Chapter 21 Chapter 6 Ancient Medical Affairs Management and Medical Education
Before the Zhou Dynasty, the medical management system could no longer be studied in detail. According to the analysis of unearthed cultural relics, doctors and witches were closely related, and divination was used to predict diseases and good fortune. This was still the case in the Shang Dynasty.
Although the "Zhou Li", which is called the "Official Classic", is said to come from the Eastern Zhou Dynasty, the official names in it cannot be fabricated at will, so it can reflect the official system and system of the royal family of the Western Zhou Dynasty. In "Zhou Li", the duties and responsibilities of Chinese medicine practitioners and shamans have been clearly separated. The medical officer belongs to the "Tianguan Zhongzai", and the shaman Zhu official belongs to the "Chunguan Zongbo".Medical officers set up "physicians", with two sergeants, four corporals, two officials (custodians), two historians (secretaries), and twenty apprentices; "food doctors": two sergeants; ": eight sergeants; "ulcer doctor": eight corporals; "veterinarian": four corporals.Physician is the leader of all medical officers and is in charge of medical administration.If there are sick people in the country, the doctors will distribute them to various medical officers for treatment, and the treatment effect will be recorded in the record.At the end of the year, the salaries of the medical officers are determined according to their treatment effects.Perfection is the top; cure ten losses to one, followed by second; cure ten losses to two, and then again; cure ten losses to three, and second; cure ten losses to four is the bottom.Based on this, it is divided into five grades.The food doctor is responsible for preparing food for King Zhou, which is equivalent to today's nutritionist.All kinds of food such as grains, drinks, meat, vegetables, etc. must be prepared according to the law of seasons and five flavors.Disease doctors treat internal diseases, and patients who are sick are divided and treated. After treatment, the cause of death of the patient must be recorded and submitted to the doctor.Ulcer medicine specializes in the treatment of sores, trauma, and bone injuries.Veterinarians are responsible for treating veterinary diseases, and after treating deaths, they must also record the number as the basis for promotion and promotion.This is the earliest document about the medical system, but the medical career in the Zhou Dynasty was not limited to this. According to historical facts, each prince also had a full-time doctor at that time.Probably Qin State's medical skills are relatively high, so "Zuo Zhuan" records that Jin Jinggong and Jin Pinggong asked doctors from Qin State when they got sick, so the medical delay and medical harmony were recorded in the annals of history.This historical material also shows that there were medical exchange activities among the vassal states at that time.
But the above are all medical officials serving the emperor of Zhou and the princes. After all, the objects they serve are limited, so the society mainly relies on folk doctors who are not under the jurisdiction of the government.Bian Que (from Qinyue) is an outstanding representative among them. He is well-known all over the world, and he freely practiced medicine between various vassal states, and his specialty also changed according to the custom.These facts show that during the Eastern Weekend period, the level of medical care and social needs no longer met the rough division of "disease medicine", and more detailed medical divisions have been formed among the people.
There are not many relevant documents on the medical administration in the Qin Dynasty.It is only known from historical biography that there are imperial physician orders and attendant physicians.The Imperial Physician Order is the highest officer in the medical administration; the physicians are at the king's side, in response to emergencies.During the Warring States Period, the medical officers of the Qin State were set up in this way. Around the Eastern Zhou Dynasty, there were also differences in the establishment of the vassal states, but they never left the main line of doctors (emperor physicians) in charge of all doctors (servant doctors).
The establishment of medical officials in the Western Han Dynasty was divided into two branches, each with an imperial physician order, an imperial physician officer, and an attendant physician (also known as an imperial edict).One is affiliated to Taichang (central agency in charge of the etiquette of the ancestral temple and the selection of doctors); the other is affiliated to Shaofu (an agency serving the royal family).At that time, all the vassal states also set up imperial physicians and attendant physicians. For example, among Chunyu Yi's disciples were the imperial physician of King Jibei and the attendant physician of King Qi.Female doctors also appeared among the attendants, also known as breast doctors, that is, obstetricians and gynecologists.
The medical officials of the Eastern Han Dynasty were all under the command of the Shaofu. There was one imperial physician order, who was in charge of medical affairs management, two medicine officials, who were in charge of medical affairs, and two Fangcheng officials, who were in charge of formulating.There are 293 doctors and 19 officials.Other names of medical officials include Attendant Physician, Shangyaojian, Chief Pharmacist, Chief Medical Officer, Chief Medical Engineer, etc., among them there may be more than one post.
