Abstract 摘要

This essay offers a genealogy of medical epistemology in ancient China, which, unfortunately, lost its independent status after the Song Dynasty, when Confucian morality became the dominant discourse in all disciplines, including medicine. The author challenges the common view held by Confucian scholars that medicine does not constitute a self-contained domain of activity with its own morality and ethics, because it is seen as a realm of “applied ethics.” This view makes medicine, medical techniques, and medical ethics instruments for the embodiment and actualization of the Confucian virtue of benevolence (ren), but undermines the complexity of medicine and medical practice.

It is concluded that the moralization of medicine can be a dangerous practice. It is equally dangerous when ancient Chinese ideas such as “the unity of heaven and humanity” (tianren heyi) and “mutual identification between medicine and Confucianism” (yiru xiangtong) are used to explain and resolve contemporary problems without qualification.

在中國古典知識論當中,醫學(以及所有的技藝之學)與先王之法、諸子之藝本為一體,後世所謂“醫儒相通”、“醫易相通”之說源起於此。但知識論上的共同起源並不能保證醫學在歷史流變中能夠保持其地位,經過春秋時期諸子興起、學術分裂,和《漢書.藝文志》對古典知識體系進行的分類排列,醫學的知識論地位及醫者的社會地位便一路下行,諸子,尤其是儒學與技藝之學的高下、先後、體用次第關係逐漸被固定下來。到宋代援儒入醫,以“仁術”統攝之,在某種意義上進一步貶低了醫學作為技藝之學這一維度,將其落實為幫助儒家實現“仁”之價值目標的工具。經過這一知識論分裂和儒學反身侵入的知識學改造,醫學知識內部的“目的之善”與“技藝之善”的割裂也隨之加劇,再也 不能回歸到原始醫家熔融自在的自然純樸狀態。所以,想要超越今天西方因為天人二分、醫學技術與道德分離等問題而形成的倫理難題與道德困境,建構一種有效的“中國醫學倫理學”,恐怕不能用“天人合一”、“醫儒相通”等大而化之的概念輕易穿越,還有大量艱苦的工作需要一步步的來完成。