臺灣博碩士論文加值系統

本論文係以希臘市民城邦（polis）之意識型態與社會脈絡，根據《希波克拉底斯全集》，來探究古代醫生之形象與醫療行為。古代醫療市場是個眾聲紛云，擁有許多不同醫療方式的空間。本論文的目的是要將希臘醫生及醫學重新「脈絡化」，呈現出對古代希臘醫生較為素樸與一致的觀點。為達成這預期之結果，論文將由古代希臘醫生之形象與醫療行為、疾病的詮釋、〈希波克拉底斯誓言〉以及對生死之看法來著手研究。
古代希臘醫生為因應競爭以及建立論述，符合城邦之公共價值，需為自己作為醫療「工匠」的存在理由及所進行之醫療行為被認可之技藝，而進行系統性的辯護。根據《全集》，醫生為建立一個好的名聲，發展出一套獨特醫療行為，具有明顯「避險」機制的特色，讓他們能夠判斷病情，避開棘手病例，減少醫療失誤，在古代醫療市場建立其可信度。
其次，如果就《全集》中醫生所做之醫療建議，其臨床效果常十分有限，那醫師如何進行治療，建立其可信度？根據《全集》中的資料，希臘醫生常以日常語言向病患述說一套疾病的故事，以體液論幫助病患理解自己生病的現象以及疾病對他們生活的影響。這一套疾病詮釋突顯出在古代社會中，醫生所強調或人們期待醫生所要做的是其治療模式，而非其治療成果；透過對疾病的詮釋，醫生成為疾病與病患間的溝通者。此舉減少因古代受限科技，於是在治療上常效果有限而導致的責難。另外，〈希波克拉底誓言〉在這觀照之下，應該被詮釋為古代「醫神之子」（類似醫生「行會」）團體的職業道德憲章，提醒他們醫學技藝的目的與限制，並非如現今所常認為的那種具現超歷史之人道主義精神或永恆價值的文獻。
最後，希臘醫生對治療之行為及結果之有所保留，還可能涉及希臘人對生命及死亡的一般看法。希臘人認為所謂的靈魂（psyche）是種生命現象，而死亡並非截然屬於另一種存在，而是種稀薄、陰暗、低實質的生命現象；生命及死亡宛如是連續之光譜的兩個向量，必須由宗教性質之喪禮來劃清其界限。這種觀點使醫生面對急症病患時，除了一方面為確保自己的職業地位外，同時也許是體認到醫學技藝的能力有限，以及死亡並非純然難以接受之狀態，所以常有建議以非侵入性的養生攝食或生活習慣之改變，來讓病人不受到太多折磨下，坦然面對死亡之到來。

This thesis is to use Greek polis as the context for an inquiry, based on the Hippocratic Corpus, into the image of Greek doctor and his healing practice, in order to establish a more realistic and comprehensive picture of ancient Greek doctor in general. This attempt to re-contextualize Greek doctor will be approached from four perspectives: the image of doctor as medical technician, his interpretation of disease, his oath as well as his view of life and death conditioning his medical practice.
Ancient Greek healing market was full of competing views on healings and allowed various kinds of practices, and the Greek doctors, inter alias, had to compete and establish their own authorities to justify their medical healing as a worthy techne and their status as medical “technician”. Accordingly, the Corpus tells us that Greek doctors developed their own way of medical practice, fortified with risk-prevention mechanism, that helped them pass plausible judgments on symptoms and avoid cases that would end in failures in treatment and bring ruin to their reputation.
In his healing practice a Greek doctor developed an interpretative strategy of diseases in terms of ordinary language. He would use a widely shared knowledge of humoral balance and its lack to help his patient understand the diseases he suffered and the impacts exerted on his life. Such an interpretative system throws light on why the Greek doctors were not concerned so much with the effect of healing as the procedure of healing. Through such an interpretation a doctor would became an intermediary between the disease and the patient in question. This would reduce drastically the moral blame that came with the lack of efficacy the Greek medicine in general would bring about. Furthermore, the famous Hippocratic Oath under this light would then be reinterpreted as a code of practice for the guild of doctors that regulated and informed the Asclepiadai. The Oath should, in addition, not be taken as a trans-historical document that embodied permanent values. It is ancient and Greek.
If a Greek doctor seems less an interventionist in his treatment, it might be because he was further conditioned by the Greek view on life and death. For the Greeks soul (psyche) is a “self-moving” principle, a principle of life that could take different degrees in terms of scala naturae. Death, by contrast, is a minimal version of this principle, a very tenuous form of life, and so in the Hades the dead maintained a certain degree of existence that could be revived temporally by sacrificial blood. What constitutes life and death seems like two vectors of a continuum that has to be marked arbitrarily by the ritual of funeral. This less drastic view of death might prompt a Greek doctor whose resources were limited and a patient who shared this popular view of death not to push medicine to its limit. This explains why a Greek doctor often suggested a benign regimen or a moderate change of habits as a way of healing so that the patient could face up calmly the disease he suffered or even the last minutes of his life.

