本文旨在探討晉唐之間中國小兒醫學的成立與發展，並討論時人對小兒醫學的態度。此一關鍵時期，小兒醫學專門著作與專家漸多，小兒醫學的定義、內容與範圍逐漸明朗化，唐朝太醫署設立少小醫學分業與教育，小兒成為特定醫學領域的規模至此底定。 然而，故事還不僅止於此。漢末以降，社會上瀰漫輕賤醫學的風氣，使得有心成為小兒醫者裹足不前。小兒「氣勢微弱」，醫者又缺乏經典以資參考，卻需要更多的知識與技術輔助，加上小兒難以說明身體病痛，使得醫者學習與參與診療小兒的過程充滿艱辛，「立功差難」。新生兒多由「不潔」的產母照顧，「乳氣腥臊」之餘，「操行英雄」詎肯瞻視。再者，或因照顧小兒是女性職責，其醫療知識多在女性間傳承，「操行英雄」多不願跨越性別藩籬，診治小兒。同時，晉唐醫界對於小兒醫學的分類與界定尚存在歧見，且在維持聲譽與經濟收入的考量下，小兒醫並不具備吸引力。基於上述原因，縱使若干醫者戮力為小兒醫學開疆拓土，它卻始終位居男性主導之醫療領域的邊緣，人們對從事小兒醫的興趣不高，以致於終唐之世，可資教學與臨床操作的小兒醫籍為數有限，或在綜論性醫籍中敬陪末座，或甚至隱身於婦人方之中。但與此同時，卻有醫者挺身而出，大聲疾呼「養小為大」的崇本真義，企圖提升小兒醫學的能見度。以上這些在同一個時代脈絡中交互穿疊的諸多面向，其交會與偏離的軌跡紛然雜沓，正足以顯示中古醫療與社會的多元風貌。 古代小兒的聲音、感覺與渴求，淹沒在以成人為中心的醫病情境與醫學書寫中，小兒之痛，只換來「乳氣腥臊」之名。至此，小兒聲勢之弱，不可言喻。

This paper examines the establishment and development of pediatrics from the Jin to the Tang dynasties (265-907), focusing on contemporary attitude toward pediatrics and the hesitation of male medical experts to become pediatricians. Pediatrics was apparently a rising field in Chinese medicine during the Jin-Tang period. Although pediatricians still had to compete with gynecologists and obstetricians in serving their clients and offering pediatric advice, the Jin-Tang period witnessed an increase in pediatric texts, and experts and pediatricians started to assert an independent voice. During the Tang dynasty, pediatrics even became a required subject in official medical training. However, in practice, the number of male pediatricians remained small. The reasons for this were multifold. First, medicine was regarded as less than a respectable occupation and faced fierce competition from witches and religious healers. Second, because children were “frail and feeble,” the success rate in pediatrics was believed to be comparatively low. It therefore was regarded a difficult field in which to seek fame and reward. Moreover, since taking care of children was traditionally regarded as women’s task, and its related medical knowledge and skills mostly passed down between female generations, male pediatricians had to recreate a new professional image and renegotiate the gender divide. Furthermore, the medical culture at the time was still androcentric and discriminated against the “stinking breast qi” (ruqi xingsao) of new-born babies and “contaminated” mothers, elements that would compromise the “virtuous and heroic” (caoxing yingxong) male qualities associated with the profession. These reasons, particular to the medieval China, in addition to such intrinsic difficulties of the field as the extra diagnostic skills needed for treating young patients incapable of articulating their symptoms, practioners’ reluctance to enter into the field. Despite the Tang government’s establishment of a pediatric division in medical training, pediatrics remained a marginal domain within the practice of medicine. It was against this professional environment that Sun Simiao called on medical practitioners to attend the beginning of life and to assist the mission of “cultivating the small/youth to accomplish the big/adult.” These various dimensions of medical culture informed the complex process of the formation of pediatrics as an independent field in medieval China. Yet this complexity must be recovered from extant medical writings, which often communicate only the “virtuous and heroic” male physicians’ viewpoint. In the end, the children’s own voices were not loud enough to make their way into the historical record.

少小；小兒；醫學；孫思邈；操行英雄；乳氣腥臊

pediatrics; child; medicine; Sun Simiao; virtuous hero (caoxing yingxong); stinking breast qi (ruqi xingsao)