中國麻風病概念演變的歷史

The Historical Nosology of li/lai in China

本文是從中國傳統疾病分類的角度，在現存的歷代文獻中探討古代「癘／癩疾」、「大風」、「惡風」以至「麻風」等病的概念。「癘／癩」、「大風」這個疾病被中國當代醫史學者一般認為是等同於麻風病。我們放棄這個先入為主的想法，純粹從歷代醫書及相關文獻對「癘／癩」、「大風」、「麻風」的描寫看這個疾病在概念上的變化，不同時代的醫書對這幾個病名的描述、病因分析、療法等有所不同，從中可以分析疾病分類概念的變化及其背景。本文從「癘／癩」、「麻風」這個具體例子來看中國傳統醫學裡疾病分類方式的歷史。時代從上古至清代十八世紀末止。從疾病的分類概念變化看來，我們無法確定古醫書所說的大風、癘／癩病到麻風是否確實指涉現代西方醫學所定義的真麻風（leprosy），雖然明清以來有關麻風的描述的確比較接近今人對這個病的了解。我們不能確定這些不同名詞所代表的疾病類別是完全相同的疾病類別，而且懷疑這些疾病分類在悠長的歷史裡曾有過重要的變化。《內經》所說的大風或癘、宋元時代的「大風癩」、或明代的麻風並不一定指涉完全同樣的疾病。不過，從病癥、病因、療法概念的演變，可看出從「大風」發展到「麻風」的這一連串疾病類別，雖然在不同時代可能有不同的內容，但是其密切的關係，其一貫性，是明顯地有歷史軌跡可尋的。「大風－麻風」病的概念變化部分是來自經典醫學思想的影響，也明顯地受到各時代許多其他因素的影響，如道教思想、醫者與患者的社會背景、地域因素、新疾病等的影響。疾病概念的形成，顯然不單是醫學知識的問題，更牽涉著複雜的社會文化因素。

This paper attempts to reconstruct the historical development of the conceptualization of the illness li/lai in China that most contemporary historians of medicine consider to be the equivalent of leprosy. It is, in fact, impossible to prove that li/lai and leprosy mean exactly the same illness(es). What one can work out from old medical texts from the Antiquity to the late 18th century regarding the li/lai illness is the evoluation of the terminology that reflects changes in the nosology of the disease(s). Terms like li/lai, ta-feng (big-wind), ma-feng (numb-wind), ta ma-feng (big-numb-wind), etc. were used in different periods to describe the disease(s) that show(s) many of the symptoms that are strongly suggestive of leprosy. However, differences in the causes and treatment of the illness(es) signified by these terms show that there were important changes in the conceptualization and classification of this li/lai category over the past centuries. It would be problematic, for instance, to presume that what Ming-Ch'ing texts describe as ma-feng, which is currently used to translate ''leprosy'', is exactly the same thing as li or lai in old, classical texts. There is, nonetheless, an obvious thread of continuity that goes through these terms implying that they do belong to a same, or comparable group of illness(es). Changes in the nosology of li/lai reflect influences of medical thoughts of different periods, regional and socio-economic variations, as well as the impact of other newer diseases, including syphilis.