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今日不發文,先福祝各位好朋友中秋節快樂、家平安囉。

 

老皮

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最近部落格很安靜,原因是「醫療史新時代」為因應臺灣Yahoo奇摩部落格停止服務,遂進行了搬家。在幾位好朋友的建議下,決定搬至痞客邦,新網址為:http://pikuoli.pixnet.net/blog 請大家繼續給予指教。初步看了一下,我在背景方面不是很會設計,所以總感覺這個版型怪怪的,如果有甚麼建議,也歡迎給版主老皮建議。

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版主:《師大歷史系電子報》創刊號發行了。版主忝為師大的一份子,不能為師大歷史系做些甚麼,只能濫竽充數、占占版面。如果的微不足道的經驗可以給學弟妹們一點點點點的小啟發,版主就滿足了。也請大家多多支持師大歷史、多多交流。完整第一期電子報在此:http://mail.his.ntnu.edu.tw/E-Paper/001/001-index.htm





謹此感謝陳登武主任的邀請,也謝謝陳韋聿學弟的採訪和整理。





 





系友皮國立先生訪談紀要





(圖片部分因版主過胖、審查不通過已被刪除,請參閱原報)





熟悉的朋友喚他「老皮」,研究所的學弟妹們則通常帶著幾分敬慕,稱呼他「國立學長」。至於「皮國立」三個字,則是臺灣中國醫療文化史研究群的新生代當中,最常被人提起的名字之一。從大學時代開始萌生對中醫的興趣,到實際鑽研中醫醫理、通過國家檢定考試,最終成為一名專業的醫療史研究者,即將進入中原大學通識中心任教的國立學長,和我們分享了他對中醫的學術與現實關懷,以及他對師大研究生涯的點滴回憶。透過電話,《師大歷史系電子報》和國立學長進行了將近一個半小時的採訪,以下是這次訪談的內容紀要。







(對談雙方,《師大歷史系電子報》稱「報」,國立學長稱「皮」。)





 





報:首先恭喜您在不久前完成了一本優秀的博士論文,順利取得學位,並能在畢業後旋即躋身專業史家之林。是否能請您為我們概略介紹博士論文的基礎關懷與核心論題?





 





皮:我的博士論文延續碩士階段的研究方向,仍然關注中醫與西醫在近代中國史上的匯通之理路。我的碩論寫的是清末,念了博士班,就進一步想要了解這個中西醫學匯通的過程,在民國以後的變化。一開始我選擇以「外感熱病學」[1]為研究題目,主要想觀察的是西方醫學理論對於中醫在「熱病」的理解、詮釋以及知識形構等方面所帶來的衝擊。當時我初期的指導老師李建民先生認為這個題目太大了,需要找一個切入點,於是我便從一些醫史的研究與史料當中,找到了「氣」與「細菌」這樣一個核心問題。這個問題,在民國時期是醫學的爭論焦點,因為「氣論」是中醫知識內的重要核心,而細菌學在那時剛剛傳入中國不久,並且為傳統醫學理論帶來了諸多衝擊。我們知道,中醫對疾病與醫療的詮釋,是所謂的「辨證論治」[2],它不像西醫一樣有科學實驗。沒有實驗,它也就看不出細菌、論不出細菌來。於是西醫便指著中醫的鼻子罵說:你們不懂細菌!但是,中醫最初認識細菌的方式,根本不是走西方科學的路子。他們關注的是細菌學與中醫在醫療理論、身體觀方面的共通之處,討論的是「氣」與「菌」之間的關聯性。中醫根據自有的「氣論」以及經典醫學文獻,與外來的細菌學理反覆對話,建立起一套匯通中西醫學的獨特歷史模式。在這個模式當中,古典醫書的經驗與醫療方法再度獲得肯定,而「外感熱病」也重新被理解、詮釋與定義。這個歷史模式體現出近代中國的一個本土知識體系,在面對西方文化力量的挑戰時,如何選擇性的吸收與排拒這些衝擊,最終達成自我的更新。





    這種中西醫學理論交融與互動的過程,在「內行人」看起來會覺得很有趣,我的碩士論文主要也是在處理這種所謂的「內史」,[3]後來出版成專書,我才發現,喜歡那本書的讀者很多都是醫生,反而是歷史學者會覺得比較看不懂。這種情況讓我產生一些反省,並且開始尋求其他人的意見。有些學者持正面的看法,覺得醫療史本來就該做一些「內史」,不然一直在外邊團團轉,只能成為一種「沒有醫療的醫療史」。但是另一些老師就認為,既然我們的讀者主要是歷史學家,那麼寫作的時候還是應該注意到「外史」,讓論文與整個時代社會文化的大背景連結在一起。這兩方面的意見,對我而言都有重要的影響,所以我在博士論文裡面,便提出了所謂的「重層醫史」(multi-gradations of medical history research)觀。這個理論架構的設計,也受到李建民老師的影響。他曾經使用過一個概念,叫做「被忽略的中層」(Neglected Middle),也就是除了上層菁英的知識形構、下層的醫療與民間生活之外,我們也許還應注意到「菁英與大眾」之間的交會地帶,亦即不同階層的、大多數人關於醫療的共同心態,共同的實踐基礎(common practices)[4]在上層,我們關注醫療的技術與知識體系本身的轉變;但反過來,我們也關心這些醫療知識如何進入下層,與普羅大眾的日常生活產生連結。這兩個層面的歷史,以及它們之間方方面面的互動關係,便是「重層醫史」所關心的主題。





 





報:您知道您另外一件為人所稱道的事情是,身為一個醫療歷史的研究者,您不僅在桌案前做文獻的研究工作,同時也身體力行的學習中醫,甚至通過專業的檢定考試。我們想了解您最初是如何選擇走上中醫史研究的?另外,您是在決定以中醫為論文題目以後,才有參加檢定考試的想法嗎?這件事情對您的歷史研究又帶來一些什麼樣的影響?





