SEXUALITY IN CHINESE MEDICINE

This article is a discussion of sexuality in Chinese medicine.  The first part will deal with the social conditions of women in ancient China.  This is drawn primarily from an important book by R. H. Van Gulik, Sexual Life in Ancient China, Barnes and Noble, New York, 1961.

The second part will discuss Daoist sexuality and the role of the extraordinary vessels in sexuality.

The topics discussed are:

1. A brief historical overview of sexual customs in ancient China
2. Daoist sexual practices
3. Differences between men’s and women’s sexuality from the point of view of Chinese medicine
4. Sexuality and extraordinary vessels
5. Sexuality and emotional problems in ancient china

          HISTORICAL OVERVIEW OF SEXUALITY IN ANCIENT CHINA

SHANG DYNASTY (1600-1100 BC)
Old myths and legends credit women with special magical powers and represent women as the guardian of the arcana of sex and repository of all sexual knowledge.  All texts on sexual relations introduce a woman as the great initiator and man as the ignorant pupil.

It should be noted that the term wu (shaman) referred to women shamans.  Men shamans were called xi.

ZHOU DYNASTY (1100-221 BC)
The three major strands of Chinese philosophy, i.e. Confucianism, Daoism and Yin-Yang School, developed during the Warring States Period (576-221 BC).

The strictly patriarchal system of the Zhou and subsequent dynasties reversed the position that  women occupied during the Shang dynasty.  The Confucianists especially extol man as the undisputed leader and head of the family, as strong and active, symbol of light and superior to woman who is weak and passive, symbol of darkness. 

Yet, all the centuries of Confucianist doctrine could not succeed in eliminating the mother image from the Chinese subconscious.  Throughout the history of Chinese thought and religion one finds a persistent counter-current, later consciously canalized in Daoism, that praises negative as superior to positive, Yin to Yang, inactivity to activity.

The Dao De Jing in fact frequently refers to the “feminine principle”, to yielding (which is Yin as opposed to Yang) and to the power of water always flowing to the lowest pace but being capabe of eroding the strongest structures.  

Daoist terms for sex organs such as deep vale (for uterus) or mysterious gate (for vulva) derive from the ancient conception of woman as the Earth-Womb.  The Earth was thought to harbour cosmic vital essence (see also Native Americans; kiwa).  The Zhou rulers would enter underground rooms or caves for celebrating important events. 

The association of Woman-Womb-Earth-Creative Power is older than that of Man-Phallus-Heaven-Creative Power.  Perhaps the former association dates back to the times when people had not yet recognized that the coitus is the unique cause of the woman’s conceiving.

The ruling class believed itself to possess a great amount of De, inherited from their ancestors and passed on to their offspring.  This De formed the link between the ancestors and their descendants, it connected the dead with the living.  The living had to sacrifice regularly to the ancestors, for if these sacrifices were broken off the de of the ancestors would diminish and they would become malevolent gui, with disastrous results for their living offspring. De here is the De as in Dao De Jing.  De is usually translated as "Virtue" but, according to most sinologists it is also "Power".   Thus the Dao De Jing would be the "Classic of the Dao and its Power".  

Hence it was every man’s sacred duty to his ancestors and also to himself to produce male children who would continue the sacrifices in the ancestral hall (hence the preference for male children which continues to the present day).  The ancestors on their side took part in the life of the living, they kept a benevolent watch over them and the living had to keep them informed of all their doings.  The hun as an ancestral spirit is fed by the sacrifices of the descendants on earth.  Ancestor cult was the cornerstone of Chinese life until recently and even now.

Since the king has a maximum of De, he needs a large number of female partners to nourish and perpetuate it through sexual intercourse.  The king has 1 queen (hou), 3 consorts (fu ren), 9 wives of the second rank (bin), 27 wives of the third rank (shi fu), and 81 concubines (yu ji). 
Special court ladies, called nu shi, regulated and supervised the sexual relations of the king and his wives. 

They saw to it that the king had sex with them on the correct calendar days and with the frequency established by the Rites for each rank.  They kept careful note of the sexual unions with special red writing brushes calledtong guan; hence throughout the later ages descriptions of the sex life of the ruler are designated in Chinese literature as tong shi, i.e. “Records made with the Red Brush”. 

The general rule was the women of the lower ranks should be copulated with before those of high rank, and more frequently. The king cohabited with the queen only once a month.  This rule is based on the belief that during the sexual union the man’s vital force is fed and strengthened by that of the woman, supposed to reside in the vaginal secretions. 

Thus the king copulated with the queen only after his potency has been increased to its maximum by the frequent previous unions with the women of lower rank, and when there was consequently the best chance of the queen conceiving a strong and intelligent heir to the throne.

Only the consorts of the higher ranks were allowed to spend the whole night with the king.  The concubines had to leave the bedroom before dawn.  An old poem in the Book of Odes (Shi Jing) describes the resentment of the concubines at these unequal rights.  It says:

Twinkling, twinkling those small stars
humbly following Scorpio and Hydra in the East
Thus modestly we walk through the dark
while night still reigns in the palace.
Women’s fates are different indeed!
Twinkling, twinkling those small stars,
like those in Orion, in the Pleiads.
Modestly we walk through the dark,
carrying our own quilts and coverlets.
Women’s fates are different indeed!

The title of the poem, “Small Stars” (Xiao Xing), has become a common literary term for “concubine”.

