The Clinical Utility of the Concept of Jing in Chinese Reproductive Medicine

Gametes

A primary theme in the literature is that of jing being used as a direct analogue with the biomedical concept of the gametes. For example, Lyttleton—arguably the most influential Western authority on the CM treatment of infertility and a self-professed exponent of Chinese and Western medicine ‘fusion’—boldly states that ‘what the doctors in China 2000 years ago were referring to when they described the Kidney Jing is what modern Western medical science refers to as the gametes or eggs and sperm themselves.’³⁸ In such a reading of jing, a pattern of jing deficiency corresponds to a pathological lack of eggs or sperm—premature ovarian failure or azoospermia, for example—for which a viable clinical strategy is to ‘strongly reinforce the Kidney Jing to try and influence the nature of the eggs themselves’.³⁹ Whilst appealing in its simplicity and pragmatism, the idea of the narrow correspondence between jing and the gametes is not universal. For example, a modern paper discussing Chinese herbal medicine (CHM) and egg quality does not refer to jing at all.⁴⁰ Clearly, it is not a clinically indispensable concept, even when egg quality and quantity are the primary focus.

Menstrual blood

Prior to the twentieth century, practitioners of CM did not know about eggs or sperm, but rather the female analogue to male jing (semen) was menstrual blood. Traditional doctors were aware that when a woman became pregnant, menstruation ceased, and thus deduced—erroneously as we now know—that conception was the result of the coalescing of the male semen and female blood. Unschuld quotes the sixteenth-century author Zhang Huang, ‘Man has life because he . . . has received from his father and mother semen and blood. When [the latter two] contact each other, they unite and congeal to become a fetus in the womb.’⁴¹ The Qing-dynasty gynaecological expert Fu Qingzhu further explains that ‘Menstruation is not blood but heavenly water or the tian gui. Originating in the kidneys, it is the essence of consummate yin . . . it is red like blood, but it is, in fact, not blood. . . . People nowadays regard the menstrual flow as blood, but this is an incorrect assumption’.⁴² Such a belief is frequently encapsulated in the pithy phrase ‘Menstruation comes from the Kidney’,⁴³ although modern readings take this to mean that the Kidney governs the hormonal functions of the hypothalamic-pituitary-ovarian axis.⁴⁴ Because jing was traditionally viewed as extremely precious, menstruation was viewed as severely depleting,⁴⁵ such that Daoist nuns would practise specific qigong exercises in order to stop menstruation and thus preserve their jing.⁴⁶ Regulation of the menstrual cycle was thus of primary importance in traditional women’s medicine and seen to have effects far beyond merely reproductive function.⁴⁷ Congruent with this, published cases of infertility tend to show pregnancy occurring as soon as the menstrual cycle has been sufficiently regulated.⁴⁸ However, the view of menstrual blood as a precious manifestation of jing conflicts with other widely-held Chinese folk beliefs that menstrual blood is a superfluous and unclean pollutant,⁴⁹ suggesting that competing scripts have been active through Chinese history.

DNA and heredity

Modern authors frequently make a direct correspondence between jing and DNA. For example, in cases of male infertility due to chromosomal abnormality, Lyttleton identifies the causative factor as ‘Kidney Jing weakness’.⁵⁰ Such a correspondence is perhaps unsurprising, given that the typical characteristics of jing—‘derived from the parents . . . provides for a person’s constitutional make-up . . . a fixed substance that cannot be added to or replenished.’⁵¹—could be just as accurately applied to DNA. Such correspondence is frequently made without acknowledging any semantic or cultural complications: thus for Magidoff ‘mutated DNA’ is ‘changes in the jing’.⁵² Damone, on the other hand, exhibits more paradigmatic sensitivity by describing reproductive essence as ‘genetic-like’.⁵³ Whilst a general thread runs through the literature acknowledging the difficulty of altering the genetic make-up of gametes with CM, a recent study suggests that this may in fact be possible with CHM.⁵⁴ Horne argues that the possible mechanism of this may involve influencing epigenetic components that dictate how genes are expressed throughout the reproductive system.⁵⁵

