西方醫學之父 希波克拉底 Hippocrates

西方醫學之父

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「視彼兒女，猶我弟兄」，這充滿著同理心的誓詞，淋漓展現了希波克拉底那種父母醫者的寬大仁心。

 一、希波克拉底生平

希波克拉底（約前460年至約前370年），為古希臘伯里克利時代的醫師，約生於公元前460年，後世人普遍認為其為醫學史上傑出人物之一。在其所身處之上古時代，醫學並不發達，然而卻能將醫學發展成為專業學科，使之與巫術及哲學分離，並創立了希波克拉底醫學學派，對古希臘之醫學發展貢獻良多，故今人多尊稱之為「醫學之父」。

公元二世紀的希臘婦科醫師以弗所的索拉努斯，乃首個為希氏立傳之人，關於希氏的個人記述，多源於此。此外，亦有其他古籍述及希氏生平，然而資訊相對較少，諸如公元前四世紀的亞里士多德所書之文，公元十世紀拜占庭的《蘇達辭書》，及公元十二世紀策策斯的文獻。索拉努斯指出希氏之父亦為醫師，名為赫亞克里德斯；其母為Phenaretis之女，名為Praxitela。而其二子，雷沙勒斯、杜累哥及女婿波呂波斯悉為其學生。另外，據後世醫師葛倫（亦譯為蓋侖，英文為Galen）所言，波呂波斯正是希氏的真正繼承者，得其真傳，而其二子則各有一子以希氏為名。

索拉努斯稱希氏他其父親及祖父處學習醫術，並拜德謨克利特和高爾加斯為師，學習其它學科。他很有可能在科斯島上的阿克波里斯神殿（亦譯為醫神神殿）里接受培訓，並得到來自色雷斯的醫師希洛地卡斯的教晦。在其時代，關於他本人的記述很少（或可說流傳至今的不多），只有柏拉圖的對話錄普羅塔哥拉里有一句述及之，曰：「科斯島之希波克拉底，艾斯庫累普派之人也。」總而言之，終其一生，皆在教授及鑽研醫學，並遨遊四方，足跡最遠可達色薩利、色雷斯及馬爾馬拉海。至於其死亡之事，眾說紛雲，有說他死於拉里薩、有雲其卒於家鄉；有指其享年八十三、有說其享年九十，更有雲其享壽逾百者，今人無從查證。

   

二、希波克拉底對醫學的貢獻

（一）、專業精神

希氏醫學以其專業精神、修養及嚴格之訓練與實踐見稱。其作品《醫師之路》（On the Physician）正可表達此精神，文中指醫師須時刻保持整潔、誠實、冷靜、明理及嚴肅之態度，凡希氏學派之醫師皆恪守之。而在其手術室里，不論燈光、人事、儀器、病人定位及包紮與夾板方法都有詳盡規定，更有甚者，手指甲之長度亦受到規管，可算是一絲不苟 。

其學派認為臨床理論，首重觀察記錄。故此，其要求醫師詳實地記錄療程中之發現及所用之療法，使得這些記錄可以留傳後世，為其他醫師所用。希氏本人則謹慎並完整地記錄了眾多症狀，諸如病人之氣色、脈搏、發熱、疼痛、運動及排泄等事。據信其嘗於記錄病歷時，量度病人之脈搏，以確定其言之真確性。其更將臨床觀察延展至病人的家族病歷及家庭環境。故有人雲：「對希氏而言，有臨床檢測，方有醫學」 ，故更應稱之為「臨床醫學之父」，而非廣義的「醫學之父」。

（二）、直接貢獻

希氏及其追隨者說明了很多疾病及醫療狀況，而且許多是前人所未知的。據信他是第一個說明杵狀指的醫師，而杵狀指就是慢性肺癰、肺癌及發紺先天性心臟病的徵兆。亦因如此，杵狀指別稱為「希氏指」。他也是第一個說明希氏臉的醫師。莎士比亞的名劇，《亨利五世》里的第三場的第二幕，述及福爾斯泰夫之死時，即有強烈暗示其罹患此疾。

他將疾病歸類為急性、慢性、風土、傳染四種，並使用轉劇、復發、消散、危象、發作、峰、康復諸名詞來形容病患之不同時期。他對症狀學、理學檢查、外科療法及膿性胸膜炎預後的說明，亦可堪稱為重要貢獻。其教訓時至今日，對研習胸腔內科及外科之學生而言，仍能受用。他也是書寫心胸外科文獻的第一人，而其心得，直至今天，大多仍告有效。