The girls of the common people had a much fuller and freer sex life than their sisters of the upper classes.  Marriages of the common people were arranged and celebrated during spring meetings and festivals.  With the advent of spring, the rural communities organised spring festivals where the young men and women performed dances together and sung songs, nearly all of which bore relation to fertility cults and were often of a frankly erotic character. 

During these festivals each young man selected and courted a girl and had sex with her.  These relationships continued throughout the summer and autumn and were regularised before families moved back to the winter quarters.  Probably the main criterion was whether or not the girl had become pregnant.  Both the man and the woman had the freedom to accept or not the other and to change their mind afterwards.  Thus, it can be seen that the sexual customs of common people were much freer than those of the ruling classes.  Some poems from the Book of Odes bear this out:

The rivers Chen and Wei
see their waters rising!
Boys and girls
carry armfuls of orchids
The girls ask: ‘Did you look there?’
The boys answer: ‘We are just back,
but shall we go again?
For on the other bank of the Wei,
There is a lovely field!’
The boys and girls
there assemble for their sporting
and a peony is the gauge.

Going out through the east city gate
I see girls as numerous as clouds.
But although they are as numerous as the clouds
there is none that captivates my heart.
But she of the white robe and grey headdress,
She alone gives joy to my heart
Going out by the gate tower
I see many girls as fair as flowers.
But although they are as numerous as the clouds
there is none that captivates my heart.
But she of the white robe and grey headdress,
She alone gives joy to my heart.

One poem complains of double morality applying to men and women:
Alas, young women,
do not take your pleasure with men!
If a man takes his pleasure
little does it matter who talks about it.
But if a woman takes her pleasure,
She cannot afford to be talked about

Another poem talks about nightly visits by a lover to his girl:
I beg you , master Zhong,
don’t climb into our quarters,
don’t break our willow trees!
It’s not that I cherish those,
but I fear my father and mother.
I do love you, Zhong,
but what my father and mother say,
I certainly must fear.
I beg you master Zhong,
don’t climb over our wall.
don’t break our mulberry trees!
It’s not that I cherish those,
but I fear my cousins.
I do love you, Zhong,
but what my cousins say,
I certainly must fear.
I beg you, master Zhong,
don’t climb into our garden,
don’t break our tan trees!
It’s not that I cherish those,
but I fear the gossip of the people.
I do love you, Zhong,
but the people’s gossip,
I certainly fear.

This poem is interesting for its use of the word “love”, always absent from Daoist sex manuals and also because of the girl’s fear of people’s gossip, i.e. she is worried about what other people will say: nothing has changed in China!

Widows were called wei wang ren, meaning “persons waiting only for death”, a term still used in Japan bibojin.

Probably the first record of Chinese doctor indicating excess sex as a cause of disease is from 540 BC.  In 540 BC the prince of Jin had fallen ill and various cures did not help.  A physician was called in and he attributed the prince’s illness to excessive sexual intercourse. 

He said: “Woman complements the male force (yang) and should be cohabitated with during the night.  If one goes to excess in his sexual intercourse with her, an internal fever will develop and the mind becomes affected.  You do not practise moderation in the sexual act, engaging in it even during daytime: how could you avoid becoming ill?”1

The latter half of the Zhou dynasty saw the beginning of the Confucian philosophy and ethics. Confucius assigned a lower place to women.  The Confucianist School states that women are absolutely and unconditionally inferior to men.  A woman’s first and foremost duty is to serve and obey her husband and his parents, to look well after the household, and bear healthy children.  Her biological function is emphasised and her emotional life given secondary consideration.

Daoism has been much more considerate to women and has given much more thought to her physical and emotional needs than Confucianism ever did.  In fact, the general principle of Daoist sex was that both partners should share in the benefits accruing from the sexual discipline.

Later on, Buddhism too assigned a higher place to women and it is significant that the Indian bodhisattva Avalokitesvara became a female deity in China (Kuan Yin).

SUI DYNASTY (590-618)
The main reason why handbooks of sex continued to enjoy such wide popularity with both Confucianists and Daoists was that those textbooks of sex answered a real need.  Without their guidance, the head of a large family could hardly have managed his numerous womenfolk without becoming a nervous wreck.

All the sex handbooks lay great stress on the necessity of a man understanding the sexual needs and sexual behaviour of women.  They teach the householder the fundamental differences in pre- and post-orgasm experiences of man and woman, using the simile of Water and Fire. 

The texts warn a man again and again not to force himself on one of his women to engage in the sexual act if both partners are not in complete emotional harmony.  The texts stress the importance of making the woman reach orgasm during every coitus.  Incidentally, the description of the 5 signs of a woman’s sexual arousal described in the ancient texts agrees in all details with that given in A C Kinsey’s “Sexual Behaviour of the Human Female” (see below).

Early sexual manuals never refer to oral sex, fellatio, cunnilingus, or anal intercourse. Sadism and masochism were practically non-existent until the Qing dynasty.  Male homosexuality was particularly common during the Song dynasty but not during other dynasties.  Female homosexuality was quite common and viewed with tolerance: this was due to the living conditions of wives and concubines in the women’s quarters. 

Lesbians used to stimulate each other’s genitals, cunnilingus and sexual toys.  One described in the texts was made from a short, ribbed stick of wood or ivory with two silk bands attached to the middle: each silk band was tied round each woman’s waist and the stick inserted in each other’s vagina. 

