清朝传统医学教育研究

【作者】 崔京艳；

【导师】 梁峻；

【作者基本信息】 中国中医科学院 ， 中医医史文献， 2007， 博士

【摘要】 清朝是中国历史上最后一个封建王朝，也是传统医学发展的重要时期。纵观清朝的中医教育，一方面大体上承袭宋、明制度，但由于清朝已经处于封建社会的没落时期，所以官方医学教育已不复历代规模。尤其鸦片战争后，传统医学教育已是每况愈下，宫廷式的教育更面临崩溃边缘；另一方面清末社会性质的改变，为中医教育带来了挑战，但同时也为它提供了发展契机。西方教育思想的影响使学校教育从最初的官办走向民间，从清初官方教习厅、民间师授徒，到清末学校、社团等多样化发展，客观构建成中国中医教育近代模式。民族医学教育尤其是藏、蒙医学，由于清政府的民族优待政策，在相对稳定的社会环境中获得了较大发展空间。同时，清政府“大兴黄教”的宗教政策，一方面使寺院医学教育在藏族地区加快发展，一方面又使藏医学包括藏医教育模式广泛传入蒙古地区，为传统蒙医注入新的活力。任何事物的进步或衰落都有内因和外因，清朝医学教育的起落固然与清政府的兴衰有关，但与医学教育制度本身也必有关联。所以有必要系统研究有清一代的医学教育制度，进而初步总结出传统医学教育进步和衰落原因。本文写作目的便是尽量还原历史的本来面目，梳理出清朝传统医学的发展脉络，给历史以应有的尊重，并从中找到诸多问题的答案：中医教育如何变迁?藏、蒙医学为何发展?什么因素在影响着医学教育?清朝医学教育有哪些经验和教训?为现代传统医学教育又提供了什么借鉴?本文在收集《清实录》、《清史稿》、《大清会典》、清朝历史档案等专门文献和众多相关资料的基础上，坚持运用唯物史观，采用史学研究方法和文献学研究方法，对所收集到的资料进行综合分析和归纳演绎，得出客观结论，求出共性。由于一篇论文无法面面俱到，综合各方面因素，本文最终选择从四个角度切入清朝传统医学教育进行研究。第一个角度是从时间维度上对清朝中医教育作一个总体的把握，即分期将其发展脉络理清；第二个角度是从类型切入，对清朝中医教育进行分类研究；第三个角度是从藏、蒙医教育入手，介绍清朝传统医学教育的另一个重要组成部分——民族医教育；第四个角度是对清朝传统医学教育的成就、教训及对当今的启示方面进行了探索。本文的分期，在承认教育史的演变与政治因素相关的前提下，更注重教育史自身的发展规律，把社会变迁与教育演进有机地结合起来，将清朝中医教育作出不同以往的重新划分：承传，衰落，图强。清初至嘉庆末(1820)太医院教习厅逐步废弛之前，中医教育沿袭明朝旧制，没有太大变化，只能视为继承；道光元年(1821)至光绪十一年(1885)中国最早民办中医学堂出现之前，中央教育时起时落，民间教育除师承方式外几乎一片空白，中医教育整体走向衰落；光绪十一年(1885)至宣统三年(1911)清朝被推翻，期间历经戊戌变法、学制改革、清末新政时期，中医界多方努力发展，摆脱了过去比较单一的教学方式，出现了学堂、学会等各种传播中医学的组织，故可视为图强期。清朝中医教育的分类依据，既考虑了办学主体，又考虑教学模式，大体分为四类，每一类又选取其典型代表进行述评：官办中央医学教育无论在时间上还是办学质量上都是最有影响的，因此便作为第一种类型。太医院教习厅以其鲜明的特点和高质量教学成为此类型的典型代表；第二种类型是官办地方医学教育。虽然在清初即府设正科、州设典科、县设训官，但真正形成规模的地方医学教育是清末省立医学堂。所以本类选取的例子是河北保定医学堂；第三类是清末具有很大影响的民间医学校，代表选取意义最大的利济医学堂；同属民办性质，书院和学术团体为清朝中医教育作出了不同于学校的贡献。这种介于正规院校和师承之间的教育形式，对中医学和中医教育的普及极其有益，故将其列入第四类进行研究，并分别以侣山堂和广东医学求益社为例。藏、蒙、维、壮、苗、傣等民族医学都是中国传统医学不可分割的重要组成部分。这些民族医学的传承，历来都是以家传、师带徒或民间口耳相传的方式进行，清朝也是这种情况。唯一例外的是，清朝有两个民族——藏族和蒙古族医学教育开始走向正规并逐渐形成规模。所以本文选取这两个民族的医学教育来作重点阐述。另外，随着藏蒙文化的交流及其在宗教方面的联系，藏、蒙族在医学方面的关系愈发密切，使两个民族的医学教育在发展时期、教育方式、制度等方面都极其相似，所以又将其合并论述。根据清朝藏、蒙医教育的不同教学方法，可将其概括为曼巴扎仓、学校、师承等三种形式。其中曼巴扎仓这一寺院中专门承担医学教育的机构因稳定的社会环境、优待的民族政策、积极的宗教政策等原因在此期快速发展，由组织机构、修习方法、学位授予等方面组成了一套比较严密的教育体系，成为藏、蒙医教育的主体形式。学校和师承也在不同程度上对藏、蒙医学教育形式进行了补充。尤其是师承教育，因符合蒙古族游牧的生活习性，在很大程度上弥补了寺院地点固定的缺陷。三种教育方式在互相补充间共同完成了一个朝代本民族的医学教育任务。官方医学教育由太医院以集中授课方式进行。大体以教习厅——医学馆——新医学馆为脉络发展。期间不但历经了机构变迁，在制度方面亦发生了由纯中医向中西并设的变化。清朝前期资鉴因革刘宋助教部、隋唐太医署、两宋太医局之教学经验，在明朝医学教育的基础上继续发展。道咸衰落，同治复兴并坚持发展，虽然和同期的西医教育、甚至民国时期中医教育比较整体呈缓慢态势，但其承前启后作用是不容抹杀的。经过有清一代268年的发展，培养了大批的医药人才、出版了诸多医学著作，为后世中医教育的发展提供了客观条件；清末中医教育改制，增设西医课程，为后世树立了范式；正规学堂的设置、其他辅助教育形式的探索，积累了丰富的开办教育经验，亦对中医教育的纵向连续发展起了不可低估的作用。此外，大清皇帝对医学教育的典范作用，推广种痘术、设立痘疹科，取消祝由科，《医宗金鉴》的纂修成功，也都是清朝中医教育中比较醒目的亮点。清朝中医教育的得失给现代中医教育诸多提示。主动学习西方医学、积极拓展教育基地、努力提高学术水平，这些都是清朝志士仁人努力发展中医教育的做法，为如何发展现代中医教育树立了良好榜样。其他经验有：积累了丰富的在不同条件、背景下的多元办学模式的经验；在特殊状态下如何发展医学教育的经验；建立近代中医教育模式的经验等等。现代中国传统医学教育依然面临着办学模式、教育模式等一系列问题，清朝的这些经验仍具有借鉴意义。总结经验的同时，也应该看到清朝中医教育带来的教训：现在的医学教育中，人文教育没有受到足够的重视是不争的事实，而这劣变的种子在清朝就已埋下。此外，清末出现了两种医学并存的局面，中医教育体制随之进行了中西并设的转变。但是，设置两类课程让学生学习并不意味着中西医就可以有机相融。这种形式上的结合，并没有解决中医如何吸收西医的根本问题。同为中国传统医学的组成部分，中医和藏、蒙医教育肯定有着相同之处。如都把家传和师带徒作为传承本民族医学的重要方式。但因各种原因，二者又有着明显的差别。前者是以太医院教习厅为代表的学校式；后者是以曼巴扎仓为中心的寺院式。教育载体的根本区别，以及社会、文化背景的差异，决定了这两种医学的教育在分布方式、管理方式、入学条件、授课方式等各方面的不同。不过教育模式的差异，并不影响清朝对藏、蒙医学的重视。虽然政府有其政治目的，但民族亲和力、民族医本身的价值以及一系列优待政策的实施，确实使藏、蒙医学及其教育在清朝得到快速发展。为我国传统医学的发展打开了新局面，为当代中藏蒙医学共同发展的政策也提供了借鉴。中藏蒙医教育并举对当代之中国传统医学亦有极大现实意义：中藏蒙医教育同步发展，是缩小民族差距、增强民族团结、构建和谐社会的重要方法；此举提升了藏、蒙医学的地位，使三者在学术交流方面更加便利；中藏蒙医教育并举，突显出各自优秀的教学方法。现代医学教育的任务是，从这些各具特色的方法中筛选出最好并加以推广。综观清朝中医教育事业，较之其他时期，具有如下特点：一是办学延绵不断，虽间有停办，但此起彼落，从清初至清末未曾间断；二是民间办学积极，其形式多种多样，但各司其职，都为医学的发展和普及作出了很大贡献；三是敢于创新，清末无论官办还是民间都作出了中西医同设的尝试，民间还出现了中医函授等当时国内鲜见的中医教育方式；四是发展不平衡，女子教育只见于极少数师带徒和学校中，地域分布则是偏重北京、广州、上海与浙南一带经济较发达地区，偏远落后地区的教育仍令人堪忧。藏、蒙医教育则呈现出发展力度较大、与宗教密切相关、以寺院为主要载体、政府积极支持等时代特点，当然它也有女子教育匮乏等缺点。总体来看，保守、取缔会给医学教育造成负面影响，而改革、优待则为其带来发展高潮。清朝前期闭关锁国，错失学习世界先进科学的良机；道光取消针灸科，割裂针灸学与中医教育的联系。这些都是政策防碍教育的证明。反之，清朝传统医学教育取得的诸多成就，亦与清政府的支持不无关联。如使传统医学模式向近现代医学模式平稳过渡；藏、蒙医教育的大力发展以及蒙医学新体系的建立。由此可见，政府关注程度、政策积极与否是决定医学教育发展的最大因素。更多还原

