published_or_final_version / Chinese / Master / Master of Philosophy

本文回顧了前近代時期中國傳統婦產科一門的醫學沿革與歐美產科醫學的「現代化」過程，追溯了西方婦產醫學自19世紀中期以來傳入廣州的發展軌跡。同時將目光聚焦於傳統醫學與19世紀傳入廣州的西方醫學，並將兩種體系進行比較。發現在不同的情況下二者表現出不同的利弊，無法評價其各自方法之優劣。而由傳教士所帶來的西法接生因為其統一、規範的操作被務實的廣州人所接受，並被善堂採用而作為慈善服務的一種，從而在廣州傳播並得到普及。可見，在廣州的西化過程中，是國人將適合自身的西方事物融入到本地社會生活中，並在不斷的磨合中完成「現代化」，而非國人克服種種困難，不斷地追求科學等現代指標。 / 此外，本文描繪廣州社會在20世紀初期接納「西法接生」，並將其作為一種摩登的接生方法而運用的歷史。受教會訓練的「女醫生」已成為一種正當的職業在社會上存在，「西法接生」這種由西醫外科衍變而來的技術為女醫生所利用，成為她們執業的亮點。通過善堂的贈接生善舉，「西法接生」在廣州的認知度得以提升，直至政府將婦女生產納入其衛生行政體系，並對接生從業者加以規管。可見，廣州婦女分娩的「現代化」並非得力於政府衛生行政的推動，而是在更早時期自發出現的。 / 通過比較香港、北京、廣州、上海四地政府對助產人員的規管條例，不同城市顯示出各自的特色。北京、上海借助西方公共衛生行政管理方法，集中對產婆進行培訓、登記，使其接生操作符合衛生行政要求，從而建立出一套適應中國社情的混合式制度，並以這一模式進行婦女生產的「現代化」。在中國醫療西化的過程中，不同的地方社會有著不同的衛生行政管理軌跡。 / This article examines the introduction, development, and proliferation of western Obstetrics, in particular the Midwifery, in Canton from 1860s to 1930s. By comparing and contrasting treatment of childbirth by traditional Chinese Midwifery in pre-modern period, especially the Ming and Qing Dynasties to the Western Midwifery brought to Canton in this period, it is concluded that, subscribed to each distinctive medical theories, the two applied different views and strategies on the course of childbirth. Nevertheless, from an overall perspective, western Midwifery didn’t display obvious advantages compared with the Chinese traditional one. During the period of 1890s and 1920s, local philanthropic organizations actively promoted the approach and benefits of western midwifery to the local community to the childbirth modernity. / In addition, the modernization on childbirth in Canton was different to which in Beijing, Shanghai and Hong Kong. In Beijing and Shanghai, the Municipal Governments established a new blended system legislating the centralized training and registration of traditional midwives to archive childbirth modernization with the application of western public health methods. In Canton, on the contrary, a large number of young women who have had more systematic classes and professional western medical training actively in missionary or local medical schools, became so-called “Obstetrics doctors. They participated in the “Free Delivery service offered by local philanthropic organizations with their western midwifery skills as a selling point, and replaced the traditional midwives to obtaining the majority of midwives. This led to another path to childbirth modernization. / It was suggested that different areas of China progressed variously during the journey of medical modernization and Canton played the unique role in the medical modernization of China. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / 蔡笳. / "2012年8月". / "2012 nian 8 yue". / Thesis (M.Phil.)--Chinese University of Hong Kong, 2012. / Includes bibliographical references (leaves 89-95). / Abstract in Chinese and English. / Cai Jia. / 摘要 --- p.i / 目錄 --- p.iii / 導論 --- p.1 / Chapter 一、 --- 19、 20世紀中國的「現代化」問題 --- p.1 / Chapter 二、 --- 醫療史與中國「現代化」問題的討論 --- p.3 / Chapter 三、 --- 女性生育與醫療 --- p.4 / Chapter 四、 --- 廣州與中國「現代化」的地區差異 --- p.6 / Chapter 五、 --- 章節結構 --- p.8 / Chapter 第一章 --- 明清中國產科與17-19世紀的西方產科 --- p.9 / Chapter 一、 --- 明代以前中國的婦產醫學 --- p.10 / Chapter 二、 --- 明清以來中國婦產醫學與生育習俗 --- p.11 / Chapter （一） --- 明清時期中國婦產醫學 --- p.11 / Chapter （二） --- 明清時期的分娩處理 --- p.12 / Chapter 三、 --- 18、 19世紀歐美產科醫學的發展 --- p.18 / Chapter （一） --- 英國產科醫學的概況 --- p.18 / Chapter （二） --- 現代醫學的產生與婦產科之變化 --- p.20 / Chapter （三） --- 18、 19世紀的美國產科發展 --- p.21 / Chapter 四、 --- 小結 --- p.22 / Chapter 第二章 --- 西醫產科傳入廣州（1834-1890） --- p.25 / Chapter 一、 --- 西醫產科的早期發展 --- p.25 / Chapter （一） --- 伯駕的到來（1834-1850） --- p.25 / Chapter （二） --- 嘉約翰的成就：西醫醫院的雛形和西醫教育（1855-1899） --- p.27 / Chapter 二、 --- 