CHAPTER 5

Diseases of Qing

Medical and Literary Views of Depletion

Some doctors traced the ultimate cause of Li Ping’er’s illness to blood loss, beginning as it had with the birth of her son. Ping’er had always had a delicate constitution, however, and had a history of falling ill from worry and longing (youchou silü) over her lover and fiancée’s neglect of her. At the time, a doctor diagnosed her with a “melancholic congestion in her chest which cannot be resolved” (yujie yu zhong er busui). By reading her pulses, he further asserted that her ailment derived from her “six desires and seven emotions” (liuyu qiqing),¹ and said that if she were not treated in time, “it may develop into a “bone steaming disease” (guzheng zhi ji), which is of the family of [fatal] melancholic disorders.”² These maladies are also related to Li Ping’er, in her longing, being visited by a fox spirit (huli) in her dreams. Every night he slept with her, sapping her vitality until she grew wan and emaciated.³ The doctor was incredulous as to why a healthy young woman of twenty-three, born and bred in respectable circumstances, with ample means to supply all of her needs, would have been suffering from a melancholic congestion and deficient condition (yujie buzu zhi bing).⁴ The doctor cured her easily enough, but whether it was his prescription or his marrying her that did it is not clear.

Now, years later, Li Ping’er had again lost her appetite, become lethargic and feverish, and suffered from bouts of delusion and derangement. Dr. Jiang had not able to fulfill her sexual desires and satisfy her longing well enough, and she had returned to Ximen Qing, for whom she had left her first husband. She became one of his wives and gave birth to a son. Her rival sister-wife, Pan Jinlian, endeavored to kill Li Ping’er by haranguing her to death. Li Ping’er weakened, suffering from significant vaginal blood loss. Jinlian’s ferocious cat attacked the baby; he had convulsions and died. Li Ping’er despaired and dreamt of a visitation by her former husband, Hua Zixu, who accosted her for her unfaithfulness and her role in his ruin. A nun explained to Li Ping’er that the baby actually came into this life to trouble her for some past sins (yuanjia).⁵ Ping’er, tormented by Jinlian, mourning and losing blood, grew weaker and died. The cause of her death, according to her ghost, and the cause many scholars thus assume to be the ultimate one, is “a case of acute metrorrhagia.”⁶ But her case is overdetermined, her death the result of a different cause, depending on who is speaking. Yet a full description her illness and death is not ambiguous; it integrates mundane bodily, emotional, and demonological causes—a multivalent condition that was more in line with an inclusive, robust medical diagnosis than with a metaphor or simple literary device.⁷

SEX, LONGING, AND DEPLETION

Most clearly, Ping’er’s illness has to do with blood, grief, and resentment. Ximen and Old woman Feng both suggest this, and try to employ emotional counter-therapy by shocking her out of her disposition by showing her the coffin that has been made for her.⁸ Ximen tells Second Sister Shen that Li Ping’er is so preoccupied by her child’s death that it has given rise to this ailment. “She’s just a woman after all, and doesn’t know how to put [the grief] behind her,” and “it is this excess of grief that has brought on her illness.”⁹ Further, Dr. Hu said that anger has disrupted her blood, and the nursemaid makes it clear that her ailment began as a result of suppressed anger, and then she wore herself out with worry over her sick baby that was then compounded by grief at his death. The nursemaid says, “When someone is suffering from suppressed anger, it helps to discuss it with someone else, but the mistress won’t let anything out.”¹⁰ There are two emotional causes of Li Ping’er’s illness—excessive emotions and repressed emotions. Those emotions result in physical symptoms: her anger disrupts her blood, and the taxation results in depletion from continual blood loss.

An example of the interrelatedness of these various illnesses comes from the Materia Dietetica (Shiwu bencao, early 16th century), an herbal in four volumes.¹¹ In juan 27 there is an illustration of black bean sauce (douchi) and a description of its properties and uses that reads, “Black bean sauce is bitter in flavor, cold in thermostatic character, and nonpoisonous. It is efficacious against conditions such as cold damage [shanghan] and headache [touteng], miasmas [zhang qi], malign poisons [edu], impatience-melancholy [zaomen], depletion exhaustion [xulao], difficulty breathing [chuanxi], ague/malaria [nüeji], and bone steaming [guzheng].”¹² Dr. Jiang Zhushan says of Li Ping’er’s condition, “It is like nüe, but it is not nüe, it is like [shang] han, but it is not [shang] han.¹³ In eliminating these two, Jiang is, at least according to the Materia Dietetica, delimiting Li Ping’er’s disease to one of depletion, emotion, and bone steaming.

Emotions (anger, grief, and melancholy), taboo violation (Ximen insisted that they have sex while Ping’er was menstruating) that allowed semen into her blood, and the conflict of blood and anger results in hemorrhaging, according to the aged physician in Plum in the Golden Vase, Old Man He.¹⁴ If blood was seen as the root of the most serious female maladies, and that which characterized an illness as female, it seems to have been a fact widely known by educated people. Doctors, healers, shamans, and acquaintances draw on their own knowledge of medicine to diagnose her. Ximen says that he knows Li Ping’er is in possession of some sanqi ginseng, which “is certain to cure all those troubles from which women suffer.”¹⁵ He may have relied on pharmacological literature when he mentioned that it came from Guangnan, a fact also recorded in the Systematic Materia Medica. Li Shizhen says that this drug was discovered only recently, and that it is also known as “[drug] that cannot be traded for gold [jinbuhuan].”¹⁶ It stops bleeding, removes blood stasis, and relieves pain. It treats profuse menstrual and uterine bleeding, disperses remaining blood stasis after childbirth, and reduces pain due to blood disorder.¹⁷ The local prefect recommends that Ping’er take ash of the palm leaf and white cockscomb flower, both recommended by Systematic Materia Medica for uterine bleeding.¹⁸ If readers were savvy enough to recognize these drugs, they would know that the characters who recommend them see Li Ping’er’s illness as one common to women postpartum. Whether because of excessive emotions, the blood-based nature of the illness, the violation of sex taboos symbolized by semen in blood, or the confluence of all three, Li Ping’er’s illness is the emblem of women’s illnesses in the late Ming.