During the Three Kingdoms period, Wei inherited the Han system and set up the Imperial Physician Order, the Imperial Physician, the Shangyao Supervisor, the Yaochang Eunuch Supervisor, and the Ganoderma lucidum Garden Supervisor.
The Imperial Physician Order of the Western Jin Dynasty has a "copper seal and ink ribbon", which belongs to Zongzheng.Zongzheng of the Eastern Jin Dynasty was merged with Taichang, and the officials of the imperial physician belonged to the province under the door.
In the Southern Dynasties and Song Dynasty, there was one imperial doctor order and one prime minister, who belonged to Qibu (an institution that built ancestral temples and palaces) and also belonged to the leading army (in charge of the central army, as a subordinate official of the Xiangfu).This system has been extended to the Southern Qi Dynasty.In the Liang Dynasty, under the Imperial Physician Order, there was also an Imperial Physician Zheng, and all the imperial physicians were also responsible for educating medicine, and the Imperial Physician Order was still under the Menxia Province.Chen Xiliang system.The Northern Wei Dynasty adopted the old system of the Western Han Dynasty: the Imperial Medical Order was Taichang, and the Shangyao Province set up a Shangyao Bureau.Under the Imperial Physician Order, there are official positions such as Imperial Physician Cheng, Imperial Physician Doctor, Imperial Physician Assistant Teaching Assistant, etc., and have fixed ranks.The Northern Qi Dynasty and the Northern Zhou Dynasty had roughly the same medical system. The Shangyao Bureau had two Dianyu, four attendant imperial masters, and four Shangyao supervisors who were in charge of imperial medicine.In addition to the Imperial Physician in the Northern Zhou Dynasty, there were also minor doctors under the doctor, minor doctors, ulcer doctors, ulcer doctors, ulcer doctors, medical officials, doctors, doctors, food doctors, and chief physicians. The corporal of medicine belongs to the heavenly official (official department).The upper, middle and lower veterinarians belong to Xia Guan (Military Department).The establishment of the hospital began in the Southern and Northern Dynasties, and it was set up for "the poor, sick and unable to support themselves". There are records in "Book of Southern Qi" and "Book of Wei".The titles of medical officials from the Southern and Northern Dynasties also reflected the existing medical education function at that time.Qin Chengzu, the Imperial Physician of the Liu Song Dynasty, proposed to set up medicine and became the first person to establish medical education.
After Emperor Wen of the Sui Dynasty Yang Jian unified the north and the south, he made many major reforms to the country's laws and regulations, and the medical management system was also improved.The medical officers of the Sui Dynasty belonged to Menxia Province, Taizimenxiafang, Taichang Temple and Taipu Temple respectively.Under the Menxia Province, the Bureau of Shangyao and the Bureau of Shangshi are in charge of medical and health care matters for the palace; under the Prince’s Gate, the Bureau of Tibetan Medicine is under the administration of the Prince’s Tibetan Medicine Bureau, which is dedicated to serving the East Palace; the Taichang Temple is under the administration of the Imperial Medical Administration, which is the most important medical management and medical education institution; The servants are veterinarians and serve the imperial stables.In the Sui Dynasty, the division of labor between medical officials was very detailed and large-scale, and medical education also started to be taught in different disciplines, including doctors of medicine, doctors of massage, doctors of Zhu Jin, and doctors of veterinary medicine.
The Tang inherited the Sui system, but it was more stringent than the Sui system in terms of medical administration, medical care, pharmaceutical affairs, and education.The most important thing is that the medical education of the Imperial Medical Office in the Tang Dynasty has the scale of a medical school, which can be said to be the earliest medical school in the world.Tang Tai Medical Office had 16 chief executives, including two officials, two officials, four medical supervisors, and eight doctors.The Imperial Physician Order is in charge of all the work of the Imperial Medical Office, with the Imperial Physician Cheng as the assistant, and the following are the Medical Superintendent and the Medical Officer.It is divided into two parts: medicine and pharmacy.