 





皮:我是在師大念碩士班的時候通過中醫師檢定考試的。那時候就是一邊讀我本來就感到興趣的醫書,一邊想著論文該做些什麼題目。我原本修了王爾敏老師的課,想說就做思想史吧,便跑去問王老師,可不可以請他指導我做中醫思想。王老師很謙虛地說,這方面的研究他不熟,請我再去徵詢其他老師的意見。當時在師大,其實不太容易找到醫療史專長的學者。最後是呂實強老師說,要幫我介紹一位剛到他們近史所任職的年輕人給我認識,這個人就是我碩士論文的指導老師,張哲嘉先生。很幸運的,張老師對於我在醫療史方面的許多想法很支持,也願意擔任我論文的共同指導教授。有趣的是,我後來才知道他其實和我一樣,也通過了中醫師檢定考,而且我們是同一年去考的。後來我還一度想要考完最後一關,也就是當時還存在的中醫師特考,考過的話就有執業醫師資格了。但一方面這個考試的確是特別的難(錄取率約在0.5%左右),另一方面我忙著修課、寫報告,也沒有太多時間去準備醫學類的專業考試。我博士班前期的指導老師李建民先生直截了當地跟我說,歷史學家或者中醫師,只能選一條路走,兩邊都做是不可能專精的。所以我大概在博二的時候,就打消了繼續考試的念頭。





    但無論如何,準備中醫師檢定考的經驗,還是對我的研究提供了許多助力,比方說那時我上過一些解讀《傷寒論》和《內經》的課程。原本這類醫學文獻在歷史研究者來說,常常看得一頭霧水,但為了考試,上課的老師就會使用相對比較現代的語言,帶我們理解這些醫書的內容。上過這些課,配合既有的歷史知識,後來真正要使用這些古典醫學文獻來做研究的時候,也就能夠感覺到比較深入的認識與掌握了。





 





報:我們知道您在2000年以後便成為師大歷史系的一份子,並且在這裡接續取得了碩士與博士學位。我們想了解您在這段日子裡面生活、求學、研究於師大歷史的感想,同時您對於母系又有一些什麼樣的想法與期待?





 





皮:我記得當初進來師大的時候,第一件想做的事情,其實是修教育學程,後來也確實花了時間去進修,並且在考上博士班以後先去實習了一年,拿到教師證。之後,我大概在博士班階段真正確認了自己的興趣與規劃,還是比較想做點研究,也就沒有繼續往高中歷史教育的方向發展了。





    剛考進碩士班的時候,我對師大歷史的第一個感想,就是我們的學術環境很自由,不太干涉學生的研究興趣,另外像是我到近史所找張哲嘉老師指導論文,也沒有碰到什麼限制,所上老師多抱持鼓勵與正面的態度。但相對而言,自由的反面,可能就是我們所內的凝聚力,比起我們的競爭對手,可能會顯得薄弱一些。比方說,臺大的研究生透過《史原》和《早期中國史研究》等刊物,以及研究生組成的各種讀書會、研討會,同學之間可能擁有比較多進行學術討論的機會與場合。政大的研究生則是有許多的海外進修與交流管道,另外他們也會由所裡面指派研究生參與研討會,發表論文。相形之下,我們感覺上比較仰賴個人在研究上的作戰能力,而同學之間的聯繫、討論、交流,或者有組織的研究群就少了一些。這種情況,或許也讓外面的朋友,感覺到我們在學術研究方面的特色,不是那麼凸出。或許未來,我們可以考慮舉辦一些研究生的成果發表會,邀請幾位重要的學者來參與評論,一方面創造系所內外研究交流的平台,一方面也拓寬學術視野,讓研究生與學界的老師們有更多的互動機會。像是近幾年由陳登武老師主持的一系列研究生講座,我覺得就是一個很不錯的活動,能夠讓同學們主動地去認識許多海內外的一流學者,對於當代學術市場的脈動,也會比較熟悉一些。





 





問:您剛結束學生生涯不久,對於目前正在學術道路上勉力前進的學弟妹們,您有些什麼樣的建議可以提供給他們知道呢?





 





皮:我的第一個建議是多寫文章多發表,讓自己的研究成果能夠被學界所看見。發表不用強求一定要刊登在「i」的重量級期刊上面,[5]博士班階段能有 一兩 篇文章被這類期刊接受,已是很不錯的成績了。其他就是勉力寫作,廣泛發表,提高自己的能見度。第二個博士班學弟妹們可以考慮的建議,則是在不影響研究的前提下,試著尋求到大學兼課的機會,累積教書的經驗與人脈,這對以後的求職,可能會有些幫助,很多學校並不只看研究,他們需要的是馬上能上陣教書的老師。畢竟我們畢業以後的目標,主要還是到學校裡面任教,除了專業的研究能力以外,也得學會怎麼教書,除非你只考慮到研究機構或公家單位任職,那對現在的博碩士畢業生而言,都已非易事。因此,就求職的考量來說,充實一些教學資歷,便可能會擁有一些優勢。另外,兼課還有個好處,就是可以讓我們暫時離開苦苦鑽研的論文題目,把心思轉移到平常比較沒有機會關心的研究領域。特別是一些歷史視野比較寬泛的通識課,透過課程內容的準備安排,或者在課堂當中與學生之間對話所形成的教學相長,說不定還能讓我們在學術上獲得一些不一樣的想法。





 





報:我們知道您的學術作品在質量與產量上都有很優秀的表現,對於研究生階段的文章寫作,您是否有什麼的心得可以和我們分享?





 





皮:我寫文章的初衷其實就是喜歡中醫,想幫中醫做一點事情。研究中醫史的現實關懷很多,因為中醫還活著,中西醫學之間的各種論爭也仍然吵得熱鬧,甚至主張廢除中醫的論調也還一直存在。這些關懷可能讓我有點使命感,寫起文章來也會比較認真。





   
寫作方面,我覺得研究生可以積極地尋求到研討會發表論文的機會,不要只是為了完成畢業標準才與會發表。研討會的好處是,一旦我們把摘要丟出去,截稿日期擺在眼前,就不得不去把文章完成,想偷懶也沒辦法。另外就是儘量聚焦在自己關心的研究主題上,從碩論的成果,或者博論計畫要寫的章節出發,把觸角延伸出去。等你真正在寫博士論文的時候,自己寫過的東西等於一種思想準備,已經發表的作品還可以拿回來引用,總之就是一舉數得囉。





 





報:學術以外,我們也想和您聊一些比較輕鬆的話題。您身為師大歷史人的資歷長達10年,有許多重要的人生階段,都是在10年當中度過的。能不能和我們談談關於師大生活的感想?





