|
The Enigma of Chinese Medicine A few years ago, while visiting Beijing, I caught a cold. My wife, who is Chinese, and wanted me to feel better, took me to a local restaurant. After we sat down, she ordered a live turtle. The proprietors sent it over. I startled as the waiters unceremoniously cut the turtle’s throat, then poured its blood into a glass. To this frightening prospect, they added a shot of baijiu, very strong grain alcohol. The proprietor and waiters, now tableside, gestured with obvious pride for me to drink the potent medicine. I winced, found the courage, and drank up. 几年前的北京之行期间，我感冒了。我的妻子是中国人，她希望我好起来，于是带我去了当地的一家餐馆。我们坐定后，她点了一只活甲鱼。店主送了过来，在我惊讶的注视中，服务员随手切开了甲鱼的喉咙，把血倒进玻璃杯中。在这番骇人的情形下，他们又倒上了一盅白酒，这是谷物酿成的一种烈酒。站在桌边的店主和服务员带着明显的自豪神情示意我喝下这剂猛药。我皱紧了眉头，鼓起勇气一饮而尽。 I felt better later that night and in the days that followed, but I wasn’t sure why. Was it the placebo effect? Perhaps my body was already on the mend that night, rendering the medicine superfluous. Or did the turtle blood-baijiu potion speed my recovery? Maybe in years to come we will discover some subtle chemical properties in turtle blood that ameliorate certain illnesses. 当天晚上及接下来几天，我感觉好多了，不过并不能确定原因何在。是安慰剂效应吗？也许当天晚上我的身体已经在康复了，喝下它完全是多此一举。还是说白酒送服的甲鱼血加速了我的康复？也许多年以后，我们会发现，龟类的血液中含有某种微妙的化学特性，有助于减轻某些病症？ Many Westerners will scoff at the very idea that turtle blood could have medicinal effects. But at least some of those same people will quaff a tree-bark tincture or put on an eggplant compress recommended by Dr. Oz to treat skin cancer. We are all living in the vast gray area between leech-bleeding and antibiotics. Alternative medicine has exploded in recent years, reawakening a philosophical problem that epistemologists call the “demarcation problem.” 许多西方人会对甲鱼血的药用价值予以嘲笑，不过同样一群人中，少说也有一部分会痛饮奎宁，或是会听从奥兹医生(Dr. Oz)的建议用茄片来治疗皮肤癌。我们全都生活在“水蛭吸血疗法”和抗生素之间巨大的灰色地带。替代医学近年来取得了爆炸性的发展，重新唤起了对一个哲学问题的探讨，也就是认识论学者所说的“划界问题”。 The demarcation problem is primarily the challenge of distinguishing real science from pseudoscience. It often gets trotted out in the fight between evolutionists and creation scientists. In that tired debate, creationism is usually dismissed on the grounds that its claims cannot be falsified (evidence cannot prove or disprove its natural theology beliefs). This criterion of “falsifiability” was originally formulated by Karl Popper, perhaps the most influential philosopher of science of the 20th century, and, at first blush, it seems like a good one — it nicely rules out the spooky claims of pseudoscientists and snake oil salesmen. Or does it? 划界问题主要涉及的挑战是区分真正的科学和伪科学，在进化论学者和创世论学者之间的论战中，动不动就会被搬出来。在这场旷日持久的争论中，创世论常常因为其主张不能被证伪的理由而受到驳斥（即证据既不能证明其自然神学信仰是成立的，也不能证明它是不成立的）。“证伪原则”是由卡尔·波普尔(Karl Popper)首先提出的，而他或许算得上是20世纪最具影响力的科学哲学家。乍一看，这条标准也显得很不错。它令人满意地排除了伪科学人士，以及各路江湖郎中的奇谈怪论。但是，的确如此吗？ The contemporary philosopher of science Larry Laudan claims that philosophers have failed to give credible criteria for demarcating science from pseudoscience. Even falsifiability, the benchmark for positivist science, rules out many of the legitimate theoretical claims of cutting-edge physics, and rules in many wacky claims, like astrology — if the proponents are clever about which observations corroborate their predictions. Moreover, historians of science since Thomas Kuhn have pointed out that legitimate science rarely abandons a theory the moment falsifying observations come in, preferring instead (sometimes for decades) to chalk up counter evidence to experimental error. The Austrian philosopher Paul Feyerabend even gave up altogether on a so-called scientific method, arguing that science is not a special technique for producing truth but a flawed species of regular human reasoning (loaded with error, bias and rhetorical persuasion). And finally, increased rationality doesn’t always decrease credulity. 