草药与信仰：萌发于修道院的西方医学

Carlo Marino

欧洲中世纪相当于中国从南北朝至明朝的时期。传统中医的起源可以追溯至大约5000年前的神话人物神农氏，传统中医被认为是第三古老的医学形式，仅次于西医的第二广泛使用的医学体系。传统中医的原理植根于古代哲学道家学说。中医将人体，进一步将整个人看成一个统一的有机整体，心灵、精神、情感和身体方面被看成相互联系又相互依赖。这大概解释了一些人将中医视作整体疗法的原因。另一方面，西医医生观察到眼前的事实，用当前的生理学理论来解释这些事实。西医医生分开人体多种系统和器官，越来越深入地钻研构成物质的粒子。

基督教徒第一次与中国接触，是唐朝时由7世纪的叙利亚东正教修道士促成的。中国人给他们的宗教信仰命名为“景教”，“光明教”。

大秦景教流行中国碑  图片来自网络

直到9世纪，这些修道士能够建造修道院和居住区。他们的踪迹随后都消失了。罗马的天主教会在第一次传教中未起到作用，直到19世纪末，他们才到达中国。 

到了中国的南北朝时期，也就是公元476年，罗马帝国灭亡，这是欧洲修道院发展的第一步。

修道院是照顾病人和传播医学知识的最重要场所之一，修道院医学反映了基督教会照顾病人的基本责任，也是这些修道院团体自给自足的特点和学术中心的角色所决定的。

意大利的西方修道院   Carlo Marino摄 

本笃会准则由努西亚的圣本笃（公元 480-547 年）于 6 世纪发明，其精神概括为格言：“平和”和传统的“祈祷和工作”，修道院提供了特别人性化的设施给生病的修士和修女，这种准则有时也适用于在家的平信徒，以及来自团体以外的客人。关于如何保持和恢复健康的关键医学原则被吸收到修道院的生活方式中，尤其体现在饮食调节的实践中，人们认为通过调节饮食可以确保人体内适当的体液平衡来预防疾病。因此，保持身体健康在修道院团体中很重要，这表明，与人们对于中世纪宗教的许多传统印象相反，修士和修女并没有忽视他们的身体。

努西亚的圣本笃 图片来自网络

西欧中世纪医学由来自古代的伪科学观点构成。在中世纪早期，罗马帝国灭亡后，标准医学知识源自于保存在修道院或其他地方的希腊、罗马文本。中世纪医学被广泛误解，其观点被一概而论，被认为是将希望寄托在教会和上帝身上，以治愈所有疾病，而疾病本身则是命运、罪恶和星光影响的产物，是生理原因。

古代药店草药容器 Carlo Marino摄

另一方面，中世纪医学，特别是在中世纪后半期（公元 1100 至 1500 年 ，中国的元明时期），成为正式的理论知识体系并在大学中制度化。中世纪医学将疾病归咎于罪恶行为，而不是自然原因，疾病只与罪行有关是相当普遍的观点，即人类罹患疾病是因为从上帝之国堕入世俗的结果。中世纪医学还认识到疾病会在人与人之间传播，某些生活方式可能会导致健康不佳，而且有些人会比别人更容易得病。

希腊文明  图片来自网络

和整个西方社会一样，西方医学传统可以追溯至古希腊文明和地中海北岸文明。希腊人当然奠定了西方医学实践的基础，但很多西方医学也可以追溯到中东、日耳曼和凯尔特文化。

希腊医学基础来自一份文集，今天称之为《希波克拉底文集》。《希波克拉底文集》体现在现代医学中，以“希波克拉底誓言”或“不做害人之事（Do No Harm）”最为著名。

希波克拉底文集  图片来自网络

《希波克拉底文集》一般认为是古希腊医生希波克拉底所著，他生活的时代相当于中国的战国时代，他奠定了医疗保健的基础。希腊哲学家将人体视为大自然运作规律的映射，希波克拉底将这种理念应用于医学，人体作为大自然的映射，包含四种元素特性，对希腊人表述为四种体液。四种体液分别代表火、空气、土壤和水，对应四种特性：热、冷、干和湿。人体健康依赖于保持体内体液平衡。