These earthly, logical, cause-and-effect kinds of explanations for her illness are supplemented by a variety of shamans and diviners who make it clear that Li Ping’er is paying for sins committed in this life or a previous one. Immortal Wu predicted in her twenty-seventh year she would face a catastrophe, and that is the year she dies.¹⁹ Master Huang, after being given the dates and times of Li Ping’er’s birth, says, “If it is the horoscope of a female, it is very unpropitious. The judgment reads: given over to sorrow without respite / if you want to know why this woman is so afflicted, / and as unlikely to endure as a tangle of threads: / Ponder the events before conception and postpartum.”²⁰ Which is to say that she is fated to suffer postpartum blood loss exacerbated by sorrow as retribution for past misdeeds. Li Ping’er herself “fears that there are evil influences at work,” and Ximen asks Abbot Wu for “a couple of written spells which can be pasted up in her room with a view to suppressing them.”²¹

Figure 5.1. Li Ping’er dreams of Hua Zixu demanding her life in Plum in the Golden Vase. Xiaoxiaosheng, Jinping mei cihua.

But more than generic evil influences, Ping’er knows that her former husband is the cause of her suffering; he says as much to her in a dream. Daoist Master Pan (who is able to perform exorcisms and write effective prescriptions, reads incantations) performs rituals and confirms that it is a court case against her in the underworld that is the cause of her suffering.²² Finally, Yinyang Master Xu reads from his little black book (heishu)²³:

In her former life, she was the son of a family named Wang in Pinzhou and was guilty of killing a pregnant ewe. Consequently, in this life she was reborn as a female in the year of the sheep, her nature was gentle and compliant, and she was given to artifice from her earliest years . . . her fate was crossed by the three penalties and six banes.²⁴ Although she acquired a distinguished husband in her years of maturity, she suffered from continual ailments and the ‘matched shoulders’ in her horoscope. She gave birth to a son, but he died prematurely, and her suppressed anger brought on hemorrhaging from her lower body that resulted in her death.²⁵

The yinyang master diagnoses everything at once—proximal, distal, and ultimate causes.

How was a reader to understand the meaning of such a polygenetic illness? The various editions and recensions of Plum in the Golden Vase are themselves conflicted about the primary cause of Li Ping’er’s death. The chapter 60 title couplet in the earliest edition reduces Ping’er’s issue to one of emotion: “Li Ping’er becomes ill because of grief and anger.”²⁶ The later chongzhen and Zhang Zhupo commentary editions have “Li Ping’er’s illness invokes death and retribution.” It is tempting to say that ultimate, karmic causes are the most important, most meaningful, in understanding illness, but then why include such detailed diagnoses, prescriptions, and medical information? Obviously the nature of the illness reveals something about a character, but if a character is fated to die, that removes the agency for contracting a disease either through contagion, infection, or moral transgression.

Li Ping’er is clearly the victim of Pan Jinlian’s machinations, but the narrative; the shamans, Daoists, and Buddhists; the chapter titles; and, not least, the depiction and diagnosis of her illness and death make it clear that she is also being punished for sins in her previous life, for her role in the death of her previous husband, and for her role in bringing disharmony and ritual violation to her own house. If readers were conflicted about judging Ping’er as harshly as her fate seems to demand, it may be because her major sins come early in the novel and she is basically kind and generous, because she is overshadowed in lasciviousness and deceit by Pan Jinlian, or because there is a crisis in the text when the most authoritative doctor is giving his diagnosis of Ping’er. At the end of chapter 54, Dr. Ren feels her pulses and proclaims:

Her liver conduit is hyperactive. People do not understand her. The element of wood [in her liver] has overcome the element earth [in her stomach], so that her stomach qi has been weakened. As a result there is no way for her vital energy to be replenished, or for her blood to be regenerated. . . . Because her blood is depleted, her two kidneys and the joints through her body all ache, and she has lost her appetite for food and drink. . . . Do not assume that this is an ailment of exogenous origin. It is not that at all. The symptoms are all those of deficiency. Her original store of vital energy was weak, and her postpartum conditions have not been stabilized, with the result that her blood has become depleted. It is not a case of blockage that would require purgative medications. Only if she is treated gradually with a regimen of pills can she be induced to come round and make a recovery. . . . It is only necessary to know that these are the symptoms of deficiency. The pain in her chest beneath the diaphragm is caused by an inflammation and is not of exogenous origin. The unusual pains afflicting her waist and the area of her ribs are due to depletion of her blood, and not to stagnation of the blood. Once she has taken the prescribed medications, these conditions should naturally be alleviated, one by one. There is no cause for alarm.²⁷

The language of this passage is oddly and significantly repetitive, as if the author were repeatedly copying out of a medical text so as to get it right and to make it clear that this is a disease of a beautiful, delicate, and refined woman that concerns her personality, her predisposition to depletion, her weak qi, and her blood depletion from sex and resentment. The reader of Plum in the Golden Vase turns the page and in the first passage of chapter 55 goes back in time and reads all over again the diagnosis Dr. Ren gives Li Ping’er, in slightly altered version:

The story goes that after Doctor Ren had palpated Li Ping’er’s pulses, he returned to the reception hall and sat down. . . . “This illness of your wife’s,” said Doctor Ren, “is the result of inadequate care in the treatment of her postpartum conditions. . . . Right now, the pulses on your wife’s two wrists are feeble rather than replete. When palpated, they are both scattered and large, as well as flaccid, and unable to recuperate themselves. These symptoms are all indications of inflammation, resulting from the fact that in the liver the element earth is deficient, and the element wood is in the ascendant, causing an abnormal circulation of the depleted blood. If these conditions are not treated at once, they will only grow worse in the future.”²⁸

The discontinuity and redundancy of the opening of this chapter are two of several indications that this chapter was probably not by the same hand as the two preceding chapters, or perhaps not edited by the same person.²⁹ If this is the case, and this passage was written by another hand without reference to the preceding chapter, it shows remarkable consistency in the diagnosis of depleted blood with liver fire and wood (liver) encroaching on earth (spleen).

Disregarding the textual issues surrounding Li Ping’er’s diagnosis, there is little doubt that Dr. Ren views her condition as one of yin depletion, and consequent yang heat. Yet there are so many possible causes of her illness: anger, grief, postpartum issues, being an orphan, being highborn, having bad luck, being beautiful but neglected, having an excess of sexual activity, having semen in the blood, having a vengeful, dead husband, and having a karmically meager fate. Women were not soldiers. For them, simple blood loss did not cause death. Blood loss caused haunting, dreams, and fantastical and phantasmagoric sex. For Li Ping’er, contagion is retribution, but there are multiple kinds of retribution at work all at once, karmic (killing a ewe in her past life), vengeful ghosts (Hua Zixu), chronic (repressed emotion), and immediate (sex during menstruation). All of these are medical conditions, though only the karmic explanation is not found in the Systematic Materia Medica. None may be characterized as venereal disease, as could bian du, since the contagion (namely the causes of Li Ping’er’s disease that stem directly from another person) are from ghosts. On a more quotidian level, Ping’er’s blood loss and depletion fatigue occur when she is wracked with longing, when she suffers from anger and resentment, and when she engages in excessive and taboo sexual activity. The paradox of her illness symbolizes how women were always in medical jeopardy, regardless of their sexual situation.