Developmental stages

The locus classicus of jing and reproductive theory is undoubtedly the first chapter of the Huang Di Nei Jing Su Wen, in which the seven- and eight-year cycles of females and males are described (see Appendix 2). The ‘Tian gui’ (also translated as ‘Kidney water’, or the more opaque ‘Heavenly Tenth’ by Wiseman and Feng⁵⁶) referred to in this chapter is widely understood to refer to jing ‘in its role in creating the menstruate’,⁵⁷ and is frequently glossed without the semantically difficult ‘tian gui’ (‘essence is responsible for the onset of puberty, fertility and the menopause’).⁵⁸ Thus tian gui describes an essentially temporal process that, where pathological, can be treated via the jing, ‘If periods never begin (primary amenorrhoea) . . . the TCM doctor will treat the Kidney Jing.’⁵⁹ It is noteworthy that in CM the arrival of tian gui is seen to be a virtually identical process in males and females (with minor differences in timing⁶⁰), whereas in biomedicine, puberty and the ending of reproductive capacity are governed by fundamentally different physiology. Thus oogenesis begins in females before they are born and continues until ‘the pool of remaining ovarian follicles becomes exhausted’ in their forties, whilst spermatogenesis starts in males at puberty and ‘healthy men . . . can retain reproductive capacity into their eighties or nineties’.⁶¹ Such differences call into question the direct commensurability of jing with such biomedical analogues.

Matter and spirit

Unlike most CM concepts that tend to be processual in focus,⁶² jing easily becomes glossed as a static material form. This probably originates from the the Su Wen statement, ‘Essence is the root of the human body.’⁶³ A modern Chinese textbook subtly distorts this into the more decisively earthbound, ‘essence is the material base of the human body’⁶⁴. For Sivin, jing is a ‘fundamental substance’, for Porkert, it is ‘the concrete basis of . . . individual existence’, Damone describes it as a ‘raw material’ and for Kaptchuk, it is a ‘texture’.⁶⁵ Thus jing is frequently portrayed as a kind of anabolically-potent source material from which semen, blood, bone marrow, brain, and spinal cord originate, and as such represents the earthly base of a continuum of increasingly subtle physiology that culminates in shen. Such a model matches agreeably for modern sensibilities with scientific distinctions of solid, liquid, and gas (represented by jing, qi, and shen).

However, the conceptual borders of jing are not always so distinct. Although associated with the physical body, Larre and Rochat de la Vallée suggest that ‘Essences have no form and no shape. They are the condition of any shape, they are able to make any and every form’.⁶⁶ Damone presents the beguiling theory in this regard that jing represents the stem cells from which all other physical substance and cells are derived.⁶⁷ There are clearly dynamic potentials within jing; as Larre and Rochat de la Vallée state, ‘Essences are . . . the elements or components of life, and life is inside these components’.⁶⁸ Horne makes a cogent point of comparison in relation to gametes, which are not inert lumps of cytoplasm (i.e., yin without yang), but are filled with thousands of times more mitochondria than typical human cells⁶⁹—tiny energy factories which have been found to respond to CHM.⁷⁰ In CM it is of course impossible to have yin physical substance independent of yang: ‘Qi can generate essence, and essence can generate Qi.’⁷¹ Porkert’s ‘structive potential’ is illuminating in this regard—where ‘structive’ is a complement to the ‘active’ principle represented by qi and shen, and implies the capacity ‘to render concrete, to substantiate, a given effect without regard to its quality’.⁷² Such a reading harks back to chapter eight of the Ling Shu that states, ‘The kidney stores essence; essence is the abode of spirit’. This relationship is repeated in chapter 36 of the Nan Jing, where jing is first introduced as the dyad ‘spirit-essence’ (see Appendix 2). To forget the ‘vertical’ interpenetration of jing with shen—which modern reductive readings of the term seem to—can have repercussions with regard to fertility treatment, ‘A change on the shen level also involves a change on the jing level . . . in this sense shen facilitates fertility on the physical level.’⁷³ To this end, modern clinicians of CM frequently emphasise psychoemotional support in their treatment programmes for poor ovarian reserve.⁷⁴

