明中期,醫官身份逐漸固化,專業化的趨勢也讓他們漸漸遠離了傳統的儒醫形象。非科舉正途出身的醫官,越來越受到文官的蔑視。但在明成化、弘治兩朝的傳奉升授浪潮中,醫官成為主要的受益群體之一,得以突破自身身份的限制,遷轉至文官系統。因此,文臣與醫官之間的矛盾逐漸激化。雖然傳奉醫官僅僅被授予超越醫官的職位,并未有超越醫政的職權,但這并不妨礙文臣將其視為異端。官員出身的限制、文官與伎術官的分野在此時成為爭論的焦點。通過成化、弘治兩朝傳奉醫官升遷及其爭議的考察,可以窺見明代醫官選拔的制度化過程,以及官僚體制中政治文化對于醫官身份及社會形象的塑造。

The identity of medical officers was consolidated in the mid-Ming era,when a trend toward professionalization gradually set them apart from the traditional image of the Confucian physician.Medical officers who had not passed the imperial examinations were increasinglylooked down on by civil officers.But in the Chenghua and Hongzhi reigns,there was a trend for eunuchs to"submit orders for official appointments"that made it possible to become an official without passing the examinations.Medical officers were among the main beneficiaries of this practice;many were able to break through the restrictions on their status and move into the civil service,a shift that intensified the conflict between civil officials and medical officers.Although the medical officials thus promoted had been raised to higher positions,their powers were limited to medical administration.However,that did not prevent officials in the civil stream from treating these newly promoted medical professionals as heterodox.Limits on the ways one could become an official and the distinction between civil and technical officials were hotly debated.Investigation of how medical officers were promoted and the debates surrounding this topic in the Chenghua and Hongzhi reigns can give us an understanding of the institutionalization of medical officers’selection in the Ming dynasty and the way their identity and image were shaped by the political culture of the bureaucracy.