明代醫籍中的女性診療問題

A Study on Medical Related Problems of the Medical Diagnoses and Treatment Practices of Female Patients Based on the Recorded Medical Case Studies of the Ming Dynasty

蔡政純(Chen-Chun Tsai) ； 釋慧開(Venerable Huei Kai)

《生死學研究》 3期 (2006/01) Pp. 165-207

https://doi.org/10.29844/JLDS.200601.0005

摘要

本論文的目的，在於挖掘明代醫療史中，因為性別差異所衍生的診療問題，俾能提供對明代社會在醫療實踐上的相關認識。透過明代醫籍中，醫者的自述、醫案中醫者與病人、醫者與病人家屬交談的內容，了解女性患者接受醫療時，遭遇四診合參的困境。明代社會醫療環境，首先，由於空間的限制，女性醫者活動於排除男性醫者的閨閫、產房之內；而在父權社會嚴厲撻閥之下，女性醫者被賦予負面的形象；但是，女性醫者的先天條件與實務經驗，可以提供醫者增長學習的事實卻是不容忽視的。第二，女性患者接受問診時，須透過家屬至親的傳達，大多數患者在問診過程中無法直接發聲，女性患者不具有自主權；女性也因身體與行為的個人隱私而諱疾忌醫，以致拖延而回天乏術。第三，醫者對女性生理及心理的認知，有先入為主的成見，多認為易怒、鬱悶、情緒脆弱及情緒不穩，醫案中對女性患者的敘述並非全然客觀友善的。第四，從真實病案和醫療記載的呈現，也透露出女性在接受診療時，未必全然履行士大夫階級所強化的嚴防男女的概念，少數外科醫案包括乳癌、乳癰的治療以及陰道內診等病案，其所表達的意義，頗值得注意。女性診療固然因為男女大防的強化而形成障礙，然而庶民階層為個人生命尋求生存機會，掙脫社會價值觀規訓的過程，也為醫學理論建構帶來發展的動力。

關鍵字

明代醫籍 ； 女性患者 ； 女醫 ； 病人的聲音 ； 診療 ； 醫案

並列摘要

The main purpose of this study is to provide the enhanced understanding in learning about the medical practices in social environment during the Ming Dynasty by researching and studying the reported case studies in medical historic books due to the gender difference and its derivative causes. Through the existing medical cases recorded in books of the Ming Dynasty, this paper examines the autobiography written by medical doctors and the conversations between the medical doctors and patients or between the doctor and patients' family members in order to further understand the embarrassment and difficult challenges due to the recorded four-constraint limitations and the relatively restricted exposure of the female patients. The characteristics of the medical treatment practices, in their social environment under once prevailing medical practices of the Ming Dynasty, are researched and studied in the following outlined summary: First of all, limited by the constraints of the social environment, female physicians were only exclusively practicing in the residence accommodating females and birth rooms; female physicians were also facing the negative images imposed by the male-dominant society; and nevertheless it cannot be neglected that their pre-existing conditions and practicing experiences had still provided other in-service physicians with abundant educationable knowledge. Secondly, the medical consultation and communication had to be performed through a female patient's family or close relative. Most patients could not make a request or ask a question directly; they were passively recognized as patients without voices; female patients were feeling embarrassed in requesting a medical service due to their concern over the confidential privacy which could delay their chances to cure their diseases and could eventually cause their unavoidable death. Third, physicians had their bias opinions over females on the basis of their knowledge of the female physiology and psychology. They assumed that females were easily to get agonized, depressed, emotionally weak and unstable. Most descriptions regarding female patients, according to the medical case studies, were neither objective nor friendly. Fourth, according to the recorded case studies and the registered medical treatment history, not all the socialized restrictions between males and females were followed up closely when the females were undertaking the medical treatments. It deserves our attention that a few surgical-related cases, including the treatment of breast cancer, mastitis and vaginal examination, exposed many helpful medical contexts and their meanings. Although female medical diagnoses and treatment practices put the barrier between the working physicians and patients due to the strengthening forms from the socialized gender restrictions between males and females, however, the infrastructure of the medical research development was greatly revived and improved by the striking life-seeking survival from the ordinary individuals and the revolutionized process in breaking up the socially- restricted practicing rules and judgments.

並列關鍵字

medical reference books of the Ming Dynasty ； female patients ； female physician ； voice of patient ； medical treatment ； medical case studies