清朝蒙医医事制度研究
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摘要
中国是一个统一的多民族国家,各民族共同创造了华夏文明。在众多民族医药当中,蒙医学(包括蒙药学,以下同)是一块灿烂的瑰宝,是祖国传统医学的重要组成部分之一。蒙医学同其他传统医学一样,都是在人们长期的医疗实践中逐步形成和发展起来的,具有鲜明的民族特色和地域特色。《黄帝内经》、《汉书》等,都记载了一些蒙医医疗活动的情况。16世纪末,随着藏传佛教格鲁派(黄教)传入蒙古,藏医的许多经典著作也随之而来。蒙医学在原有基础上吸收藏医三因学说和临床治疗经验形成了自己的体系。到了清代,蒙医理论、诊断、方剂、疗术、防疫、正骨以及临床各科都得到前所未有的发展,涌现出大量的蒙医学家和蒙医学著作。任何事物只有在内外界环境、条件都适合其发展的时候才能欣欣向荣。那么,清代蓬勃发展的蒙医学也必定存在符合其自身发展规律的内外在因素。所以有必要以清代为切入点,通过系统研究有清一代蒙医医事制度,初步理清蒙医学发展脉络,为现代蒙医学发展提供资鉴。
     笔者在撰写本文时,学习了部分蒙医药知识,还曾到蒙医的主要发祥地——辽宁省阜新佛寺公社进行过实地考察,采访了一些相关知情人员,获得了一些资料。在此基础上,笔者通过整理研究所收集到的资料,将清朝蒙医医事制度主要分为宫廷和地方两种机构制度进行研究。
     宫廷的主要机构为上驷院绰班处。蒙医骨科受蒙古民族生产方式和生活习惯的影响,形成较早,发展较快,具有鲜明的民族特色,是蒙医的一门主学科。早在清初,清统治者就已接触、了解到蒙医精湛的正骨技术,并在上驷院设立了绰班(“绰班”为满语,意为正骨)处这一蒙医医疗机构,专门为自己服务。
     地方的主要机构是喇嘛寺庙中的“曼巴扎仓”。蒙医与喇嘛教有着密不可分的联系,在传播和发展蒙医学方面,作为传播喇嘛教载体的寺庙更有它不可替代的重要作用。清政府自提倡黄教以来,在蒙古地区广建寺庙。随着寺庙不断地发展、扩建,很多规模较大的寺庙都设立了曼巴扎仓,即便规模较小没有设立曼巴扎仓的寺庙,一般也都设有医生席位。当时蒙古医道缺少,这些僧人通过为当地人民治疗各种疾病,达到了传教的目的。
     蒙古地区许多著名医生都是出身于召庙的喇嘛。蒙古地区的曼巴扎仓无论从组织形式还是教学内容,最初在很大程度上借鉴了藏医学的模式,许多医生撰写的著作也是用藏文写成的。到了18世纪,这种状况有所改观。蒙医学者将藏医学的理论、医疗经验与本地区的自然气候、生活习俗、疾病流行特点等因素结合在一起,提出了“六基症”、“十要症”等蒙医理论,奠定了近代蒙医学的基础。这个阶段也是蒙古传统医学吸收藏医知识的过程。19世纪,许多出身于寺庙的喇嘛,在蒙医理论、诊断、药物、方剂、疗术及临床各科等领域著书立说,使蒙医学术理论体系更加趋于完善。
     蒙古草原除有系统组织的曼巴扎仓为广大牧民提供医疗服务外,还有一些萨满和还俗喇嘛为牧民诊治疾病,形成一种散在的医疗活动形式。由萨满传承的医学属家传式医学,而由还俗喇嘛传承的医学则兼顾寺院与家传两种性质,属寺院家传混合式医学。
     清廷推崇黄教,萨满教虽在一定程度上受到排挤,但其传承下来的蒙医药学却较少受到清政府的干预,有相对自由的发展空间,更多地继承了传统蒙医药知识。萨满教的社会地位与喇嘛教不可比拟,以这种形式传承下来的蒙医学也并非主流。只是寺院曼巴扎仓的一种补充。另外,萨满传授蒙医药知识多以家传(或授徒)方式进行。这是一种神秘而保守的医学传授方法,在一定程度上保持了传统特色,但也难免出现断代失传现
China is a unified country composed of multiracial nation, and each race created China civilization together. Among these multiracial medicines, Mongolian medicine(including Mongolian pharmacy, the following together) is a brilliant treasure and an important part of traditional medicine in the motherland. Like other traditional medicine, Mongolian medicine forming and developing gradually in the people's long-term medical practice, having clear-cut race and region special features. Huangdi Nei Jing, Han book etc., all of these books have recorded the actions which people using Mongolian medicine to cure for disease. At the end of 16th century, many classic Tibetan medical works along with the Buddhism Dgelugs-pa(Yellow Sect) are rolling into Mongolia. Mongolian medicine on the original foundation, absorbed the three-cause theory and clinical treatment experience of traditional Tibetan medicine became own system. Arrive to Qing dynasty, Mongolian medical theories, diagnosis, pharmacy, treating technology, preventing epidemic disease, bone-setting and each clinical sections all get an unprecedented development, famous Mongolian medical doctors and works are emerging in a constant stream. Any thing can grow flourishing when inside and outside environment and conditions suit for it's development regulation. So, the rapidly development of Qing dynasty's Mongolian medicine must have some internal and external factors which fit for it's development rules. So it is necessary to take Qing dynasty as an important researching point, through research to Mongolian medical work regulation systematically, make clear out the train of thought of Mongolian medicine, and providing a reference for the modern Mongolian medicine's development.The writer studied part of Mongolian medical knowledge while composing this text, even once have gone to Mongolian medicine's main cradle- Fuxin Fosi commune of Liaoning province, carried out on-the-spot investigation, covered some insiders, acquired some data. On this foundation, the writer through sorting and studying the collected materials divide Qing Dynasty's Mongolian medical work regulation into two parts, the fist one is the imperial palace organization systems, the other one is the local place organization systems.The main organization of imperial palace is Shangsiyuan Chuoban. Orthopedics of Mongolian medicine have influenced by the production and living habitual of Mongols greatly, becoming early, developing quickly, having fresh and clear race special features, and became a main subject of Mongolian medicine. Early Qing dynasty, the Qing ruler has already got in touch with the consummate bone-setting skill of Mongolian medicine, and established a medical treatment organization Chuoban("Chuoban" is Manchuria language, meaning bone-setting) place at