目錄


中文摘要 i

英文摘要 iii

關鍵字 v

謝辭 vi

第一章 緒論 1
第一節 文獻回顧與研究動機 1
第二節 研究取向、方法學與基本史料 7
第三節 章節安排與預期成果 13

第二章 賣藝為生之古代醫生：
以《希波克拉底斯全集》之〈症狀之預後〉為分析基礎 16
第一節 部分醫學史家眼中的古代醫者形象 16
第二節 古代醫生是一個「醫療工匠」（demiourgos） 23
第三節 古希臘醫療技藝的避險機制－以〈症狀的預後〉為例 44

第三章 《希波克拉底斯全集》之疾病詮釋 53
第一節〈病患訪視錄〉（Epidemics）：醫療工匠的使用手冊 53
第二節 希波克拉底斯醫生的養成與訓練 68
第三節 社會的身體：古代醫學的社會性功能 85

第四章 〈希波克拉底斯誓言〉：
「醫神之子」（Asclepiadai）的職業規範 103
第一節 歷史上之〈希波克拉底斯誓言〉103
第二節〈希波克拉底斯誓言〉之脈絡 106
第三節〈誓言〉為職業風險的重點提要 114

第五章 死亡的馴服：
古代醫生面對死亡之態度及對其醫療行為之影響 133
第一節 荷馬史詩所呈現的死亡意像 133
第二節 城邦與死亡 146
第三節 希波克拉底斯醫生眼中的死亡 156

第六章 結論 166

第七章 書目 170

附表一：〈病患訪視錄〉症狀統計表 59

附圖一：體液論示意圖 79

原典史料：
Aristotle:
Jonathan ed. The Complete Works of Aristotle: the Revised Oxford Translation. New Jersey: Princeton University Press,1984
Apuleius:
Apuleius The Golden Ass translated with introduction and explanatory notes by
Walsh. P. G. New York: Oxford University Press,1994

Hippocrates:
Hippocrates Hippocrates vol. I-II, W. H. S. Jones trans. Cambridge, Mass: Harvard University Press, 1923
Hippocrates Hippocrates vol. III, W. H. S. Jones trans. Cambridge, Mass: Harvard University Press, 1928
Hippocrates Hippocrates vol. IV, W. H. S. Jones trans. Cambridge, Mass: Harvard University Press,1931
Hippocrates Hippocrates vol. V, W. H. S. Jones trans. Cambridge, Mass: Harvard University Press,1988
Hippocratic Writings. G.. E. R Lloyd ed. Translated by J. Chadwick and W. N. Mann, Penguin, London,1983
.
Homer:
Harold Bloom ed. and with an introduction, Homer's The Iliad (New York: Chelsea House,1987)
Plato:
John M. Cooper and D. S. Hutchinson edited Plato: Complete Works, Indianapolis, Hackett Publishing Company, Inc. 1997
Pliny the Elder:
Pliny the Elder, Natural History XXIX. 18. John F. Healy trans. England: the Penguin Group,1991
Soranus:
Soranus’ Gynecology, Owsei Temkin trans. with an introduction. Baltimore: The Johns Hopkins Press,1956

