I. Summer-Western Zhou Dynasty
In the early stage of human class society, before the development of medicine, due to the limited development of productive forces, people's lack of scientific understanding of nature and limited means of resistance, they could only turn to the gods for help for various diseases, so this period was a historical stage dominated by witch doctors and witchcraft prevailed. However, witch doctors are not full-time doctors and still belong to the category of "witch doctors".
Witchcraft prevailed in this period, and the air of mysticism enveloped the whole society like a fog. As a witch who specializes in prayer and sacrifice, he acted on behalf of slave owners, influenced state affairs through divination, auspiciousness, sacrifice and other activities, and formed a special political force with an extremely prominent position in society. In the long-term prayer and sacrifice activities, some people have absorbed some medical experience and knowledge from the people, and they are superstitious about others with the attitude of being able to communicate with ghosts and gods, which puts a mysterious coat on medical activities and creates the illusion that doctors and witches are mixed. These witches are the so-called witch doctors and pioneers of early doctors. Under the condition that there were no full-time doctors at that time, witch doctors played a leading role in the medical activities of the whole society.
Although witch doctors mainly appeared in society as witches rather than doctors in this period, they were, after all, early intellectuals in human society. By virtue of their social status and cultural knowledge, they can concentrate their initial medical activities and knowledge, conduct mysterious thinking, record some effective medical experiences and drugs, and systematize them, thus making it possible for later medicine to get rid of witchcraft and embark on the road of independent development. For example, The Classic of Mountains and Seas, known as the ancient sorcerer's book, is a classic in witchcraft [1], but it records a lot of pharmaceutical knowledge and accurately describes the origin, performance and efficacy of some drugs. Fifty-two Prescriptions for Diseases unearthed in Mawangdui, Changsha, is the oldest medical prescription discovered so far in China, and there are many prescriptions for witch doctors to treat diseases in the book. As we all know, there are many records about diseases in Oracle Bone Inscriptions. It is inconceivable that ancient medical knowledge could be passed down to future generations if there is no witch doctor to systematically sort out medical knowledge and record it in Shan Hai Jing and other related documents. Under the conditions at that time, the duties of witch doctors were irreplaceable by others. On the one hand, we must affirm the positive influence of witch doctors on medical development, but we can't completely deny it.
Second, the Spring and Autumn Period-Early Western Han Dynasty
During the Spring and Autumn Period and the Warring States Period, our society experienced a transition from slavery to feudalism. Due to the improvement of productivity, the development of natural science and technology, the further expansion of social division of labor, all walks of life are becoming more and more specialized, medicine has begun to be separated from witchcraft, and some full-time doctors have appeared in society to practice medicine and help the world. In the Spring and Autumn Period, Zhou Li listed "martial master" as an official, while doctors were under the jurisdiction of "heavenly officials and butchers". Since then, doctors and witches have separated.
Compared with the witch doctors in mysterious cloaks in the Yin (Western) Zhou Dynasty, doctors in this period no longer played an important role in the political life of the country, and their status declined. However, at that time, knowledge was mainly monopolized by the aristocratic ruling class, and the status of medical intellectuals-doctors was naturally different from that of ordinary people at that time, but they belonged to the "scholar" class and still had a considerable position in society [2], which attracted social attention. For example, when the doctor Bian Que arrived in the State of Guo, the monarch of the State of Guo greeted him at the palace gate and called him "Sir"; After Qi, the Marquis of Qi Huan treated him as a distinguished guest. At that time, even Confucius, the founder of Confucianism, paid more attention to the profession of doctors. "A man without perseverance cannot become a witch doctor."
