【作者】 李超；

【导师】 姜锡东；

【作者基本信息】 河北大学 ， 中国古代史， 2020， 博士

【摘要】 在宋朝统治者自上而下的推动下,医药的法律与制度获得了全面发展。立法规制之下,形成了涵盖医者、医院与药品管理领域的完整制度。病者有其医,医者有其责,制药有其规。良性的医药秩序,是确保两宋时期三百余年间,医患关系总体平稳的重要原因。总体上讲,区别于以往以专题或个案的研究方法,全文系统性、全面性的研究了宋代通过立法手段,全面架构起医药管理秩序。医者、病者、医院、药商、药局等这些主体在宋代医药法律体系中遵循着各自的规范,有序运行。文章改变以往单纯从社会史、医药史的路径去解读宋代医药问题的研究方法,而是另辟蹊径从法经济学角度去观察、分析宋代的医药法律体系的积极效益与有限性价值。宋代通过法律构建了官府医者自中央到地方的准入体系,设置了对官府医者的遴选、考核、职责等具体制度。对官府医者而言,宋政府体制内的法律管控是官府医者行医合法性的保障,同时也是对其身份、地位的确认。宋政府通过法律建立了对编外医者的管控,强调其工作职责,工作流程,确立了宋代对执行公务职吏的“参公式”管理范式。宋政府通过法律设置了民间草泽医者、女性医者、僧道医者执医的合法性,并确认了国家对医术卓越者的赏识和任用,从而对民间向医风气的形成起到导向性的作用。法律管控下的宋代医者,各司其职,各守其责,形成了宋代相对平稳的医疗秩序。在宋代法律的引导下,民间渐渐形成了民风向医的风气,民众逐渐形成了对医者的信赖,促进了宋代独特的医患关系的形成。但是,在这种法律体制管控之下,不可避免的出现了官府医者的公益属性、市场属性被淡化,甚至抹杀;医而入仕的法律政策,的确起到了引导社会向医的主流风气,但不可避免的成为一些士人投机钻营的契机;法律政策的不稳定,不连贯性,导致巫医坑害民众性命、钱财的事例不可能穷尽。宋代设置了自上而下的医疗机构体系,既有医疗管理机构,又有医学教育机构;既有综合性医院,亦有专科性医院;既有宫廷医院,亦有普通平民医院;既有地方医院,亦有军队专科医院;此外,更是设立了历史上第一个官办药局。在宋代医疗体系的建构中,体现出政府的官方主导格局。在国家“信用背书”的前提下,宋代的医疗体系初步具有了实现“效率医疗”的基础性条件。但是,不容否认的是宋代的医药机构在制度落实中,的确出现了矫枉过正的现象;因制度缺乏整体性、延续性的必要设计,影响了医药机构发展的规模性、整体性格局。宋代对药材市场进行管控,从对药材市场“准入”关口严格把关,进而对药材税收进行调控,干预药材的对外贸易,打击假伪药材的泛滥。在确立国家对药材市场的主导管理的同时,客观上的确对药品质量的整体提高起到了促进作用。但是,不可否认的是,宋代药业法律制度在落实中,的确出现了一些问题,以至于宋代药材走私现象、药材作伪现象并未禁绝。整体上看,在医药法律的调整下,宋代的医疗领域表现出崇尚医学、责任政府、社会福利以及政府理性等特点。宋代的医药在获得国家高度认可的同时,亦获得了医药法律的有利支撑,从而出现了蓬勃发展的格局。更多还原

【Abstract】 Under the top-down promotion of the rulers of the Song Dynasty,the law and system of medicine were fully developed.Under the legislative regulation,a complete system covering the fields of doctors,hospitals and drug management had been formed.The sick had their doctors,the doctor had its responsibility,and the pharmaceutical had its regulations.The benign medical order was an important reason to ensure the overall stability of the doctor-patient relationship during the Song Dynasty.On the whole,this paper systematically and comprehensively studies the overall structure of medical management order through legislative means in the Song Dynasty,which is different from the previous research methods of special topic or individual case.Doctors,patients,hospitals,pharmacists and pharmacies followed their own regulations and operated in an orderly manner in the medical law system of the Song Dynasty.This paper changes the previous approach of interpreting the medical problems in Song Dynasty from the perspective of history,social history or medical history.It finds a new way to observe and analyze the positive benefits and limited value of the medical legal system in Song Dynasty from the perspective of law and economics.In the Song Dynasty,the access system from the central government to the local government was established by the law and specific systems were set up for the selection,examination and duties of government doctors.For the government doctors,the legal control within the government system was not only the guarantee of the legitimacy of the government doctors,but also the confirmation of their identity and status.The government established the management and control of the medical staff which was out of authorized size of a government body by law,emphasized their duties and work process and established the management model for the officials whose treatment was based on the civil servants.The government established the legitimacy of folk doctors,women doctors and buddhist doctors,confirmed the recognition and employment of outstanding medical practitioners,thus playing a guiding role in the formation of folk medical ethos by law.Under the control of law,the Song Dynasty doctors performed their respective duties and responsibilities,forming a relatively stable medical order.Under the guidance of the laws of Song Dynasty,the folk people formed the ethos toward medicine and the public belief in doctors,promoted the formation of the unique doctorpatient relationship.However,under the control of this legal system,it was inevitable that the public welfare attributes and market attributes of government doctors were diluted or even eliminated.The law and policy of entering the official position as a doctor had played a leading role in the mainstream trend of the society towards medicine,but it had inevitably become an opportunity for some people to get into the business of speculation.The instability and incoherence of law and policy make it impossible to end the cases of witch doctors who have taken people’s lives and money.The Song Dynasty set up a top-down system of medical institutions,including medical management institutions and medical education institutions.There were both general hospitals and specialized hospitals.There were both palace hospitals and general civilian hospitals.There were both local hospitals and specialized military hospitals.In addition,it set up the first official drug bureau in the history.The construction of medical system reflected the government’s official dominant pattern in the Song Dynasty.Under the premise of national credit endorsement,the medical system had the basic conditions for efficient medical treatment.However,it was undeniable that there was a phenomenon of overcorrection in the medical institutions during the implementation of the system.Due to lack of integrity,continuity of the necessary design for regulations,it had affected the scale of the development of medical institutions and their overall patterns.The Song Dynasty controlled the market of medicinal materials,started from the market access mechanism,regulated the tax system of medicinal materials,intervened in the foreign trade of medicinal materials and cracked down on the flood of false medicinal materials.The establishment of the state’s leading management of the medicinal materials market had promoted the overall improvement of drug quality.However,it was undeniable that there were some problems in the implementation of the pharmaceutical legal system,so that drug smuggling and drug counterfeiting were not banned in the Song Dynasty.On the whole,under the adjustment of medical laws,the medical field of the Song Dynasty showed the characteristics which were advocating medicine,responsible government,social welfare and rational government.In the Song Dynasty,medicine was highly recognized by the state,and also gained the favorable support of medical laws,so it developed vigorously.更多还原