Shangsiyuan, only provided service for themselves.The main organization of local place is Lama Temple's Manbazhacang. Mongolian medicine have an inseparable contact with Lamaism. As a carrier of spreading and developing Mongolian medicine, the temple has an important and irreplaceable position. A large number of temples have been built at Mongolia region since Qing government promoted Yellow Sect. Along with the temples' constantly developing, a lot of temples with bigger scales are all established Manbazhacang, even those smaller scale temples which hadn't established Manbazhacang, also established a doctor's seat. Mongolia doctor were lacked at that time,
    these lama through to treat various disease for local people, coming to the purpose of preaching Buddhist doctrines.Many famous Mongolia doctors in Mongolia region were from the temples' lama. At the beginning Manbazhacang of Mongolia region regardless from organized form or content of course, drawing a large extent lessons from the mode of Tibetan medical science, many doctors compose the work by Tibetan language. 18th century, this kind of condition had to present new look. The Mongolian medical scholar combine Tibetan medical theories and treatment experience with local natural climate, life custom, the characteristic of epidemic disease etc. factors, putting forward many new theories such as "Liujizheng", "Shiyaozheng" etc. and establishing modern Mongolian medical foundation. This stage is also the process that the traditional Mongolian medical science absorbing Tibetan medical knowledge. 19th century, many Lamas who were from temples, in Mongolian medical theories, diagnosis, medicine, treating technology and each clinical section etc. area expounding their ideas in writings. It made Mongolian medicine academic theories system more perfect.In addition to the Manbazhacang which has systematic organization providing a medical treatment service for the large herding people in Mongolia, there are some Shaman and resume secular life's Lama to make a diagnosis and give treatment for local people, and it become a kind of spreading medical treatment form. The medical science which handed down from Shaman belonging to the family type medical science, and which from resume secular life's Lama have temple and family properties belonging to" mixed temple and family type medical science.The Qing government worships Yellow Sect, the Shamanism was attacked to some extent, but the Mongolian medicine passed on by them was less intervened by Qing government, so it have relative freedom space in development, and it inherited more traditional Mongolian medicine knowledge. The social status of Shamanism can't compare to Lamaism, the Mongolian medicine handed down by this form are not essential, just as a kind of complement of Manbazhacang. Moreover, Shaman passed on Mongolian medicine knowledge with the form of inherited in the family .This is a kind of mysterious and conservative method, kept traditional special features to some extent, but sometime it fail to handed down from past generations unavoidably, on the contrary in certain degree it limited the development of traditional sect. Therefore, this Mongolian medicine developing form in Qing dynasty just more inherit, rare innovation development, and nearly no monograph came out. Much Mongolian medical knowledge handed down by Shaman are traditional therapies, such as bone-setting, emergency treatment, brain-setting, massage etc..The mixture way of the temple and the family education of Mongolian medicine was produced for social activities circumstance in Mongolia region at that time. This educational way not only inherited traditional Mongolia medical science but also blended with temple's advanced medical knowledge, have certain superiority. And it also fit for the living habit of Mongols, remedied the defect of temple's fixed location.At that time these spreading educational ways of Mongolian medicine are beneficial to the temple's educational system. The Mongolian medicine passed down in these ways usually are what elder teach junior by precept and example, so it have such characteristics as direct and easily to be controlled. This kind of way which academic spreading in family have exclusiveness in some extent, hence the scope of the induction isn't as extensive as temple's.
