Lady Tan’s Circle of Women (2023) is a work of adult historical fiction written by American author Lisa See. The novel fictionalizes the life of Tan Yunxian, a female physician who lived in imperial China during the Ming dynasty and whose compendium of her cases is the earliest surviving Chinese medical text written by a woman. Yunxian, shaped by the early death of her mother and educated by grandparents who are both medical practitioners, marries into a wealthy family and lives as an obedient wife, mother, and daughter-in-law, but learns through her friendship with young midwife Meiling to defy tradition and pursue her ambition to treat women of all classes and walks of life. In providing health care, Yunxian works against the prevailing cultural belief that values women only for their childbearing and decorative functions, while her friendships prove that a circle of supportive and nurturing women provides the foundation for a fulfilling life.

Following Chinese convention, in both the novel and this guide character names are presented with the family name or surname first and the given name second (i.e., Tan Yunxian, Shi Meiling, Yang Maoren).

This guide uses the hardcover edition published by Scribner in 2023.

Plot Summary

When she is eight years old, Yunxian witnesses the death of her young mother due to inefficient doctoring and is sent to live with her grandparents, both of whom practice medicine. While Grandfather Tan has learned medicine from books, Grandmother Ru employs the knowledge and remedies handed down through her family for generations, and she finds a capable student in Yunxian. As doctors are prohibited from touching blood, Grandmother works with a midwife whose young daughter, Meiling, is Yunxian’s age and becomes her dear friend. Yunxian teaches Meiling how to read and conduct herself like an upper-class lady, while Meiling tells Yunxian stories of the outer world she is not allowed to see, being restricted to the family home.

While Yunxian’s betrothal is arranged to the son of a wealthy merchant family, Yunxian receives instruction from her grandmother in doctoring the ailments specific to women, especially those that involve pregnancy and childbirth. Yunxian learns the conceptual models of balance and harmony, which must be reflected in the body as in the universe, and she also learns how to treat specific ailments. As she learns more about the history of her maid, Poppy, and that of Miss Zhao, the woman who is the mother of Yunxian’s half-brother, Yunxian begins to understand the precarious state of women in a world where their livelihood depends on pleasing men and producing sons to carry on the family name.

One day, one of her grandfather’s concubines falls in the garden and breaks her leg. Yunxian offers to help by setting the bone herself but is instructed to let the bonesetter do this. When she sees Miss Zhao sold and replaced with another woman, and shortly after meets her father’s new wife, Yunxian develops a sharper understanding of the value and place of women within her world. At the same time, she sees a “circle of good” (66) in the women who help protect, guide, and nurture her, including her grandmother, Poppy, Miss Zhao, and Meiling.

When she is 15, Yunxian marries Yang Maoren, the son of a wealthy silk merchant, and comes to live at the Garden of Fragrant Delights. Yunxian is shy but pleased by her husband, but her mother-in-law, Lady Kuo, forbids Yunxian to practice medicine. Lady Kuo insists Yunxian’s only duty is to bear Yang sons, and Doctor Wong will provide medical care for the household.

Yunxian finds seclusion in the inner chambers tedious and lonely. When she tries to treat a young girl who is experiencing digestive disorders, Lady Kuo responds by curtailing Yunxian’s friendship with Meiling, who is beneath her in social status. Yunxian becomes pregnant and gives birth at the same time as Miss Chen, one of Yang’s concubines. Yunxian disappoints the family by delivering a girl, while Miss Chen delivers a son who could become second in line to inherit. Weak and ill after the difficult birth, Yunxian is upset further when she discovers the drowned body of Spinster Aunt, who hinted that she knew some secret about Miss Chen. Yunxian attends the inquest and watches the magistrate draw false conclusions about what led to Spinster Aunt’s death. When Yunxian becomes gravely ill, Lady Kuo allows Grandmother Ru and Meiling to attend her, and with their help and knowledge, Yunxian heals.

