漢唐之間醫書中的生產之道

Childbirth in Late Antiquity and Early Medieval China

自古娩乳大故，有如就死，對產婦而言，是存亡關頭，對產家而言，則為成敗之機。在宋代婦產科形成專科之前，醫者產家對生產有何因應之道，事關重大，而研究者寡。本文先以醫書資料為主，重建漢唐之間婦女在入月滑胎、設帳安廬、臨產坐草、難產救治，以及產後處理等各方面的情形。然後配合正史、筆記等其他資料，嘗試探討生產相關行為的社會文化意涵。漢唐之間，婦女早婚、早育，醫家勸戒而俗風難改。面對生產大事，人們在入月、分娩和產後都有因應之道。滑胎湯藥，漢魏六朝時對於服用的月份或尚未有清楚的意見，唐宋以後則標定各種湯藥的服用時間。由於產孕不吉的觀念，產婦生產的地點選擇不易。寄產安廬，便是以隔離為前題，為產婦尋找一適合分娩的場所。唐代以前，分娩或在戶內，或在戶外，大多有帳以避風邪。生產依產圖行事，包括設帳、安廬、向坐、埋胞。隋唐之際，產圖經歷一重整的過程，由分門別類逐漸統合為一圖。貴賤之別，在產前準備與產後照顧中，表現較為明顯。至於分娩當下，不論社會階層，多眾治齊下，但求順產速效。臨產坐草，或攀繩倚衡，或由人抱腰，大多以蹲坐為主要分娩姿勢。漢唐之間，醫家對於難產的解釋，已超越觸忌犯神的範圍，對於橫生逆產亦有刺縮回順的處理。而難產救治的過程，顯示人們相信應及早干預、眾治齊下、和物物相感等諸觀念。丈夫被視為責無旁貸，而鄰里的參與亦不無可能。坐草之時，助產者、親友可能聚集發表意見，男性醫者認為將影響產婦的自然生產時間，故而加以指責。然因女性助產者向來沒有自己的聲音，男性醫者又多在難產時才被召至，兩者之間的恩怨，不免成為醫療史與婦女史上的的公案。胎兒胞衣皆出之後，產婦的辛苦雖暫告一段落，卻因防避風邪和產乳不吉的觀念，仍須與日常生活暫時隔離。婦女雖由於血露污穢和社會角色轉換等因素，被視為不潔，但在醫書療傷補虛的觀念下，富貴人家的產婦，或因而得以休養月餘。在此期間，親友持滋補之物相賀，醫者謂「補養五內，非慶其兒也」，又勸婦女晚嫁少產，以免「血枯殺人」，也算是對女性本身，而非其作為生育工具的一種關懷吧！

Childbirth may have been the most important experience of women in traditional society. The behaviors and their interpretations before, during and after the delivery not only indicated medical development of a certain period, but also revealed women's place in the patrilineal society. From late antiquity to early medieval China, it was gradually agreed in medical texts that the process of childbirth started from the last month of pregnancy and lasted at least till one month after the delivery. In the last month of pregnancy, the expecting mother was advised to take herbal medicine to enhance a quick and safe delivery, while her family should prepare a place for the childbirth according to the ''delivery charts''. The exact month for pregnant women to take such medicine varied in ancient medical texts, but was fixed to the last month of pregnancy by the eighth century. There may have been separate charts that demonstrated proper locations and directions of the delivery tents, the squatting positions, and the placenta-burying. By the eighth century, however, medical texts indicated an integration of all these items in one chart that included twelve sub-charts for each month of the year. Women usually took vertical positions, most often squatting, during delivery, either clinging to fastened ropes or being supported under the arms by midwives. Methods to solve complications such as breech included ritual techniques and manual manipulations. Such methods often implied the father's importance in delivery and the resonant relations between him, his wife and her baby. Male-authored medical texts after the six century sometimes accused female attendants of hasty and unnecessary interventions. Nevertheless, deliveries were usually handled successfully by women, including the pregnant mother, her female relatives and the midwives. During the month right after the delivery, the new mother would be restrained from social contact, both due to the need of care and the concept of pollution. Although she was considered polluting, either for her shedding blood in the delivery or for her changed role from wife to mother, the seclusion did give her a chance to rest. Friends and relatives then would bring over precious and nutritious food to ''nourish her body'', said the medical texts, ''not just to celebrate the child''.