这和传统中医凭借五行学说——火、土、金、水和木解释人体如何运行，并指导治疗非常相似，这些元素与人体器官和组织对应，描述发生的生理活动和病理变化。 

西方古代药店 Carlo Marino摄

维持患者体内体液平衡的方式有多种。医生会通过初步检查评估患者的情况。问诊时要考虑病人的家庭情况，饮食情况和占星图。上天通过体液元素对每个人产生影响，这些都是诊断的重要依据。检查之后，医生要确定患者的哪种体液不平衡，并开出新的食谱来恢复平衡。食谱不仅规定什么可以吃什么不可以吃，还包括药物和锻炼方案。目标是治疗潜在的不协调以修复人体的平衡，提高病人的整体健康而非缓解症状。

草药  图片来自网络

希波克拉底的医学知识被记录在《希波克拉底文集》中，因此医生被要求有文化。关于饮食、手术和药物的知识构成了医学学习的基础，罗马帝国时期的希腊医生、哲学家盖伦（公元 129-216 年）基于这些写出了自己的著作。

西方中世纪的一些医学起源于异教和民间习俗。教会神学家们加强了这种影响，他们吸纳了异教和民间习俗的各个方面，并将它们记录在自己的作品中。教会医生所采取的方法，以及他们对异教和民间传统的态度，反映了他们对这些方法的理解，尤其是体液疗法和草药疗法。在中国，草药产品已被传统医学用于治疗许多医疗问题，包括中风、心脏病、精神障碍和呼吸系统疾病（如支气管炎和普通感冒）。

草药  图片来自网络

西方中世纪医学实践是经验主义的和实用主义的，主要聚焦于治疗疾病而非解决病因。那时，通常认为，病因是超自然的。然而，治疗疾病的世俗方法也是有的。中世纪人们通过古希腊体液学说来理解医学。因为既然土地的肥沃显然取决于元素恰当平衡，那么人体也是如此，身体内的各种体液必须保持平衡。

整个中世纪，这个方法对医学理论有很大影响。草药普遍使用于药膏和饮品，用以治疗一系列疾病。具体草药的使用，很大程度上依赖于当地文化，并且经常根源于基督教产生以前的宗教。草药疗法的成功通常被归因于其对人体体液的作用。例如，并头草属植物的种子（用于治疗头痛病）看起来像微型脑袋；兜藓的白色斑点叶子（用于治疗肺结核）与病人的肺看起来相似。通常认为，存在大量这类相似性。

草药  图片来自网络

为了供应草药治疗，许多修道院建有草药植物园。这些草药植物园是民间医学的一部分，也被一些专业医师使用，产生了草药疗法的专著。

中世纪民间医学有很多针对不同疾病的草药疗法。在花园中种植各种具有药用特性的草药的做法受到了罗马古代花园的影响。许多中世纪早期的手稿因包含使用草药的实践描述而著称。

修道院后来成为中世纪医疗实践的中心，并且维持着医用草药植物园的传统。这些园子成为专门的园子，能够种植来自南半球的植物，并在冬季保养植物。

宾根的希尔德加德（公元1098-1179年） 图片来自网络

宾根的希尔德加德（公元1098-1197年）就是一位既接受了古典希腊医学教育，也使用民间医疗疗法的中世纪医生。在医学方面，她对植物的理解影响了她对人体体液的评论，她在她的医疗文集中描述的疗法深受她所精通的民间疗法影响。在希尔德加德时代的农村社会，大部分医疗保健和其他家务都是由妇女承担的。厨房备有草药和其他小病民间疗法所需的物品。

对自然的理解对希尔德加德的医疗学说有影响，但是她仍然坚持认为疾病的根源是人与上帝之间的妥协关系。中世纪早期，异教徒与基督教之间对于疾病的观点存在许多相似之处，二者的差异是基于信仰上的根本差异：基督教徒关于个人与上帝之间的关系的信仰对他们的医学观点有很大的影响。