当代科学哲学家拉里·劳丹(Larry Laudan)宣称，哲学研究者尚未给出区分科学与伪科学的可信标准。就算是实证科学的基石“证伪原则”，也将前沿物理学里许多合理的理论排除在外，却将不少怪论包含在内，比方说，如果倡导者精挑细选能验证其预测的现象，占星术也可以算成科学。而且，托马斯·库恩(Thomas Kuhn)以降的科学史学者指出，正经的科学很少会在证伪的观测结果甫一出现时抛弃某项理论，反而会将反面证据归为实验误差（有时会持续数十年）。奥地利哲学家保罗·费耶阿本德(Paul Feyerabend)甚至全盘抛弃了所谓的“科学方法”。他认为，科学不是产生真理的一种特殊方法，而是常规人类推理中的一种有缺陷的门类（充满了误差、偏误和修辞性的劝说）。最后，增进理性，也并非总是能减少轻信。 We like to think that a rigorous application of logic will eliminate kooky ideas. But it doesn’t. Even a person as well versed in induction and deduction as Arthur Conan Doyle believed that the death of Lord Carnarvon, the patron of the Tutankhamen expedition, may have been caused by a pharaoh’s curse. 我们乐意认为，严格运用逻辑将会减少奇谈怪论。实际并非如此。即使是精通归纳与推理的亚瑟·柯南·道尔(Arthur Conan Doyle)也相信，资助图坦卡蒙墓穴探险的卡那封伯爵(Lord Carnarvon)，可能死于法老的诅咒。 The issue of alternative medicine, especially Traditional Chinese Medicine (T.C.M.), brings fresh passion to the demarcation problem. Americans are gravitating to acupuncture and herbal medicines (less so the zoological pharmacology, like my turtle blood), but we crave some scientific validation for these ancient practices. And the Chinese are themselves looking for ways to legitimize T.C.M. to the Western world, and distinguish it from the more superstitious aspects of traditional culture. 替代医学的问题，尤其是传统中医，给划界问题注入了新的活力。美国人逐渐受到针灸和草药（不怎么包括甲鱼血这样的动物医药）的吸引，不过，我们也渴望这些古老的疗法能得到些许科学验证。中国人自己也在想方设法让中医在西方世界获得主流社会的认可，并将其与该国传统文化中迷信色彩更浓厚的部分区分开来。 A couple years after the Beijing visit, while I was looking for a place to live in Shanghai, a realtor assured me that the apartment we were viewing was in a very auspicious location. Looking out the window 10 floors up, I could see the bend of Suzhou Creek as it passed the building. He explained that this curve and flow was very good feng shui. It was a prosperous channel of “positive qi energy.” 北京之行的几年后，我在上海寻找住处。中介向我保证，我们看的那处地方非常吉利。从10层楼上的窗户往外张望，我能看到苏州河在楼前绕了个弯。他解释说，弯曲的河道和流淌的河水表明风水很好，这是输送“吉气”的富贵通道。 I took the apartment. 我租了那套公寓。 The general facts of feng shui (literally “wind and water”) strike many of us as relatively indisputable. Simply put, if you arrange your furniture in certain patterns and directions, it feels to most people psychologically better than certain other patterns. But the metaphysical “causal theory” behind these facts is more controversial. Chinese medicine holds that energy meridians mark the flow of a force called “qi” and this force is streaming throughout nature and our bodies — causing harmony and health or disharmony and illness (depending on the degree to which it is blocked or unblocked). 在许多人看来，风水的基本事实比较可信。简单地说，如果按照某种格局和方向布置家具，多数人会在心理上感觉比另外一些格局舒服。不过，这些事实背后的形而上的“因果论”则更具争议性。中医认为，经络代表着“气”的流动线路，而这股气流经自然和人体，从而决定了健康和谐或疾病失调（取决于气血的通畅程度）。 I certainly don’t need this theory to be true to explain why I feel less agitated when my office desk faces the doorway than I do when my back is to the door. And I don’t think I need it to explain the sense of peace I get from looking out my window at Suzhou Creek. Perhaps the metaphysical qi theory of feng shui will eventually give way to one that aligns with our understanding of sensory perception or psychology. Growing clinical evidence showing the palliative effects of placebos has led many tough-minded doctors to conclude that beneficial physiological responses (like endorphin and dopamine release) can be triggered by subtle suggestions, sugar pills, prayer, music and other seemingly gratuitous mechanisms. So, why not furniture placement? 