藥醫不死病，佛度有緣人：明、清的醫療市場、醫學知識與醫病關係

“Medicine Cures Only Benign Illnesses; The Buddha Saves Only Those with the Right Karma”: The Medical Market, Medical Knowledge and Patient-Physician Relationships in the Ming-Qing Period

本文從「藥醫不死病，佛度有緣人」一語，分析明、清的醫療情境，探索時人如何詮釋醫病關係與疾患的意義。本文認為「藥醫不死病，佛度有緣人」所指涉的心態源於醫療市場缺乏管制，醫生素質不齊，醫療理論、文本與治方之多樣性。在此情境下，擇醫仰賴口碑與推薦、市場上充斥過多的選擇與訊息，使病家既輕信又難以專信醫家；而醫家則抱怨無法掌握醫療過程，雙方遂將緊張的醫病關係投射於宗教的宇宙觀上。機緣與果報遂成為醫病理解疾患意義的中介，成為自由醫療市場中那隻看不見的手，讓醫病雙方訴說著醫療失敗時的委屈與不滿，並在這宗教宇宙觀的基礎上，自行備藥、避免藥害、省心行善或解罪求福。

This paper investigates the mentality represented by the proverb ”medicine cures only benign illnesses; the Buddha saves only those with the right karma” (藥醫不死病, 佛度有緣人) in the Ming-Qing period. Depending on context, the meaning of this proverb fluctuated from ”medication is useless for incurable diseases” to ”whether or not one is cured largely depends on the fateful encounter between the patient and the right physician.” The proverb nonetheless expressed patients' anxieties over healing and mistrust of medicine and physicians. I argue that this proverb was embedded in the laissez faire medical market of the Ming-Qing period during which there was not even a minimum guarantee of the quality of a given physician. Although medical information circulated freely and physicians were abundant, patients at that time were troubled by the problem of how to find useful information and competent physicians. Patients chose a physician based on word of mouth, and often employed several physicians at the same time, but also changed them quickly. It seems that patients were easily convinced of the skill of a given physician while at the same time mistrusting physicians generally, since they were not sure how to assess physicians' skills. In response, patients developed strategies to reduce risks. They tried to learn medicine and prepared medications themselves, appealed to religious healing, and argued for moral cultivation to nourish both the physical body and spiritual life and to guard against illness. To cope with their patients' state of mind, physicians resorted to the art of persuasion in addition to medical skills. Physicians also complained that the behavior of the patient might actually increase risks since they exerted no control over the healing process. The proverb ”medicine cures only benign illnesses; the Buddha saves only those with the right karma” thus encapsulated the tense patient-physician relationship and projected it to a religious cosmology where the frustrations of medical encounters were expressed in Buddhist terms of chance and fate.