中醫(yī)學(xué)文化依存性解蔽課件

ToRemovetheDependency

ofCultureinTCM

—TCMStudyinthefieldsofPhilosophyandScience中醫(yī)學(xué)的文化依存性解蔽

——在哲學(xué)和科學(xué)之間的中醫(yī)學(xué)研究

程偉張浩黑龍江中醫(yī)藥大學(xué)哈爾濱

ChengWei&ZhangHaoHeilongjiangUniversityofChineseMedicine,Heilongjiang,Harbin150040ToRemovetheDependency

ofC1

中醫(yī)藥學(xué)何以值得高度關(guān)注

WhyTCMisremarkable中醫(yī)學(xué)是否科學(xué)，是中醫(yī)學(xué)界內(nèi)外久盛不衰論戰(zhàn)不休意見常常尖銳對(duì)立的話題。WhetherTCMisscientificornotisacontroversialtopicwhichhasbeendisputedinalongtimeincommunity.就多元文化視角下的中國(guó)科技史研究這一主題來說，中醫(yī)問題值得深入討論。

TheissueofTCMisworthytobediscussedintheviewofmulticulturalbackgroundofhistoryofscienceandtechnologyinChina.中醫(yī)藥學(xué)何以值得高度關(guān)注

WhyTCMi2中醫(yī)藥學(xué)何以值得高度關(guān)注

WhyTCMisremarkable中醫(yī)學(xué)在臨床醫(yī)學(xué)領(lǐng)域有不可替代的重要價(jià)值。TCMisincomparableinclinicalmedicine.但其豐富的實(shí)踐經(jīng)驗(yàn)與其古樸的傳統(tǒng)理論之間存在著復(fù)雜的內(nèi)在關(guān)系。Therearecomplexrelationsbetweentherichclinicalexperienceandclassicaltraditionaltheory.中醫(yī)學(xué)理論以其特有的方式把握著某種尚未被現(xiàn)代科學(xué)研究說明的規(guī)律性的東西,其潛在的科學(xué)價(jià)值不容忽視。TCMhavesomeregularitywhichhasn’tbeenprovedbymoderntechnologyyetinuniqueway,andthescientificvalueofTCMcannotbeignored.對(duì)中醫(yī)科學(xué)性的質(zhì)疑往往與中醫(yī)理論的民族化的表達(dá)形式有關(guān)。ThedisputeinthescienceofTCMalwaysfocusontheoryofTCM.中醫(yī)藥學(xué)何以值得高度關(guān)注

WhyTCMisrema3

一、自然哲學(xué)形態(tài)理論的不徹底性

TheUn-thoroughnessoftheoryabouttheNaturalPhilosophyForm中醫(yī)學(xué)的基本理論核心概念并非生命現(xiàn)象、疾病現(xiàn)象專屬的確切概念ThebasictheoryofTCMisnotspecificconceptionofLifeandDiseases.其理論框架、邏輯結(jié)構(gòu)、推理方式受制于其理論核心陰陽五行的學(xué)說體系Thetheoryframe,logicstructureandreasoningmethodsareconfinedbythecoreofTCM.一、自然哲學(xué)形態(tài)理論的不徹底性

TheU4實(shí)際經(jīng)驗(yàn)雖被系統(tǒng)化說明，但其各個(gè)組成部分之間并不存在嚴(yán)格的邏輯關(guān)系，常常只是在有限的范圍內(nèi)言之成理Thoughthepracticalvalidityhasbeenprovedsystematically,thereisnostrictlylogicrelationshipamongconstituents.Usuallythepracticalexperiencesonlyarereasonableinlimitedfield.實(shí)際經(jīng)驗(yàn)雖被系統(tǒng)化說明，但其各個(gè)組成部分之間并不存在嚴(yán)格的邏5作為自然哲學(xué)的理論體系，中醫(yī)理論解釋生命世界的模型并非由核心概念、基本原理、基本規(guī)律逐級(jí)展開的嚴(yán)格的層級(jí)性邏輯系統(tǒng)。Asnaturalphilosophy,theinterpretationoflifeworldinTCMisnotastrictlogicsystemincludinglevelsofcoreconcept,basictheoryandbasicregularity.理論模型中不同構(gòu)件間的關(guān)系有些是虛構(gòu)而成InthetheoreticalmodelofTCM,someoftherelationshipamongdifferentelementsisimaginary.作為自然哲學(xué)的理論體系，中醫(yī)理論解釋生命世界的模型并非由核心6陰陽五行、臟腑經(jīng)絡(luò)、氣血津液及各種辨證方法等等不同層級(jí)的學(xué)說、概念的內(nèi)涵及其現(xiàn)實(shí)相關(guān)度有很大差異ThecontentsofYinyangandfiveelements,fuorgansandmeridian,Qiandbloodandsomereasoningmethodsarefarfromthemechanismofbody.看似相同的概念在不同層級(jí)上的含義，如陰陽、陰虛陽虛、腎陰腎陽、腎陰虛腎陽虛分屬不同層級(jí)Someconceptsseemedlikeeachotherareindifferentlevelofmeanings,suchasyinandyang.陰陽五行、臟腑經(jīng)絡(luò)、氣血津液及各種辨證方法等等不同層級(jí)的學(xué)說7概念內(nèi)涵只有在某種變動(dòng)不居的關(guān)系中動(dòng)態(tài)性把握Conceptsandconnotationsonlycanbedynamicacknowledgedinsomerelationship.

