CHAPTER 4

Diseases of Sex

Medical and Literary Views of Contagion and Retribution

Ximen Qing drunkenly stumbles into the room of his most lascivious wife, Pan Jinlian. It is late and he has been complaining of fatigue the past few days. No wonder, since he has been disporting himself with Laijue’s wife, Ben the fourth’s wife, Wang Liu’er, and three of his own wives in recent days, and in all of those sexual encounters, Ximen has employed a powerful aphrodisiac obtained from a mysterious foreign monk. Now in his wife’s room, he falls asleep immediately. Unable to produce an erection from her husband in his drunken slumber, Pan Jinlian gives him an overdose of the monk’s medicine and makes love to him. He ejaculates all of his semen, followed by blood and cold air. He slips in and out of consciousness. The following day he is dizzy. It becomes difficult for him to urinate, and his scrotum swells. Pan Jinlian continues to make love to him since the effects of the aphrodisiac have not yet abated. Finally, his scrotum bursts, and days later he dies.

This notorious scene from chapter 79 of Plum in the Golden Vase is invariably interpreted as a case of the unwise overexpenditure of limited bodily resources. However gruesome, it is a prime example of the dangers of sex and, by extension, all kinds of excessive behavior. The reader is told that Ximen “sought only his own sexual gratification but did not realize that ‘when its oil is used up the lamp goes out.’”¹ Title couplets and illustration captions imply similar diagnoses: “Ximen Qing in His Licentiousness Incurs Illness” (Tanyu de bing). These kinds of excesses were a major concern of doctors and scholars in the late Ming, a period often thought to be the height of sensuality in premodern China.² Death by excess is read as a metaphor for the entire novel, the age, and the dynasty.³

Yet, Ximen’s case is not so cut-and-dried. The narrative of Plum in the Golden Vase subverts and supplements a straightforward reading of his illness and death as one brought on by simple cause and effect. Death from excess is a kind of worldly retribution, a simple result of unwise behavior,⁴ but Ximen also dies from haunting by the ghosts of people he has driven to death. Ximen’s illness is identified by a variety of characters knowledgeable about medicine as “poison in the region of relief” (bian du) and “yin cold” (yinhan), diseases found in the medical texts with a range of symptoms and causes.⁵ The novel also occasionally refers to Ximen’s disease as something contracted through sex. The lesions on his groin that emit a yellow fluid, lower back pain, and painful urination are symptoms of diseases known at the time to be transmitted by sexual intercourse—namely gonorrhea (baizhuo) and syphilis (yangmei).⁶

Given the interest in syphilis among medical and other authors during the period in which Plum in the Golden Vase was written, it is not surprising that it finds mention in the novel. It is surprising, however, that it does not play a more prominent role. Prescriptions for bian poisoning in the Systematic Materia Medica, for instance, were said to also treat numerous diseases caused by or related to sex and resulting in skin lesions.⁷ Most often we see bian poisoning occurring alongside “evil chancre” (echuang), “carbuncle and chancre (dingchuang) and “fish mouth” (yukou).⁸ Some drugs for bian du also cure syphilis sores and bug or worm bites (chongyao). Most often, bian du “breaks out” (chufa)—it is latent on the inside and becomes manifest.⁹ The Systematic Materia Medica also discusses bian du as being caused by the following pathoconditions: sexual overexertion, restraint of ejaculation, or failure in love affairs, which cause stagnation of vital essence and blood or retention of sperm. Bian du can also be caused by “excessive anger that has damaged the liver, bringing with it stagnation of vital energy and blood in the channels and veins. A hard mass may appear in the groin area, which may develop into ulceration.”¹⁰ References to bian du in fiction and medical texts drop off after the Ming and disappear almost entirely by the eighteenth century.¹¹ This malady seems to have been a precursor to contagious venereal diseases, such as yangmei in its many symptoms and often sex-related causes, but it also evokes emotional disorders such as consumption, since it can be caused by anger and disappointment in love affairs. Bian du was a malady caused by a broadly defined desire that encompassed both excessive carnality and extreme feelings.

A story contemporary with Plum in the Golden Vase, “A Husband Leaves His Wife in Xi’an Fu and in Heyang County a Man Becomes a Woman” (Xian fu fu bie qi, Heyang xian nan hua nü, 1632) features a man, Li Liangyu, who contracts bian du syphilis (bian du guangchuang) from visiting a prostitute.¹² His penis ulcerates and “festers to the root,” and he loses all of his facial hair, which makes him look like a “stunning lady-in-waiting.” He is taken to see King Yama, from whom he learns that a clerical error caused him to be reborn a man rather than a woman. Yama thus has him changed into Lady Li. The story makes clear at the outset that “if one can uphold one’s morality, then one is most likely a man; if one cannot keep one’s virtues, then one is most likely a woman,” and Li, having violated his morality as a man, is turned into a woman both by syphilis and by Yama. His disease punishes men with mundane and karmic retribution for immoral acts.

Medical case histories that included treatment of yangmei patients invariably identified those patients as men. All of the maladies recorded in Wang Ji’s Stone Mountain Medical Cases (Shishan yi’an, 1531) related to sex are attributed to men.¹³ Although this does not reflect the reality of his day (perhaps Wang did not treat prostitutes, or perhaps women with diseases related to sex would not ask to be seen by him), that his records show men suffering primarily from sex and exhaustion (and drink) contributed to a public perception that these are diseases of men.

Ximen Qing’s illness and death are most often and most simply read as stemming from sexual depletion. While he develops bian du from excessive sex and from being morally corrupt, it is interesting that his female doppelgänger develops consumption. Pang Chunmei is the most licentious character in the novel after Ximen Qing and Pan Jinlian die. Chunmei indulges in a variety of sexual affairs, living for nothing but pleasure. She gives herself over to her passions for her new lover, Zhou Yi. They enjoy themselves in bed without the slightest restraint. Chunmei,

because of immoderate lust, developed consumptive bone steaming. Although she took medicine, she lost her appetite. Her spirits were depressed and her body became very thin, but she never gave up indulging in lust. . . . She stayed in bed with Zhou Yi all day. They were having intercourse when suddenly she exhaled cold breath and her lusty juices emanated from her vagina. She died right there upon Zhou Yi’s body. She was twenty-nine sui [twenty-eight years old].¹⁴

Later in that last chapter of Plum in the Golden Vase (admittedly a point of crisis in the text), when the ghosts of the dead are assigned their lot in the next life, they appear before the monk who will assign them described only by their bodily descriptions upon their deaths. Chunmei, whose face is pale and thin, says that she died of “sexual consumption” (selao zhi si).¹⁵ Hers is a reenactment of Ximen Qing’s death from overindulgence in sex, only this time it is gendered female. Not only is Chunmei’s depletion disorder related to lust and sex, it is the female equivalent of yin coldness and bian poison.

