【作者】 任冰心；

【导师】 华涛；

【作者基本信息】 南京大学 ， 中国古代史， 2011， 博士

【摘要】 时代特殊性赋予了元代医学独特的内涵：“庙学合一”的三皇庙学、医户制度、科举停废对医人的影响、蒙古统治者重医工之特有心态和传统、儒→医→官的流行路径等。这些都使元代医学管理之研究具有重要的价值。关于元代医学教育及医药管理,学术界已做了一些关注及研究。其中,部分研究者的成果颇有价值,但多数成果,材料使用较为单一、述多论少、深度不够,使研究者的一些观点、结论有再检讨的必要。本研究借助于前人学术贡献,采用历史学科实证、分析归纳、历史比较等方法,对元代医学教育、药品及行医管理三方面进行较为深入探讨。以《元史》、《元典章》等正史、政书中所载的相关史料为基础,结合元人文集、方志、笔记等文献材料,相互印证,将元代医学教育、医药管理与政治、社会、经济、文化、心理等因素紧密结合,展示元代医学管理较为真实面貌,弥补元代医学研究之缺失。前言。第一部分点明本论文选题出发点和研究价值。庸医问题及相关研究的缺乏引起了本人对元代医学管理的兴趣和关注。元代医学管理制度独特的内涵、学术界流行的一些关于元代医学的错误观点、相关研究成果存在的问题、研究范式方面值得再检讨等,使得元代医学教育及医药管理的研究具有独有的学术价值。这是笔者选择该题的出发点和价值所在。第二部分将有关元代医学研究成果进行分类述评。肯定前人研究取得的成就和学术价值,同时指出不足和可商榷之处。第一章：元代医学教育管理。本章对官办医学建立的时间、分布范围、在三皇庙学体制及社会中的地位、教官和学生来源及其出路、师生考核、世医的影响、教师的待遇地位等做了较为深入的分析。认为,元朝中央政府重视医学教育及医药管理是事实,但因等各种因素的制约和影响,重视医学教育、医药管理的法令、规定,真正在地方上得到落实的并不多。因此,官办医学教育不可能,事实上也不是元代培养大批合格医生的场所。第二章：医药管理。主要对元代制药、售药及用药三个管理层面进行剖析,认为元朝政府对医药管理还是给予了一定的重视,尤其是对毒药的管理,不可谓不严。但因时代局限、管理体制等因素的制约,使得政府在民间制药、售药管理、用药监督等方面“有心而无力”,造成医药管理效果不佳。第三章：行医管理和庸医问题。本章分两部分。第一部分。通过查检、分析大量史料,肯定了元朝政府在行医管理上所做的努力和历史性贡献。探讨了元代行医管理实施困难效果不佳的诸多原因,其中时代的局限是最主要的。对元代儒医与医学管理之间的关系作了一定的剖析。认为：“由儒而医”风气在元代为最盛的原因是科举停废。元朝统治者重用医工是由医而仕的基础。儒→医→仕是当时一个颇为流行的现象。第二部分论述了元代的庸医问题、评析了元朝政府在禁庸医方面所作出的努力及其效果。认为,行医资格管理是保证行医质量的门槛,它左右着禁庸医的内容及形式；而禁庸医的成效高低,又反过来影响着行医资格管理的具体实施。两者相辅相成,互为因果。结语。一是本人对元代医学研究的认识和反思：医学教育方面的研究空间较大,但必须要发现和使用新材料。学术界对元代行医管理和医药管理的研究需要加强。改变医学史考察传统的以医学本体研究为主的路径。元代医学史研究的特殊性对研究者是否掌握波斯语等非汉语语言的要求。二是未来研究展望。主要指出本论文需要解决而未能解决的一些问题。例如：三皇庙学的实质,非汉族统治、多民族融合给医学带来哪些影响?这些问题既是笔者的困惑,也是本人未来努力的方向。附录。《元史》、《元典章》和元人文集中所记载的有关元代医学之材料汇编。其中,元人文集包括《全元文》(李修生主编)所收录所有元人文章。《通制条格》、元人笔记、方志等所载元代医学材料过于分散,数量少,故不收录。更多还原

