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Chinese Medicine and the Anthropology of Menstruation in Contemporary Taiwan Author(s): Charlotte Furth and Ch'en Shu-yueh Source:
Medical Anthropology Quarterly, New Series, Vol. 6, No. 1 (Mar., 1992), pp. 27-48 Published by: Wiley on behalf of the American Anthropological Association Stable URL: http://www.jstor.org/stable/648741 . Accessed: 30/09/2013 05:38
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CHARLOTTE FURTH
Department of History University of Southern California CH'EN SHU-YUEH Department of Nursing and Midwifery Chung-t'ai College of Medicine and Medical Technology
Chinese Medicine and the Anthropology of Menstruation in Contemporary Taiwan

Structured interviews with 54 Taiwanese women reveal three frameworks used in interpreting menstruation: biomedicine, traditional Chinese medicine, and popular Buddhist teachings concerning menstrual pollution. Age and class influence women's preferences in ways that only partially reflect traditional-modern dualisms. Although it does not challenge the prestige of biomedicine, Chinese medicine provides an alternative to Western-style medicalization of menstruation, while pollution beliefs are positioned within a discourse on social decency, seen as religious piety or symbolic cleanliness. Although most women did not criticize the negative images of female gender embedded in any approach, they interpreted them to serve their convenience and protect their sense of dignity. They represented themselves as making choices as individuals. These findings modify models of Chinese women as simple victims of the culture's symbolic construction of menstruation as polluting, as well as questioning stereotypes of biomedicine as an unproblematicforce for their liberation. Chinese medicine emerges as a symbolically multidimensional contributor to Taiwanese Chinese menstrual beliefs and practices. [women's health, menstruation, Chinese medicine, Taiwan]
lassical accounts of menstruation in anthropology have linked it with beliefs about pollution and taboo. Such beliefs have been seen as marking male fears of women in social structures where female power is viewed ambiguously. In this tradition of interpretation (Douglas 1966) culture is viewed holistically, from the point of view of socially dominant male, often religious, authority. Recent revisionistic work has explored menstrual symbolism cross-culturally, finding it sometimes linked to a culture's cosmological foundations and sometimes to rituals expressing women's solidarity or to female sexual strategies (Buckley and Gottlieb 1988). This new work lends itself to a woman-centered
Association. All rights MedicalAnthropology Quarterly6(1):27-48. Copyright? 1992, AmericanAnthropological reserved.Not for furtherreproduction.
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MEDICAL ANTHROPOLOGYQUARTERLY
view of body process and may or may not make claims concerningculture as a in the context whole. It also pointsto the possibilityof reinterpreting menstruation of folk medical beliefs in which monthly blood flow is associated with female fertilityand vitality. In a complex society like contemporary Taiwan such beliefs are partof the still-living traditionof Chinese medicine (Chungi), which prescribesherbaltonics for menstrualhealth (t'iao ching yao). This little-studiedrepertoryof beliefs andpracticesexists side by side with those baseduponbetterknownpopularBuddhist accountsof the pollution of menstrualblood and with Chinese versions of biomedical accounts of menstruation,which are taught in schools and through mass media. Our study, carriedout in the summerof 1985, is based on personal of interviewswith 54 native Taiwanesewomen; we exploredtheirunderstanding all how and Chinese medicine and the menstruating they negotiatedamong body three frameworksfor the managementof their menses. This small and informal sample was not designed to produce robust sociometric conclusions, but it did allow us to look at a few basic social categories such as age and class and also at personalaccounts given by our respondentsas individuals. We were able to explore a dynamic interplaybetween sociologically structuredpatternsof understandingand the meaningsconstructedthrougha numberof actors' own stories. The rich medical pluralism of contemporaryTaiwan makes available an drawnfromall threeframeworks,allowelaboratemenuof menstrual precautions categories of explanation. For example, ing both parallel and interpenetrating bothtraditional Chinese medicineand Westernbiomedicineportraymenstruation as an essential aspect of health and fertility in women while warningof female at this time. Similarly, Taiwaneseculture'spollutiontaboos, which vulnerability lasam in Hokkien) or "poison" focus on menstrual"dirt" (tsang in Mandarin; for "clean" (kan-ching)monthly with a concern tuk (tu [M]; [H]),' interpenetrate healthpracticesidentifiedwith biomedical sanitarynorms. Both traditionaland modem medicalsystems allow for a positive valuationof female powersof childbearing,while hintingat costs in an accompanyingfemale bodily weakness. Our interview questions were also designed to elicit ways in which age, of this diverse arrayof inclass, and gender influencedwomen's understanding was differentiallydisavailable of the systems Experience possibilities. terpretive acrossthese sociological categories, but the differencesonly partiallyretributed dualisms. We found that contemporary or traditional-modern flectedrural-urban educationis weakeningpollutionbeliefs somewhatamongthe young, butthe continuingvitality of popularreligion ensures that certainritualavoidances are still respected.At the same time, Taiwan's prosperityreinforcesthe appeal and accessibility of Chinese medicine among all women. For women as a gender, both functionedto submerge old and new forms of the medicalizationof menstruation the negativeaspectsof pollutionbeliefs, andreligiousrestrictionswere most often as a form of piety. Thus our intervieweesdid not questionthe various interpreted implicitin the differentpracconcerningfemale bodily disadvantage assumptions tices they favored. Women from every sociological group, however, identified some preferredpracticespositively as empoweringthem to overcome disadvantage to attainhealth and decency. They revealed their sense of agency by seeing themselvesas makingchoices based on individualcircumstances.
CHINESE MEDICINE AND MENSTRUATION
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In sum, a woman-centeredview of menstruation in the complex setting of to a sociologically andculmoder Taiwanshows medicalpluralismcontributing turallydiverse range of beliefs and practices, but not to a critiqueof gender bias embeddedin old or new formsof medicalandreligiousauthority.Rather,it seems that the pluralisticnature of theory and practice itself weakens that authority, while multiplyingthe possibilities for remedialaction. This creates social space for women to supporta sense of personalself-worthand female identitybased on chosen strategiesfor the care of the body. Menstrual Norms in Chinese Medicine, Popular Religion, and Modern Hygiene The medical traditionof Chung i exists as both historicalrecordand living therapy.Chinese medical theory and practicehave undergonemarkedshifts over the past centuryas the system has confrontednew paradigmsof biomedical science and Marxismand as its experts have been forced to compete with Westerntrainedrivals (Kleinman1986; Sivin 1987; Topley 1976). Still, both canon (classical texts) andpraxis(the authorityof the doctor'spersonand uniqueexperience) remainthe basis of medical authorityfor Chung i expertstoday (Farquhar 1986). continue to rely heavily upon classical texts and to base Therefore,practitioners theirherbalremedieson historicallyrecommendedingredients,which in Taiwan mustbe importedfromthe mainland,addingto both theirmystiqueand theircost. Most doctorsoperateout of modest storefrontapothecaryshops, where relationships between