A Ming text says that country women used the plant Suo Yang Herba Cynomorii songarici as a sexual toy which they inserted in their vagina and which swelled as soon as it came into contact with the Yin juices.  It was also used internally as an aphrodisiac and the text says that it is better than Rou Cong Rong Herba Cistanchis deserticolae.

TANG DYNASTY (618-907)
Sun Si Miao had a section on sexual hygiene in his book Qian Jin Yao Fang.  Three innovations by Sun Si Miao:

1) He attached great importance to a man reaching the age of 40 which he considers a turning point in a man’s sexual life and his general physical condition;

2) For the first time Sun Si Miao advises the pressing of different points to stop ejaculation (instead of Ren-1) and he advises pressing the point Ping Yi, one inch above the right nipple and also a point called San Yang Xue (“Point of the Three Yang”), 8 inches above the external malleolus, with moxa.

3)  Sun Si Miao states that the process of making sperm return to the brain results in union of the male and female principles in the brain of the practitioner (symbolised by a red sun and a yellow moon, symbols probably imported from India).

SONG DYNASTY (960-1279)
During the Song dynasty Confucianism became established as the dominant philosophy and religion, but only by absorbing elements of Daoism and Buddhism, hence the name Neo-Confucianism.

During this time, sexual relations became to be restricted by the numerous stringent rules in the classics and free association of men and women frowned upon.  The Confucianists re-interpreted all the old classics in the light of their philosophy not without a lot of distortion. 

Zhu Xi (1130-1200), for example, stressed the inferiority of women and the strict separation of the sexes, and forbade all manifestations of love or sex outside the intimacy of the wedded couch.  This bigoted attitude manifests itself especially in his commentaries on the love songs of the Book of Odes, which he explains as political allegories, which, of course, they are not.


YUAN DYNASTY (1279-1368)
During the Yuan dynasty China was a country occupied by invaders.  Confronted with Mongol soldiers billeted near them, Chinese men began to encourage their women to remain in their quarters and now began to appreciate more the Confucianist rule for the seclusion of women.  It is possible that it was during this period that the germs of Chinese prudery came into existence, and the beginnings of their tendency to keep their sexual life a secret from all outsiders.

MING DYNASTY (1368-1644)
Whereas men in general were interested in Confucianism, Daoism and Buddhism alike, women favoured nearly exclusively Buddhism.  The Buddhist creed of universal love and compassion, preaching equality of all beings, answered women’s spiritual needs, while the dazzling ceremonies centering around beautiful female deities like Kuan Yin, who helps women in distress and grants children to the childless, lent colour to their rather monotonous daily life. 

Buddhist nuns, who by virtue of their sex, had free access to the women’s quarters, were the favourite counsellors of the ladies of the household.  Buddhist nuns gave the ladies of the household advice in personal problems and  generally acted as counsellors of a sort.  Public opinion regarded nuns and nunneries with disfavour.  The idea alone that women abandoned their sacred duty of propagating the family and went to live in self-contained communities where they were not subject to the control of their male relatives, was abhorrent to the Confucianists. 

Writers of Ming novels and short stories were mostly Confucianist literati who had ipso facto a prejudice against everything Buddhist.  Buddhist monks and nuns were their favour black sheep. Therefore, when reading this kind of literature one should guard against making generalizations and take the scathing denouncements of the moral turpitude of nuns with a generous pinch of salt. 

Nuns were suspected of having entered religion only to practise unnatural vices.  There is an element of truth in this suspicion as many girls became nuns not out of devotion but for various other reasons: sometimes parents forced them to become nuns to ingratiate the ancestors spirits, sometimes girls became nuns to avoid an arranged marriage, sometimes concubines became nuns to escape sadistic husbands or mother-in-laws and sometimes purely because of lesbian tendencies.

The principles of handbooks on sex were still applied but the sex manuals did not circulate freely any longer.

A Ming dynasty sex manual makes some interesting observations on women’s psychology in ancient China.  It says that women’s lives were monotonous and that sex was their only diversion ad interest.  He says:  “Wives and concubines are daily occupied with the control of all trifling household chores.  Except for attending to their hairdress and their face powder and rouge and engaging in music and card-games, they really have nothing to gladden their hearts but sexual intercourse.  Therefore it is the duty of every enlightened householder to acquire a thorough knowledge of the Art of the Bedchamber, so that he can give complete satisfaction to his womenfolk every time he copulates with one of them.”2

Therefore women’s sexual life was more important to them than to the men as men had many other outside interests that women could not have: this is a new idea never before expressed in sex manuals.  The same text then makes the point that a man’s skill in the sexual act means more to most women than his youth or charm; and also that sexual frustration makes women quarrelsome and difficult to handle.

In fact, the author says: “East of the street lives a young and vigorous man of imposing mien; his women quarrel from morning till night and do not heed him.  West of the street lives a greybeard who walks with a stoop; his women do their utmost to serve him obediently.  How can this be explained?  The answer is that the latter knows the subtle secrets of the Art of the Bedchamber, while the former is ignorant of it.”3

In the second half of the Ming dynasty the Daoist sexual arts became more and more a secret tradition.

END NOTES

1.  R. H. Van Gulik, Sexual Life in Ancient China, Barnes and Noble, New York, 1961, p. 34.

2.  Ibid., p. 269.

3.  Ibid., p. 269.

DAOIST SEXUAL PRACTICES

The essence of Daoist sexuality is the idea that the sexual act is an exchange of Yin and Yang essences, from the woman and man respectively, which is beneficial to each partner: it represents the harmonious interaction and mutual nourishment of Yin and Yang.