当然了，我并不需要这套理论来解释，为何办公桌面朝门外的时候会让我比背对着门的时候更舒服。我想，我也无需用它来解释看到窗外的苏州河时感受到的平静。也许，形而上的风水望气论最终会让位于符合我们的感官知觉或心理的理论。越来越多的临床证据显示出安慰剂的治标效应，这让许多思维缜密的医生得出结论，有益的心理反应（如内啡肽和多巴胺的分泌）可由微妙的暗示、糖片、祈祷、音乐等看似无理的机制来激发。这么说来，家具布局有何不可？ *** Aristotle distinguished science from other kinds of knowledge on the grounds that it gave a causal explanation for observable experience, and its claims were systematic (logically coherent). By these Aristotelian criteria, T.C.M. at least looks fairly scientific — the system of qi provides the causal foundation for specific associations within acupuncture healing, kung fu skills, feng shui architecture, herbal remedies and so on. 亚里士多德将科学和其他各种知识区分开来的理由是，科学为可以观测到的经验提供因果解释，而且科学理论是系统性的（在逻辑上具有连贯性）。根据亚里士多德的这些标准，中医至少看上去相当科学：关于气的这套体系为针灸治疗、功夫、建筑风水、中草药等之间的特定关联提供了因果根据。 Starting in the 17th century, however, the definition of science changed significantly. It wasn’t enough to have a systematic causal story, since many competing stories could fit the same observable phenomenon. Retrograde planetary motion could be explained by Ptolemaic epicycle causation, for example, but that causal picture was eventually unseated by a shift to heliocentric astronomy. What’s needed is the correct and verifiable causal explanation; and the scientific method (the “hypothetico-deductive model” in philosophy of science parlance) arose in order to put causal explanations through a gantlet of empirical tests. 然而，自17世纪以来，科学的定义发生了巨大的变化。有一套系统的因果说辞还不够，因为许多相互冲突的说法可能会适用于观测到的同一现象。比如，行星逆行现象可以用托勒密的“地心说”本轮模型来解释，但因为天文学发展到了“日心说”，这个解释最终被推翻。我们需要的是正确且可被证实的因果解释；为了让因果解释通过实证检验的挑战，科学方法（即科学哲学术语中的“假说-演绎法”）应运而生。 Can qi theory be scientific in this more rigorous sense? Skepticism seems reasonable here because no one has seen qi directly. Even the meridians (or channels) of qi in the body remain undetectable to Western instruments, yet T.C.M. practitioners spend years mastering the meridian anatomical charts. 在这种更严格的意义上，气理论还科学吗？怀疑看来是合理的，因为没人直接看到过气。尽管中医从业者要用多年时间掌握人体经络穴位图，但西式器械仍未检测到气在体内流动经过的经络。 Are they chasing an illusion that takes authority from tradition alone, or are we still only at the commencement stage of discovery? Qi energy looks unfalsifiable, but maybe the promissory note will soon be paid. After all, scientists theorized, hypothesized and assumed the reality of the gene (a unit of heredity) long before anyone actually observed one. And the Higgs boson was posited in the 1960s, but only confirmed in 2012. Will qi energy be confirmed as the causal underpinning for the often-reported correspondence between acupuncture and healing? 他们是在追随一种唯一来源只是传统的假象吗，还是我们依然只处在新发现的起步阶段？气看起来无法证伪，但也或许人们很快便能一睹其究竟。毕竟，在有人真的观测到基因（遗传物质的单元）之前，科学家们很久以前就建立了相关理论，进行了猜想和假设。此外，希格斯玻色子的假说是上世纪60年代提出的，直到2012年才得到证实。经常有报道称，针灸治疗了一些病痛，那么，气会不会被证实是其中的原因呢？ In the 19th century, Darwin’s scientific revolution didn’t correspond to the experimental method of the falsifiability model. Galileo had been rolling balls down inclined planes and making direct observations to evaluate his gravitation theory, but Darwin’s theory of natural selection was less observable. Instead, Darwin’s natural selection attained increasing scientific acceptance because it explained so many diverse phenomena (like adaptive structures, anatomical homologies, the fossil record, and so on). The paradigm of qi is as explanatorily resourceful and deeply rooted in China as Darwinism is in Western science. But there’s a major difference, too, and it needs articulation. 