清代江南医说分歧下的医患行为考察

Investigation on Doctor-Patient Behaviors Against Divergent Medical Opinions in Jiangnan During Qing Dynasty

清代江南地区,温补风气依旧,温病学说日盛,时行瘟疫多发,疾病类型复杂。结合医理、医案、医话等材料,探究清代江南社会医说分歧下的医患行为特点,可知中医药学术理论发展中医说纷纭,医界对疾病疗法多有分歧。具体诊疗过程中,医患双方难以达成一致。用药上温补易售,峻剂难施。患者的保守倾向影响了社会用药趋势,诊疗中的风险与疗效难以调和。面对不同疾病,医患双方各有考量,如疑难杂病的患者在面对各执己见的医者时更显慎重,治疗胎产病时医者需在具有强烈干预意愿的患者家属与疗效之间寻找平衡。医说分歧易引起医患矛盾,以清代江南医患互动为镜,希冀对改善当代医患关系有所裨益。

In Jiangnan area during the Qing Dynasty,the use of warm tonic medicine was prevalent,and the doctrine of Warm Diseases became dominant,with increasing occurrence of epidemics and plagues and complicated varieties of diseases.This paper explores the characteristics of doctor-patient behaviors against divergent medical opinions in Jiangnan society during the Qing Dynasty by referring to works of medical theories,records,and discourses,and discusses the conflicting opinions during the development of academic theories of Chinese medicine and the various therapies for diseases within the medical academia.Specifically,it is difficult for doctors and patients to agree on the diagnosis and treatment of some cases;it is easy to sell warm tonics and difficult to administer drastic medicine,since the conservative tendency of patients affects the social preference for medication,which makes it harder to reconcile the risk and efficacy during diagnosis and treatment;in face of different diseases,both doctors and patients have their own considerations,for patients are more cautious when facing doctors with different opinions in treating difficult miscellaneous diseases,while doctors treating pregnancy and obstetrical diseases need to find a balance between the efficacy of the treatment and the patient’s family members’strong intervention.Divergence in medical opinions can cause doctor-patient conflicts,and it is expected to be beneficial to the improvement of contemporary doctor-patient relationships to learn from the gains of doctor-patient interactions in the Jiangnan region during the Qing Dynasty.