概念內(nèi)涵只有在某種變動(dòng)不居的關(guān)系中動(dòng)態(tài)性把握8類比推理的或然邏輯未必表達(dá)得出真實(shí)世界的必然性聯(lián)系ProbablelogicofAnalogyreasoningimprobablyshowsinevitabilityofrealworld.臨床實(shí)踐成功經(jīng)驗(yàn)表述方式受到這種理論語言的局限常常難于確切把握Theexpressionofthesuccessfulexperiencesinclinicalpracticeislimitedbythetheoreticallanguage,therefore,it’shardtograspprecisely.類比推理的或然邏輯未必表達(dá)得出真實(shí)世界的必然性聯(lián)系9不同層級(jí)理論概念現(xiàn)實(shí)相關(guān)度差異很大

There’smuchdifferencebetweenthepracticalcorrelativedegreeofeachdifferentlevel.概念的理論來源與經(jīng)驗(yàn)的組織、呈現(xiàn)方式、理論概念與經(jīng)驗(yàn)的交互作用、經(jīng)驗(yàn)究竟如何檢驗(yàn)著理論都需要給出更透徹的說明Itneedmoreclearexplainaboutthetheoreticalsourceoftheconceptandtheorganization,modesofpresentationofexperience,interactionbetweentheoreticalconceptsandexperienceandhowexperienceexaminethetheory.不同層級(jí)理論概念現(xiàn)實(shí)相關(guān)度差異很大

There’10哲學(xué)化的語言如不改變形態(tài)便難于轉(zhuǎn)化成可以進(jìn)入現(xiàn)代體系的公共語言，難于成為確切的研究對(duì)象Ifthephilosophilizednarrationdidn’ttransformintopubliclanguagethatcanadaptitselftomodernsystem,TCMwillbedifficulttobeaspecificstudysubject.對(duì)以舊有方式表達(dá)的各種經(jīng)驗(yàn)的本質(zhì)的揭示，不能固守傳統(tǒng)理論，而應(yīng)專注于特定表達(dá)方式背后的真實(shí)經(jīng)驗(yàn)Torevealtheessenceoftheexperiencesinterpretedwitholdexpression,insteadofadheretotraditiontheory,weshouldfocusontherealexperiencesbehindthespecificexpression.哲學(xué)化的語言如不改變形態(tài)便難于轉(zhuǎn)化成可以進(jìn)入現(xiàn)代體系的公共語11

文化依存性放大與疆界迷失

Toextendthedependencyofcultureandtoblurtheboundary

何為中醫(yī)學(xué)理論？正統(tǒng)教科書式的表述并未全面清晰界定WhatisTCMTheory?Thereisnocomprehensiveandcleardefinitionintheorthodoxtextbooks.各類中醫(yī)古籍所涉內(nèi)容幾乎無所不包ThecontentsofancientbooksanddocumentsofTCMalmostincludesallaspects.文化依存性放大與疆界迷失

Toextendt12近年，中醫(yī)學(xué)的傳統(tǒng)文化依存性被有意無意地放大，使中醫(yī)學(xué)幾乎迷失了自身疆界,養(yǎng)生亂象與此有關(guān)。TheculturaldependencyofTCMstudyhasbeenexaggeratedconsciouslyorunconsciously,whichmakesTCMstudyalmostloseitsownboundarytoalargerextent.魚龍混雜的復(fù)雜局面侵蝕著中醫(yī)學(xué)的機(jī)體，中醫(yī)藥學(xué)依然需要長(zhǎng)期的文化解蔽。Themixed-upcomplexityhasbeenerodingTCMstudy,andtheprocessofde-shieldingTCMwithhighlyculturedependencywillbeforlong.近年，中醫(yī)學(xué)的傳統(tǒng)文化依存性被有意無意地放大，使中醫(yī)學(xué)幾乎迷13如何從獨(dú)特的文化傳統(tǒng)成果中開掘出可資當(dāng)今醫(yī)學(xué)科學(xué)借鑒的再生資源，研究仍處于起步階段We’restillattheinitialstageofstudyinghowcanweminingrenewresourceswhichmodernmedicinecanbeabsorbingfromthroughresearchingouruniquetraditionalculture.如何從獨(dú)特的文化傳統(tǒng)成果中開掘出可資當(dāng)今醫(yī)學(xué)科學(xué)借鑒的再生資14二、中醫(yī)學(xué)整體觀念及其經(jīng)驗(yàn)載體

ThewholeconceptofTCManditscarrierexperience中醫(yī)學(xué)整體觀念確實(shí)體現(xiàn)著中醫(yī)學(xué)的某種獨(dú)特性。ThewholeconceptofTCMembodytheuniquenessofTCM.但整體觀念的實(shí)現(xiàn)始終只能依賴于具體的醫(yī)療經(jīng)驗(yàn)。However,itcanonlydependonthedetailedclinicalexperiencetoachievethewholeconcept.強(qiáng)調(diào)中醫(yī)研究不能脫離臨床蓋緣于此。That’swhythestudyonTCMcannotbeseparatedfromclinicalpractice.二、中醫(yī)學(xué)整體觀念及其經(jīng)驗(yàn)載體

Thewhol15

醫(yī)療實(shí)踐的整體性

Theintegrityofmedicalpractice醫(yī)學(xué)始于對(duì)疾病的認(rèn)識(shí)而非始于健康觀念。Medicineoriginatefromcognitionofdiseaseratherthanconceptofhealth.疾病現(xiàn)象總會(huì)伴生某種整體狀態(tài)，至少是患者的心身感受。Diseasealwaysproducesomekindofwholestate,atleast,thephysicalandmentalfeelingofpatients.