女傳教士醫生的到來和西醫婦產醫療的實踐 --- p.32 / Chapter 三、 --- 女醫學堂的緣起 --- p.35 / Chapter 四、 --- 女醫學堂的醫學教育 --- p.37 / Chapter （一） --- 教育培訓 --- p.37 / Chapter （二） --- 西醫助產方法操作規範 --- p.40 / Chapter （三） --- 備用器材 --- p.44 / Chapter 五、 --- 夏葛醫校與柔濟醫院的婦產醫療實踐 --- p.44 / Chapter 六、 --- 小結 --- p.45 / Chapter 第三章 --- 西醫婦產在當地社會的發展（1895-1930） --- p.47 / Chapter 一、 --- 清末民初廣州善堂的「贈接生」服務 --- p.47 / Chapter （一） --- 順德水藤如春善社與廣州贊育醫社 --- p.49 / Chapter （二） --- 廣州方便醫院 --- p.50 / Chapter 二、 --- 清末民初產科醫院的創立 --- p.53 / Chapter 三、 --- 廣州婦產醫生群體 --- p.55 / Chapter （一） --- 出身背景 --- p.56 / Chapter （二） --- 女性產科師在醫患關係中的角色 --- p.57 / Chapter 四、 --- 政府衛生行政對產科從業者之規管 --- p.59 / Chapter 五、 --- 小結 --- p.68 / 結論 --- p.69 / 附錄 --- p.75 / 參考書目 --- p.89

Finally, through the application of spatial analytical and spatial statistical methods, a better understanding of the spatial patterns of TCM and Western medical services and their correlations with urban morphology, market, religious, educational and legal patterns can be acquired. / First, Republican Beijing historical information management can successfully manage integrated data for medical service studies of Republican Beijing. Historical data coming out of the historical enquiries can be collected, organized, managed, processed, analyzed and displayed. This framework may have some methodological implications on how to collect, organize, represent and analyze historical urban information in a GIS environment. / Second, Republican Beijing historical GIS database is not just the foundation of spatial analysis in this research, but provides a useful resource for scholars in many years to come. Through this database, public health, urban morphology, education, religion, market and legal cultural observations can be accessed by any investigator throughout Republican Beijing. The approach to identifying the street number improves the accuracy of the database while the approach of zoning 80 districts solves the Modifiable Areal Unit Problem. In fact, these are very common problems encountered in historical GIS research that are concerned with "accuracy" and "scale". The two approaches may shed some light on solving such problems. / This research applies an historical GIS approach, which focuses on the spatial dimension as well as quantitative analysis to explore aspects of TCM and Western medical services in Beijing from 1912 to 1937. This dissertation provides a framework for successful integrated data management by establishing Republican Beijing historical information management as an organizational priority. Based on this framework, a system that integrates the functions of data storage, selective retrieval, analysis, display and archiving is established. First, Republican Beijing historical GIS database is produced. Two approaches are provided to work out the street number sequences and zone the 80 subdistricts respectively. Second, four kinds of spatial analytical methods, including buffer analysis, two-step floating catchment area method, spatial auto-correlation and GWR are integrated and used to explore the spatial patterns of TCM, Western medical services and their correlations with urban morphology, market, religious, educational and legal patterns. The main contributions are three-fold: / Zhang, Peiyao. / Advisers: Lin Hui; Billy K. L. So. / Source: Dissertation Abstracts International, Volume: 73-01, Section: A, page: . / Thesis (Ph.D.)--Chinese University of Hong Kong, 2010. / Includes bibliographical references (leaves 150-163). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Electronic reproduction. [Ann Arbor, MI] : ProQuest Information and Learning, [201-] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Abstract also in Chinese.