health-careprovider and client are familiar and markedby little social distance. In this contemporaryversion of Chinese medicine in Taiwan, women's healthproblemshave an important place. The Sung dynasty classic, Ch'en Tzu"Good for Women" (Fujen liangfang) is requiredreading ming's Prescriptions at Taiwan's leading medical college for trainingChung i practitioners.In addiarefamiliarwith a wide varietyof Ming-Ch'ing tion, ordinary doctor-pharmacists authorities on "medicine for women" (fu k'o). Althoughdoctorstoday, as in Imperialtimes, continue to be overwhelminglymale, their typical client nowadays andgyneis morelikely thanbeforeto be female (Unschuld 1976:314). Menstrual cological problemsprove well-suited to a medical system that is seen by today's users as gentle and slow-acting, good for prevention, and better at managing chronic complaints than acute emergencies. Doctors interviewed for our study agreedthat women commonly became regularclients after the birthof their first baby. Theirresponsivenessto Chinese medicine at this time is encouragedby the seclusion (tso yueh), where rest custom of a month's postpartum still-widespread is supportedby special foods flavoredwith strengtheningherbs from the classic materiamedica. Younger women users rely on their mothersto buy the proper herbsfor them or on patentmedicine versions of standardformulas. Chinese medical texts from the Ming and Ch'ing periods(1368-1911) teach that males and females are endowed at conception with a store of vital "primal ch'i" (yuan ch'i) inheritedfrom heaven, which accumulatesin the body through puberty, but thereafteris graduallylost throughreproductiveacts-particularly ejaculationin males and menstruation,childbirth,and lactationin females. Metabolic processes, supported by eating, breathing,activity, and rest, replenishand
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circulatethe body's vital forces, producinga rhythmof cyclical renewal sustainthe primal ing female yin blood andmale yang essence. But they do not regenerate ch'i itself, which wanes as reproductivevitality declines and the body ages. Womenare at a particular disadvantagein this process of entropydue to the deand loss is analogousto pletion accompanyingbirthand lactation. Menstruation childbirth-a potentiallydangerousconditionof imbalance,depletingthe body of vital blood. Variationsin timing, consistency, color, or amountof flow are signs of internaldisorder. If a woman's menses are regularand normal accordingto these standards, norm she will be healthy, while any deviationfromthe menstrual threatens the whole body. In light of this theory, it is not surprising that "menstrualregulation"(t'iao ching) was the first, and often, the longest section of any late traditionalmedical text devotedto women. Women were encouragedto pay carefulattentionto their periods and to take complex herbal infusions at the first sign of anomaly. They were thus taughtthatthe menstrualperiod is a time of potentiallydangerousvulnerability.Classically traineddoctorsoffered more formulasfor the treatmentof in timing, consistency, color, or amountof menstrualflow than for irregularity the immediatetreatment of pain, which tendedto be seen as a byproductof functional imbalance. Althoughphysicians generally associated female emotionality with disease, they did not identify ordinary menstrualcycles with moods or depression.The logic of traditional pharmacywas that menstrualdisorderis best curedby herbalinfusions, which work graduallyto restorebalance and vitality. The main therapeuticstrategieswere herbal infusions that act on blood to "vivify" (huo), "activate" (tung), and occasionally "disperse" (san), breakingup or stasis. Particularly were ingredientswith a "warmingand stagnation important supporting"(pu) function, assumed to build vital new blood and counteractthe naturalyin tendency of females towardbodily "cold." "Supporting" formulas for women were particularly recommendedfor promotingfertility and were seen as milder versions of drugs enhancing male potency (Wu Ch'ien et al. 1981 [1742]; Wu Chih-wang 1958 [1665]). In termsof reproduction, the Chinesemedicalclassics constructed yin blood, of which menstrual fluidwas one manifestation,as the female counterpart to male to conching as seminalessence and taughtthatit was the woman's contribution ception. In anotheraspect, yin blood nourishedthe fetus during gestation, and finally it became "transformed"(hua) into breast milk. TraditionallyChinese families encouragedearly and universalmarriagefor women, and demographic statistics suggest that people made no effort to limit pregnancies (Coale 1985; Wolf 1985). As Harrell( 1981) has observed, in the historicalChinesepopulation, induced by frequentgestation and lactationwould have made menamenorrhea strualcycles infrequentand heightenedtheir associationwith fertility. Reinforcingthis association, Chinese medical authoritiesviewed menstruation not only as an index of generalfemale health but also as the literal sign that a woman was ready to conceive. On analogy with estrus in animals, they identifiedthe momentat the end of the monthlyflow as the woman's fertiletime, when, as they put it, old blood hadbeen dispelledand new blood was beginningto grow. Carefulattentionto the timing of intercoursewould even ensure conception of males.
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As a markof fertility, then, menstruationwould be a focus of attentionin Confucianfamilies; at the same time, women's reproductivefunctions entailed greaterrisk of illness and a speedier decline into age than those of men. In this as analmedicine encouragedwomen both to view menstruation way, traditional ogous to childbirthand to believe that their bodies were weakened by it. The statedopinionsof Ming andCh'ing dynastydoctorswere thatwomen arethe more sickly sex and that their diseases are more deeply entrenchedand harderto cure
(Furth 1986, 1987).2
If traditionalChung i stressed female weakness in the service of reproducblood. The defining tion, popularBuddhismfocused on the pollutionof menstrual of a pollutingsubstancein Chinese society is that "it preventsthose characteristic who come into contactwith it from associatingwith the gods" (Ahern 1975:202). blood continueto be the most common and widespread Menstrual andpostpartum sourcesof ritualpollution in folk belief (Chu 1980; Seaman 1981). Historically, women were forbiddento entertemples, to have contactwith priests menstruating or shamans,or to participate in auspiciousceremonieslike weddings. The month of postpartum seclusion and sexual abstentionprotectedsociety from being defiled by women and infants still markedby the pollutions of birthand kept them out of sight of the high gods of Heaven. In Taiwan these beliefs are partof society's living memory, and the modem popularityof pai pai (the island's festivals and ritualsdedicatedto the worshipof local gods) perpetuatesthem. Thusthe menstrualtaboos of popularreligion have reinforcedapprovedcosmological hierarchieswhile restrictingwomen ratherthan empowering or protecting them. If there is any power for women in these ideas, it would appearto lie in women's capacityto use their menstrual"dirt" or "poison" to injuremen and the agnaticdescent group, either throughbringing ill luck or by causing illness (Ahem 1975;Wolf 1972). But as early as Ming andCh'ing times, physicians were linking religious, magical, and medical theories to tame the power of pollutionof folk tradition-adapting it to a system of healing ambiguouslyprotective becamerecognized of women. The dirtof female blood of gestationandchildbirth as a source of pediatric illness-"fetal poison" (tai tu)-common to the first monthof life. But by interpreting pollution as disease, doctors also offered strategies for cure throughcleansing medicines and herbalbaths for newborns, while seclusion was recastas time for women to rest andrestoretheirvitality postpartum with "supports" and strengtheningfoods. In this way, Chung i "medicalized" pollution stigma and offered women affirmationin the socially useful work of But in return,medical authorityreinforcedwomen's place as weak reproduction. and dependentin the Confuciansocial order. Morerecently,Taiwanesewomen have been exposed to a thirdframeworkAs earlyas the 1970s, a biomedicalversionof the medicalizationof menstruation. concernededucationaland public health authoritiesintroducedbiomedicallyoriented educationabout menstruationinto the schools, where teacherscommonly had to deal with adolescent girls' fright at the first sight of menstrualblood and with the panicandrumorsaccompanyingit (Kao 1979). Today middle school and is a "normalphysjuniorcollege girls read healthtexts statingthat menstruation iological phenomenon." These texts and articles in the popularpress attribute menstrualdysfunction to anatomical and hormonal anomalies (Kuo 1972). If many textbook recommendationsfor menstrualhealth, such as to avoid cold,
