在技術烏托邦的彼岸: 中西醫學再評價

Beyond Technological Utopia: Re-evaluating Traditional Chinese and Modern Western Medicine

Abstract

LANGUAGE NOTE | Document text in Chinese; abstract also in English.

本文試圖綜合本期各篇文章的主要觀點，依據“目的”、“體驗”和“價值”三條線索來對傳統中醫和現代西醫做一初步的評價。由於醫學的內在目的在於防治疾病、維護健康，而不是追求真理、認識世界，因而中醫與西醫都可以發揮作用，現代化研究與傳統式探索也可以並行不諱，只要有助於醫學的目的即可。此外，西方醫學從傳統走向現代的過程，乃是從重視病人的親身感受轉向注重病理解剖事實的過程，而中醫學體系提供了一種不同的臨床現象學。最後，醫學是負荷看價值和意識形態的人類活動，應當超越當前的技術烏托邦傾向，成為良好生活方式的一個和諧部分。

The contemporary world is characteristic of science-fetishism and technological utopia. Every social issue is explored in the name of science, and all difficult problems are to be resolved by renovated technologies. This is even more so in modern China than in the West. The people attempt to modernize their lives in all respects. For many of them, everything old needs to be weighed on a modern scientific scale and anything unscientific must be rejected. This constitutes the context in which traditional Chinese medicine is generally evaluated. This essay argues that this context is misleading. It intends to reevaluate traditional Chinese versus modern Western medicine in consideration of the internal aim of medicine, patients, experiences, and ideologies and values.

There has been a long-standing debate in China in this century regarding whether or not traditional Chinese medicine is a science. Both sides of the debate, ironically, agree that if traditional Chinese medicine is not a science, it should be abandoned. However, this debate is non-sensical. Medicine as medicine, whether it is a traditional medicine or a modern medicine, is not a science. Medicine is not a science because its internal aim differs from the aim of science. While the internal aim of science can be identified as pursuing truth and knowing the world, the internal aim of medicine consists in maintaining health as well as treating and preventing diseases. Undoubtedly, modern Western medicine is scientific. Its theories and practices are based upon typical modern sciences such as physics, chemistry and biology. But medicine as medicine does not have to be scientific. Given the internal aim of medicine, as long as a practice or method contributes to the treatment of disease or the promotion of health, it is legitimate. The existence of varieties of non-scientific alternative medicine and faith medicine in the US where modern science and technology are most advanced, is a good example of this. To put it in a famous Chinese saying, "whether it is a white cat or a black cat, as long as it catchesthe mouse, it is a good cat."

No one can deny the tremendous achievements that modern scientific medicine has made in fighting diseases. However, focused on a technologized anatomico-pathologic view of the body and diseases, contemporary medicine discounts the significance of patient complaints and it is naturally easy to lose sight of the non-technological aspects of medical practice, especially the experience of the sick person. Traditional Chinese medical theory and practice provide a heuristic alternative. By viewing the essence of illness as symptom-complex rather than anatomico-pathological lesion, by identifying imbalanced climate and emotional factors rather than disease entities as the sources of illnesses, by using ordinary contacts rather than complicated lab and mechanical investigations as medical examining tools, by focusing on the experience of being sick rather than on pathological anatomy, by following balancing rather than curing as the treatment principle, and by emphasizing prevention rather than treatment, traditionalChinese medicine offers a systematic medical phenomenological system in which a patient’s life experience and intuitive knowledge of the body is the center of clinical practice.

Finally, medical theory and practice are value-laden. "Our ideologies and expectations concerning the world move us to select certain states as illnesses because of our judgment as to what is dysfunctional or a deformity and to select certain causal sequences,etiological patterns, as being of interest to us because they are bound to groups of phenomena we identify as illnesses" (Engelhardt). Our ideologies and expectations also move us to select certain modes of medicine and therapeutic methods as most useful and promising because of our judgments about the appropriateness and efficacy of practical instruments. Accordingly, practicing and accepting medicine is part of a way of life. As people accept different value systems and life expectations, they must be careful about what medicine and technology they want to accept and develop. We must reflect on the contemporary ideology of technological utopia that intends to resolve all problems by newly developed complicated technologies. Not all conflicts and tensions of life can be resolved by technologies. What is worse, the overwhelmingly powerful incentive to develop high tech medicine in the third-world countries would drain on their scarce health care resources, which would significantly harm most people in those countries.

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