【Abstract】 The Qing Dynasty is the last feudal dynasty in the Chinese history, also is development important time of the traditional Chinese medicine. Looks over Qing Dynasty’s medicine education, it carries on Song and Ming Dynasty system on the whole, but because the Qing Dynasty already was the declining time in the feudal society, therefore official medicine education already no longer grand scale as all previous dynasties. Especially after The Opium War, the traditional medicine education becomes worse and worse, and the palace-like education faced the collapse edge; On the other hand, that the end of the Qing the society nature changed, has brought roughly for the traditional Chinese medicine education, but simultaneously also has provided the development turning point for it. The western education thought influence causes the school edition from the initial government operated trend folk, the form from teaching hall of Official and priest and disciple type in folk to the diversification develops such as school edition, the mass organization organized, academic periodical and so on ,finally it established foundation for the Chinese medicine education pattern of modern times.The goal of this article is tracks down the phase of history, returns to original state of the historical true self as far as possible, inquires about the development vein of the Qing Dynasty traditional Chinese medicine education, summarizes the success and failure, and gives respect to history which should have: Who has made the contribution for Qing Dynasty’s traditional Chinese medicine education? What its content and the way? how about status Qing Dynasty traditional Chinese medicine education in Chinese medicine education ? Provided what for the modern traditional Chinese medicine education ?Because one paper is unable to attend to every detail, synthesizing various factor, this article finally chooses from four angles reseach the Chinese medicine educational history of the Qing Dynasty. The first angle is makes an overall from the time to the Qing Dynasty’s Chinese medicine education, namely clears off its vein by stages; The second angle is cuts into from the type, conducts the classified research to the Chinese medicine education of the Qing Dynasty; The third angle is through elaborating of Mongolia, the Tibetan medical educates , introduces another important constituent of the Qing Dynasty traditional medicine,namely nationality medical education;The fourth angle is exploration to the achievement, the lesson of the Qing Dynasty’s Chinese medicine education and its enlightenment to nowdays.Under the premise that history of education evolution correlate with the political factor, pays great attention to the history of education own law of development.The stages of this article, Unifies the social vicissitude and the education evolution, divide the Qing Dynasty traditional Chinese medicine education to three time time: The inheritance, declines, tries hard to promote. Initial period of Qing Dynasty to Daoguang first year that Imperial hospital teaching hall gradually becomes lax, the Chinese medicine education follows the Ming Dynasty old system, and does not have the too sweeping change, so it only can regard as the inheritance; Daoguang first year to the Guangxu 11 year that most early medical school managed by the people in China appeard, the central committee education intermittent and the folk education was a piece of blank besides priest and disciple type.The traditional Chinese medicine education whole moves towards the decline nearly; Guangxu 11 