儒醫是宋以後經過醫學文本訓練的，男性醫者的，文化認同/角色/定位。道醫、巫醫和女性醫者等其他醫者漸成為邊緣他者。儒醫宣稱比其他醫療實踐者更加深諳醫學經典、更加理性。儒醫攀附儒自居，模仿理學門戶互相攻訐，有學派之分。元代婺州朱震亨，「丹溪學派」的創始者，是明代儒醫的典範。本文將以朱震亨和「丹溪學派」為個案，一方面探討儒醫如何建構醫學身體、疾病觀念及其實踐，另一方面探討「丹溪學派」的思想和社會史。 / 第一、二、三章分別從三個角度探討元明儒醫的身體觀。首先，在強烈的「南人」認同之下，元代江浙的士人強調「南/北」身體的差異，「北醫」的療法不適合「南人」的身體，朱震亨被塑造為「南醫」的典範。其次，自劉完素以後，「火」不是日常生活中的火熱之氣，也不是推算運氣的術語，成為元明醫家對身體疾病的想像。據此，朱震亨提出「陽有餘而陰不足」的身體觀，是明代「丹溪學派」遵守的教條。第三，鬼神病因漸漸從儒醫的身體觀中淡出。道教醫學中的「傳尸勞瘵」，混雜了鬼邪和血氣病因，宋元儒醫卻劃分血氣「虛勞」和鬼邪「勞瘵」的界線。朱震亨將「勞瘵」解釋為「陰不足」病。追隨丹溪之後，虞摶病人見鬼實際上是「心神不寧」，清醫吳瑭認為「祝由科」是巫術，儒醫無法容忍鬼邪病因和儀式療法。 / 第四、五章討論儒醫多樣化的實踐。在臨床實踐中如何治療「陰不足」病，「丹溪學派」並不一致，王綸提倡的「補陰丸」在明代江浙醫者的實踐中廣受歡迎，但來自學派內部嚴厲的批評聲同時存在。明代醫家認為唐宋方書治「勞瘵」的天靈蓋「殘忍」，但紫河車卻是明代常用的治療「勞瘵」藥物。儒醫反對儀式療法，但某些驅除鬼邪的針灸療法，改頭換面依然留存在醫學實踐中，比如「秦承祖灸鬼法」。 / 第六、七章指出，從朱震亨到「丹溪學派」，是元代婺州地方士人建設宗族組織、講習理學、建構地方認同背景之下的社會史，也是蘇州城市醫者專業化、組織化的結果。元明政權更迭之後，「丹溪」弟子進入太醫院，依靠政治權威提升「丹溪」的醫學地位。1450年代以後「丹溪」成為商業書坊的暢銷本，注重師承關係的學派逐漸消解，「丹溪」成為大眾通俗的醫學入門文本作者。清代，考據醫學「丹溪」為通俗庸醫，「丹溪」不再是醫者撰寫醫書、醫療實踐的必引權威。 / This thesis aims to explain how Confucian physicians (儒醫) constructed the medical thoughts and practice. A Confucian physician is supposed to be a well-educated gentleman (儒) and a master of the medical classics. From the 12th century on, Confucian physicians gradually became a new identity of the orthodox doctors, while the Taoists, shamans, midwives and surgical practitioners all became the “others. At the same time, among the Confucian Physicians, different schools appeared. The Danxi School (丹溪學派) was a group of disciples following Zhu Zhenheng (朱震亨1282-1358) from the 14th to 15th centuries in Jiangnan (江南) . Zhu was a gentleman from Wuzhou, who was treated as an ideal model of “Confucian physicians through the whole Ming dynasty. / The first three chapters focus on the medical thoughts of Confucian phycians. Chapter One studies on the body of the “Southerners (南人). People living in the territory of Southern Song identified themselves as the “Southerners. This identity was strengthened by the unequal racial policy under the Mongol reign. It motivated the Jiangnan literati to appeal for a medical knowledge body specifically for the “Southerners, which would focus on treating the ailments caused by the “southern environment and dietary habits. Chapter Two explores the concept of “fire. In the Song dynasty, “fire is an element of the prevalent cosmological theory of “the five circulatory phases and the six seasonal influences (五運六氣) . However, in Liu Wansu (劉完素1132-1208) ’s innovative interpretation, the concept of “fire was internalized into the body structure. Zhu Zhenheng inherited this concept of bodily “fire and developed the theory of “yang is always in excess, yin is always deficient (陽有餘而陰不足) , which was later strictly followed by the Danxi School. Chapter Three investigates the disease of “laozhai (勞瘵) . According to the Taoist interpretation, the disease of “laozhai was due to the ancestor’s sin. However, Confucian physicians developed a new meaning