Quantity and decline

The theme of jing being material in nature is closely associated with it being presented as being restricted in quantity and undergoing continuous decline—something like a candle burning inexorably down. Indeed, Dharmanda documents the traditional Chinese fears around declining jing recorded in a Ming Dynasty novel that tells the story of a man who dies from sexual indulgence, whose doctor’s concluding comment is ‘The candle flickers once the oil is used up’.⁷⁵ Thus Flaws states: ‘We are each endowed with a certain quantity and quality of this . . . at the moment of conception and this cannot be augmented or modified.’⁷⁶ It is a ‘finite bundle’⁷⁷ that is either plentiful or scant—such that Lyttleton is able to divide its pathological lack into severe, moderate; and mild, each with specific symptoms.⁷⁸ The view that jing (as eggs) ‘gets used up with the hundreds of menstrual cycles a woman experiences’⁷⁹ is mirrored by biomedicine’s precise numerical formulations: ‘at birth, approximately 200,000 to 2,000,000 primary oocytes remain in each ovary . . . and around 400 will mature and ovulate during a women’s reproductive lifetime’.⁸⁰ Such temporal diminution of the gametes is also the case for men, ‘sperm production decreases 50–70% between ages 60 and 80’.⁸¹ The Chinese notion that men lose jing through ejaculation is associated with a long tradition extolling the benefits of sexual abstinence,⁸² so that Chinese doctors frequently advise sexual abstinence in cases of infertility.⁸³ Originally it was thought that just excessive sexual activity depleted the jing, but the Qing dynasty doctor Wu Tang (1758–1836) expanded this so that ‘all human activity can agitate and disturb the essence’.⁸⁴ However, although such linear temporal decline tallies nicely with the biomedical view of the gametes, it is at odds with the theory that jing is continually augmented by postnatal jing (and thus jing operates metaphorically more like a rechargeable battery than a candle).

Whilst primarily quantitative in nature, discourse on the decline of jing sometimes involves qualitative entropy that is often likened to the damage suffered by DNA in Western theories of reproductive ageing.⁸⁵ Thus Lyttleton reports that ‘less than ideal Jing may be inherited if the parents are older than 40’.⁸⁶ Lyttleton criticises Western artificial reproductive technology (ART) for pursuing quantity at the expense of quality, ‘Kidney Jing, that hard-to-measure quality of inheritance, is being ignored’. Indeed, ART seems to produce male offspring who themselves have compromised reproductive health.⁸⁷ Such understandings have a historical basis in traditional CM—as Wu documents, traditional doctors would blame anomalies, such as hermaphrodite offspring, on the jing.⁸⁸

The clinical utility of the concept of jing ultimately rests on whether clinicians are able to intervene if it is found to be deficient. One of the difficulties in assessing this is that authors tend to present only successful case studies. Liang, for example, documents a 48-year-old perimenopausal woman who, after CM treatment, managed to produce 18 eggs during an IVF cycle and successfully conceive.⁸⁹ Lewis⁹⁰ and Horne⁹¹ also describe cases where women in their late forties were able to conceive with help from CM. For many authors, jing deficiency is an entirely relevant clinical distinction and ‘tonify jing’ a viable treatment strategy.⁹² For example, Jin gives ‘Excessive consumption of Kidney Essence’ as a pattern differentiation for oligospermia, and provides his own formula—‘Jin’s decoction for replenishing essence and sperma liquefaction to nourish the Kidney and replenish Kidney essence’.⁹³ Lyttleton acknowledges that treatment of jing deficiency requires long-term treatment (over months and years), and asserts her experience of doctors in China providing successful treatment in cases of jing deficiency.⁹⁴ Indeed, numerous clinicians explicitly assert that CM is able to improve egg quality in cases where biomedicine is unable to help.⁹⁵