year to the Xuantong 3 th year that Qing Dynasty are overthrown, through WuXu political reform ,the reform in the school system, the end of the Qing new deal time, the Chinese medicine passed through diligently develops in every way, got rid of the quite sole teaching way, appeared many dissemination traditional Chinese medicine organization like the school, the mass organization and so on. Therefore this stage may regard as tries hard to promote time.According to the difference of school main body and the educational system, this article divide the Qing Dynasty Chinese medicine education into four kinds to conduct the research, and each kind will select its typical representative to carry on the commentary: traditional Chinese medicine education which the government operated has two kinds that were the central committee and the place , also may regard as state-run and the provincially established. Before he national capital big school medicine learning center appeard, the heavy responsibility undertook continuously by imperial hospital teaching hall for the central medicine education. Although the place medicine education set up zheng subject in government office,Dian subject in state,Xun Official in county from the beginning of the Qing Dynasty, that had the accurate literature record and forms the scale to have the influence is truly the provincially established medicine school in end of the Qing. But imperial hospital and the school, these two kind of education form system is obviously different. So it will be also classified to elaborate. Although belongs to managed by the people, the school, the academy and the learned society have separately undertaken the regular Chinese medicine education, the popularization as well as dissemination of Chinese medicine education, therefore classificated it to research.Tibet, Mongolia, Uygur, Zhuang, Miao and Dai and so on all is the inalienable important constituent of Chinese traditional medicine. These national medicine inheritance, always are by handed down in the family or ShiDaitu to carry on, the Qing Dynasty also is this kind of situation. The only exception is, the Qing Dynasty has two national-Tibetan nationality and the Mongolian nationality medical education starts to move towards regular and gradually forms the scale. Therefore this article selects these two national medical education to make the key elaboration. According to the different teaching method of Tibet and the mongolian medical education, it have three kind of forms that are the temple namely ManBaZhaCang, the school and ShiDaiTu. Temple education because the stable social environment, favored treatment and positive religious policyin, becomes the main body in Mongolia and the Tibetan medical education. The school and ShiDaiTu has also Carried on the supplement to Mongolia, the Tibetan medical education in varying degree. Especially ShiCheng ,because conforms to the life habit which the Mongolian nationality moves about in search of pasture, has made up the flaw that temple place is fixed in the very great degree. Three educations ways have completed medical education task together in mutually supplementing way.Many medical history scholars thought our country Qing Dynasty medical education quite is backward. This was before dynasty is a reference system, carried on the appraisal to the Qing Dynasty medicine education which the longitudinal comparison made. In order to understand the complete picture of the Qing Dynasty medical educates, we also have the necessity to carry on the crosswise comparison to it.In other words, also needs to understand the survey of West medicine education this time. In