家國之間－－南北朝末期至唐初醫術世家的身份嬗變及其與國家醫學機構之互動

The Imperial Medical Office and the Transformation of Identities of Aristocratic Physicians from the Late Six Dynasties through the Early Tang

本文試圖勾勒南北朝以來形成的醫術世家進入隋唐時代的官方醫學機構所面對的世界。在太醫署等國家醫學機構成立之後，醫術世家仍然試圖維持其權勢，醫學選拔制度中傾向有家傳醫學者，為其提供了制度基礎。但是機構和制度的建立也在重塑醫術世家對自身的認識，技術官的身分化逐漸限制了醫學官員的升遷途徑。南北朝以來的醫術世家在隋唐初期開始遭遇種種選擇和身分拉扯。從外看來，展現為醫術世家在醫學機構中交替或代謝的歷史圖景。就其自身的敘述而言，也並非取決於被描述者自身對於醫學官僚生涯的認知，而在於家族成員未來路徑的選擇。

This article explores the changing self-representation of physician of aristocratic descent as, over time, they established, maintained, and abandoned distinguished traditions of medical expertise. These shift involved conflicts between career concerns, considerations of social status, and an orientation that deemed filial piety as the primary end of medical practice. The Chinese state' effort to institutionalize medical practitioners reached a climax in the Sui dynasty (581-618 C.E.), with the establishment of the Imperial Medical Office. However, the tension between cultural distinction and state employment continued to haunt physicians of aristocratic descent. The nostalgia for a relatively independent cultural identity was intensified when the early Tang state enacted regulations to strictly confine their promotion trajectories to the medical bureaucracy, thereby reinforcing physician' social segregation. They were left with a choice between remaining a member of the elite with a personal interest in medicine, and developing a career as a medical officer. These tensions precipitated ongoing debates throughout the Tang.