Central to Daoist sexuality is the idea that man must conserve its sperm and only ejaculate occasionally: this is because sperm is a direct physical manifestation of Jing and too frequent ejaculation depletes Jing. If sperm is not ejaculated and directed upwards along the Du Mai to the brain, it can be transmuted and then lowered down to the Dan Tian where it nourishes the body and mind.

Since excessive ejaculation weakens the Jing, and since sex without ejaculation can replenish the Jing, it follows that Jing lost through sexual activity can be replaced by sexual energy itself, by practising sex without ejaculation.

Sexual intercourse was considered to have two aims: first to produce sons who would continue the family (and look after the parents' grave). This was a sacred duty to one's ancestors since the well-being of the dead could only be ensured by regular sacrifices made by their descendants, especially the male ones.

The second aim (more relevant to us) was to strengthen a man's vitality by making him absorb the Yin essences of the woman. As a matter of course, these two aims were closely interwoven. 

In order to obtain healthy male children the man's Yang essence should be at its apex when he ejaculates, and ancient sex manuals frequently pointed out the optimal conditions the best conditions for a healthy child: at the time of ejaculation and subsequent conception, the man should not be in a state of exhaustion and should not drink alcohol, for example.

To the Daoists, sex was like a process of alchemy, of transformation of the sexual essences into Qi and Jing, through the harmonious intermingling of Yin and Yang. They identified the woman with a crucible and her vital essence with cinnabar (red); they identified the man's white semen with lead; the coitus with the mixing of the elements, and the technique of the coitus with the firing times.

Since men had to restrain themselves by not ejaculating whereas women could reach an orgasm whenever they liked, the onus was very much on men to conduct and prolong sexual intercourse by sexual expertise; in fact, because of this, sexual intercourse is often described by the Daoists as a "battle", as "riding a tiger", or as "walking on the edge of a precipice": i.e. man is easily aroused and easily ejaculates and must learn to control his ejaculation to prolong sexual intercourse (see below).

There were also social reasons for this as the sexual art was essentially for the upper classes whose men had a wife and concubines and they therefore had to restrain themselves in order to satisfy them all.

A constant theme running through Daoist sex manuals is that excessive ejaculation is detrimental to health. This is because too frequent ejaculation leads to a direct loss of Jing and also Minister Fire: thus it depletes both Water and Fire. As we all know, this is very much a theme of modern Chinese medicine books where "excessive sexual activity" features prominently in the aetiology of diseases. As I will explain below, I think that this cause of disease does not apply to women.

The role of the Ming Men (Minister Fire) in human physiology should be discussed. The Fire of Ming Men represents the physiological Fire within the Kidneys, it arises from the area between the two kidneys and is closely related to the Yuan Qi from which the Du, Ren and Chong Mai originate. 

Under physiological conditions, the Fire of Ming Men warms the Uterus, the Intestines, the Bladder and the Heart and balances the Yin influences: it makes conception possible and is related to sexual desire. In women, "it is through Kidney-Yang [and therefore the Fire of Ming Men] that the Tian Gui turns red [i.e. it turns into Blood]".1

The Fire of Ming Men is the origin of the "formless" Minister Fire which also generates Water, hence the Kidneys are the source of both Water and Fire. This physiological Fire is unique in that, not only it does not dry up Water, but it can nourish Water. 

The Minister Fire is called "formless" because it is a non-substantial Fire which actually generates Water rather than overcoming it. It is a Pre-Natal type of Fire formed at conception on the Du/Ren Mai axis.

In fact, the "Golden Mirror of Medicine" (1742) says: "The Pre-Natal Tian Gui originates from the mother and father, the Post-Natal Jing and Blood are derived from food and water, a girl's Tian Gui matures at 14, when the Ren Mai is open, the Chong Mai is flourishing and the periods arrive".2

The commentary then explains: "At 7 the Motive Force [Dong Qi] is flourishing. At 14 the Tian Gui matures: this is the Motive Force within the Pre-Natal Water of Tian Gui, crystallizing in a girl's uterus".3

"Motive Force" (Dong Qi) is the Yuan Qi. This last passage is interesting as it confirms that the Yuan Qi and the Minister Fire are pre-natal and present before the onset of the periods. It also highlights the close integration of the Minister Fire and the Tian Gui (the Yang and Yin aspects of the Kidneys).

Zhang Jing Yue says: "The Ming Men is the Root of the Yuan Qi and the residence of [both] Water and Fire. The Yin of the 5 Zang cannot nourish without it and their Yang cannot develop without it".4  

This passage clearly shows how the Minister Fire is the Fire within Water, interdependent with Water and inseparable from it. The Emperor Fire (of the Heart) is called "with form", i.e. it is a substantial Fire which overcomes Water, is formed after birth and is therefore post-natal.

It is important to note again that the Minister Fire cannot be seen in the context of the Five Elements, it is not like the Fire of the Heart and it is a Fire within Water of the Kidneys that actually nourishes Water.

DIFFERENCES BETWEEN WOMEN'S AND MEN'S SEXUALITY

Women pertain to Water and men pertain to Fire and there are important differences in their sexuality. Women are like water, i.e. slow to bring to the boil and slow to cool down; men are like fire, i.e. easy to arouse and quick to cool down. 