Ximen Qing’s disease, whatever its name, is complicated and tied to his sexual activities. But the vector of his illness is not well defined. It is caused by both retribution and contagion. The concept of interpersonal contagion was, if not completely new, undergoing redefinition in the medical texts of the late Ming, largely in response to syphilis epidemics. Contagion became tied up with retribution and gender. It was a cause of illness that incorporated new knowledge into old beliefs. Contagion implicated border crossings of all kinds, but, as with Ximen’s case, also moral transgressions, supernormal vengeance, and mundane accumulations in the body. Because contagion is a concept foundational to medicine and rich in metaphorical possibilities for literature, and since it forced somewhat of a paradigm shift at the moment domestic fiction was becoming so popular, it is worth investigating how the concept was used in medicine and fiction.

A BRIEF HISTORY OF CHUANRAN

In early twentieth century China, the term chuanran quickly became the standard translation of the biomedical concept of contagion. In traditional Chinese medicine, illness was usually perceived as being the result not of microorganisms but rather of blockages or the improper flow of qi within the body. Before the nineteenth century no one in China suffered from plague, cholera, typhoid fever, or malaria. Millions, though, died from yin deficiency (yinxu) and foot qi (jiaoqi) and cold damage (shanghan),¹⁶ not to mention bone-steaming (guzheng), flying corpse (feishi), and ghost infection (guizhu). Before the biomedical revolution of the late nineteenth century, neither physicians in China nor Europe had any notion of syphilis’s spirochete or of the mycobacteria that cause tuberculosis. Chuanran was a new concept with modern, Western, and scientific implications.

But chuanran is an old word, used as early as the tenth century to express complex concepts about the spread of disease from person to person. In premodern Chinese medicine, several different kinds of transmission fall under the conceptual umbrella of chuanran. Chuan, “to pass on,” for instance, referred to the transmission of a pathogen from a corpse, place, or other nonliving source to a living body, while ran, literally meaning “to dye,” described the movement of a disorder between living things, including processes of “mutual dyeing” (xiangran), “exchange by dyeing” or “dye and exchange” (ranyi), and “affect by dyeing”(ganran).¹⁷ Thus, the binome chuanran literally meant “transmission by dyeing” or “dye by transmission.”

The word chuanran appears in many medical texts from the premodern period. In the tenth century, chuanran began to replace ranyi as the preferred term for describing the flow of qi between people.¹⁸ In medical texts of the Ming and Qing, there are essentially three ways in which something could chuanran: by direct or indirect physical contact with the sick, by hereditary transmission, and by transmission through sexual intercourse.¹⁹ Gong Tingxian, a sixteenth-century palace doctor, uses chuanran to describe modes of transmission from a sick body to a healthy one when he observes, “If one is careless while traveling, mafeng [probably leprosy] could be transmitted [chuanran] in toilets, in living quarters, or by bedding and clothes.”²⁰ Family and members of the community often worried that the qi or physical corpse of a laozhai (consumption) victim could contaminate objects, which in turn could contaminate those who come into contact with them. People could be infected by a residence (wuchuan), by clothes or bedding (yichuan), or by food or medicine belonging to the deceased (shichuan). If a patient died of “corpse pouring” (shizhu) or depletion-consumption (laozhai), his clothes, utensils, and residence were all likely to retain harmful qi, which could then infect his relatives and neighbors if they could not afford to dispose of them.

The second type of chuanran was hereditary transmission, particularly within a household. Although some Daoist texts as early as the Southern Song recognized gu poison contagion “irrespective of family relationship,” it was common to think of disease transmission as something that happened primarily among family members.²¹ The concept of gu contagion reveals a conflation of spatial proximity with lineal proximity—families transmit disease to members through shared sin and through shared space and objects. Gong Tingxian presents family ties as another potential vector for the transmission of mafeng: “[The disorder could be] transmitted to others from ancestors or parents [to descendants], from husbands and wives, or other members of the family.”²² Hereditary transmission could mean the passing of some irregularity or contaminant from mother to child, through breast milk or blood, but it also included illnesses inherited from the father as well as from ancestors, both living and dead.

The third type of chuanran was by sexual intercourse. An early concept related to this was “yinyang exchange” (yinyang yi), an ailment transmitted by sexual intercourse when one partner had not yet fully recovered after being cured from “harm by cold” (yinhan).²³ In the case of a man’s illness transmitted to his female partner, Li Shizhen prescribes the ashes from the burnt crotch of the man’s trousers. In the case of a woman’s illness transmitted to her male partner, physicians should treat him with the ashes from the woman’s burnt pubic hair. Both of these cures obviously relied on sympathetic medicine and carried the symbolic stain of sexual intercourse. “Yinyang exchange” referred to the pouring out of essence, which enabled noxious influences to enter the body during a period of depletion. Sexual transmission was primarily discussed in the late imperial period in the context of a new disease called yangmei chuang (“plum-blossom sores”)—also called Guangdong chuang (“Guangdong sores”), as the disease was believed to have originated in Guangdong province—which modern historians of medicine often identify as syphilis and which was first recorded in southern China during the first decade of the sixteenth century. The section “Essentials of Authentic Methods in External Medicine” (Waike xinfa yaojue) in the Golden Mirror of the Medical Lineage (fig. 4.1) makes it clear that “there are two types of yangmei chuang: those that have at their essence a change in jing [essence] and those that have a change in qi. The change in jing is the result of licentiousness and desire, [while] the change in qi is the result of contagious [chuanran] qi.”²⁴ This disease was caused by evil or heteropathic qi entering the body, and also by (or aided by) a depletion of “original essence” (yuanqi) as a result of (excessive) sexual activity and, more specifically, illicit sexual contact outside the family.

Most doctors throughout China’s long literary and medical history did not define chuanran clearly as three modes of transmission. The term meant contamination not only by contact with the sick but also by contact with a pathogenic qi that could be epidemic or individual, an old idea originally expressed by “mutual dyeing” (xiangran). From the late Ming onwards, many southern doctors distinguished between the noncontagious qi that provoked “cold damage” disorders and contagious, local, impure, epidemic qi.²⁵ Chuanran also meant that members of the same household or people related by blood were believed to be more vulnerable to contamination by the patient, a notion already described in seventh-century texts. Chuanran was a nebulous, plastic concept, and it was not an important topic in medical discourse until the late Ming. Up to the modern period, chuanran was never the only cause of a disorder.²⁶ A polluted location, unseasonal weather, the weak physical constitution of the victim, extremes of emotion, bad geomancy of a residence, or moral flaws or wrongdoings were equally valid or more important causes. However, disorders considered more prone to chuanran tended to be particularly deadly, such as severe epidemics caused by impure qi, chronic disorders with conspicuous poisonous sores such as yangmei sores and mafeng, or those ending in a slow, painful death such as laozhai. Some of these disorders were closely associated with sexual transmission, and all of them provoked fear or disgust in Late Imperial society.²⁷

Figure 4.1. Entry on syphilis in the “Essentials of Authentic Methods in External Medicine” section of Golden Mirror of the Medical Lineage, 1742, juan 73. Waseda University Library, Japan.