Lewis, a high-profile CM reproductive specialist, is at pains to reject typical Western ideas of reproductive ageing and presents her perspective on ‘the truth about our eggs’, in which ‘the ocean of our fertility doesn’t dry up; it just becomes still. And with help it can flow once more.’⁹⁶ She tends to side step the idea that the body ‘runs out’ of something (jing/eggs), and instead posits the decline in fertility due to age as being due to ‘hormonal balance and blood flow’.⁹⁷ It may be that such a view has a historical basis in traditional CM—as Farquhar suggests, ‘the discrete transplantable objects of Western medicine . . . are seen as mere products of powerful processes that govern the life of the body.’⁹⁸ Lewis also disputes the effects of ageing on egg quality: ‘contrary to what Western medicine would lead us to believe, a woman’s eggs do not have an “expiration date”’.⁹⁹ Anecdotal evidence seems to confirm that CHM may indeed be able to restore reproductive capacity, even in relatively severe cases of premature ovarian failure.¹⁰⁰ Horne boldly supports such a notion (‘We can reverse signs of aging until a woman enters the menopause’), and provides treatment protocols that involve ‘slowing or reversing oocyte aging’.¹⁰¹ Such protocols might be seen to be supported by China’s long historical tradition of practices designed to prevent or replace the loss of jing, especially from within the Daoist tradition.¹⁰²

Other authors are more careful to avoid the emotionally charged issue of ‘turning back the clock’ with regard to reproductive capacity. Elliott, for instance, disputes that CM treatment can prevent the affects of ageing on egg quality.¹⁰³ West, a high-profile infertility specialist in the UK, asserts her awareness ‘that a woman is born with all the eggs she is ever going to have’ but maintains that ‘you can improve the environment that the existing eggs are growing in’ by using acupuncture to ‘help improve blood flow to the ovaries, as this reduces significantly with age’.¹⁰⁴ Heese initially asserts that CM cannot turn back time and affect egg quality, but is later apparently unable to resist an about-face: ‘Whilst it cannot turn back time and improve egg quality in an older woman, it may . . . indirectly influence its maturity and quality.’¹⁰⁵ Most authors seem to side-step the contradiction inherent in CM theory—that the gradual depletion of jing is a natural part of ageing but as soon as it becomes a barrier to conceiving it is made pathological. Liang, however, acknowledges this, stating that ‘Although this [decline] is a natural stage of a woman’s development, for the purposes of achieving pregnancy, it is considered a pathology here’.¹⁰⁶

Yin and fluids

Jing is widely associated with yin and fluids: ‘Qi belongs to Yang whereas blood and essence belong to Yin’.¹⁰⁷ Hammer clinically tangible evidence supporting this theory: ‘Kidney essence is often associated more with Kidney yin than with Kidney yang; partially because on the pulse, deficiency of Kidney yin and Kidney essence have similar qualities (tight and wiry).’¹⁰⁸ Lin and Flaws suggest a broader classification, in which ‘yin jing’ includes jing, blood, and jin ye—all of the fluid aspects of the body.¹⁰⁹ Elsewhere, however, Flaws equates jing directly with Kidney yin: ‘Kidney yin is the jing essence and the substantial aspect of the kidney.’¹¹⁰ Other authors, however, point out that jing can be seen to be ‘before’ yin and yang—and thus the origin of both.¹¹¹ For some authors, female sexual secretions are manifestions of jing,¹¹² whilst Lyttleton disputes this based on the narrow equation of jing with gametes: ‘Since these secretions do not contain gametes, they do not have such a direct connection to the Jing. Rather, they reflect Kidney Yin reserves.’¹¹³ Historically, some doctors have taken the idea of jing being a fluid-like material substance to its logical conclusion, leading to various historical arguments regarding the topography of literal ‘pathways of essence’ connecting the brain, Kidneys, and reproductive organs.¹¹⁴ As a sidenote, the herbs that tonify jing in the material medica tend to be warm, sweet, and salty yang tonics, rather than the moist, cool, and sweet medicinals that one might expect to support yin and fluids.¹¹⁵