中文翻譯史料：
柏拉圖著，Jowett, Benjamin英譯，侯健中譯《柏拉圖理想國》。（聯經，台北，1976）
柏拉圖著 王曉朝譯《柏拉圖全集》卷二，〈國家篇〉。（左岸，台北，2003）
柏拉圖《斐多篇》 王曉朝譯《柏拉圖斐多篇》（臺北：左岸文化，2007）
亞里斯多德著，顏一、秦典華譯《政治學》。（知書房，臺北，2001）
亞里斯多德著 苗力田主編 顏一與秦典華譯 《亞里斯多德全集》（中國人民大學出版社，北京，1994）
荷馬著 羅念生．王煥生譯《奧德賽》（貓頭鷹出版社：臺北，2000年7月初版）
荷馬著 羅念生．王煥生譯《伊利亞特》（貓頭鷹出版社：臺北，2000）
修昔底德著 謝德風譯《伯羅奔尼撒戰爭史》(上冊)（北京：商務印書館, 1985）
蘇弗克里茲著 呂健忠譯 《安蒂岡妮:墓窖裡的女人》（臺北：書林, 1995十版）

史料選輯：
Allen, R. E. Ion, Hippias Minor, Laches, Protagoras—The Dialogues of Plato, volume3. Cambridge, Mass.: Yale University Press, 1996
Emma J. Edelstein and Ludwig Edelstein ed. Asclepius: Collection and Interpretation of the Testimonies London: The Johns Hopkins University Press,1998
Guthrie, Kenneth Sylvan The Pythagorean Sourcebook and Library Grand Rapids: Phanes Press,1987
Longrigg, J. Greek Medicine from the Heroic to the Hellenistic Age: A Source Book. London: Duckworth, 1998
Mary R. Leftkowitz ＆ Maureen B. Fant ed. Women’s Life in Greece ＆ Rome: A Source Book in Translation London: Duckworth,1992
Rice, David G. and Stambaugh, John E. ed. Sources for the Study of Greek Religion
Scholars Press for The Society of Biblical Literature, 1979

專業參考辭典：
Homblower, Simon and Spawforth, Antony edit. The Oxford Dictionary USA: Oxford University Press: 1996.

網站史料：
Aeschylus:
Agamemnon1148 ed. Herbert Weir Smyth in
http://www.perseus.tufts.edu/cgi-bin/ptext?doc=Perseus%3Atext%3A1999.01.0004＆query=choral%3D%2370 3/11/08
Demosthenes 43
http://www.perseus.tufts.edu/cgi-bin/ptext?doc=Perseus%3Atext%3A1999.01.0078;query=section%3D%23124;layout=;loc=43.61 060308
Euripides
Alcestis1 ed. David Kovacs in
http://www.perseus.tufts.edu/cgi-bin/ptext?doc=Perseus%3Atext%3A1999.01.0088;query=card%3D%231;layout=;loc=28 031108
Lucian:
Lucian, Slander. A Warning, http://www.sacred-texts.com/cla/luc/wl4/wl402.htm. 03/06/2007

