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[运用微观史学的方法与实践:儒医李梦坤(1495 - 1567)的日记]

[Applying the Methodology and Practice of Microhistory: The Diary of a Confucian Doctor, Yi Mun-gǒn (1495-1567)].

作者信息

Shin Dongwon

机构信息

Science Culture Research Center & Department of Science Studies, Chonbuk National University, Jeonju-si, Jeollabuk-do, KOREA.

出版信息

Uisahak. 2015 Aug;24(2):389-422. doi: 10.13081/kjmh.2015.24.389.

Abstract

Since microhistory's approach to the past is based on an understanding of and a sympathy for the concrete details of human lives, its area of interests overlaps with the history of medicine and medical humanities, which examine illness and health. If we put a specific region and society in a specific period under a microscope and increase the magnifying power, we can understand the numerous network connections among the body, illness management, and medicine and how multilayered were the knowledge and power applied to them. And this approach of using microhistory to illuminate medical history can be more effective than any other historical approach. This article focuses on Yi Mun-gǒn's extensive volumes of Mukchaeilgi (Mukchae's diary) in approaching medical history from the perspective of microhistory. Simply defined, this work is a Confucian scholar-doctor's diary. Its author, Yi Mun-gǒn, played the role of a Confucian doctor, although not professionally, during his 23-year exile, after serving in a high governmental office on the senior grade of the third court rank. Thanks to this extensive and detailed diary, we can now get adetailed andthorough picture of his medical practice in the Sǒngju region, 270 kilometers southeast of Seoul, where he was exiled. This article aims to understand the state of medical practice in the Sǒngju region in the 16thcentury through the"zoom-in" method adopted by microhistory. In particular, I will focus on the following three aspects:1) Yi Mun-gǒn's motivation for and method of medical study, 2)the character of Yi Mun-gǒn'spatient treatment as hwarin (the act of life-saving), and 3) the plural existence of various illness management methods, including pyǒngjǒm (divination of illness), sutra-chanting, exorcism, and ch'oje (ritual toward Heaven). All three aspects are closely related to Confucianism. First, Yi Mun-gǒn decided to acquire professional-level medical knowledge in order to practice the Confucian virtue of filial piety. He sharpened his medical knowledge during the process of caring for his ill mother. In Confucian Chosǒn society, a patient was encouraged to be deeply involved in the process of his or her medical treatment and the space of clinical treatment was not an exclusive domain for the doctor, but for public discussion, where both doctor and patient participated in making the best medical choices. In this atmosphere, a patient's family members would also naturally learn the clinical process, not unlike today's interns learning from renowned doctors. Second, after studying medicine up to a professional level, Yi Mun-gǒn administered the "life-saving" medicine to many people, yet he did not open his doors to all individuals. His medicine was practiced within his social network of blood, regional, and intellectual relations, where priority was established according to the level of closeness to himself, according to Confucian ideology. Nevertheless, because he did partially accept patients outside of these networks, his practice setin motion the symbolic system of Confucian ideal of universal "life-saving."Third, in the Sǒngju region during the 16thcentury, various methods of treating illnesses-such as medicine, divination, sutra-chanting, exorcism, and kumyǒngsisik (life-saving, food-offering ritual)-co-existed and were selected according to individual conditions. Confucianism did not want to either acknowledge or outright reject most of these methods, except for officially acknowledged medicine, at that time. In fact, this coexistence was inevitable because there was not one entirely effective means of curing illness at that time. Also, the system of Confucian ideology was not powerful enough to enforce what it championed. On the contrary, behind the outer austerity of Confucian society, people sought out unorthodox methods, such as exorcism, Buddhism, and Taoism-ironically, in order to practice the important Confucian values of filial piety and patrilineage in the face of their parents' or sons'illnesses. It was only after the emergence of modern ideology and methodology of hygiene, which had the ability to control epidemics and prioritize the preservation of the life of individuals and the population, following the opening of the port in the late 19th century, that this pluralistic culture for illness management became much less prevalent.

摘要

由于微观史研究过去的方法基于对人类生活具体细节的理解与同情,其兴趣领域与医学史和医学人文领域相互重叠,后两者研究疾病与健康。如果我们将特定时期的特定地区和社会置于显微镜下并放大倍数,就能理解身体、疾病管理与医学之间众多的网络联系,以及应用于它们的知识和权力的多层次性。而且,这种用微观史阐明医学史的方法可能比任何其他历史方法都更有效。本文聚焦于李汶崐卷帙浩繁的《木斋逸记》,从微观史的视角探讨医学史。简单来说,这部作品是一位儒家学者兼医生的日记。其作者李汶崐,在担任三品高级官职后经历了23年流放,期间虽非专业行医,却扮演了儒家医生的角色。多亏了这本内容丰富且详细的日记,我们现在得以全面而深入地了解他在被流放地——首尔东南270公里处的松州地区的医疗实践。本文旨在通过微观史采用的“放大”方法,了解16世纪松州地区的医疗实践状况。具体而言,我将关注以下三个方面:1)李汶崐学医的动机与方法;2)李汶崐作为“活人之术”(救人行为)的患者治疗特点;3)包括“病占”(疾病占卜)、诵经、驱魔和“朝天”(向天祭祀仪式)等多种疾病管理方法的多元存在。这三个方面都与儒家思想密切相关。首先,李汶崐为践行儒家的孝道美德,决定获取专业水平的医学知识。他在照顾生病的母亲过程中提升了自己的医学知识。在儒家朝鲜社会,鼓励患者深度参与自身的治疗过程,临床治疗空间并非医生的专属领域,而是供公众讨论的地方,医患双方共同参与做出最佳医疗选择。在这种氛围下,患者家属也会自然而然地了解临床过程,这与如今实习生向知名医生学习并无不同。其次,在达到专业医学水平后,李汶崐给许多人施用“救命”药物,但他并非对所有人敞开大门。他的医疗行为在基于血缘、地域和知识关系的社会网络内进行,根据儒家思想,依据与他关系的亲疏程度确定优先级。然而,由于他确实部分接纳了这些网络之外的患者,他的实践推动了儒家普遍“救命”理想的象征体系。第三,在16世纪的松州地区,各种治疗疾病的方法——如药物治疗、占卜、诵经、驱魔和“救命飨礼”(救命、供品仪式)——并存,并根据个人情况选择。当时的儒家思想除了官方认可的医学外,不想承认也不想完全排斥这些方法中的大多数。事实上,这种并存是不可避免的,因为当时没有一种完全有效的治愈疾病的方法。而且,儒家思想体系的力量还不足以强制推行其倡导的内容。相反,在儒家社会表面的严肃背后,人们寻求非正统方法——如驱魔、佛教和道教——具有讽刺意味的是,是为了在面对父母或儿子的疾病时践行儒家重要的孝悌价值观。直到19世纪末港口开放后,现代卫生观念和方法出现,有能力控制流行病并优先保护个人和人口的生命,这种多元的疾病管理文化才变得不那么普遍。

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