中世纪医生治疗病人的插画  图片来自网络

许多著名的早期基督教思想家提供了异教对新兴基督教医学实践影响的证据。医生作为一个无私的仆人，必须忍受令人不快的任务并提供必要的、通常是痛苦的治疗的经典观念对早期的基督徒从业者产生了重大影响。基督徒不会忘记，基督才是最终的医生。异教哲学以前认为，追求美德不应次于对身体的关注。

同样，基督徒认为，虽然照顾身体很重要，但它次于精神追求。信仰与身体疾病之间的关系解释了为什么大多数中世纪的医疗实践是由基督教修士进行的。

古代插画中的人体  图片来自网络

修道院不仅发展成为精神中心，而且发展成为知识教学和医疗实践的中心。修道院普遍与世隔绝并且能够自给自足，这要求修道院的居民要自己生产食物并照顾病人。在现代医院出现之前，周围城镇的人们向修道院寻求帮助以治疗他们的病人。

药柜  Carlo Marino摄

精神和自然疗法相结合用来治疗疾病，草药疗法和祈祷，以及其他宗教仪式被修道院修道士和修女用于治疗。草药被修士和修女视作上帝的创造之一，是有助于病人精神治愈的自然辅助。记录草药疗法的传统也在中世纪修道院发展起来。

位于意大利南部城市萨勒诺的第勒尼安海湾的萨勒诺医学院（建于公元 9 世纪），在其附近的蒙特卡西诺修道院里，从希腊语和阿拉伯语翻译而来的世界医学文献一应俱全 。萨勒尼坦的大师们逐渐建立了一套标准，被称为医学技艺或小技艺，成为几个世纪以来欧洲医学教育的基础。

（原载：天瓯智库）

英文版

Similarity between Medical knowledge in western Monasteries 

and Traditional Chinese Medicine

 

Middle Ages in Europe corresponds to the period of time between the Northern and Southern dynasties and Ming Dynasties in China.

The origins of traditional Chinese medicine can be traced to Shen Nong Shi, a mythological figure from about 5,000 years ago and is considered the third oldest form of medicine and second most used medical system next to Western medicine. Its philosophy is rooted in the ancient philosophy of Taoism.

Chinese medicine views the body and further, the whole person, as a unified organic whole. Spiritual, mental, emotional and physical aspects are all seen as interrelated and interdependent. This perhaps explains why some people see Chinese Medicine as a holistic therapy. On the other side, the western doctor observes the facts before him and uses the current physiological theories to explain them. He separates the various systems and organs of the body and delves deeper and deeper into the particles that comprise matter.

The first Christian contacts with China were forged by the monks of the Eastern Church of Syria in the seventh century, under the Tang dynasty. The Chinese gave their faith the name ‘Jingjao’, ‘religion of light’. 

Until the ninth century these monks were able to found monasteries and communities. All trace of them subsequently disappeared. The monastic orders of the Latin Church played no part in the first missionary encounters, and it was not until the end of the nineteenth century that they arrived in the Empire of the Centre.

The fall of the Roman Empire 476 A.D., at the time of Northern and Southern dynasties (Chinese: 南北朝; pinyin: Nán-Běi Cháo) was the first steps of Monasteries in Europe.

Monasteries were among the most important sites for the care of the sick and the dissemination of medical knowledge and the medical preoccupations of monastic communities reflect the fundamental Christian duty of visiting the sick, they also resulted from the self-contained character of these communities and their role as centers of learning. 

From the invention of the Benedictine Rule, written by Benedict of Nursia (480-547 AD) in the sixth century, whose spirit  is summed up in the motto: "peace" and the traditional "pray and work", monasteries offered specially personalized facilities to sick monks and nuns, and such provision was sometimes extended to resident lay people, as well as to guests from outside the community. Key medical principles about how to maintain and restore health were assimilated into the monastic way of life, shown particularly in the practice of the regulation of the diet, which was understood to prevent ill health by ensuring the proper humoral balance within a person’s body. Physical health, therefore, was important in monastic communities, indicating that, in contrast to much historical thinking about medieval religious, monks and nuns did not repudiate their bodies.

