中医科学吗？
Is Traditional Chinese Medicine Scientific?
文、译/林巍1
〔1〕“中医科学吗？”这个百年老问题，困扰更多的是中国人而非西方人。因我去西方留学，最先读的是“自然疗法学”，故对此有些亲身体会2。
[1] “Is Traditional Chinese MedicineScientific”, that century-old question, has puzzled more Chinese than westerners – I know this from my first-hand experience when initially I studied Natural Therapies in the West.
〔2〕在西方，中医与其他自然疗法学一样，都属于“另类医学3”，许多国家允许其开诊和授课，人们关注的主要是其疗效，而很少纠缠其是否科学。在中国，因有与西医竞争的问题，故要证明真伪。
[2] In the West, as part of natural therapies, Traditional Chinese Medicine (TCM) is categorized as an “alternative medicine”, which is accredited for practice and teaching in many countries and regions. People consult practitioners mainly for its curative effect and are rarely bothered with the issue of its scientific nature. In China, however, to compete with Western Medicine (WM), a certain kind of authenticity or legitimacy has to be proved.
〔3〕“科学”概念最早源于西方，后经日文传入中文4，其基本特性是“一种系统知识、一整套收集证据的法则和对于事实、逻辑作出的试验证明”。在中国传统文化里，中医是一种“形而上者”的学问，更具理性。根据《周易》：“形而上者谓之道，形而下者谓之器”；“道” 为根本规律和事理，是无形的大学问，“器”为具体操作，体现为具体病症的表象和与之相应的具体治疗方法，即西医中的所谓“科学”。
[3] Originally, the term “science” (or “scientific”) stemmed from the West, and was then retranslated into Chinese from the Japanese language, defined of rules for gathering evidence and testing claims against fact and logic”. According to The Book of Changes, things in the universe are classified into two categories, namely the metaphysical which belongs to the Dao, and the physical which are deemed to be the Qi. In traditional Chinese culture, the Dao is “noble scholarship” searching for something rational and fundamental ruling the universe. The Qi, on the other hand, pertains to practical things in general and in TCM in particular to concrete treatments and remedies for certain diseases and illnesses, which perhaps fall under “science” in WM.
〔4〕在这个意义上，中医的范畴比西医要宽泛——是一门“人的医学5”，其医学对象，在本质上不是“病”，而是“人”。由人治病，则视野当然更宏观、更具哲理性。
[4] In this sense, the scope of TCM is far broader than WM, making it a kind of “human medicine”, which focuses on the person rather than the sickness. Treating diseases from the perspective of a specific human body surely requires something more macroscopic and philosophical.
〔5〕中医典籍《黄帝内经·素问》里有这样一段著名论述：“从阴阳则生，逆之则死；从之则治，逆之则乱。反顺为逆，是谓内格。是故圣人不治已病，治未病，不治已乱，治未乱，此之谓也。夫病已成而后药之，乱已成治之，譬如渴而穿井，斗而铸锥，不亦晚乎？” 若脱离语境，此段可以是哲学、政治学、文学或管理学。类似的中医表述还有很多，如“釜底抽薪”“逆流挽舟”“如丧神守”“阴阳交感”“阴阳互根6” “孤阳不生7”“孤阴不长”“重阴必阳8”“重阳必阴”等。
[5] In “Plain Questions” of The Yellow Emperor’s Classic of Internal Medicine, a well-known classic of TCM, it notably states: “Obedience to the principle of Yin-yang cultivates life and resistance to it speeds up death. Patients acting in compliance with the principle can be cured while those who prefer the other way might end up in a worsening case. Resistance, instead of obedience, to the principle of Yin-yang means killing oneself from within. That shows the reason why wise people give priority to the prevention rather than cure of diseases. They take precautions to nip in the bud the first signs of illness rather than sit on them until illness has become a reality. Medication after the contraction of illness, comparable to drilling a well after feeling thirsty and forging weapons after a war breaks out, is therefore too late.” If it is out of context, this passage could be read in a work of philosophy, politics, literature or management science. There are many similar sayings in TCM, such as “taking away firewood from under the cauldron”, “saving a boat in an adverse current”, “loss of mind, unconsciousness, restlessness, delirium and so on caused by excess of internal heat”, “interaction of yin and yang”, “mutual rooting of yin and yang”, “solitary yang failing to grow, solitary yin failing to increase”, “extreme yin turning into yang”, “extreme yang turning into yin” and so on.