DEPLETION AND THE PROBLEM OF SEMINAL EMISSION

Among the many diseases Li Shizhen lists in the Systematic Materia Medica under the category of depletion and decrease (xusun) are those caused by the five overstrains and seven impairments (wulao qishang), and those marked by depletion with much dreaming (xu er duomeng), depletion and taxation with fever (xulao fare), excessive sexual intercourse with spitting blood (fanglao tuxue), and “cold and hot feeling in the penis with pain” (jingzhong hanre tong).³⁰ Li mentions parenthetically that diseases of depletion and decrease can be caused by qi deficiency (qixu), blood deficiency (xuexu), essence deficiency (jingxu), deficiency of the five viscera (wuzang xu), deficiency of heat (xure), and deficiency of cold (xuhan), but he details only those deficiencies of qi, blood, and essence.³¹ This category of disease, depletion and decrease, or depletion and exhaustion (xulao), was one of the most discussed in late-Ming medical texts, and one from which both men and women suffered.³² Xu Dachun, for instance, wrote frequently about depletion in his medical cases and other texts.³³ Strengthening yin and bolstering vital essence (qiangyin yi jingsui) was a common approach for doctors to overcome these diseases, because although there were clearly a number of things that could be depleted in the body, the most often discussed seem to be qi, blood, and essence, and particularly blood and essence.

Blood was often associated with women’s maladies, and, correspondingly, essence often came to mean “semen” in medical cases of the Song and later periods and to be associated with illnesses of men.³⁴ Although on a basic level essence and (menstrual) blood would seem to be paired opposites yang and yin, given their complimentary roles in procreation, from the Yellow Emperor’s Basic Questions of the Inner Canon on, in medical literature both seminal essence and menstrual blood are grouped together as “yin blood” (yin xue), and “in this sense, male seminal essence [jing] is also yin, a specific form of a more general and primary yin, blood.”³⁵ Depletion from sexual excess was, medically speaking, a disease related to loss of yin. Like prescriptions that treated yangmei and female blood loss, there was a great deal of overlap in the prescriptions recommended to reinforce the sexual ability of men and the ability of women to have babies. These drugs were also good for treating consumptive disease with exhaustion of the vital essence (xulao jingjie). Zhu Zhenheng, writing in the Yuan dynasty, warned, “Human beings’ sexual desire can be boundless. How can yin qi, which is hard to develop but easy to deplete, provide supplies [to meet the demands] of such desire?”³⁶ He was not alone in his concern about the proliferation of depletion diseases.

Although emotional causes seemed to fade from descriptions of venereal diseases that featured sores and chancres, in both fiction and medical literature, emotions were very much a part of depletion disorders. Anxiety, physical labor, irregular regimen, sexual deprivation, losing oneself in art, obsession, mental overstimulation, aimless imaginings, pining away for a desired object, and disturbing dreams were all types of experience in addition to sexual overindulgence that resulted in depletion of semen. In fact, loss of semen for reasons other than sexual intercourse was considered particularly dire. This type of taxation, called “loss of essence taxation” (yijing lao), was a major illness discussed widely in medical texts.³⁷ There was a virtual epidemic of spontaneous seminal emission in the twentieth century, and it was a serious concern dating back at least to the fourteenth century.³⁸

Seminal emission was inherently dangerous because it wasted precious bodily resources and because the depleted emptiness created by seminal loss left one vulnerable to attack by pathogenic factors such as ghosts and cold wind. From at least the Ming, to the end of empire and through the Republican period, spontaneous seminal emission was a key concern of elite and vernacular medicine. One of the Berlin manuscripts, for instance, contains a “discourse on involuntary/spontaneous emission of semen” in which the (anonymous) author records the rhymed statement, “It is better to have sex ten times than to [involuntarily] lose one’s essence even once.”³⁹ Seminal emission was often grouped in the late Qing medical manuscripts with treatments and discussions of the venereal diseases yangmei, bian du, and others.⁴⁰ Late Qing and early twentieth-century clinical records suggest a disproportionate concentration on this malady.⁴¹ Perhaps medical fear of the ailment was extreme because of the connotations of immaturity or impotence. One of the Annals of Herbs and Trees plays has the evil monk Mituo sing to the nun Cigu:

I have produced my black curculigo root [heixianmao; popular term for penis]. It strengthens the yang and benefits the kidneys. / There is this little red bean [chixiaodou; popular term for clitoris]. It takes away the pain and dissolves ulcers. / Let us produce some mixed quiet and running water [yinyang shui; suggesting the mix of male ejaculate and female fluid]. It is effective against cholera. / Quickly, let your soft lotus stamen [lianrui] cure my involuntary seminal emission.⁴²

The Annals of Herbs and Trees play, like many medical manuscripts, presents a number of treatments for this condition, some presented in mnemonic fashion.⁴³ Perhaps it was because this malady was so closely linked with those with postpartum bleeding or menorrhagia that it was felt to be particularly shameful and dangerous and thus so widely discussed.

Emotional excess was also a cause of yin depletion, and thereby linked to sexual excess. Zhu Zhenheng states the connection clearly, “Both the liver and the kidney depot harbor minister fire, and both have a link to the heart above. The heart is the ruler fire. When it is excited and brought in motion by desires, the minister fire willingly follows it. The chamber of semen is disturbed and, as a consequence, the semen flows off in the dark, discharged and drained even when not having intercourse. That is why the sages always instruct people to withdraw and nourish the mind.”⁴⁴ An early Republican-era medical manuscript copies a 1730 text by the Shanghai physician Shen Fan (zi Luzhen). This work, the “Medical Case Histories of Mr. Shen Luzhen from Tiesha” (Tiesha Shen Luzhen xiansheng yi’an) copies the above quote from Zhu Zhenheng but adds, “the patient must calm down [his desires] to nourish his mind. This way, the original semen can be stabilized. Otherwise it is trying to put out a burning cartload of lumber with a cup of water.”⁴⁵