SEXUAL TRANSMISSION, SEXUAL HEALING

It might seem logical to investigate sexual contact as the origin of the notion of interpersonal contagion. Sexual transmission of disease seems like an obvious vector given that the symptoms of venereal disease appear at the locus of contact and affect the parts of the body used to transmit blood, essence, and qi from one body to another. Diseases of this type did indeed receive more attention in medical texts in the late imperial period, considering the increased concern for women’s reproductive health in the Ming and Qing periods, marked by a proliferation of medical publications that specialized in female disorders, and noted by many scholars.²⁸ The importance attached to conception and reproductive health is apparent in the large volume of books published on obstetrics, childbirth, and pediatrics. Medical discourse attempted to restrict sexuality to a marital context by drawing on the pathological consequences of sexual excess for the health of future progeny. Sexual disorders were also approached in the context of reproduction, and a number of publications referred to diseases enabled, caused by, or transmitted by sexual intercourse. Yangmei chuang (“red bayberry sores” or syphilis) in particular was the object of medical attention starting in the late sixteenth century. The symptoms of this condition were described in a number of medical texts with detail and consistency, but the root cause of it was given as sexual excess rather than contagion.²⁹ Li Shizhen quotes Wang Ji as saying, “Recently, among those who are fond of licentiousness, many have become ill with sores of yangmei poison [yangmei du chuang],” but Wang Ji did not suggest that they had contracted this ailment through sex, and explains the etiology of this disease according to normal pathogenic models: “Humidity accumulates together with heat in the muscle and the interstices, resulting in the emergence of carbuncle and swelling with contractions and spasms.”³⁰ Li Shizhen underlined how this disease had spread (chuan) from the Lingbiao region in south China to the four corners of the empire. He pointed to the humid climate, the spicy food, and the sexual intemperance of the locals, all thought to contribute to an accumulation of wetness-heat and to the appearance of yangmei. But the nature of the transmission seemed to have two vectors—either yangmei is contracted directly by heat, humidity and spiciness, or indirectly by sex with someone who has the lesions that form from those conditions. Li writes, “Dampness and heat accumulate thickly to form a pathogen [e, lit., “evil”] that causes the development of malignant sores that are mutually contagious among people [huxiang chuanran].”³¹ The climate of the south is brought north in the bodies of those with excessive dampness and heat.

Although the infection may have been caused by the climate, as in yangmei feng (“red bayberry wind”), once the yangmei sores form, they are transmitted through intercourse, since Li writes explicitly, “All those who become sick with it are lascivious people.”³² This term, literally “people of lascivious evil” (yinxie zhi ren), suggests that sex invites disease through depletion, and invasion by pathogenic wind or demons. But there did not necessarily need to be invasion by malicious forces for an illness to develop. Excess itself was a cause of disease, whether it was excessive emotion, excessive food or drink, or excessive sex. Other maladies were caused by excess, too, as is evident in the Ming discussions of obsession in which a pi (hobby, habit, or mania) can literally form a pi (hardness or stone), and block the flow of qi and food.³³ One Yuan dynasty encyclopedia, for instance, has a prescription for “pathogenic desire that turns into chancre” (e zhi yu cheng chuang).³⁴ This particular malady is an instance of a sexual disease, though one grown rather than contracted.

A detailed account of syphilis was published in 1632 by Chen Sicheng, titled Secret Account of the Rotting Sores Disorder (Meichuang milu), a work based on an epidemic that had occurred at the beginning of the 1630s.³⁵ Chen similarly wrote that yangmei has its origins in the Lingnan climate, where “it is humid and hot, snow never falls, snakes and chong [worms, bugs] never hibernate, and all manner of nastiness and filth are stored up. When the first yang [transition from spring to summer] arrives, damp poison and miasma [zhangqi] steam [under the sun]. Things in contact with it easily rot and perish. Human beings in contact with it are easily infected with rotting sores.”³⁶ Yangmei, according to Chen, can be transmitted sexually and lineally: “This ailment is not transmitted only through sexual intercourse. When people with weak constitutions go to use toilets in town, or talk with patients that have the disorder, they are sometimes infected with toxic qi. . . . The disease can also be transmitted [by a husband] to members of the inner chamber. Even if the wife or concubine does not fall ill, the disease can be transferred [yi] to sons and daughters, nephews, or grandchildren.”³⁷ That the disease can be passed directly to nephews or grandchildren is clearly not the simple sort of transmission of modern biomedicine, and suggests that once it has contaminated one member of the household, even if originally contracted through sex, it can contaminate relatives through other means. Chen blames not just sex but lasciviousness as the mode of contagion. In response to the question “How is it that these sores are transmitted and contagious [chuanran] without end?” he replies,

In the past ran worked like this: relatives did not live together [with the patient], when eating and drinking, they did not share utensils [with the patient], they would place themselves quietly in their rooms, and thus wait until they recovered, and hence chuanran was infrequent. Recently, [the current generation] has become weak [shibo], and men rashly submerge themselves and hide in brothels. Many neglect to shun taboo. They repeatedly visit poisonous prostitutes, the fire of lasciviousness burns in them, and this is the true origin of their weakness. The poisonous qi takes advantage of this weakness, and attacks. Before they realize [that they are infected], they have already transmitted [the disease] to their wives and concubines or to their pretty boy servants. In previous generations, there were few medical books to correct this, which explains the endless transmission and contamination [chuanran buyi].³⁸

For Chen, yangmei, among other modes of transmission, was a disease of moral weakness, of taboo violation, excess, carelessness, and recklessness. It was moral weakness that allowed evil qi to invade the body, and once inside, it could be passed to innocent sexual partners or nearby relatives.³⁹

Chen Sicheng and Li Shizhen, in discussing the ostensible transmission of climate (miasmas, evil qi) through sex, were aligning themselves with Confucian moralists of a century or two earlier. The concept of miasma (zhang), usually a feature of environment, that was now being applied to lascivious southerners in Lingnan had previously been used to characterize Burmese women, who were seen as promiscuous. Zhang Hong, who visited Burma in 1407, recorded, “The Mian people [Burmese] often cultivate promiscuous women to seduce our soldiers. Anyone who has sex with these women will die. Hence, these women are called human miasma [renzhang].” He lectured his soldiers: “When you left for here, your parents, wives, and children cried farewell, knelt and prayed to heaven, and longed for your return. If you die of human miasma, and your wives then marry other men, how will your parents be able to bear it?” Zhang Hong claims that his men were touched by his words, and they did not dare to contract human miasma.⁴⁰ The discourse on yangmei now cast lascivious people as the carriers of a poisonous southern miasma that was circulating around the empire. Bodily invasion by bad local qi was not the only geospatial concern related to chuanran. Ultimately, deceased ancestors also caused diseases of place. The return of vengeful ancestors required people to leave a certain place to “avoid the killing” (guisha or bisha). Victims of disease are often victims of places. Dirt is matter out of place, but in many instances, in China, illness was a matter of people out of place. Chuanran meant that the infected had brought climates out of their regions. The infected were the embodiment of an unhealthy climate: they had become bottled wind.

