歷史學X醫療史新時代

「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(學)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.