Ever since very early times, Chinese sexual manuals stressed that women like "slowness" and "duration" and abhor "haste" and "violence". This difference is the crux to understand the different sexual behaviour by men and women necessary or a successful sexual life. For this reason, all Daoist texts stressed very much the importance of expert foreplay by the man to arouse his partner and hence the detailed description of the signs of women's arousal.

The Five Signs of sexual arousal in a woman are:

1) Flushing of the face, indicating arrival of Heart-Qi;
2) Hardening of the nipples and sweating around her nose, indicating arrival of

     Liver-Qi;
3) Parched throat, dry lips indicating arrival of Lung-Qi;
4) Moistness of the vagina, indicating arrive of Spleen-Qi;
5) Extreme moistness of the vagina with dripping of thick, viscous fluid, indicating

     the arrival of Kidney-Qi.

Others have the Five Signs as follows:

1) Flushing of the face: Heart-Qi;
2) Moist eyes with an expression of love: Liver-Qi;
3) Speechlessness with head lowered: Lung-Qi;
4) Pressing her body close to the man's body: Spleen-Qi;
5) Dilation and moistness of the vagina: Kidney-Qi.

The Five Desires are:

1) "Intent": manifested by short, shallow breathing and a rapid pulse.

2) "Awareness": she wishes the man to touch and stimulate her genitals: indicated by flared nostrils and parted lips.

3) When a woman approaches the peak of passion, her entire body shakes and she clutches the man closely.

4) Occurs during orgasm and is called "Concentration": the woman sweats.

5) Occurs only in a state of extreme passion and pleasure beyond normal orgasm: her body straightens and grows rigid, her eyes close and she clamps her thighs tightly together around the man.

Thus, it can be seen that much of the instruction is directed at men, teaching them how to conduct foreplay, how to arouse the woman, how to detect the signs of her arousal and her intentions and how to delay ejaculation. This is because of the above-mentioned biological difference between men and women, i.e. women are "slow to heat up" whilst men are "quick to flare up and become extinguished": thus the onus is very much on men to control themselves to give time to the woman to reach arousal and orgasm.

From the point of view of Chinese medicine, there are important differences between men's and women's sexuality. In men, the lower Dan Tian contains the "Room of Sperm" and is, so to speak, "empty"; in women, the lower Dan Tian is, so to speak, "full" as it contains the Uterus and Blood. Excessive sexual activity does not affect women as much as men for various reasons. 

In men, ejaculation is a direct (but temporary) loss of Jing as sperm is derived directly from the Jing.   Sperm is Tian Gui whereas Tian Gui in women is menstrual blood and ovarian follicles and eggs. As in sexual activity men lose sperm but women do not lose menstrual blood (unless they have sex during the period which they should not do) or follicles.

As there is no comparable loss of Jing in women as there is in men, there is no equivalent depletion after sex. Quite simply, the Kidney-Jing is the origin of sperm in men and of menstrual blood and ova in women: while men lose sperm during sex, women do not lose menstrual blood or ova.

Although some practitioners consider the lubricating fluids secreted by the Bartholin's glands during sexual arousal in a woman to be also a manifestation of Jing comparable to sperm, I tend to disagree because such fluids are secreted by glands in the vagina and not by sex organs (such as the ovaries in women or testicles in men): I would therefore consider these fluids precisely as a form of Body Fluids (jin ye) rather than a direct manifestation of Jing. In fact, the Bartholin's glands in the vagina are homologous to the Cowper's glands in men and their function is purely lubricative.

In other words, sperm is a direct manifestation of Jing, the equivalent of which would be the ova and menstrual Blood in women: the former is lost in men's orgasm, the latter are not lost in women's orgasm.

Furthermore, the Lower Dan Tian in men contains the Room of Sperm which is directly related to Jing, while in women it contains the Uterus which is related to Blood. The Room of Sperm is related to the Kidneys while the Uterus is related also to the Liver and Blood (although also to the Kidneys through the Bao Luo). Because the Lower Dan Tian in women contains the Uterus rather than the Room of Sperm, in women excessive loss of blood after childbirth or excessive loss of blood in menorrhagia would be equivalent to excessive sex for men.

In men, the lower abdomen is occupied by the Room of Sperm and it is therefore "empty", also because sperm is easily discharged while Blood is not. 

The book "Elementary Medicine" (1575) says: "The Room of Sperm in men suffers no accumulation or fullness, while the Blood Chamber in women suffers from accumulation and it overflows downwards in the period....[The Lower Dan Tian] in men stores Jing [=sperm] while in women it stores the Uterus and foetus.  Men pertain to Qi and when it mixes with the Abysmal [the trigram corresponding to Water], Qi makes Water steam and produces sperm which is white... Women pertain to Blood, when this mixes with the Clinging [the trigram corresponding to Fire], Blood is transformed into the period which is red".5

END NOTES

1. Cong Chun Yu 1989 Chinese Medicine Gynaecology (Zhong Yi Fu Ke Xue), Ancient Chinese Medicine Texts Publishing House, Beijing, p.11.

2. Wu Qian 1977 Golden Mirror of Medicine (Yi Zong Jin Jian), People's Health Publishing House, Beijing, vol. 3, p.7.  First published in 1742.