 





皮:這段期間很重要的事情,當然就是認識了同為師大歷史人的太太(張慧瑩老師,本系碩士班87級系友,現任教於宜蘭縣立羅東高中)。我們在念碩士的時候開始交往,之後在我考上博士班以後結婚,也生了小孩,一起組成一個美好的家庭。其實我覺得要做歷史研究,父母和另一半的支持是很重要的。你想,我們每天跟這麼多書為伍,佔空間又不能當飯吃,研究了老半天好不容易寫成一篇文章,結果一投出去即有可能被審查意見砍個半死,已經很沮喪了,回到家如果還要面對家人的不支持、不瞭解,老婆還不懂你為什麼總是坐在書桌前而不去多賺點錢養家活口,面對這些質疑,其實很難讓年輕人繼續走下去,所以一個背後支持你研究的家庭,是非常重要的。我太太在碩士班階段的指導教授,和我一樣都是呂芳上老師,寫論文的時候也是一路被訓練過來的,她非常了解我在研究的過程當中所碰到的各種問題與困境。我自己感覺這確實是很幸運的事情,一些同學和朋友們也覺得這樣的結合蠻完美的。而且後來生了小孩,我申請休學還不算在畢業年限裡面,有考量到男性的家庭照顧立場,這點也是師大進步的地方。後來我還問我太太說是不是可以再生幾個,延長寫論文的期限,結果她說你還是早點寫完論文,不要給我想那麼多(笑)。





 





報:您在大約兩年前架設了一個名為「醫療史新時代」的部落格,作為一個研究訊息的分享平台。我們想知道您對這個部落格的想法與期待是什麼?除了部落格以外,您在學術方面還規劃了哪些特別的工作呢?





 





皮:成立部落格,是期待大家能夠互相交流研究資訊,然後介紹一些新書,其實就是一個服務性質的工作,希望能透過網路,讓有興趣的人知道這個研究領域現在在搞些什麼東西。其實我們做歷史,有時候還挺封閉的,我們覺得有趣的事情,外頭知道的人並不多,我們也很難了解別人對歷史這個學門的興趣或看法。如果能夠藉由這樣的網路平台,把學界重要的研究成果推廣出去,讓大家知道,並且獲得回饋,我覺得這對學術是一種良性的刺激。歷史學在現代人的普遍印象當中,仍然存在很多的誤解,很多人聽到歷史系,還是覺得我們都在挖死人骨頭(笑)。雖然是個玩笑話,但這也代表我們太少把研究的成果普及化為一般群眾有興趣的知識或資訊。很多醫生平常專注在醫療工作,但他們看過「醫療史新時代」以後,也會跟我聊天,表達他們對醫療史的興趣,這些回饋讓我覺得,透過這樣子的一個網站,我們可以做得事情比過去更多了。





   
現在的醫療史學界,醫者與史家之間的跨領域對話,也還逐漸在展開當中。像是我所參與的「臺灣中醫醫史文獻學會」,主要的成員是醫生,但他們現在與歷史學者的互動慢慢增加。明年我們打算在中國醫藥大學開一個研討會,我們把題目設定為「內史與外史‧史家與醫生的對話」,同時聯絡了許多治醫療史的學者,諸如李貞德、林富士、張哲嘉、李尚仁、劉士永、雷祥麟、祝平一等幾位老師,希望這些前輩能提供該會議一些建議與想法。醫療史的研究者,以前通常就是被邀請到醫學單位裡面做個演講,現在是醫生跟史家一起來進行研究討論,彼此之間的聯繫有機會變得更緊密一些。





   
另外,我自己正規劃一本醫療史的專刊,名字也叫做「醫療史新時代」。考慮到稿源、經費、運作等等問題,理想的出版形式,大概是一年一本,收集文章,大家共同來出一本不錯的書。我們鼓勵對醫療史有興趣的學弟妹們來試試身手,同時也希望能夠提供比較仔細、有助修改的審查意見。協助一些還未能發展成熟的作品,完善最後的成果,得以發表出來讓大家看見。





 





報:最後想請教您博士論文的出版計畫,新書大約什麼時候能夠和我們見面呢?





 





皮:目前已經在跟一些學校出版單位或者學術書籍的出版社接洽了。這本論文字數稍多,含註釋大約43萬字,找出版社的時候主要的考量,還是希望能夠保留整個論文的完整性,不要因為必須迎合市場或售價等考量,任意刪減文字,至於稿費則是最次要的問題。相信近期差不多就會有結果了,再於部落格中和大家分享。





 





報:非常謝謝您接受《師大歷史系電子報》的訪問,祝您一切順利,並且希望您有空能回到母系來為我們演講,和我們分享您的學術研究與成就,感謝您!





 





採訪後記





    對《師大歷史系電子報》和它的第一任編輯者來說,這樣的採訪經驗都是生命中頭一遭。很幸運的,我們碰到的是無話不談的國立學長,天南地北的聊了一個多鐘頭,比原本估計的時間整整多上了四、五倍,當然,收穫也是遠遠超過了一篇採訪紀要的內容所能載述。特別當他談到使命感──我的感覺其實有些複雜。上一次我們能夠和別人分享對於研究的由衷熱忱,是什麼時候的事了?





    投入學術的初衷,始終沒有離開國立學長的筆桿,以後大概也不會吧。雖然有些搗蛋,但我想學長應該不會介意我在這篇紀要的結尾也來吶喊助威一下。──「帥啊老皮!」





 





註釋:





[1] 所謂「熱病」,指的是以發熱為主要臨床症狀的疾病。「外感」則是泛指造成發熱病徵的一切外界因素,諸如風、寒、暑、濕、燥、火等所謂「六淫」,以及「毒」或「疫氣」等等。參見皮國立,〈「氣」與「細菌」的中國醫療史──民國中醫外感熱病學析論〉(臺北:國立台灣師範大學歷史研究所博士論文,2011),頁3-4,註16





[2] 「辨證」指的是通過中醫基礎理論對患者所表現的症狀、體徵進行綜合性的分析,「論治」則是根據「辨證」的結果,確定相應的醫療方法。參見李經緯等主編,《中醫名詞術語精華辭典》(天津:天津科學技術出版社,1996),頁1156,「辨證論治」條。