期刊：
Amundsen, D. W.(1978)“Images of physicians in classical times, Journal of Popular Culture, v.11: 642-55.
Day, J. W. (1989) “Rituals In Stone: Early Greek Grave Epigrams And Monuments in Journal of Hellenic Studies 109: 16-28
Garland, Robert (1981)“The Causation of Death in Iliad: A theological and Biological Investigation, BICS 28: 47-60.
------ (1982)“Geras Thanonton: An Investigation into the claims of the Homeric Dead,BICS 29: 69-79.
------ (1989)“The well-ordered corpse: An investigation into the motives behind Greek funerary legislation, BICS 36:1-15
Hamilton, J. S. (1986) “ Scribonius Largus on the medical profession, Bulletin of the History of Medicine 60: 209-16
Hanson, A.Ellis (1987) “The Eight Month’s Child and the Etiquette of Birth, Bulletin of the History of Medicine 61: 589-602.
Heinrich von Staden (1996) “In a pure and holy way: personal and professional conduct in the Hippocratic Oath? Journal of the History of Medicine and Allied Science, v 51. 4: 404-37.
Horstmanshoff, H. F. J. (1990) “The Ancient Physician: Craftsman or Scientist? Journal of the History of Medicine and Allied Sciences 45: 76-97.
Kudlien, Fridolf (1970) “Medical Ethics and Popular Ethics in Greece and Rome, Clio Medica, Vol. 5: 293-311.
------ (1976) “Medicine as a ‘liberal art’ and the question of the physician’s income, Journal of the History of Medicine and Allied Science v.31: 448-459.
Michler, Markwart (1968) “Medical Ethics in the Hippocratic Bone Surgery,Bulletin of the History of Medicine, v. XLI 4: 297, 311.
Morris, Ian (1989)“Attitudes Toward Death in Archaic Greece,’’ Classical Antiquity, Vol 8: 296-320.
Nutton, V. (1993) “Beyond the Hippocratic Oath, Clio Medica Vol. 24: 24-37.
------ (1995) “What’s in an oath? Journal of the Royal College of Physicians of London. Vol. 29 No.6: 518-24.
Oberhelman, S. M. (1987) “The Diagnostic Dreams in Ancient Medical Theory and Practice, Bulletin of the History of Medicine, 61:47-60.
Oliver, J.H. and Mass trans, P.L.（1939）“An ancient poem on the duties of a physician Bulletin of the History of Medicine, 7: 315-23
Pearcy, Lee T. (1992) “Diagnosis as narrative in ancient literature, American Journal of Philology, 113: 595-616.
Rocca, Julius (2008) “Inventing and Ethical Tradition: A Brief of History of the Hippocratic Oath Legal Ethical, 11: 1-40.
Temkin, O. (1953) “Greek Medicine as Science and Craft, Isis, 44: 213-25.
Winau, Rolf (1994) “The Hippocratic oath and ethics in medicine, Forensic Science International 69: 285-89.