Although the social status of doctors is difficult to compare with that of early witch doctors, after all, medicine has embarked on the road of independent development and got rid of the bondage of witchcraft. Doctors can engage in medical activities aboveboard, sum up experience and improve theories. In addition, due to the need of their own rule, the vassal States actively recruited talents and all kinds of talents. At that time, doctors, as a kind of scholars, were also treated by monarchs of various countries and their activities were relatively free. For example, Bian Que traveled around the world, practicing medicine in Qi, Zhao, Qin and Zhou, and became a doctor in different specialties according to the needs of people everywhere; Doctors' medical care and medical care went to Jin State to treat Jin He respectively. During this period, the vassal regime was divided politically, hundred schools of thought contended, and the academic democratic atmosphere was strong. On the one hand, the free movement of doctors enables people of all countries to get maximum treatment when they suffer from diseases. At the same time, due to the frequent wars and epidemics, it also provides doctors of all warring countries with a broad field to display their talents and enrich their clinical practice. On the other hand, the free flow of doctors is also conducive to the exchange and improvement of medicine. Doctors, regardless of their positions, especially in economically and culturally developed countries, can absorb the most advanced ideas and technologies at that time and apply them to the medical field, thus promoting the development and progress of medicine. Chinese medicine philosophy such as Yin-Yang and Five Elements was applied to Chinese medicine theory to guide clinical practice during this period.
In the Qin Dynasty, in pursuit of immortality, Qin Shihuang prized alchemists (including doctors at this time) and burned books to bury Confucianism. "Anyone who dares to hide poems, books and hundreds of languages will know it and burn it; Medical books, divining and planting trees, medical books are not burned, which avoids unnecessary losses in this cultural catastrophe and enables medicine to develop continuously and healthily.
In the early Western Han Dynasty, due to the influence of peasant war and Chu-Han war at the end of Qin Dynasty, social productive forces were greatly destroyed. In order to restore the development of social production, the rulers have to implement the policy of rest and recuperation. In order to stabilize social stability, the government attaches great importance to nursing, providing for the elderly and stabilizing people's livelihood, and the social status of doctors has also improved accordingly. The imperial court often summoned private doctors to consult drugs and curative effects. Emperor Wendi once summoned Chunyu Kun, a famous doctor at that time, and asked him in detail about his medical study, diagnosis and treatment of diseases and the specific details of taking his disciples. Chunyuyi answered them one by one. Sima Qian recorded these contents in Historical Records? Biography of Bian Que Cang Gong left the earliest existing medical record in our country-Diagnostic Book.
Third, the Middle Western Han Dynasty-Tang and Five Dynasties
The mid-Western Han Dynasty was a period of consolidation and development of feudal society. Due to the development of feudal economy and the unprecedented economic and political policies of the rulers, especially during the period of Emperor Wu of Han Dynasty, the order of "scholar, agriculture, industry and commerce" in feudal society has also been finalized. Since Confucius advocated private school, academic culture began to move towards the people. After hundreds of years of development, the monopoly of "learning in the official" has been completely broken, and ordinary people can gain more knowledge. Because of the technical nature of medical knowledge, doctors have been completely regarded as "jobs", and their medical skills have also been classified as Ji Fang (Han Shu? Art and literature "). The status of doctors has dropped from the original scholar class to the "worker" class. More importantly, during this period, hundred schools of thought's contention was broken, and Confucianism gained a dominant position. Emperor Wu of the Han Dynasty accepted Dong Zhongshu's suggestion of "ousting a hundred schools of thought and respecting Confucianism alone", guided politics with the thought of Confucian unification, and regarded the five classics, such as Poetry, Book, Rite, Book of Changes and Spring and Autumn Annals, as Confucian classics, which were required reading for feudal scholars. The selection of officials mainly came from Confucian scholars, and Confucianism gradually developed, which became the orthodox thought of feudal society for the next two thousand years.
Confucianism attaches importance to humanistic ethics knowledge and despises science and technology. Confucianism believes that "self-cultivation, keeping the family in order, governing the country and leveling the world" is the most important thing in life. "Governing the country and leveling the world" is the most important thing for intellectuals, so to "learn to be an official", you must finish reading books and become an official. For intellectuals, being an official is the only right way, while others are regarded as deviant, and everything they have learned is unified within the scope of Confucian classics. "Governing the people" is the foundation and "governing things" is the purpose; It is considered as "small skill" and "magic skill" to "value science and technology, medicine and other knowledge with scientific understanding". As a profession, doctors, like other occupations of labor nature, are discriminated against, and their social status is greatly reduced.