〔6〕中医认为，“人生于地，悬命于天”，故人与自然都在一个互动关联的有机系统里，自然界的变化，可直接或间接地引起人体生理或病理上的反应；而人体本身也是一个由脏腑经络、五官九窍、四肢百骸组成的统一体，上下沟通、表里9相连。西医源于解剖分析，病理论证，“分而治之10”。
[6] According to TCM, while man was born into the world, his fate is registered in the heavens; in a way, man and nature are interrelated in an organic system where any natural changes may affect the human body biologically or pathologically in one way or another. The human body is composed of the viscera, meridians, five sensory organs, nine orifices, four limbs and all the skeletal parts, affecting one another horizontally and vertically, internally and externally. In WM, diagnosis and treatment, primarily based on anatomy and pathology, have been strictly classified into different and unrelated sections.
〔7〕与之相应的，是不同的治疗原则和方法。中医是辨证论治11，即通过四诊（望、闻、问、切）所收集的症状、体征等临床资料，进行分析、归纳和综合，概括为某种性质的症状，然后根据辨证的结果确定相应的治疗方法。西医则是利用科技手段，通过对患者的体征、症状、治疗背景及必要的实验室检查及X 线检查等结果的分析，来确定疾病的本质和治疗方法（这可弥补中医许多方面的不足）。与西医的“头痛医头，脚痛医脚12”不同，中医是将人看作一个系统来医治：头痛可能医脚，眼病可能治肝。中医认为，显微镜下固然可以看到细菌，但却看不到产生病症的心理与情绪；人往往需要综合诊治。
[7] Correspondingly, different therapeutic principles and methods have been developed. Typically, in TCM bianzheng lunzhi or the scheme of “syndrome differentiation and treatment” has been institutionalized, by which the clinical data of symptoms and signs collected by the four diagnostic methods (inspection, listening and smelling, inquiry, taking the pulse and palpation) are analyzed, induced, synthesized, adjudged and summarized into certain syndromes, and consequently the therapeutic methods are decided according to the results of syndrome differentiation. WM, meanwhile, relies heavily on technical means – laboratory tests, X-ray examinations if necessary, as well as the patient’s signs, symptoms and medical background, to determine the nature of a disorder and the therapeutic methods, so treatment has often been labeled as “merely curing the symptoms instead of the causes”. By contrast, viewing the human body as an integrated system, TCM treats a patient more holistically: a headache may be cured from the foot, or an eye complaint from the liver. TCM practitioners believe that the human body needs to be dealt with comprehensively, and that under a microscope one can find bacteria but not mentalities and emotions that may have caused the malady.
〔8〕由此也形成了中西医两套性质不同的术语系统。就“五脏”而言， 中医里虽然也有“心”“肝”“脾”“肺”“肾”，但在许多情况下不能对应西医的heart、liver、 spleen、lung、kidney，因为它们不单是解剖学上的“概念”， 而且还有“象13”的意义（脏象），是一种理解人体生理和病理在整体系统中运作状况的“理念”。例如“心”，在中医里不仅是一个“位于两肺之间、尖端向左前下方的空心圆锥形肌性器官”，而且还“主血脉”“藏神”，又是“君主之官”。
[8] The two sets of terminologies developed in TCM and WM are differentiated by their nature. Take the five internal organs as an example: in TCM, xin (heart), gan (liver), pi (spleen), fei (lung) and shen (kidney) are not only anatomical “concepts” but also meanings of xiang (manifestations), namely the “state of the viscera”, which are “ideas” to understand the functions and conditions of human biology and pathology in this holistic system. They are therefore not equivalent to their counterparts in WM, despite their nominal identities. Xin (heart) in TCM, for instance, is not only “a hollow muscular cone-shaped organ, lying between the lungs, with the pointed end (apex) directed downwards, forwards, and to the left”, but also both a functional “blood pump” and a “spiritual house” which is paramount to the “monarch of a state”, with definite determining power to control all matters and entities within a body.