醫(yī)療實(shí)踐的整體性

Theintegrityo16即便某種疾病的產(chǎn)生有著相對(duì)局限、單一或者確定的內(nèi)在根源，其外在表現(xiàn)也會(huì)呈現(xiàn)出某種整體性。Eveniftheproductionofsomediseasehastherelativelimitation,soleorthedeterminationintrinsicroot,theexternalperformancewillalsopresentsomekindofintegrity.在沒有通過實(shí)體結(jié)構(gòu)變化理解疾病根由的條件下，細(xì)致觀察外在狀態(tài)就是醫(yī)生的唯一手段。Intheconditionofunderstandingdisease’soriginwithoutthesolidstructurechange,theonlymethodthatadoctorcouldtakeistocarefullyobservetheexternalcondition.即便某種疾病的產(chǎn)生有著相對(duì)局限、單一或者確定的內(nèi)在根源，其外17

醫(yī)療實(shí)踐的整體性

Theintegrityofmedicalpractice在相對(duì)特異性的疾病中，規(guī)律性地表現(xiàn)出來的狀態(tài)就被規(guī)定為某種證候。Intherelativespecificitydisease,theconditionwhichregularlydisplaysisdefinedassomekindofsymptoms(ZhengHou).同一疾病在不同時(shí)期或在不同情況下，其不同狀態(tài)間存在某種演化關(guān)系，使人們?cè)趯?duì)其內(nèi)在根源的推測(cè)中也建立了某種聯(lián)系。Thereisaevolutionaryrelationshipsbetweendifferentstatesofthesamediseaseatdifferenttimesorindifferentsituations,whichestablishalinkinpeople’sinference

ofitsunderlyingcauses.醫(yī)療實(shí)踐的整體性

Theintegrit18捕捉到某種其他認(rèn)識(shí)方式尚未把握到的內(nèi)在規(guī)律是中醫(yī)學(xué)的獨(dú)到之處。TocapturetheinternallawthatothermeansofcognitionfailedtograspistheuniquenessofTCM.得到一定程度系統(tǒng)化說明的舊經(jīng)驗(yàn)在新的現(xiàn)實(shí)面前可以引出某種新嘗試并可能不斷導(dǎo)致某種成功。Infrontofnewreality,theoldexperienceswhicharedescriptinsystematicwaytosomeextentcanleadtoanewattemptandmaycauseaseriousofsuccess.捕捉到某種其他認(rèn)識(shí)方式尚未把握到的內(nèi)在規(guī)律是中醫(yī)學(xué)的獨(dú)到之處19但中醫(yī)作為經(jīng)驗(yàn)科學(xué),實(shí)踐基礎(chǔ)是經(jīng)驗(yàn)而還不具有系統(tǒng)的實(shí)驗(yàn)研究的證據(jù)基礎(chǔ)；Asascienceofexperience,TCMpracticeisbasedontheexperienceratherthantheevidenceprovedbythesystematicexperimentalstudy.它在現(xiàn)今的知識(shí)增長(zhǎng)方式仍然主要靠在具體的醫(yī)療實(shí)踐過程中摸索積累。Itsknowledgedevelopmentmainlydependontheexploringandaccumulationofspecificmedicalpractice.但中醫(yī)作為經(jīng)驗(yàn)科學(xué),實(shí)踐基礎(chǔ)是經(jīng)驗(yàn)而還不具有系統(tǒng)的實(shí)驗(yàn)研究的20而難于借助現(xiàn)代技術(shù)引入實(shí)驗(yàn)研究領(lǐng)域深入探索，就不能較快轉(zhuǎn)化為具有普遍意義的規(guī)律性知識(shí)。

Itcannotbequicklytransformedintotheuniversalknowledgeinlawwithdifficultyinintroducingexperimentalstudytoexplorethedomainthoroughlywiththeaidofmoderntechnology.強(qiáng)調(diào)整體性經(jīng)驗(yàn)的價(jià)值不應(yīng)一味歌頌舊整體觀Emphasizethevalueofintegrityexperiences,butshouldnotblindlypraisetheoldwholeconcept.而難于借助現(xiàn)代技術(shù)引入實(shí)驗(yàn)研究領(lǐng)域深入探索，就不能較快轉(zhuǎn)化為21由于缺少對(duì)實(shí)體內(nèi)部結(jié)構(gòu)的深入了解，缺少對(duì)結(jié)構(gòu)與功能的關(guān)系的追索，對(duì)生命活動(dòng)和疾病現(xiàn)象的把握只能著眼于現(xiàn)象表層，以推究?jī)?nèi)在狀態(tài)。Wecoulddeducetheinternalsituationonlyfromthesuperficialleveloflifeactivitiesanddiseasephenomenawiththelackofdeepinsightintotheinternalstructureofentitiesandtheabsenceofexploringtherelationshipbetweenstructureandfunction.由于缺少對(duì)實(shí)體內(nèi)部結(jié)構(gòu)的深入了解，缺少對(duì)結(jié)構(gòu)與功能的關(guān)系的追22這種情況在以連續(xù)性、不可分割性、自我化生性為特征的氣論哲學(xué)思想體系中得到強(qiáng)化。ThissituationhasbeenstrengthenedbythephilosophyofQiwhichischaracterizedbycontinuous,indivisibleandself-metaplastic.中醫(yī)的整體觀從非結(jié)構(gòu)性實(shí)體認(rèn)識(shí)來說是無奈的，而從氣一元論哲學(xué)來說是自覺的。ThewholeviewofTCMfromnon-structuralentityunderstandingiscompelledtodo,butfromQimonismphilosophyitisconscious.這種情況在以連續(xù)性、不可分割性、自我化生性為特征的氣論哲學(xué)思23三、新整體觀可否重生于分析性研究

Cannewwholeconceptrebirthintheanalyticalstudy

在中醫(yī)學(xué)界的自我辯護(hù)中，作為中國(guó)傳統(tǒng)文化性格表征的整體論一直被反復(fù)強(qiáng)調(diào)。Inself-defenseofChineseacademiccircles,wholismhasbeenunderlinedrepeatedlyastherepresentingtheChinesetraditionalculture.在當(dāng)今世界整體論思想受到空前關(guān)注的情況下，中醫(yī)學(xué)界對(duì)自身優(yōu)長(zhǎng)評(píng)價(jià)很高且期望甚殷。Undertheconditionthatwholismdrawsunprecedentedattentioninnowadays,theChineseacademichighlyevaluatetheirownsuperiority.三、新整體觀可否重生于分析性研究

