Chinese medicine has always stressed the importance of excessive sexual activity: in this article, I would like to bring to your attention two factors:
- The distinction between men and women in sexual activity
- Insufficient sexual activity as a cause of disease

When discussing sexual activity, Chinese books never distinguish between men and women. There are substantial differences in the sexual physiology of men and women so that excessive sexual activity is less of a cause in disease in women than it is in men. The reason lies in the nature of Tian Gui.

Tian Gui is the generative essence that renders men and women fertile. It is mentioned in the very first chapter of the Su Wen: “When a girl is 14 Tian Gui arrives, the Ren Mai is open, the Chong Mai is flourishing, menstruation starts and she can conceive”. For boys, “When a boy is 16, Kidney-Qi is strong, Tian Gui arrives, sperm is discharged, Yin and Yang are in harmony and he can fertilize.” Thus, Tian Gui is the essence that allows women to conceive and men to fertilize: in women, it is the ova, in men, sperm. Tian Gui is a direct manifestation of Kidney-Jing. In men, loss of sperm therefore implies a loss of Jing and therefore excessive (too frequent) sexual activity may diminish Jing; in women, during sexual activity there is no corresponding loss of Jing as they obviously do not lose ova during sexual activity and therefore there is no corresponding loss of Jing.

While Chinese books always mention excessive sexual activity as a cause of disease, they never mention insufficient sexual activity as a possible cause of disease. This has not always been so as, during past dynasties, all sex manuals explicitly said that sexual activity is essential for the health of both men and women. Indeed, sexual abstinence was viewed with suspicion (as Buddhist nuns were).

Some Chinese doctors considered lack of sex and sexual frustration as a major cause of emotional stress in women. 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 specifically the Heart and Pericardium. The Heart is connected to the Uterus via the Uterus Vessel (Bao Mai) and, in women, 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 become pathological, 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 Shen, 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. Thus, the crucial factor is the mental attitude and sexual desire.

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 body but not finding a satisfaction in the Heart and mind: besides sexual frustration, he is also referring to emotional frustration and craving for love.

Thus, considering the social position of women in ancient China and the frequency of the above-mentioned emotional frustration, it is no wonder that Qi stagnation occupies such a central place in women’s pathology, and emotional stagnation in women was often the result of sexual frustration, separation, loss and loneliness: these are the recurrent "anger" in Chinese medicine books.

Sexual frustration was a common cause of disease especially from the Song dynasty onwards as Confucianists frowned upon sexual activity and believed that it should be carried out in secret and that there should be no public display of affection (as in modern China). The current pruderie of Chinese medicine and society is clearly a result not so much of the Communist influence but of the Qing dynasty's Confucian influence. 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. The Confucianist abhorrence of sexual philandering was determined mainly by the fear that promiscuity might disrupt the sacred family life.

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

Written by Giovanni Maciocia