doctor would have to ask to view more of the patient. these social and cultural beliefs were often barriers to learning more about female health, with women themselves often being the most formidable barrier. women were often uncomfortable talking about their illnesses, especially in front of the male chaperones that attended medical examinations. women would choose to omit certain symptoms as a means of upholding their chastity and honor. one such example is the case in which a teenage girl was unable to be diagnosed because she failed to mention her symptom of vaginal discharge. silence was their way of maintaining control in these situations, but it often came at the expense of their health and the advancement of female health and medicine. this silence and control were most obviously seen when the health problem was related to the core of ming fuke, or the sexual body. it was often in these diagnostic settings that women would choose silence. in addition, there would be a conflict between patient and doctor on the probability of her diagnosis. for example, a woman who thought herself to be past the point of child-bearing age, might not believe a doctor who diagnoses her as pregnant. this only resulted in more conflict. yin yang and gender yin and yang were critical to the understanding of women's bodies, but understood only in conjunction with male bodies. yin and yang ruled the body, the body being a microcosm of the universe and the earth. in addition, gender in the body was understood as homologous, the two genders operating in synchronization. gender was presumed to influence the movement of energy and a well-trained physician would be expected to read the pulse and be able to identify two dozen or more energy flows. yin and yang concepts were applied to the feminine and masculine aspects of all bodies, implying that the differences between men and women begin at the level of this energy flow. according to bequeathed writings of master chu the male's yang pulse movement follows an ascending path in "compliance so that the cycle of circulation in the body and the vital gate are felt...the female's yin pulse movement follows a defending path against the direction of cosmic influences, so that the nadir and the gate of life are felt at the inch position of the left hand". in sum, classical medicine marked yin and yang as high and low on bodies which in turn would be labeled normal or abnormal and gendered either male or female. bodily functions could be categorized through systems, not organs. in many drawings and diagrams, the twelve channels and their visceral systems were organized by yin and yang, an organization that was identical in female and male bodies. female and male bodies were no different on the plane of yin and yang. their gendered differences were not acknowledged in diagrams of the human body. medical texts such as the yuzuan yizong jinjian were filled with illustrations of male bodies or androgynous bodies that did not display gendered characteristics. as in other cultures, fertility and menstruation dominate female health concerns. since male and female bodies were governed by the same forces, traditional chinese medicine did not recognize the womb as the place of reproduction. the abdominal cavity presented pathologies that were similar in both men and women, which included tumors, growths, hernias, and swellings of the genitals. the "master system," as charlotte furth calls it, is the kidney visceral system, which governed reproductive functions. therefore, it was not the anatomical structures that allowed for pregnancy, but the difference in processes that allowed for the condition of pregnancy to occur. pregnancy traditional chinese medicine's dealings with pregnancy are documented from at least the seventeenth century. according to charlotte furth, "a pregnancy (in the seventeenth century) as a known bodily experience emerged out of the liminality of menstrual irregularity, as uneasy digestion, and a sense of fullness". these symptoms were common among other illness as well, so the diagnosis of pregnancy often came late in the term. the canon of the pulse, which described the use of pulse in diagnosis, stated that pregnancy was "a condition marked by symptoms of the disorder in one whose pulse is normal" or "where the pulse and symptoms do not agree". women were often silent about suspected pregnancy, which led to many men not knowing that their wife or daughter was pregnant until complications arrived. complications through the misdiagnosis and the woman's reluctance to speak often led to medically induced abortions. cheng, furth wrote, "was unapologetic about endangering a fetus when pregnancy risked a mother's well being". the method of abortion was the ingestion of certain herbs and foods. disappointment at the loss of the fetus often led to family discord. postpartum if the baby and mother survived the term of the pregnancy, childbirth was then the next step. the tools provided for birth were: towels to catch the blood, a container for the placenta, a pregnancy sash to support the belly, and an infant swaddling wrap. with these tools, the baby was born, cleaned, and swaddled; however, the mother was then immediately the focus of the doctor to replenish her qi. in his writings, cheng places a large amount of emphasis on the four diagnostic methods to deal with postpartum issues and instructs all physicians to "not neglect any ". the process of birthing was thought to deplete a woman's blood level and qi so the most common treatments for postpartum were food (commonly garlic and ginseng), medicine, and rest. this process was followed up by a month check-in with the physician, a practice known as zuo yuezi. infertility infertility, not very well understood, posed serious social and cultural repercussions. the seventh-century scholar sun simiao is often quoted: "those who have prescriptions for women's distinctiveness take their differences of pregnancy, childbirth and bursting injuries as their basis." even in contemporary fu ke placing emphasis on reproductive functions, rather than the entire health of the woman, suggests that the main function of fu ke is to produce children. once again, the kidney visceral system governs the "source qi", which governs the reproductive systems in both sexes. this source qi was thought to "be slowly depleted through sexual activity, menstruation and childbirth." it was also understood that the depletion