Canne24實(shí)際上，對(duì)一種哲學(xué)傳統(tǒng)的關(guān)注主要在于它倡導(dǎo)的思維方式、思想導(dǎo)向和概念模型Infact,theconcernofaphilosophicaltraditionisthatitinitiatedthewaysofthinking,thoughtguidanceandconceptionalmold.研究實(shí)踐需要清晰的路線和具體的工具與方法。

Studypracticeneedaclearline,specificmethodsandinstruments.實(shí)際上，對(duì)一種哲學(xué)傳統(tǒng)的關(guān)注主要在于它倡導(dǎo)的思維方式、思想導(dǎo)25當(dāng)今對(duì)現(xiàn)代醫(yī)學(xué)某些局限的強(qiáng)烈關(guān)注使中醫(yī)界出現(xiàn)了對(duì)所謂還原分析方法的嚴(yán)重懷疑

Nowadays,there’sgenerateseriousdoubtsbyconcerntocertainlimitationsofmodernmedicineontheso-calledreductionanalysismethodinTCM.以致忽視了中醫(yī)、西醫(yī)研究對(duì)象原本一致、只是由于方法與手段的不同走上了不同的道路。SothatignoringthesamesubjectofChineseandWesternmedicine,differentmethodsandmeansleadtodifferentroads.當(dāng)今對(duì)現(xiàn)代醫(yī)學(xué)某些局限的強(qiáng)烈關(guān)注使中醫(yī)界出現(xiàn)了對(duì)所謂還原分析26二者雖各有所長(zhǎng)，但傳統(tǒng)中醫(yī)經(jīng)驗(yàn)方法在確切把握認(rèn)識(shí)對(duì)象的有效性方面，缺少必要技術(shù)工具因而成長(zhǎng)緩慢。Bothofthemhaveadvantages,intheaspectofeffectivenessoftheknowingobject,traditionalChineseexperiencemethodgrowslowlyduetolacksoftheessentialtechnicaltools.二者雖各有所長(zhǎng)，但傳統(tǒng)中醫(yī)經(jīng)驗(yàn)方法在確切把握認(rèn)識(shí)對(duì)象的有效性27中醫(yī)藥現(xiàn)代研究為時(shí)尚短，成就有限，使有些人將現(xiàn)代分析研究方法斥之為還原論局限而多方懷疑。ModernStudyofTCMstartsnotforlongwithlimitedachievement,somodernanalysismethodsisusedinTCMthatcausedmuchmoredoubtsaboutReductionism.在復(fù)雜性研究正在興起的背景下，更有人直接給中醫(yī)冠以復(fù)雜性科學(xué)的美稱，夸大著獨(dú)立發(fā)展的意義。Underthebackgroundofcomplexresearch,somepeopletookthecomplexscienceforgranted,andexaggeratedthesignificanceofindependentdevelopmentofTCM.中醫(yī)藥現(xiàn)代研究為時(shí)尚短，成就有限，使有些人將現(xiàn)代分析研究方法28生命科學(xué)及醫(yī)學(xué)面對(duì)至為復(fù)雜的生命現(xiàn)象和人類疾病，中醫(yī)學(xué)的確以特有的方式觸及到某種尚未被現(xiàn)代科學(xué)研究說明的規(guī)律性的東西。Thelifescienceandmedicinefacingthecomplexbiologicalphenomenaandhumandisease,TCMmedicineindeedisrelatedtoregularthingsintheuniquewaywhichhadn’tbeenindicatedbythemodernscience.然而，要深化這些認(rèn)識(shí)，做出更為深刻的說明，則非借助現(xiàn)代分析研究不可。However,todeepentheunderstandingandtomakeamoreprofoundnoteshoulddependonthemodernanalysis.生命科學(xué)及醫(yī)學(xué)面對(duì)至為復(fù)雜的生命現(xiàn)象和人類疾病，中醫(yī)學(xué)的確以29中醫(yī)的所有可貴發(fā)現(xiàn)都應(yīng)成為研究對(duì)象AllthevaluablediscoveryofTCMshouldbestudied.而進(jìn)一步研究就需要借助日益強(qiáng)大的現(xiàn)代研究手段，研究仍然主要靠分析。Furtherstudyaskforthesupportofscientificmethod,andstudydependsonanalysis.以科學(xué)工具解文化之蔽至為重要。It’simportanttogetridofthefalsebyscientificmethod.中醫(yī)的所有可貴發(fā)現(xiàn)都應(yīng)成為研究對(duì)象30透過成功經(jīng)驗(yàn)，直接面對(duì)現(xiàn)實(shí)中具體對(duì)象展開研究，才有望取得可持續(xù)深化的成果。It’spossibletohaveachievementsthroughthestudyofthesuccessfulexperienceandthespecificrealobjects.因?yàn)殡S著現(xiàn)代科學(xué)技術(shù)的高速發(fā)展，人們認(rèn)識(shí)生命現(xiàn)象和疾病的能力大大增強(qiáng)，幾乎每一項(xiàng)相關(guān)技術(shù)的進(jìn)步都在改變著現(xiàn)代醫(yī)學(xué)的面貌。Withtherapiddevelopmentofmodernscienceandtechnology,people’sabilitytoknowthebiologicalphenomenaanddiseaseenhancedgreatly.Almosteveryrelatedtechnologyadvanceschangethewayofmodernmedicinemoreorless.透過成功經(jīng)驗(yàn)，直接面對(duì)現(xiàn)實(shí)中具體對(duì)象展開研究，才有望取得可持31中醫(yī)學(xué)要在現(xiàn)代人的知識(shí)體系中處于應(yīng)有位置，成為現(xiàn)代知識(shí)譜系的分支，采用現(xiàn)代科學(xué)技術(shù)手段，運(yùn)用現(xiàn)代社會(huì)、國(guó)際社會(huì)共有的表述方式。TCMwillholdproperpositioninmodernknowledgesystems,itwillbecomeapartofscience,bymeansofusingmodernscientifictechniquesandcommonexpressionwayofmoderninternationalsociety.