Medieval medicine in Western Europe was composed of a mixture of pseudoscientific ideas from antiquity. In the Early Middle Ages, following the fall of the Western Roman Empire, standard medical knowledge was based essentially upon surviving Greek and Roman texts, preserved in monasteries and elsewhere. Medieval medicine is widely misinterpreted, thought of as a uniform attitude composed of placing hopes in the church and God to heal all sicknesses, while sickness itself exists as a product of destiny, sin, and astral influences as physical causes.

On the other hand, medieval medicine, especially in the second half of the medieval period (c. 1100–1500 AD- Yuan and Ming Dynasties in China), became a formal body of theoretical knowledge and was institutionalized in the universities. Medieval medicine attributed illnesses, and disease, not to sinful behaviour, but to natural causes, and sin was only connected to illness in a more general sense of the view that disease manifested in humanity as a result of its fallen state from God. Medieval medicine also recognized that illnesses spread from person to person, that certain lifestyles may cause ill health, and some people have a greater inclination towards bad health than others.

The Western medical tradition goes back directly to the early Greek civilization, northeastern Mediterranean civilization, much like the foundation of all of Western society. The Greeks certainly laid the foundation for Western medical practice but much more of Western medicine can be traced to the Middle East, Germanic, and Celtic cultures.

The Greek medical foundation comes from a collection of writings known today as the Hippocratic Corpus. Remnants of the Hippocratic Corpus survive in modern medicine in forms like the "Hippocratic Oath" as in to "Do No Harm".

The Hippocratic Corpus, popularly attributed to an ancient Greek medical practitioner known as Hippocrates, who lived at the times of the Warring States period (simplified Chinese: 战国时代 ) laid out the basic approach to health care. Greek philosophers viewed the human body as a system that reflects the workings of nature and Hippocrates applied this belief to medicine. The body, as a reflection of natural forces, contained four elemental properties expressed to the Greeks as the four humors. The humors represented fire, air, earth and water through the properties of hot, cold, dry and moist, respectively. Health in the human body relied on keeping these humors in balance within each person.

Traditional Chinese Medicine relies on the theory of five elements — fire, earth, metal, water, and wood — to explain how the body works and guide treatment; these elements correspond to particular organs and tissues in the body and describe the physiological activities and pathological changes that occur.

Maintaining the balance of humors within a patient occurred in several ways. An initial examination took place as standard for a physician to properly evaluate the patient. The patient's home climate, their normal diet, and astrological charts were regarded during a consultation. The heavens influenced each person in different ways by influencing elements connected to certain humors, important information in reaching a diagnosis. After the examination, the physician could determine which humor was unbalanced in the patient and prescribe a new diet to restore that balance. Diet included not only food to eat or avoid but also an exercise regimen and medication. The goal is to treat the underlying disharmony and restore balance to the body, and improve a patient’s overall well-being rather than alleviate symptoms.

Hippocratic medicine was written down within the Hippocratic Corpus, therefore medical practitioners were required to be literate. The combination of knowledge in diet, surgery, and medication moulded the foundation of medical learning upon which Galen (129-216 AD), Greek physician, surgeon and philosopher in the Roman Empire,(Han Dynasty in China, would later build upon with his own works.

Some of the medicine in the Western Middle Ages had its roots in pagan and folk practices. This influence was emphasized by the interaction between Christian theologians who adopted aspects of pagan and folk practices and registered them in their own works. The practices adopted by Christian medical practitioners, and their attitudes toward pagan and folk traditions, reflected an understanding of these practices, especially humoralism and herbalism. In China herbal products have been utilized by traditional medicine for many medical problems, including stroke, heart disease, mental disorders, and respiratory diseases (such as bronchitis and the common cold).