Reproductive strength and constitution

In CM terms strong jing implies a dyad of robust constitution combined with a high reproductive capacity at both macro and micro levels, so that Lyttleton states that ‘Plentiful Jing increases fertility . . . women who are successful in having babies in their 40s . . . often live longer than average’¹¹⁶ and ‘sperm that lack the wherewithal to carry out penetration and fertilisation of egg cells [reflect] quite serious Kidney Jing deficiency.’ Wu details that such reproductive strength was traditionally viewed as being intrinsic in the jing itself, such that where male jing dominated it would produce a boy and vice versa.¹¹⁷ However, the linear equation ‘more jing=greater reproductive potential’ might be seen to be challenged by modern studies in which increased frequency of ejaculation actually improves sperm quality and quantity.¹¹⁸

Sex and morality

Because jing is inseparable from reproduction—and therefore sex—traditional Chinese discourse around it unsurprisingly reveals moral scripts. The origins of such sensitivities might be traced back to the Su Wen, where Qi Bo explains that, ‘The people of today . . . through their lust they exhaust their essence, through their wastefulness they dissipate their true [qi].’¹¹⁹ In a commentary by Wang Bing, he elucidates: ‘To make frivolous use [of one’s essence] is called “wastefulness.” . . . it is because the sages cherished [their] essence and carefully considered its use that their bones were full of marrow and strong.’¹²⁰ Thus jing is used as moral currency to make a point about physically weakening effects of licentiousness sex. Such scripts continue to the present day—for Xingzhe ‘Sex is worse than tigers or wolves’ and ‘anything that excites desire, especially sexual desire, disturbs jing . . . unbridled craving for things is ultimately weakening for the whole society; less essence, less spirit, less will.’¹²¹ Both quotations reveal a discourse in which jing is the link between frivolous sex and a weakening of the very foundations of the individual body and society. In the case of women, Furth has clearly documented how the depleting effects of female gestational functions were associated with a discourse that emphasised women’s fundamental weakness in comparison to men.¹²² Further gendered questions might be asked about how the label for the male seed became synonymous with the generative aspect of life in a patriarchal society.¹²³

Depth and density

Discourse around jing frequently emphasises qualities of depth and density: ‘there is a kind of earthly aspect, a density. . . . Essences are very dense because they are full of life;¹²⁴ ‘it is the life spring sourced in our deepest origins . . . [if] the deficiency is deep, treatment needs to be strong, persistent, and lengthy’.¹²⁵ This is epitomised in the nature of semen, ‘sperm. . . . In the form of a liquid it is nothing other than a very rich and dense possibility of making life’.¹²⁶ Treatment of jing is usually through herbs (rather than acupuncture), in particular herbs that—according to the Nei Jing—have ‘affinity for flesh and blood’—e.g., animal products. Given that in western countries, such as the UK, animal products are banned, one might question whether it is possible to tonify jing effectively with the remaining available CHMs. Damone quotes Ye Tianshi (1667–1746) in this regard: ‘Essence and blood have form. [Therefore do not] use grasses and wood—substances, which lack feeling. . . . Their qi does not correspond to [essence and blood]’.¹²⁷ Unsurprisingly, given its multiple identities, a variety of words express the effects of herbs on jing. Thus Shan Yao and Tu Si Zi ‘secure’ jing, Don Chong Xia Cao and Ba Ji Tian ‘augment’ jing, Shu Di Huang and Lu Rong ‘generate’ jing, Zhi He Shou Wu ‘preserves’ jing, E Jiao ‘replenishes Kidney’ jing, Rou Cong Rong ‘enriches’ jing and Bu Gu Zhi ‘stabilises’ jing.¹²⁸ Because Kidney jing is nourished by post-heaven jing, clinicians working in the area of low egg reserve tend to make diet and nutrition a high priority,¹²⁹ frequently employing substances from modern naturopathic nutrition such as wheatgrass, royal jelly, Co-Enzyme Q-10,¹³⁰ algae, and seaweed.¹³¹ Arguably the quintessential substance to tonify jing is Zi He Che (Hominis Placenta), which according to the Commentary on the Divine Husbandman’s Classic of Materia Medica, ‘tonifies dual deficiency of yin and yang, with the ability to restore the root and return the primal [qi]’.¹³² Assessing the constituents of this substance from a biomedical perspective is revealing, and reads like a primitive combination ART medicine—complete with gonadotropins, estradiol, progesterone, and prolactin—to powerfully activate the endocrine glands.