中醫(yī)學(xué)要在現(xiàn)代人的知識(shí)體系中處于應(yīng)有位置，成為現(xiàn)代知識(shí)譜系的32作為應(yīng)用科學(xué)，醫(yī)學(xué)必須借助現(xiàn)代技術(shù)手段才能對(duì)生命現(xiàn)象、對(duì)健康疾病認(rèn)識(shí)不斷深化Medicine,aspracticalscience,needrelyonmoderntechnologytodeepentheknowledgeofbiologicalphenomenon,healthanddisease.任何新認(rèn)識(shí)離開當(dāng)今科學(xué)技術(shù)手段都是不可想象的。Itisunimaginablethatthemodernscienceandtechnologybecomedisconnectedfromthelatestcognition.作為應(yīng)用科學(xué)，醫(yī)學(xué)必須借助現(xiàn)代技術(shù)手段才能對(duì)生命現(xiàn)象、對(duì)健康33中國(guó)醫(yī)學(xué)因?yàn)樘囟ǖ臍v史條件和文化傳統(tǒng)走出了一條獨(dú)具特色的發(fā)展道路值得驕傲ItisproudoftheexcellentdevelopmentofChinesemedicinewithdistinguishingfeatureunderspecialhistorybackgroundandculturaltradition.但在今天如果不能對(duì)其寶貴經(jīng)驗(yàn)的科學(xué)內(nèi)涵加以說明則非常值得遺憾。It’sapityoverthematterthatwecouldnotinterpretthescientificcontentsofpreciouspracticalexperiencesinmodernways.中國(guó)醫(yī)學(xué)因?yàn)樘囟ǖ臍v史條件和文化傳統(tǒng)走出了一條獨(dú)具特色的發(fā)展34單純強(qiáng)調(diào)中醫(yī)藥學(xué)實(shí)踐上的成功或滿足于傳統(tǒng)的延續(xù)是缺少遠(yuǎn)見的固執(zhí)。It’snotwisetoemphasizethesuccessofTCMinpracticeorbesatisfiedwithrelayingtradition.全方位引進(jìn)、吸收現(xiàn)代技術(shù)和思想觀念，才能充分認(rèn)識(shí)并逐步揭示中醫(yī)藥學(xué)顯在或潛在的科學(xué)價(jià)值。AbsorbingmoderntechnologyandconceptentirelycanmakeuscompletelyunderstandandprogressivelyrevealthescientificvalueofTCM.單純強(qiáng)調(diào)中醫(yī)藥學(xué)實(shí)踐上的成功或滿足于傳統(tǒng)的延續(xù)是缺少遠(yuǎn)見的固35ToRemovetheDependency

ofCultureinTCM

—TCMStudyinthefieldsofPhilosophyandScience中醫(yī)學(xué)的文化依存性解蔽

——在哲學(xué)和科學(xué)之間的中醫(yī)學(xué)研究

程偉張浩黑龍江中醫(yī)藥大學(xué)哈爾濱

ChengWei&ZhangHaoHeilongjiangUniversityofChineseMedicine,Heilongjiang,Harbin150040ToRemovetheDependency

ofC36

中醫(yī)藥學(xué)何以值得高度關(guān)注

WhyTCMisremarkable中醫(yī)學(xué)是否科學(xué)，是中醫(yī)學(xué)界內(nèi)外久盛不衰論戰(zhàn)不休意見常常尖銳對(duì)立的話題。WhetherTCMisscientificornotisacontroversialtopicwhichhasbeendisputedinalongtimeincommunity.就多元文化視角下的中國(guó)科技史研究這一主題來說，中醫(yī)問題值得深入討論。

TheissueofTCMisworthytobediscussedintheviewofmulticulturalbackgroundofhistoryofscienceandtechnologyinChina.中醫(yī)藥學(xué)何以值得高度關(guān)注

WhyTCMi37中醫(yī)藥學(xué)何以值得高度關(guān)注

WhyTCMisremarkable中醫(yī)學(xué)在臨床醫(yī)學(xué)領(lǐng)域有不可替代的重要價(jià)值。TCMisincomparableinclinicalmedicine.但其豐富的實(shí)踐經(jīng)驗(yàn)與其古樸的傳統(tǒng)理論之間存在著復(fù)雜的內(nèi)在關(guān)系。Therearecomplexrelationsbetweentherichclinicalexperienceandclassicaltraditionaltheory.中醫(yī)學(xué)理論以其特有的方式把握著某種尚未被現(xiàn)代科學(xué)研究說明的規(guī)律性的東西,其潛在的科學(xué)價(jià)值不容忽視。TCMhavesomeregularitywhichhasn’tbeenprovedbymoderntechnologyyetinuniqueway,andthescientificvalueofTCMcannotbeignored.對(duì)中醫(yī)科學(xué)性的質(zhì)疑往往與中醫(yī)理論的民族化的表達(dá)形式有關(guān)。ThedisputeinthescienceofTCMalwaysfocusontheoryofTCM.中醫(yī)藥學(xué)何以值得高度關(guān)注

WhyTCMisrema38

一、自然哲學(xué)形態(tài)理論的不徹底性

TheUn-thoroughnessoftheoryabouttheNaturalPhilosophyForm中醫(yī)學(xué)的基本理論核心概念并非生命現(xiàn)象、疾病現(xiàn)象專屬的確切概念ThebasictheoryofTCMisnotspecificconceptionofLifeandDiseases.其理論框架、邏輯結(jié)構(gòu)、推理方式受制于其理論核心陰陽五行的學(xué)說體系Thetheoryframe,logicstructureandreasoningmethodsareconfinedbythecoreofTCM.一、自然哲學(xué)形態(tài)理論的不徹底性

