to an official career and no one except her would be able to carry forward medical tradition.
Unlike their male counterparts who often learned skills form a certain master with the purpose of setting up their own clinics right after they completed their apprenticeship, women in the profession. Received medical training largely to assist the males in their family by doing some supporting work. One important source of male doctors was those would-be scholars who failed the official examination. This was impossible for females who were not qualified to take the official examination at all. Most male doctors were not from medical families and many officials and learned men studied medicine out of personal interest. Even after they became prominent physicians, they did not rely on medicine to make a living. No such examples were found among female doctors. Family training was the standard mode of education for them and few female doctors were known who received systematic training outside the family. While they might be very skilled in certain medical techniques, they rarely made any theoretical contributions. The extant medical works contributed by them were mostly case records or summaries of their clinical experience. This may be attributed to their limited training.
In contrast to the family-based female doctors, many itinerant female healers were active throughout the land, rendering their service to the bottom of society sometimes in the city but largely in the country, where Confucian ethics had little influence. Few of them received ant formal training. There such a variety of them that no single picture of then can be presented. Some of them were nuns or simply witches. They sold hers, which were often professed as "secret recipes," "magic drugs" or "panacea." They acted as midwives who might assist with abortions sometimes. Among them, midwifery was a stable profession throughout the dynasties. Yet they were among the most despised in the society, usually classified together with fortune-tellers, sorceresses, matchmakers, middlemen, or even procuresses. In novels written in the Ming and Qing dynasties, they were often depicted as women who earned their living by dishonest means.
Although some of them were experienced, midwives generally had little technical competence. They simply could do nothing in cases of difficult labor. There went a saying in the Han dynasty that, during delivery, there was "only one survival after ten deaths." According to Yang Kanghou杨康侯, a physician in the Song dynasty, "there are very few good midwives and death is often the outcome." As was also pointed out by Chen Zhidao 陈治道, the author of safe delivery (Baochan wanquan fang保产万全方) in the Ming dynasty, "it is precarious to risk two lives on a midwife." A steady and experienced midwife might save the life of both the mother and infant, but this is purely chance and the not the consequence of good knowledge and skill. In contrast, a rude and ignorant quack might turn an otherwise uneventful case into a difficult one and, frightened by the unexpected outcome out of her wits, she might even take the opportunity to blackmail the family though death of at least the infant was usually the case. In Supplement to the Classified Medical Records of Distinguished Physicians (Xu mingyi leian续名医类案), one can see an account of a midwife in the Yuan dynasty who broke the arm of an infant leading to its death in the womb. Much criticism was directed at midwives for their lack of technical competence and morality.
Many female healers used witchcraft to deify their skill. During the Song dynasty, a certain Madam Zhang 张 practiced witchcraft while performing acupuncture on her patients. And in the Qing dynasty, Madam Li李 , a female healer in Shunyi顺义 County, was famous for her magic arts as well as her art of healing. With the effects much tauted, she became praised as the "Old Buddha of Western Hills" (Xishan laofo西山老佛), attracting a good many to come to worship her. For fear that this might lead social instability, the authorities eventually executed her on a pretext. Such female witch-healers and common female healers of low standard did great harm to the image of female doctors in general. All these led Xiao Jing萧京, a physician in the Qing dynasty, to conclude: "It is really risky to entrust the midwife with the life of one's wife and son. They have already killed a good many."
Summary
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