3. Ibid., p. 7.

4. Zhang Jing Yue 1986 The Complete Works of Jing Yue (Jing Yue Quan Shu), Shanghai Science and Technology Press, Shanghai, p.19.  First published in 1624.

5. Elementary Medicine (Yi Xue Ru Men ) 1575 cited in Zhang Qi Wen 1995 Menstrual Diseases (Yue Jing Bing Zheng), People's Hygiene Publishing House, Beijing, p.10.

SEXUALITY AND THE EXTRAORDINARY VESSELS

Human sexuality is closely linked to the physiology and pathology of the extraordinary vessels, especially the Du, Ren and Chong Mai.

The Du and Ren Mai are the expression of Fire and Water respectively with regard to sexuality: the exchange of sexual essences and of Yin and Yang during sexual intercourse takes place through the intertwining of the Du and Ren Mai during intercourse.

Both these vessels arise from the space between the Kidneys where the Yuan Qi throbs: they then flow down to the perineum where they separate, one following the spine up to the brain, the other following the front up to the face and eyes.  However, internally they intersect and both flow through the heart.

The “Su Wen” in chapter 60 has the following pathway for the Du Mai: it starts near the uterus, goes down to the pubic bone, in women to the vagina.  Its Luo channel goes around the vagina, passes to the perineum, then the buttocks, down to meet the Kidney and Bladder channels inside the upper thighs; it then rises up the spine and wraps around the kidneys.  In men it goes around the penis and then the perineum.  We can therefore see that, besides flowing up the back, the Du Mai flows to the genitals and is therefore stimulated by sexual intercourse. 

Chapter 60 of the Su Wen also describes an abdominal branch of the Du Mai that starts in the abdomen, goes up to the umbilicus, past the heart, throat, chin, around lips and reaches the eyes.

Some see this “main vessel” as being the Ren Mai.  In fact, what it means is that the Du and Ren Mai are almost like two branches of the same vessel, one Yang and one Yin, intersecting inside.  Li Shi Zhen says: “The Du and Ren Mai are like midnight and midday, they are the polar axis of the body...there is one source and two branches, one goes to the front and the other to the back of the body...we can make connections between them.  When we try to divide these, we see that Yin and Yang are inseparable.  When we try to see them as one, we see that it is an indivisible whole.”

Wang Big considered this “main vessel”, not as the Ren Mai but as a branch of the Du Mai flowing with the Ren Mai: “Another branch [of the Du Mai] starts in the lower abdomen, comes up the abdomen, to the centre of the eyes, following the pathway of the Ren Mai.  This is why we can say that the Du, Ren and Chong Mai have different names, but are all the same.”

Thus, the Du Mai embodies the Minister Fire and the Ren Mai Water: the contact of the penis inside the vagina establishes the link between the Du and Ren of the man and woman and therefore the exchange of Yin and Yang sexual essences between them.

Moreover, if the partners also kiss simultaneously, the communication between the Du and Ren is established not only below but also above as the Du Mai ends on the upper gum and the Ren Mai flows to the mouth, thus completing the circle.

THE THREE DAN TIAN
The three dan tians are of course closely linked to the Du and Ren Mai.

Upper Dan Tian: this is variously identified as the point Yintang, Du-20, a point between the eyes, the centre of the brain called “ni wan” or the centre of the chest.  In any case, all these points are either on the Du or the Ren Mai.

Middle Dan Tian: on the Ren Mai, Ren-12.

Lower Dan Tian: generally below the navel, could be Ren-6, Ren-5, Ren-4.

There are actually three Dan Tian on the same level: one anterior on the Ren, one in the middle on the Chong and one posterior on the Du (Du-4).

Some Chinese sex manuals give three different locations for women:

Upper Dan Tian: the breasts.
Middle Dan Tian: the navel itself.
Lower Dan Tian: the uterus.

THE THREE PASSES

The three passes are also along the Du Mai; they are like energetic bottlenecks through which Qi has to pass in its ascent to the brain.  The lower pass is at the coccyx; the middle is in the middle of the thoracic vertebrae; the upper is at the occiput.

THE NINE ORIFICES

The nine orifices in sex manuals are different than the usual ones (eyes, ear, etc.): they are the three dans tians, the three passes and the three points: these last three are Du-20, Ren-1 and the point called niwan (centre of the brain).  The three dan tians, three passes and three points form a circuit which is activated during sexual intercourse.

In the pre-natal life, the Du and Ren Mai are connected, whilst after birth, they are severed.  The connection can be re-established through the two “magpie bridges”, in the mouth (holding pressing the tongue upwards on the palate) and in the anus (by contracting the anal sphincter).  Both these manoeuvres are effected during Ba Gua exercises and the first during Tai Ji Quan and Xing Yi.

THE THREE PEAKS

The Three Peaks are related to the Ren and Chong vessels.  In a woman, the Three Peaks are the mouth, breast and vagina: during intercourse, the man can absorb a nourishing Qi and fluids from these three peaks.

The upper Peak is called Red Lotus Peak and its medicine is called Jade Fountain; the middle Peak is called the Double Lotus Peak and its medicine is called the Peach of Immortality; the lower Peak is called Peak of Purple Agaric, Grotto of the White Tiger or Mysterious Gateway and its medicine is called White Lead or Moon Flower. 

This is the fourth and last part of Sexuality in Chinese Medicine.

