It is hard to accurately assess how long ago sexual transmission was recognized as a vector of disease in Chinese medicine. Many diseases that are now known to be caused by particular organisms or other vectors of disease were traditionally believed to be caused by the invasion of evil qì contracted from environmental factors. For example, malaria was not known to be caused by mosquitoes; it was classically attributed to contraction of summerheat during the hot season, contact with mountain forest miasma, or contraction of cold-damp. Similarly, many sexually transmitted diseases were long thought to be due to contraction of external environmental evils, possibly related to constitutional weakness or unclean hygiene habits.

In ancient times, many sexually transmitted diseases would be difficult to conclusively link to sexual transmission. For example, gonorrhea and similar diseases that manifest with urinary symptoms were grouped under the traditional category of strangury (lin) disorders. In fact, the modern Chinese name of gonorrhea in Western medicine is lin bing, which reflects term borrowing from the traditional Chinese disease category known as lin zheng. Both sexually transmitted and non-sexually transmitted cases of urinary tract infections were traditionally grouped together, so some cases would be linked to sexual history while others would not be.

Traditional Chinese cultural tendencies towards privacy about sexual life may also be a factor in the lack of extensive literature on sexual transmission in early texts. Furthermore, other sexually transmitted diseases such as human papilloma virus(HPV) and herpes simplex virus (HSV) would be particularly difficult to conclusively link with sex due to their latency, potential transmission from asymptomatic carriers, and recurrences unrelated to sexual intercourse.

In fact, the first strong evidence that sexual transmission was well-known in Chinese medicine is not clearly seen until the Ming dynasty, after the discovery of the New World and the introduction of syphilis into China. It is generally accepted that syphilis reached the Old World via European New World explorers. The historical use of the name “Cantonese Sores” (guangdong chuang) to describe syphilis supports the theory that the spread of syphilis through China followed the trade routes that linked early European traders with Canton province. Following the arrival of syphilis, it is easy to conclusively say that sexual transmission was known in Chinese medicine.

Zh?ng Zhòng-J?ng’s Han dynasty Sh?ng Hán Zá Bìng Lùn (On Cold Damage and Miscellaneous Diseases) is the first text to describe disease transmission by sexual means, but it does not obviously refer to sexually transmitted disease per se. Rather, it documents the observation that one could contract disease of the six excesses without environmental exposure, if one is in close contact with an individual afflicted by disease from the six excesses. In other words, it shows knowledge of the transmission of contagious disease, but not necessarily sexually transmitted diseases.

We can see more clear evidence that the Chinese knew of sexual transmission by 1264 CE, in the Southern Song dynasty text Rén Zh?i Zhí Zh? F?ng Lùn. This text states: “[After] great licentiousness, sores are formed on the penis…women also have sores at the jade gate, which are called genital erosion sores.” Although this text goes on to describe a disease that is more severe than a condition such as genital herpes, it nonetheless suggests knowledge of sexual transmission.

By the Ming dynasty, sexual transmission was indisputably recognized as a causative factor in syphilis (?? méi dú). In 1624 CE, Zh?ng Jiè-b?n (also known as Zh?ng J?ng-yuè) described the pathomechanisms of syphilis in his text, the J?ng Yuè Quán Sh? (J?ng-Yuè’s Complete Compendium). He states: “…most of these pathoconditions are engendered following the transmission of licentious (sexual) toxins. Following the discharge of essence, the qì of this foul licentious toxin follows the essence pathway, exploiting vacuity to penetrate directly into the life-gate before pouring into the controlling (rèn) vessel. It goes to all the places that the controlling (rèn) vessel reaches, the skin and body hair in the outer body, and the bones and marrow in the inner body; there is no place that it does not reach.”

Yin Sores

Y?n sores and/or genital erosion are mentioned in the earliest texts of Chinese medicine, including the Shén Nóng B?n C?o J?ng (The Divine Husbandman’s Herbal Foundation Canon) and the J?n Guì Yào L?e (Essential Prescriptions of the Golden Coffer). The text Zh? Bìng Yuán Hòu Lùn (The Origin and Indicators of Disease), written in 610 CE during the Sui dynasty, further developed discussions on the pathomechanisms of y?n sores. This text indicated that worms were an etiological factor in this disease, and also mentioned that right qì vacuity allowed the disease to develop.

By the time of the Song dynasty text Fù Rén Liáng F?ng (Good Remedies for Women), it was understood that heart vexation and depression, in conjunction with spleen-stomach weakness, was a factor in the development of y?n sores, which were also referred to as “invisible worms.” In the Ming dynasty, the J?ng Yuè Quán Sh? (J?ng-yuè’s Complete Compendium) stated that vaginal sores were mostly caused by damp-heat pouring downward. Additional causative factors indicated by this text include fire formation from the seven affects and heat-toxin strike resulting from overindulgence in medicinal applications.

It is interesting to note that invisible worms were believed to be an etiological factor in this disease as late as the Qing dynasty. In the Qing Imperial classic on gynecology, the Y? Z?ng J?n Jiàn (The Golden Mirror of Orthodox Medicine), we find the following statement: “Sores of the y?n in women (i.e., genital sores) are known as ‘invisible worms.’ This malady is due to depression-fire from the seven affects damaging the liver and spleen, such that qì and blood congeal and stagnate, and damp-heat pours downward. After a long time, worms are engendered. Sores form as the worms feed, then pus drips; at times there is pain and at other times itching, and the patient senses crawling worms.” It is also worth noting that some descriptions of severe, incurable y?n sores that appear in pre-modern literature are likely descriptions of cancerous lesions.

(Originally published by Eric Brand at Pacific Symposium in 2006, a version was also published on the Blue Poppy blog in 2009.)