The practice of medicine in the western Middle Ages was empirical and pragmatic. It concentrated primarily on curing disease rather than determining the cause of diseases. Often it was believed the cause of disease was supernatural. However, secular approaches to curing diseases existed. People in the Middle Ages understood medicine by adopting the ancient Greek medical theory of humors. Since it was clear that the fertility of the earth depended on the proper balance of the elements, it followed that the same was true for the body, within which the various humors had to be in balance.

This approach greatly affected medical theory throughout the Middle Ages. Herbs were commonly used in ointments and drinks to treat a range of maladies. The particular herbs used depended largely on the local culture and often had roots in pre-Christian religion. The success of herbal remedies was often ascribed to their action upon the humours within the body. For example, skullcap seeds (used as a headache remedy) can appear to look like miniature skulls; and the white spotted leaves of lungwort (used for tuberculosis) bear a similarity to the lungs of a diseased patient. A large number of such resemblances were believed to exist.

Many monasteries developed herb gardens for use in the production of herbal cures, and these remained a part of folk medicine, as well as being used by some professional physicians and books of herbal remedies were produced.

Folk medicine of the Middle Ages dealt with the use of herbal remedies for ailments. The practice of keeping physic gardens abounding with various herbs with medicinal properties was influenced by the gardens of Roman antiquity. Many early medieval manuscripts have been noted for containing practical descriptions for the use of herbal remedies.

Monasteries later became centres of medical practice in the Middle Ages, and carried on the tradition of maintaining medicinal gardens. These gardens became specialized and capable of maintaining plants from the Southern Hemisphere as well as maintaining plants during winter.

Hildegard of Bingen (1098- 1179 AD), at the time of Emperor Yingzong of Song, the fifth emperor of the Song dynasty of China, was an example of a medieval medical practitioner who, while educated in classical Greek medicine, also utilized folk medicine remedies. Her understanding of the plant based medicines informed her commentary on the humors of the body and the remedies she described in her medical text were influenced by her familiarity with folk treatments of disease. In the rural society of Hildegard's time, much of the medical care was provided by women, along with their other domestic duties. Kitchens were stocked with herbs and other substances required in folk remedies for many ailments.

The understanding of nature could inform medical treatment of the body for Hildegard but she maintained the belief that the root of disease was a compromised relationship between a person and God. Many parallels between pagan and Christian ideas about disease existed during the early Middle Ages. Christian views of disease differed from those held by pagans because of a fundamental difference in belief: Christians' belief in a personal relationship with God greatly influenced their views on medicine.

Evidence of pagan influence on emerging Christian medical practice was provided by many renowned early Christian thinkers. The classical idea of the physician as a selfless servant who had to endure unpleasant tasks and provide necessary, often painful treatment was of great influence on early Christian practitioners. The metaphor was not lost on Christians who viewed Christ as the ultimate physician. Pagan philosophy had previously held that the pursuit of virtue should not be secondary to bodily concerns.

Similarly, Christians felt that, while caring for the body was important, it was second to spiritual pursuits. The relationship between faith and the bodies ailments explains why most medieval medical practice was performed by Christian monks.

Monasteries developed not only as spiritual centers, but also centers of intellectual learning and medical practice. Locations of the monasteries were secluded and designed to be self-sufficient, which required the monastic inhabitants to produce their own food and also care for their sick. Prior to the development of hospitals, people from the surrounding towns looked to the monasteries for help with their sick.

A combination of both spiritual and natural healing was used to treat the sick. Herbal remedies, known as Herbals, along with prayer and other religious rituals were used in treatment by the monks and nuns of the monasteries. Herbs were seen by the monks and nuns as one of God’s creations for the natural aid that contributed to the spiritual healing of the sick individual. An herbal textual tradition also developed in the medieval monasteries.

At Salerno Medical School, on the Tyrrhenian Sea in the south Italian city of Salerno in Southern Italy, in the 9th century AD, Tang dynasty in China, medical texts from the Greek and the Arab world were readily available, translated from the Greek and Arabic at the nearby monastic centre of Monte Cassino. The Salernitan masters gradually established a canon of writings, known as the art of medicine or little art, which became the basis of European medical education for several centuries.