丹溪補陰丸——明代的身體、藥方與性別

Reflections on the Yi n-Replenishing Pill: Body, Medicine, and Gender in Ming Society

本文立足於挖掘明代流行的一種成方藥—補陰丸的誕生歷史，以此探討明代醫學流派、身體與性別相關議題。元代醫者丹溪朱震亨結合程朱理學重新闡釋《內經》中的「相火」觀念，提出「陽有餘而陰不足」的身體觀，認為「陰氣」對男女老少重要性等同，此觀點對明代醫學影響極深。配合朱震亨的身體理論，丹溪弟子戴思恭、劉純在著述中先後提到補陰丸，然而直至官至湖廣巡撫的儒醫王綸以後，補陰丸對應的「陰虛」疾病類型才逐漸清晰。經過王綸著作傳播，補陰丸成為明代醫界廣泛採用的成方，尤其男性士人為求子或養生長期服用此方。隨之，明代中後期醫界亦出現抨擊補陰丸的聲音，他們或認為補陰丸過於「寒涼」，或認為補陽比補陰重要，體現與丹溪學派相悖的療法傾向。無論如何補陰，整體而言，在晚明急劇變化的社會中，圍繞補陰丸的醫學爭論折射了當時面對日益激烈的科考競爭，生活於富足商業化城市環境中男性士人的社會焦慮。而且，醫者關於補陰丸的論述絕大多數指向男性，雖然偶爾特別考慮女性的身體，但只是因為她們所擔負的產育天職以及其與男性迥然不同的社會環境。在「陽有餘而陰不足」身體觀籠罩下，女性的身體，無論是陰陽血氣還是生殖器官，在醫學中都不構成有意義的性別差異。

This paper uncovers the history of the yin-replenishing pill, a prescription popular in the fifteenth and sixteenth centuries, to explore changing body perceptions and gender discourses in Ming society. The formula of the pill was predicated upon a view that “yang 陽 is always in excess and yin 陰 is always insufficient” in the body, promoted by the iconic Yuan Confucian physician Zhu Zhenheng 朱震亨 (1281-1358). Zhu imagined that yin and yang were in balance in the body, but that yang could easily disrupt this balance, leading yin to become drained. The yin-replenishing pill was concocted to replenish yin and solve problems caused by overactive yang. The pill was a regular treatment used by Zhu and his disciples, yet was not widely circulated until the promotion of Wang Lun 王綸 (1453-1510) to senior provincial office. To his contemporaries, Wang was both a senior Ming government official as well as a benevolent practicing doctor. Wang recommended the pill as a daily therapy to treat illnesses caused by yin depletion, especially for male literati, who enjoyed a sophisticated urban lifestyle, suffered from the pressures of examinations and governmental affairs, or indulged in lust and material luxury. Yet not everybody in Ming medical circles agreed with Wang. In the mid-late Ming, the pill was criticized by some of his opponents, who believed it had an excessive, possibly harmful “cooling effect” on the body, while others argued it was more important to replenish yang, and so prescribed milder and warmer herbs, such as ginseng. Despite this controversy over the pill’s efficacy, both sides expressed anxiety over the bodily weakness of male literati in the face of a rapidly commercializing and urbanizing society. The history of the pill also reveals changing gender discourses after the Song dynasty. The controversy over the pill in the sixteenth and seventeenth centuries was mainly based upon cases of male patients; women were only occasionally mentioned in cases relating to their special social functions, such as lactation, miscarriage, and pregnancy, or in cases of uncontrollable anger caused by their special social surroundings. Yin and blood, which symbolized the female discursive body in Song medicine, as opposed to yang and qi for men, became equally important for both men and women, and even more important for literati men in the Ming. Whether in terms of yin and blood, or of yang and qi, there was no distinction made between the female and male body in Ming medicine.