Thirteen years later, Yunxian is a busy wife and mother. She is raising three girls to be proper ladies, obedient and graceful, and overseeing the painful process of binding the feet of her youngest, Ailan. She continues to have a wary relationship with Lady Kuo, but despite her mother-in-law’s disapproval, Yunxian visits Meiling in secret and offers medical assistance to whomever she can. When a visiting official brings his wife and mother-in-law to her home, Yunxian shares her medical expertise with them, while they observe Meiling assisting a birth. Shortly after, Meiling is summoned to Beijing to act as midwife to the women of the imperial court, and she in turn sends for Yunxian when a woman of the court has an eye infection. Though she would rather not travel, as she is pregnant again, Yunxian submits to her husband’s desire to elevate the family through service to the emperor and makes the long journey to Beijing with her maid and Miss Zhao. She is worried when her patient turns out to be the empress herself, but the empress is so pleased by Yunxian’s care that she insists Yunxian stay to assist during her birth. Yunxian also tends to Meiling, who is likewise pregnant, and becomes concerned when Meiling develops acute morning sickness.

Meiling goes into labor at the same time as the empress, and while the empress delivers a healthy baby boy, Meiling delivers a stillborn baby girl. The emperor is horrified that this act should have polluted the empress’s chambers and he orders that Meiling be put to death. Both the empress and Yunxian intercede, asking the emperor to consider Meiling’s service, and the sentence is commuted to flogging. Aching for her friend, who is despondent and severely beaten, Yunxian violates the doctor’s taboo on touching blood to nurse Meiling herself. After Yunxian at long last gives birth to a baby boy, she and Meiling return to Wuxi. During their voyage, Meiling confesses that she took a concoction that Doctor Wong had prescribed for Yunxian. When Meiling describes the ingredients, Yunxian is horrified to recognize several herbs meant to induce miscarriage.

On her return home, Yunxian finds her household impacted by smallpox. Yunxian, who had the disease when she was young, surrenders her infant son to the care of her mother-in-law while she nurses the afflicted, which includes her youngest daughter. Ailan recovers, but many die, including Maoren’s new concubine and her infant son. Miss Chen loses several of her children, including Manzi. As she tends him, Yunxian realizes the boy does not look like Master Yang, his purported father. When the smallpox has passed and the threat is over, with the help of Grandmother Ru and Miss Zhao, Yunxian speaks with Meiling and Meiling’s mother, Midwife Shi, who attended Manzi’s birth. She finds enough evidence to write her father, now a high-ranking magistrate, and ask him to come to Wuxi to consider the case she means to bring against Doctor Wong.

Though her husband and in-laws scold her for bringing scandal and shame to the family, Yunxian wants to see justice done. Spinster Aunt’s body is exhumed, and Yunxian’s father determines that the fracture in her skull suggests murder. Meiling testifies that Doctor Wong prescribed Yunxian a remedy full of abortifacients, and Midwife Shi reveals that Miss Chen identified Doctor Wong as Manzi’s father at his birth—which Spinster Aunt witnessed, and for which reason Doctor Wong killed her. Yunxian’s father presses Doctor Wong to confess to a plot to prevent Yunxian from bearing a son who could supplant Manzi as a potential heir.

Shortly after the inquest, Yunxian is called to the deathbed of Grandmother Ru, who has a breast tumor. Grandmother bequeaths her pharmacy and all her medical records to Yunxian. After her death, Yunxian is so worn down by her many challenges that she again falls gravely ill. In a delirious dream, she imagines Grandmother visiting her: She tells her exactly where to look in her notes to find a remedy, and reminds Yunxian not to give into the imbalance of emotions causing her illness. Once again Meiling nurses Yunxian back to health. When she is strong, Yunxian confronts Lady Kuo, who admits that while she encouraged Doctor Wong to father a son with Miss Chen, she did not think he would become so avaricious as to harm others in the family. Lady Kuo at last consents to allow Yunxian to practice medicine openly, and she begins by asking Yunxian to treat her chronic cough. Yunxian, who has long known what ails Lady Kuo, extracts an enormous tapeworm, and this at last reconciles the two women.

In the last and fourth phase of her life, Yunxian finds she is doing anything but sitting quietly. Her husband has become head of the Yang family and Yunxian runs an extensive household, overseeing servants, food stores, women and children, and the family’s medical needs. Breaking with tradition, Yunxian allows the wives and children to attend the annual Dragon Boat Festival, where she is happy to see her friends and family thriving: Her daughter-in-law has given birth to a son, Meiling also has a son of her own, and her brother, Yifeng, is doing well. Meiling persuades Yunxian to publish a compilation of her medical records as a way to encourage the proper medical treatment of women, no matter their status or age. Happy with her ongoing medical practice as well as her growing family, Yunxian reflects that Meiling has been the steadfast companion of her life and is glad they are growing old together.