中西醫論爭背景下的中醫理論現代化歷程──以陸淵雷的學術討論為焦點

The Process of Modernizing Traditional Chinese Medicine Theory Against the Backdrop of the Debate between TCM and Western Medicine with Focus on Lu Yuanlei's Academic Discussion

民國時期的中西醫論爭，是中醫學術理論傳承現代化過程的重要推手。匯通派醫家陸淵雷與當時各類思想理論的代表人物均有交流問難，是本研究比較分析的焦點。論爭起源於余巖批評《內經》中臟腑經絡理論無法被人體解剖學知識所印證，而惲鐵樵以「《內經》之五臟乃四時之五臟、氣化之五臟」的回應，未必受其它主張改良中醫的同志所信服。章太炎的理論學說以傳統中醫臟腑經絡出入傳化為主，填充以部分西學知識；陸淵雷更希望用西方醫學知識取代傷寒理論，深究後不難發現仍須無法脫離虛實寒熱等辨證概念作為臨床實務輔助。章、陸二人強調與臨床應用高度相關的傷寒體系知識，引入日本醫家之方證藥證學說也逐漸形塑出廢醫存藥的風潮。惲鐵樵認為《傷寒論》六經結構與《內經》外邪傳變由表入裡的病機高度相關，強調《內經》營衛經絡等學說屬生理層面的運作模式，無法透過死亡解剖知識進行理解，若想企及惲氏「非以《內經》為止境」創新性的學術境界，仍有賴後學從中西病理生理學的匯通處入手。

The debate between Chinese and Western medicine during the Republic of China period was an important driving force behind the modernization of the inheritance of Chinese medical theory. Lu Yuanlei, a doctor of the Coverged Medicine School, had exchanges and discussions with representatives of various ideological theories at the time, and is the focus of this study's comparative analysis. The debate originated from Yu Yan's criticism that the theory of viscera and meridians in the Neijing could not be confirmed by knowledge of human anatomy. Yun Tieqiao's response that '' The five viscera in the Nei Jing are the five viscera of the four seasons and the five viscera of qi transformation.'' may not be convincing to other comrades who advocated the reform of traditional Chinese medicine. Zhang Taiyan's theoretical doctrine is mainly based on the traditional Chinese medicine's viscera and meridians, supplemented with some Western knowledge; Lu Yuanlei hopes to replace the theory of Shanghan Lun with Western medical knowledge. After further study, it is not difficult to find that it is still necessary to use the concepts of TCM such as deficiency and excess, cold and heat to assist clinical practice. Zhang and Lu emphasized the knowledge of the Shanghan Lun that was highly relevant to clinical application, and the introduction of the Japanese physician's theory of prescription, syndrome and medicine syndrome also gradually shaped the trend of abolishing medical theory while retaining pharmacology. Yun Tieqiao believed that the six- meridians structure of Shanghan Lun was highly related to the pathogenesis of the transmission of external evil from the exterior to the interior through the Neijing. He emphasized that theories such as Ying (Nutrient Qi) and Wei (Defensive Qi) circulation in the meridians belong to physiological operating models and cannot be understood through knowledge of post-mortem anatomy or cadaveric anatomy. If one wants to reach Yun's innovative academic realm of ''not stopping at the Neijing '', it still depends on future generations to start from the intersection of Chinese and Western pathophysiology.