明清小说中喜脉诊断的叙事伦理困境

Narrative Ethical Dilemma of Pregnancy-Pulse Diagnosis in Ming-Qing Novels

“喜脉”诊断叙事挽结了医术、叙事、宗族与伦理诸要素,是探究传统医学叙事伦理困境的绝佳个案。《素问》《灵枢》等传统医学早期文本为临床医患沟通提供了原则性的伦理“指南”,而明清时代《红楼梦》《娱目醒心编》《风月梦》等小说和医案医话等叙事文本则为解决叙事伦理困境提供了具身性的医学情境。首先,上述文本呈现出医生受制于性别秩序等礼法习俗,无法准确辨证,难以兼顾病家颜面与宗族秩序,极易丧失医患互信,造成双输局面的叙事伦理困境;其次,叙述者将喜脉误诊归因于医患地位不平等、患者信息不全面、医生叙事能力差和医德缺位等缘由;最后,明清小说与医案还从讲脉清晰、曲为周全和挑战禁忌三个层次提出了破解叙事伦理困境的诊疗经验。喜脉诊断的叙事伦理困境破解对于叙事医学中国化之借鉴意义,可谓见微知著。

The narrative of pregnancy-pulse diagnosis in traditional Chinese medical practice involves medical skills,narration,clannish ideology and ethics,which may best serve as an excellent case for the exploration of the ethical dilemma in ancient Chinese medical narratives.The early texts from traditional Chinese medicine(TCM)classics such as Su Wen(《素问》Plain Question)and Lingshu(《灵枢》Miraculous Pivot)provide a principal ethical guide for clinical doctor-patient communication,while narrative texts from popular novels such as Hong Lou Meng(《红楼梦》A Dream of Red Mansions),Yu Mu Xing Xin Bian(《娱目醒心编》Collection of Eye-Catching Mind-Shaking Stories)and Feng Yue Meng(《风月梦》Wind-Moon Dreams/Erotic Romance Dreams),and from medical case records or notes in the Ming and Qing dynasties,present an embodied context for solving those ethical dilemmas.First,according to the texts of Ming-Qing novels,the doctors involved are subject to gender order and other rituals and customs,unable to accurately make the pregnancy-pulse diagnosis without embarrassing the patient’s family or jeopardizing clannish order,thereby easily damaging the mutual trust between doctors and patients and resulting in a lose-lose ethical dilemma.Second,the narrators tend to attribute pregnancy-pulse misdiagnosis to four reasons:unequal status between doctors and patients,incomplete inquiry of patient information,poor narrative competence and low medical virtues of doctors.Finally,Ming-Qing novels and medical cases propose treatment experience to solve this moral dilemma from three levels:clear pulse explanation,empathic consideration and valiant taboo violation.This discussion on the narrative ethical dilemma of pregnancy-pulse diagnosis in TCM practice can be employed as an effective reference for the localization of narrative medicine in China.