（三）、文集

希氏文集為古希臘醫學作品之結集，計有文章70，以愛奧尼亞方言書成。希氏本人是否文集結集者，迄今尚無定論，然而諸卷冊之分類，極可能經其學生及追隨者之手而成。因為諸文之主題、文風及所述時代大有不同，所以學者多認為其非出自一人之手。可能是希氏知名於上古，而且其作風與文集所述相類，方以之為名。因此，文集實有可能為科斯島圖書館之殘餘，或為公元前三世紀時，亞歷山卓的人們所做之結集。

希氏文集復蓋繁多，有教本、訓誡、研究、筆記及諸醫學課題之哲理論文。其內容深淺不一，有為專家而設的，亦有為門外漢而寫的，而有時亦會自相矛盾。在此列出文集中較有名者：《希氏誓言》、《預後之書》、《治病之路》、《格言》、《論空氣、水和環境》、《復位儀器》、《癲癇之論》等等。

三、希波克拉底誓言

希波克拉底誓詞，俗稱醫師誓詞，是西方醫生傳統上行醫前的誓言，在希波克拉底所立的這份誓詞中，列出了一些特定的倫理上的規範，乃是西方最早的醫學職業道德宣言。

Hippocrates：The Oath of Medicine

I do solemnly swear each by whatever he or she holds most sacred.

That I will be loyal to the Profession of Medicine and just and generous to its members.

That I will lead my lives and practice my art in uprightness and honor.

That into whatsoever house I shall enter, it shall be for the good of the sick to the utmost of my power, my holding myself far aloof from wrong, from corruption, from the tempting of others to vice.

That I will exercise my art solely for the cure of my patients, and will give no drug, perform no operation, for a criminal purpose, even if solicited, far less suggest it.

That whatsoever I shall see or hear of the lives of men or women which is not fitting to be spoken, I will keep inviolably secret.

These things I do swear. Let each bow the head in sign of acquiescence.

And now, if I will be true to this, my oath, may prosperity and good repute be ever mine; the opposite, if I shall prove myself forsworn.

中文翻譯：

醫神阿波羅、阿斯克勒庇俄斯，及天地諸神為證，鄙人敬謹宣誓：

我願以自身能以判斷力所及，遵守此約。凡授我藝者敬之如父母，為終身同世伴侶，彼有急需，我接濟之。視彼兒女，猶我弟兄，如欲受業，當免費並無條件傳授之。凡我之所知，無論口授書傳俱傳之吾子、吾師之子、及發誓遵守此約之生徒，此外不傳他人。

我願盡我之能力與判斷力之所及，遵守為病家謀福之信條，並檢束一切墮落及害人之敗行，我必不得將危害葯品給與他人，並不作此項之指導，雖人請求亦必不與之，尤不為婦人施墮胎之術。我願以此純潔與神聖之精神，終身執行我之職務。凡患結石者，我不施手術，此則有待於高明。

無論何適何遇，逢男或女，貴人奴婢，我之唯一目的，為病家謀幸福，並檢點吾身，不為各種害人及劣行，尤不做誘奸之事。凡我之所見所聞，不論有無業務之牽連，我以為應守秘密者，願保守秘密。倘我嚴守上述之誓詞，願神僅僅使我之生命及醫術，得無上之光榮；我苟違誓，天地鬼神共殛之！

   

四、希波克拉底的影響

希波克拉底誓言撼動人心，是行醫者對神的誓言，它流傳千古，成為醫生行醫濟世的指引明燈。希波克拉底告訴世人，任何人都可以免費向他學習醫術，而他提出的條件是：「如欲受業，必須立下相同的誓言！」 他開創的醫學大學希波克拉底大學，世世代代的門徒都謹記奉行他留下的醫者誓言。

希波克拉底深遠的影響了西方的哲學與醫學，也更深刻的影響了人類對職業道德的認知，從而達到一致性，即：無論膚色、種族之不同，也無論階層、集團之區別，對職業道德的價值上的認可是沒有歧義的。

The Hippocratic Oath

The Hippocratic Oath is an oath historically taken by physicians and other healthcare professionals swearing to practice medicine ethically. It is widely believed to have been written by Hippocrates, often regarded as the father of western medicine, or by one of his students. The oath is written in Ionic Greek (late 5th century BC), and is usually included in the Hippocratic Corpus. Classical scholar Ludwig Edelstein proposed that the oath was written by Pythagoreans, a theory that has been questioned due to the lack of evidence for a school of Pythagorean medicine. Of historic and traditional value, the oath is considered a rite of passage for practitioners of medicine in many countries, although nowadays the modernized version of the text varies among them.

The Hippocratic Oath (orkos) is one of the most widely known of Greek medical texts. It requires a new physician to swear upon a number of healing gods that he will uphold a number of professional ethical standards.

