漢唐之間求子醫方試探──兼論婦科濫觴與性別論述

Reproductive Medicine in Late Antiquity and Early Medieval China: Gender Discourse and the Birth of Gynecology

生育是婦女生命中的大事，對婦女的影響重大深遠。就性別角色而言，生育的能力肯定她是一個正常而沒有問題的女人；就社會角色而言，生育（尤其是生兒子）使婦女確立自己在夫家的地位。多子多孫是傳統社會父系家族繁榮昌盛的表徵；而鼓勵生養蕃息是歷代政府的人口政策。因此，不論主觀意願或客觀形勢，都使生育成為婦女的「天職」，生好兒子更是重要。肩負重責大任，傳統中國婦女除了敬拜神佛、求助於巫和佩帶咒藥之外，又有就醫治療一途。醫方求子之法，自先秦以迄隋唐頗有轉變與發展。漢魏六朝，求子論述多出現在房中書內，以行房宜忌主導求子良窳。合陰陽之影響所及，包括求孕、求男與求好男，期勉畢其功於一役。行房求子，在天時、地利等觀念上，與行房養生相去不遠，但在施術與受術的人選方面，卻頗不同。行房養生被視為交戰，爾盈則我虛，因此女性施術，是對男性的威脅。但若為了求子，女性便可施術，採取主導與觀察的位置。即使男性主導，仍需成熟女性互相配合，與養生時好尋「不知道」的童女相異。房中書預設的讀者既以男性為主，求子之責似當由丈夫肩挑。訪求多男婦人以生子的作法，甚至有挑戰養生規則中處女情結的意味。然而此種觀念，卻也將能否生育的矛頭重新指向婦女。婦女成為醫方求孕、求男與求好男的焦點，可由隋唐之際的求子藥方一窺究竟。草藥求子，在先秦兩漢的醫方中難得一見。隋唐之際，求子藥方才大量增加，卻多列於婦人方中，甚少涉及男性病變。婦人方並始錄求子專章，說明無子之因與治療之法。與前代相較，可歸納出兩項發展。第一、隋唐之前，醫方處理婦人雜病多著重於妊娠、產後諸疾。而隋唐醫者對於產育活動的介入，似有從妊娠、分娩，提前到行房、受孕的軌跡。而用藥則是醫者的重要自我界定。第二、隋唐之際，男性求子之論述與藥方皆無突破。醫方言及無子，雖曰「夫病婦疾」，但論男性病變既不設無子專章，診治藥方也少提生子之效。顯然，生育並非醫者認識或論述男性身體的重點。反之，產育則逐漸成為醫者認識並論述女性身體的基礎。其中，孫思邈在《千金方》〈婦人方〉中首列求子，並暢談產育與女性的關係。從婦人胎產功能、生理結構和性格特質等三方面，一層深似一層地說明婦人別立一方的理由，可說為婦科醫學之成立提供了性別理論依據。醫方除協助女性求孕之外，又以安胎藥方確保妊娠順利，以感應方術和滋補藥物求男及求好男。醫方視為慈戀愛憎、嫉妒優憒的女性，一旦受孕，戰戰兢兢，謹言慎行，或為自己身體健康，或為祈求骨肉平安。胎教論述賦予女性「賢母卒生聖子」的希望，而士人醫家，也不忘提醒「諸生子有癡疵醜惡者，其名皆在其母也」。如此一來，女性的生育之苦，似又不限於胎產崩傷而已了。

Reproduction may have been the most expected function of women in traditional Chinese society. Procreative ability confirmed a woman's sex role, and giving birth to a son assured her status in her husband's family. Fertility not only represented fortune in a patriarchal society, but also fulfilled the population policy of most dynastic governments. Burdened with such duty, barren women resorted to all kinds of remedies, medical help as one of them. Reproductive medicine underwent several transformations in China between the 3rd century B.C. and the 7th century A.D. First was the change of methods. In the early stage, most advice of begetting a child, a find boy as the best, were sexual techniques that appeared in texts for the arts of bedchamber. In the 7th century, however, herbal medicine to enhance pregnancy became abundant and was mostly recorded in medical texts. Since both the arts of bedchamber and medicine were considered divisions of the scholarship called ''recipes and techniques'' in ancient and early medieval Chinese categorization, the shift between the two showed a rising concern on fertility in the medical profession. Secondly, while the arts of bedchamber were usually performed by men and herbal medicine was mainly recorded in various ''recipes for women,'' the shift before the 7th . century also indicated a growing focus on women as the primary agency of reproduction. Such shift of focus could also be detected in the contents and arrangements of medical texts. While medical prescriptions for male diseases in the 7th century still emphasized their efficacy on sexual virility as the arts of bedchamber did before, hardly any word on fertility was mentioned. On the contrary, the ''recipes for women'' began to include chapters such as ''(how to) beget a son,'' followed by chapters on pregnancy and post-partum care to form the major parts of the texts. Reproduction thus became the viewpoint for the medical profession to perceive a female body, but not a male one, in the 7th century. Thirdly, the emergence of the ''recipes for women'' as an independent entity in medical texts demonstrated the connection between gender discourse and the birth of gynecology in China. The 7th century doctor Sun Ssu-miao stated bluntly in his book that women needed to have their own section of medicine not only because they had to experience childbirth which caused numerous disorders different from men's, but also because their body structure was delicate and subject to more problems than men's. Moreover, in his treatise on the ''recipes for women,'' he proposed that women required separate treatment also due to the fact that they were emotionally weak and hard to be cured. Reproductive medicine in ancient and early medieval China provided women with recipes and techniques not only to enhance conception but also to protect and to instruct the fetus so that a fine boy could be born. Once a woman, considered delicate and weak, was pregnant, she had to behave in a careful and moral manner to preserve the health and reputation both of herself and of her son. Since the quality of her child testified to her virtue according to the theories on fetus education, apparently a woman's burden would not be lifted even after the childbirth.