Wang Kentang names four sources of the disorder, cited for centuries, in his Guidelines for Treating Illness (Zhengzhi zhunsheng, comp. ca. 1597–1607).⁴⁶ These are “excessive mental exertion” (yongxin guodu), which causes seminal loss (shijing); “unsatisfied lascivious thought” (si seyu busui), which causes “semen to leak out” (jing er chu); “too much sex” (yu taiguo), which causes “the semen to flow uninterrupted” (huaxie bu jin); and “abstinence when in life’s prime” (niangao qisheng jiuwu seyu), which causes “the jingqi to overflow” (jingqi manxie).⁴⁷ Zhu records a case history in which a man over twenty contracted this disease from overexerting himself studying for the official examinations. Another contracted it through an invasion of yin evil when caressing the statue of a maiden at a temple and subsequently obsessing over it.⁴⁸ Seminal emission was a chaste form of sexual excess. “The illness is in the heart,” writes Zhu, “[seminal emission] arises from thoughts/lovesickness [sixiang].”⁴⁹ Seminal emission often accompanied erotic dreams, another form of sex without sex. Li Shizhen, in his chapter on seminal emission and emission with dreams (yijing mengxie), writes, “When excessive melancholy damages the heart, seminal emission occurs.”⁵⁰ This was an illness brought on by excessive emotion, and longing resulting from erotic dreams or resulting in erotic dreams, a condition Li Shizhen calls “depletion and exhaustion with dreams and leaking” (xulao mengxie).

Though the medical literature rarely if ever discusses disease explicitly as being the result of retribution—either karmic retribution or worldly retribution—fiction was much clearer about these etiologies.⁵¹ Medical literature tends not to pass judgment on victims of particular illnesses, but diseases linked to sex were clearly thought to be dirty in the popular imagination, and those who suffered from them were being punished for moral lapses.⁵² Like sexual exhaustion, involuntary seminal emission is a disease of quotidian retribution in novels. As a result of lovesickness, it is also at times identified as stemming from a karmic debt, implied in terms such as guobao (retribution / karma), yinguo (cause and effect / karma), yezhang (retribution for sins in a previous incarnation), yuannie, and yuanye (“injustice curse”). But some of these, particularly yuannie and yuanye, become conflated with quotidian retribution for transgressions related to love.⁵³ For instance, in Story of the Stone, one of the claims that Baoyu’s jade talisman makes is that it cures retributory illnesses, yuanji.⁵⁴ The word yuan is essentially a negative term referring to enemies, or, in the Buddhist view, sin, but it is also often used for love relations, especially in the words yuanjia, yuanye, and yuannie, all of which may refer either to enemies or, playfully, to lovers, the usage most common in Story of the Stone and Plum in the Golden Vase. Love and desire are seen as the results of karmic retribution for sins in earlier lives, and they are the cause of harm in this life. In this view, that which Baoyu’s jade cures is a disease of retribution or lovesickness or both. This is the same malady from which Jia Rui, the obsessed masturbator, suffers (yuanye zhi zheng).⁵⁵ Jia Rui dies from misreading and from obsession, and from the expenditure of his bodily resources, but the real clue to explaining his death is the pool of semen in which he dies. Jia Rui masturbates while longing for Xifeng, which brings him to a dire strait, but once he is given the mirror for the romantic, the fantasies he encounters in its reflection result in involuntary seminal emission (xiaji yile yi tanjing).⁵⁶ Jia Rui dies from mistaking fantasy for reality, from misreading, but that misreading causes a fundamentally emotional taxation, a longing and frustration that result in a depletion disorder. Lovesickness and sexual exhaustion are thus fundamentally linked in fiction by their symptoms and retributory etiology.

Seminal emission was closely related to exhaustion from sexual activity on the one hand, and depletion with coughing blood on the other. Wang Ji’s case histories record a patient debating with the doctor about his condition, and the patient shows his (presumably popular) understanding that “exhaustion from sexual activity, coughing blood, and nocturnal seminal emission are all disorders of the blood.”⁵⁷ Xu Dachun has a treatise in which he discusses how, during depletion from sexual excess or seminal emission, “when the [blood and qi] are decrepit and exhausted [ghost] evils can consequently enter [the body],” resulting in raving, mumbling nonsense, and hallucination. But the primary cause of involuntary seminal emission, from the Yellow Emperor’s Classic down to the twentieth century, were obsessive thought and feeling, particularly longing (sixiang).⁵⁸ Uncontrolled depletion came from uncontrolled emotion. Because of the link between yijing and emotion, it may seem strange that women fade from the medical discussions of these essence loss disorders early on.⁵⁹ Of the over two hundred drugs that Li Shizhen discusses that treat seminal emission, only a few of them also explicitly treat women’s erotic dreams with discharge of secretion.⁶⁰ In the medical manuscripts there is also little mention of female emission, though one early Republican manuscript implies a difference between the sexes. In view of involuntary seminal emissions (yijing), “emissions come, and emissions go. The bone marrow is depleted.” In view of vaginal discharge (daixia), “discharges come, and discharges go. The body is depleted.”⁶¹

This paucity of cases detailing female involuntary emission of essence may well be because women were often depicted as having their own disease of depletion: consumption (xulao, xusun). This was one of three broad internal syndrome clusters defined by women’s medical texts in the late Song. This category assembled afflictions marked by slow, chronic wasting, where the sufferer grew emaciated and debilitated, accumulating a host of secondary symptoms, from pallor, indigestion, and shortness of breath to hair loss, hot sensations on palms of hands and soles of feet, and palpitations, while also experiencing a destabilized psyche marked by disturbed dreams or insomnia and fits of melancholy or anger. Coughing with bloody sputum was an important but not definitive symptom in this syndrome.⁶² Consumption in its many forms becomes in fiction of the Qing a disease almost exclusively of romantic heroines.

EMOTIONS, GHOSTS, WORMS, CORPSES, AND DREAMS

Li Ping’er’s illness, in its multivalent iteration, presents a picture almost exactly as fully as did medical texts contemporary with Plum in the Golden Vase. There is an etymological link between lao 勞 exhaustion, and lao 癆 “exhaustion illness” with the sickness 疒 radical. Terms such as “exhaustion sickness” (laobing), “exhaustion disease” (laozheng), “taxation disease with cough” (kesou laozheng), “illness of exhaustion and depletion” (lao sunxue zhi bing), and “depletion exhaustion” (xulao) are all synonyms for lao. In some medical texts, laozhai 勞瘵 (“exhaustion consumption”) is simply an alternate term for laozhai 癆瘵 (“exhaustion-illness with consumption”). In the case of taxation and depletion, most medical texts refer to depletion (of qi, blood, or essence) in one of the five viscera, though, as Dai Yuanli, a physician of the early Ming, wrote, “Although all five viscera can have taxation, that of the heart and kidney happen most commonly. The heart is ruled by blood, and the kidney is ruled by essence—when the essence is exhausted [jie], and blood is dried up [zao], this gives rise to lao.”⁶³ Excessive emotion was thought to cause depletion, but was often accompanied by different kinds of taxation—from writing, thinking, worrying, and fatigue.⁶⁴ These strains were thought to take many shapes, particularly in women, in whom one could find thirty-six different maladies caused by the “five taxations, seven harms, and six extremes.”⁶⁵

