一九二〇年代上海における霍乱流行と中医 (特集 : 病)

Abstract

近代において様々な感染症に見舞われるなかで、他国同様中国も近代的な衛生行政を構築するようになるが、その過程で行政と民衆との間でしばしば対立が生じた。そして、多くの場合それは西医と中医との対立とも関わるものであった。こうした問題については従来西医の視点からの研究が多かったが、近年では中医の側から見たものも増えてきている。本稿もそうした視点を受け継ぎ、一九二六年に上海で発生した霍乱論争を中医の側から検討する。ただ、この論争の特徴的なところは西医対中医だけでなく中医対中医という構図もあったことにある。そのようになった背景を、清朝後期以降の中医による霍乱認識や治療法の変化、一九二六年の上海におけるコレラ流行の状況とそこでの中医の位置づけ、実際の論争の推移、などを跡付けながら考察していく。そして、最終的に当時の中医界全体の動きや霍乱研究そのものにとって霍乱論争が果たした意義について指摘する。

With the occurrence of various infectious diseases, China, like other nations, attempted to construct a modern health administration during the modern period, but there were often clashes between government administration and the civilian populace during the process. These frequently involved opposition between physicians of western medicine and those who practiced traditional Chinese medicine. In regard to this issue, most studies had been conducted from the viewpoint of western medicine, but in recent years the number of studies from the standpoint of traditional Chinese physicians have been increasing. Continuing this trend, this article examines the debate that accompanied the outbreak of huolan 霍乱 in Shanghai in 1926 from the standpoint of traditional Chinese physicians. As is explicated below, huolan refers to acute gastrointestinal diseases, including cholera, and the attack in 1926 was in fact cholera. A special characteristic of this debate was that it did not merely involve physicians of western medicine versus those who practiced traditional Chinese medicine but was also conducted between traditional Chinese physicians themselves. In regard to the factors behind the composition of the participants in this debate, this article traces such matters as the fluctuations in the actual debate as well as changes in the understanding of huolan and its treatment by physicians of Chinese medicine from the late Qing period, and locating Chinese physicians within the context of the 1926 cholera outbreak in Shanghai. Then, in conclusion I indicate the significance of huolan debate for the study of huolan and the workings of the entire field of traditional Chinese medicine at the time. The following is a summary of each sections of this article. In the first section, I examine debates about huolan by Chinese traditional physicians prior to 1926. Huolan can be roughly divided into the noncontagious variety (acute gastrointestinal inflammation and bacterial food poisoning) and contagious huolan or cholera. However, in China prior to the 19th century when the influence of the theory of bacterial transmission was limited, there were very few who could distinguish non-contagious from contagious huolan. In these circumstances, particularly remarkable were the Huolan lun 霍乱論 and Suixiju (chongding) Huoluan lun 随息居(重訂)霍乱論 written by Wang Shixiong 王士雄. Wang distinguished cold huolan 寒霍乱 and hot huolan 熱霍乱 and argued for separate treatments for each. After Wang's death, there were some traditional Chinese physicians in the Jiangnan (the lower Yangzi area) who identified hot huolan as cholera. They implemented treatment of hot huolan based on the concept of cold and cool medicine (寒涼薬) described in Wang's works, but determining whether the huolan raging before them was cold huolan or hot huolan, or whether it was contagious or non-contagious huolan remained difficult, and it was often the case that appropriate treatment was not implemented. In the second section, I concentrate on the spread of huolan in Shanghai in 1926 when the debate over huolan arose as well as the response to it by Chinese traditional physicians and the government. According to a report of the Royal Army Medical Corp, cholera was rampant in Shanghai from July of that year, and over 3000 were suspected of being infected and over 700 died. The epidemic was stopped by November through the effort of the government and others, but we can confirm from an article in the Shen bao 申報 that physicians of traditional Chinese as well as doctors of western medicine were both involved in the treatment of patients. In the third section, I examine the specifics of the huolan debate. The trigger for the debate was death of the Ding Ganren 丁甘仁, representative of traditional Chinese physicians, during the huolan epidemic. Thereafter, the debate over huolan raged in pages of in Shanghai daily Shen bao. The first to open fire was Ding Huikang 丁恵康 who criticized the actions of traditional Chinese physicians from the perspective of western medicine. This was followed by Zhang Binglin 章炳麟 who was particularly well-versed in traditional Chinese medicine. However, Zhang did not address Ding Huikang's opinions in particular, and instead criticized the activities of traditional Chinese physicians from the point of view of traditional Chinese medicine. In other words, most traditional Chinese physicians understood the huolan of 1926 as hot huolan and responded to it with the cold and cool medicine prescribed in Wang Shixiong's Huolan lun and Suixiju (chongding) Huoluan lun, but Zhang instead took the huolan outbreak of this year as cold huolan and argued it should be treated with warm and hot medicine 温熱薬, such as si ni tang 四逆湯, based on Shang han lun 傷寒論, and argued that if that such treatment was not followed, western medical treatments should be followed with injections of saline solution. It was the traditional Chinese physician Wang Yiren王一仁who argued directly against Zhang's position. Wang stated that this year's huolan was indeed hot huolan and should be treated with cold and cool medicine. Later, approximately ten western and Chinese physicians participated in the debate, which at times grew heated. However, this was not only a confrontation between physicians of western and traditional Chinese medicine, but among Chinese physicians themselves, and the latter was even more heated. In the fourth section, I point out the following three points regarding the background to the struggle among traditional Chinese physicians during the huolan debate: 1) huolan presented a variety of symptoms that were differentiated as cold huolan and hot huolan and these were difficult for traditional Chinese physicians to distinguish; 2) there were various opinions regarding the direction for the reform of traditional Chinese medicine at the time, and this process included increasingly vocal calls for the modernization of traditional Chinese medicine and a reevaluation of Shang han lun; and 3) as Ding Ganren, a leading figure among traditional Chinese physicians in Shanghai, died, and the role of traditional Chinese physicians in the treatment of cholera in Shanghai was reduced, there were many traditional Chinese physicians who felt it necessary to redress its position of inferiority. In relation to the third point, there were a number of traditional Chinese physicians in the huolan debate who offered constructive opinions that benefited all physicians of traditional Chinese medicine. Moreover, in 1927 when the huolan debate had drawn to a close, Shanghai China Medical College was established by Wang Yiren, and Zhang Binling, who had opposed him in the huolan debate, was appointed chancellor. In this fashion, behind the huolan debate were a number of issues that had embroiled Chinese traditional physicians at the time. The debate itself was not settled, but the trumping of the debate by Shen bao, which was a representative daily in Shanghai at the time, appears to have made Chinese traditional physicians conscious of the situation in which the world of Chinese traditional medicine was placed, disseminated the issue to the wider society, as well as having had some significance in the development of the study of huolan itself. Therefore, the activities of traditional Chinese physicians during the huolan epidemic of 1926 in Shanghai, which at first glance seem to have been merely an internal struggle, cannot be dismissed as having been solely composed of negative elements.