    These spreading way not only enriched Mongolian medical education forms, but also brought convenience for Mongolian people to see a doctor.Through researches into Mongolian medical work regulation of Qing Dynasty, the writer think the development of Qing dynasty's Mongolian medicine have two main lines: One is traditional Mongolian medicine that from the Bo(or Wudagan)of Shamanism;Another is traditional Mongolian medicine that growing up in temple's Manbazhacang. The development of Mongolian medical science can be divided into three processes: First is the process that traditional Mongolian medical science continue to gain experience;Second is the process that the traditional Mongolian medical science absorb Tibetan medical theories knowledge;Third is the process that Mongolian medicine continue to develop after absorbing Tibetan medical theories knowledge.This text discuss those factors which influence on the development of Mongolian medicine, these factors mainly are the policy of Qing government ruling Mongols, policy of religious, temple's regulations, the natural environment of Mongolia region, the Mongolia living custom and personality etc..As race policy, the Qing government mainly adopt the policy of "suit measure to customs", and spreading Mongolian writing in Mongolian region, promoting to use Mongolian language and Mongolian writing, also organized a great deal of manpower and material resources to translate Tibetan Buddhist scriptures such as Vkmzkuer, ganzhuer etc. into Mongolian language. These unprecedented active translation and print activity, make a lot of Tibetan medicine contents streaming into Mongolian region, and infuse new vitality into traditional Mongolian medicine, also accelerate the process that Mongolian medicine theories turn and systematize.Religious policy aspect, because of Qing government's supporting, the number of temple and Lama increasing quickly, it make Manbazhacang burgeoning at Mongolian region. The Qing government give Lama very high treatment from policies to wealth, it made Lama setting their mind to study. Qing Court still established some rules for lama to practise medicine. These rules had promoted the quality of practising medicine to a large extent, and reduced the phenomenon of "false lama doctor" to practise medicine, so it is a good measure for praise.The temple system aspect, each Manbazhacang has it's own teaching and practises medicine system, but the academic degree promoting rules are much the same with only minor differences. The academic degree promoting mainly by the debate examination. Its strict request makes each apprentice lama study hard, in order to acqurie a good result and academic degree. Argument examination form has opening character, it will give each apprentice lama an equal opportunity to promote, as long as apprentice lama study hard, there is hope to acquire academic degree. Temple have very strict jegulations for Lama to practise medicine: The one who beg to cure can not to pay any service fees, but if the Lama who invited is a "Daobuqie"(the private doctor of living Buddha ) need to prepare cart and horse for Daobuqie to use. At that time, this provision raised Lama doctor's social status undoubtedly.The natural environment is an important factor which influences mankind's activity, is also an important factor which decide local resident's production, life style, and spiritual life. The special weather, geography condition in Mongolian region, make the animal, plant, mineral medicine forming their own characteristics. These abundant medicine resources are the essential factors to the development of Mongolian medicine. We can say that the natural
    environment of Mongolian plateau is exactly the rich soil where Mongolian medicine are forming and developing.Part of contents of living customs have a close contact with medicine, hygiene and health care. Mongolian ancestors were restricted by nature condition, chose nomadic life style historically. This kind of life style makes Mongols shaping many special life custom, thus influence the formation and the development of Mongolian medicine which have a close interrelation with it. Such as the custom of drinking sour horse milk, make Mongolian medicine sum up a special kind of "sour horse milk therapy".The Mongols have broad-minded, the bold and uninhibited character make them accept other races' excellent culture more easily. The Mongols adopt a "bring here doctrine" attitude towards the experience of defending disease and medicine knowledge which accumulated by neighbouring countries and region's people for several thousand years, and infusing new vitality into traditional Mongolian medicine constantly. This is an important reason why Mongolian medical developing up to now and isn't on the wane.Through researching into the development condition of Qing Dynasty's Mongolian medicine, this text regards the governmental support, reasonable policy, scientific teaching system, fair promoting system and Mongolian medicine continuously creative enterprising spirit are all the important factors that influence and decides to Mongolian medical development, but among them the loosen policy established by Qing government is a key to development of Mongolian medicine.
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