參考書目：
Annas, Julia (1981) An Introduction to Plato’s Republic. Oxford: Clarendon Press
Adkins A. W. H. (1970) From the Many to the One: A Study of Personality and Views of Human Nature in the Context of Ancient Greek Society, Values, and Beliefs. Great Britain, Constable and Company Ltd.
Baas, John Hermann (1971) Hermann: Outlines of the History of Medicine and The Medical Profession. Robert E. Krieger Publishing Co Inc, New York.
Barker Ernest. (1960). Greek Political Theory London: University Paperbacks.
Blundell, S. (1995) Women in Ancient Greece London:British Museum Press
Bowler, Peter J., J. (2003) Evolution: The history of an idea. USA: University of California Press
Bremmer, Jan N. (2002) The Rise and Fall of the Afterlife London: Routledge
Brian Hurwitz, Trisha Greenhalgh and Vieda Skultans ed. (2004) Narrative Research in Health and Illness M A: Blackwell publishing
Calne, Roy (1988) History of Surgery Sweden: AB Nordbok
Cantor, David ed. (2002) Reinventing Hippocrates England:Ashgate Publishing Limited
Carella, Michael J. (1991) Matter, Morals and Medicine New York: Peter Lang Publishing
Cartledge, Paul (1993) Religion in the Ancient Greek City. Cambridge: Cambridge University Press
------ (1998) Cambridge Illustrated History Ancient Greece. Cambridge: Cambridge University Press.
------ (2001) Medical Ethics in the Ancient World.Washington D.C: Georgetown University Press
Choron, Jacques (1963) Death and Western Thought. New York: Macmillan
David Cohen (1991) “Seclusion, separation, and the Status of Women in Classical Athens in Ian MacAuslan and Peter Walcot ed.1996 Women in Antiquity. Oxford: Oxford University Press.
Dittler, Edgar (1938) The Hippocratic Oath. New York: Liveright Publishing Company
Dodds, E. R. (1951) The Greeks and The Irrational. California: University of California Press.
Douglas M. MacDowell (1978) The Law In Classical Athens. New York: Cornell University Press.
Dover, K. J. (1974) Greek Popular Morality In the time of Plato and Aristotle. New York: Basil Blackwell
Easterling, P. E. and Muir, J. V. (1985) Greek Religion and Society. Cambridge: Cambridge University Press
Freud, Peter E. S. et al. ed. (2003) Health, Illness and the Social body: A Critical Sociology. North Carolina: Prentice Hall
Garland, Robert (1990) The Greek Way of Life: from conception to old age. London: Duckworth
-------- (1985) The Greek Way of Death. New York: Cornell University Press
Good, Byron J. and Good, Mary-Jo Delvecchio (1992) “The Meaning of Symptoms: A Cultural Hermeneutic Model For Clinical Practice, in Leon Eisenberg and Arthur Kleinman ed. 1992 The Relevance of Social Science for Medicine. Holland: D. Reidel Publishing Company
Griffin, Jasper (1980) Homer On Life And Death. Oxford: Oxford University Press
Grmek, Mirko D. (1983) Diseases in the Ancient World. trans by Mireille Muellner and Leonard Muellner, Baltimore: The Johns Hopkins University Press
------- (1993) translated by Antony Shugaar. Western Medical Thought from Antiquity to the Middle Ages. Cambridge, Mass: Harvard University Press
Guthrie, W. K.C. (1971) The Sophists. Cambridge: Cambridge University Press
------- (1981) A History of Greek Philosophy: VI Aristotle: an encounter. Cambridge: Cambridge University Press
Hope, Valerie M. and Eireann Marshall (2000) Death and Disease in the Ancient City. London: Routledge
Ian MacAuslan ＆ Peter Walcot, ed. (1996) Women in Antiquity. Oxford: Oxford University Press
Jackson, Ralph (1988) Doctors and Diseases in the Roman Empire. London: British Museum Press
Jouanna, J. (1998) “The Birth of Western Medical Medicine, in Miro Drmek (1993) ed. trans. by Antony Shugaar. Western Medical Thought from Antiquity to the Middle Ages. Cambridge, Mass.: Harvard University Press
------ (1992) Hippocrates. trans. by M. B. DeBevoise. London: The Johns Hopkins University Press
Kerferd, G. B. (1997) “The sophists, in C. C. W. Taylor ed. Routledge History of Philosophy- From the Beginning to Plato Volume I. London: Routledge.
King, H. (1998) Hippocrates’ Woman. London: Routledge
Kraut, Richard (1992) The Cambridge Companion to Plato. Cambridge: Cambridge University Press
Kuczewski, Mark. G. and Ronald Polansky ed. (2002) Bioethics: Ancient Themes in Contemporary Issues Mass.: MIT Press
Langholf, Volker (1990) Medical Theories in Hippocrates. Berlin: Walter Gruyter.
Lloyd, G. E. R. (1970). Early Greek Science: Thales to Aristotle. London: Norton ＆ Company.
------ (1979) Magic, Reason And Experience- Studies in the origins and development of Greek science. Cambridge: Cambridge University Press.
------ (1994) “Medicine in Cambridge Ancient History VI. 2nd edition Cambridge: Cambridge University Press.
Longrigg, James (1997) “Medicine in the Classical Word in Irvine Loudon ed. Western Medicine. Oxford: Oxford University Press.
------ (1993). Greek Rational Medicine: Philosophy and Medicine from Alcmaeon to the Alexandrian. London: Routlege.
Loraux, Nicole (1986) The Invention of Athens: The Funeral Oration in the Classical City. Cambridge, Mass.: Harvard University Press
Loudon, Irvine (1997) Western Medicine - An Illustrated History. Oxford: Oxford University Press.
McAuslan ＆ Walcot Ian McAuslan ＆ Peter Walcot (1996) Women in Antiquity. Oxford: OUP
Majno, Guido (1975) The Healing Hand: Man and Wound in the Ancient World. Cambridge, Mass.: Harvard University Press
Mikalson, Jon D. (1983) Athenian Popular Religion. Chapel Hill: The University of North Carolina Press
Morris, Ian (1989) Burial and ancient society. Cambridge: Cambridge University Press
Nutton, V. (1988). From Democedes to Harvey: Studies in the History of Medicine. London: Variorum Reprints.
------- ( 2004) Ancient Medicine. London: Routledge.
Osborne, Robin ed. (2000) Classical Greece 500-323 BC. Oxford: Oxford University Press
Pearson, Lionel (1962) Popular Ethics in Ancient Greece. California: Stanford University Press
Pomeroy, Sarah B. ed. (1991) Women’s History and Ancient History Chapel Hill: University of North Carolina Press
Pottered, R. (1996) Cambridge Illustrated History Medicine. Cambridge: Cambridge University Press
Roochnik, David (2004) Retrieving the Ancient. MA: Blackwall Publishing Ltd.
Rousselle, Aline (1988) Poneia: On Desire and the Body in Antiquity Oxford: Blackwell
Scarborough, John, Philip J. Van Der Eijk, Ann Hanson, Nancy Siraisi ed.(2005) Hippocrates In Context: papers read at the XIth International Hippocrates Colloquium, University of Newcastle upon Tyne 27-31 August 2002. MA, Brill Academic Publishers
Sigerist, H. A. (1961) A History of Medicine. New York: Oxford University Press
Shldon, Watts. (2003) Disease and Medicine in World History. New York: Routledge.
Taylor, C. C. W. ed. (2003) Routledge History of Philosophy - From the Beginning to Plato Vol I. London: Routledge
Temkin, Owsei and Temkin, Lilian C (1987) Ancient Medicine- Selected Papers of Ludwig Edelstein. London: The Johns Hopkins University Press.
------- (1991) Hippocrates in a World of Pagans and Christians Baltimore: Johns Hopkins University Press
------- (2002) On second thought and other essays in the history of medicine and science Baltimore: Johns Hopkins University Press
Van Der Eijk, Philip J. (2005) Medicine and Philosophy in Classical Antiquity Cambridge: Cambridge University Press
Vermeule, E. (1979) Aspects of Death in Early Greek Art and Poetry London: University of California Press
Vernant. Jean-Pierre (1991) Mortals and Immortals: collected essays. New Jersey: Princeton University Press