Sun Simiao wrote in the Song, “Women’s longings and desires are more intense than those of their husbands, and they are more frequently stimulated to become ill. Add to this that in women envy and dislike, compassion and love, grief and sorrow, attachments and aversions are all especially stubborn and deep-seated. They cannot themselves control these emotions [qing], and from this the roots of their illnesses are deep, and their cure is difficult.”⁶⁶ According to the standard treatise One Hundred Questions on Female Disorders (Nüke baiwen, 1279), a major cause of female sickliness was women’s “inability to control their emotions.” The resulting excesses of “compassion and love, aversion and envy, melancholy and grief lead to bodily imbalance.”⁶⁷ Although these emotions existed in a relationship to one another that implies equality, in that each can conquer or give rise to another emotion, certain emotions caused illnesses to which women were particularly prone. Anger caused liver fire (ganhuo), and melancholy engendered “static congestions” (yujie). The New Book of Childbearing (Taichan xinshu, 1793) classified menstrual and fertility disorders according to a woman’s physical and emotional type. Thin and repressed women suffer from “static congestion,” and hot-tempered and jealous types are afflicted with “liver fire,” while lethargic and plump women can be expected to suffer from “phlegmatic stagnation.”⁶⁸

It seems that this paradigm was widely understood, given that the three most prominent female characters in Story of the Stone conform to it: the thin and repressed Daiyu, the hot-tempered and jealous Xifeng, and the plump and reserved Baochai. These characters fit the types defined by the New Book of Childbearing, but the causes and significance of their illnesses are more complex than personality archetypes. Women were seen as being particularly prone to anger, which could cause miscarriage (as in the case of Wang Xifeng) or a variety of functional blood disorders. Anger was visualized as a kind of heat associated, when extreme, with the fire of the five phases that caused heat, the upward movement of qi in the body, and drying up of blood. However, women were also particularly subject to static congestion, a kind of melancholy syndrome of congealed blood associated with spleen system dysfunction. This syndrome was experienced as feelings of oppression and suffocation, pressure or tightness in the chest, languor, and loss of appetite, all linked to pent-up resentments and repressed desires. Physicians knew that static congestion and liver fire were related, and despite their differences in marital status and sexual experience, this link is quite clear through a medical analysis of Lin Daiyu and Wang Xifeng in The Story of the Stone. “Static congestion” and “static anger” (yunu) were often paired. Congestion that blocked yin could produce reactive heat, as excess yang surged in the vacancy left by underlying yin depletion, with manifest “wind and fire ascending” and overconsumption of blood.⁶⁹ Static congestion was seen primarily as a syndrome of women because of its metaphorical implications with blood and emotions. As the Golden Mirror of the Medical Lineage explained it, “Women must follow others and do not command their own persons; therefore they suffer from worry, resentment, and static qi.”⁷⁰ Further, this disorder particularly afflicted young women whose circumstances did not allow them to “fulfill their desires.” “Maids and concubines often suffer from stasis; their emotions are not outgoing and unimpeded.”⁷¹ “Static congestion” implies sexual frustration, just as loss of blood and essence points to sexual excess.

Medical practice associated static syndromes in women with grave, potentially life-threatening “depletion and wasting disorders” (xulao). “Bone steaming” (guzheng) was often presented as a final, fatal transformation of such disorders. Immediately following his chapter in the Systematic Materia Medica on depletion and decrease (xusun) in which these links are made, Li Shizhen details treatments for similar maladies that fall under the category of “malign influx” (liaozhu), and those in the category of “ghosts and demons” (xiesui). These are diseases that share symptoms and treatments with laozhai and guzheng, maladies caused by an accumulation of “worms” (chong) and corpse qi (shiqi), and those caused by malignant qi taking advantage of depletion resulting in congestion of phlegm, blood, and fire.⁷² In these chapters (and throughout the Systematic Materia Medica), depletion illnesses (xulao, guzheng, and laozhai) are closely related to, share common treatments with, or are proximally caused by corpse transmission (chuanshi), corpse infusion (shizhu), ghost infusion (guizhu), flying corpse (feishi), demonic influence (or sex with demons; guimei), evil [heteropathic] qi (xie’e qi), attack of malignant forces (zhong’e), or worm infusion (chongzhu).⁷³ Li gestures at a complex matrix of syndromes that are ultimately caused by depletion and taxation but which are essentially contagious, resulting from more immediate causes. These disorders were messy metaphors in fiction—although emblematic of women’s’ problems, they were also overdetermined, suggesting personal responsibility for uncontrolled emotions or desires, retribution from worms or ghosts for immoral lapses, or simply an unfortunate encounter with a pesky demon or proximity to the corpse of someone who had died from such. The tendency of authors of fiction to deemphasize retributory aspects of consumption,⁷⁴ or its ghost and worm causes, might be explained by the general trend in Ming and Qing medicine to replace such older explanations with those that emphasized internal disharmony and unfulfilled desire as root causes.⁷⁵ The demon- or worm-centered explanation still persisted, but learned doctors displayed their superiority by recognizing and addressing the root internal disharmony that allowed the invasion to occur in the first place. Thus, the Ming-Qing authors who emphasize emotion and depletion are actually consistent with broader developments in learned medicine.⁷⁶

Learned healers in the late imperial period increasingly attributed the root cause of disease to internally generated imbalances and pathologies rather than to invasions of external pathogens.⁷⁷ An important result of this was that doctors in the Ming and Qing increasingly attributed a variety of illnesses to internal damage caused by unregulated emotion.⁷⁸ Yet emotions themselves are contaminated by these exogenous, supernatural forces. Depletion disorders, caused by demons, ghosts, worms, or malevolent wind give way to dreaming of demons or spirits, a fictional, illusory version of invasion by pathogenic forces. The external pathogens that once caused consumption become internalized. Although in Plum in the Golden Vase consumption could be caused by sexual excess and transgression, as it becomes an illness of emotions and repressed sexual desires in the hands of Qing authors, it also takes on the stain of ghosts, corpses, and worms. Increasingly, these female depletion disorders are associated with emotions and with dreams. Dreaming of sex with demons was both a symptom and a cause of excessive emotions, in the same way that reading fiction was both a symptom and a cause of excessive emotionality.