[3] 「內史」與「外史」是在科學史與科學哲學研究當中歷史觀點的習慣劃分。一般而言,「內史」關心科學自身的獨立發展,注重此一發展當中的邏輯展開,以及概念、方法、理論、實驗等等。「外史」則強調社會、文化、政治、經濟、宗教、軍事等環境因素對科學發展過程的影響,把科學的發展脈絡置放在更複雜的歷史背景當中。參見劉兵、章梅芳,〈科學史中「內史」與「外史」劃分的消解──從科學知識社會學的立場看〉,《清華大學學報(哲學社會科學版)》,2112006),頁132-133





[4] 有興趣的讀者可參見李建民,〈先秦兩漢病因觀及其變遷──以新出土文物為中心〉,收錄於陳昭容主編,《古文字與古代史‧第一輯》(臺北:中央研究院歷史語言研究所,2007),頁479-480





[5] 所謂的「i」泛指在學術界較具權威地位的期刊索引(index)。這類索引通常會計算所收錄期刊的影響係數(impact factor,即俗稱的IF值),作為評價該期刊品質的參考指標。以國內出版的歷史類學術期刊來說,最具影響力的「i」,應是由國科會人文學研究中心於2009年開始公布的「THCI Core」,即「臺灣人文學引文索引核心期刊」。在該索引當中,歷史類的期刊只收錄七種,而本系出版的《臺灣師大歷史學報》亦年年名列其中。





 





 





http://mail.his.ntnu.edu.tw/E-Paper/001/001-f.htm






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版主:把博論的中英文摘要(The abstract of My Theses and Dissertations in Taiwan)放上來供大家參考。忍痛在國圖選擇「不開放」,因為修改後希望出版更完整的專書,原來的版本就不用繼續獻醜了。




 




「氣」與「細菌」的中國醫療史民國中醫外感熱病學析論




皮國立




中文摘要:




緒論:主要談研究動機、名詞界定(如何謂「外感熱病」)和研究回顧。藉著回顧過去醫史的研究,特別著重台灣的醫療史回顧,並試著提出「重層醫史」的角度來試著以多面向的切入視角來談一個特定之主題,從醫療看中國歷史,在上下層之間,其中必有交會共同之處,但絕對也有上下相異之處。我們已經強調了「內史」之理論建構的上層,還要看看這些知識如何與下層生活產生連結。甚至像是某類知識,如熱病知識(包括預防、調養的技術)在下層如何被理解與實踐的一些問題。




    第二章:主要敘述細菌學普及中國之前,中西醫對熱病面貌的描述。基於翻譯語言和兩者對熱病症狀的描述,其實在近代有著一致性,例如發炎、熱感或「火」的概念。也簡介一下傷寒和溫病的簡史,以及中西醫對「熱」的身體感一致性。對氣的體認與致病因子描述上的一致性,在治療與預防上,中西醫在民國之前的近代,也有許多類似之處,如用發汗與瀉下法等等。




    第三章:本章透過統計與論述相結合,來對民國時期的中醫外感熱病學相關醫籍之出版狀況進行考察,依據傷寒、溫病、瘟疫等三類醫書的出版,先行統計出「民國中醫熱病學文獻編年類纂表」,而後再加以分析其背後所代表的意義,以明瞭當時該學門發展之概況與趨勢。目前,有關該學門的二手研究,多僅止於清朝為止;而近代(1840年開始)至民國後的文獻,尚無人進行統計分析並賦予意義。若論及對中醫產生較大影響或衝擊之理論,類似融入「微生物致病說」這樣顯著且重要的變化,還是發生於民國時期。除了圍繞著古典醫學理論的再發展外,本文還考察了來自日本漢醫的翻譯醫書之影響、西方醫學衝擊與「中醫傳染病學」漸趨成型等幾個面向來加以論述。可以看出以中醫熱病學為主的兩方面學術轉型:對外是與西醫的細菌或傳染病學對話,對內則是傷寒學和溫病學兩個()派別的融合,而且傷寒學說也更加的興盛。不過,這份資料內容龐大,況且民國中醫文獻,去今未遠,典籍佚失或難以考證的狀態也較少見,日後仍不排除增補表格內容之必要。故本章只能算是一個初步的嘗試,謹希望能對研究中醫文獻、疾病史,近代中醫史的學者有些微的貢獻。




    第四章:近代中國傳統醫學與西醫的交會,產生了許多有意思的醫史課題,本章藉由梳理一個疾病名稱的轉譯過程與翻譯前後的意涵,配合中國醫學自身的歷史發展背景,來檢視民國中西醫詮釋疾病的界線與脈絡,它凸顯了民國時期中醫發展之方向與本身轉型之必要與限度。傷寒,西方名Typhoid fever,以之為例,我們看到了一個新名詞,從中國本土之外的西方與日本傳入,並與中國的古代醫學經典《傷寒論》,以及在清代與之對立的溫病理論,進行一次融合、再解釋的歷程。當時中醫的困難來自:必須面對自身學術內的寒溫論爭與分歧的態勢,又要回應西醫的說法。我們將看到,中醫擁有堅定的古典醫學定義,但西醫的衝擊讓中醫必須去反省原來的疾病定義,中醫們除了梳理任何熱病學內統整、劃畫一的說法,還必須用經典去重新定義西醫病名的屬性與名稱,最後,中醫並沒有根本地改變古代疾病論述。這段疾病史,可說是中國醫生對疾病解釋權的堅持,也預示了當時中國醫者與古典醫學之間永無休止的對話。