in the context of Danxi’s “yin is deficient body. Demons were gradually excluded from the etiology of the Danxi School. / Chapter Four and Five study on the practice of Confucian physicians. The Danxi School didn’t have consensus on how to treat the “yin is deficient disease. Therefore, the therapy of “nourishing yin (滋陰) was quite differential in individual practices. However, it is certain that Confucian physicians tended to use herbs to treat patients who declared themselves suffering from demons. Religious rituals of expelling demons were excluded from their clinical practice. However, Confucian physicians didn’t refuse to use some unusual herbal remedies such as the placenta, or moxibustion that might function as Taoist rituals of expelling demons. / Chapter Six and Seven analyze the rise and fall of the Danxi School. The reason why Zhu became a powerful medical master lies not only in his medical thoughts or skills but in his social activities. He was very active in the lineage organization and local administration. In the local society, Zhu gained the power and fame as an authoritative Confucian gentleman, though he had never received any governmental position. After the death of Zhu, his disciples achieved successful careers as professional doctors in Suzhou (蘇州) . Later when the Ming Empire was established in Nanjing, most of Danxi’s disciples went into the Imperial Medical Service (太醫院) . After the 1450s, Zhu Zhenheng became a best-selling author and a symbol of the popular medicine. The popularity of his works eventually destroyed the structure of the master-disciple relationship in the Danxi School. The Danxi School gradually disappeared. In the end, because the mid-Qing physicians preferred ancient masters such as Zhang Zhongjing (張仲景 fl. 168-196) to the modern, vulgar Danxi, the Danxi School and their medical master faded away from the mainstream medicine. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / 張學謙. / Thesis (Ph.D.)--Chinese University of Hong Kong, 2012. / Includes bibliographical references (leaves 197-217). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Abstracts in Chinese and English. / Zhang Xueqian. / 導論 --- p.1 / Chapter 一、 --- 儒醫：宋元明清醫者的身份認同 --- p.2 / Chapter 二、 --- 儒醫的理性與實踐 --- p.6 / Chapter 三、 --- 丹溪學派：醫學思想的社會史 --- p.11 / Chapter 四、 --- 研究說明 --- p.16 / Chapter 第一章 --- 元代醫學的「南/北」身體觀 --- p.18 / Chapter 一、 --- 南宋和元：「南人」認同的多層含義 --- p.18 / Chapter 二、 --- 「南/北」身體觀論述 --- p.24 / Chapter 三、 --- 製造「南醫」/「北醫」 --- p.32 / Chapter 四、 --- 結論 --- p.38 / Chapter 第二章 --- 丹溪學派的口號：「陽有餘而陰不足」的身體觀 --- p.40 / Chapter 一、 --- 五運六氣與宋人的身體觀 --- p.40 / Chapter 二、 --- 內丹對醫學身體觀的影響 --- p.46 / Chapter 三、 --- 朱震亨的相火論 --- p.50 / Chapter 四、 --- 結論 --- p.59 / Chapter 第三章 --- 宋明儒醫的「理性化」：以「勞瘵」為中心 --- p.60 / Chapter 一、 --- 《道藏》文本中「勞瘵」的界定 --- p.62 / Chapter 二、 --- 儒醫文本中「勞瘵」的界定 --- p.68 / Chapter 三、 --- 儒醫「勞瘵」與明代社會身體 --- p.73 / Chapter 四、 --- 明代儒醫對「祝由」的困惑 --- p.77 / Chapter 