The consequence of this is that people are ashamed of practicing medicine, even ashamed of practicing medicine, which makes many intellectuals flinch from practicing medicine because of social pressure and psychological influence when possible, which will inevitably make medicine lose many outstanding talents in its inheritance and development; In addition, it is easy for many rulers to discriminate against medicine and even destroy it, thus affecting the normal development of medicine to some extent. For example, Hua Tuo, a famous doctor in the Eastern Han Dynasty, regretted practicing medicine for himself even though his medical skills were superb and famous all over the world. "He also knows several classics", "But as a scholar, he often regrets himself for seeing a doctor." Later, because he didn't want to be Cao Cao's doctor, he offended politicians and was put in prison. When Yu Xun pleaded for Hua Tuo with "technology is practical, life is at stake, and it should be contained", who knows that the ruler who has the name of "appointing people on their merits" in history even said: "Don't worry, there will be no such rats in the world!" In the end, a generation of famous doctors were killed, which made their works spread all over the world, and the famous surgical prescription-"Ma Fei San" was lost from then on, which deeply regretted later doctors. At the same time, another famous doctor, Zhang Zhongjing, made an immortal contribution to the development of traditional Chinese medicine. At that time, there was not a word in the so-called official history. "Commentators call it a sage of traditional Chinese medicine, but Ye Fan's Book of the Later Han Dynasty did not make a biography of Zhongjing, so the gentleman has regrets." [4] We can also imagine the social status of doctors at that time.
During the Jin, Southern and Northern Dynasties, there appeared many scholars and doctors who were proficient in medicine, but quite a few of them only regarded medical knowledge as a tool for their survival, and most of them didn't want to use it to treat ordinary patients. For example, Yin Hao, a scholar-bureaucrat in the Eastern Jin Dynasty, was a leader in talking about capital at that time, and he was good at Confucian classics and classics. However, he refused to see a doctor for junior staff. Once, a junior clerk's mother was ill and went to see him until she kowtowed and bled. When the patient is cured, burn his own prescription, so as not to be treated as a doctor again. This shows that the scholar-officials studied medicine for themselves and refused to be human. At the same time, it also reflects that the status of doctors at that time was not very high [5].
What is more worth mentioning is the Tang Dynasty. On the one hand, the Tang Dynasty perfected the imperial examination system in the Sui Dynasty, opened the door to official career, and made scholars flock to it, burning incense and succeeding to the throne in order to get a job; On the other hand, most of the supreme rulers in the Tang Dynasty liked poetry, which further influenced the Confucian scholars and the literati class, and the extreme prosperity of literature and art in the Tang Dynasty was also related to this. However, most of them do not attach importance to medicine or even despise it. "Every step, divination, physiognomy, medical skill and cleverness are all skills, and ... villains can do it ... so the former sage didn't think about teaching." [6] Han Yu, a literary master at that time, put it more bluntly: "Witch doctors are musicians, and hard-working people are despised by gentlemen." Sun Simiao, a medical scientist in the Tang Dynasty, was famous for his literature and brilliant. After studying medicine, the history books classified him as "Ji Fang", but he did not enter the Scholars. Zhu felt very sorry for this. He said, "Muse was a famous scholar in the Tang Dynasty. Because he knew medicine, he was demoted to a skill stream. What a pity! " [7] Only the entry of a doctor into "another book" is enough to deter many Confucian scholars who were willing to become doctors. No wonder Gao Baoheng, a medical scientist in the Song Dynasty, lamented: "I cherish the medicines listed by Tang Linglie and pay for them, but I recommend Mr. Kun without saying anything" [8]. It is precisely because of the discriminatory attitude of the ruling class that the social status of doctors is low, so that the social atmosphere at that time was "in the name of scholars who are ashamed of their medical skills in the ruling and opposition parties, in order to seek fertility and cure diseases, but it is unqualified to teach their children to recite short essays and make small strategies" [9]. This also led to the fact that the medical talents in this period could not be compared with the unprecedented prosperity in other fields of contemporary science and culture in terms of quantity, academic attainments and influence on later generations. On that day, this could not but arouse people's deep thoughts.