order to makes the reference value qualitative and the localization to Qing Dynasty medical education .The time beginning Qing Dynasty established is precisely the Western medicine develops vigorously. Under government’s concern, the Western especially Europe carried out education reform, introducd large quantities of medicine talented person, and started the Western medicine education to rise rapidly. This time, university medical school, school, hospital, guild and so on education carriers emerged one after another incessantly, the scientific instrument invents unceasingly, teaching ancillary facilities such as library and aboratory construct vigorously, all these add fuel to the flames for the Western medicine development and has gradually surpassed Chinese medicine education. Western large-scale running school time, our country actually still along a prescribed path; The western school assumes the development trend, our country is moving towards the decline . Certainly, besides the objective factor, the academic system and the social background ’s difference also is the reason that creates distance between tow medicines. But the various countries itself traditional medicine all is assimilated by the western medicine,the traditional Chinese medicine still inherit and develop. This explanation traditional Chinese medicine education was still effective. Therefore the affirmming disparity is not disparaging oneself oneself, but is seeking the reason, and try to catch up.The official medical education was carried by imperial hospital that is concentrate teaching.Roughly take teacher hall-medical learning center-new medical learning center as development of vein.This period not only has had been through repeatedly organization vicissitude, also occurred the change at the system aspect that is the Chinese medicine to the China and the West establishing together.After 268 years development, Official medical education of Qing Dynasty has trained the large quantities of medicines talented person, published many medical works, and provided the detachment condition about Chinese medical education development for the later generation.The end of the Qing Chinese medical education changed the system and additionally established the western medicine curriculum,it set up the model for the later generation.The establishment of regular school and the exploration of other assistance form accumulated richly experience for setting up the education, also has the function of longitudinal continuously development to the Chinese medical education which could not be underestimated.The success and failure of Chinese medical education of the Qing Dynasty educates many prompts for the modern Chinese medicine.Initiatively studying western medicine, positively developping the education base, diligently raising the academic level, these all are procedures of the Qing Dynasty person with lofty ideals that diligently developped the Chinese medicine education, then set up the good example for how develop the modern Chinese medicine education .Other experiences includes: Accumulated rich experience how multiplicat to set up school under the dissimilar condition and the background,how develop the medical education under the special condition,and how establish modern times Chinese medical education pattern and so on.The modern China’s traditional medical education still faced a series of questions such as the school pattern, the education pattern and so on, these experiences of Qing Dynasty is having the model significance.Summing up experience, also should see the lesson of Qing Dynasty that Chinese medical education brought at the same time: In the