Medicine is divided into four subjects, namely medicine, acupuncture, massage, and mantra.Doctors, teaching assistants, physicians, medical engineers, and doctors are assigned to each subject.The four departments of traditional Chinese medicine are the largest and have the largest number of teachers and students, with a total of 164 teachers and students; followed by acupuncture, with 52 teachers and students; massage, 36; and curse and ban, 21.Medicine is divided into five majors, and the length of study is different.That is, physical therapy (internal medicine) for seven years; juvenile and pediatrics (pediatrics) for five years; ulcers (surgery) for five years; ears, eyes, and articulation for four years; horn method (physiotherapy) for three years.The number of students in each department is also different. Physical therapy students are the most, accounting for more than half of the medical students, while there is only one student in angle law.After medical students enter school, they first learn basic courses, including classics such as "Su Wen", "Mai Jing", "A and B Classics of Acupuncture and Moxibustion", and then study their respective clinical specialties.The basic courses of acupuncture are the same as those of medicine, and then learn meridians, acupuncture points, and acupuncture.The massage department learns the method of message guidance, including bone and injury treatment.The method of cursing and banning science "fulu [lulu] wishing [fufu]".The assessment system of the Ministry of Medicine is also very strict. At the time of admission, "examinations are as good as those of the Imperial College (Tai Xue)", and after admission, the examination is conducted by a doctor once a month; The higher authority of the department) conducts a general examination on the students.According to the pros and cons of the test results, the future of the students is determined.Students whose academic performance exceeds the level of medical officers in the department will be replaced; if they still fail the exam after nine years of study, they will be ordered to drop out of school.Moreover, the strict assessment is not limited to students. "Every doctor, doctor, and medical worker treats a person's disease, and writes about how much he has recovered, thinking that he will test the class." This ensures the quality of teaching, and at the same time encourages medical officers to study medical skills. Diligent in practice, in order to keep making progress.
In the pharmacy department, there are two people from Fu, four people from Shi, eight people from main medicine, 24 people from medicine children, two people from medicine garden teachers, eight people from medicine garden students, and four people from Zhanggu (warehousing).Pharmacy built a medicine garden in Chang'an City, planted medicines, and recruited young people under the age of 20 from the common people as students in the medicine garden.Under the guidance of teachers, students in the medicine garden learn to cultivate, collect, identify and process medicines.The establishment of the medicine garden not only cultivated pharmaceutical talents in practice, but also became a base for physical research of medicinal materials.Therefore, it is no accident that the world's first pharmacopoeia was completed in the Tang Dynasty.
As a place for medical education, the Imperial Medical Office of the Tang Dynasty is also remarkable in the history of world medical development.It appeared more than 200 years earlier than the earliest medical school in Europe, the Salerno Medical School in Italy, and its large scale, detailed divisions, and strict organization are incomparable to the latter.
Medical education in the Tang Dynasty was not limited to the central government, but spread throughout the country.From the third year of Zhenguan (AD 629), many state capitals also established local medical education institutions, which were in charge of doctors of medicine (later called doctors of medicine).These reflect that the medical education industry was very prosperous at that time, so the Tang Dynasty attracted medical students and monks from many countries to study in our country, and some countries also imitated the system of the Tang Imperial Medical Administration to establish their own medical systems.
my country is the first country in the world to adopt the isolation system for leprosy patients.At the latest in the Qin Dynasty, there was "疠(li) relocation", and there was a record in the Qin law about the compulsory isolation of leprosy patients.In the Tang Dynasty, the "Danrenfang" was more common than before. At first, the Danrenfang and the sickroom (hospital) were placed in temples equally. After Tang Wuzong banned Buddhism and abolished monks and temples, it was managed by the local government.
During the Five Dynasties and Ten Kingdoms period, the warlords separated the regimes, the regimes were scattered and changed frequently, and it was impossible to create new laws and regulations.However, the position of Hanlin medical officer was established during this period, and was later inherited by the Song Dynasty.
The medical management system of the Song Dynasty underwent several reforms. Generally speaking, the Song Dynasty was the government that paid the most attention to medicine in all dynasties. , There are new measures in the system and setting, so it has made more outstanding achievements.
In the Song Dynasty, the Hanlin Medical Official Academy was established to be in charge of medical administration, while the Imperial Medical Bureau was in charge of medical education, thus separating the two.