Original

Original, translated into English:

I swear by Apollo, the healer, Asclepius, Hygieia, and Panacea, and I take to witness all the gods, all the goddesses, to keep according to my ability and my judgment, the following Oath and agreement:

To consider dear to me, as my parents, him who taught me this art; to live in common with him and, if necessary, to share my goods with him;

To look upon his children as my own brothers, to teach them this art, without charging a fee; and that by my teaching, I will impart a knowledge of this art to my own sons, and to my teacher's sons, and to disciples bound by an indenture and oath according to the medical laws, and no others.

I will prescribe regimens for the good of my patients according to my ability and my judgment and never do harm to anyone.

I will not give a lethal drug to anyone if I am asked, nor will I advise such a plan; and similarly I will not give a woman a pessary to cause an abortion.

But I will preserve the purity of my life and my arts.

I will not cut for stone, even for patients in whom the disease is manifest; I will leave this operation to be performed by practitioners, specialists in this art.

In every house where I come I will enter only for the good of my patients, keeping myself far from all intentional ill-doing and all seduction and especially from the pleasures of love with women or with men, be they free or slaves.

All that may come to my knowledge in the exercise of my profession or in daily commerce with men, which ought not to be spread abroad, I will keep secret and will never reveal.

If I keep this oath faithfully, may I enjoy my life and practice my art, respected by all men and in all times; but if I swerve from it or violate it, may the reverse be my lot.

Classic

Classic translation into English:

I swear by Apollo the Physician and Asclepius and Hygieia and Panaceia and all the gods, and goddesses, making them my witnesses, that I will fulfill according to my ability and judgment this oath and this covenant:

To hold him who has taught me this art as equal to my parents and to live my life in partnership with him, and if he is in need of money to give him a share of mine, and to regard his offspring as equal to my brothers in male lineage and to teach them this art – if they desire to learn it – without fee and covenant; to give a share of precepts and oral instruction and all the other learning to my sons and to the sons of him who has instructed me and to pupils who have signed the covenant and have taken the oath according to medical law, but to no one else.

I will apply dietic measures for the benefit of the sick according to my ability and judgment; I will keep them from harm and injustice.

I will neither give a deadly drug to anybody if asked for it, nor will I make a suggestion to this effect. In purity and holiness I will guard my life and my art.

I will not use the knife, not even on sufferers from stone, but will withdraw in favor of such men as are engaged in this work.

Whatever houses I may visit, I will come for the benefit of the sick, remaining free of all intentional injustice, of all mischief and in particular of sexual relations with both female and male persons, be they free or slaves.

What I may see or hear in the course of treatment or even outside of the treatment in regard to the life of men, which on no account one must spread abroad, I will keep myself holding such things shameful to be spoken about.

If I fulfill this oath and do not violate it, may it be granted to me to enjoy life and art, being honoured with fame among all men for all time to come; if I transgress it and swear falsely, may the opposite of all this be my lot.

In the 1870s, many American medical schools chose to abandon the Hippocratic Oath as part of graduation ceremonies, usually substituting a version modified to something considered more politically and medically correct, or an alternate pledge like the Oath of Maimonides.

The Hippocratic Oath has been updated by the Declaration of Geneva. In the United Kingdom, the General Medical Council provides clear modern guidance in the form of its Duties of a Doctor[6] and Good Medical Practice statements.

Modern version

A widely used modern version of the traditional oath was penned in 1964 by Dr. Louis Lasagna, former Principal of the Sackler School of Graduate Biomedical Sciences and Academic Dean of the School of Medicine at Tufts University:

I swear to fulfill, to the best of my ability and judgment, this covenant:

I will respect the hard-won scientific gains of those physicians in whose steps I walk, and gladly share such knowledge as is mine with those who are to follow.

I will apply, for the benefit of the sick, all measures [that] are required, avoiding those twin traps of overtreatment and therapeutic nihilism.

I will remember that there is art to medicine as well as science, and that warmth, sympathy, and understanding may outweigh the surgeon's knife or the chemist's drug.

I will not be ashamed to say "I know not", nor will I fail to call in my colleagues when the skills of another are needed for a patient's recovery.

I will respect the privacy of my patients, for their problems are not disclosed to me that the world may know. Most especially must I tread with care in matters of life and death. If it is given to me to save a life, all thanks. But it may also be within my power to take a life; this awesome responsibility must be faced with great humbleness and awareness of my own frailty. Above all, I must not play at God.

I will remember that I do not treat a fever chart, a cancerous growth, but a sick human being, whose illness may affect the person's family and economic stability. My responsibility includes these related problems, if I am to care adequately for the sick.

I will prevent disease whenever I can, for prevention is preferable to cure.

I will remember that I remain a member of society with special obligations to all my fellow human beings, those sounds of mind and body as well as the infirm.

If I do not violate this oath, may I enjoy life and art, respected while I live and remembered with affection thereafter. May I always act so as to preserve the finest traditions of my calling and may I long experience the joy of healing those who seek my help.

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