中文刊物與專書：
Otto L. Bettman著，李師鄭譯《圖解醫學史》。（台北：民生報社，1971）
William Coleman and George Basalla著，嚴晴燕譯《19世紀的生物學和人學》。（上海：復旦大學，2000）
雅克．安德烈著 楊洁，吳樹農譯 《古羅馬的醫生》（桂林，廣西師範大學出版社，2006）
Frederick Copleston 著 傅佩榮譯 《西洋哲學史(一)—希臘與羅馬》（黎明文化事業 台北 1995四刷﹚
翁嘉聲〈希臘醫神阿斯克勒庇俄斯（Asclepius）與夢療〉發表於〈文化實踐與社會變遷〉創刊號 於2010年6月出版 台北：財團法人台灣社會改造協會，頁77-125
翁嘉聲，1997，〈身體與政體身體之社會建構：對希臘Pederasty及同性戀之初步探討〉，《成大西洋史集刊》。第7期，頁1-109。
翁嘉聲，1999，〈希臘舊喜劇之嘉年華理論並試論亞里士多芬尼斯之《雅典女人在婦女節》（Thesmophoriazusae）〉，《成大西洋史集刊》。第9期，頁1-125
David Furley 主編 馮俊譯 《史特利奇哲學史第二卷: 從亞里斯多德到奧古斯丁》（北京．中國人民大學出版社，2004）
艾德格．萊依著 張維娟譯《荷馬》（臺北：商周， 2006）
讓-皮埃爾．費爾南著 余中先譯《神話與政治之間》（北京：三聯書局，2001）
郭莉娟，（賣藝為生的古代醫生：以Hippocratic Corpus之 “Prognostic與“Epidemics為分析基礎） 發表於國立成功大學歷史系舉辦之「第一屆西洋史青年學者論文發表會」，2004（民93）5月。即將發表於臺灣社會改造協會出版之《醫學、歷史與社會》第一期。
郭莉娟，（一個關於希波克拉底斯誓言的歷史研究），發表於2007年3月19至24日由The Center for Ethics of Science and Technology, the College of Public Healthy, Chulalongkorn University and UNESCO Bangkok所主辦的The Eighth Asian Bioethics Conference（ABC 2007）。（未刊稿）