五、 --- 結論 --- p.85 / Chapter 第四章 --- 「陰虛」病與療法 --- p.87 / Chapter 一、 --- 丹溪「陰虛」病及療法 --- p.87 / Chapter 二、 --- 補陰丸與人參之爭 --- p.93 / Chapter 三、 --- 薛己、趙獻可：從補陰血到補陰精 --- p.99 / Chapter 四、 --- 結論 --- p.103 / Chapter 第五章 --- 儒醫的實踐 --- p.105 / Chapter 一、 --- 道醫「追蟲」儀式 --- p.105 / Chapter 二、 --- 儒醫勞瘵療法 --- p.108 / Chapter 三、 --- 天靈蓋與紫河車在明代醫學中的不同遭遇 --- p.113 / Chapter 四、 --- 從「秦承祖灸鬼法」到「灸鬼哭穴」 --- p.121 / Chapter 五、 --- 結論 --- p.125 / Chapter 第六章 --- 從朱震亨到「丹溪學派」的社會史 --- p.126 / Chapter 一、 --- 朱震亨的出身與赤岸朱氏宗族的建構 --- p.129 / Chapter 二、 --- 「儒醫」朱震亨與地方社會 --- p.136 / Chapter （一） --- 朱震亨之行醫 --- p.137 / Chapter （二） --- 朱震亨之醫療產業 --- p.140 / Chapter （三） --- 朱震亨在地方社會的角色 --- p.142 / Chapter 三、 --- 元代婺州的「丹溪」門徒 --- p.147 / Chapter （一） --- 地方醫療資源與組織 --- p.147 / Chapter （二） --- 婺州地方士族的網絡 --- p.151 / Chapter 四、 --- 元末蘇州的「丹溪」門徒 --- p.155 / Chapter 五、 --- 明代太醫院的「丹溪」門徒（1368-1450） --- p.162 / Chapter 六、 --- 結論： --- p.166 / Chapter 第七章 --- 「丹溪」的大眾化與清代醫學的轉折 --- p.167 / Chapter 一、 --- 「丹溪」文本的製造與流傳 --- p.168 / Chapter （一） --- 「丹溪」文本的製造 --- p.168 / Chapter （二） --- 「丹溪」文本的印刷與晚明私人的商業書坊 --- p.178 / Chapter 二、 --- 「丹溪」權威的下降 --- p.183 / Chapter （一） --- 明清醫者對「南/北」身體觀、療法的不同意見 --- p.184 / Chapter （二） --- 「陰不足」到「命門火衰」 --- p.186 / Chapter （三） --- 考據醫學之批評「丹溪」 --- p.188 / Chapter 三、 --- 結論 --- p.192 / 結論 --- p.193 / 參考書目 --- p.197 / Chapter 一、 --- 一手文獻 --- p.197 / Chapter (一) --- 醫書 --- p.197 / Chapter (二) --- 正史 --- p.200 / Chapter (三) --- 文集 --- p.201 / Chapter (四) --- 地方志和家譜 --- p.203 / Chapter (五) --- 筆記和其他： --- p.204 / Chapter 二、 --- 工具書： --- p.206 / Chapter 三、 --- 近人研究： --- p.207 / Chapter (一) --- 中文專書 --- p.207 / Chapter (二) --- 英文專書 --- p.209 / Chapter (三) --- 中文論文 --- p.212 / Chapter (四) --- 英文論文 --- p.214

Taking into account of the colonial nature of modern Hong Kong, this author is to examine how the TWGHs as a medical space gradually developed from one that used only Chinese medicine into one in which Chinese medicine and western medicine coexisted. However, it finally became a western style hospital using only western medicine in the inpatient services in the 1940s, along with the growing hegemony of western medicine that was underpinned by colonial power. The multidimensional relationships among different agents in the process of transformation of medical services in the TWGHs constitutes another important theme of this thesis. These relationships touched upon a series of significant interactions between colonial government and Chinese community, colonial authorities and the Tung Wah Board of Directors, Chinese and western medical practitioners, Chinese community and the Tung Wah authorities, and so on. / The implantation, dissemination and expansion of modern western medicine, as an important part of western learning that infiltrated into the Orient, exerted profound impacts on Chinese traditional medical patterns and Chinese medical ideas and practices. As the center for exchange between Chinese and