Historicising jing

Modern Western clinical texts frequently present CM as an ahistorical system that was defined millennia ago and has endured without change.¹³³ Recent scholarship, however, suggests that CM is ‘deeply historical’,¹³⁴ and documents the complexities of its relationship with modern biomedicine.¹³⁵ Modern Chinese reproductive specialists are—by definition—practitioners of ‘integrated Chinese-Western medicine’,¹³⁶ and as such represent the fruit of the Communist agenda of integration and ‘scientisation’.¹³⁷ Liang, for example, epitomises the typical mindset of the modern CM gynaecologist when she states that, ‘The Chinese medical concept of the kidneys correspond directly to the endocrine and reproductive systems’¹³⁸ (and congruent with such a view Liang supplements the Kidneys in virtually all of her case studies of ageing women). Li similarly elevates the Kidney to a physiological position in andrology: ‘Only the kidney is the crucial organ for male infertility . . . insufficient essence is the fundamental causative factor of male infertility’.¹³⁹ Modern Western ‘specialists’ in the field of Chinese reproductive medicine, of course, learnt their trade since biomedicine arrived so forcefully in China, and unsurprisingly therefore tend to stick close to the modern ‘party line’ of integration, such that CM concepts and theory remain congruent with biomedicine.¹⁴⁰

At some point during the twentieth century, CM had to grapple with the reality of eggs and sperm (first discovered by the seventeenth-century European biologist Leeuwenhoek)¹⁴¹—and the derision from some quarters that it did not know about them.¹⁴² Farquhar has documented the pressure exerted on CM during the late twentieth century to come up with similar tangible entities to those recently discovered by biomedicine (e.g., bacteria, viruses, gametes, etc.).¹⁴³ Fortunately, representatives of CM were able to save face by pointing out the correspondence of the gametes with jing, simultaneously proving that CM was way ahead of its time. As a happy coincidence, polarising the focus of conception around jing (and thus the Kidneys) meant that the potentially humiliating theory that semen unites with female blood at conception could be allowed to fade into obscurity.

It is of course not an entirely modern occurrence to gloss jing as a physical object (whether ‘the body’ or ‘gametes’)—this has a historical basis in its alternative identity as semen. Whilst it is impossible to verify how the pre-Han originators of CM conceived of jing, one might imagine that despite their primary focus on process, resonance, and relationship,¹⁴⁴ they still had to somehow classify the physical ‘stuff ’ of the human body—physicality that visibly suffered inexorable temporal decline, with an associated deterioration in reproductive capacity. It may be that jing fitted as a descriptor of the ‘body’ in this regard.

For modern clinicians, who tend to tread a path somewhere between CM and biomedicine, considering jing as ‘the refined part of all the qi in the universe [and] all the useful entities within the human body’ eludes clinical utility.¹⁴⁵ Practitioners are required to make clinical decisions, and jing is therefore required to take on the identity of a physical substance that can be present or deficient in discrete amounts and thereby influenced through treatment. Such narrow readings, however, exhibit the common tendency to edit out the contradictions and anomalies that do not fit one’s own agenda when assembling a coherent version of another culture’s medicine.¹⁴⁶ Thus for modern clinicians the scope of jing identified in the themes above—that includes aspects of form, function, and process—becomes restricted in the interests of clinical expediency.