    第五章:主要著重民國中醫對細菌學的正面回應,是全本論文篇幅最重的部份。文中探討了細菌學對中國醫學的影響及其重要性,並探討中國醫學的一些回應(如章太炎「據古釋菌」的例子:中國人認識細菌的角度不是「觀察細菌」,而是去觀察人的行為導致細菌滋生的原因,另還涉及了「蟲」的觀察過往。)爭議之一,在於氣候生菌,所以氣候是主因,不是菌,這一點成為中醫反覆論證的重點。人在氣中,因氣而生,治療、疾病的身體觀都存乎於氣化之中。爭議之二:人體的本質(氣化、機械工具)與醫學檢驗難易、錯誤之爭議問題(戈公振之死)。中醫雖對細菌學產生諸多質疑和抨擊,卻也在這些討論中,發展「創造」出殺菌藥物。中醫界拼命圍繞著這個議題反覆申論,又反而代表著他們對這類議題之重視。菌與毒、瘀血、解毒問題:中醫不拘病原、病名,但已指出發汗、催吐與下(催便)法為針對病者之體質及病人身上之「毒」而立的方法,後來湯本更將「毒」引伸成「菌毒」;或是殺蟲=殺菌。毫無疑問的,中醫當然能夠治療瘟疫。但是能不能治療具近代意義的、經過細菌學洗禮的傳染病,則是民國以來,透過中醫與西方細菌學不斷的對話,重新詮釋、肯定古典醫書中的經驗與治法,而建立起治療的信心,並賦予外感熱病學新的定義。自西醫細菌學傳入中國之後,中醫就沒有強烈的排拒細菌論,甚至將其納入新課程。中醫從實用的觀點,把細菌在人體內產生的身體變化,用各種「毒」來加以解釋,而對於細菌作為一種生物角色而言,中醫則強調「菌在氣中」,細菌不能脫離空氣、季節、溫度、濕氣等外在客觀因素而生長,進而將細菌學拉至氣論的範疇中,此即近代中西醫氣論與細菌論匯通的歷史模式,也可以說是「再正典化」中的一種具選擇性的「存而不論(西說)」。




    第六章:民國初年這段期間,大概是近百年來中西醫衝突、爭論最嚴重的時刻。就實際的歷史來看,中醫在這段期間顯然是區居下風的,但是在言論思想上,反倒可以說是中醫在整個中國歷史中最活潑、多元的一刻。惲鐵憔生在這個時代,他有與傳染病搏鬥的悲傷過往,人生經驗使他培養了對傳統中醫的深厚感情和掌握西醫新知識的能力、意願,造就了他成為民初中醫歷次運動或言論的重要參與者。中西醫匯通、中醫革新、中醫科學化等議題,皆可由其著作中尋找到蛛絲馬跡,這讓他在民初中醫的學術譜系內佔有重要的地位。國內外皆已有學者對民初中西醫的歷史做過梳理,其中,「一病有一病之源」的說法在民初漸漸受到重視,而中醫自古以來從未發展出實驗方法來研究或觀察細菌,故為西醫所訕笑:病人若找中醫治療將「不知死於何病」(Sean Hsiang-lin Lei , 2003)。本章針對惲鐵憔的學術思想與其對西醫的回應,大多是惲鐵樵個人獨特的見解,也有不少是代表當時中醫所面臨之問題的縮影,特別是在細菌學與疾病定義這兩個問題的反省上;藉著這些討論,來釐清民初中醫在這兩個層面中可能遭遇的困境及其回應之道,並於這樣的探索歷程中,拼湊出近代中醫對自身學術,特別是疾病經典的語境重構與實際醫療場域上所出現的某些現象之自我反省。




    第七章與第八章:主要從日常生活史切入,但也扣緊經典醫書內知識的影響,如何影響一般人判斷疾病與日常養生、防疫的一些舉措。西醫知識並不是沒有影響中醫,從肉食、肉精、維他命等營養品到新式「衛生」商品來看,傳統的禁忌界線確實部分鬆動了(當然我們不能誇大這樣的影響,有些知識是僅是換一種語言呈現,例如補腎與外感病調養的問題)。而且,本章之設計,就是希望換一種視角來看「現代性」的問題,由於過去研究都是「大城市衛生史觀」,可能過分誇大西方醫學的現代性在整個中國現代史的作用,甚至我們也不清楚,傳統的一些知識如何可能在一般人的日常生活中實行,例如中醫的防疫與家庭照護等等(當然,用這樣的篇幅來探討還是不夠的,只能作為一種經典日用的輔助說明和解釋路徑而已)。也證實了上層(醫者)與理論知識在下層社會有一種很強的實用性連結,以及一種現代「個人」衛生觀可能的日常性實踐。




    第九章總結論:主要指出本文之貢獻與侷限,並延伸一些觀察與想法。




過去談中醫熱病學史,都只針對大範圍的背景或幾位醫者的貢獻做統括式的論述,學者不知道這個學門有甚麼重要醫書文獻、知識如何轉型,又如何影響日常生活,研究範圍也多僅止於清末,少論及民國。本文試圖以「重層醫史」的構想來開展「中醫熱病學近代史」,實已彌補某些空白之處。歷史本為解釋過往人物與事件而生,現代中醫至少有兩個傾向,是可以從本文的分析中看出來的,第一是現代中醫仍必須反覆閱讀經典,它不僅是一個既存現象,本文尚證實了它思想形成的近代歷程,與近代中醫的學術性格是息息相關的。過去在近代史各學門的研究者,總是強調「西化」的影響,事實上它也是中國近代史不能逃避的問題;但是,除了西化以外,有沒有一種中國本土脈絡還持續存在著的?答案之一是中醫的經典。另外在正文中,或許也能做為「從周邊看中國」的一種延伸,從日本漢醫的歷史來反觀中醫在中國近代之發展。我們看到了日本漢醫研究的推波助瀾,實於精神和物質研究上給中醫信心,日本譯名的可參照性,也讓中醫的疾病定義重新洗牌。民國醫者為發展中醫學術而提倡古代經典的復興,不單是指唐代前的醫書,也包括後出溫病派的經典在內,只是兩者有彼消我長的層次關係,而且直到現代,寒溫派的基準都處在不斷重整中;在民初時,《傷寒論》被抬高至新的地位,也為後來擴張至整個中醫內科學研究奠定基礎,後來劉渡舟又稱該書為「中醫之魂」,其來有自。




