人醫、獸醫與庸醫：清代蒙古大夫再探

最遲至康熙朝後期，清廷便於上駟院設置蒙古大夫職缺，且最晚在清中葉以後便出現了「coban」、「綽班」等別稱。惟「coban」、「綽班」與「蒙古大夫」之間，起初並非劃上等號，其意義經歷了一段長時間的演變。就醫治對象而言，《大清會典》等官書記載蒙古大夫主治馬、駝的疾病；在清宮檔案和筆記文集的記述中，蒙古大夫則是以治療人之骨傷聞名的專業醫者。值得注意的是，除了上駟院蒙古大夫之外，太醫院亦設有正骨科，形成清宮骨傷醫療的雙軌系統。此種雙軌系統的出現，與兩者在經驗累積和治療方法上的差異關係密切。清代蒙古大夫正骨技術以接骨、肋骨復位為主，其知識與技術大多來自於蒙醫自元代以來實際操作經驗的累積和師徒傳承；太醫院大夫則「專從血論」，其經驗多來自《黃帝內經》中相關之經絡、氣血等文本知識的累積。由此觀之，太醫院較強調內治法，然如遇緊急情況，尤其是在骨傷出現頻繁的戰場上，內治法往往緩不濟急，是以另外設置蒙古大夫，強化正骨醫療的臨床操作。除了治療骨傷外，蒙古大夫亦可醫治頭疼暈眩等內症，且治療時，與太醫院大夫同樣注重氣、脈以及身體要素的平衡。晚近以降，蒙古大夫的形象卻開始轉趨負面，逐漸與「庸醫」畫上等號。以「蒙古大夫」而非其他類型醫者來指涉負面醫療行為者的原因，與蒙古大夫自清初以來既醫人也醫獸的形象，及其所擅長之骨傷科在中國醫學的地位向來不高不無關係。本文的目的並非在於翻轉蒙古大夫的形象，而是透過細緻入微的探究，「重新」找尋和詮釋蒙古大夫，以期對蒙古大夫能有全新的理解與認識。

關鍵字

蒙古大夫；綽班；清宮醫療；庸醫；上駟院

並列摘要

No later than the late Kangxi period, the Qing dynasty had created the post of Mongolian doctor, and they had gained aliases like ＂coban＂ or ＂Chuo Ban 綽班＂ by the mid-Qing dynasty. However, ＂coban＂, ＂Chuo Ban 綽班＂ and ＂Mongolian doctor＂ cannot be seen as the same before a long period of development. With regard to the patients they treated, Da Qing Huidian 大清會典 recorded that the Mongolian doctor treated diseases of horses and camels, while documents from the Qing Court note that they were renowned as professional orthopedic surgeons. The Qing dynasty formed a kind of dual system for its own orthopedic medicine based on the Mongolian doctor of the Shangsì yuan 上駟院 and the Department of Orthopedics in the Imperial Institute of Medicine. The appearance of such a system was closely related to their different approaches to treatment and their different accumulated experiences. The orthopedic techniques of the Mongolian doctor were focused on setting bones and the stabilization of ribs, knowledge and techniques that were inherited from an accumulation of experience that dated back to the Yuan dynasty. On the other hand, the main concern of the physicians of the Department of Orthopedics in their therapy was the notion that ＂injury concerns blood only,＂ which came from the Yellow Emperor's Inner Classic 黃帝內經. The Imperial Institute of Medicine put its focus on ＂internal treatment,＂ yet this was not suitable for the battlefield, where injuries were far more common. Thus, the Qing court established the position of Mongolian doctor to enhance clinical orthopedic treatment. Aside from their orthopedic duties, the Mongolian doctor could also perform treatment on internal diseases like headaches and dizziness. Just like their counterparts in the Imperial Institute of Medicine, they also took Qi 氣, Mai 脈, and the balance of the elements of the body into consideration in their practice. The image of the Mongolian doctor turned negative in modern times, and gradually a ＂Mongolian doctor＂ came to be considered as a quack. One of the reasons why people tend to describe negative medical practices by using the term ＂Mongolian doctor＂ is that Mongolian doctors healed both human and animals. Another reason is that orthopedics held pretty low status in Chinese medicine. This article does not aim to overturn the image of the Mongolian doctor, but rather to re-discover and interpret the Mongolian doctor through detailed research in the hopes of achieving a better understanding of the Mongolian doctor.