In the eighteenth century, the “poison of the plum” (meidu) was thought to be transmitted in three different ways: by semen (jing) during sexual intercourse, by vitiated air (qi) emanating from a contaminated person, and from the mother to the fetus. Wu Qian published the most systematic account, in which he claimed that “absorption of air through the nose in encounters with people who suffer from these chancres, eating unclean substances in error, or using toilets infected with the vitiated air of meidu could lead to infection.”⁴¹ Prostitutes in particular were said to harbor the poison in their vaginas. Diseases caused by unhealthy emanations were considered to affect the surface of the body only, while syphilis transmitted by intercourse would infect the bones and marrow of victims.

Despite growing interest in sexually transmitted diseases, epidemics, and the concept of chuanran as person-to-person transmission of disease in the late imperial period, many physicians still had reservations about the concept of interpersonal contagion.⁴² Most accepted the possibility of mutual contamination within the same household because members shared similar physical traits, habits, air, food, and living space, but it was not yet commonplace to think of these as facilitating person-to-person transmission of an agent of disease. Xiao Xiaoting (d. 1801), for instance, wrote, “[Since] the qi and blood of a person each follows its own vessels, how could [a contagion] be transmitted from one [person] to another?”⁴³ For many who were not physicians, it was difficult to understand chuanran contagion as the primary reason that someone was sick, when the vital blood and qi of a person were believed to circulate in a closed system corresponding to and interacting only with the cosmos. It is difficult and often anachronistic to draw sharp distinctions between interpersonal contagion and shared miasmas (zhangqi). The primary concern was that people became sick through “mutual dyeing” (xiangran) or “communicated dyeing” chuanran. The source of the evil qi with which one became dyed, whether endemic to the area or emanating from a particular individual, was secondary.⁴⁴

Descriptions of yangmei in medical literature, though they emphasized sexual excess and sexual transgression as foundational reasons for the spread of disease outside of its natural habitat, were also beholden to traditional frameworks for explaining illness. In premodern China, “people fell ill, in short, for many different reasons, but two factors mattered most: emotions and the weather. Weather was the external threat. . . . Demons, heavenly displeasure, the attacks of wind and cold, and the emotional exhaustion that makes one susceptible to attack—these are, by far, the dominant themes.”⁴⁵ Yangmei, though at times described as something almost subversive of dominant medical paradigms and always discussed in the Ming as a new disease, upon greater scrutiny borrows from traditional metaphors of invasion by wind, unseasonal climate change, and borderland “barbarian” people who are themselves the embodiment of miasma.

Although vectors of transmission were a topic for debate, the meanings of yangmei and its association with sex and prostitutes were part of its earliest descriptions. It was a disease to be embarrassed about, and as such was often the purview of itinerant doctors, who could treat the illness in the patient’s home and then move along out of town, enabling the patient to more easily keep his condition a secret from neighbors and community members. Itinerant physicians were most often asked to treat abscesses and other such ailments associated with the specialty of external medicine. One medical manuscript, for instance, lists numerous therapies recommended for treating ailments such as “chancres and sores” (ganchuang) and “lower chancre” (xiagan), both terms referring to syphilis or similar ailments, and “vaginal-itch” (yinyang).⁴⁶ Stories in other manuscripts, such as the one attached to the prescription “Guanyin’s recipe to save one from suffering” (Guanyin jiuku fang), make clear that these are afflictions about which patients were embarrassed, and people avoided seeking physicians for treatment of them. There is a story of a pious widow who suffered from vaginal itch and was too embarrassed to seek help from a physician. Guanyin assumed the form of a beggar and gave her an effective remedy.⁴⁷ Treating these ailments was obviously an important source of revenue for itinerant doctors, given examples from manuscripts like that written by a physician named Yang Xiuwan, in which he records following the recipe for a “scent causing the red bayberries [i.e., syphilis] to immediately disperse [yangmei lixiao xiang]” and about which he admonishes, “This is a secret treasure that must not be divulged to outsiders. Watch it, treasure it!”⁴⁸ Syphilis was also frequently discussed in daily-use encyclopedias, presumably meaning that patients could relatively easily self-diagnose and treat themselves to spare themselves the embarrassment or shame of sharing their condition with a doctor.

At first glance, yangmei and other venereal diseases seem not to be represented often in fictional literature. If it was understood as a disease simply contracted during sex, it might have limited use as metaphor, but that clearly was not the case. Syphilis came to China at approximately the same time that the domestic novel gained popularity—with its focus on relationships within the household and quotidian details such as medicine and sex—it might seem particularly odd that venereal disease did not enter more largely into novelistic discourse or even gain more than passing mention in fiction.⁴⁹ Given that yangmei and related maladies were discussed in vernacular texts such as daily encyclopedias, almanacs, practical medical texts, and medical manuscripts, as well as by scholar-doctors such as Wang Kentang and Xue Ji, and official works such as the Golden Mirror of the Medical Lineage (Yizong jinjian, 1742), we might expect that novels particularly known for depictions of sex would be eager to portray maladies such as yangmei. These novels do exhibit traces of these diseases, and such traces infect the depictions of illnesses related to desire (yu) and to sentiment or passion (qing).

In the late Ming and certainly in the Qing sex is often presented as something that is dangerous—in excess, in taboo violation, in careless disregard for procreation. But sex is also something that can be used, usually sympathetically, to cure certain unhealthy conditions. The tension between a disease transmitted by sex and one that is cured by sex is illustrated in discussions of the practices of “passing lai” (guolai)⁵⁰ and “selling the sickness” (maibing). An example found in an 1850 account by Chen Jiongzhai (d. 1857) titled “Transmission of Lesions” (Liyang chuanran) records, “In the southeast the land is low and the climate is humid. The inhabitants are plagued with sores [liyang], which beyond the mountains are called damafeng [leprosy or syphilis]. This disease is contagious [chuanran] and cripples entire families. Those who get it are abominated by others and ostracized from their own kind.”⁵¹ Here we find a traditional notion of chuanran: namely the belief that transmission is facilitated by weather, climate, and geography, wherein the qi of an environment provides the medium for transmission. Chen explains that the treatment is a combination of quarantine and rigidly controlled marriage: “In Guangzhou and Chaozhou there were formerly mafeng colonies where [the infected] came together, like with like, and lived as a community. They were led by a feng- chief. In their ranks were fengren [persons with mafeng] of the second and third generations. The chief arranged their marriages in strict order, ensuring no mixing of generations. By the third generation the disease had run its course, and the children were allowed to leave the colony—hence the saying “Mafeng lasts only three generations.”⁵² In this interpretation of the disease, it becomes less powerful over time, the infected must be quarantined from the healthy, and “generations” of infected must be quarantined from those whose parents or grandparents had it. While in the colony, contagion passes along vectors of heredity and sexual contact. Unless subjects are reinfected, the disease diminishes over time, such that by the third generation children are born free of the disease and are therefore permitted to leave the colony. The disease affects families and at the same time is cured by a series of carefully monitored marriages. A disease that can be transmitted by sex is cured by the maintenance of proper marriage traditions.⁵³