The Hanlin Medical Official Academy (later renamed "Medical Official Bureau") was in charge of medical decrees and palace medical affairs.There are eight departments of Dafangmai (internal medicine), Xiaofangmai (pediatrics), obstetrics, ophthalmology, acupuncture, sores, articulation, and golden arrowheads, and the medical officers are uniformly assigned by the medical official hospital.In the early Song Dynasty, there was no fixed number of staff in the medical official academy. In the first year of Baoyuan (AD 1039), it was stipulated that there should be 102 people, including envoys, deputy envoys, Zhiyuan, Shangyao Fengyu, medical officials, medical officials, and Zhiwai.By the time of Emperor Huizong, there were "overwhelming medical positions", and there were more than 1,000 medical officials in the hospital. The ranks of medical officials were set up with 14 ranks, such as Dr. An and Dr. Cheng'an. 22 steps.Because the official titles of medical staff are mostly called "doctor" or "doctor", so later in northern my country, doctors were called "doctor", and in the south, doctors were called "doctor", forming a customary appellation.Hanlin medical officers are selected and appointed from those who are over 40 years old and have passed various examinations. Among them, those with the best grades stay in the Hanlin Medical Academy, and others serve as doctors of medicine, or are sent to other states as professors of medicine.In addition to the central government, there are also medical officers in other states and counties.The laws of the Song Dynasty stipulated the professional ethics requirements of doctors and the punishment methods for medical malpractice.Anyone who uses medicine to defraud property will be treated as a bandit; quack doctors who accidentally injure lives will be brought to justice; officials in charge who do not sympathize with the suffering of their subordinates will also be punished.
The Imperial Medical Bureau in the Song Dynasty was a specialized medical education institution.The Imperial Medical Bureau has one referee (principal) and two judges (vice principals), and it is specially stipulated that the post of the judge should be held by a "knowledgeable doctor".There are three disciplines: Fangmai (learn Dafangmai, Xiaofangmai, Fengke); Acupuncture (learn acupuncture and facial features); Ulcers (learn sores, fractures, golden sores, book ban).The compulsory courses of the three subjects are "Plain Questions", "Difficult Classics", "On the Causes and Symptoms of Various Diseases", "Supplementary Notes on Materia Medica", and "Thousand Gold Prescriptions". According to the needs of undergraduates, different professional homework is set.Each subject has one professor, and the number of students is 300. According to the "three houses" method (a method of assessment and teaching students in accordance with their aptitude created by Wang Anshi's reform education in Taixue), 40 people are divided into "upper houses" and "inner houses". 60 people, and 200 people in the "outside house".The exam is completely modeled on the Taixue exam method: a private exam every month, a public exam every year, and an exam every other year.Those with excellent grades will be promoted to the inner house or the upper house.In addition to the examination, let the medical students take turns to diagnose and treat diseases for the students of the other three schools (namely Taixue, Law School, and Wuxue) and the soldiers of each battalion, and record the treatment process and effect. Those who are poor (that is, those who lose five out of ten) will be expelled from school.Learning and assessment focus on both theory and practice, which is indeed a major advancement in medical education.During the Southern Song Dynasty, the Imperial Medical Bureau changed many times, but the examination system remained unchanged.In addition to the central government, the states and counties have also followed the example of the Imperial Medical Bureau and set up local medical schools, where doctors of medicine are assigned to teach medicine, and some current officials who are proficient in medical skills serve as teachers.
In the Song Dynasty, there were also "Royal Medicine Institute" and "Shangyao Bureau".The Royal Pharmacy Institute kept the precious medicinal materials tributed at home and abroad for use by the court; the Shangyao Bureau was the highest drug administration agency in the country.When Wang Anshi's new law was implemented in the Northern Song Dynasty, medicines were national patent products, and the government controlled the medicine trade. Several "pharmacy sales offices" and "repair medicine offices" (that is, processing workshops) were set up to supply formulas and sell medicines.This kind of official medicine bureau run by the government, because it prevents businessmen from speculating, the price is low, and the quality is guaranteed, and when the epidemic is prevalent, it can also provide preventive medicines for free, so it is convenient for the people to seek medical advice, and it is also beneficial to the country and society. It was later renamed "Taiping Huimin Bureau" and "Heji Bureau" and extended to all states and counties across the country.The establishment of the official drug bureau also played a positive role in standardizing the prescription of patented medicines and promoting the use of patented medicines.The Song court also ordered Pei Zongyuan, Chen Shiwen and other medical officials to sort out the prescriptions collected and used by the official pharmacy bureau, and compile them into the "Mixed Prescription Bureau" as a preparation specification.Later, it was supplemented and renamed "Taiping Huimin Heji Bureau Prescription" and promulgated all over the place, which had a great influence at that time and later generations.
In addition to the establishment of the Medical Official Academy and Shangyao Bureau, the Song Dynasty also took some measures and set up some institutions in medical treatment, health care, and charity.Such as Anjifang (a place hosted by monks to treat diseases for poor people), Baoshou Cuihe Pavilion (a sanatorium for patients with illnesses in the court), Sanatorium (responsible for recuperation of foreign guests and tourists when they are sick), Futianyuan (located in the suburbs of the capital, to adopt the orphans, widows, sick, and old people), Louze Garden (to bury the poor dead or unowned bones), etc.
