明清的人痘法──地域流佈、知識傳播與疫苗生產

Smallpox Inoculation in Ming-Qing China: Regional Spread, Knowledge Dissemination, and Bacterin Production

本文考察明清人痘法普及的歷程，並討論這個過程中知識傳播、疫苗產銷的概況，及人痘接種所存在的地域性、階層性。據先前學者考證，明朝隆慶年間（1567-1572），人痘法出現於安徽寧國，但經過本文探究，起源於江西的可能性更大。這種預防天花的方式出現後，主要流行於江西、湖廣、安徽、江蘇、浙江、福建與廣東等地。直至一六七○年代，才有醫者至北京為上階層種痘。康熙十七年（1678），康熙皇帝將人痘法引進宮中，成為皇室認可的醫療技術。不久之後，朝廷將人痘法傳往蒙古等地。但在整個傳播過程中，朝廷並未勒令地方官全面推行此一療法，故人痘法的傳播主要依靠士人與醫者。人痘法傳播的初期，種痘知識仰賴傳抄，技術並不公開。至康熙五十二年（1713），種痘法首次出現於出版的醫書內，乾隆六年（1741）才有專談種痘的醫書出版。次年（1742），種痘法被納入御醫所編的《醫宗金鑑》中，種痘知識亦隨著這部欽定的醫書不斷再版而流傳。爾後，也有其他種痘書刊行，人痘法遂普及於世。在疫苗的製造方面，安徽寧國與浙江德清是比較著名的中心。其次，也有一些專門製造疫苗的醫家。除了向外人購買之外，不少醫者也自行研製。由於疫苗成為有利可圖的醫藥商品，市場上甚至出現許多贗品，造成不少後遺症。整體而言，在十九世紀初，人痘接種雖已相當普遍，但種者仍以上階層居多，且有南盛北弱的情況。

This article investigates the popularization of smallpox inoculations during the Ming and Qing Dynasties and discusses the processes of knowledge dissemination, bacterin production, and marketing, as well as the regional and social aspects of smallpox inoculation. According to earlier scholars, smallpox inoculation began in Ningguo, Anhui, between 1567 and 1572. However, as this study demonstrates, it is highly possible that smallpox inoculation originated in the Jiangxi region. Following the discovery that smallpox inoculation protects people from smallpox, the technique spread throughout the Jiangxi, Huguang, Anhui, Jiangsu, Zhejiang, Fujian, and Guangdong regions. Not until the 1670s did physicians arrive in Beijing to inoculate the upper-class community. In 1678, Emperor Kangxi introduced smallpox inoculation to the Palace, and it became a royally approved medical technique. Shortly thereafter, the Court transferred this technique to Mongolia and the surrounding regions. Local officials, however, were never ordered by the Court to actually perform or promote the inoculation procedure, so it was mainly disseminated by scholars and physicians. In the early stages of the inoculation's dissemination, only handwritten knowledge was circulated; the techniques themselves were not made public. In 1713, the inoculation procedure first appeared in printed medical books. In 1741, medical books dedicated to smallpox inoculation began to be published. In 1742, royal physicians included the procedure in their version of the Yizong Jinjian, and the knowledge was widely circulated by this royally approved and continually reprinted book. Soon thereafter, more and more medical books on inoculation were published, and smallpox inoculation became increasingly widespread. Ningguo, Anhui, and Deqing, Zhejiang, were famous manufacturing centers for the bacterin, although some private clinics also specialized in producing the bacterin. In addition to purchasing the bacterin, many physicians also developed their own versions. Since this bacterin was a profitable medical product, there were numerous fake products on the market, which resulted in various aftereffects. In the beginning of the 19th century, smallpox inoculation was widely available, yet only the upper-class was inoculated. Smallpox inoculation was much more prevalent in the south of China than in the north.