In Japan, the terms akujo (Fig. 1) and Minikui Josei have been used to refer to ugly women. The term akujo first appeared in a medical text titled “Ishinpo,” the oldest medical book in Japan, dating back to 984 AD and compiled by Yasuyori Tamba. Through analyzing the description of an ugly woman in this work, I believe that we could gain insights into the categories of beauty and ugliness in Japan in the 10th century. In Ishinpo (Volume 28) Chapter 23 (Akujo), the author describes the features of an ugly woman [1]. “A head with disheveled hair, a pockmarked face, a thick neck like a hammer, an Adam’s apple protruding like a man’s, black teeth, a gong voice, a large mouth, a high nose, cloudy eyelids. A woman with long, hair on her chin and around the mouth. Her bone joints are thick and protrude, her hair is yellow and fleshy and thin, and her pubic hair is thick and stiff, and grows densely upside down. Any man who interacts with a woman like this will be harmed.” This book also describes the “beautiful woman” (with its meaning eventually extending to denote a good woman). “If you want to choose a woman, first of all, you should choose a young woman. A woman whose breasts are still firm and fleshy, hair is thin, and eyes are small. A woman with clear sclera and black pupils, smooth skin on her face and body, clear speech and voice. From the neck down, all the joint bones of her limbs are hidden in the flesh. It is best if her hair is thin and not thick. It is desirable that there is no hair on the genitals or axilla, but if present, the hair should be thin and smooth.” “A woman who is good to man is gentle in nature and has a soft Surgeryvoice, thin and dark hair, soft skin, and slender bones. She is neither tall nor short, neither too fat nor too thin, and has neither long nor short legs. She is a woman with no hair on her genitals. She is between 25 and 30 years old, and has never given birth.”

It is notable that the meaning of akujo, which was used for “ugly woman,” extended to “harmful to man.” Similarly, the meaning of “beautiful woman” became generalized to “nice woman” or “fair lady.” If a plastic surgeon could transform an “ugly” woman into a beautiful one through surgical procedures, she could become a “fair lady.”