從中醫觀點反思本體論轉向

Reflections on the Ontological Turn from the Perspective of Chinese Medicine

文/艾理克 Eric I. Karchmer

翻譯/李宜澤、李梅君、何俊頤、趙恩潔

近來在 American Ethnologist 期刊上,人類學家 Paul Nadasdy 的〈究竟有多少世界?:本體論,實踐與含混未定〉一文,強力地挑戰了人類學近來的本體論轉向,尤其是他稱為「多重世界論」或「複宇宙論」的概念。有別於這些概念,Nadasdy 建議我們回歸到一個基本上「含混未定」(indeterminate)的單一世界。對於「多重世界論」的擁護者來說,這概念的一大吸引人之處在於它是人類學理論與實踐去殖民化過程中不可或缺的一環。但 Nadasdy 認為,複宇宙論在理論上有缺陷,而他自己所提倡的單一「未定世界」(an “indeterminate” world)反而才是更有效的抵抗殖民政治的工具。透過本文,我想要從我自己在中醫方面的研究觀點來反思這個論戰。許多學者認為,中醫是一種(與西醫)截然不同的醫學實踐,因為它建立在一種對人體與病痛有著本體論上截然不同理解的基礎上。然而在同時,在台灣、中國以及其他東亞社會裡,中醫是與當代生物醫學共同被使用操作的。難道使用中醫的醫者與病人活在與當代科學世界絕然脫節的另類世界裡嗎?或者,他們共享一個同樣的但未定的世界,透過個人選擇的醫療實踐方式,以不同的方式經歷同一個世界?我認為藉由強調後殖民狀態下權力不平等與混雜的重要性,中醫醫者的經驗可以為這個討論帶來些許貢獻。

In a recent essay published in American Ethnologist, “How Many Worlds Are There?: Ontology, Practice, and Indeterminacy,” Paul Nadasdy made a vigorous challenge to what has become known as the ontological turn in anthropology, with a special focus on what he calls the “multiple worlds thesis” or “pluriverse.” Nadasdy proposes instead a return to a unitary world that is fundamentally “indeterminate.” A significant part of the appeal of the “multiple worlds thesis” is that its proponents consider it integral to decolonization of anthropological theory and practice. But Nadasdy considers the pluriverse to be theoretically flawed and argues that his proposal for an “indeterminate” world is a better tool for anti-colonial politics. In this essay, I want to reflect on this debate from the perspective of my own research on Chinese medicine. Many scholars have argued that Chinese medicine is a radically different form of medical practice, based on an ontological distinct understanding of the human body and its illnesses. At the same time, Chinese medicine is practiced side-by-side with contemporary biomedicine in Taiwan, China, and other East Asian societies. Do doctors of Chinese medicine and their patients live in another world radically disconnected from the modern world of science? Or do they share a single, indeterminate world that can be experienced in different ways, depending on the type of medical practice one chooses? I’d like to propose that the experience of doctors of Chinese medicine can contribute to this discussion by highlighting the importance of examining postcolonial power inequalities and hybridity.

本體論轉向與多重世界論的根本源自一些基礎的民族誌觀察,也就是許多原住民社群並不會從功利主義式的、「已除魅的」(disenchanted)角度去看待大地、植物與動物;這種觀點是現代世界所認定的基礎。相對於現代觀點,在地原住民社群把這些動植物與大地都當作「除了人類之外」(other-than-human)的複數個體(persons),與他們有著互惠、乃至往往有親屬連帶的關係。長久以來,人類學家把這樣的觀點稱為「信仰」,作為在地文化實踐的有趣面向,但並不當作是對於世界的正確描述。當這樣的民族誌描述所預設的偏見被攻擊的時候,人類學者的理論框架開始從認識論脫離,紛紛轉移到本體論。在 Nadasdy 的文章裡,他批評學者如 Marisol de la Cadena 或者是 Mario Blaser 過於極端的推進這樣的轉向,宣稱不同的人群生活在無法共量的世界,只有在特定時候才會暫時且片面地與現代社會連結。當然 Nadasdy 對於這種轉向工程的去殖民動機是同情的,但是他認為這個多重世界論(或者又稱複宇宙)與他自己對加拿大北部育空地區原住民社群的異質性生活的觀察經驗,有很大的不同。他認為原住民族群也許和一些動物之間仍然維持著那種「除了人類之外」的特殊關係,但這樣的狀態已經被殖民國家等多種政策經驗改變且削弱了。更甚者,不論自願或者被迫,原住民族群常常參與加拿大政府制定的「除魅」政策,包括取得土地所有權,管理國家公園,或者在採礦公司工作。因此,Nadasdy 認為要了解原住民族人生活在加拿大殖民國家政策下的複雜性與異質性,一個「未定含混」的世界觀更能夠說明他們所經歷的多重情境。