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damp, or heavy exercise, appearvery close to the views of Chungi doctors, they areofferedin the contextof biomedicalaccountsof reproductive processes, evoking the authorityof Westernscience. Taiwanesewomen arealso now exposed to the Westernculturalconstruction of menstrual distressthatincludesmonthlypain andnegativeemotions. This view commonly appearsin reportsof biomedical researchand in columns of popular magazinessuch as New Woman(Hsin nii hsing), where the neologism "premenstrualtension" (ching chi chin-chang)has recentlybeen introduced.Using questionnairesbased on U.S. researchmodels, the second authorof this articlefound that young women respondedaffirmativelyto the suggestion that menstrualperiodsare likely to be accompaniedby backache,bellyache, painfulbreasts,headaches, and dizziness; many also agreedthatemotional symptomssuch as depression, irritability, lethargy,inabilityto concentrate,and insomniacould be a problem. Nonetheless, comparedwith young U.S. women, Chinese women answerdistressmore ing standardized questionsstressedphysical symptomsof menstrual thanpsychologicalones and reportedfar more "behavioralchanges" in exercise, bathinghabits, and diet duringtheir periods (Ch'en 1983, 1984). This suggests thatbiomedicalconstructions based on concepts of psychosomaticmedicine have not displaceda more indigenousculturallogic.3 Survey Research Design and Sample Our interviewquestionnairewas designed to probe women's understanding and experienceof the indigenousmodels of menstruation, Chungi and religious, in a context which encouragedcomparisonwith biomedical alternatives.Structuredquestionsasked them aboutspecific beliefs and practicesbased on all three frameworks; follow-up informalprobes encouragedthem to offer opinions and commentin theirown words. The surveywas designed by Furth,a U.S. historian with researchexperience in the history of Chinese medicine, and by Ch'en, a biomedicallytrainedTaiwaneseprofessorof nursingandmidwiferyat Chung-t'ai MedicalCollege, locatedon the outskirtsof the city of Taichung.Eightof Ch'en's studentsassisted in the interviews, and all of the women interviewedwere volunteersrecruitedthroughfriends, neighbors,or kin of people associatedwith the college. About half of the interviewees lived in the immediateneighborhoodof the college itself; the rest lived in the city up to a half-hourbus ride away. We excluded from our survey group any students at the college itself or any other women with trainingin traditionalor modern medicine. Thereforerespondents were dealing with membersof their own community whom they recognized as modernexperts from the local medical school as well as with a foreign expert obviously interestedin "traditional"ways. Chung-t'aiMedical College is a privatelyowned junior college for training nursesand medical technologists. The college is located in Dakeng, a small village abouta half-hourbus ride from downtown Taichung, the provincialcapital of Taiwan. Formerlya farmvillage, Dakeng lies in an ecologically distinctfoothill regionwherepeasantsspecialize in the cultivationof bambooshoots fromthe hills. Today's surviving farm families live groves which cover the surrounding side by side with small shopkeepersand other workerswho provide services for newly establishedsuburbanresidents and for the employees and studentsof the
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medicalcollege. Taichungitself is Taiwan's second largest urbancenter, but by contrastwith the capital of Taipei, the pace of life is relaxed and local cultureis dominatedby the Hokkien-speakingnatives of the island ratherthan the heterogeneous mainlanderswho fled to Taiwan with the Nationalistsin 1949. The setting, then, gave us access to a mix of people of ruraland urbanbackground,who sharedin the common provincialcultureof the native Taiwanese. Ourintervieweeswere classified into two age groups of roughly equal size: 26 young unmarriedwomen between 18 and 25 years old; and 28 women past (from45 yearsold to the mid-70s). Unfortunately,a projectdesigned childbearing to occupy a single summerdid not allow time to add a group of women in their childbearing years. The youngerwomen in our survey were productsof Taiwan's new publiceducationalsystem in an era of rapideconomic development. As high school or junior college graduates,the younger women were a far more educationallyhomogeneousgroupthanthe older ones, who rangedfrom illiteratepeasants to teachersand the cultured,though not necessarily well schooled, wives of local businessmen. Social class for these women was a complex variable, then, where wealth and family occupationproved to be more useful markersthan educationallevel. The 13 peasant women, all elderly and largely illiterate, had spent their reproductive years as farm wives, though some of them now worked part-timein the medical college cafeteriaor lived as widows with newly prosperoussons. Only two of the youngerwomen came fromtrulyhumblebackgrounds-a pairof seamstresses who had migratedfrom their ruralvillage to work in Taichung. At the time of our interviewsthey were living independentlyin the city; they, therefore, appearin our survey as "workers." Among the rest of our interviewees, who were largely membersof Taiwan's new middleclass, we distinguishedbetween "petit bourgeois" and "grandbourgeois." The formertypically belonged to families thatran small, open storefront shops as a householdbusiness, but also includedwives or daughtersof a soldier, a primary school teacher,a utilityworker,anda motorcyclerepairman. The grand from came well-to-do or business families, bourgeois professional includingones headedby a banker,a college professor, and a shoe manufacturer; these families were also distinguishedeconomically by the ownershipof a car. Forbackground we also interviewedfourmale Chungi doctorswho ranlocal herbalshops and two well establishedwomen who served as modernhealth exof a Western-stylepharmacyand the pertsin the village. One was the proprietor otherthe local midwife. The survey took about an hour to administerand usually took place in the respondent'shome. The student nurses served as interviewersin teams of two, withone askingthe questionsandthe othertranscribing the answers,togetherwith the interviewee'svolunteeredspontaneousremarks,on a questionnaire sheet. The wordingof the questions and the goals of the survey were discussed at length by the whole group in advance, and a pretest of 14 interviews served as training. (These responses are not included in the final sample.) At least one of the two authorswas present, either as an intervieweror observer, for all but two of the interviews,and in every case an authorand the studentinterviewersdiscussed the interviewimmediatelyafterward and recordedany additionalimpressions.