Figure 5.2. Relative occurrence of terms discussed together in Systematic Materia Medica, chapters 3.35 and 3.36.

Anxieties about excessive emotion paralleled anxieties about the sexual activity of women. A useful example of the problem of female sexual activity and its metaphors is presented in Sequel to Plum in the Golden Vase. Jingui, the reincarnation of Pan Jinlian, repeatedly dreams of a rendezvous with her lover under a grape arbor (reminiscent of Jinlian’s infamous scene in the original) and becomes physically drained. She soon becomes unable to function sexually, and becomes a stone woman (shinü):

Like Pan Jinlian, [Jingui’s] sensual tendencies made her fall easy prey to the demons of voluptuousness and concupiscence. It was all too easy for them to make their way into her soul through the gaping holes in her defenses and master her. But Jingui’s unbridled license in the realm of fantasy had been too much for her; even her strong passions had been drained and exhausted. She was now nothing but an empty shell. And that was not all. . . . She could only stammer meaningless and disconnected words; her legs were incapable of supporting her body. She could not eat or drink. In short, she was seriously ill. She lay on her bed for ten whole days, seemingly lifeless.⁷⁹

Jingui (Jinlian) is punished by being desexed, which makes sense according to literary logic, but not medical logic—the complete loss of yin essence results in her becoming a stone woman, who is a creature of pure yin. One commentator writes in the margin that “these symptoms are all those of Li Ping’er’s illness,” defining that malady, too, as one that had sexual excess at its root.⁸⁰ Jingui dreams of sex, which saps her essence. Traditionally, dreaming of sex was tantamount to dreaming of sex with ghosts or demons, and that was a result of demonic invasion. Since the Han, “dreaming of intercourse” (meng jienei) was interpreted as the function of deficient qi dwelling in the “genital organs” (yinqi). The Eastern Han physician Zhang Ji (ca. 150–219) categorized erotic dreams in terms of “fatigue disorder” or “depletion taxation” (xulao). He believed that such consumptive diseases resulted in women’s “dreaming of intercourse,” and contrasted this with men’s “loss of semen.”⁸¹

According to Prescriptions Worth a Thousand in Gold (Qianjin yaofang, seventh-century), in men sexual desires exhaust human thoughts and result in the illnesses of “depletion and damage” (xusun), such as “losing semen,” “turbid urine,” and “having sex with demons” (guijiao).⁸² In women, it was not sex but dreaming of sex, and particularly dreaming of sex with demons, that was tied to an internal fatigue disorder resulting from external stimuli.⁸³ The late-Ming physician Zhang Jiebin not only addressed the emotional origin of cases of women “dreaming of sex with demons,” he also contributed to a new nosology of “stagnation disorders” (yuzheng) in which unmarried women’s love sickness and widows’ sexual frustration were now included.⁸⁴ Repressed passions and unfulfilled desire were seen to cause blockages such as “ghost fetus” (guitai) and invited sexual dreams with demons, which either produced or were caused by internal taxation vacuity. The imbalance of emotions owing to lovesickness and sexual frustration then became a new perspective through which physicians interpreted the diagnosis of women “dreaming of sex with demons.” The medical basis of these dreams shifts from “mutual affection with demonic qi” ( xieqi jiaogan), “demonic influence” (guisui), and unsatisfied sexual appetite to increased emphasis on the seven emotions diminishing the heart’s blood.⁸⁵ The late Ming physician Zhang Jiebin, in particular, discussed in depth the condition of women “dreaming of sex with demons” in terms of both internal emotions and external demonic influence. Excessive emotion led to fatigue and lethargy during the day, and “dreaming of sex with demons” (meng yu guijiao) at night. Zhang Jiebin writes that the emotions of pensiveness, anger, and sorrow often transformed themselves into disorders of static congestion yu.⁸⁶ These concepts extended from elite to mundane medicine, with one instance from an 1847 medical manuscript including a recipe for “pills to end passions,” (duanyu wan), which were recommended for “virgins, widows, and nuns, whose longing for a man cannot be fulfilled, in order to prevent these more severe consequences of longing.⁸⁷ Diseases that were historically tied to sex increasingly became tied to thoughts of sex, dreams of sex, and ultimately simply prolonged feelings of passion, longing, or resentment. This progression in medicine and fiction coincided with (or happened just after) related trends, such as the “cult of qing [passions]” and the “cult of female chastity.”⁸⁸

Xulao and laozhai were the quintessential disorders of female blood, and had their counterpart in the spontaneous seminal emissions expected in men who came down with depletion and wasting disorders.⁸⁹ In Ming fiction and vernacular literature prior to that period, these female maladies, like seminal emission, were diseases associated with sexual exhaustion, even though sufferers often were loyal wives, chaste widows, or virgins. Sexual dreams, medical wisdom had it, were especially likely to trouble celibate women such as widows, nuns, palace women, and those whose marriages were too long delayed. Static congestion and depletion and wasting disorders, as gender-linked syndromes, were associated both with sexual frustration and with the results of sexual fulfillment. They became disorders of anxious and longing virgins that manifested in menstrual irregularity and bodily lassitude. But depletion and wasting disorders were also endemic in worn-out mothers, who had expended their sexual vitality in childbearing or through rage and worry.

The gendering of laozhai and guzheng extended to the gendering of their victims. That is, women who suffered from these conditions were gendered as male or as hyperfeminine. If women engaged in excessive sex, as men were wont to do, they suffered depletion of their yin, allowing yang heat to increase, leading to bone steaming and frequently to vaginal bleeding. They were depleted women, but they were also women who had depleted their femininity. However, depleted yin in virgins with repressed and excessive passion resulted in consumption and bone steaming, and those illnesses come to be represented in fiction as the malady of young women and virgins par excellence.

Although Li Ping’er’s illness is represented as being the result of almost every one of these forces, many later authors of fiction took the gendering of depletion disorders to even greater lengths than did Ming medical writers. Seizing upon the notion that depletion disorders were really caused by emotions, and ignoring that they also were commonly thought to be caused by agents of retribution such as ghosts and consumption worms, suggesting sexual excess and transgression, we find statements about xulao stripped of retributory notions: the illness, with symptoms of consumption, was “brought on partly by melancholy [yuzheng], partly by lovesickness [sizheng], partly by cowardice [qiezheng] and partly by fright [jingzheng].”⁹⁰ Emotional disorders belied the sexual and retributory implications of this malady.