Fourth, the Song and Yuan Dynasties.
The important political change in Song Dynasty was the development of civilian rule, and the social status of intellectuals was greatly improved compared with that of previous dynasties. During this period, the supreme ruler was interested in medicine and attached great importance to it. For example, among the nine emperors in the Northern Song Dynasty, at least five were familiar with medicine. Song Taizu himself studied medicine and personally treated his younger brother Zhao Guangyi's back with moxibustion [10]; Song Taizong Zhao Guangyi paid attention to his medical skills before he ascended the throne, and collected more than 1000 famous prescriptions. After he proclaimed himself emperor, he mobilized medical officers to compile a prescription book with a volume of 100, named Taiping Sheng Huifang, and made an imperial preface [1 1]. Song Zhenzong, Song Huizong and so on. He personally prefaced medical books, and Song Huizong also wrote and published Shengji Jing in his own name (actually a medical officer) [12]. In the history of Northern Song Dynasty 167, there were 10 large-scale medical books carved by the central government, and one or several important medical monographs were published in the world every time, which became excellent medical books. In the Song Dynasty, the selection and appointment of medical officers were also emphasized while selecting officials through the imperial examination, which led to a period of high salary for medical officers. Later generations began to call doctors "doctors" and "doctors" from this period. Xie Guan, a historian of modern medicine, said: "No one in China attaches more importance to medicine than Song."
Because the rulers attached importance to and advocated medicine, it became a fashion for scholars to know and understand medicine, and the name of "Confucian medicine" appeared in this period. The social status of doctors has been greatly improved. People don't think it is shameful to know how to practice medicine, but think that medicine is the skill of benevolent people and the business of Confucianism. "The principle of treating a country and a person is the same", "If you are not a good doctor, you are a good doctor". A large number of Confucian scholars infiltrated into the medical field, and generations of Confucian scholars emerged, which significantly improved the quality of the medical team, promoted the renewal of the knowledge structure of medical practitioners and the efficiency of medical research, and played an important role in the development of medical theory and the summary and improvement of clinical experience.
Mongolian and Yuan rulers attached great importance to medicine out of the need of rule. Xian Zong (Meng Ge) ascended the throne, and wise SHEN WOO. The emperor actually asked what medicine Confucianism was like [13]. This reflects the status of medicine at that time from one side. "Others are favored by the light because of their words and deeds and medicines." [14] In the process of reunifying the whole country, Mongolian soldiers attacked the city and plundered the land, killing them miserably, but instead of killing the craftsmen, they were captured as slaves, and doctors regarded them as craftsmen to avoid death. In February of the 13th year of Zhiyuan in Yuan Shizu, Jiangnan was pacified. In the imperial edict, it was ordered to collect "noble celebrities such as Confucianism, medicine, monks, Taoism, divination, and seclusion in the mountains" [15], thinking that the ruling class served and doctors also used it. After Yuan unified the whole country, he practiced cruel racial discrimination and class oppression, and divided the people of all ethnic groups into four classes, with Han people and southerners in the last two classes. In society, people are divided into ten classes according to their occupations, namely, one official, two officials, three monks, four Taoist priests, five doctors, six workers, seven hunters, eight craftsmen, nine Confucian scholars and ten beggars [16]. Doctors are in the fifth place, above Confucianism. "However, there were many differences in official positions at that time, and official positions were not customized. School background, imperial academy studies, ... medicine "[17], doctors can be selected as officials at any time, which shows the social status of doctors at that time. On the other hand, it also reflects the plummeting status of intellectuals in the Yuan Dynasty. At the beginning of Yuan Dynasty, the imperial examination system was abandoned for nearly 80 years. Because of the change of social status, quite a few of them turned to medicine, which is called "benevolence" The increase of intellectuals specializing in medicine has further developed and consolidated Confucian medicine and influenced later generations.
