| 摘要: | 本論文主要探討明代醫學蓬勃發展，明代醫生在險惡多變的環境下，要求自己鎮定、冷靜、思考、研究，獻身疾疫現場所持有的行醫信念，包括他們自身內在德行素養、外在專業行為的要求；對「醫道」一連串思考、反省、辨證的過程；對當時社會醫療環境所形成的困境與衝突，表達他們的關懷、批判與折衷思維等；以及明代醫生的行醫精神放在現代社會脈絡當中所可以提供的參考意義。 本論文依據洪武元年到崇禎十七年（1368~1644）間，表達醫生個體行動價值觀的醫籍序跋與醫論；在當時深具代表性，世界醫學史上第一個民間醫學團體──一體堂宅仁醫會，要求成員的道德信念、學術素養與自律規範的《一體堂宅仁醫會會錄》；及明代醫家李時珍、徐春甫、楊繼洲、龔廷賢、李梴、繆希雍、王肯堂、陳實功、張景岳及李中梓、蕭京等人論述行醫精神內涵等三項史料為主要研究材料，輔以當時文人筆記與地方志等文獻，作歸納、比較、綜合、分析與解釋的歷史探索。 本論文以史料中集體人物的出身背景，和比較瘟疫發生率與醫學典籍中醫德論述的多寡差異，作為明代醫生行醫精神論述的序曲。進而擴及人物思想和當時社會生活世界的關聯，由個人思維擴及整體醫療行業及社會的時空脈絡，做四個層次的探討： 第一部分，以行醫者為中心的探討。明代醫生認為醫生行醫必須懷抱「仁心」，「平等施予」病患，「諦察深思」診療開方，了解「病人之情」做完整的治療，讀儒書充實人文素養，並樂於與他人分享、學習等內在素養；熟讀基本醫典，廣讀古今方書；藉「講習討論」進修學習；以「格物致知」的態度追求真理；於醫道「深刻意會」靈活權變；及認識自身侷限等條件，作為學習與整合醫學理論的專業要求。 第二部分，以行醫者及其行醫專業場域為中心的探討。透過醫生論述「醫」是「大道之學」的過程，醫生釐清自己對醫道的主觀性認知；經由對醫道概念的詮釋經過，醫生由建構醫道的觀點轉而建構醫生行使社會責任，賦予自身使命感為主的觀點，清楚明瞭醫生在其歷史與社會脈絡中集體意向的中心思維與主觀意義。醫生提出對其專業領域裡同行之間專業素養的不同見解，對同行中的良莠區別做出評價，推崇明良有信之士，指責庸劣無術者。在論述「良相」和「良醫」的功能與意義時，明代醫生認為成為良醫是自我實現生命價值取向的途徑，救治病人的志業，即是兼善天下的博愛行為。 第三部分，以行醫者及其關聯的社會脈絡為中心的探討，明代醫生認為「醫通仙道，半積陰功」，對醫生而言，行醫既是工作，也是修行道德的德業；對罹患疾病又難以痊癒的病人而言，疾病是患者道德瑕疵與上天的懲罰，所以奉勸病人服用「修德行善」的陰騭方。同時透過醫療理論撰述與傳達的過程，將心身疾病導入以生理歸因為主的醫療理論論述，逐步剔除醫學典籍中的咒禁之術，對癲狂、鬼祟病施以相應的心理療法，以駁斥迷信與鬼神信仰，避免延擱病人接受醫療救治的時機。 面對明代社會由上至下的社會問題時，明代醫生對荒淫腐敗的社會，直接提出糾舉，指正方士煉丹求長生之藥的謬誤，呼籲「節欲」養生，唾棄以「房中補益之術」為號召的「淫醫」；指出「割股療親」以人肉療疾是偏激不當的說法；堅守行醫者的生活規律，明哲保身，避免奢華過度造成行醫者貪圖財力的不當行為；對貧賤者用心診治；認為禮教傳統影響醫生對婦女進行望、聞、問、切的診療，實際問診則挑戰婦女閨閫禁忌話題，而封閉社會下婦女多受壓抑、婦女生理特點及胎前產後重重問題等，既挑戰醫生的行醫能力也影響婦女的醫療診治，反對婦女生產與巫覡牽扯關係；同時明代醫生在疾疫流行，社會動盪時，用生命和鬥志對抗疾病，他們幸者揚名地方，不幸者犧牲生命，留名芳譜。 第四部份，以現代醫生與明代醫生所屬行醫精神關聯性為中心的探討。以現代的觀點切入探討整個明代醫生行醫精神內涵對當代社會醫生行醫的客觀意義，作為現代社會醫療倫理發展的建言。 無論醫療與科技的發展如何快速，疾病的型態如何變化，人類需要具有人道尊嚴的高人性醫療服務的法則，始終是我們社會最大的需求。「德」「術」兼備的行醫者是社會最需要的醫療人才，其高尚情操與精湛醫術所蘊藏的生命力，也決定我們整體後代子孫的繁榮與延續。
This essay aims to delve into the faith of medical practice adhered by doctors in Ming Dynasty, an era when medicine was thriving, as they demanded themselves to keep their composure, calmness, thinking and study to devote to the cure of diseases and plaque under ominous and changeable circumstances, with such faith including their self-demand disposition of morality and conduct and outer professional behavior. A series of thinking, introspective and dialectical course toward “Tao of Medical practice,” expression of concern, criticism and eclectic thought toward the plight and conflict formed under then medical environment, and the referred meaning what can be offered when put the spirit of medical practice by doctors in Ming Dynasty into modern social context are also presented. This essay is based on three historical data, i.e. Prefaces of Medical Literatures and Discussion of Medicine which expressed the value of doctors’ individual action, “Record of Yi Ti Tang Zhai Ren Medical Association” by Yi Ti Tang Zhai Ren Association, the first civic medical group in the world medical history and a representative group then, that demanded its members to be adhered to moral faith, scholar disposition and self-disciplinary norms, and exposition on connotation of spirit to practice medicine by Shih-Zhen Li, Chun-Pu Xu, Ji-Zhou Yang, Yen-Ting Gong, Ting Li, Zi-Yong Miu, Ken-Tang Wang, Shih-Gong Chen, Jing-Yuen Zhang, Zhong-Zi Li, and Jing Xiao, all of which were medical experts, from the first year under the reign of Emperor Hong Wu to the seventeenth year under the rule by Emperor Chong Zhen (1368~1644) as major materials of research, along with supplemental literatures including literatus’ notes and local annals, all of which are available for exploration into induction, comparison, synthesis, analysis and explanation of history. In this essay, it takes the collective figures’ background recorded in historical data, comparison of the prevalence rate of plague, and difference in exposition of medical ethics in medical records and books as preface of exposition on the spirit of medical practice by doctors in Ming Dynasty. It further extends to the association of figure thought with the world of life in then society to conduct four aspects of discussion from an expansion of individual thought to the integral medical trade and social context: In the first aspect, it focuses on a discussion on those who practice medicine. Doctors in Ming Dynasty considered that a doctor shall have a professional demand on his learning and integration of medical theories as he entertains the thought of “kindness” to treat patients with equality, diagnoses and prescribes in attentive observation and deep thought, understands patients’ conditions to conduct complete treatment, and cultivates inner disposition by reading books of Confucianism to intensify his humanistic disposition and being willing to share and learn with others; a doctor shall also be well versed in basic medical canons, read both ancient and modern medical books intensively and extensively, work on advanced study through lectureship and discussion, pursue truth in an attitude of investigating things and extending knowledge to the utmost, perceive medical skill spontaneously to adjust himself to changing situations flexibly, and