THE CONSUMPTIVE HEROINE IN THE QING

Given that the complex of symptoms and causes surrounding depletion and retributory agents became increasingly one of women and their emotions, it should not be surprising that Story of the Stone, which is perhaps the first long work of fiction in the Chinese tradition in which emotions are of primary importance, features these diseases so prominently. This focus on the novel’s emotionality and language also ironically reinforces the traditional (and still widely prevalent) tendency to read the novel as “autobiography” and its characters as historical people. Not only was Story of the Stone read as autobiography, but more than that it was read, the novel claims, as “a true record of real events.” The poetic status granted to the novel through its emphasis on emotions further bestowed upon it the veneer of truth, since, as we have seen, poetry, and particularly often-quoted poetry, served medical writers (as well as writers of encyclopedias, guides to daily life, and other such texts) as evidence, most often captured in the formulation “there is a poem as proof.”⁹¹

If Story of the Stone was about emotions, it was equally about young women, and it acted as a medical case history of female emotionality. Lin Daiyu, Qin Shi, Adamantina (Miaoyu), Skybright (Qingwen), and Wang Xifeng all suffer from a wasting disease brought on by abundant and unexpressed emotion (qing).⁹² Their maladies are all are tied to blood. The nature of this illness was recast by Story of the Stone as one primarily of emotions, stripped (mostly) of sexual connotation, ghosts, demons, worms, and corpses. The different manifestations of these depletion disorders in the world of Story of the Stone all became related to one malady that had at its root extreme emotion. However, even in this novel of female emotion published at the height of the “cult of female chastity,” the vestiges of transgressive behavior are still visible beneath the veneer of transgressive emotionality.⁹³

Xifeng has persistent blood loss postpartum,⁹⁴ but she, like Daiyu, also has repeated bouts of coughing and vomiting blood.⁹⁵ Each manifests the symptom set of a consumptive who suffers from passion, grief, worry, or ambition. Qin Shi’s diagnosis is notably almost exactly the same as Daiyu’s (and very similar to that of Li Ping’er’s in chapters 54 and 55 of Plum in the Golden Vase). Dr. Zhang says of her,

A deep and agitated left distal pulse indicates a febrile condition arising from the weak action of the heart; the deep and faint median pulse is due to anemia caused by a sluggish liver. A faint and feeble distal pulse on the right wrist comes of debility of the lungs; a slight and listless median pulse indicates the wood element of the liver is too strong for the earth element of the spleen. The fire produced by the depletion of heart qi results in irregular menses and insomnia. A deficiency of blood and sluggish condition of the liver produce pain in the ribs, delayed menses, and heartburn. Debility of the lungs leads to giddiness and perspiration in the early hours of the morning, and a feeling like seasickness. The earth of the spleen is overcome by the wood of the liver and causes loss of appetite, lassitude of spirit, and soreness in the limbs.”⁹⁶

We know that Qin Shi is suffering from retribution for sexual transgression with her father-in-law, yet her symptoms, with the exception of uterine bleeding, are exactly the same as those of the longing maiden Daiyu.⁹⁷ Further, Skybright, a maid who is said to look and act just like Daiyu, is said to have died specifically from nü’er lao—girl’s (virgin’s) consumption.⁹⁸ In other words, the thing that separates Daiyu’s and Skybright’s illness from Xifeng’s and Qin Shi’s is sexual experience, and their illnesses manifest differently only in which emotions are being repressed and where the blood comes out.

Of all those amorous souls waiting in the Land of Illusion at the beginning of Story of the Stone to be reincarnated in the realm of red dust, these young women waste away. Their consumptive illnesses, like those of earlier heroines, have both karmic and retributory aspects, even if they seem less susceptible to invasion by ghosts, demons, or worms than those of their literary predecessors. The story makes clear that licentiousness and passionate thoughts are punished as one transgression: “The fact of the matter is that all these noble ladies to whom you refer hail from the Skies of Passion and the Seas of Retribution [qingtian niehai]. Since olden times their sex has been under a natural obligation to remain pure, pure from licentiousness [yin], pure even from the infection [zhanran] of passion [qing].”⁹⁹ The narrative makes it clear that Daiyu’s illness (like Qin Shi’s) is improper. Grandmother Jia says of her diagnosis, “If her illness is of a respectable nature, I do not mind how much we have to spend to get her better. But if she is suffering from some form of lovesickness [xinbing], no amount of medicine will cure it, and she can expect no further sympathy from me either.”¹⁰⁰ The meaning of consumption as constructed by the traditional case casts doubt on Daiyu’s character in the eyes of Grandmother Jia. Consumption in Story of the Stone is a disease of women with an overabundance of repressed passion and longing, the symptoms of which cause Daiyu to be all the more desirable.¹⁰¹ Thus, while she has no power and is not sexually active, she is a threat to the family name and family line because of her sexuality, which is apparent in the manifestations of her illness. Daiyu’s case reflects the same paradox as in contemporary medical casebooks, namely that women are susceptible to consumption because it is affiliated with sex through its association with blood, which recalls menstrual blood, birth, and contamination, even if the patient is a virgin. Moreover, the condition heightens beauty and desirability (Daiyu is happy with her consumptive flush, which she says is “brighter than the peach-flower’s hue”).¹⁰² We see essentially two forms of depletion disorders in the women in Story of the Stone, and in many medical cases: the kind that is affiliated with anger, resentment, and (sexual) transgression and that seems like the female counterpart of male sexual exhaustion and venereal disease; and the chaste, longing, repressed passion and erotic dreams (with or without demons) paralleling male seminal emission.¹⁰³

An example of how Story of the Stone whitewashes sex with sentiment extends even to the protagonist Jia Baoyu. His “lust of the mind” (yiyin) seems to have been borrowed from the Yellow Emperor’s Basic Questions of the Inner Canon, in which it is clearly a disease of excess, of overflow:

When pondering [sixiang] is without limits

When one does not get what one had longed for

When [lewd] sentiments [alternatively, excessive desire, yiyin] flow unrestrained to the outside and

When one enters the [women’s] chambers excessively,

[then] the basic sinew slackens.

This develops into sinew limpness.

It also causes white overflow.¹⁰⁴

In emphasizing licentiousness of the mind, rather than the flesh, the text is further feminizing Baoyu, contrasting his condition (and seminal emission after his dream in chapter 5) with the more common male malady of sexual excess. With the increased focus on internal causes of disease, emotions become pathological and transgressive, as Grandmother Jia says of Lin Daiyu’s illness caused by longing.¹⁰⁵ Anxieties of women having sex evolve into anxieties of women thinking about sex. Yet these cause the same illnesses, and those illnesses—taxation vacuity, demonic infection, dreams of sex with ghosts and spirits, coughing blood, and losing blood—are all tied up with retribution for sex.