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Special care was taken to standardizethe phrasingof the questionnairein orderto accommodate the asymmetries betweenHokkien(Minnan hua) andMandarin.The regional spoken tongue of most native Taiwanese, Hokkienlacks voand modernmedicalterminologyand includessome cabularyfor some traditional uniquecolloquialismsfor describingmedical symptoms. As the language of literacy in an increasinglyeducated society, Mandarinwas a familiarsecond language to most participants,and the only one capableof producinga writtentext. It provedfairly easy to phrasequestionstaking advantageof the substantialoverlap in vocabularyand syntax between the two, makingthe writtenquestionnaire text a Mandarinversion. Similarly, the respondents'replies, which formed the "text" for analysis, were recordedin Mandarinwith occasional phonetic interpolationsusing Romanlettersfor untranslatable "key terms" from Hokkien. AuthorCh'en was thejudge in these linguistic mattersand the translator (from Hokkien to Mandarin)for authorFurth. In the end, 29 of the interviews were conductedin Hokkienand the rest in Mandarin-the latterall among the bettereducatedrespondents.Choice of languagewas always left up to the respondent. The Nature of Menstrual Blood When asked variousgeneral questions aboutthe natureof menstruation,respondentscame up with eclectic answersthatshowed familiaritywith some of the vocabularyof all three models of menstrualfunction. The majority (40 of 54) spokeof it as natural,using the languageof normality:"partof being grownup," "if it is normal, childbirthwill go easily." A biomedical orientationpredomia standardmiddlenated among a numberof younger women who paraphrased school healthtextbook:"a normalphysiological phenomenon." In keeping with this was the commonplaceview that menses is "superfluous"blood. Between a third and a half of the women, mostly older ones, understood basic reproductivefunction in Chung i terms: "When your menses stops, the blood goes to make the baby." "Babies are made from father'sessence [ching] and mother's blood [hsueh]." "Breast milk is like menses-it is food for the baby." "It is blood thatcan support[pu]the body and serve as medicine." Others showed the influence of traditionalmedical concepts in remarkssuggesting that unexpelled menstrualblood was unwholesome. "You have to let it flow out" several said, "or you will get sick." "Mama says it must flow out until clean" (a young office worker). "It needs to come out and make room for new blood, otherwisea woman gets warts and moles" (an elderly peasant). Many women's also reflectedconcernaboutdepletionfrom menstrualloss: a 49-year-old remarks housewife said, "Some say menses depletes the body so it needs nourishment." "A heavy flow makesyou weak," said a teacher.In the opinion of a young bookkeeper, "Since menstrualblood is precious, afteryou've lost it you may feel depleted [hsu]." All these comments are consistent with Chinese medicine's focus on the dangersof bodily imbalanceand on cyclical renewalto correctthis and on the value of menstrualblood as an essential aspect of fertilityand vitality. blood is "unclean" At the sametime, almosteveryone agreedthatmenstrual (pu kan-ching)and a majorityconsideredit "shameful" (k'o hsiu) (see Table 1). Even strongerlanguage was used by those who volunteeredthat it is "dirty" (tsang [M]; lasam [H]), connoting that such blood is also socially offensive, ca-
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TABLE 1 The nature of menstrual blood. Respondents (N = 54) Agree with statement % N
Statements about menstrual blood in rank order
It is unclean It is superfluous It is shameful It is likethebloodof birth It is thebloodthatmakes thebaby It is precious It is poison(tu,tok) Itcanharm others
45 38 37 23 21 12 9 6
83 70 69 43 39 22 17 11
pable of affrontingmen and gods. However, only a few were willing to say that term stronglyconnotingpollution menstrual blood is "poison" (tu), a traditional in the formof disease. In generaltheiraversionwas morereadilyexpressedusing the rhetoricof health or cleanliness than thatof woman's pollutingnature. of biomedicine and of Chung i to Women used their popularunderstanding medicalize and disguise pollution beliefs. This complex of attitudeswas especially clear in responsesto questions aboutsexual intercourseduringthe menses. blood Well establishedTaiwanese folklore claims that menstrualand postpartum is particularly dangerousto men throughsexual contact. Chinese medicine historicallyhas stressedthe healthrisks of this to both sexes. Women who were able to be articulateon the sensitive subjectof sexuality (usually older ones) strongly agreedabout the medical dangers, using the language of Chinese medicine and biomedicine interchangeably. "It can disorder the menstrualcycle." "It can cause a fever in the womb." "A woman can get an infection." Moreover, they emphasizedthe medicalrisks to women. Nineteen respondentssaw women as the victims of an act thatthey said was harmlessto men, and some commentedtartly on inconsiderate husbands.Eleven believed that sex duringmenstruation injures both sexes, and only two women were convinced that men alone are subject to harm,expressedas "tu" (poison).
Precautions Recommended for a Healthy Menstruation
Early in the interview, each woman was presentedwith a list of menstrual and asked to commenton them (see Table 2). This list was drawnup precautions of Chinese medon the basis of behaviorsrecommendedby modem practitioners icine (Huang 1985:17;Wu 1975:15), those found in a well-known secondaryeducationhygiene textbook published by the Ministry of Education(Chiao-yu-pu chun-hsunch'u 1983:176-177), and those well-known in anthropologicalaccounts of folk religious practices (Ahern 1975; Chu 1980; Wolf 1972). Toward the end of the intervieweach womanwas askedaboutherown menstrual practices and was given an opportunityto explain discrepanciesbetween her personalbehaviorand the normsshe had previously identifiedfavorably.
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Women were aware of a very large number of recommended behaviors for menstruating women which in fact draw on the repertory of Chinese medicine: to avoid strenuous exercise, to avoid cold, damp, and tub baths, to keep warm, and to control anger. They also knew about dietary precautions to avoid "cooling" or "heating" foods or those identified as "cold and raw" (sheng leng); and they were familiar with Chung i formulas for menstrual regularity. But the most frequently mentioned behavior was the ritual command to show respect for the gods by, for example, avoiding going to temples. The average respondent identified between six and seven of these practices as in her opinion recommended. Although most people claimed to follow fewer precautions than they mentioned favorably (respondent average was 4.1), the rank order of the two lists in Table 2 is practically identical. Table 2 shows the persistence of the main religious taboos though minor ritual cautions (against presence at weddings or contact with pregnant women) have fallen into neglect. Most of the other precautions show the strong influence of Chung i thinking. The majority of women in our survey were concerned about diet and they all used Chung i categories to identify what foods were improper. Moreover, they particularly approved of "supporting" herbal formulas (pu p'in) as aids to a healthy menstruation, and though few had a sophisticated understanding of the theory of yin-yang balance underlying Chung i "support" therapy, they knew the rule that you don't take "supports" until your period is over because they are too strong. Taken between menstrual periods, however, supports were thought good for renewed vitality and a healthy cycle next time. The category of foods called "cold and raw" (sheng leng) was generally avoided as "too cooling" and bad for the weak, while three people mentioned the traditional medical association between "cold and raw" foods and leucorrhea ("the whites," pai tai). TABLE 2 Menstrualprecautions recommendedand practiced. Respondents (N = 54) Practiced Recommended Precautions in rank order Avoid gods Avoid tub baths Avoid heavy exercise Take "supports" Avoid iced foods Avoid "cold/raw" foods Don't wash hair Avoid "heating" foods Keep warm Avoid anger Avoid weddings Avoid pregnantwomen N 45 44 43 39 37 25 16 16 11 10 10 0 % 83 82 80 72 69 46 30 30 20 19 19 0 N 36 45 28 23 17 15 3 12 5 5 0 1 % 67 83 52 43 32 28 6 22 9 9 0 2