V. Ming and Qing Dynasties (before the Opium War)
Ming and Qing Dynasties were the last two dynasties of feudal society in China, and the feudal society was in decline. In order to maintain its decadent ruling position, the feudal ruling class strengthened its political, ideological and cultural autocracy unprecedentedly and went to extremes. In order to strengthen ideological control, a series of cultural and academic measures are taken to restrain people's words and deeds. During this period, the imperial examination system was more complete, with eight essays for selecting scholars and four books and five classics as the main examinations, and scholars also studied classics on this basis. This rigid academic tradition absorbed countless best scholars at that time and wasted their talents and energy; And "deviant", the thought is a bit "obedient to the saints and learning righteousness", that is, the rulers give their individuals and even their families severe punishment, ranging from physical to genocide. "A husband is an artist and a warlock, but a bandit can climb the moral path" (Ming history), such as medical science and technology, are all regarded as "strange skills and cunning" and "paths" and restricted and attacked.
The Ming Dynasty inherited the craftsman system of the Yuan Dynasty. In the Yuan Dynasty, doctors were favored by the rulers, so they were free from handyman and only paid three taels of silver for medical expenses every year [18]. Doctors in the Ming Dynasty were not exempt from official tax except for some miscellaneous duties [19]. Another example is the medical position of Taiyuan Hospital. The highest rank in the Yuan Dynasty was Zhenger. In the Ming Dynasty, the highest grade of Tai Hospital was reduced to positive three products at the beginning of the founding of the People's Republic of China, and then to positive five products [20]. The Qing dynasty basically followed the imperial court system of the Ming dynasty, and its discriminatory attitude towards medicine was even worse than that of the Ming dynasty. For example, the order to "stop acupuncture in Imperial Hospital forever" hindered the development of acupuncture therapy to some extent; Pei, governor of Jiangxi province in Qing dynasty, once said, "... doctors often fake their technology to confuse people." Although it is not a cult, it should be severely punished at an appropriate time. " At that time, Yong Zhengdi was "deeply admired", which shows his attitude towards the doctor of medicine [2 1].
During this period, many doctors did not take the initiative or volunteered to take up medicine, but were forced to join medicine because of the frustration of studying classics and taking the road of official career, even Li Shizhen, the most famous physician in Ming Dynasty, was no exception. His father, Li Yanwen, was a local famous doctor. However, due to the low social status of doctors at that time, he didn't want Li Shizhen to practice medicine any more. He wanted Li Shizhen to take the road of imperial examination and enter his official career. Li Shizhen 14-year-old Jinshi, the last three Jinshi failed. After the age of 23, he had to give up taking the imperial examination again and decided to study medicine with his father.
At that time, some dignitaries in the society were "arrogant and extravagant, serving doctors as officials, ignoring doctors as workers, and having patients at home, so they urged them to adjust their treatment and make them born with rights and responsibilities" [22], which made doctors' social status not respected, and then made doctors themselves and their families feel inferior in practicing medicine, and even kept their medical skills secret. For example, Xue Xue, a famous doctor in Qing Dynasty, was good at treating damp-heat, and wrote books such as Distinguishing Damp-heat, which made great contributions to the development of febrile diseases and occupied an important position in the medical history of China. But after his death, his grandson wrote an epitaph for him, summing up Naizu's life, but "said nothing about medicine" and put him in the stream of Neo-Confucianism. Yuan Mei, a famous writer at that time, was filled with indignation. He thought it was "getting rid of evil spirits and getting rid of bad smell" and wrote an article to refute it. Imagine how many outstanding intellectuals take the initiative to engage in medicine in such an environment where the thought of drilling Confucian classics and taking official career is dominant, and doctors have low social status and are despised. Even if you are engaged in medicine, people mostly regard it as a skill to support their families and survive on their own, and rarely regard it as a science. These undoubtedly have a negative impact on the development of medicine.