My Good Friend Yùexìn

Originally published April 5, 2022.

In honor of this beautiful new moon that heralded the arrival of the “dragon month” a few days ago, this is a bit of a technical post where I consider the challenge of translating the innocuous-looking character 月 in gynecological literature. Basically, my conclusion is that this is a poster child for why, ultimately, it is impossible to translate certain words or phrases from classical Chinese into modern English in certain contexts. Let me show you how I arrived at that sad conclusion:

My student and friend Andrew Loosely and I first ran into a serious problem in translating the compound 月信 yuèxìn in the following line from the famous Sòng dynasty gynecology text Fùrén dàquán liángfāng 《婦人大全良方》 (“Complete Collection of Great Formulas for Women”) by Chén Zìmíng 陳自明 from 1237 CE:

The menstrual/lunar fluids resemble the phases of the moon, and we refer to them as yuèxìn (“menstrual/lunar reliability”).

月水如期，謂之月信。

At first sight, the character 月, pronounced yuè, is one of the easiest characters around. It’s simply a depiction of the moon crescent and in its most literal meaning refers, as expected, to the moon. It comes as no surprise either that, by extension, it also means “month,” or “lunar” when used as an adjective. And again by a further extension that is beautifully similar to the etymology of Western terms like the English “menstruation,” in modern and traditional Chinese gynecological literature it refers to all things “menstrual,” as evidenced by any number of compounds: From the standard Chinese 月經 yuèjīng, which we can translate as “menstruation” or, a bit more literal, as “menstrual/monthly period/constancy,” to 月事 yuèshì (literally “menstrual/monthly affair”), 月水 yuèshuǐ (“menstrual/monthly fluids”), to the pathology 月閉 yuèbi (“menstrual block”), to the therapy of 月調 yuètiáo, which I like to translate as “attuning the menses” but which is commonly referred to in English as “menstrual regulation.”

But what exactly does the character 月 express in these compounds? What is the specific relationship between the moon, the month, and menstruation, and how are we to translate this character in gynecological compounds? While the choice in contemporary TCM literature is obviously “menstrual,” is that also true for the classical literature or did the authors conceive of it in more literal terms as either “lunar” or “monthly”?

We have terms that unequivocally express this close connection between women’s menstrual cycles and the moon’s waxing and waning dating back more than two thousand years: Thus we find the compound 月朔 yuèshuò (literally “lunar conjunction/rise/first day of the new moon”) as a reference to menstruation in the Mǎwángduī medical manuscripts from the second century BCE. Here it is clearly used in the Tāichǎnshū 《胎產書》(“Book on Pregnancy and Childbirth”) to explain the mechanism of conception by recommending intercourse three days after the end of the menstrual flow. According to Donald Harper (Early Chinese Medical Manuscripts, p. 378), this compound in fact associates the onset of menstruation not only with the lunar cycle but more specifically with the spring tide that occurs on the new moon. This connection between the monthly flow of blood in a healthy non-pregnant woman’s body and the monthly fluctuations of the ocean tides is reflected also in the later compound 月潮 yuècháo “monthly tide,” which is another term used in gynecological literature to refer to menstruation.

This brings us now to the term that is the topic of the present post: 月信 yuèxìn, a combination of 月 with the character 信 xìn, which is yet another traditional Chinese compound used to refer to menstruation. The character 信, composed of the characters for “person” 人 and “to speak” 言 and explained in the second century CE character dictionary Shuōwén jiězì 《說文解字》 as 誠 “sincerity,” has a wide range of meanings in both classical and modern Chinese. In the classical literature, it can already mean anything from “reliability,” “integrity,” “truth,” and “trustworthiness” to “faith” and even “pledge” or “evidence” in the sense of true and reliable information. And I have to admit that none of these English words, in my opinion, manage to do justice to the power of the Chinese 信. In modern Chinese, it can also mean “letter” or “news.” And I believe that this modern meaning is the basis for a common English translation, advocated by Nigel Wiseman, for example, of the gynecological compound 月信 as “monthly news,” when used to refer to menstruation.

While I am a great admirer of Wiseman’s terminology, when it comes to historical gynecological literature, which is admittedly my favorite cup of tea, I sometimes have to disagree with his choices. But I never do so lightly and unnecessarily. In this particular case, however, I believe it is essential that we honor and reflect in translations the traditional Chinese association of the female bleeding cycle not just with the length of a month but very literally with the cycle of the moon, and specifically with the absolute certainty of this cycle.

This connection, encapsulated so beautifully in this compound 月信 if we only read it correctly, is a very important message in the context of gynecological diagnosis and treatment. I propose that the early gynecological literature suggests a far stronger message in this compound than just “monthly news,” namely the fact that women’s cyclical bleeding is as reliable, natural, self-evident, and important, in a healthy body, as the certainty with which the moon waxes and wanes, disappears and reappears on a monthly basis. Most importantly, the message to take away for practitioners and to convey to your patients is the gravity of a situation in which this menstrual cycle fails to appear naturally, and the urgency with which this pathology must be addressed by practitioners of Chinese medicine. Can you see how this “reliability” or “faithfulness” of the moon carries a very different tone and message than “monthly news” and fundamentally changes how we read a line like the one I started this post with?

This message is spelled out even more specifically in another passage by the same author, Chén Zìmíng, albeit in a version quoted in a Qīng dynasty text:

The Classic states that the tiānguǐ arrives in women in their fourteenth year. Tiān “heaven” refers to the genuine Qì of heaven, while guǐ refers to rénguǐ water, rén being Yáng Water and guǐ being Yīn Water. Women are in the category of Yīn. The Chōngmài is the Sea of Blood and the Rènmài is in charge of the womb and fetus. When these two vessels flow freely all the way through, the blood in the channels gradually fills up and then descends in resonance with the proper timing. Because it is the descent of the genuine Qì of Heaven, it is called tiānguǐ. Under normal circumstances it appears once in every three ten-day cycles and thereby mirrors the waxing and then waning of the moon. Because it does not lose this lunar periodicity, therefore we call it yuèxìn.

經云：女子二七天癸至。天謂天真之氣，癸謂壬癸之水。壬為陽水，癸為陰水。女子陰類，衝為血海，任主胞胎，二脈流通，經血漸盈，應時而下，天真氣降，故曰天癸。常以三旬一見，以像月盈則虧，不失其期，故名曰月信。

I hope you have enjoyed this short excursion into my world of classical gynecology. It is just so rich and potent and alive with the potential to make a real and positive difference in the way women in our modern Western culture experience their menstrual cycles, in my humble opinion. As practitioners of Chinese medicine, you have the power not only to treat the symptoms that women suffer from as the result of menstrual disorders that biomedicine does not even recognize as pathological. Going much deeper and further, we are called on to fundamentally alter the way in which our friends, patients, family, and colleagues think about the female body and its reproductive cycles. Each of us may just be a drop of water in the ocean of popular and biomedical discourse on “The Curse,” but bit by bit, one conversation at a time, we can take the “s” out of that awful term and think of it more like the sweet casual Chinese term 我的好朋友 “my good friend.”