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Concerningmany nondietaryprecautions-such as those against bathing, cold, or heavy exercise-there was some ambiguityas to whetherthis was thought to be "traditional"or "modern" wisdom. Not only do many contemporary authoritieson Chinese medicine claim equivalencebetween theirtheoriesof female functioningand those of modernscience (Wu 1975:16), but the leading hygiene textbook, which gives a thoroughlybiomedical account of reproduction,offers, without explanation, the following menstrual precautions: keep clean; avoid baths,cold water, and salt water;avoid violent exercise; andkeep calm andcheerful (Chiao-yii-pu chun-hsun ch'u 1983:176). Such opinions, though viewed guardedlyby authorCh'en, who together with some other health professionals recommendsexercise (Ch'en 1983), are frequentlyechoed in the popularpress. Underthe circumstances,then, it is not surprisingthat women who avoided bathing used biomedical language to express their concern about invasion from without-they spoke of "contamination,""infection,'' and "germs." A few obof bioservedthatcold causes menstrualpain. PopularTaiwaneseinterpretations medicine, in sum, have reinforcedratherthan limited a traditionalpatternof behaviormodification. So many precautionsmight appearburdensomeand a source of anxiety, but in explainingtheirown practice, women disclosed a more complex attitude.Most explained their failure to observe specific precautionswithout challenging the value of the precautionin principle. For example, when it came to "cold and raw," "supports," or exercise, most of those who were asked why they did not follow the recommendedbehaviorexplained it in terms of convenience, health, or necessity. Good health, several said, is a matterof inbornconstitution, and they considered themselves beneficiariesof a "lucky fate." For others, social circumstancesdictatedtheir behavior:"I can't be fussy;" "I was too poor to be able to eat supports." Six of those who exercised in spite of the warningsagainst it explained that they needed to work, and only two-a young aerobics teacher and her pupil-were openly skepticalof the precautionitself. Adjustingbehavior to circumstanceswas somethingwomen felt free to do as individuals. Interestingly,the traditional precautionagainstangerwas one of the few that women rejectedoutright. In Chinese medical thinking, emotional moderationis vital, and angerrisks dangeroushepatic "fire." However, most women were unapologetic aboutthis negative emotion. Thirty-sevenvolunteeredthat menstruation made them feel "fed up" (fan tsao), "bothered" (mafan), "ill tempered" (t'ao yen), "irritated"(ch'a ya [H]) and "mad" (iukat [H]). Their words were their own colloquialisms and not the modern psychological phrases used in biomedicalwritings. Only a few identifiedtheirnegative emotion with such psychological states as being "low" or "depressed" (fan [M]; hoan [H]). Most ex"Women get mad because menstruation is uncomplainedit morepragmatically: fortable," said a lively middle-aged mother who clearly relished gossip about "female complaints." "How can you help getting mad?" asked an old peasant; while one young woman confessed, "I quarrelwith my friends," and another observed, "Your speech is not so gentle." A couple of modernistsmentionedthe influence of "hormones" as an exat this time, but most talked simply aboutfeelplanationfor women's irritability and dirty. In both kinds of explanation,angerwas acceptedas ing uncomfortable naturaland inevitable, as much a partof the female conditionas the physical pro-
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MEDICAL ANTHROPOLOGY QUARTERLY
cess of menstruation itself. Threeolder women suggestedthatprecautionsagainst anger were part of modem book learning, something the senior generationwas unawareof. "In the old days we never heardaboutprohibitionson anger," said the 55-year-old mother of a young nurse. "Now my daughtertells me." Such remarks suggest thatneitherChungi nor biomedicinehas shapedfemale psychological norms, and that women's focus on modifying their behavior during the menses does not functionpsychodynamicallyto displace negative emotion. In sum, the vast majorityof respondents(50) believed that, in general, it is women to take health precautions,but they were also prudentfor menstruating flexible about the applicationof any specific rule to themselves as individuals. Precautionswere partof a logic about health that emphasizedpreventionof distress ratherthan its immediaterelief and that looked to the long term. Yet this logic was not so compelling as to preventconvenienceandnecessity from shaping practice. Menstrual Regulation By far the most "traditional"menstrualtherapiescome from the repertory of the classical pharmacistand folk imitations of these. "Menstrualregulation prescriptions"(t'iao ching yao) are a standardcategory in the classical pharmacopoeia availablein customized forms from Chinese doctors. Moreover, a number of classical formulas form the basis for patent medicines in pill or infusion houses and available in form producedfor sale by commercial pharmaceutical Western-style pharmacies.Chungchiang t'ang, a well-known brand,is a variant on the classical formulacalled "four ingredientsinfusion" (ssu-wu t'ang), and severalbrandsare available from Tsumura,a Japanesepharmaceutical company that specializes in Chinese medicines. To satisfy traditionalistpreferences for medicine in infusion form, Chungchiang t'ang is packagedin teabags. It is also advertisedin women's magazines. The ingredientsfor most classical prescriptions are imported,but local "fresh herbs" (ch'ing tsao), rememberedby older people as free for the gatheringin fields and along roadsides, are regularlysold along with fresh produceat local marketstalls. Fresh herbs are thoughtof as an inexpensivesubstitutefor classical materiamedica. Fourteenwomen did not recognize the classical termt'iao ching (menstrual regulation),which is not used in Hokkien or in colloquial Mandarin,where the ordinary spokenexpressionis yueh-chingkuei-tse. Nonetheless the vast majority (46) agreed that Chinese medicine is good for menstrualproblems. When presented with 11 specific claims for Chinese medicine, most women were not only positive about its therapeuticvalue but responded favorably to precisely those claims thatare based on Chungi theoriesof menstrualfunction (see Table 3). Thusthey were most frequentlyimpressedwith Chinese medicine's claim to harmonize body functionby "supporting,"dampening"fire," and ensuringnormal periodicity. They also gave Chinese medicine high marks as a panacea for both preventingand curing nonspecific "female disorders." When asked about theirown monthlypractice,35 said thatthey changedtheirdiet in accordancewith Chinesemedical norms, and 33 said thatthey took Chinese medicine. A healthy majorityof respondents(60%), includingyoung and old and women from every could be called strongadherents of Chungi, claimingthatthey social background,
39
TABLE 3 Benefits of Chinese medicinefor menstruation. Respondents (N = 54) agree with statement N %
Benefits in rank order
Provides "support" Cures female disorders "fire" Dampens Easesmenstrual pain Keeps regular periods comeon time Helpsthenextperiod Prevents femaledisorders anddiscoloration Improves clotting Helpsa woman get pregnant Helpscleanout"dirt" Prevents pregnancy
49 48 46 44 41 39 35 30 27 20 19
91 89 85 82 76 72 65 56 50 37 35
