【作者】 王敏；

【导师】 钱杭；

【作者基本信息】 华东师范大学 ， 中国古代史， 2012， 博士

【摘要】 本文选取中国医学史上一个传衍800多年的行医世家江南何氏为个案,透视、考察传统社会世医家族的传承与繁衍,探究其独特的家族形态,部分还原其生活史,并在此基础上探析传统社会民间医疗运作模式。基于此,本文尝试着进行一项家族史与医疗社会史的交叉研究,从江南何氏家族自身的医学命运与传统社会民间医疗场域运作模式和特质两个维度来展开。第一,世医家族历代行医,其职业特性在很大程度上影响了其家族形态。通过对江南何氏家族繁衍历程的梳理,厘清世系与主要分支,进而部分还原这个家族与行医有关的生活史,可以看到,世医家族比普通的农业家族具有更强的流动性和向外发展的张力,这是避免同一地域内同宗医生之间内部竞争的必要手段。同时,在传统社会主流意识的影响下,世医家族第一选择的发展目标与其他家族并无二致,即为科举入仕,而非行医,尤其是在明代中期以后,世医家族成员进入政府医疗体系的管道受阻后,他们由医学向儒学的转向更为明显。但受制于科举竞争的残酷与激烈,他们会以“医、儒兼济”作为折中的发展策略,不少家族成员成为儒医,活跃于地方社会,建立起广泛的“儒医社交圈”,甚至向着文化型家族的方向转变。这在客观上又反作用于其价值观和行医方式。第二,整个中国古代历史上,以太医院为首的官方医疗机构都没有意愿、亦没有能力满足民众的医疗需求,中下层官员以及广大普通民众,主要是从自由开业行医的民间医人那里获得医疗服务。民间医疗基本不受政府管辖,缺乏制度与规范,医者与患者在一个开放的医疗空间中展开互动与博弈,使得民间医疗场域充满了力量、弹性、灵活性与自我调节能力,同时也充满了混乱。无疑,社会地位、关系网络、文化等级这样一些因素,在医疗场域的博弈和竞争中起到了非常重要的作用,并影响了医疗资源的分配与流向。值得注意的是,不同层级的医者之间的竞争,从来都不是纯粹的知识、技艺之争,也体现为文化伦理上的尊卑之争。从某种意义上说,世医家族的全部努力与最终命运都系于此。从以上两个维度,本文将“世医家族”与“民间医疗”作为研究对象与核心问题展开,在民间医疗场域中透视世医家族的发展策略、生存智慧、道德价值观与生存困境等问题。在明代中后期世医逐渐退出官方医疗体系,回归地方社会后,一些源远流长的世医家族是以一种文化性的面目和策略进入民间医疗场域。一方面世医通过对宗族起源的追溯、建构,以及与士人阶层的文化交流、积极参与地方事务,来实现“攀援于儒”、争取医学正统地位的努力,从而在现实中有希望摆脱污名化的医者身份,比附乃至归属于儒者群体,在地方社会形成其独特的社会资源与文化权力；另一方面,这些深受儒家思想涵育的世医家族,作为传统社会最重要的医者群体之一,也深刻地形塑着民间医疗场域的运作规则与道德约束力,在一定程度上对自由放任的市场竞争产生规制作用。但是,在缺乏行业共同体和政府管制的大背景下,这些精英医者的努力仍难以改变民间医疗整体性的混乱的自治状态,高度道德化与技术主义完美结合的市场只存在于理想之中。更多还原

【Abstract】 In the vast information of medical history, the doctor is a very meaningful object of study. This paper selects Family He of River South that has passed through800years in Chinese medical history as a case, to examine generation medical family’s heritage and reproduction in traditional society, to explore its unique family form, to restore partially its life history, and hence, on this basis, analyzes the operation mode of private medical care in traditional society. Based on this, this paper tries a cross-over study of a family history and medical social history, which unfolds two dimensions of the medical destiny of Family He of River South, and the operation mode and characteristics of private medical field in traditional society.First, generation medical family practices medicine successively, and their occupational characteristics greatly influence the shape of their family. Through combing the reproduction history of Family He of River South, clarifying the descent and main branches, and then partially restoring the life history of this family and medical practice, we can see the generation medical family is more migratory and enjoys more outward tension of development than ordinary agricultural family, which is the necessary means to avoid internal competition among the common ancestry doctors in the same geographic area. At the same time, under the influence of traditional social mainstream consciousness, the first choice of development goals for generation medical family was no different from other family, which was getting official position by Imperial Examination, rather than practicing medicine. Especially after the mid Ming dynasty, since members of generation medical family were blocked from entering government health care system, they turned from the medical to Confucianism obviously. But being subject to the brutal and intense competition of Imperial Examination, they took the development strategy of combining medicine and Confucian as a compromise. Many family members became the Confucian doctors who were active in the local community, established a wide range of social circle of Confucian medical, or even evolved toward cultural family. It was objectively counterproductive to their values and mode of practicing medicine.Second, in Chinese ancient history, since the official medical institutions led by Imperial Hospital had no desire and nor ability to meet the medical needs of the people, the middle and lower officials and the vast majority of ordinary people mainly got medical services from private doctors who practiced freely. Because private medical care were basically not subject to the jurisdiction of government, and lack of systems and regulations, doctors and patients interacted with the game in an open medical space, which made private medical field full of energy, resilience, flexibility and self-regulating capacity, but also full of chaos. It is no doubt that the factors of social status, network of relationships, culture class had played a very important role in the game and competition in the medical field, and affected the allocation and flows of medical resources. It is worth noting that the competition between doctors at different levels is never on pure knowledge and skills instead of the inferiority or superiority battle of the cultural ethics. In a sense, all the efforts and ultimate fate of generation medical family depended on it.Based on the two dimensions above, this paper takes generation medical family and private medical care as the object of study and the core issue, explores the generation medical family’s development strategy, survival wisdom, moral values and survival predicament in the domain of private medical field.In the late Ming Dynasty, generation medical family gradually withdrew from the official medical system, and returned to the local community. Some long-standing generation medical family entered the private medical field in the image and strategy of sense of culture. On the one hand, generation doctors actively participated in local affairs through retrospective and construction of clan origin, and cultural exchanges with the literati class, so as to achieve "seeking connections with Confucianism", and to reach the medical orthodox status, which in reality there was a hope to get rid of the stigma of the medical identity, to be connected with and even attributed to Confucian groups, hence formed their own unique social resources and cultural power at the local community. On the other hand, the generation medical family fostered deeply by popular Confucianism, as one of the most important doctor groups in the traditional society, profoundly shaped the operational rules and the moral force of the private medical field, and to a certain extent regulated the laissez-faire market competition. However, in the context of absent industry community and government control, these elite doctors still make efforts in vain to change the whole status of chaos and autonomy of the private medical care. Therefore, the market combined with high ethics and technique only exists in ideal.更多还原