【Abstract】 The specific characteristics of era endows unique connotation of medicine in the Yuan Dynasty:the Temple School with three Emperors of one syncretic temple and school, the system of medical health care, the influence on clinicians because of the abolition of imperial examination system, the Mongolia rulers’ unique attitude and tradition on a highly regarded group of clinicians and the prevalent path of Confucianism→Medicine→Officer. All these make the research on medicine management in the Yuan Dynasty have significant value.Some attentions and research have been done on the medical education and medical management in the academic circles. Some research findings among them are valuable, but most of the achievements and the material used is relatively simplex and lack of depth of research so that some opinions or conclusions of these researchers do have the necessity for further review. Based on the previous academic contributions, this paper adopts the empirical, inductive and comparative methods of history discipline to undertake a relatively deep discussion from the three perspectives of medical education, medicine and medical practice management. Based on the Historical data of History of the Yuan Dynasty and The Ordinances of the Yuan Dynasty, this paper is also combined with the Yuan anthology, local records, notes and other documents to confirm each other, closely combining the medical education and medical management with the political, social, economic, cultural, psychological factors in order to demonstrate the real appearance of medicine management to make up the deficiency of medicine research in the Yuan Dynasty.The first part of this thesis is about the preface which specifies the starting point and research value of the paper. Quack problems and lack of research led me to produce interests and concerns on the medicine management. The unique connotation of medicine management system in the Yuan Dynasty, prevailing wrong points of views in academia about the medicine in the Yuan Dynasty, problems in present research and research paradigms make the research on medical education and medical management the Yuan Dynasty have a unique academic value. This is my original intention and the significance of selecting the topic. In the second part of the paper is about literature review of the findings on medicine by means of classification. The paper Affirmed the achievements and academic value of previous research while it also points out the deficiency and what is still open to discussion.The first chapter is about medical education management of the Yuan Dynasty. The author introduced and analyzed the setup time, the distribution range, the position of the temple school system with three Emperors, sources and employment of teachers and students, assessment of instructors and students, the influence of generations of doctors and the treatment status of teachers of the official medical schools. The author thinks that the central government of the Yuan Dynasty attaches importance to medical education and medical management. This is a fact, but attention in medical education, laws and regulations on medical management was not really implemented in local places because of various restricted elements. Therefore, it is impossible to set up the official medical schools. Actually the official medical schools were not the the main places in which many qualified doctors were trained in the Yuan Dynasty.The second chapter is about pharmaceutical management. The paper mainly analyzed on three managemental levels of pharmacy, drug sale and medication. The thesis claims that the government gave a certain attention to medical management, especially was strict with the management of poison. But because of the limitation of the era, management system and other factors, the government had no great achievements to pharmaceutical, drug sale management and drug supervision resulting in the bad effect in medical management.The third chapter is about medical practice managements and quack problems. This chapter is divided into two parts. The first part is to confirm the efforts and historic contributions of the government of the Yuan Dynasty in the medical practice management by consulting and analyzing a large number of historical data. Then the thesis explores different reasons of implementation difficulties of poor medical practice management and finds that the limitation of the times is the biggest problem. The thesis also dissects the relationship between Chinese Confucianism doctors and medical management. The author thinks that the social conduct from learned men to doctors is most prevailing because of the abolition of imperial examination system in the Yuan Dynasty. The rulers of the Yuan Dynasty put medical engineering in an important position and it is the foundation from doctors to government officials. This trend from learned men to doctors and officials starts to prevail at that time. The second part discusses the quack problems and analyzes the efforts that the government is devoted to making to ban quacks in the Yuan Dynasty. The author thinks that the management of practice qualification is a guarantee to ensure the medical quality. It influences the content and form of baning quack, and the effect of baning the quack, in turn, affects the practice of medicine qualification management. The two aspects exist side by side and play a part together reciprocal causation.The last part is about conclusion. Firstly it is about the author’s understanding and reflection on medical research on the Yuan Dynasty. The medical education research space is larger, but new materials must be found and used. It needs to be strengthened on the medical practice and medical management research in Academic circles. The research method based on medical ontology in the traditional medical history should be Changed. Mastering the Persian and other foreign language is a new requirement due to specific characteristics of the research on the history of medicine in the Yuan Dynasty. Secondly, it is about the prospect of the research in future. This paper mainly points out some of the problems which needs solving but failed to solve. For example: the essence of the Temple school with three Emperors, what influence will be brought to medicine in the dynasty ruled by non-Han rulers in the times of the multi-national integration? These problems are not only the author’s confusion but also my focus in the future.Appendix:material compilation comes from the recorded one from History of the Yuan Dynasty, The Ordinances of the Yuan Dynasty and the Anthology composed by peoples in the Yuan Dynasty. Among them, the anthology on medicine composed by Yuan people in the Yuan Dynasty, which includes all articles in Quan Yuan Wen Edited by Li XiuShen. Materials come from Pass system of Georgia, Notes of Yuan people and Local Records were not indexed here in view of the excessively scattered distribution and limited quantity.更多还原