    這也印證了第二條道路,即現代中醫為何如此強調統整、融合寒溫兩派的菁華?中西醫在近代的熱病學論爭,證實寒溫爭論已無用於和西說對抗,必須統整融合出一個新的範疇與學科,此即近代中醫傳染病學漸漸成型;清代以前,根本沒有外感熱病學這一學門,它是經過近代不斷討論,才逐漸形成一個學科的界線。其次,經過近代的發展歷程後,《傷寒論》又被抬高至一個新的階段,不但是傳染病學內中的一支,也占據了外感熱病學的經典地位。毫無疑問的,中醫當然能夠治療瘟疫。但是確立能治療具近代意義、經細菌學洗禮的傳染病,則是民國以來透過中醫與西方細菌學不斷的對話,重新詮釋、肯定古典醫書中的經驗與治法,而建立信心,並賦予外感熱病學新的定義,此過程見證了中醫文獻「再正典化」的過程,重要醫書在民國時不斷透過反覆刊刻印行,強化中醫熱病知識體系的對內認同。當然,伴隨著這個現象而生的,是一連串的影響,其歷程實決定了現代中醫的性格。在中醫走向現代化的同時,不自覺的或被各種力量的正、反作用力推向了傳統;中醫的改變是有目共睹的、但其實不變的傳統仍持續著,其學術不是斷裂,而是還具有延續性的意義在內。這個歷程所帶來的影響,至今仍影響著中醫學習的方式。由於「再正典化」的力量非常強,所以也導致了:中醫從吸收細菌論、接受部分理論、論爭,當最後卻放棄「大部分」細菌實驗科學、存而不論,這可以說是一種選擇後又放棄的歷程。它導致現代中醫可以治傳染病,但卻不會找一堆「殺菌藥」,或是用細菌再爭論唯一的病名。




    近代中國學術的「西化」已不用多談,這個舊框架將阻擋我們觀看近代中國史的全貌,因為它只有單一視角而已。很多人也許會質疑,這是不是一種「反科學」的立場?站在歷史研究上,本來就不能只有一種單線論述,就像Dorothy Ko提出的突破五四史觀框架一樣,本文的立場同為:如果我們一直停留在中醫科不科學(怎麼不完全採用細菌學的視角來質問),或中醫為什麼不科學的「五四史觀」中,我們永遠不會發現中醫在近代的多元文化史以及中醫在當時日常生活中的種種可行性,而即便我們探究了受西醫影響的部分,我們也無法得知當日中醫對傳統做了甚麼樣的保護與妥協。何況對多數中國人來說,生活不是科學,而是一種自然的文化土壤,文化與歷史的發展可能、也不會只有單線。「重層醫史」視角下的醫療史與國史:必以一主題貫穿一段歷史,求其通達。中醫的實驗場域就在特定文化歷史所構築的個人身體感知與日常生活內。若僅將中醫史視為、或切割成純科學史、內史,就要大失其義了。筆者當初設計「重層醫史」的目的,就是希望能在專門內史與史家關切之問題上求得一些融會,做為國史,過去的現代史強調中國的現代化,主體只有現代化與西化,而少談古典化;但現在則多呼籲從中國史的或中國中心的脈絡來看歷史。我們要瞭解各個學門的近代轉型,就非深入其中去探索不可。連結至中醫史,若沒有文化的深層關懷,其「出路」何在,恐怕就真的只能是就「內史」而論陳跡了(至少對筆者的主觀而言,感覺不出重大意義,或許這是自己的偏見);就好比拋棄經典的中醫,也不成其為中醫了。從經典的醫書與理論出發的中醫學史,是亦本論文從中醫角度去理解中醫史之謂也。




 




 




關鍵字:中醫、熱病體系、傳染病、醫療史,氣(邪氣),細菌學,西醫,身體觀




 




 




 




 




 




The Chinese Medical History of Qi (pathogenic qi) and Bacteria – Analysis
of exogenous febrile disease in Chinese medicine during the Republican Period




 




Pi
Kuo-li




Abstract:




Introduction: This chapter describes the research motives, term definitions (e.g. what is “exogenous febrile disease”), and research review. By reviewing the past medical history with a special focus
on the medical history of Taiwan, this study attempts to discuss a specific
topic from the multi-faceted
perspective by proposing the
perspective of “multi-layer medical history”. Looking at the
Chinese history from the
medical perspective
, this study finds that there are rendezvous
similarities
and difference between the upper and lower layers. The upper layer is the theoretical
construction of “internal history”
, while the lower layer is the practices in daily
life. This paper examines how
the knowledge in the upper
layer
is linked
with the
layer,
such as
knowledge about the febrile disease (e.g., prevention and recovery techniques) is understood and practiced in the lower layer.




Chapter Two: This chapter presents the description of febrile diseases
in the Chinese and Western medicine before bacteriology was introduced into
China. According to literal translation and the descriptions of febrile disease
symptoms in the Chinese and Western medicine, there were consistent concepts
such as inflammation, heat or “huo” (fire) in modern times. The history of
typhoid fever and epidemic febrile disease of traditional Chinese medicine
(TCM) is also briefly introduced. The consistency in the physical perception of
“heat” in the Chinese and Western medicine as well as the consistency in the
understanding of Qi and descriptions about causative agents is also discussed.
There were many similarities in treatment and prevention, such as sweating and
catharsis, in modern times before the period of the Republican Period.
 




Chapter Three: Through statistical analysis and discourses, this chapter examined
the publications of Chinese medical books on fever during the Republican
Period. “The List of Chronological Compilation of Chinese Medical Books on
Fever During the Republican Period” is established in accordance with
publications of medical books on typhoid, febrile disease, and plague. This
research then analyzed the meanings behind the publications of those books in
order to see the overall situation and tendency of development of this field. Meanwhile,
most second handed researches of this field have been done until Qing Dynasty. There
is little research on statistical analysis and interpretation of documents of
Chinese Medicine during pre-modern era (since 1840) and the Republican Period.
However, there were drastic changes in the Republican Period. For example,
theories of Chinese Medicine merged with theories, such as “notion of
pathogenic microorganisms,” and have had great influence or impact on Chinese
medicine and changed its direction. Apart from the re-development of classic
medical theories, this research examined other dimensions, such as influences
from translated medical books from Japanese Han doctors, impact from Western
medical theories, and infectious diseases in Chinese medicine. This research
found two aspects of academic transformation centering on Chinese medical
theories of fever: externally speaking, there was a dialogue between Chinese
medicine and Western medical theories of bacteria or infectious diseases;
internally speaking, there was an incorporation of the school of typhoid and
the school of febrile disease which flourishes theories of typhoid. However,
contents of the data are huge because documents of Chinese medicine in the
Republican period are very recent, and it is rare to see missing or unverified
documents. If it is necessary, contents of the established list will be amended
and extended. Therefore, this chapter is a preliminary attempt to contribute to
studies of Chinese medicine documents, history of diseases, and history of
pre-modern Chinese medicine.