TheU39實(shí)際經(jīng)驗(yàn)雖被系統(tǒng)化說明，但其各個(gè)組成部分之間并不存在嚴(yán)格的邏輯關(guān)系，常常只是在有限的范圍內(nèi)言之成理Thoughthepracticalvalidityhasbeenprovedsystematically,thereisnostrictlylogicrelationshipamongconstituents.Usuallythepracticalexperiencesonlyarereasonableinlimitedfield.實(shí)際經(jīng)驗(yàn)雖被系統(tǒng)化說明，但其各個(gè)組成部分之間并不存在嚴(yán)格的邏40作為自然哲學(xué)的理論體系，中醫(yī)理論解釋生命世界的模型并非由核心概念、基本原理、基本規(guī)律逐級(jí)展開的嚴(yán)格的層級(jí)性邏輯系統(tǒng)。Asnaturalphilosophy,theinterpretationoflifeworldinTCMisnotastrictlogicsystemincludinglevelsofcoreconcept,basictheoryandbasicregularity.理論模型中不同構(gòu)件間的關(guān)系有些是虛構(gòu)而成InthetheoreticalmodelofTCM,someoftherelationshipamongdifferentelementsisimaginary.作為自然哲學(xué)的理論體系，中醫(yī)理論解釋生命世界的模型并非由核心41陰陽五行、臟腑經(jīng)絡(luò)、氣血津液及各種辨證方法等等不同層級(jí)的學(xué)說、概念的內(nèi)涵及其現(xiàn)實(shí)相關(guān)度有很大差異ThecontentsofYinyangandfiveelements,fuorgansandmeridian,Qiandbloodandsomereasoningmethodsarefarfromthemechanismofbody.看似相同的概念在不同層級(jí)上的含義，如陰陽、陰虛陽虛、腎陰腎陽、腎陰虛腎陽虛分屬不同層級(jí)Someconceptsseemedlikeeachotherareindifferentlevelofmeanings,suchasyinandyang.陰陽五行、臟腑經(jīng)絡(luò)、氣血津液及各種辨證方法等等不同層級(jí)的學(xué)說42概念內(nèi)涵只有在某種變動(dòng)不居的關(guān)系中動(dòng)態(tài)性把握Conceptsandconnotationsonlycanbedynamicacknowledgedinsomerelationship.

概念內(nèi)涵只有在某種變動(dòng)不居的關(guān)系中動(dòng)態(tài)性把握43類比推理的或然邏輯未必表達(dá)得出真實(shí)世界的必然性聯(lián)系ProbablelogicofAnalogyreasoningimprobablyshowsinevitabilityofrealworld.臨床實(shí)踐成功經(jīng)驗(yàn)表述方式受到這種理論語言的局限常常難于確切把握Theexpressionofthesuccessfulexperiencesinclinicalpracticeislimitedbythetheoreticallanguage,therefore,it’shardtograspprecisely.類比推理的或然邏輯未必表達(dá)得出真實(shí)世界的必然性聯(lián)系44不同層級(jí)理論概念現(xiàn)實(shí)相關(guān)度差異很大

There’smuchdifferencebetweenthepracticalcorrelativedegreeofeachdifferentlevel.概念的理論來源與經(jīng)驗(yàn)的組織、呈現(xiàn)方式、理論概念與經(jīng)驗(yàn)的交互作用、經(jīng)驗(yàn)究竟如何檢驗(yàn)著理論都需要給出更透徹的說明Itneedmoreclearexplainaboutthetheoreticalsourceoftheconceptandtheorganization,modesofpresentationofexperience,interactionbetweentheoreticalconceptsandexperienceandhowexperienceexaminethetheory.不同層級(jí)理論概念現(xiàn)實(shí)相關(guān)度差異很大

There’45哲學(xué)化的語言如不改變形態(tài)便難于轉(zhuǎn)化成可以進(jìn)入現(xiàn)代體系的公共語言，難于成為確切的研究對(duì)象Ifthephilosophilizednarrationdidn’ttransformintopubliclanguagethatcanadaptitselftomodernsystem,TCMwillbedifficulttobeaspecificstudysubject.對(duì)以舊有方式表達(dá)的各種經(jīng)驗(yàn)的本質(zhì)的揭示，不能固守傳統(tǒng)理論，而應(yīng)專注于特定表達(dá)方式背后的真實(shí)經(jīng)驗(yàn)Torevealtheessenceoftheexperiencesinterpretedwitholdexpression,insteadofadheretotraditiontheory,weshouldfocusontherealexperiencesbehindthespecificexpression.哲學(xué)化的語言如不改變形態(tài)便難于轉(zhuǎn)化成可以進(jìn)入現(xiàn)代體系的公共語46

文化依存性放大與疆界迷失

Toextendthedependencyofcultureandtoblurtheboundary

何為中醫(yī)學(xué)理論？正統(tǒng)教科書式的表述并未全面清晰界定WhatisTCMTheory?Thereisnocomprehensiveandcleardefinitionintheorthodoxtextbooks.各類中醫(yī)古籍所涉內(nèi)容幾乎無所不包ThecontentsofancientbooksanddocumentsofTCMalmostincludesallaspects.文化依存性放大與疆界迷失