There are some accounts of “selling the sickness” in fiction, but they tend to be very late. Wu Jianren (1866–1910), in his novel Bizarre Happenings Eye-witnessed over Two Decades (Ershi nian mudu zhi guai xianzhuang, 1905–1910), for instance, writes,

It really isn’t funny, but it is hard not to laugh. In fact, as far as this disease mafeng is concerned, it’s not that other provinces don’t have it. In fact, I’ve even seen one case in Shanghai; it’s just that other provinces don’t fear [such cases]. In Guangdong, people dread those with it [fengren]. Now, why they would or would not fear them is inscrutable. Perhaps because it is so hot in Guangdong, that it makes the disease fester, and in other provinces it doesn’t fester, and so you have some that fear it and some that don’t. In Guangdong, people are so offended by those that have this disease that their fathers and sons act as though they don’t recognize them. Moreover, they have even created a mafeng colony, to adopt this group of people and to prevent their chuanran. Not only can this disease chuanran, it has no visible symptoms after being transmitted through heredity [chuanzhong] for three generations, yet the root of the disease remains in the bones. This kind of person will have to try to pass it to others [by sex]. It is easy for men to do that, but women can only seduce passersby in the countryside [where they will not encounter people they know]. They only need to do it once or twice, and it will be passed [to others], and the man that has been deceived will have to move into the mafeng colony. This is called “selling the feng.” The burdened have to do this outside the home under the cover of darkness. No one does this publicly or in the light of day in their homes. It doesn’t take even a month to get rid of [the disease] completely.⁵⁴

This might be related to the concept of transmission by “pouring,” but just as likely draws on the notion of a rudimentary bodily economy of spending or saving essential essences, fluids, and qi. More importantly, one contracts and cures oneself of these diseases by the same method, and in this regard the transmission of illness via sex or down a lineage obeys a similar logic: taboo sex cures taboo sex, and passing disease to one’s children eventually cures descendants of diseases originally contracted from one’s parents. Wu Jianren seems to suggest that these two modes of transmission are also interchangeable. The passing of generations cures diseases contracted through sex, just as sex rids patients of the latent root of the disease.

Sex was not something universally to be feared—at least not by women. The late-Ming scholar-official Wang Linheng (1548–1601) noted that “when women are afflicted with feng they pretend to run away from their families or get lost on the road in order to seduce men. Once they have had sexual intercourse, the ailment passes to the men. The custom is called ‘passing on feng’ [guofeng].”⁵⁵ It is due to this custom, Wang claims, that most of those who suffer from the ailment in Guangdong were men. According to Xiao Xiaoting, “It is rare for a man to transmit [mafeng] to a woman, and common for a woman to transmit it to a man.”⁵⁶ Moreover, the disease itself affects men and women differently. According to Chen Jiongzhai,

The face of a [male] fengren is swollen, his hands and feet ulcerated; the sight is nauseating. Female fengren, on the other hand, are transfigured: their complexion takes on a rosy bloom, and they have no other visible symptoms of infection. They often deck themselves in finery to tempt men to fornication. When some stupid young rake falls into the trap, he contracts the disease. It attacks his vitals, and in no time his limbs begin to itch unbearably. As the man takes over the woman’s disease, her own chronic condition immediately improves and she is restored to normal.⁵⁷

These medical theories that women were much more likely to infect others and cure themselves through sexual contact must have played on the fears of Confucian moralists that men were too often frequenting brothels or having extramarital encounters while traveling. They also reveal an attitude that remained quite consistent between late Ming and the Republican period that men, much more so than women, were likely to contract (or less able to rid themselves of) sexually transmitted diseases.⁵⁸ Despite the cult of female chastity that prevailed throughout the Qing, in medical discourse, sex was an activity that was particularly dangerous to men.⁵⁹

CHAOS AND THE STONE WOMAN

Another form of “sexual healing” in fiction concerns the curious case of the stone woman or stone maiden (shinü). Ming and Qing medical writers showed a great and systematic interest in biological variation.⁶⁰ Doctors, especially scholar-doctors, naturally showed a great interest in fertility, and the variety of medical practitioners did a brisk business in enhancing reproductive power.⁶¹ Li Shizhen, to take just one example, discusses at least thirty drugs that can be used to treat female infertility or enhance fertility in women. In a social milieu concerned with creating male heirs, the figure of the stone maiden, who suffered from a condition in which her vagina was impenetrable, or even closed entirely, stands out among anomalies.⁶² Li Shizhen includes them in a description of those who are desexed in the last chapter of the Systematic Materia Medica on “human anomalies” (rengui):

Qian [man] becomes the father and Kun [woman] becomes the mother. This is a normal condition. But there are five types of men who cannot act as fathers and five types of women who cannot act as mothers. Why is this? Isn’t it that [these] men have a deficiency of yang qi, and [these] women have a blockage of yin qi? The false females are the corkscrew [spiral stria of the vulva?], the striped [stricture of the vagina], the drum [imperforate hymen], the horned [elongated clitoris?], and the pulse [amenorrhea or menoxenia]. The false males are the natural eunuch [impotence], the bullock [castrated], the leaky [seminal emission], the coward [inability to ejaculate when having sex], and the changeling [genitals have forms of both sexes].⁶³

Li and other medical writers who repeated these classifications explain that four of these five terms applied to women refer to genital abnormalities of the sort that would make sexual penetration impossible.⁶⁴ Those referred to in medical texts as the “drum” (or, in other versions, “small door”), well-known in popular lore as a “stone maiden,” one who has an impenetrable vagina (vaginal atresia).⁶⁵ Medical writers addressed the issue of biological variation in physical sex characteristics most systematically in the late Ming and Qing periods, but many stopped at observing and cataloging this syndrome and did not venture a “cure” for it.⁶⁶ Stone maidenhood was a wonder of the universe in medical texts. Since sexual determination was women’s work to be done at birth by midwives or the like, variation in female sex organs was doubly mysterious to men.⁶⁷ Stone maidenhood was also a malady happily assigned meaning and treatment by writers of fiction.

