The spine of the book leaping out at me and its immediate availability were happy moments of serendipity, but my good fortune didn’t end there. I tracked down Lorraine Wilcox—thank you, Internet—and discovered that she lived about fifteen minutes from me! Vaccines were still unavailable, and it was many months before we would meet in person, but Lorraine and I spoke often on Zoom. She recommended online lectures for me to watch, put me in contact with many scholars, and sent me all kinds of material, including a xeroxed copy of the second edition of Miscellaneous Records of a Female Doctor, reprinted by Tan’s great-nephew in 1585. Lorraine gave freely of her time and resources, and I am deeply indebted to her gifts of knowledge and insight.
Tan Yunxian was a remarkable woman by any measure. According to the scholar Charlotte Furth, in a standard catalog of the twelve thousand known Chinese medical works to be found in Chinese libraries, only three were written by women, with Tan Yunxian’s text being the earliest. (Charlotte Furth passed away as I was working on the final edits on the novel. Not only did she bring Tan Yunxian back from the brink of oblivion, but her influence on women scholars focusing on women’s lives in China cannot be overstated. Some would argue the field would not exist if not for her.) Many of the formulas Tan listed in her book are still used today in traditional Chinese medicine and are based on traditions more than two thousand years old. Still, little is known about her life beyond the few pages she wrote in the introduction to her book and from the prefaces and afterwords written by her male relatives. She did record words spoken by Respectful Lady on her deathbed and recounted her grandmother’s ghostly visit, including the prophecy about the length of Tan’s life, which turned out to be wrong.
The greatest keys to her life are found in her cases. She opens each one with a description of her patient, usually a woman or girl described as living in an elite household. Scholars believe that most likely these women, girls, and servants lived in Tan’s husband’s household. Their real-life cases are reflected in the fictional stories in the novel: Yining, the girl who suffers from food damage caused by excessive love (Case 11); Widow Bao’s problems with menopause (Case 24); her daughter’s ailments caused by excessive weeping and which Tan treated from afar (Case 18); the young wife suffering from postpartum Wind itching (Case 15); and Meiling’s problems (Cases 4, 23, 27, and 31). Then there are the cases that involve women who reside in the outside world: the brickmaker (Case 3) and the tiller woman (Case 2). I asked myself how Tan might have met those women. I also thought about what may have happened to Tan after her son and grandson died and why she never recorded additional cases, despite the fact that her remedies were reported to have improved in her later years and were considered by many to be miraculous. Did being a doctor change for her as she aged? Did practicing medicine become a necessity—a way of earning money, of personal survival?
I’d like to acknowledge some of the women scholars who have inspired me and so many others with their work on women’s lives in imperial China: Victoria Cass’s Warriors, Grannies, and Geishas of the Ming and “Female Healers in the Ming and the Lodge of Ritual and Ceremony”; Patricia Buckley Ebrey’s The Inner Quarters; Dorothy Ko’s Teachers of the Inner Chambers, Cinderella’s Sisters, and Every Step a Lotus; Susan Mann’s The Talented Women of the Zhang Family; Wang Ping’s Aching for Beauty; and Yi-li Wu’s “Ghost Fetuses, False Pregnancies, and the Parameters of Medical Uncertainty in Classical Chinese Gynecology” and “Between the Living and the Dead: Trauma Medicine and Forensic Medicine in the Mid-Qing,” as well as her Zoom lecture “Myth-Busting the History of Chinese Medicine: Going Beyond the ‘Function, Not Structure’ Stereotype.” My gratitude extends to Tobie Meyer-Fong, who answered questions by email and gave of her time in a telephone interview on topics that ranged from details about women’s lives to how large family compounds functioned day to day.
With this novel, perhaps more than any other, I got to research clothing, cosmetics, jewelry, and other personal adornments. So much fun! When I wanted inspiration for a particular outfit, I looked at images in Chinese Dress by Valery Garrett, Chinese Clothing by Hua Mei, and Traditional Chinese Clothing by Shaorong Yang, as well as at Ming dynasty paintings. For information about the lives of children during the time that the novel takes place, I turned to A Tender Voyage: Children and Childhood in Late Imperial China by Ping-chen Hsiung and Chinese Views of Childhood edited by Anne Behnke Kinney.
The following journal articles and books helped me to understand different aspects of traditional Chinese medicine, with an emphasis on women: “Dispersing the Foetal Toxin of the Body: Conceptions of Smallpox Aetiology in Premodern China” and “Variolation” by Chia-feng Chang; A Flourishing Yin: Gender in China’s Medical History, 960–1665 by Charlotte Furth; Thinking with Cases edited by Charlotte Furth, Judith T. Zeitlin, and Ping-chen Hsiung; The Web That Has No Weaver by Ted J. Kaptchuk; The Expressiveness of Body and the Divergence of Greek and Chinese Medicine by Shigehisa Kuriyama; “Women Practicing Medicine in Premodern China” by Angela Ki Che Leung, who also served as editor of Medicine for Women in Imperial China; Oriental Materia Medica by Hong-yen Hsu et al.; “Between Passion and Repression: Medical Views of Demon Dreams, Demonic Fetuses, and Female Sexual Madness in Late Imperial China” by Hsiu-fen Chen; “The Leisure Life of Women in the Ming Dynasty” by Zhao Cuili; and “Female Medical Workers in Ancient China” by Jin-sheng Zheng.
Concerns about female reproductive health are probably as old as humankind, and I had many interesting conversations with people listed in these pages on this topic, but perhaps none were more important or more poignant than the ones I had with Marina Bokelman, folklorist, healer, family friend, and second mother to me. In our last conversation before she decided to leave this life, she spoke at length about Hildegard von Bingen, a Catholic nun born in 1098, who became an abbess, composer, writer, and medical practitioner. In her medical texts, Physica and Causae et Curae, she described herbs and provided recipes that would regulate menses, offer contraception, end unwanted pregnancies, and see a woman through pregnancy and birth.
A few comments on medical terms and issues I addressed in the novel: The term child palace dates to the first or second century C.E. and is still used in contemporary Chinese for the uterus. Today we can recognize infant-cord rigidity as tetanus presumed to have been contracted while squatting on straw to give birth or sitting on wet ground during or after labor. (Tetanus is still one of the main causes of death for postpartum women in the third world.) In her book, Tan wrote of her treatment of scrofula lumps and sores in Cases 5, 7, and 16. Today medical professionals would understand these symptoms as mycobacterial cervical lymphadenitis related to tuberculosis. She treated these patients with moxibustion, which was recognized in China as a successful remedy for the condition since ancient times, as well as herbal remedies. Last, I’d like to recommend a fascinating article, “On the Origins of the Midwife” by Sarah Bunney in New Scientist, in which she explains why childbirth is more dangerous for humans than for any other primate.
I was also inspired during the creation of this story by Brian E. McKnight’s translation of The Washing Away of Wrongs by Sung Tz’u (Song Ci in pinyin). This is known to be the first book of forensics in the world and is datable to 1247. It precedes similar works in the European Renaissance by nearly four hundred years. (That said, state-ordered forensic records in China date back to the second century C.E.) The Washing Away of Wrongs continued to be used by forensic scientists in China well into the twentieth century. Maybe that’s not all that remarkable. The indicators of death by drowning, hanging, stabbing, or poison have not changed through time. I have followed Sung Tz’u’s practices for inquests, including revealing a naked body for all to see, the accused standing to face the corpse, examining the spot where a victim drowned, and the concept that the family and the accused must have the opportunity to face each other.