used it for their own menstrualproblemsand that they recommendedit enthusiastically. Moreover, many of the rest who were not themselves users also recommendedChinese medicine freely (for five or more reproductive disorders).What accounted for this pattern? Some people probably were repeating what they thoughtwas commonplacebelief. We suspect thatyoung women often were parroting what their mothers said at home. Postmenopausalwomen, who were reportingon past behavior,were undoubtedlyless reliablein theiraccountsof practice than in their endorsementof norms. Among both old and young, the commonest explanationfor failure to use Chinese medicine was that they personally were healthy. It is clear thatmenstrualregulationtherapycould keep a woman returning to her pharmacist monthly. Dakeng's matronly,Western-stylepharmacistwas well awareof this. She proudlyidentifiedfive brandsof patent"menstrualregulation" medicinesin her shop, all requiringthe patientto take a dose daily between menses. Two were Japaneseimportsand, at 300 and 350 NT (U.S. $7.69 and $8.97 in 1985 currency),were not cheap. medicines were closely associFurther,the virtues of menstrual-regulating atedwith the generalbenefitsattributed to "supports"as both food and medicine. Even those who did not use herbal infusions to improve their menstrualhealth mentionedthe custom of stewing ssu wu or similar herbs with meat, poultry, or fish and eating this as a strengthening health food in winter, the most yin season of the year. Younger women living at home might well take their supportswith the family meal: "When Mamamakes it, I eat it." Thusfor the young the decision to take Chinese medicine for menstrualregulationwas not necessarilya personal one; behind the girl was a watchful motherwho monitoredher children's health throughcontrolof the family menu.
40
In sum, "supporting"was seen by the women as the most important theraclaimed peutic actionof Chinese medicine for menstrualregulation.Thirty-three to use supports regularlyfor theirmenses, and almosteveryoneused them at some time or otherfor generalhealthmaintenance.Concerningsupportsfor menses in some people thoughtthey correcteda specific anomaly, like irregularparticular, ity or pain. "When menstruationis regularyou don't need supports;you take " "Mamasays to take supportsbetweenperiodsto make themwhen it is irregular. the next cycle go easily." But others saw them as addressinga more general weakness and debility. "Supportskeep your body from deteriorating.""If you are weak, supportswill build you up." "Eat to supportand make up for deficiency." "If you take supportsto avoid weakness, later when you are old you won't suffer from disorders." Not all understanding of the benefits of Chinese medicine was based on an to the appeal therapeutic logic underlyingclassical Chungi functionalism.A subblood as dirtywhen they said stantialminorityshowedconsciousnessof menstrual thatChinesemedicinewas good for cleansing. "When the dirtyblood has flowed out, your body is easy to nourish and build up." One older woman, a devout Buddhist,had thoughtabout the ambiguitiesof blood as both vital and a source of aversion. "Inside the body it is clean," she said. "It's when it leaves the body thatit is dirty." Olderpeasantwomen, in explaining the virtuesof fresh herbs, also seemed to have an unorthodox of drugaction. The herbthey most favored, understanding "ducktongueyellow" (ah hsi tong [H]), would be identifiedin a classical materia medica as "cooling and bitter" in action-inappropriate for a support. These women said it was good for pain and for "menstrualwind" (chingfeng)-a term unknownto classical nosology. Such readingsof female body functionas "hot" could reflectdeviantlocal female understandings. The women in ourstudywere most skepticalof 'menstrualregulation"thermedical authorapies when the subjectwas fertilityregulation.Wheretraditional ity fostered high fertility, modem family planning programsattemptto shape women's reproductive lives today. Accordingly, though abouthalf believed that Chinese medicine promotes fertility, this was less importantto women than its generalhealthbenefits. Herequestionsof female healthandvitalityappearto have lost some of their intimateinvolvementwith reproduction. Instead, the subjectof fertilityprovoked spontaneouscomments about biomedicine'sefficacy in birthcontrol;it also led to relativelyopen, if comparatively skeptical,discussionof Chinesemateriamedicaandabortion.Historically"menstrual regulation" has had an ambiguous relationshipto fertility, since a drug which brings on a late period may also work as an abortifacient.Such formulas could serve female sexual strategiesthat society and doctorsviewed suspiciously Chinesein Malaysiahas (Bray 1990). RecentfieldworkamongHokkien-speaking shown that women who feared they might be pregnantused patentChung i formulas designed to "activate blood" (t'ung hsueh), a practicethat allowed them to leave the exact natureof their condition ambiguous (Ngin 1984). Dakeng's Western-trained midwife recognized this when she observedthat heavy doses of materiamedica with a "disperseblood" (san hsueh) action were sometimes useful for terminating pregnancy.The same logic has led Taiwaneseabortionclinics (untilrecentlyillegal) to advertisetheirservices as "menstrualregulation"(yueh-
41
ching kuei-tse), even thoughit is said they use surgicaltechniques.In spite of the contraceptiverevolutionand recent legalization of abortion, terminatinga pregnancy remainssuspect on Taiwan, and for women who wish to do this, Chung i serves as a shadowy competitorto biomedicine-doubtful, but clandestine and inexpensive. Pollution, Hygiene, and the Public Gaze On the surface, it mightseem surprising thatthe templetaboo was mentioned just as frequentlyby women in our survey as the many behavior modifications oriented toward health. Two other pollution taboos involving menstruating women-avoidance of weddings and of pregnantwomen-were no longer rememberedexcept by a few older respondents:"You couldn't go to weddings in the old days becauseblood was not nice to see. But today we have [sanitary]pads and it doesn't matter." "At weddings nobody tells anyone [whethersomeone is menstruating]."But the temple taboo was known by all and respectedby a majority (36), including some younger women. Although there are folkloristic accounts (by males?) that read menstrualpollution as injuriousto the gods (Chu 1980), the women who commentedon the taboo saw it differently.To them it was a matterof respect:when yourbody is dirty, to appearbeforethe gods is impolite. Gods, unlike humanbeings at weddings, can see what is meantto be concealed. In this context, the discourseon pollutionoverlappedwith one on menstrual hygiene. Keeping clean was very much on the minds of our respondents.Thirtyfour volunteeredcomments on the subject without first being asked about it. Cleanliness,of course, had the prestigeof biomedicinebehindit, as evidenced by the languageof sanitation:"Wash your hands with soap," "Don't touch food," "Use disinfectant." Some spoke of "germs," "contamination," and "infection." But in talking about hygiene and dirt, women shifted ambiguouslyfrom healthconcernsto those animatedby a sense of shame. "Don't let others see or you will be embarrassed.""People will laugh at you." Washing, changingpads often, wearingdark, loose, comfortableclothing all made sense as partof a logic of concealment.Even the precautionsagainstheavy exercise or the injunctionnot to consume powerful "warming" and "supporting" foods, as several respondents made explicit, served to decrease the chances of accidents. These were not merely inconvenientor messy but intensely shaming. Among older women the issues of symbolic and literal decency converged as they recalledtheirmanagementof menstruation in the environmentof the Taiwan of their youth. In those days-no more than 50 years ago-it was commonplace to see blood-stainedgarmentson poorerwomen who used no monthlyprotective paddingof any kind. Symbolic decency gained weightiness in such circumstances.A numberof olderwomen appeared to take special pleasurein telling the young moder nurses conductingthe interview [here the foreign visitor was irrelevant]about the literal facts of menstrual"dirt" in a world of poverty and labor, without indoor plumbing or ready-madesanitarynapkins. They remembered makingpads out of rags and washing them in ditches and streams. But in doing so, they riskedpollutingstreamwaterandoffendingthe gods or theirneighborsor both. In the wordsof severalold peasants, such conductwas disrespectful to the "water lord and lady" (shui kung, shui p'o). But if you poured the dirty