Chapter Four: The exchange of traditional Chinese medicine and Western
medicine in modern times has produced many interesting issues in the history of
medicine.
This chapter examined the
demarcation and context of illness interpretation in Chinese Medicine and
Western medicine by reviewing the translation process of the name and meaning
of an illness before and after it was translated. Under the background of
historical development of Chinese medicine, it highlighted the developmental
direction of Chinese medicine in the early period of the Republic of China, as
well as the necessity and restrictions of transformation that it faced.




Taking
typhoid fever for example, it was a new noun introduced into China from Western
countries and Japan, and was integrated with the illness interpretation of the
traditional medical classic, “Shang Han Lun,” and its opposite theory of warm
illness in the Qing Dynasty. The difficulties that Chinese medicine faced at
that time were the disputation over the classification of typhoid between
theories of cold illness and warm illness, and the reply to the statements of
Western medicine. It was found that the classical medical definitions of
illness in Chinese medicine were firm; however, the impact of Western medicine
made it necessary for Chinese medicine to introspect the original definitions
of illnesses. Doctors of Chinese medicine started to organize and unify similar
statements in the study of heat illness, and re-defined the properties and
names of Western diseases within Chinese medical classics. At last, Chinese
medicine did not change the discussions and descriptions of traditional
illnesses thoroughly. It could be said that this history of illness
interpretation was the insistence of Chinese medicine doctors on the right over
illness interpretation, which also revealed the endless dialogues between
practitioners of Chinese medicine and classical medicine at that time.




Chapter Five: This chapter
focuses on the positive response of TCM to bacteriology in the Republican
Period (1912-1949), which is the most important part of this paper. This paper
discusses the significance and impact of bacteriology on TCM, as well as some
responses of TCM (e.g., Chang Tai-yan’s explanation of bacteria according to
ancient interpretations: Chinese people learn about bacteria from observations
of human behaviors that may cause the growth of bacteria rather than “observing
bacteria”; another example is the observation of the history of “worm” in TCM).
One of the disputes is the causation of bacteria by climate. Hence, the climate,
rather than bacteria, is the major cause of disease, and this is a key point of
repeated verification in TCM. People live in Qi and were born in Qi, hence,
treatment and disease should be focus on the context of Qi. Another dispute is:
the contentious issue regarding the nature of human body (Qi vs. mechanical
tool) and the difficulty and error in medical inspection (the death of Ge Gong-chen).
Despite many doubts and criticism on bacteriology, TCM also “created”
bacteria-killing drugs in such discussion. The TCM community’s repeated
discussions and elaborations on this topic indicate their attention to such
issues. In terms of the issues of bacteria, poison, bleeding and detoxification,
regardless of pathogens and disease terms, TCM has pointed out that sweating,
vomiting and catharsis method are methods to purge patients of “poison”. Late
on, Tang Ben further expanded the concept of “poison” to “bacteria poison”, in
other words, killing the worm in TCM =killing the bacteria in Western medicine.
Undoubtedly, TCM can treat epidemics; however, can it treat the infectious
diseases based on bacteria in the modern sense? Since the Republican Period,
through continuous dialogue between TCM and Western bacteriology and
reinterpretation of TCM, the experience and treatment methods in TCM classics
have been confirmed as effective to rebuild the confidence in TCM for
treatment, giving a new definition of the study in exogenous febrile diseases.
After the introduction of the Western bacteriology into China, TCM has never
rejected it strongly and even has incorporated it as a new course of study.
From the practical point of view, TCM explains the changes of human body caused
by bacteria by a variety of “poison”. To bacteria in the sense of biological
role, TCM stresses that “bacteria live in Qi” and cannot grow without external
factors such as air, season, temperature and humidity, thus incorporating
bacteria in the field of Qi. This is the historical model to bridge the TCM’s
Qi theory and bacteria of the Western Medicine. It can also be described as an
optional “Epoche (western)” in “Re-canonization”.




Chapter Six: During the early period Nationalist Government, it was
perhaps the most critical era of the conflict among Chinese and Western
medicine. From historical perspectives, Chinese medicine was obviously in a
disadvantageous position. In theoretical expression, Chinese medicine was at
its most lively and diverse moment in Chinese history.  Yun Tie -chiao struggled with infectious
disease; life experiences taught him deep feelings towards traditional Chinese
medicine and the ability and intention to learn Western medicine. He became an
important participant of the previous Chinese medicine political movement and
speech in that period. His writings revealed topics of communication between
Chinese and Western medicine, Chinese medicine reform, and scientific Chinese
medicine. This proved his important status in the academic history of Chinese
medicine in the early period of Nationalist Government.




There are
many collection for Chinese and Western medicine history in the early period of
Nationalist Governmenty. Among them, the saying of “there is a source of every
disease” became respected. From ancient days, Chinese medicine has yet not
found experiment to study or observe bacteria; it is mocked by Western medicine
that if patients look for Chinese medicine, they would not even know how they
died (Sean Hsiang-lin Lei ,
2003). This chapter focuses on the academic history of Yun Tie-chiao and his
reaction to Western medicine. They are mostly his personal unique opinion and
many reflections on the problems of Chinese medicine of the time, especially on
two questions of bacteriology and disease definition. From this discussion, we
clarify the difficulty and its reaction in these two aspects for Chinese medicine
in Early Twentieth Century. During this exploration, we generalize the
self-examination of certain phenomenon presented in classical disease language
reconstruction and actual medical field.




Chapter Seven and
Eight:
The two chapters discuss
some measures that affect the judgments of the public regarding disease
diagnosis, daily health cultivation and disease prevention from the history of
daily life with a focus on the influence of medical classics. Western medicine has
certain influence on TCM. From meat, refined meat, vitamins and other
nutritional supplements to new “healthy” products, the traditional taboos have
neglected partially (of course, we cannot exaggerate this effect, some
knowledge is only the presentation in another language, such as the issues
regarding kidney nourishing and the recuperation of exogenous diseases). These
two chapters intend to look at “modernity” from another perspective. As
previous studies are from the “medical historical perspective of large cities”,
the role of the modernity of Western medicine in China’s modern history may
have been exaggerated. We are even unclear about how some traditional knowledge
is possibly applied in the daily life, such as the TCM epidemic prevention and
household care (this topic requires a longer paper for discussion, and it only
provides an auxiliary explanation and interpretation route of the daily
applications of TCM classics). It also confirms that there is a very strong
practical linkage between the upper layer (doctors/healers) and theoretical
knowledge with the lower layer, as well as the daily practice of a modern
“individual” health concept.




