世医家族与民间医疗：江南何氏个案研究

发布时间：2018-06-20 00:22

本文选题：世医家族 + 民间医疗　；参考：《华东师范大学》2012年博士论文

【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。
[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
【学位授予单位】：华东师范大学
【学位级别】：博士
【学位授予年份】：2012
【分类号】：K25;R-092

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