present medical education, the humanities education has not received enough value, but this poorly changed seed has buried in the Qing Dynasty. In addition, the end of the Qing appeared the aspect which two medicine coexisted, according to it the Chinese medical education system has carried on the transformation which the China and the West supposed together. But, established two kinds of curricula to study did not mean the Chinese and the western medicine may organic melt. This kind of form union, hasn’t solved the basic problem Chinese medicine how to absorb the western medicine.They are all constituent for the Chinese traditional medicine, so the Chinese ,the Mongolia and the Tibetan medical education definitely has same place,for example all take the handing down in the family and ShiDaitu as the important way which this national medicine inherits. But because of each kind of reason, they also has the obvious difference. Former is the school type that the imperial hospital teacher hall is representative; Latter is the temple type that take the ManBaZhaCang as the central. Education carrier as well as social, cultural context are different, and it had decided these two medical education in various aspects difference such as the distribution way, the management way, the matriculation condition, the teaching way and so on.But the difference in pattern, certainly did not affect the Qing government to takes very much to Mongolian, the Tibetan medicine. Although the government has its political objective, but the national affinity, the national medicine itself value as well as a series of favored treatment, truly causes Mongolia, the Tibetan medicine and its education obtained the fast development during the Qing Dynasty. It has opened the new look for traditional medical development, also provided the model for the policy of Mongolian and Tibetan communal development in present. The Chinese , Mongolian and Tibetan medical education development simultaneously also have the enormous practical significance to Chinese traditional medicine: The Chinese and Mongolian ,Tibetan medical education synchronizedly developped, is the important method that reduces the national disparity, enhances national unity, constructs harmonious social; This act has promoted the status of Mongolian and the Tibetan medicine,so make the academic exchanging to be more convenient; The Chinese and Mongolian Tibetan medical education developped simultaneously, make each one teaching method outstanding. The modern duty of medical education is that screens best from these characteristic methods and to promote.The overall looked that, conservative and bans can bring the negative influence to the medicine education , but reforms and giving favored treatment can bring the high tide of development for it. The Qing Dynasty earlier period stopped all foreign contact, missed good opportunity studied world advanced science; Daoguang canceled the acupuncture and moxibustion branch, separated relation between the acupuncture and moxibustion with the Chinese medical education. These all are proofs that the policy interrupted education. Otherwise, the traditional medical education of Qing Dynasty obtained many achievements, also had the connection with Qing government’s support.For example,caused steady transition that the traditional medical pattern to the modern medicial pattern; Mongolia, the Tibetan medical education vigorously developped as well as new Mongolian medical system established. Thus it can be seen, the degree which the government pays attention to and the policy is positive or not is the biggest factor that the medical education develop .更多还原