Chinese medicine has always stressed the importance of excessive sexual activity as a cause of disease but not insufficient sexual activity.  This has not always been so as, during past dynasties, all sex manuals explicitly say that sexual activity is essential for the health of both men and women.  Indeed, sexual abstinence was viewed with suspicion (as Buddhist nuns were). 

The current pruderie of Chinese medicine is clearly a result not so much of the Communist influence but of the Qing dynasty’s Confucian influence.  As we have seen, the Confucianists frowned upon sexual activity and believed that it should be carried out in secret and there should be no public display of affection (as in modern China until recently). 

It is important to understand, however, that these rules did by no means imply that sex was a “sin” and woman was the origin of such sin as in the Christian view: nothing could be further from the truth.  The Confucianist abhorrence of sexual philandering was determined mainly by the fear that promiscuity might disrupt the sacred family life, and also by their reverence for the process of human procreation, a solemn process that must not be debased by superfluous amorous play. 

Therefore, although the Confucianists considered women as inferior to men, this idea appeared natural to them as that of Earth being inferior to Heaven, thus inferior in a philosophical sense rather than in a concrete sense; it did by no means imply that they hated or despised women, as many medieval Christian thinkers and mystics did. 

Moreover, women had their own vested rights, and one of them was the right to satisfaction of their sexual needs.  Although physical contact was strictly limited to the marital bed, there the husband had to give all his women the personal attention he was supposed to deny them as soon as they had left the bed.  The Li Ji (one of the Confucian classics) mentions sexual neglect of one of the women as a grave offence; neither age nor beauty should make the husband deviate from the strict protocol set for sequence and frequency of his sexual intercourse with his wives and concubines. 

As we have seen, from the latter part of the Ming dynasty onward, Chinese society became more and more straight-laced and frowning on matters of sex.  We have also seen how Chinese doctors considered lack of sex and sexual frustration as a major cause of emotional stress in women: this is all the more likely to happen as, as we have seen, women’s sexuality is more complex than that of men and they therefore need a man who is expert in the sexual art and foreplay. 

Sexual desire depends on the Minister Fire and a healthy sexual appetite indicates that this physiological Fire is abundant.  When sexual desire builds up the Minister Fire blazes up and Yang increases: the orgasm is a release of such accumulated Yang energy and, under normal circumstances, it is a beneficial discharge of Yang-Qi which promotes the free flow of Qi. 

When sexual desire builds up, the Minister Fire is stirred: this affects the Mind and, in the terms of organs, specifically the Heat and Pericardium.  The Heart is connected to the Uterus via the Uterus Vessel (Bao Mai) and the orgasmic contractions of the uterus discharge the accumulated Yang energy of the Minister Fire.

When sexual desire is present but does not have an outlet in sexual activity and orgasm, the Minister Fire can accumulate and give rise both to Blood Heat and to stagnation of Qi in the Lower Burner.  This accumulated Heat will stir the Minister Fire further and harass the Mind, while the stagnation of Qi in the Lower Burner can give rise to gynaecological problems such as dysmenorrhoea.

Of course, if sexual desire is absent, then lack of sexual activity will not be a cause of disease.  Conversely, if one abstains from sexual activity but the sexual desire is strong, this will also stir up the Minister Fire but without release.  Thus, the crucial factor is the mental attitude.

With regard to sexual frustration, Qing dynasty’s Chen Jia Yuan wrote very perceptively about some women’s emotional longing and loneliness.  Among the emotional causes of disease he distinguishes “worry and pensiveness” from “depression”. 

He basically considers depression, with its ensuing stagnation, due to emotional and sexual frustration and loneliness.  He says: “In women...such as widows, Buddhist nuns, servant girls and concubines, sexual desire agitates [the mind] inside but cannot satisfy the Heart.  The body is restricted on the outside and cannot expand with the mind [i.e. the mind longs for sexual satisfaction but the body is denied it].  This causes stagnation of Qi in the Triple Burner and the chest; after a long time there are strange symptoms such as a feeling of heat and cold as if it were malaria but it is not.  This is depression”.

Although the above thoughts derive from Dr Chen’s clinical experience with servant girls, Buddhist nuns and concubines and should therefore be seen in the social context of the Qing dynasty, they also have relevance to our times as he is essentially talking about sexual frustration and loneliness and his reference to widows confirms this (in old China widows were shunned and seldom remarried).  He perceptively refers to sexual craving agitating the Heart and Mind but not finding a satisfaction in the body: besides sexual frustration, he is also referring to emotional frustration and craving for love.

A constant theme of all this was also SEPARATION: the emotions resulting from separation (sadness and grief) are often at the root of Qi stagnation, not of the Liver, but of the Heart and Lungs and some times development of breast lumps and breast cancer.  It is important to realize that stagnation of Qi comes not only from the Liver but also from Lungs and Heart, especially Lungs.  In fact, even emotions that cause depletion of Qi such as sadness and grief, may cause stagnation of Qi (of the Lungs) because, when Qi is depleted in the chest, it does not circulate well and therefore stagnates. 

In the particular case of breast lumps, the stagnation of Qi of the Lungs and Heart is particularly relevant because these two organs and channels are situated in the chest.  Zhu Dan Xi says: “When a woman is worried and depressed, accumulation develops, Spleen-Qi becomes weak, Liver-Qi rebels horizontally, stagnant Qi turns into nodules like turtle eggs, there is no pain or itching.  After 10 years ulcers develop and the disease is called Ru Yan [breast cancer]”. 