〔9〕中医里的许多哲学理念颠覆了西医中的科学概念。例如，对于人体“有毒”的概念，西医认为是含有重金属的一切物质，而在中医是指那些有助于加重病症的物质：一杯凉白开水，在西医看来不可能含有任何毒素，但在中医眼里，对于一个胃寒14的人，就会令其体内更为阴盛，加重其胃痛，因而是一种“毒素15”。而中药在许多情况下的功效，又是“以毒攻毒”。
[9] In that sense, many philosophical ideas of TCM override the scientific concepts of WM. “Toxicity” in the human body, for example, in WM refers to any heavy metal element, but in TCM to materials that may deteriorate the patient’s condition. A cup of cold boiled water may be benign in the eyes of a WM doctor, but a hard drug to a TCM practitioner whose patient has “cold syndrome of the stomach”, since it will aggregate the “yin deficiency” and make his or her condition worse. And the efficacy of traditional Chinese pharmacology often lies in “combating poison with poison”.
〔10〕作为在国外从事过这方面诊疗和担任过相关课程的教师，我也目睹了中医被越来越多的国家（包括“一带一路16”的国家）和文化所接受的过程。他们所以看重中医，不是因为它有多少科学性，而是因为它的疗效，以及其中对于生命、病理、病情的文化内涵和丰富哲理。
[10] As a TCM practitioner and lecturer, I have witnessed what TCM has gone through in terms of recognition by more and more countries and cultures, including these along the Belt and Road Initiative. Again, foreigners’ interest in TCM has everything to do with its curative effect, cultural connotations and profound philosophy concerning life, pathology and state of an illness, but little to do with the question of whether it is scientific or not.
注释：
1. 博士，暨南大学翻译学院特聘教授。
2. 句序重组，将该句提前译出，以更顺应英文表达方式。
3. 又译为Complementary and Alternative Medicine，简称CAM。如1998年美国成立了National Center for Complementary and Alterative Medicine (NCCAM)，即“国家辅助及另类医学中心”。
4. 即是一种“转译”，亦为indirect translation。
5. 亦可译为Human Medical。
6. 亦可译为interdependence between Yin and Yang 等。
7. 亦可译为solitary Yang fails to exist without Yin 等。
8. 亦可译为Yin in extreme must convert to opposite Yang 等。
9. 中医里的“表里” 是个相对概念：以内外来分，人体的皮毛、经络为表，脏腑为里；以深浅而论，外感病者，病邪入里一层，病深一层；出表一层，则病浅一层（The idea of “exterior and interior” are a comparative term: concerning internal and external relations, the skin and hair channels and collaterals are regarded as the exterior, and the zang-fu organs as the exterior. In terms of diseases caused by exopathogen, the further the exapathogen invades, the deeper the disease; while the further the exopathogen is expelled to the surface, the more exterior the disease）。
10. 这里没有按字面意思译出，如divide and rule，而是将其融汇在整句的医疗表述之中
11. 亦可译为planning treatment according to diagnosis 等。
12. 字面意思为treat the head when the head aches, treat the foot when the foot hurts 但一般情况下都将其引申为no overall plan for a fundamental transformation；the partial methods, which can not solve the fundamental problem; not to find the root cause of the problem but to take stop-gap measures。这里还原其医疗术语的本意。
13. 主要指反映脏腑机能的象征、脏腑的实质形象（the external signs and substantial figure reflected by the functions of the Zang-fu）。
14.中医特殊用语，主要指寒邪侵犯胃腑，胃阳虚阴，阴寒内的里寒征候（an interior cold syndrome manifested by invasion of the stomach by patheogenic cold or deficiency of stomach-yang, resulting in cold accumulation in the interior）。
15. 本段中的几个“毒”用了不同的译词，以表达两种医学里的细微区别。
16. 现还有多种译法，如 the Chinese Marshall Plan（主要见于西方媒体）、Land and Maritime Silk Road programs、the Belt and Road Initiative 等。