近代中醫對醫療規範之認識（1840－1937）

Understandings of Medical Guidelines among Modern Practitioners of Traditional Chinese Medicine (1840-1937)

醫者在療癒生命的過程中，種種醫療行為的取捨，在於知識、經驗與技術的累積判斷外，也關係著許許多多規範間的拉扯，如道德規範與法律規範。晚清以降，在西方醫學的衝擊下，中醫不僅在理論和臨床上受到質疑，在醫療規範上亦面臨嚴峻之挑戰，民國初期中國西醫群體甚至企圖以法律規範將中醫驅除出「醫師」的群體之外，可見規範上的轉變對中醫的影響其實更為現實直切。本文欲從中醫之角度，分析近代中醫所面臨醫德規範與法律規範層面上之挑戰，了解當時中、西醫規範間之衝突、轉變與影響。近代中醫界反省其醫療困境之根源，為提高中醫知識之高度與信賴度，將「相互精進研究、交流分享」、「團結合作」、「勿批判同道」等視為中醫需具備的重要醫德內涵，並訂定會員醫德規範標準，儘量約束會員，維持群體形象及良好的執業環境等。此外，中醫界更加認識參與醫療法律規範制定之重要性，動員群體力量，要求政府取消種種衛生行政上之禁令，遏止外在規範力過度干涉中醫發展，且鼓勵醫者參與政治，以爭取、保障中醫群體之權利。 In the process of curing lives, the medical practitioners have to make selections from various methods of treatment. These selections are based of the accumulation of knowledge, experience and judgment of technology as well as the controversy of many guidelines, such as norm of ethics and norm of laws. Under the impact of Western medicine in the late-Qing dynasty, traditional Chinese medicine has faced not only the questioning in theory and clinic treatment, but also the severe challenges in medical norms. Western medicine even intended to drive traditional Chinese medicine practitioners out of so called the group of ‘doctor' by means of medical laws. It was evident that changes of norm influenced traditional Chinese medicine were more direct and realistic. This article attempts to analyze the challenges confronted in medical ethics or in medical laws to traditional Chinese medicine from the angle of traditional Chinese medicine practitioners in modern China. It also tries to understand the conflicts, changes and influence of medical norms between traditional Chinese medicine and Western medicine. Traditional Chinese medicine practitioners have reflected on the root caused its medical dilemma in modern China. In order to improve the knowledge and reliability, they considered 'to learn from each other, to share each other', 'to be united and cooperative ', 'Don't criticize fellows' and so on as crucial elements of modern traditional Chinese medicine ethics. They set standards for members' medical ethics, restricting members, maintaining group image and good practice environment. Furthermore, after they were more aware of the importance of participating in the development of medical laws, they mobilized the power of the community, requiring the Government to abolish the ban on health administration to curb excessive external interference in the development of traditional Chinese medicine. They also encouraged fellows to take part in politics so as to strive for and protect the rights of traditional Chinese medicine groups.