The stone maiden was an object of humor, a female clown, in much fiction from the Northern Song compendium of story, lore, and anecdote Broad Gleanings of the Era of Great Peace (Taiping Guangji), through works by late-Ming and Qing authors such as Li Yu and Yuan Mei.⁶⁸ Perhaps the best-known stone maiden comes from the late Ming play Peony Pavilion, in which Sister Stone (Shidao Gu, nicknamed for her malady) of Purple Light Convent is a bawdy nun, born a shinü, failed in marriage, and fit only for the “shaman’s robe.” In her self-introduction, one of the funniest passages in all of Peony Pavilion, she misapplies many quotations from the Thousand Character Classic, a primer for writing known to virtually all literate people. She tells her own story as a stone maiden:

My shit was like “twigs of the chaste tree”

My piss was like “drips from the lotus leaves”

At the delta where there should have been “a vast lake or swamp”

There was only a stretch of land, which is “a dried pond with an arid rock”

Although the pebbled path could “clutch the scholar-trees,”

How could the barren land “grow corn and millet”?

Who would marry me for “unproductive echoes in the empty valley”?⁶⁹

As the burlesque speech of Sister Stone suggests, in popular idiom the stone maiden could be a figure of fun, an old crone, or a termagant wife, for what is more useless in the Confucian milieu than a woman who cannot reproduce, much less even have sex? But the nature of her malady, however humorous, is consistent with previous descriptions in nonfictional texts. This is a congenital problem, and one that Li Shizhen would agree stems from the mysteries, even the chaos, of the universe. Sister Stone refers (hilariously) to her young husband trying to penetrate her closed vagina as “trying to drill a hole into fleshy chaos of ‘black sky and yellow earth,’” a description made doubly poignant, since it misappropriates the first line of the Thousand Character Classic that in turn references a famous parable in The Zhuangzi about the interdependence of regularity and irregularity.⁷⁰ Li Yu’s story “The Hall of the Ten Weddings” (Shijinlou, 1658) features a protagonist who is a shinü.⁷¹ Eventually, after she suffers from an infection, her vagina proves penetrable. Her condition is also referred to as “primal chaos” (hundun), and her recovery is the restoration of order.⁷²

If Miao women had previously been represented as elemental anomalies, human miasmas, a threat to the family because they can infect through sex and have rapacious sexual drives, they are brought under control in the novel Humble Words of an Old Rustic. Wen Suchen heals a Miao stone maiden’s deviant body and sexuality through his yang embodiment of moral force. This stone maiden has a body of pure yin, which makes her pallid and prevents the proper development of her sexual anatomy, resulting in an impenetrable vagina. Although she is nineteen years old, the girl has received no marriage proposals. Compelled to sleep in the same bed as the stone maiden during his travels to the Miao frontier, Wen, with his body of pure yang energy, warms the stone maiden’s cold body.⁷³ In fact, Suchen is said to “steam” (zheng) her. “As he slept . . . she gently took his hand and first massaged her breasts, then her abdomen, and then her vagina. She felt even more stimulated and excited, all over her body. She was numb in every spot and couldn’t stop moaning and cooing.”⁷⁴ Eventually, her menses begin to flow. Suchen’s cure is described as an act of “boring open chaos and destroying heaven’s neglect” (zao hundun er po tianhuang).⁷⁵ The chapter-end commentary also characterizes Wen Suchen’s massaging of the stone maiden’s vagina to affect the cure as the “boring open of chaos” (zaokai hundun).⁷⁶ When massaging Shinü’s body, Suchen instructs her to curb her chaotic sexual drive and enlightens her about Confucian sexual norms. Domesticating these chaotic creatures is all the more important because Shinü (the name by which she is called) was conceived when her mother dreamed that she was being raped by a horse. Suchen achieves his civilizing project by marrying Shinü to the descendent of a wronged Han Chinese general who had been exiled to the Miao frontier in a ceremony strictly conducted according to Confucian rituals. Cured and civilized, Shinü (no longer a shinü) is now endowed with extraordinary fertility and rejuvenates the decimated family line of the displaced Han general by giving birth to twenty-eight sons. The chapter-end commentary calls this outcome “chaos transformed into civility” (hundun bian wei wenming).⁷⁷ If disease contracted through sex or in conjunction with sex happens because of carelessness, the maladies of sexual impossibility are forms of natural chaos. Sexing the desexed was a project that required the transgressive use of sexual proximity to cure something fundamentally in need of sex (or yang), and also a way to bring order to the chaos of nature.

COMEDY

Stories such as “The Fan Tower Restaurant as Witness to the Love of Zhou Shengxian” (Nao Fanlou duoqing Zhou Shengxian), published around 1627 in Feng Menglong’s Constant Words to Awaken the World (Xingshi hengyan), in which a grave robber violates the corpse of a beautiful maiden and surprisingly thus brings her back to life, also display the curative properties of sexual intercourse. Bringing ghosts back to life with an infusion of yang relied on a literary logic more than a strictly medical one. In this story, the maiden falls ill from longing, but her wealthy father categorically refuses a match when her mother broaches the subject. Upon overhearing their exchange, the girl is so shocked and upset she dies on the spot. The narration describes her surprising return to life with the words “it turned out that the young lady, with all her heart set on Second Brother Fan, had died a few days ago from a fit of rage against her father when he was lashing out at her mother. Now, however, upon the infusion of yang qi, so soon after her death, her soul revived and she came back to life.”⁷⁸ A dominant medical explanation of anger during the Qing was that it caused an upsurge of liver fire, and it is not logical that yang qi would have addressed this medical imbalance, nor would the semen to which “yang qi” likely refers. Rather, ghosts and fox demons are yin qi by definition, therefore they benefit from taking the yang of living beings. The robber is curing death itself, not the cause of death. The yinyang ideology in this story seems to owe less to medicine than to stories of female fox fairies who nourish themselves by seducing human men and acquiring their semen during intercourse.