This statement clearly points out the emotional influence on the development of the disease and also its long term development.  It is important to remember that stagnation of Qi in women is very often secondary and the consequence of a deficiency of the Liver and Kidneys affecting the Ren and Chong Mai. 

The “Orthodox Manual of External Diseases” (Wei Ke Zheng Zong) written by Chen Shi Gong in 1617, says: “Depression injures the Liver, pensiveness affects the Spleen, accumulation develops in the Heart, the channel-Qi stagnates and generates [breast] nodules”.

The modern doctor Xia Shao Nong thinks that breast cancer is due to widowhood, breaking of relationships, divorce, death of one’s children, bereavement at a young age from the loss of one’s spouse.  These events, especially if occurring suddenly, upset the mind and lead to Qi stagnation.  It is interesting that all the events this doctor cites have to do with separation.

The Uterus Vessel (Bao Mai) connects the Uterus to the Heart: since the Heart is always affected by emotional problems (because it houses the Shen), this connection explains the profound influence of emotional stress on the menstrual function.  For example, the “Su Wen” in chapter 33 says: “When menstruation does not come, this is due to the Uterus Vessel being blocked.  The Uterus Vessel pertains to the Heart and connects with the Uterus; when Qi rebels upwards towards the Lungs, Heart-Qi cannot flow downwards and the periods do not come”.  “Qi rebelling upwards towards the Lungs” describes in particular the effect of worry, sadness or grief.

Emotional problems are all the more detrimental in women if they occur around the time of puberty.  At this time, a girl’s health is particularly vulnerable and emotional problems will affect her body and mind deeply and with long-lasting effect.  In particular, emotional stress at this time will deeply affect the Ren and Chong Mai creating the imbalances that will cause gynaecological problems later in life.

Emotional stress influences menstruation by affecting the movement of Blood by Qi.  In fact, the first effect of emotional stress is to impair or alter the circulation of Qi by depleting Qi, making Qi stagnant or making Qi rebellious.  Each of these pathologies will affect Blood which follows Qi and becomes deficient, stagnant or rebellious. 

The “Golden Mirror of Medicine” says: “Women are frequently affected by worry, pensiveness, anger or depression: these make the Blood move, stop, rebel or conform, which is all due to Qi movement”.

Qing dynasty’s Chen Jia Yuan wrote with regard to worry: “Worry injures the Lungs and pensiveness injures the Spleen, when these two organs are injured Qi and Blood stagnate, there is a feeling of indignation, palpitations, a feeling of oppression of the chest and amenorrhoea”. This passage confirms that stagnation of Qi affects not only the Liver but also that amenorrhoea may occur from stagnation as well as from a deficiency.

Thus, considering the social position of women in ancient China and the frequency of the above-mentioned emotional and sexual frustrations, it is no wonder that Qi stagnation (not always of the Liver) occupies such a central place in women’s pathology, and we can also conclude that emotional stagnation in women was often the result of sexual frustration, separation and loneliness: these are the recurrent “anger” in Chinese medicine books. 

This is essentially the clinical meaning and application of Xiao Yao San.  As sexual frustration in women is fairly common in our society (often deriving from men’s sexual inadequacy or inexperience), Dr Chen’s observations on the influence of sexual frustration on stagnation of Qi and depression acquire particular relevance.  This is often a cause of disease somewhat akin to emotional stress.

However, Xiao Yao San may work less well in modern women who have weaker Kidneys than in the past: there is no point in “moving Qi” is there is no Qi to move.  This is, in my opinion, the reason why Xiao Yao San does not work so well in modern women unless it is modified with the addition of some Kidney tonics.

                                       CONCLUSION

What have we got to learn from Daoist sex? One thing that stands out is how the Daoist sex manuals never mention “love”.  Sex seems to be an exercise in moving Qi, releasing the Minister Fire and exchanging Yin and Yang essences with the partner. Both the Daoists and the Confucianists removed love for different reasons and never mention love (although the old poems do).  The modern Chinese have even removed the “heart” from the “love” ideogram! 

Modern character for "love" (ai)




Old character for "love"




Heart (xin)





However, there are some useful lessons for us:

1. Differences between men’s and women’s sexuality: many men could learn from that.
2. Importance of women’s orgasm and sexual frustration as cause of Qi stagnation.
3. Importance of men’s expertise in sexual techniques and foreplay.
4. Blow the myth of simultaneous orgasm and the importance of orgasm in men. If the man is         particularly experienced, the woman could have multiple orgasms before his.
5. Western sexuality fixed on orgasm, hence Western men often unskilled: this causes female frustration.  Modern men can learn from Daoist sex to allow for the difference between Water and Fire and therefore women’s slower response.

END NOTES
1. Chen Jia Yuan 1988 Eight Secret Books on Gynaecology (Fu Ke Mi Shu Ba Zhong).  Ancient Chinese Medical Books Publishing House, Beijing, p.152.  Chen’s book, written during the Qing dynasty (1644-1911) was entitled Secret Gynaecological Prescriptions (Fu Ke Mi Fang), and published in 1729.

2. 1979 The Yellow Emperor’s Classic of Internal Medicine - Simple Questions (Huang Di Nei Jing Su Wen), People’s Health Publishing House, Beijing, first published c. 100 BC, p.197.

3. Golden Mirror of Medicine (Yi Zong Jin Jian), p.9.

4. Eight Secret Books on Gynaecology, p.152.