42
ANTHROPOLOGY MEDICAL QUARTERLY
waterout on the bank, these waterspiritswould look kindly on you and carrythe dirtaway, they said. Then therewere the problemsof drying such garmentswhere they could not be seen. Women recalleddevices such as hanging rags inside a pair of women's trousers,underthe eaves, over the chamberpot, hiddenby a towel, in the latrine or behinda door. A 50-year-oldprofessorrecalledlearningfromher teachershow to make homemadepads with cotton wadding, indicatingjust how recent is the inconveniencewas not age of modemconvenience. She also notedthattraditional apportioned equally. "Before then," she said, "people used 'grass paper' . . . stiff, like the paper used for funeral money. . . . The rich liked grass
paperbecause it could be thrown away. The poor used cloth." Over and over, women spoke of their sense of exposure: "These things naturallyare not nice to look at." "If otherpeople see it, it is embarrassing,impolite." "In the old days to people didn't want others to see." "In the old days people were embarrassed them in the dry open." Moreover,in attenuatedform, the sense of shamefulexposure continues to felt thatit is still somehow influencehygienic practice.Abouthalf the respondents to be washed not nice for men's andwomen's clothing(especially undergarments) is our Tai"It old but others said this Some fashioned, simply, together. thought wanese custom." Hygienic rationales("Men's clothes are dirtier." "Women's clothes aredirtier.") were given side by side with occasionalcommentsrevealing thatthis was not ordinarydirt. "It will bring bad luck to the man." "Your husband'sbusiness will suffer." It may be thatwomen's memoriesof shameanddirtduringthe old days were the more intense because contemporarystandardshave changed. In the actual conditionsof preindustrial Taiwan, symbolic decency may have sufficed. But discussion of both literal and symbolic dirt converged on a common underlying meaning. Menstrualpollution for these women was defined by what is exposed is woman's workin China, andwomen to publicgaze andinvites shame. Laundry themselves have transmittedthe practices that mark female dirt as defiling. Womenthemselveshave monitoredthe temple taboo and taughtit to theirdaughters, for who else normallyknows whetherthe time of month is a clean one or not?In publicplaces-temples, outdoorsunderthe sky-their acts show a decent respect for community standardsof religious piety. At home they are properly modest before the males who representthe public sphere in the family. In this reading, many practicesthat mark menstrualblood as polluting become understandableas cleansing rituals by which women have defended themselves from sexual shame and affirmedtheir own dignity and piety. The modem hygienic menstruation healthregimen surrounding submergesthis patternbut has not entirelyeffaced it. Finally, the women in our study did not appearseriously burdenedby the normsof decency they espoused. Cleanlinesswas an attainablestandard,and the numberof gods were easily satisfied. The women volunteeredan extraordinary of religious practice.Most took the formof discriminating flexible interpretations whichgods would takeoffense. Five women said thatBuddhistgods did not mind menstrual blood; threesaid it was all right to worshipthe gods on altarsat home. Seven simply placedall male gods off limits, and otherssingled out the following gods as exceptions:Matsuand Kuanyin(both female deities); the city god (cheng
43
huang);the local god of the soil (tu ti kung); and the gods of yang and yin (male deities). Anotherapproachwas to discriminatebetween temples ratherthan their or one could satisfy inhabitants. spiritual Only big or new temples were forbidden; the gods by simply staying in the outer courtyard. The varietyof stratagemssuggests thatcommunicationnetworksconcerning ritualtaboos are weak; for young women it is a matterof "what Mama says," while olderones maketheirprivatebargainswith the gods. Religious festivals are popularand the ritual atmosphereeasygoing, and even among modem-minded youth, expressionsof skepticismwere mild. In fact the most outspokencritics of the temple taboo were not young secular feminists but four older women-two Christiansand two Buddhists-who said that their own creeds espouse a higher morality.Perhapsthe most thoughtfulcommentcame from an older woman who turnedto a classical neo-Confuciancritique of ritualjudged by the public gaze "I only half believe: afterall, the mind's sincerity basedon externalappearances: is an [inner]spiritualthing and has nothingto do with menstruation." Sociological Variation: Age and Class in Clearlythereare many possible ways for women to managemenstruation Taiwan. Taiwanese readingsof biomedical norms select for those contemporary that complementChinese medical teachings about menstruation,while hygienic regimensecho concerns for public decency taughtby old pollution beliefs. One aim of our survey was to determinewhether sociological factors such as age or class played a role in choices women made in managingtheir monthlyperiods. Pollutionpracticesproved far more sensitive to class and generationalvariationthandid involvementwith Chinese medicine. The poorerand older women the were more likely to respectseveralpollutiontaboos (two or more), supporting hypothesisthat such traditionalbeliefs are eroding with developmentand prosperity(Table4). Even this trend, however, is brakedsomewhatby the vitality of popularreligion in thatmany who rejectedevery other sort of ritualavoidanceas old fashionedstill acknowledgedthe proprietyof respectingthe gods. In contrast, women's positive attitudetowardChinese medicine proved remarkablystable across class and generation(see Table 5). A healthymajorityat all ages and all social levels both recommendedChinese medicine and claimed to use it for menstrualproblems. Its abidingpopularityamong the young could be a naturalproductof their adolescent stage in the life cycle. Moreover, several elderly peasantswho scored low on involvementbecause they had not themselves been users duringtheir fertile and childbearingyears had economic explanations for this lack. "I was too poor to take 'supports'; you have to work to make money." "I couldn'teat 'supports'myself when I was young becausemy parents the fields you can't avoid hardwork." One braggedthatnow the family was more and she takes them: "I used to weigh 70 chin; now I weigh 100," she prosperous laughed. Althoughin our study therewas no clear statisticaltrendshowing thattoday taking Chinese medicine is an elite habit, these peasant women were making a shrewdcommenton historicalreality. In Imperialand pre-WorldWar II Republican China, the classical materiamedica were commerciallyavailablelargely in
were poor." "I always worked hard and didn't have time . . . when you are in
44
TABLE 4 Observanceof menstrualtaboos by class and age. Observed two or more taboos Class or age category Class Peasantor worker Petitbourgeois Grandbourgeois Total Age Younger(18-25) Older(45-70 +) Total N 13 8 5 26 5 21 26 19 75 % 87 38 28
Observed one or no taboos N 2 13 13 28 21 7 28 81 25 % 13 62 72 Total 15 21 18 54 26 28 54
TABLE 5 Use of Chinese medicines by class and age. Used and recommended Chinese medicine Class or age category Class Peasantor worker Petit bourgeois Grandbourgeois Total Age Younger(18-25) Older(45-70 +) Total N 9 12 11 32 17 15 32 65 34 % 60 57 61
Did not use Chinese medicine N 6 9 7 22 9 13 22 35 46 % 40 43 39 Total 15 21 18 54 26 28 54
