宋、明之際的醫史與「儒醫」

Narrations of Histories of Medicine from the Song to the Ming and the Rise of the Confucian Physician

本文考察「儒醫」的身分認同與其對文本知識的態度如何表現在宋、明之際的醫史書寫上。宋代的醫史比附佛、道的宗教傳統，而醫學知識仍和宗教傳統關係密切。明代的醫史轉而比附儒學傳統，以為建立醫家統緒的模範。醫史書寫的變遷，和「儒醫」群體在醫療場域興起有關。「儒醫」之名起於宋，到了明代「儒醫」已漸次成為醫療市場中的顯貴。然而「儒醫」缺乏一定的通過儀式來確定成員的身分，因此所謂的「儒醫」並沒有固定的疆界，擺盪在「社會聲望的標籤」和具體的「社會群體」之間。聲稱「儒醫」的醫者一面要應對醫者作為伎流的污名；一面又要誇示其他醫者。「儒醫」便以界定醫學正典和道統、區隔不同文本間的地位，以文本的階層界定醫者層級、壟斷醫療知識和倫理價值，並透過醫史的寫作和醫學社群中其他的成員區隔。藉著和儒者傳統相提並論，他們以「儒醫」的標籤區隔其他的醫者。「儒醫」的名號雖有助於他們誇示其他的醫者，卻無法在現實上拉近他們和士人的社會鴻溝。「比附」雖成為「儒醫」誇耀鄰近社群的策略，卻也同時反應出他們無法「向上提昇」的社會窘境。從宋到明醫史中所折射出來的正是醫療群體與知識變遷的歷史。

This article studies the representations of Confucian physicians and their attitudes towards textual knowledge in medical histories written between the Song and Ming dynasties. The Confucian physician, a new social category that emerged in the Song dynasty, occupied a position between the literatus and the physician in the social hierarchy. Confucian physicians viewed themselves as the elite group in the realm of medicine. However, the social dilemma of the ''middle'' position of the Confucian physician is evident in the medical histories written during this period. These texts emphasize the importance of textual knowledge as the sole avenue to the art of medicine and construct genealogies of physicians parallel to that of the Confucian tradition. The medical histories produced during the Ming departed from previous modes of historical narratives, mostly religious, which compared physicians with eminent practitioners in the Taoist and Buddhist traditions. The social strategy of mimicking Confucianism enabled Confucian physicians to distinguish themselves from other physicians but was not enough to prevent others from eroding their professional boundaries, reading medical texts, and despising them as specialists. This mimicking strategy, though it distinguished Confucian physicians from other doctors, revealed that these elite physicians were unable to achieve the social status of literati who had passed through the thorny gate of the civil service examinations.