明清以降,清代官方主导的医政体系出现了明显变化,县级层面的医政机构——医学署逐渐衰落。本文对清代医学署的实际运作、衰落情况以及社会影响等进行了分析,认为,作为基层政权的辅助和补充,医学署的兴废与地方官员及士绅等倡导直接相关,医学署的衰落,使得政府在救治灾异等公共卫生事件中无法依赖官方机构,致使医生准入机制缺失,庸医泛滥,民众的就医选择趋向多元化。 In the Ming and Qing dynasties, the government-led medical system in the Qing Dynasty experienced obvious changes. The medical administration at the county level, the Medical Department, gradually declined. This paper analyzes the actual operation, decline and social influence of the Qing dynasty medical school. According to the analysis, as the supplement and supplement of the grass-roots political power, the rise and abolition of medical department is directly related to the promotion of local officials and gentry. The decline of medical department, Making the government unable to rely on official agencies in public health incidents such as catastrophic disasters. As a result, the lack of access mechanisms for doctors and the proliferation of quack doctors have made diversified medical choices for the general public.