Many doctors believed that unmarried women and widows were prone to suffering from a “congestion [yu] of pensiveness.” Although a medieval medical work had already defined “demonic fetuses” as an exclusively female disorder mostly attributed to unmarried women and “pensive women” (sifu), it was not until the Ming period that physicians widely discussed pensiveness as one of the seven emotions in relation to women’s melancholy and consumption.¹⁰⁶ Meanwhile, it was also said that widows’ and nuns’ sexual dreams may result in their specific ailments of “concretions and conglomerations” (zhengjia) or “demonic fetuses.”¹⁰⁷ Zhang Jiebin (ca. 1563–1640) stated that unmated women, including nuns and unmarried women, often fall into “unrestrained fantasy due to yearning for love” or “unfulfilled wishes owing to distant love.” Their hearts are shaken by the “fire of desire” (yuhuo), which in turn weakens their “true yin” and hence induces irreparable damage.¹⁰⁸ Consequently, some diagnostic works dating from the Qing dynasty emphasize that a physician should treat widows and nuns with care because their symptoms are often different from those of normal women owing to their “mostly suppressed and stagnated emotions” (qing duo yuzhi).¹⁰⁹ This viewpoint remained influential in Qing China; typified by explaining the menstrual blockage of unmarried women, widows, nuns, and jealous concubines in terms of their “malady due to suppressed feelings” (yu yi cheng bing).¹¹⁰ According to the Tang dynasty poet Li Shangyin (813?–858), “Extreme passions truly weaken fate” (duoqing zhen boming), and, according to the poet and sing-song girl Yang Lai’er (fl. 874–888), “Extreme passions are the cause of many illnesses” (duoqing duobing).¹¹¹ But these sentiments now reflected contemporary medical literature as well.

In the late Ming, diseases of excess, particularly sexual excess, bifurcated along gender lines. This is not surprising, given the flourishing of women’s medicine and focus on reproduction. Excess led to gruesome deaths of blood flow out of the sexual organ. In the Ming, depletion caused women to become less attractive. In the case of Li Ping’er, she loses color in her face, her flesh becomes emaciated, and her radiant good looks fade.¹¹² There is a graphic depiction of her symptoms: her blood leakage, and inability to get off of the kang to use the restroom, and the attendant’s need to change the absorbent pad she was laying on two or three times a day. There was a foul odor, and the narrator says that that she had grown so emaciated that she “did not bear looking at.” Virgins who suffer from laozhai become more beautiful, their youth enhanced, as in the case of Lin Daiyu. Their beauty becomes etherealized rather than degraded. Even when affecting virgin beauties, consumption retained a whiff of sex.¹¹³ It is a disease of the “meager fated” (boming), but “meager fated” was a code word for the most desirable young women.

In both fiction and medicine Chinese men more than women suffer from sexual overindulgence; women suffer inordinately from sexual repression and manifest bodily depletion.¹¹⁴ Men actively contract yangmei in the brothels; women passively fall prey to seductive fox spirits or erotic fantasies in their dreams. Men have too much sex; women possess excessive desire and repressed passion. Depleted males, like Jia Rui, often appear as pale, weak, and fragile as female ghosts and sickly women—the two literary tropes of hyperfemininity.¹¹⁵ Thus, in his Medical Case Histories of Stone Mountain (Shishan yi’an, 1531), Wang Ji’s preference for restoratives may have been implicitly as much about restoring the masculinity of his male patients as they were explicitly about treating their depleted bodily resources.¹¹⁶ This implicit intention would bolster the argument that Zhu Zhenheng’s earlier doctrines of “yang surplus and yin deficiency” aligned the medical body with neo-Confucian metaphysics and a new construction of literati masculinity.¹¹⁷ Wang Ji also recommends self-cultivation only to his male patients, as an antidote to their overindulgence in sex, alcohol, and diet.¹¹⁸ Women are neither susceptible to such excesses nor capable of moral self-cultivation.¹¹⁹ This recommendation echoes the apologies for fiction in novel prefaces, which suggest that the (male) reader can use fiction to cure his ills, even by observing the plights and diseases of unfortunate female characters.

Understanding certain illness as metaphor in the premodern period is a difficult prospect because maladies such as depletion disorders were so overdetermined in the medical literature. Cases such as Plum in the Golden Vase and Story of the Stone thwart such an investigation because they not only incorporate sophisticated understandings of elite medical texts and the medicine of systematic correspondences but also integrate kinds of vernacular medicine practiced by itinerant physicians, monks, yinyang masters, and midwives. While one character or even the narrator might make clear to the reader their belief that one or another diagnosis is correct, the novel taken as a whole tends to embrace almost every aspect and signification of the illnesses they portray. These novels are certainly by and for “literati” and, as many scholars have demonstrated, contain a complex structure and fantastic degree of engagement with all manner of other texts, but that does not necessarily mean that the “low” medicine represented in these novels—the zhuyou ke demonology, flying corpses, and consumption worms—was an object of derision.¹²⁰ Rather, modern readers often underestimate the degree to which demons, ghosts, and chong were real etiological factors. Vernacular knowledge held that retributory illnesses really were the result of a past life’s deeds impinging on the events of the present, or, for that matter, the logic of the universe that meets out poetic justice, often in the form of illness.

In the gendering of depletion disorders, men had depleted semen and women had depleted blood, but when those women with depleted blood were unmarried young women, their depletion was not depletion due to blood loss but marked by it. Venereal disease in premodern Chinese medical and entertainment literature, though more complicated than simple person-to-person transmission, was still a fairly straightforward instance of retribution at work on the body. Medicine construed women as more complex bodies, more difficult texts to read, and requiring a more sophisticated kind of reader. But consumption was a disease that resisted being read, in the sense that it required multiple readers: elite physicians to read pulses, doctors to read emotions, fortune tellers to read the future, and exorcists to read disturbances in the unseen world. Consumption was often read as a disease of qing. As such, its etiologies changed as definitions of qing changed. In this sense it was extremely contagious, spreading though and across all kinds of texts.

Of course chuan can also mean “to transmit” in the nonmedical sense. Many medical texts contain this word in their titles, and some of the terms for “rumor” include it, too, as in “transmitted to each other” (xiangchuan) and “to transmit and speak” (chuanyan). For instance, when news of Pan Jinlian’s lasciviousness spread among the monks in Plum in the Golden Vase, “one told the other [yige chuan yige] until none did not know.”¹²¹ Female emotion and thought were contagious, all of these beautiful, sickly characters making so many female readers sickly.¹²² Fear and fascination of women having sex, or being consumed by longing and repressed desire, also spread from text to text, until none did not know.