The Song court attached great importance to the collation of medical books, and made outstanding achievements in the revision of various medical books such as medical classics, herbal medicines, and prescriptions.A group of well-known medical scientists and other scholars gathered at the Correction Medical Books Bureau to collect, collate, verify, and collate important medical books of all dynasties in a planned way, and published them one after another.Many medical classics that have survived to the present, such as "Su Wen", "Treatise on Febrile Diseases", "Synopsis of the Golden Chamber", "Jade Letters of the Golden Chamber", "Multiple Classics", "Classics of Acupuncture and Moxibustion", "The Origin of Diseases" "On", "Thousands of Golden Prescriptions", "Thousands of Golden Prescriptions", "Waitai Secrets", etc., were all sorted out by the revised medical bookstore during this period, thus making important contributions to the preservation and dissemination of ancient medical books .
The medical management organization of the Song Dynasty can be said to be comprehensive in medical administration, drug administration, medical treatment, education, medical registration, and social welfare.In particular, the medical and health undertakings have obviously not been limited to the court, and have taken a big step forward in facing the society.Although due to various malpractices of the feudal society, the implementation of some measures is very reluctant, even inconsistent with the name, but from the perspective of the system itself, it can be said that it has made obvious progress compared with previous dynasties.
In the Jin and Yuan dynasties, the medical system not only inherited the Song system, but also had its own corresponding characteristics.During this period, the Hanlin Medical Official Hospital was renamed "Taiyuan Hospital". Since then, the name of Taiyuan Hospital has been used until the Ming and Qing dynasties.In order to improve the level of medical care and prevent quack doctors from killing people, in the ninth year of the Yuan Dynasty (1272 AD), a "Medical Promotion Department" was established to take charge of such things as the examination of doctor qualifications, the assessment of in-service medical officers, and the editing and review of medical books, medicinal materials, etc. identification, training of medical staff and other matters.
In view of the fact that the medical system of the Jin and Yuan Dynasties inherited from the Song Dynasty had already been developed quite well, the Ming Dynasty mostly continued to use it directly, with only minor adjustments in the allocation of officials and institutional functions, and began to set up imperial doctors in the sixth year of Hongwu (1373 A.D.) .
The imperial hospital system in the Qing Dynasty can be said to be more complete.In addition to the regulations on administrative settings and the number of doctors and doctors, the on-duty system of imperial doctors is also clarified.In terms of the promotion of medical officers, Qingtai Hospital's system is also stricter than previous dynasties. In addition to examination and selection, medical officer guarantees are also required.The Tai Hospital was divided into 11 departments during Shunzhi, and nine of them took the longest time to be classified, namely, Dafangmai, typhoid, women, Xiaofangmai, articulation and throat, eyes, sores, bone setting, and acupuncture.Lieutenant Jiaqing merged Orthopedics into Department of Sores and Ulcers.In the second year of Daoguang (AD 1822), a decree was issued: "Acupuncture and fire moxibustion are not suitable for the king, and the Imperial Hospital is ordered to stop acupuncture and moxibustion forever."But folks have never neglected acupuncture and moxibustion.During the Tongzhi period, Dafangmai, typhoid fever, and women were combined into one discipline, so there were only five disciplines.In the Qing Dynasty, subjects such as Zhu You and Forbidden Spells of previous dynasties were removed, which is undoubtedly a progress in medicine to eliminate the false and preserve the true.
The medical education in Qingtai Hospital is divided into "internal teaching" and "external teaching".The students in the internal teaching are eunuchs, and the students in the foreign teaching are the male brothers and nephews of medical officials.In the first year of Tongzhi (AD 1862), the Qing government was established in Beijing. It once set up medical courses, but still taught "Su Wen", "Mai Jue", Materia Medica, and Fang Shu.In the spring and autumn of each year, the teaching hall of the Taiyuan Hospital sends personnel to take the exam, and every six years, the Taiyuan Hospital and the Ministry of Rites take a big exam, so it is still the way the Taiyuan Hospital runs schools.During the reign of Emperor Guangxu, Chinese medicine schools began to exist in various places. At that time, the Qing government sent overseas students, including medical students.Western medical schools established by the church also appeared here one after another.The first western medicine school run by the Qing government was the "Beiyang Medical Administration", which was founded in Tianjin in the seventh year of Guangxu (1881 AD), and was later renamed "Beiyang Medical School".
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