Western Culture, Hong Kong became a significant space for the spread and practice of western medicine. A wide range of western medical services and activities were delivered and developed by the colonial government, western missionaries, benevolent societies, and private practitioners in order to promote the development and popularization of western medicine among the Chinese community, including the establishment of hospitals, dispensaries and clinics, the opening of medical schools and training of western doctors, and the promotion of public health education. / This thesis also points out that the early intense prejudice and resistance against western medicine is not necessarily and cannot be entirely attributed to the underlying difference in the concept and practice of healing and sickness in the two different medical systems. Instead, I argue that a number of technical and practical factors in the delivery of western medical services provided by different agencies greatly affected and determined the choices and uses of the Chinese population. At the same time, the gradual recognition and reception of western medicine among the Chinese was not only the passive result of the compulsory western medical system developed by the colonial government, but also an active realization of the real efficiency and value of western medicine among the indigenous population and their consent and acceptance of its ideology and cultural value, to a great extent. / This thesis examines the confrontation and interaction between Chinese medicine and Western medicine, and the diverse and complicated Chinese attitudes towards western medicine by studying the history of the introduction of western medicine into Hong Kong and the case of transformation of Chinese and western medical services in the Tung Wah Group of Hospitals (TWGHs) during the period between 1894 and 1941. The history of the TWGHs dates back to the opening of the Tung Wah Hospital in 1870. Originally intended for the accommodation and treatment of those Chinese who had strong fears and prejudices against western medicine, the Tung Wah Hospital was founded to provide treatment only by Chinese doctors using Chinese medicine. The bubonic plague of 1894 in Hong Kong marked an important turning point in the history of medical services of the Tung Wah Hospital. Since then, western medicine was formally introduced into the Tung Wah Hospital in 1897. / 楊祥銀. / Adviser: Hon-ming Yip. / Source: Dissertation Abstracts International, Volume: 69-02, Section: A, page: 0715. / Thesis (doctoral)--Chinese University of Hong Kong, 2007. / Includes bibliographical references (p. 279-306). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Electronic reproduction. [Ann Arbor, MI] : ProQuest Information and Learning, [200-] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Abstracts in Chinese and English. / School code: 1307. / Yang Xiangyin.