understand his limited conditions. In the second aspect, it emphasizes on a discussion of those who practice medicine and their professional practice. Doctors clarify their own subjective cognition on medical skill through a course of doctors’ exposition of “medicine” as “ways of the great learning.” Through the interpreting course of concept of medical skill, doctors shifted to exercising the social responsibilities from the original viewpoint to construct medical skill by endowing themselves with a sense of fulfillment and learning clearly the central thought and subjective meaning of collective intention in historical and social context. In their professional field, doctors should bring up their different opinions on professional disposition between the same trades to evaluate the distinction between good and poor points in the same trade, hold those who have eyesight and are trustful in high esteem, and censure those quackeries. When the functions and the meaning of “wise prime ministers” and “good doctors,” doctors of Ming Dynasty thought that becoming a good doctor is one path to fulfill their life value orientation, while devoting themselves to the heath of patients is a fraternal behavior to benefit all people in the world. In the third aspect, the issue of discussion is focused on those who practice medicine and the associative social context. Doctors in Ming Dynasty recognized a concept of “doctors versed in immortal ways are to store up the unpublicized good deeds.” For a doctor, medical practice is a work as well as a moral undertaking to practice moral teachings, while diseases arising out of moral flaws are punishments from Heaven for those patients who can hardly have recovered from illness, thus patients are advised to take the prescription of “practicing moral teachings and doing good deeds.” Through the course of narrating and delivering the medical theories, meanwhile, lead mental and physical disorders into physiological attribution-based medical theory exposition to eliminate skills of spells recorded in medical books step by step by giving mental therapy to insanity and misfortunes brought by evil spirits, thus refuting superstition and belief in spiritual beings and offering patients the best opportune moment to be avoided from a delay of receiving medical treatment. Confronted with the prevailing social problems in Ming Dynasty, doctors in Ming Dynasty brought up impeachment toward the dissolute and corrupted society directly, rectified the fallacy that alchemists make pills of immortality, called for “abstinence” for life cultivation, showed contempt for “licentious doctors” who called for “skills of invigorating therapy in room,” pointed out the inappropriate concept of “cut flesh to cure parent” to use human flesh in medical treatment, called for an adherence to a doctor’s life disciplinary and being wise about personal survival, and called for an avoidance of indulgence in excessive luxury to lead those who practice medicine to inappropriate behavior of coveting fortune, and carried out attentive treatment to the poor and untouchable with heart. They also thought the tradition of ethical education influenced the steps doctors take to diagnose a woman’s disease, i.e. observing the symptoms, listening to the patient’s description of his/her ailment, asking the patient relevant questions, and feeling the patient’s pulse with the exact interrogation to challenge women’s taboo issues, while the majority of women faced numerous issues of being suppressed in the closed society, women’s physiological traits, and pre-pregnancy and postpartum period that challenged doctors’ medical capacity as well as influenced women’s medical diagnosis and treatment and proposed opposition to an involvement of women’s child-birth with sorceries. It is noticeable that when epidemic was raged and the society was in turmoil in Ming Dynasty, meanwhile, those doctors who combated diseases and epidemics with their life and fighting spirit survived to gain their fames or sacrificed their lives would leave behind good reputation. In the fourth respect, this essay will delve into the relevancy of spirit in practicing medicine by modern doctors and doctors in Ming Dynasty. Taking modern viewpoint as center, it aims to discuss the objective meaning of connotation of spirit in practicing medicine by doctors in Ming Dynasty to modern doctors’ spirit in practicing medicine in the hope of serving as advice for developmental direction of modern social health care ethics. No matter how rapidly medicine and technology develop or how disease modes change, the rules of governing high-humanistic medical services with dignity are still the greatest demand of us in this society. Those who practice medicine excel both in morality and skills are medical talents urgently wanted by this society, with the vitality entertained in their noble thoughts and consummate medical skill to determine the prosperity and continuity for our later generations. |
