從《王叔和脈訣》的爭議看明清醫學知識的建構

Wang Shuhe Maijue (The Pulse-diagnostic Song of Wang Shuhe) controversy and the construction of scholarly medical knowledge in late imperial China

明清醫療史的研究，近來廣受學界的關注。本文將會指出，自明代中葉開始，隨著以行醫為職業的正統醫者群體輪廓愈趨明晰，醫家對何謂正統醫學知識，越來越感到有嚴格定義的需要。因此，在以《內經》為依歸的新標準檢驗之下，以往被視為理所當然的醫學知識，也有必須重新裁汰的必要。而在被指明剔除的醫學知識當中，《王叔和脈訣》無疑最為重要。不僅因為其診脈理論和「七表」、「八裏」、「九道」的脈象分類，自北宋以來，長期主導脈學的理論和實踐；更因為肇端自明代的新醫學理論，如膻中與手厥陰經的搭配、大小腸診的脈部位等等，都是奠基在對《王叔和脈訣》徹底的批判之上，而有以致之。明末醫家破而後立的新理論塑造，更導致了明清醫學知識建構大規模的變化，《瀕湖脈學》取代了《王叔和脈訣》及其脈象分類架構，成為新的診脈理論基礎。然而，由相似的理論爭議，在清代並未導致像明末一般的知識大變動，可以看出其實明清醫學知識的建構，與其說是要解決理論的錯誤，不如說是體現了在社會和文化上，區隔其他醫療競爭者，以定義並提升自身地位的意圖。

The complicated aspects of the scholarly medical knowledge in late imperial times are on path to be the focus of attention in academic studies in the history of Chinese medicine. Among different facets pointed out by scholars, social and cultural distinction is highlighted to be an important driving force that motivated the scholarly physicians to construct and reconstruct the medical orthodoxy they held to be of utmost importance for their status and dignity. Since the middle of Ming dynasty, because of the increase in the number of medical practitioners, it’s important for the scholarly physicians to establish their own orthodox tradition, to distinguish themselves from other practitioners in order to cement their status and clientele. This paper is tasked with indicating that, with this background, specific knowledge, i.e. Wang Shuhe Maijue (王叔和脈訣), was culled to be the target of repudiation. The reason why Wang Shuhe Maijue was crucial is because of its undoubted eminence in the history of Chinese medicine since its appearance in northern Song dynasty. From then on, Wang Shuhe Maijue was so popular that not only lowbrow practitioners practiced it to earn their living, but scholars who were familiar with medicine were also deeply affected by its pulse-diagnostic theory. Its popularity was not eclipsed by the continuous fulminations from scholars and physicians during southern Song and Yuan Dynasties for its vulgarity and peccadillo in theory. However, it’s worth noting that only from the middle of Ming dynasty on that orthodox physicians contended to veto its status as legitimate knowledge of orthodox medicine. The repudiation of Wang Shuhe Maijue not only defined the orthodox medicine ever since then, but the orthodox medical knowledge invented by the orthodox physicians in late imperial China was also deeply influenced by the repudiation of Wang Shuhe Maijue. It is against this background that new orthodox knowledge was produced, and the boundary of the community of orthodox physicians was delineated.