在19世纪，达尔文(Darwin)的科学进化论并不符合证伪原则的实验性方法。为了验证自己的引力理论，伽利略(Galileo)曾让球从斜面上滚下，但达尔文的自然选择理论却不太具有可观测性。然而，达尔文的自然选择理论日渐获得科学界的认同，因为它解释了太多各异的现象（比如自适应性结构、解剖同源性、化石记录等）。在中国，气的观念根深蒂固，可以用来解释许许多多的现象，就像达尔文主义相对于西方科学一样。但必须指出的是，两者之间也有一个很大的不同。 Darwinism only posits three major ingredients for evolution; offspring vary from their parents and siblings, offspring resemble their parents more than non-kin, and more offspring are born than can survive in their environment. Each of these facts is easily observable and when you put them together you get adaptive evolution of populations. No additional metaphysical force, like qi, is being posited. 达尔文主义只假定了三大进化要素：子代与亲代及同代有差异；但比起不具亲缘关系的同类，后代更像上一代；在所处环境中，出生的后代数量多于能够生存下来的数量。这些事实中，每一项都能很容易地被观测到，而且把它们综合起来时，就能得出物种会进行适应性进化的结论。不用额外假定有什么形而上的力量，比如气。 *** While lying on the acupuncturist’s table in China recently, I wondered if I was too skeptical or too gullible about qi. Dr. Shao Lei, at the Huashan Hospital, was nationally renowned as a skillful manager of this mysterious force. I explained to him that I had chronic lower back pain. Dr. Shao made a study of my tongue and informed me that my back pain was actually a qi problem with my kidney, but he could strengthen the weak qi area. He stuck me with 10 needles in my lumbar region, and a couple of pins behind my knees. He hooked these to an electrical voltage generator and zapped me gently for 20 minutes, while warming my back with a heat lamp that looked like it could be keeping french fries hot at a fast-food joint. I did not engage in this mild torture once, but several times — just to make a thorough, albeit anecdotal, study of the matter. And I can honestly say that my back improved in the few days that followed each session. 前不久在中国，躺在针灸床上的我在想，自己是不是过于怀疑或是过于相信气了。华山医院的邵雷医生享誉中国，他熟练地掌握了这一神秘力量。我向他解释说，自己背部的下半部分长期疼痛。邵医生研究了我的舌头后告诉我，我的背痛实际上是肾气不足，不过他能补气。他在我的腰部扎了10根针，还在两膝的后方扎了几根。他把这些针连到了一台电机上，对我进行了20分钟的轻柔治疗。与此同时，一盏热灯一直在给我的背部加热，看上去就像让快餐店里的薯条保温一样。这种轻微的折磨我经历了不止一次，而是好几次，只是为了彻底研究一下针灸，尽管是走马观花。而且，我可以诚实地说，在每次针灸结束后的那几天，我的背痛有所缓解。 It seems entirely reasonable to believe in the effectiveness of T.C.M. and still have grave doubts about qi. In other words, it is possible for people to practice a kind of “accidental medicine” — in the sense that symptoms might be alleviated even when their causes are misdiagnosed (it happens all the time in Western medicine, too). Acupuncture, turtle blood, and many similar therapies are not superstitious, but may be morsels of practical folk wisdom. The causal theory that’s concocted to explain the practical successes of treatment is not terribly important or interesting to the poor schlub who’s thrown out his back or taken ill. 似乎完全有理由在相信中医疗效的同时，依然对气深表怀疑。换句话说，人们可能是在从事一种“偶然医学”——即使误诊了造成病痛的原因，症状也还是可能会减轻（西医中也一直有这种情况发生）。针灸、甲鱼血和许多类似疗法并非迷信，可能是一些实用的民间智慧。对那些扭了腰或患病的可怜人而言，用来解释治疗成效的因果理论不是特别重要，知识有限的他们也不会觉得它有意思。 Ultimately, one can be skeptical of both qi and a sacrosanct scientific method, but still be a devotee of fallible pragmatic truth. In the end, most of us are gamblers about health treatments. We play as many options as we can; a little acupuncture, a little ibuprofen, a little turtle’s blood. Throw enough cards (or remedies), and eventually some odds will go your way. Is that superstition or wisdom? 归根结底，你可以既怀疑气，也怀疑不可违背的科学方法，但依然信奉有时会出错的实践得来的真知。最终，我们中的大部分人都是在医疗问题上下赌注。我们会尽可能多地尝试各种选择：试试针灸、吃点布洛芬，或者喝点甲鱼血。赌注（或疗法）足够多了，你总会搞对几次。那么，这种做法是迷信，还是智慧？ |
|
|