Despite this recurrent motif in vernacular literature, it was also a shocking, and even humorous, proposition, as evidenced by the surprise that characters in such stories always display at the revival of the dead or the revival of the ghost.⁷⁹ Peony Pavilion (subtitled The Soul’s Return [Huanhun ji]) was phenomenally successful, and its popularity was due in no small part to the widespread fascination with the death and resurrection to love of the beautiful, talented heroine, Du Liniang. The play was the culmination of the late Ming glorification of qing (sentiment, love, passion, desire) and also a primary vehicle for the promotion and dissemination of qing as a cardinal virtue for the next two hundred years. As Tang Xianzu defined it in his manifesto-like preface to the play, “The origins of qing are unknown, but it runs deep. The living can die of it, and with it the dead can come back to life.”⁸⁰ For all of its claims to sentiment, and its obvious effect on literature written on that theme, Peony Pavilion is also a bawdy work of entertainment that was clearly meant to appeal to those with less refined tastes as well. The humor was ribald, and the play’s attitude toward sexual malfunction and disease irreverent. Sister Stone is obviously a hilarious clown, and her physical deformity a source of comedy, but even the sentimental death of Du Liniang, the archetypal lovesick, talented beauty, is also about sex. Tang Xianzu uses the phrase “to perish because of longing for beauty and sex” (muse er wang) to describe Du Liniang’s death by amorous longing for the handsome young scholar in her dream.⁸¹ A “longing for beauty and sex” (muse), updates traditional romances, which disguise the heroine’s love for the hero as “appreciation for literary talents” (liancai).⁸² In addition to the “longing for sex”–based nature of her illness, Du Liniang’s maid Fragrance (Chunxiang) cheekily drops references to venereal disease (though Du Liniang, the reader must assume, remains innocent of these references), and one commentary edition notoriously reads virtually every symbol in the play as a reference to sex.⁸³ Even if some argue against these readings, Du Liniang’s illness is still explicitly a “shameful sickness” (aza zheng), and the maid is beaten for speaking flippantly about it. Her mother asks what illness it is, and Fragrance replies that it is “spring fever” (i.e., lovesickness, chunqian bing), though the possibility of having run afoul of a flower spirit who sapped her strength is also a possibility. All of these potential causes of Liniang’s “shameful sickness” are tied to longing—for sex or for passion.⁸⁴

Tang Xianzu was familiar with the very real effects of syphilis, and made light of it in his personal life as well. In 1605, Tang wrote a series of ten poems for his friend, the writer Tu Long (1543–1605). The long title of the poem is “Changqing [Tu Long] My Friend, Suffering from the ‘Sores of Qing’ [qingji zhiyang], That Have Devastated Your Muscles and Bones, You Cry Out in Insufferable Pain, but You Will Get Some Relief with Your Whole Family Praying to Guanyin for You. Here I Compose Ten Long Jueju in Jest.”⁸⁵ A couplet in one of the poems reads, “What are the causes for this strange disease? / You should regret having allowed your heart to float in clouds and rain [i.e., overindulgence in sex],” and another, “Your flesh and eyes played with rakshasa women / your lusty body has become old visiting whore boats.⁸⁶ Despite the fact that Tu Long was certainly very ill when Tang composed these poems (he died shortly after), that did not stop him from writing about the consequences of his promiscuity in such an admittedly playful manner. Although Tang insists that these poems were composed playfully, their content is quite serious and returns again and again to his friend’s culpability for his own suffering. We might infer from these poems that the reader or viewer of Peony Pavilion did not necessarily ascribe venereal disease to the lower classes but to those with enough leisure to frequent brothels. If anything, syphilis in men was a literal and metaphorical marker of corruption, of corrupt officials. Tu Long was secretary in the Ministry of Rites in Beijing but was impeached after only one year due to his sexual misconduct. Tang mentions on the one hand that “the only medicine is to give up prostitutes,” and on the other that “the only effort you can make is to comply with Guanyin’s power.” If there is levity in these poems at all, it is pointed toward the heavenly and earthly repercussions for licentiousness, the poetry of karmic justice, since the syphilis that caused his friend pain unto death could not have been much of a laughing matter.⁸⁷

SEX AND RETRIBUTION

While romantic literati may have played with the poetic justice of yangmei, others were more sober in discussing the disease. Li Shizhen, for instance, was critical of the social mores of his day. He claimed that in remote antiquity people had medicine but did not need it because they rarely got ill. As morality declined, people needed more and stronger medicine, down to the present day, when excess and wantonness has made illnesses more intractable and many toxic drugs are needed to treat a case.⁸⁸ In premodern fiction, when sex enters into the discourse of medicine, it is usually in the form not of disease contracted through sex but disease brought on by indulgence in sex. Illness derived from sex is emphasized not as contagion but as retribution. Retribution usually concerns excess and the poor management of bodily resources, but also carelessness, transgression, and the logical outcomes of those actions. The most notorious examples come from Plum in the Golden Vase, in which retribution (bao) is one of the most important structuring themes and the agent of cosmic and earthly morality.⁸⁹ Ximen Qing and two of his wives (though notably not his most notoriously lascivious wife, Pan Jinlian), Li Ping’er, and Pang Chunmei, all die from sexual transgressions, either of excess or breaking taboo, or both. Critical terms in fiction commentary often use the language of retribution, and Zhang Zhupo employs it frequently in his commentary on Plum in the Golden Vase.⁹⁰

Despite the clear cause-and-effect nature of Ximen’s illness, it is conflated with vengeful spirits (retribution) and with venereal disease (contagion). The opening lines of chapter 79 warn the reader against excess, saying that “a surfeit of tasty foods will end up making you sick / Pleasurable events, once over, are sure to result in disaster.” While this message that excess leads to illness seems straightforward, the narrative further explains the meaning of these lines of poetry by Shao Yong: “The way of Heaven ensures fortune for the good / Both ghosts and spirits are hostile to excess.” Under this interpretation, sexual disease is not so much an issue of quotidian retribution as of heavenly retribution for evil deeds. A poem from chapter 62 of the novel relates excess, venereal disease, and retribution:

Lust does not delude people, they delude themselves.

But if they become deluded they will suffer the consequences.

Their vitality will be dissipated; their countenances grow pale;

The marrow in their bones will dry up, and their strength will wane.

Those who engage in fornication find that their families will break up;

Once venereal disease is contracted, it is difficult to cure.⁹¹

As always, “A full stomach and warm body give rise to disorder”;

Those for whom disaster is imminent never seem to realize it.⁹²

Venereal disease (sebing) is contracted (rancheng), but it is still related, in a traditional way, to excessive sex and intemperate food and drink. In a comment at the beginning of chapter 79, when Ximen Qing begins to falls ill, Zhang Zhupo writes, “Behold the precision of retribution [baoying],”⁹³ and, after describing Ximen’s symptoms, “This is clearly the working of retribution.”⁹⁴

Ghosts have always been considered pathogenic factors in the medical tradition. Doctors at least as late as Xu Dachun argued that the “ghosts and spirits” of classical medical theory were not supernatural beings but heteropathic forces such as wind, cold, damp, and heat that invaded a body with weakened defenses. He nonetheless admitted that in true cases of illness induced by wronged and vengeful ghosts, medicinal drugs were powerless, since such afflictions were the wages of sin or destiny.⁹⁵ Sexual excess was punished both by quotidian retribution and vengeful ghosts—sometimes in the form of yangmei. Syphilis demanded a paradigm shift of medical theory but not of fiction, since, in the words of a character from the 1905 novel A Flower in the Sea of Sin (Niehai hua, 1903), “Contagion is just retribution” (chuanran jiushi baoying).⁹⁶

XIMEN QING’S (TAINTED) LEGACY

Sequel to Plum in the Golden Vase (Xu Jinping mei) presents three characters who suffer from yangmei (none of whom feature in the original novel), but their retribution is quotidian rather than karmic. One is a corrupt official, one a womanizer, and one the madam of a brothel. Perhaps syphilis began to be seen as a disease that was naturally retributory, indicative of an inner rottenness, a punishment fit for transgressions in this life rather than those graver sins for which it was not severe enough. Or perhaps the etiology of sexually transmitted diseases was understood widely enough by 1660 to make syphilis an ill-fitting karmic punishment, in which the transgressor would have to be born with it (and his immediate biological parents then must also suffer the disease), or at least susceptible to contracting it. If characters had syphilis, it was because they dallied with prostitutes, or they metaphorically received a rotting disease because they were morally rotten.