At the root of the ontological turn and the multiple worlds thesis are some basic ethnographic observations that many indigenous communities do not share the utilitarian, “disenchanted” view of the earth, plants, and animals that is considered foundational to the modern world. Rather these entities are treated as “other-than-human” persons that have reciprocal and often kinship relations with local communities. For a long time, anthropologists treated such claims as “beliefs,” an interesting feature of local cultural practices, but not as true or accurate descriptions of the world. As the prejudice of these kinds of ethnographic depictions was attacked, anthropologists began shifting away from questions of epistemology to frame their work in terms of ontology. In his article, Paul Nadasdy critiqued certain scholars, such as Marisol de la Cadena and Mario Blaser, for having gone too far in this shift, arguing that different peoples inhabit incommensurate worlds that are only tentatively and partially connected with the “modern” world. While Nadasdy is sympathetic to the decolonizing impetus behind this work, he finds the multiple worlds thesis – the pluriverse – to be inconsistent with his own ethnographic experience of the heterogenous lifeways of indigenous communities in the Yukon of northern Canada. He argues that these indigenous groups may still maintain other-than-human relations with animals, but these have been attenuated by various policies of the settler state. Moreover, indigenous groups often participate, willingly or not, in the “disenchanted” policies of the Canadian government, perhaps by owning land, managing national parks, or working for mining companies. Nadasdy argues that a better way to capture the complexity and heterogeneity of everyday lives of indigenous people under Canada’s settler state policies is through the concept of a single, “indeterminant,” universe that can be experienced in multiple ways.

上述對 Nadasdy 文章的摘要雖然粗淺,但我希望能夠以此為基礎,來說明我如何從中醫觀點來思考本體論轉向、解殖政治、以及來看混雜性的議題。我在中國學習並研究中醫超過二十五年(加上過去一年在台灣),我發現自己無法在 Nadasdy 所框架的「複宇宙」與「單一宇宙」對立之間選邊站。我認為兩種觀點在檢視中醫的實踐時都是必需的。另一方面,我發現人類學的本體論轉向對於我在書寫及思考中醫的實踐時特別重要。數十年以來,中醫被中國及其它地方的政治菁英和知識份子貶斥為迷信。這種偏見大大地影響了中醫的發展。我觀察到無數的學生與年輕的醫生,對於熟練中醫的哲學與理論基礎感到苦手。中醫裡透過寒熱分析病情、感知氣候環境致病的因子(六淫)、順著經絡下針、或是學習把脈象以及檢視舌頭來解析臟腑的病徵(在中醫裡又稱為藏象),這些與身體解剖學似乎無關的技能仰賴一種信仰的跳躍,甚至,如同一位醫生告訴我的,一種近乎宗教式的信仰,才能認為所學習的內容屬於「真實」(reality)。這類的掙扎並不令人意外,因為中國、台灣、以及其它東亞國家的教育體系是如此著重現代科學。人類學的本體論轉向是否能夠將中醫從正當性的危機中解救出來呢?也許不能,但是透過敏銳地書寫一個中醫醫者必須居住的截然不同的世界,可以幫助一般人更好的理解它。我希望本體論轉向的觀點最終可以減緩中醫醫者在每日工作中不斷遭遇到的偏見。