urban centers and were more likely to be upper-class items of consumption (Furth 1991; Sutton 1981). The broad social base among contemporary users may reflect rising living standards as well as cultural continuity. Conclusion: Menstruation, Gender, and Personal Identity In anthropological and historical inquiry, the menstruating body has been interpreted as a particularly powerful cultural marker of female gender inferiority,
45
and Chinese society, with its patrilocaljoint family system and ConfucianideolAll three frameworksfor understandogy, has been seen as stronglypatriarchal. Taiwan could be said to carrynegative ing menstrualmeaningsin contemporary messages about female gender: religious taboos evoke images of female dirt; Chinese medicine calls attentionto bodily weakness as the price of childbearing capability;andbiomedicinesupportsa stereotypeof female emotionality.Historically, it can be argued that in late ImperialChina medical norms of Chung i servedto submergeand displace discourse on menstrualpollution into a concern for reproductivehealth (Furth 1986). Similarly, one might hypothesize that in today'sTaiwanbiomedicalscience offers yet a healthierandalso moreegalitarian "modem" medicalizedconstructionof female body processes. This neat teleology, if true, would lead to a progressive convergence between the spread of and social concepts of gender equalbiomedicalideals concerningmenstruation ity. In fact, the reality proved more complex. Both biomedicine and Chung i medicalize menstrualbeliefs, but the two systems were seen by our respondents as complementary, thanarrayedalong a hierarchy.The poor andthe elderly rather were more likely to express negative views of the female body (as weaker and dirtierthanthe male body) and the young were more likely to question these stereotypes. But whetherpositive or negative, these beliefs about the female body in general were not critical in shaping the stories women told about their own practicesandthe meaningsthey assignedto them. This is becauseourrespondents looked upon their own bodies not as naturalorganisms reflecting fixed, given identities,but as domainsof personalaction, shapeableby individualbehaviorin accordance with circumstances.The medical and religiouspluralismof menstrual Taiwan and the emphasisupon behaviormodification meaningsin contemporary of practiceswhich allowed each encouragedin Chungi offereda flexiblerepertory womanto do as much or as little as she thoughtneeded in her personalcase. It is certainlypossible to readthe elaboratebehaviormodificationspracticed by ourrespondentsas accommodationsto a dominantmasculinistideology marking the female as weak and symbolically unclean. When women defined menstrualdirtas the blood that is seen, they were offering a constructionin harmony with this dominantdiscourse. But in modifying their behavior, women as agents found complex ways to express other constructionsof the genderedmeaning of theirpractices. This was true of all, includingthe majoritywho offered no modernistchallenge to old societal norms. When they unabashedlygave vent to irritationand anger, floutingmedical guidelines, they might be said to be participating in a specifically female culture of resistance. When they turned to ritual cleansing and ritual respect for the gods, they were participatingin a traditionof female dirtled to the attainment basedcultureof piety, whereacknowledgment of symbolic decency. When they turnedto Chinese medicine, they were particiwhich favored pating in a perennialindigenouscultureof bodily understandings herbaltonics for healthand dietaryprecautionsand preventiveand strengthening reproductive vitality. If each of these were a culturalpossibility, it was also an alternativedictated by individualconsiderations.The elaboratemenstrualregimens described here are the productof medical pluralismand as symbolic strategiesare necessarily This diversityin itself weakensthe powerof medicalor religious overdetermined.
46
authority to shape understanding in a single mold. The emphasis upon behavior modification, encouraged especially by the indigenous Chung i system, expanded the possibilities for imagining a menstruating body corrected and transformed by one's own action. Outside sociological categories or the category of gender was the domain where the menstruating body becomes the function of a person as individual. It can be influenced by personal attributes, like a healthy or sickly constitution, which are a matter of individual fate. It can be shaped by one's personal care and attention to proper social and health-maintaining behavior. Or, this being a personal matter, one can excuse oneself, adapting society's norms to one's own circumstances, convenience, or necessity. If management of menstruation showed women influenced by their various social places and their common identity as a gender, there was also room for them to claim difference as individuals. If it showed women grappling with a sense of weakness or shame fostered by menstruation's negative social meaning, it also showed them able to define themselves positively as persons through remedial action. NOTES We owe a special acknowledgmentand thanksto ProfessorCh'en Acknowledgments. Kuang-hoand to the faculty and staff of the Chung-t'ai I-chuan of Dakeng, Taichung, Taiwan, for theirgeneroushospitalityduringthe summerof 1985. We also owe thanksto the studentsat Chung-t'aiwho served as volunteer interviewers:Liao Yu-i, Sung Tuanching, Hong Yu-chun,Hsiao Ping-ju,ChiangSheng-fang,WanTa-sheng,Ch'en Shu-chu, and Liu Lin-lin. Portionsof the researchwere supportedby grantsfrom the National Institutesof Health and from the Long Beach Foundationof CaliforniaState University at Long Beach. MarthaTocco wrote the databaseprogramand Isabella Furthassisted with the coding. Valuablecomments and criticisms of earlier drafts were supplied by Donald Brenneis,FrancescaBray, KarenLeonard,MargeryWolf, and by the editorsand anonymous reviewersof MAQ. Correspondence may be addressedto the first authorat the Departmentof History, Universityof SouthernCalifornia,UniversityPark, Los Angeles, CA 90089. '[M] indicatesa wordin Mandarin,the nationallanguageandthe languageof literacy. [H] indicatesa word in Hokkien, the spoken tongue of islanderswho are Taiwanese natives. Unmarked Chinese termsare in Mandarin. of menstruation 'This accountsimplifies the range of symbolic interpretations found in Chinese medical and religious traditionsin orderto concentrateon those most familiar in Taiwantoday. In particular,it ignores the medicinalvalue assigned to menstrualblood of "inner alchemy" (nei tan) and by associatedTaoist disciplines of selfby practitioners cultivation.These taughtwomen to treatmenstrualblood as a body elixir comparableto semen (Furth1986); Needhamand Lu 1983; Schipper 1982). 3Thesefindingsmay suggest a culture-bound style of "somatization"of psychic disobservedby Arthur Kleinmanfor depression(Kleinman1980, 1986). tresslike the patterns The Americanresearchmodel (the Moos MenstrualDistress Questionnaire)itself, however, presupposesthe categoriesof psychosomaticnosology.
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Chinese Medicine and the Anthropology of Menstruation in Contemporary Taiwan Author(s): Charlotte Furth and Ch'en Shu-yueh Source:

Chinese Medicine and the Anthropology of Menstruation in Contemporary Taiwan

CHINESE MEDICINE AND MENSTRUATION

CHINESE MEDICINE AND MENSTRUATION

CHINESE MEDICINE AND MENSTRUATION

CHINESE MEDICINE AND MENSTRUATION

Statements about menstrual blood in rank order

CHINESE MEDICINE AND MENSTRUATION

MEDICAL ANTHROPOLOGY QUARTERLY

CHINESE MEDICINE AND MENSTRUATION

Benefits in rank order

MEDICAL ANTHROPOLOGY QUARTERLY

CHINESE MEDICINE AND MENSTRUATION

ANTHROPOLOGY MEDICAL QUARTERLY

CHINESE MEDICINE AND MENSTRUATION

Observed one or no taboos N 2 13 13 28 21 7 28 81 25 % 13 62 72 Total 15 21 18 54 26 28 54

Did not use Chinese medicine N 6 9 7 22 9 13 22 35 46 % 40 43 39 Total 15 21 18 54 26 28 54

CHINESE MEDICINE AND MENSTRUATION

MEDICAL ANTHROPOLOGY QUARTERLY

CHINESE MEDICINE AND MENSTRUATION

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