當病人見到鬼：試論明清醫者對於“邪祟”的態度

本文旨在考察明清醫者對於「邪祟（病）」的理解與態度，希冀呈現中國傳統醫療的特色，並釐清「祝由」在明清醫史中的角色。本文發現：明清受過儒學與醫學經典訓練、兼具閱讀與書寫能力的文人醫者，對於「邪祟」的病因、病機、證候、脈象、診斷與治療容或有異，然其內在思維與外在態度卻頗為一致，亦即，他們多半試圖將「邪祟」的現象「病理化」、「醫療化」。這些醫者一方面強調「邪祟」之能侵犯人，其前提在於患者身心虛衰、欠缺自我防禦能力。另一方面，他們也認為透過尋常的醫療手段，必要時輔以特殊方法，就足以把「邪祟」病症治癒。換言之，方藥與針灸仍是明清醫者應付「邪祟（病）」的主要手段。他們雖認為「祝由」這類古老的禁術有存在的價值，但其主要用途在於幫助病因診斷與安慰病患心理；祝禱雖有助於平復非身心因素所造成的特殊病症，但是單靠祝由是無法治癒重大疾病的。這樣的醫療觀點除了展現傳統中醫「身心一元」的特色，劃分疾病與神異現象的界線，同時也使得醫者表面上有別於倚重儀式醫療的巫、卜、術士等。儘管如此，本文所論及的醫者嚴格說來並非無神論者，完全否認鬼妖精怪的存在。他們亦沒有完全摒棄對於「祝由」的使用。準此，對於某些當代學者將「理性主義」視為明清之前中國傳統醫學的特色，本文認為有再商榷的必要，因為此種觀點並不足以說明當時醫療行為的複雜性與多元性。

關鍵字

邪祟；醫者；祝由；儀式治療；心理治療；明清醫學

並列摘要

This article is an attempt to explore how scholarly doctors perceived and treated ”demonic affliction” in Ming-Qing China. In the recent past certain medical historians claimed that the classic Chinese medicine is a ”rationalized” medical system primarily based on naturalistic explanations of illness and methods of treatment. To me, this viewpoint is only partly true. In fact, shamanistic exorcism and religious healings have never been excluded completely from Chinese medicine throughout the ages. The ritual therapies of zhouyou 祝由 and zhoujin 咒禁 have even become a part of the official medical education since the Tang until the late Ming. It is therefore my interest to examine if the scholarly doctors in the later ages employed any ritual therapy of this kind, particularly in the cases of ”demonic affliction”. To begin with, my article introduces a category of illnesses, namely, xiesui (literally trans. ”evil influences”) as recorded in Ming-Qing medical writings. Some doctors interpreted xiesui in terms of xie as ”excessive evil” of environmental factors. Others viewed xiesui primarily as ”demonic influences”. Some of them indicated the ailments of qi depletion, blood depletion, phlegm and Fire often confused with that of xiesui. Some others suggested that the madness of xiesui should be distinguished from that of dian-, kuang-and xian-illness. Despite these incoherent viewpoints, the scholarly doctors all had an agreeable stance at its etiology, i.e., xiesui as exterior pathogens could only attack to those whose body and spirit is weak andvulnerable. For those who believed in the existence of xiesui as evil spirits, they went further to divide xiesui illnesses into various kinds, ranging from that of deities, spirits, goblins, animal fairies, ghosts, and certain ”worms-transmitted” diseases. The ”polluted” locations where afflictions by xiesui likely occur were also taken into account in some of their writings. As for the therapies, the scholarly doctors proposed methods of pulse diagnoses, prognostication and prescriptions for treating xiesui. The commonly used were drug decoctions, needling/acupuncture, burning incense/moxibustion, etc. Sometimes ointments were applied to the sexual organs of the sufferers in the cases of ”demonic sexual obsession”. Occasionally, the doctors might employ shamanistic-like methods, such as charms, spells and prayers. The ritual therapy of zhuyou was mentioned, yet never playing a key in their treatments, except for the special cases in which zhuyou serves as a sort of psychotherapy. In summary, this article is aimed at revealing the diversity of Ming-Qing scholarly doctors' interpretations and prescriptions of ”demonic afflictions”. In so doing, it only shows their perceptions of boundaries between normality and the pathological, the naturalistic and the supernatural, but to some extent the confrontation between scholarly doctors and religious healers in Ming-Qing China.