While my summary of Nadasdy’s paper is far too crude, I hope it is enough to set up my take on the question of the ontological turn, decolonizing politics, and hybridity from the perspective of Chinese medicine. I have been studying and researching Chinese medicine in China for over 25 years (and for the past year in Taiwan), and I find myself reluctant to take a side in the contest between the pluriverse and universe as Nadasdy has framed the debate. Indeed, I think both perspectives are needed when we examine the practice of Chinese medicine. On the one hand, I find the ontological turn in anthropology particularly important for my own efforts to write and think about the practice of Chinese medicine. For decades, Chinese medicine has been disparaged as superstitious by political elites and intellectuals in China and beyond. The impact of this prejudice has been profound. I have witnessed countless students and young doctors struggle to master the philosophical and theoretical foundations of Chinese medicine. Thinking in terms of hot and cold (寒熱), grasping the climatic causes of illness (六淫), inserting needles according to meridian pathways (經絡), or learning to take a pulse and examine a tongue to interpret the pathological changes to an organ system (known as 藏象 in Chinese medicine) that have little connection to the anatomy of the body requires a leap of faith, perhaps even a religious faith as one doctor told me, in the “reality” of what one is learning. These struggles are not surprising given the focus on modern science in the education systems of China, Taiwan, and other East Asian nations. Will the ontological turn in anthropology rescue Chinese medicine from its crisis of legitimacy? Perhaps not, but writing sensitively about the radically different world that doctors must inhabit to master their craft can certainly help laypersons better understand it. I hope that it can ultimately lessen the enduring bias the doctors of Chinese medicine must confront in their everyday work.

同時間,Nadasdy 對北加拿大原住民各族複雜各異的生活方式的描述,也呼應了我在當代中醫實踐中所觀察到的混合實踐。今日,中醫醫者都必須紥實地研習生物醫學。在他們的臨床工作中,他們也需要將病人的西醫診斷納入考量。在中國,醫生可以下西醫與中醫的處方,他們必須在兩種競爭的醫療體系之間判斷哪一種治療最適合他們的病人。這些醫生如何在中醫與西醫這兩個截然不同的世界中移動呢?Nadasdy 提出的「未定」(indeterminacy)概念能夠幫助我們理解。Nadasdy 受到二十世紀初期,關於光同時是波也是粒子二元性的量子力學辯論所啟發,他認為物質和符號的實踐過程(material and semiotic practices)決定了一個現象的本質,正如同光是波或是粒子取決於我們用何種儀器觀察它。Niels Bohr 在 1930 年代提出光並沒有單一的內在本質,而是透過觀察的代理者(agencies of observation)所形塑出來的現象。根據這樣的論點,當醫生透過血液樣本、X光片、超音波,以及解剖、生理、病理等等原則來解析一個人的身體時,他們再生產了一種西醫的身體。但當他們從陰陽、五行、藏象、脈診和舌象來解析一位病人時,一個中醫的身體便誕生了。

At the same time, Nadasdy’s description of the complex and heterogeneous lifeways of indigenous groups of northern Canada resonates with the hybrid practices I have observed in contemporary Chinese medicine practice. Today, all doctors of Chinese medicine must also receive rigorous training in biomedicine. In their clinical work, they must always take into account the implications of a patient’s biomedical diagnosis. In China, where doctors can prescribe both biomedical and Chinese medicine therapies, they must also adjudicate between the competing therapeutic choices of each medical system to find the best way to treat their patients. How do doctors move between the radically different worlds of Chinese medicine and Western medicine? Nadasdy’s concept of “indeterminacy” may be useful here. Drawing on early 20th century debates about the dual nature of light as both wave and particle in quantum mechanics, Nadasdy argues that our material and semiotic practices determine the nature of a phenomenon. Light can be either wave or particle depending on the type of apparatus used to observe it. As Niels Bohr argued in the 1930s, light does not have a single inherent property, but rather it is a phenomenon shaped by the “agencies of observation.” According to this argument, when doctors observe the human body through blood work, X-rays, ultrasounds, and the principles of anatomy, physiology, pathology, and so on, they are reproducing the body of biomedicine. But when they consider it through the lens of yin and yang (陰陽), the five phases (五行), viscera manifestation (藏象), the pulse and tongue exam, and so on, then a Chinese medicine body emerges.