Historians and philosophers, on the other hand, tend to allow jing a broader scope of meaning, asserting that to conceive of it as a fixed physical entity is anathaema to CM, as jing is by definition in a process of continuous movement and transformation.¹⁴⁷ For a medicine that assumes ‘transformation as the inalterable condition of being . . .’ Farquhar argues, ‘. . . essences that are permanent . . . are not issues for discourse’.¹⁴⁸ Just as clinicians require jing to assume an identity with which they can work, it is the job of the scholars to allow the manifold meanings of jing to shine. Historians and philosophers, of course, invariably read classical Chinese, and thus may be able to embrace multiple semantic subtleties, whilst modern clinicians may have to settle for the meaning appropriate to the matter at hand—in the case of reproductive medicine, the gametes (although it should be noted that modern Chinese practitioners seem to share equally narrow readings of the term). However, Wu argues against the tendency of scholars to disproportionably privilege CM medical scripts of function (‘vital flows and transformation’) over form (‘the physical bodily space’), identifying both as forming a vital tension in the discourse of traditional doctors of CM.¹⁴⁹

That the term jing defies straightforward linguistic capture in English should come as no surprise. Translation of CM is highly problematic¹⁵⁰ as there is invariably no one-to-one correspondence between English and Chinese words¹⁵¹ and Chinese meaning tends to operate contextually.¹⁵² Add to this the semiotic consideration that the concept of jing is suspended in dense cultural ‘webs of significance’,¹⁵³ one is left with the essential ‘untranslatability’ of jing.¹⁵⁴

Meaning in CM tends to be inherently flexible. Hsu has pointed out that classical CM education teaches ‘different meanings in particular contexts’ and points out ‘the basic rule for reading classical Chinese texts—that what was valid in one context was not in another’.¹⁵⁵ Unlike biomedicine, such polysemy is not viewed as problematic in CM: ‘The senior doctor Zhang made no attempt whatsoever to try to reconcile these different meanings’.¹⁵⁶ The Western translators of CM seem to continue such a tradition. Lyttleton, for instance, initially glosses jing as gametes, but without any overt acknowledgement or signposting jing comes to represent ‘the potential for gamete development’ (rather than the gamete itself), ‘the function of the ovaries and some aspects of pituitary function’, and one of ‘the “nutrients” required for an egg to develop’.¹⁵⁷ The term thus moves from form to function and object to process, demonstrating significant semantic fluidity.

For some, such flexibility captures the overlapping holistic nature of reality and exposes the falsehood in the tendency of science to present reality in terms of immutable objects and fixed meanings. For others, however, it exposes CM as an example of what Karl Popper defined as pseudo-science.¹⁵⁸ In this view, the principles of CM, like Marxism or Freudian psychoanalytic theory, can be made to explain any clinical data whatsoever and are thus unfalsifiable—and therefore unscientific. Such semantic fluidity in the hands of CM authors is frequently extrapolated cross-paradigm, allowing them to be inappropriately (from the scientific perspective) creative with biomedical ‘facts’ (see below).

The concept of jing thus eludes straightforward definition in English, and its scope goes beyond a label for any particular physical structure—as Bromley et al., point out, ‘Jing is both adjective and noun, vital and vitality, essence and essential’.¹⁵⁹ Hsu creatively bridges such linguistic shortcomings by coining the composite term ‘substance-force’ to describe jing.¹⁶⁰ The concept of jing thus includes aspects of form/substance and function/process. Just like the seed of a plant, jing is at once a spatial object as well as being the potential of other future forms. Whilst not ‘alive’ in the same way as the grown plant, a seed remains dormant, awaiting activation by the right conditions. Similarly, jing is rooted in the physical, but its primary raison d’etre is of future generation and enfoldment.

