中國中古時期的南方疾病與地理想像

Abstract

生老病死，是每個人人生中必經的過程。在不同的文化中，對於生老病死的詮釋皆有不同。本文鎖定中國中古時期的南方風土病，從疾病史與社會文化史的角度出發，探討疾病概念的形成與社會間的互動關係。 本文除序論與結論外共計五章，由於中國中古時期是由魏晉南北朝與隋唐時期共同組成，因此本文先從先秦兩漢的陰陽五行學說，在其發展過程中，透過五方和九宮說建構出術數性的地理論述，從中形成的南方卑濕致病觀，成為中國中古時期南方風土病的理論基礎，與從文化觀點說明南北地理分界的依據。 到了魏晉南北朝時，隨著南方地理觀念的形成，南方風土病的概念也漸次發展。從兩者的互動關係中，我們可以發現，中國中古時期社會的醫籍，在繼承《黃帝內經》疾病地理觀，以南方暑濕致病觀做為南方疾病地理論的主調，但在《黃帝內經》中所指涉的南方疾病，並未出現瘴氣、射工等後世所述的南方風土病。 有關本文所討論的瘴氣、射工、沙蝨、水毒等，以東晉葛洪首開系統性論述，在經過南朝陳延之《小品方》所繼承後，至隋唐醫籍所繼承，本文另舉癭病做為南方風土病的對照，在關於癭病的論述中，強調北方非漢族群患者與漢人的症狀差異，但此一論述在隋唐時期已不復見，顯示中國中古時期社會將疾病作為區分中原漢人和其他地區族群的依據。 到了隋唐時期，南北統一，但對於北方世族與統治階層而言，對於南北分界以秦嶺長江為主，因對南方這一新收服的領土瞭解不深，加上南方非漢族群時有叛亂，自然而然成為統治者眼中的「不文明之地」。為了強化這些非漢族群聚集地區的危險性與神秘性，南方風土病成為形容這些地區的主要象徵。伴隨著人口南移帶來南北文化交流，但因北人佔據統治階層與文化資源的情況下，使南方士人競相仿效北人，對於南方的論述仍延續北方學術傳統，以「中原上國」對比「南土」。 由於上述理由，南方成為帝國之中的特殊地區，反映在政治設計、軍事活動、銓敘制度上。均對南方有所調整，而在文人眼中，南方也成為處處危機的險地，充斥著奪人性命的各色疾病。這種印象並未隨著南方的開發而改變，反而進一步強化，成為社會集體意識的成果。 本文試圖透過從南方風土病在中國中古時期的的發展過程和與社會的互動關係，探討中國中古時期南方風土病的形成背景；以及對於中國中古時期社會的南方地理論述產生什麼影響。首先從文獻中找出關於五方地理及南方地理論述的發展脈絡，其次是從瘴癘與南方風土病印象出發，探討南北文人對於南方地理的論述是否有所差異。第三，試圖剖析南方風土病概念形成之後對於整體社會如何看待南方，最後考察南方風土病如何促使中國中古時期的社會衍生出的各項因應之道。Birth, ageing, illness and death are parts of our life. Interpretation of these phases differs from culture to culture. This thesis focuses on the endemic diseases of Southern China in medieval age, from the perspective of history of diseases and history of society and culture, discussing the concept formation of disease and the interaction with societies.

Apart from introduction and conclusion, we have 5 chapters in this thesis. The Chinese Medieval Ages are composed of Wei Jin Southern and Northern period and Tang dynasty, therefore, this thesis starts from the concept of geographical location, discussing the formation of idea of “South”.

In Wei Jin Southern and Northern period, with the “South” idea developing, the concept of Southern endemic diseases shaped gradually. Form the interactions between the North and the south, the imagination did not change due to the growing immigrant number to the South and the written records by Southern aristocracy, still continuing the traditional geographic discourse of the South.

In Sui and Tang dynasty, the North and the South untied. However, the ruling class from the North knew little about the newly conquered South and the rebellions by non-Han tribes happened occasionally. Therefore, the South had become a “savage land”. To fortify the danger and mystery of the non-Sino areas, the so-call endemic diseases became the main symbol of disease from these areas.

For above reasons, the South became a special area in the empire and the political arrangement, military activity and civil service adjusted accordingly in the South. For intellects, the South was also a crisis-hidden area, with various fatal virus in the air. The image didn’t change with the development of the South. Instead, the image was further strengthened and turned to be the outcome of collective consciousness of society.