Toextendt47近年，中醫(yī)學(xué)的傳統(tǒng)文化依存性被有意無意地放大，使中醫(yī)學(xué)幾乎迷失了自身疆界,養(yǎng)生亂象與此有關(guān)。TheculturaldependencyofTCMstudyhasbeenexaggeratedconsciouslyorunconsciously,whichmakesTCMstudyalmostloseitsownboundarytoalargerextent.魚龍混雜的復(fù)雜局面侵蝕著中醫(yī)學(xué)的機(jī)體，中醫(yī)藥學(xué)依然需要長(zhǎng)期的文化解蔽。Themixed-upcomplexityhasbeenerodingTCMstudy,andtheprocessofde-shieldingTCMwithhighlyculturedependencywillbeforlong.近年，中醫(yī)學(xué)的傳統(tǒng)文化依存性被有意無意地放大，使中醫(yī)學(xué)幾乎迷48如何從獨(dú)特的文化傳統(tǒng)成果中開掘出可資當(dāng)今醫(yī)學(xué)科學(xué)借鑒的再生資源，研究仍處于起步階段We’restillattheinitialstageofstudyinghowcanweminingrenewresourceswhichmodernmedicinecanbeabsorbingfromthroughresearchingouruniquetraditionalculture.如何從獨(dú)特的文化傳統(tǒng)成果中開掘出可資當(dāng)今醫(yī)學(xué)科學(xué)借鑒的再生資49二、中醫(yī)學(xué)整體觀念及其經(jīng)驗(yàn)載體

ThewholeconceptofTCManditscarrierexperience中醫(yī)學(xué)整體觀念確實(shí)體現(xiàn)著中醫(yī)學(xué)的某種獨(dú)特性。ThewholeconceptofTCMembodytheuniquenessofTCM.但整體觀念的實(shí)現(xiàn)始終只能依賴于具體的醫(yī)療經(jīng)驗(yàn)。However,itcanonlydependonthedetailedclinicalexperiencetoachievethewholeconcept.強(qiáng)調(diào)中醫(yī)研究不能脫離臨床蓋緣于此。That’swhythestudyonTCMcannotbeseparatedfromclinicalpractice.二、中醫(yī)學(xué)整體觀念及其經(jīng)驗(yàn)載體

Thewhol50

醫(yī)療實(shí)踐的整體性

Theintegrityofmedicalpractice醫(yī)學(xué)始于對(duì)疾病的認(rèn)識(shí)而非始于健康觀念。Medicineoriginatefromcognitionofdiseaseratherthanconceptofhealth.疾病現(xiàn)象總會(huì)伴生某種整體狀態(tài)，至少是患者的心身感受。Diseasealwaysproducesomekindofwholestate,atleast,thephysicalandmentalfeelingofpatients.

醫(yī)療實(shí)踐的整體性

Theintegrityo51即便某種疾病的產(chǎn)生有著相對(duì)局限、單一或者確定的內(nèi)在根源，其外在表現(xiàn)也會(huì)呈現(xiàn)出某種整體性。Eveniftheproductionofsomediseasehastherelativelimitation,soleorthedeterminationintrinsicroot,theexternalperformancewillalsopresentsomekindofintegrity.在沒有通過實(shí)體結(jié)構(gòu)變化理解疾病根由的條件下，細(xì)致觀察外在狀態(tài)就是醫(yī)生的唯一手段。Intheconditionofunderstandingdisease’soriginwithoutthesolidstructurechange,theonlymethodthatadoctorcouldtakeistocarefullyobservetheexternalcondition.即便某種疾病的產(chǎn)生有著相對(duì)局限、單一或者確定的內(nèi)在根源，其外52

醫(yī)療實(shí)踐的整體性

Theintegrityofmedicalpractice在相對(duì)特異性的疾病中，規(guī)律性地表現(xiàn)出來的狀態(tài)就被規(guī)定為某種證候。Intherelativespecificitydisease,theconditionwhichregularlydisplaysisdefinedassomekindofsymptoms(ZhengHou).同一疾病在不同時(shí)期或在不同情況下，其不同狀態(tài)間存在某種演化關(guān)系，使人們?cè)趯?duì)其內(nèi)在根源的推測(cè)中也建立了某種聯(lián)系。Thereisaevolutionaryrelationshipsbetweendifferentstatesofthesamediseaseatdifferenttimesorindifferentsituations,whichestablishalinkinpeople’sinference

ofitsunderlyingcauses.醫(yī)療實(shí)踐的整體性

Theintegrit53捕捉到某種其他認(rèn)識(shí)方式尚未把握到的內(nèi)在規(guī)律是中醫(yī)學(xué)的獨(dú)到之處。TocapturetheinternallawthatothermeansofcognitionfailedtograspistheuniquenessofTCM.得到一定程度系統(tǒng)化說明的舊經(jīng)驗(yàn)在新的現(xiàn)實(shí)面前可以引出某種新嘗試并可能不斷導(dǎo)致某種成功。Infrontofnewreality,theoldexperienceswhicharedescriptinsystematicwaytosomeextentcanleadtoanewattemptandmaycauseaseriousofsuccess.捕捉到某種其他認(rèn)識(shí)方式尚未把握到的內(nèi)在規(guī)律是中醫(yī)學(xué)的獨(dú)到之處54但中醫(yī)作為經(jīng)驗(yàn)科學(xué),實(shí)踐基礎(chǔ)是經(jīng)驗(yàn)而還不具有系統(tǒng)的實(shí)驗(yàn)研究的證據(jù)基礎(chǔ)；Asascienceofexperience,TCMpracticeisbasedontheexperienceratherthantheevidenceprovedbythesystematicexperimentalstudy.它在現(xiàn)今的知識(shí)增長(zhǎng)方式仍然主要靠在具體的醫(yī)療實(shí)踐過程中摸索積累。Itsknowledgedevelopmentmainlydependontheexploringandaccumulationofspecificmedicalpractice.但中醫(yī)作為經(jīng)驗(yàn)科學(xué),實(shí)踐基礎(chǔ)是經(jīng)驗(yàn)而還不具有系統(tǒng)的實(shí)驗(yàn)研究的55而難于借助現(xiàn)代技術(shù)引入實(shí)驗(yàn)研究領(lǐng)域深入探索，就不能較快轉(zhuǎn)化為具有普遍意義的規(guī)律性知識(shí)。