Jing and clinical practice

What are clinicians to do with such confusion? One might follow the example of Professor Li Yueqing, a modern CM andrologist, who so fully embraces the clinical relevance of semen analysis that for him ‘neither the patient’s self-sensation . . . nor his tongue show us any reliable signs . . . the microscopic examinations are the only way to make differentiation’.¹⁶¹ Or one may agree with Farquhar and resist such modern distortion of CM theory: ‘Chinese medical thinking is not naturally murky, it just gets that way when one attempts to fill its intellectual objects (patterns of pathological function) with anatomical content’.¹⁶² Professor Li’s bold statement points to a very modern problem—that ever since Chinese doctors were able to look through a lens at sperm (or indeed at eggs or ovaries), it became clear that not all patients with infertility show explicit signs of the ‘Kidney deficiency with insufficient essence’ that for Professor Li constitute the ‘fundamental causative factor of male infertility’.¹⁶³ However they think about them, modern CM practitioners working in reproductive medicine face a barrage of biomedical test results proffered by increasingly well-informed patients who expect their practitioner not only to understand them, but also to intervene successfully in order to influence them. Such tests have become the standard method to assess the effects of CM treatment modern reproductive research.¹⁶⁴ As a practitioner, one might welcome the advantages provided by such clinical information, and respond by improvising an ‘integrated’ diagnosis and treatment.¹⁶⁵ Indeed, one perspective on what has happened to CM since the arrival of biomedicine in China is that, rather than distortion, such integrative improvisation represents innovation.¹⁶⁶ Now that CM finds itself in the post-genomic era, practitioners of CM are frequently required to respond to new discoveries. Horne, for example, presents innovative theories regarding epigenetics, even suggesting—contentiously—that a woman’s body may even be able to produce fresh eggs.¹⁶⁷

There are, however, dangers associated with attaching CM so closely to biomedicine, as recently persuasively documented by Scheid in the case of menopause.¹⁶⁸ To downgrade empirical clinical knowledge built over centuries in favour of the tangible presence of ‘jing’ as seen through a microscope risks losing potentially effective—albeit at times theoretically precarious—clinical strategies that had developed prior to the paradigm shift. For instance, the shift in women’s reproductive medicine from focusing primarily on the blood (as jing) to focusing more on the eggs (as jing) entails changing the primary clinical strategy from nourishing blood to nourishing jing. Such theoretical complications are not unique in CM; in some ways this mirrors the long-running debate in Chinese medicine about the respective roles of the Heart and brain in terms of housing the shen (spirit), where new theories simply began to coexist with—rather than replace—the old theories.¹⁶⁹ Such ‘grafting’ of the new on to the old is typical of the development of CM.¹⁷⁰

Double standards

The discourse of modern practitioners of CM is apparently very different to their biomedical peers, who at times brutally pronounce¹⁷¹ on a woman’s reproductive capacity based on clinical tests, despite these tests having a modest-to-poor predictive capacity.¹⁷² Lewis states that biomedicine ‘can do little to help’ in cases of premature ovarian failure, whilst for the CM practitioner the condition is ‘rewarding’, backing up this assertion with the polemic force of a patient diagnosed as ‘irreversibly infertile’ by her Western medicine doctor who was helped to conceive with CM.¹⁷³ Lewis markets her services to a client group that biomedical consultants would view as irremediably infertile and beyond even the help of ART, so that women ‘whose FSH values are well over 100 . . . [and] . . . whose AMH values were zero conceive naturally’.¹⁷⁴ To such patients a diagnosis of jing deficiency is potentially less terrifying than ‘ovarian failure’ for both patient and practitioner, especially given the existence of herbs and acupuncture points that—theoretically at least—increase jing. Lewis rejects the biomedical view of the reproductive system as an ‘ever-deteriorating disease process waiting for intervention’ and instead views it through the ‘different lens’ of Chinese medicine, in which the body-mind-spirit is imbued with ‘miraculous’ abilities and the overall context is given as, ‘There’s no such thing as infertility’.¹⁷⁵ Despite reframing pathology through a ‘different lens’, however, Lewis’ descriptions of the reproductive system remain cast in biomedical terms: ‘FSH is the flame. The uterus is the oven. LH is the opening of the flue. The ovaries are the wood.’¹⁷⁶ This displays the tendency of practitioners of CM to cherry-pick from biomedical theory when it suits their purposes—thus the title of Lewis’ book, The Infertility Cure,¹⁷⁷ is couched in biomedical terms, and her discourse about infertility is replete with biomedical explanations of the pathomechanisms involved, thus conferring biomedical authority on her work. Despite her frequent rejections of biomedical discourse, however, her CM is informed by the same questionable biomedical scripts identified in recent scholarship by Scheid:¹⁷⁸ ‘menopausal symptoms can be alleviated when the Kidney system is tonified or stimulated, thus augmenting the Essence.’¹⁷⁹