Chapter Nine
Conclusions
: This chapter points
out the contributions and limitations of this paper as well as some extended
observations and ideas.




Previous
research on TCM febrile disease history only describes the macro-background and
the contributions of a few TCM doctors as a whole. Scholars have no knowledge
about the major medical literature in this discipline, the course of transformation,
and how it has affected daily life. The research scope is often limited to the period
of late Qing Dynasty with rare discussions covering the Republican period. This
paper attempts to develop the “modern history of TCM febrile disease study”
from the perspective of “multi-layer medical history” to fill in the gap.
History is to explain the people and things in the past. Modern TCM is
characterized by at least two tendencies that can be identified in the analysis
of this paper. First, modern TCM learners or practitioners still have to
repeatedly read classic works. This is not only an existing phenomenon. It has
been confirmed in this paper that the modern development of TCM thinking is
closely related to the academic characteristics of modern TCM. Researchers of
modern history in various fields have always emphasized the influence of
“westernization”. In fact, it is an inevitable issue in the modern history of
China. However, in addition to westernization, is there something indigenous?
The classic works of TCM is one of the answers. In addition, the development of
TCM in Japan in modern times can also be regarded as an extension of “looking at
China from the surrounding countries”. The influence of the TCM study in Japan is
the confidence given to TCM in both material and spirit. The translatability of
Japanese terms makes it possible to redefine TCM diseases. Doctors in the Republican
period promoted the resurrection of ancient classic works for academic
development of TCM. In addition to works before the Tang Dynasty, the classics
of the epidemic school were also included. Nevertheless, the two are in a
mutually failing hierarchical relationship. Up to now, benchmarks of the
epidemic school are still in continuous readjustment. In the early Republican Period,
“Treatise on Febrile Diseases” was elevated to a new height to lay the
foundation for the subsequent TCM internal medicine. The book was late on
termed as “the soul of TCM” by Liu Du-chou for such reasoning.




The above confirms
the second direction, namely, why does modern Chinese medicine lay a strong emphasis
on integrating the essence of the two fractions of TCM? The debate on febrile
disease on Chinese and Western medicine in modern times has proved that the
traditional fractions of TCM cannot be on the equal footing with Western
medicine. A new scope and discipline should be developed, and thus, the TCM
epidemiology has gradually taken shape in modern China. Before the Qing
Dynasty, there was no such discipline as the study of exogenous febrile
disease. It gradually formed the disciplinary line after continuous discussions
in modern times. Secondly, after the development in modern times,
“Treatise on
Febrile Diseases” was
once gain elevated to a new height, becoming a
branch of epidemiology and a classic works in the study of exogenous febrile
disease. Undoubtedly, TCM can treat epidemics; however, it was only in the Republican
Period, through continuous dialogue between TCM and Western bacteriology and
reinterpretation of TCM, the experience and treatment methods in TCM classics
have been confirmed as effective to rebuild the confidence in TCM for
treatment, thus giving a new definition of the study of exogenous febrile
diseases. The process witnessed the “Re-canonization” of TCM literature. Major
TCM works were repeatedly printed and released during the Republican Period,
strengthening the internal recognition of TCM febrile disease-related knowledge
system. Of course, the series of effects in consequence have determined the
nature of the TCM at present. TCM involuntarily develops or is pushed by
various forces in the direction of traditions when it is under the process of
modernization. Changes in TCM are apparent; however, traditions survive and go
on. The TCM academic study has not been interrupted but continued. The effects
brought by such process have an impact on today’s method of learning TCM. Since
the force of “Re-canonization” is very strong, TCM thus absorbs the
bacteriology and some parts of the theory and debate, and finally abandons
bacterial experimental science to a large extent. This can be regarded as a
process of sublation. As a result, the TCM at present can treat epidemic
disease but cannot provide “bacteria-killing




It is
needless to have an in-depth discussion about the “westernization” of Chinese
academics in modern times. However, this old framework can prevent us from
seeing the overview of the history of modern China as it is only one of the
perspectives. Many people may be doubtful, is this “anti-science” stance? History
study can never be described in a single line. Like Dorothy Ko proposing to
break the historical framework of the May 4th Movement, this paper argues that if
we linger in the “May 4th Movement” historical perspective questing whether and
why TCM is not scientific (why not question from the perspective of
bacteriology), we can never find the variety of applications of TCM in daily
life as well as the history of TCM, as a part of the diversified cultural
history of modern China. Even we have explored the parts affected by Western
medicine, we cannot actually know how TCM protected and compromised traditions.
Moreover, to most Chinese, life is not science, but a natural cultural soil.
The development of history and culture is not necessarily in a single
direction. The medical history under the perspective of “multi-layer medical
history” and the history of China uses a single topic throughout the period of
history. The experimental field of TCM is the personal senses and daily life
constructed by specific cultural history. If the TCM history is regarded as a
pure history of science and internal history, a lot of meanings will be lost.
The purpose of designing “multi-layer medical history” by the author is to find
out the integration of issues concerning specific internal historical study and
historians. As a part of the history of China, previous study in modern China
emphasizes modernization of China with modernity and westernization as the main
subjects, and rarely discusses classic works. However, it is widely appealed to
study the history from the development of Chinese history or with China as the
center. For the understanding of the transformation of various disciplines in
modern China, in-depth exploration is absolutely necessary. Regarding the
history of TCM, without cultural influence, we may have to rely on “internal
history” to find the “way-out” (at least, the author subjectively cannot find
out any major significance in this respect, or maybe this is the personal bias
of the author); this is analogous to the fact that TCM without classic works
cannot be regarded as TCM. The history of TCM from the perspectives of classic
works and theories is how we understand the history of TCM from the perspective
of Chinese Medicine. 




 




Key words: Chinese Medicine, pyretic architectonic, plague, medical
history, qi (pathogenic qi), bacteriology, western
medicine, ideas of body.




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