Itcannotbequicklytransformedintotheuniversalknowledgeinlawwithdifficultyinintroducingexperimentalstudytoexplorethedomainthoroughlywiththeaidofmoderntechnology.強(qiáng)調(diào)整體性經(jīng)驗(yàn)的價(jià)值不應(yīng)一味歌頌舊整體觀Emphasizethevalueofintegrityexperiences,butshouldnotblindlypraisetheoldwholeconcept.而難于借助現(xiàn)代技術(shù)引入實(shí)驗(yàn)研究領(lǐng)域深入探索，就不能較快轉(zhuǎn)化為56由于缺少對(duì)實(shí)體內(nèi)部結(jié)構(gòu)的深入了解，缺少對(duì)結(jié)構(gòu)與功能的關(guān)系的追索，對(duì)生命活動(dòng)和疾病現(xiàn)象的把握只能著眼于現(xiàn)象表層，以推究?jī)?nèi)在狀態(tài)。Wecoulddeducetheinternalsituationonlyfromthesuperficialleveloflifeactivitiesanddiseasephenomenawiththelackofdeepinsightintotheinternalstructureofentitiesandtheabsenceofexploringtherelationshipbetweenstructureandfunction.由于缺少對(duì)實(shí)體內(nèi)部結(jié)構(gòu)的深入了解，缺少對(duì)結(jié)構(gòu)與功能的關(guān)系的追57這種情況在以連續(xù)性、不可分割性、自我化生性為特征的氣論哲學(xué)思想體系中得到強(qiáng)化。ThissituationhasbeenstrengthenedbythephilosophyofQiwhichischaracterizedbycontinuous,indivisibleandself-metaplastic.中醫(yī)的整體觀從非結(jié)構(gòu)性實(shí)體認(rèn)識(shí)來說是無奈的，而從氣一元論哲學(xué)來說是自覺的。ThewholeviewofTCMfromnon-structuralentityunderstandingiscompelledtodo,butfromQimonismphilosophyitisconscious.這種情況在以連續(xù)性、不可分割性、自我化生性為特征的氣論哲學(xué)思58三、新整體觀可否重生于分析性研究

Cannewwholeconceptrebirthintheanalyticalstudy

在中醫(yī)學(xué)界的自我辯護(hù)中，作為中國(guó)傳統(tǒng)文化性格表征的整體論一直被反復(fù)強(qiáng)調(diào)。Inself-defenseofChineseacademiccircles,wholismhasbeenunderlinedrepeatedlyastherepresentingtheChinesetraditionalculture.在當(dāng)今世界整體論思想受到空前關(guān)注的情況下，中醫(yī)學(xué)界對(duì)自身優(yōu)長(zhǎng)評(píng)價(jià)很高且期望甚殷。Undertheconditionthatwholismdrawsunprecedentedattentioninnowadays,theChineseacademichighlyevaluatetheirownsuperiority.三、新整體觀可否重生于分析性研究

Canne59實(shí)際上，對(duì)一種哲學(xué)傳統(tǒng)的關(guān)注主要在于它倡導(dǎo)的思維方式、思想導(dǎo)向和概念模型Infact,theconcernofaphilosophicaltraditionisthatitinitiatedthewaysofthinking,thoughtguidanceandconceptionalmold.研究實(shí)踐需要清晰的路線和具體的工具與方法。

Studypracticeneedaclearline,specificmethodsandinstruments.實(shí)際上，對(duì)一種哲學(xué)傳統(tǒng)的關(guān)注主要在于它倡導(dǎo)的思維方式、思想導(dǎo)60當(dāng)今對(duì)現(xiàn)代醫(yī)學(xué)某些局限的強(qiáng)烈關(guān)注使中醫(yī)界出現(xiàn)了對(duì)所謂還原分析方法的嚴(yán)重懷疑

Nowadays,there’sgenerateseriousdoubtsbyconcerntocertainlimitationsofmodernmedicineontheso-calledreductionanalysismethodinTCM.以致忽視了中醫(yī)、西醫(yī)研究對(duì)象原本一致、只是由于方法與手段的不同走上了不同的道路。SothatignoringthesamesubjectofChineseandWesternmedicine,differentmethodsandmeansleadtodifferentroads.當(dāng)今對(duì)現(xiàn)代醫(yī)學(xué)某些局限的強(qiáng)烈關(guān)注使中醫(yī)界出現(xiàn)了對(duì)所謂還原分析61二者雖各有所長(zhǎng)，但傳統(tǒng)中醫(yī)經(jīng)驗(yàn)方法在確切把握認(rèn)識(shí)對(duì)象的有效性方面，缺少必要技術(shù)工具因而成長(zhǎng)緩慢。Bothofthemhaveadvantages,intheaspectofeffectivenessoftheknowingobject,traditionalChineseexperiencemethodgrowslowlyduetolacksoftheessentialtechnicaltools.二者雖各有所長(zhǎng)，但傳統(tǒng)中醫(yī)經(jīng)驗(yàn)方法在確切把握認(rèn)識(shí)對(duì)象的有效性62中醫(yī)藥現(xiàn)代研究為時(shí)尚短，成就有限，使有些人將現(xiàn)代分析研究方法斥之為還原論局限而多方懷疑。ModernStudyofTCMstartsnotforlongwithlimitedachievement,somodernanalysismethodsisusedinTCMthatcausedmuchmoredoubtsaboutReductionism.在復(fù)雜性研究正在興起的背景下，更有人直接給中醫(yī)冠以復(fù)雜性科學(xué)的美稱，夸大著獨(dú)立發(fā)展的意義。Underthebackgroundofcomplexresearch,somepeopletookthecomplexscienceforgranted,andexaggeratedthesignificanceofindependentdevelopmentofTCM.中醫(yī)藥現(xiàn)代研究為時(shí)尚短，成就有限，使有些人將現(xiàn)代