of source qi could result from the movement of an external pathology that moved through the outer visceral systems before causing more permanent damage to the home of source qi, the kidney system. in addition, the view that only very serious ailments ended in the damage of this system means that those who had trouble with their reproductive systems or fertility were seriously ill. according to traditional chinese medical texts, infertility can be summarized into different syndrome types. these were spleen and kidney depletion (yang depletion), liver and kidney depletion (yin depletion), blood depletion, phlegm damp, liver oppression, and damp heat. this is important because, while most other issues were complex in chinese medical physiology, women's fertility issues were simple. most syndrome types revolved around menstruation, or lack thereof. the patient was entrusted with recording not only the frequency, but also the "volume, color, consistency, and odor of menstrual flow." this placed responsibility of symptom recording on the patient, and was compounded by the earlier discussed issue of female chastity and honor. this meant that diagnosing female infertility was difficult, because the only symptoms that were recorded and monitored by the physician were the pulse and color of the tongue. concept of disease in general, disease is perceived as a disharmony (or imbalance) in the functions or interactions of yin, yang, qi, xuĕ, zàng-fǔ, meridians etc. and/or of the interaction between the human body and the environment. therapy is based on which "pattern of disharmony" can be identified. thus, "pattern discrimination" is the most important step in tcm diagnosis. it is also known to be the most difficult aspect of practicing tcm. to determine which pattern is at hand, practitioners will examine things like the color and shape of the tongue, the relative strength of pulse-points, the smell of the breath, the quality of breathing or the sound of the voice. for example, depending on tongue and pulse conditions, a tcm practitioner might diagnose bleeding from the mouth and nose as: "liver fire rushes upwards and scorches the lung, injuring the blood vessels and giving rise to reckless pouring of blood from the mouth and nose." he might then go on to prescribe treatments designed to clear heat or supplement the lung. disease entities in tcm, a disease has two aspects: "bìng" and "zhèng". the former is often translated as "disease entity", "disease category", "illness", or simply "diagnosis". the latter, and more important one, is usually translated as "pattern" (or sometimes also as "syndrome"). for example, the disease entity of a common cold might present with a pattern of wind-cold in one person, and with the pattern of wind-heat in another. from a scientific point of view, most of the disease entities (病; bìng) listed by tcm constitute symptoms. examples include headache, cough, abdominal pain, constipation etc. since therapy will not be chosen according to the disease entity but according to the pattern, two people with the same disease entity but different patterns will receive different therapy. vice versa, people with similar patterns might receive similar therapy even if their disease entities are different. this is called yì bìng tóng zhì, tóng bìng yì zhì (异病同治，同病异治; 'different diseases, same treatment; same disease, different treatments'). patterns in tcm, "pattern" (证; zhèng) refers to a "pattern of disharmony" or "functional disturbance" within the functional entities of which the tcm model of the body is composed. there are disharmony patterns of qi, xuě, the body fluids, the zàng-fǔ, and the meridians. they are ultimately defined by their symptoms and signs (i.e., for example, pulse and tongue findings). in clinical practice, the identified pattern usually involves a combination of affected entities (compare with typical examples of patterns). the concrete pattern identified should account for all the symptoms a person has. six excesses the six excesses (六淫; liù yín, sometimes also translated as "pathogenic factors", or "six pernicious influences"; with the alternative term of 六邪; liù xié, – "six evils" or "six devils") are allegorical terms used to describe disharmony patterns displaying certain typical symptoms. these symptoms resemble the effects of six climatic factors. in the allegory, these symptoms can occur because one or more of those climatic factors (called 六气; liù qì, "the six qi") were able to invade the body surface and to proceed to the interior. this is sometimes used to draw causal relationships (i.e., prior exposure to wind/cold/etc. is identified as the cause of a disease), while other authors explicitly deny a direct cause-effect relationship between weather conditions and disease, pointing out that the six excesses are primarily descriptions of a certain combination of symptoms translated into a pattern of disharmony. it is undisputed, though, that the six excesses can manifest inside the body without an external cause. in this case, they might be denoted "internal", e.g., "internal wind" or "internal fire (or heat)". the six excesses and their characteristic clinical signs are: wind (风; fēng): rapid onset of symptoms, wandering location of symptoms, itching, nasal congestion, "floating" pulse; tremor, paralysis, convulsion. cold (寒; hán): cold sensations, aversion to cold, relief of symptoms by warmth, watery/clear excreta, severe pain, abdominal pain, contracture/hypertonicity of muscles, (slimy) white tongue fur, "deep"/"hidden" or "string-like" pulse, or slow pulse. fire/heat (火; huǒ): aversion to heat, high fever, thirst, concentrated urine, red face, red tongue, yellow tongue fur, rapid pulse. (fire and heat are basically seen to be the same) dampness (湿; shī): sensation of heaviness, sensation of fullness, symptoms of spleen dysfunction, greasy tongue fur, "slippery" pulse. dryness (燥; zào): dry cough, dry mouth, dry throat, dry lips, nosebleeds, dry skin, dry stools. summerheat (暑; shǔ): either heat or mixed damp-heat symptoms. six-excesses-patterns can consist of only one or a combination of excesses (e.g., wind-cold, wind-damp-heat). they can also transform from one into another. typical examples of patterns for each of the functional entities (qi, xuĕ, zàng-fǔ, meridians etc.), typical disharmony patterns are recognized; for example: qi vacuity and qi stagnation in the case of qi; blood vacuity, blood stasis, and blood heat