本文選題：世醫(yī)家族 + 民間醫(yī)療　； 參考：《華東師范大學(xué)》2012年博士論文

【摘要】：本文選取中國醫(yī)學(xué)史上一個傳衍800多年的行醫(yī)世家江南何氏為個案,透視、考察傳統(tǒng)社會世醫(yī)家族的傳承與繁衍,探究其獨特的家族形態(tài),部分還原其生活史,并在此基礎(chǔ)上探析傳統(tǒng)社會民間醫(yī)療運作模式。基于此,本文嘗試著進行一項家族史與醫(yī)療社會史的交叉研究,從江南何氏家族自身的醫(yī)學(xué)命運與傳統(tǒng)社會民間醫(yī)療場域運作模式和特質(zhì)兩個維度來展開。 第一,世醫(yī)家族歷代行醫(yī),其職業(yè)特性在很大程度上影響了其家族形態(tài)。通過對江南何氏家族繁衍歷程的梳理,厘清世系與主要分支,進而部分還原這個家族與行醫(yī)有關(guān)的生活史,可以看到,世醫(yī)家族比普通的農(nóng)業(yè)家族具有更強的流動性和向外發(fā)展的張力,這是避免同一地域內(nèi)同宗醫(yī)生之間內(nèi)部競爭的必要手段。同時,在傳統(tǒng)社會主流意識的影響下,世醫(yī)家族第一選擇的發(fā)展目標(biāo)與其他家族并無二致,即為科舉入仕,而非行醫(yī),尤其是在明代中期以后,世醫(yī)家族成員進入政府醫(yī)療體系的管道受阻后,他們由醫(yī)學(xué)向儒學(xué)的轉(zhuǎn)向更為明顯。但受制于科舉競爭的殘酷與激烈,他們會以“醫(yī)、儒兼濟”作為折中的發(fā)展策略,不少家族成員成為儒醫(yī),活躍于地方社會,建立起廣泛的“儒醫(yī)社交圈”,甚至向著文化型家族的方向轉(zhuǎn)變。這在客觀上又反作用于其價值觀和行醫(yī)方式。 第二,整個中國古代歷史上,以太醫(yī)院為首的官方醫(yī)療機構(gòu)都沒有意愿、亦沒有能力滿足民眾的醫(yī)療需求,中下層官員以及廣大普通民眾,主要是從自由開業(yè)行醫(yī)的民間醫(yī)人那里獲得醫(yī)療服務(wù)。民間醫(yī)療基本不受政府管轄,缺乏制度與規(guī)范,醫(yī)者與患者在一個開放的醫(yī)療空間中展開互動與博弈,使得民間醫(yī)療場域充滿了力量、彈性、靈活性與自我調(diào)節(jié)能力,同時也充滿了混亂。無疑,社會地位、關(guān)系網(wǎng)絡(luò)、文化等級這樣一些因素,在醫(yī)療場域的博弈和競爭中起到了非常重要的作用,并影響了醫(yī)療資源的分配與流向。值得注意的是,不同層級的醫(yī)者之間的競爭,從來都不是純粹的知識、技藝之爭,也體現(xiàn)為文化倫理上的尊卑之爭。從某種意義上說,世醫(yī)家族的全部努力與最終命運都系于此。 從以上兩個維度,本文將“世醫(yī)家族”與“民間醫(yī)療”作為研究對象與核心問題展開,在民間醫(yī)療場域中透視世醫(yī)家族的發(fā)展策略、生存智慧、道德價值觀與生存困境等問題。在明代中后期世醫(yī)逐漸退出官方醫(yī)療體系,回歸地方社會后,一些源遠流長的世醫(yī)家族是以一種文化性的面目和策略進入民間醫(yī)療場域。一方面世醫(yī)通過對宗族起源的追溯、建構(gòu),以及與士人階層的文化交流、積極參與地方事務(wù),來實現(xiàn)“攀援于儒”、爭取醫(yī)學(xué)正統(tǒng)地位的努力,從而在現(xiàn)實中有希望擺脫污名化的醫(yī)者身份,比附乃至歸屬于儒者群體,在地方社會形成其獨特的社會資源與文化權(quán)力；另一方面,這些深受儒家思想涵育的世醫(yī)家族,作為傳統(tǒng)社會最重要的醫(yī)者群體之一,也深刻地形塑著民間醫(yī)療場域的運作規(guī)則與道德約束力,在一定程度上對自由放任的市場競爭產(chǎn)生規(guī)制作用。但是,在缺乏行業(yè)共同體和政府管制的大背景下,這些精英醫(yī)者的努力仍難以改變民間醫(yī)療整體性的混亂的自治狀態(tài),高度道德化與技術(shù)主義完美結(jié)合的市場只存在于理想之中。
[Abstract]:In this paper, we choose a medical family in the history of Chinese medicine for more than 800 years as a case, to examine the inheritance and reproduction of the traditional social medical family, to explore the unique family form, to restore the life history of the traditional society, and to explore the mode of traditional social medical treatment on this basis. The cross study of family history and medical social history is carried out from the two dimensions of the medical fate of the family's own family in the south of the Yangtze River and the mode and characteristics of the traditional social folk medical field.
First, the family history of the world medical family has influenced its family form to a great extent. By combing the breeding process of the family of Ho's family in the south of the Yangtze River, clarifying the family and the main branches, and then reducing the family history related to the practice of medicine, it can be seen that the family of the doctors of the world is more fluidity than the common agricultural family. At the same time, under the influence of the mainstream consciousness of the traditional society, the development goal of the first choice of the family medical family is not equal to the other families, namely, the imperial examination, not the medicine, especially after the middle Ming Dynasty. After the obstruction of the pipeline of the government medical system, the turning from medicine to Confucianism is more obvious. However, they are subject to the cruelty and fierce competition of the imperial examination. They will take "medicine, Confucianism and economy" as a compromise strategy. Many family members become Confucian doctors, active in local society, and build up a wide range of "Confucian social circles", even to cultural type. The direction of the family changes, which objectively counteracts their values and practices.
Second, in the ancient history of China, the official medical institutions, headed by the ether hospital, did not have the will to meet the medical needs of the people, the officials of the middle and lower levels and the general public, mainly from the folk doctors who were free to practice medicine. The medical field is full of power, elasticity, flexibility and self-regulation, and it is full of confusion. No doubt, social status, relationship network, cultural level and other factors play a very important role in the game and competition of medical field. It is worth noting that the competition among the doctors at different levels is never pure knowledge, and the struggle for skills is also an embodiment of the contention of respect and inferiority in cultural ethics. In a sense, all the power and ultimate fate of the family are all tied up here.
From the above two dimensions, this article unfolds the "world medical family" and "folk medicine" as the research object and the core issue. In the folk medical field, it examines the development strategy of the world medical family, the wisdom of survival, the moral values and the plight of survival. On the one hand, the world medicine, through the tracing and construction of the origin of the clan, and the cultural exchange with the scholar stratum, actively participates in the local affairs to achieve "climbing to Confucianism" and striving for the orthodox position of medicine. On the other hand, as one of the most important medical groups in the traditional society, the world medical family, which has been culvert by Confucianism, is one of the most important medical groups in the traditional society. However, in the background of the lack of industry community and government regulation, the efforts of these elite doctors are still difficult to change the chaotic autonomous state of the civil medical integrity, and the perfect combination of highly virtualization and technicalism is only ideal. In
【學(xué)位授予單位】：華東師范大學(xué)
【學(xué)位級別】：博士
【學(xué)位授予年份】：2012
【分類號】：K25;R-092

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