儘管 Nadasdy 的「未定狀態」對於思考中醫師面對一個混雜的臨床工作環境是個有用的的工具,但為了理解傳統醫者如何在由生醫-權力所支配的醫療場域下運作還是缺少一個重要的概念:即是權力。由於生物醫學是全球醫療的霸權形式(hegemonic power),中醫師必須學習如何運用混合的醫療形式。中醫師所處的法律、教育與制度結構要求他們額外投入學習第二套醫療體系。多數西醫則不會遇到這些要求,只有極少數西醫會學習一點中醫或其他傳統醫療體系。在我即將出版的專書 Prescriptions for Virtuosity: The Postcolonial Struggle of Chinese Medicine 中,我認為針對中醫師所面對的困境,最適當的描述或許是「後殖民狀態」(postcolonial--而我定義此概念的方式是透過Bruno Latour1993)的純化(purification)與混雜(hybridization)概念。在當代中國,中醫通常把他們的醫療工作描述為與西醫徹底對立的。例如,西醫被認為在治療急性病與器質性病變(acute and structural conditions)時較為有效,而中醫則擅於處理慢性病與功能性病變(chronic and functional conditions)。儘管醫師們純化了這兩種醫療體系的對立,但他們在臨床工作時仍積極追求兩者的整合。換言之,臨床工作的混雜性與在論述本體時的純化工作緊密相關。Latour 認為將這種混雜與純化的動態是現代憲章(Modern Constitution)的基礎。在傳統醫學的脈絡中,這種混雜與純化的動態源自中醫醫者所處的後殖民權力不平等。在中國,這樣的現象直到二十世紀早期都不存在,因為當時多數醫生實踐的是傳統醫療。這個不平等只有在共產黨政權試圖打造一個雖然包含中西醫體系,但明顯更重視生物醫學的國家健康照護系統時才浮現出來。之前,研究中醫的學者與從事原住民學的專家很少有交流。當我閱讀 Nadasdy 討論多重宇宙論的支持者與他試圖做為替代方案的未定宇宙之間的爭論時,我相信兩邊還有更多可以進一步討論的空間。

While I find Nadasdy’s concept of “indeterminacy” a useful first step in thinking about how doctors of Chinese medicine negotiate the hybrid world of their clinical practice, I think it still lacks a crucial ingredient for understanding how a traditional healer operates in a medical field dominated by biomedicine – power. Doctors of Chinese medicine must learn to practice a hybrid form of medicine because biomedicine is the hegemonic form of medicine around the globe. The legal, educational, and institutional structures within which they work necessitate the additional labor of studying a second system of medicine. Doctors of Western medicine do not confront these requirements and only rarely learn anything about Chinese medicine or other traditional healing systems. In my forthcoming book, Prescriptions for Virtuosity: The Postcolonial Struggle of Chinese Medicine, I argued that the predicament confronting doctors of Chinese medicine is perhaps best described as “postcolonial,” which I have defined through the concepts of purification and hybridization from Bruno Latour (Latour 1993). One interesting feature of contemporary Chinese medicine in China is that doctors typically describe their medical practice as diametrically opposed to Western medicine. For example, Western medicine is considered better at treating acute and structural conditions (急性病、器質性病變), while Chinese medicine is thought to be better at treating chronic and functional ones (慢性病、功能性病變). Even as doctors produce these idealized purifications of the two medical systems, they actively seek ways to integrate them into clinical practice. In other words, the hybridity of clinical practice is also intimately tied to an ontological purification in the realm of discourse. Latour considers the dynamics of hybridity and purification foundational to the Modern Constitution. In the context of traditional medicine, I believe they are a product of the postcolonial power inequalities in which doctors of Chinese medicine work. In China, these features of Chinese medicine did not exist in the early 20th century when the vast majority of doctors practiced traditional medicine. They only emerged with the Communist state as it tried to build a national health care system that included both medical systems but clearly privileged biomedicine. In the past, there has been little dialogue between scholars of Chinese medicine and indigenous studies. Reading Nadasdy’s article about the debates between advocates for the pluriverse or his alternative of an indeterminate universe, I feel convinced that there is much for these two groups of scholars to discuss.

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