Marriage Destinies to Awaken the World is a novel about mundane rather than karmic retribution, and in many instances retribution for excessive or illicit sex. Likely published after the 1695 Zhang Zhupo Edition of Plum in the Golden Vase and its sequel, it indicates remarkable plateaus in the punctuated evolution of venereal disease, retribution, and gender in Chinese fictional literature. According to some scholars, the novel depicts a world divided in two. One realm is a utopian paradise of temperate climate, morality, and peace, in a rural setting, while the other is a dystopian place of expanding market towns and commercial centers that foster decadence, extravagance, and decrepitude, and threatens to engulf the entire Chinese empire.⁹⁷ It is the story of the town Mingshui as it transforms from a rural village into a booming market town, and its consequent moral fall. The narrator portrays this with voyeuristic glee, and portrays the decline of the town with an exaggerated realism, detailing the grotesque and profane in a mode surpassed by few of its predecessors.⁹⁸

Although a large part of the population regarded syphilis simply as one of many diseases that plagued the empire at regular intervals, the fact that Marriage Destinies repeatedly refers to syphilis as “sores of heavenly retribution” (tian bao chuang) implies that readers were familiar enough with the etiology of this particular disease to attach it to certain immoral or excessive actions.⁹⁹ The patients who suffer these retributory sores contract them as the logical outcome of transgressive behavior, not as some karmic debt that still needs to be paid from some former lifetime. The evil scholar and teacher Wang Weilu is repaid for his misconduct with syphilis, and his sores are used as a symbol for moral corruption.¹⁰⁰ He gives up the pursuit of Confucian scholarship and goes into business, and his name puns on this fall: “the perversion of Confucianism” (wang wei ru). He becomes a money broker, who, like Ximen Qing, cheats and maltreats his clients and greedily covets the property and wealth of others. In fact, it is because he loses all of his facial hair to syphilis that officials are able to identify him as a criminal.¹⁰¹ The description of yangmei is detailed and graphic to highlight the depravity of a character that would contract such a disease.¹⁰² Wang Weilu’s deathbed scene is also reminiscent of Ximen Qing’s end in Plum in the Golden Vase, yet Marriage Destinies takes its grotesque effect even further.

Marriage Destinies depicts other syphilitics as well. The first, Shan Bao (whose name puns on “good retribution,” shanbao), falls from his position as a good Confucian son to one who beats his wife and abuses his parents. He tries to prevent his father’s proper burial and to destroy the corpse. Shan Bao indulges in drunkenness and lechery, and he dies of syphilis (tian bao chuang) as the consequence of his lascivious lifestyle. The retributory nature of the disease might have been interpreted as “karmic sores” by some readers, at least in part a punishment for his father’s way of life, the punishing teacher who competes with his students even to the point of killing some of them. Yet it is also a retributory illness for frequenting brothels in the immediate and being unfilial in the long term. It is clear that the other characters who suffer from syphilis in the novel do so as a fairly speedy result of a particular kind of action.

Two Buddhist monks, Wu Bian and Cheng An, suffer from venereal disease. Wu Bian is promiscuous and frequently visits brothels, having slept with every girl in the forty or fifty houses of ill repute along the riverbank.¹⁰³ Because of his excessive fornication, his originally strong physical constitution is depleted, and he dies of a venereal condition identified by desiccation of bone marrow.¹⁰⁴ His death, like Wang Weilu’s, is depicted in gruesome and bawdy detail. The other monk, Cheng An, explicitly suffers from syphilis (yangmei) by the time he succeeds Wu Bian.¹⁰⁵ Because he fears doctors he tries to hide his disease and engages in self-medication, employing qingfen calomel, a treatment for syphilis including primarily mercury found in Systematic Materia Medica and other medical texts of the late Ming and early Qing.¹⁰⁶ Treatment is of no avail; as “syphilis and insanity broke out together . . . following the heart sutra, first he lost his eyes, and then he lost his nose, then his tongue, and finally his entire body.”¹⁰⁷ The retributive morality, and the ironic appropriation of scripture for medical case, cannot be missed. Cheng An suffers a disease that results directly from visiting brothels, and because that practice is morally questionable, especially for a monk, he is punished with the particular disease whose symptoms parallel those depicted in the heart sutra.

The detailed and carnivalesque depictions of syphilis in Marriage Destinies are reserved for its corrupt, lascivious, selfish, and minor male characters. These sufferers were all engaging in the same practices and trades as their counterparts in Sequel to Plum in the Golden Vase, and they all contract the same illness. Consistent with contemporary medical case histories, there is a conspicuous absence of female syphilis, with prostitutes constituting the major exception, though they usually function as human miasma—unnamed and unvoiced contaminants. This is not to say that women escape the workings of retribution, they merely contract other maladies.

Syphilis was not sufficient punishment for rapacious main characters. It had limited use as metaphor, at least as it was represented in fiction, where sexual exhaustion followed by haunting or sexual dreams was much more significant and longer in coming for those such as Ximen Qing than was a simple diagnosis of sexually transmitted disease. Representing a disease as something contracted through or a result of sexual intercourse belies fears that boundaries, particularly boundaries between high and low, civilized and uncivilized, domestic and foreign, were being crossed—or worse, blurred. Fiction and medicine agreed that it was men who were most likely to transgress these boundaries, particularly in looking for sex in brothels and “prostitute boats.” But sexual intercourse was not the primary mode by which disease was contracted—it is just one aspect of the increasingly complex understanding of disease transmission. When it came to diseases contracted through sex, late-Ming and early Qing fiction diverged quite a bit from contemporary medical sources that saw maladies such as bian du and even yangmei as having multiple causes, particularly geography (south) and boundary crossing (foreigners and ethnic minorities). Fiction represented venereal disease as a disease of immoral men, particularly un-Confucian scholars, corrupt officials, monks, wastrels, and merchants.

Fiction cast yangmei as a disease of those engaging in excessive or illicit sex, and therefore it often seems to be a malady to which men, often marginal and symbolic characters, were subject. But yangmei was also a symptom of being punished by avenging ghosts and by heaven itself. A similar malady, not of passionate expression but of repression, came to be frequently and prominently portrayed in late-Ming and Qing fiction and often discussed in medical texts. These depletion disorders, consumption-like illnesses, are the subject of the next chapter.