從醫學視角探討明清時期的飲食嗜好與疾病——以辛辣為例

Abstract

本文以「偏嗜辛辣」為核心主題，旨在探討飲食偏嗜作為病因與疾病之間的關聯。除了緒論與結論外，正文分為三章展開討論，透過考察辛辣性味與食物特性，分析飲食偏嗜如何引發病家出現特定的生理反應，並進一步探究明清醫家如何詮釋相關病症的生成機轉。傳統醫學早已注意到偏嗜辛辣與疾病之間的關係，自宋元以來已有初步記載，至明清時期，醫家在前人成說的基礎上，進一步發展病機理論與病症分類。

第二章與第三章呈現明清醫家如何將偏嗜辛辣視為致病因素之一，認為其可導致臟腑積熱、氣血失調，繼而引發眼目、咽喉、痘瘡、肛門等多種病症。 醫家對偏嗜辛辣所致病機的理解，並不侷限於特定食物，而是著眼於其性味中 所蘊含的「熱氣」與「熱毒」。此外，在產科疾病的論述中，偏嗜辛辣所造成的 影響甚至可波及尚無自主飲食能力的胎兒與嬰兒，其病因被歸因於母體或乳母 的飲食與體質狀況，並透過「胎毒」、「乳食」等概念加以說明。

辛辣既為一種醫理概念，亦是日常生活中的具體食物。傳統醫學文本對偏嗜辛辣的論述多停留於理論層面，較少觸及具體食物與實證經驗。第四章遂以本草典籍所載之辛辣食物為對象，進行具體分析，並與醫家論述中的病因病機相互對照，藉此呈現不同類型文本在相關病證論述上的傳承與差異。辛辣食物因其物性各異，致病程度亦有所不同。如花椒、胡椒、辣椒皆屬辛味，然醫家普遍認為辣椒的危害更甚，尤以其易致胎病、損壽等為患。然而，本草典籍對辛辣食物的評價，並非一概視其為致病之源。醫家亦指出，其對於特定病症具有療效，效用的正負往往與使用方式是否得當，以及食用是否過量等因素密切相關。

綜合醫學與本草典籍的記載，偏嗜辛辣被視為一種潛在但非單一的致病因素，其所引發的病機常與個人體質相互作用，構成一個多元且複合的致病結構。儘管醫家多將偏嗜納入病因學範疇，卻較少提出針對矯正偏嗜行為的具體治療建議。本草家則更加重視地域飲食習慣對偏嗜現象的影響，指出如西北地區盛行嗜椒之風，與當地風土條件密切相關，並對此類群體性的偏嗜行為表達警覺。

本文結合醫學論述與本草知識，從「一病多因」與「一因多病」的視角出發，探討飲食偏嗜在疾病形成中的作用，進而凸顯理論建構與臨床觀察之間的互動關係。此種分析途徑強調醫學知識體系中，理論與實踐相互印證、相互支撐的特質。

This article centers on the theme of a "preference for spicy foods," aiming to explore the relationship between dietary preferences as a cause and the occurrence of diseases. Aside from the introduction and conclusion, the main text is divided into three chapters for discussion. By examining the spicy nature and characteristics of foods, it analyzes how a preference for spicy foods can trigger specific physiological responses in patients and further investigates how physicians during the Ming and Qing dynasties interpreted the mechanisms behind these related illnesses. Traditional medicine has long recognized the connection between a preference for spicy foods and disease; initial records date back to the Song and Yuan periods. By the Ming and Qing eras, medical practitioners built upon earlier theories to further develop the understanding of disease mechanisms and classifications of symptoms.

Chapters Two and Three present how Ming and Qing physicians regarded a preference for spicy foods as one of the pathogenic factors, believing it could lead to heat accumulation in the internal organs, imbalances in qi and blood, and subsequently cause various ailments affecting the eyes, throat, smallpox, anus, and more. Their understanding of the disease mechanisms caused by a preference for spicy foods was not limited to specific foods but focused on the "heat energy" and "heat toxins" inherent in their spicy properties. Additionally, in discussions of obstetric diseases, the impact of a preference for spicy foods could even affect fetuses and infants who had no autonomous eating ability. The causes of these conditions were attributed to the diet and physical constitution of the mother or nursing woman and explained through concepts such as "fetal toxins" and "milk food."

Spiciness is both a medical concept and a concrete type of food in daily life. Traditional medical texts often discuss a preference for spicy foods at a theoretical level, rarely addressing specific foods and empirical experiences. Therefore, Chapter Four focuses on spicy foods recorded in classical materia medica texts for detailed analysis, comparing them with the causes and mechanisms of diseases discussed by medical practitioners. This approach aims to reveal the inheritance and differences in the discussion of related diseases across different types of texts. Because spicy foods vary in their properties, their degree of harm also differs. For example, Sichuan pepper, black pepper, and chili peppers all have a spicy flavor, but medical practitioners generally consider chili peppers to be more harmful, especially since they are believed to easily cause fetal diseases and shorten lifespan. However, classical materia medica texts do not uniformly regard spicy foods as sources of disease. Medical practitioners also point out that spicy foods can have therapeutic effects on certain conditions, and whether their effects are beneficial or harmful often depends closely on proper usage and whether consumption is excessive.

Based on the records of integrative medicine and herbal classics, a preference for spicy foods is regarded as a potential but not sole pathogenic factor. The disease mechanisms it triggers often interact with an individual's constitution, forming a diverse and complex pathogenic structure. Although many medical practitioners categorize such dietary preferences within the scope of etiology, they rarely offer specific treatment recommendations aimed at correcting these preference behaviors. Herbalists place greater emphasis on the influence of regional dietary habits on such preferences, noting, for example, that the prevalence of chili pepper consumption in the northwest region is closely related to local environmental conditions, and they express caution regarding these group-based preference behaviors.

This article combines medical discourse and herbal knowledge, approaching from the perspectives of "one disease, multiple causes" and "one cause, multiple diseases" to explore the role of dietary preferences in disease formation. It further highlights the interactive relationship between theoretical construction and clinical observation. This analytical approach emphasizes the characteristic of medical knowledge systems in which theory and practice mutually verify and support each other.