本文主要在考察明代北京歷次瘟疫的疫情、流行過的瘟疫的病徵、城市環境衛生的變遷，與國家醫療體系在瘟疫流行期間所展開的應變措施。明代北京見諸於記載的大瘟疫，前後計有十五次，除前兩次外，均發生於一五四○年以後，主要係出現在嘉靖、萬曆年間及崇禎末年，其中最為嚴重的是崇禎十六年 (1643) 的大瘟疫。就資料所載，明代北京流行過的瘟疫至少有痘疹、大頭瘟、羊毛瘟、疙瘩瘟、吐血瘟這幾種疫病。證據顯示，發生在崇禎十六年的疙瘩瘟及吐血瘟，極有可能是腺鼠疫與肺鼠疫。在北京歷次瘟疫爆發時，以太醫院為首的帝國醫療體系，承擔著重要的抗疫任務，在嘉靖、萬曆這兩個時期，曾發揮某程度的作用。但在崇禎十六年大疫時，帝國的醫療體系幾乎是無法招架；也就因為病菌到處肆虐，導致北京在這一年據說有二十萬以上的人口死亡，從而造成次年三月李自成包圍北京時防守人力的不足。崇禎十六年北京的大瘟疫，間接造成了北京的淪陷與帝國的滅亡。
關鍵詞：北京 瘟疫 腺鼠疫 公共衛生 醫療體系
The Epidemics in Ming Beijing and the Responses from the Empire’s Public Health System
Institute of History and Philology, Academia Sinica
In this article, I traced each epidemic outbreak of Ming Dynasty’s Beijing, including the symptoms, the urban sanitary conditions, and the government’s responses. There were 15-recorded outbreaks in Beijing throughout the Ming Dynasty. Except for two, all occurred after 1540 and mainly during the reigns of Jiajing (1522-1567), Wanli (1573-1620) and late Chongzhen (1628-1644). The worst case was the pandemic of 1643. According to the records, these epidemics included smallpox, “big head plague,” “sheep’s wool plague,” “pimple plague” and “vomit blood plague.” The 1643 “pimple plague” and “vomit blood plague,” judging by the symptoms, were possibly bubonic plague and pneumonic plague. During each outbreak, the empire’s public health system, led by the Imperial Medical Department, played a major role in fighting the disease. It actually functioned in the reigns of Jiajing and Wanli, but failed miserably during the 1643 pandemic. Since the outbreak went uncontrolled, it claimed 200,000 lives in Beijing that year, and therefore severely compromised Beijing’s defense against Li Zicheng’s siege in the next year. The 1643 pandemic indirectly caused Beijing’s fall and the demise of the Ming Empire.
Keywords: Beijing, epidemic, bubonic plague, public health, medical system