Four Basic Concepts of Medicine in Kant and the Compound Yijing 康德和“复合易经”的四个基本医学概念 —— Stephen R. Pa
This paper begins the last installment of a six-part project correlating the key aspects of Kant’s architectonic conception of philosophy with a special version of the Chinese Book of Changes that I call the “Compound Yijing”, which arranges the 64 hexagrams (gua) into both fourfold and threefold sets. I begin by briefly summarizing the foregoing articles: although Kant and the Yijing employ different types of architectonic reasoning, the two systems can both be described in terms of three “levels” of elements. Starting at an unnumbered level devoid of any element (the tao or thing in itself), the system proceeds by elaborating a key fourfold distinction (or “quaternity”) on the first level, a twelvefold distinction on the second level, and twelve quaternities (grouped in four quadrants, each with a set of three quaternities) on the third level.
将康德的哲学体系概念与中国的《易经》相结合，称之为“复合易经”。本文从六部分的最后一部分开始，将结合64卦深入讨论“四位一体”和三倍的集合。 首先简要概括一下前面的文章：康德和《易经》采用了不同类型的体系结构推理，这两个体系都可以从三个层次进行描述。从不计其数的层次开始，不参考任何因素（道或事物本身），系统阐述了第一层的首论“四倍区别”（或“四位一体”）， 第二层的“十二倍区别”和第三层的12个“四位一体”（分为四个象限， 每个象限有三个：“四位一体”）。
Each set of three quaternities (i.e., each quadrant) on the third level corresponds to one of the four “faculties” of the university, as elaborated in Kant’s book, The Conflict of the Faculties. Previous papers have examined the correlations between three key quaternities that Kant defends in relation to each of three faculties (philosophy, theology, and law) and the 12 gua that correspond to that faculty in the Compound Yijing. The final step is to explore the fourth quaternity on the third level, the 12 gua corresponding to the medical faculty. The “idea of reason” in Kant’s metaphysics that guides this wing of the comparative analysis is freedom, and the ultimate purpose of this faculty of the university is to train doctors to care for people’s physical well-being, as free agents imbedded in nature. But this paper will focus only on the four gua that correspond to four basic concepts in Kant’s theory of medicine.
第三层的每个象限即三个“四位一体”，对应大学的四个学院，正如 康德著作《 学院的冲突》所阐述的。之前的论文已经考量了康德对应的三个学院（哲学、神学和法律）和“复合易经”的12个“卦”之间的关系。最后一步是探索第三层次的第四个“四位一体”， 即与医学相对应的12个“卦”。 在康德的形而上学论中，“理想的推理”指导着“比较分析”的这一分支是自由，这所大学的目的是训练医生去关心人们的身体健康，就像赋予自由人去大自然一样。本文将关注康德医学理论中四个基本概念对应的4个“卦”。
The two quaternities in the “yin-yang” (medical) quadrant of the Compound Yijing that will be skipped here are as follows. First, Kant’s account of the idea of freedom itself, which gives rise to the area of traditional metaphysics known as rational cosmology, comes in the first Critique’s Dialectic, in the section on the Antinomy of Reason (CPR A405-567/B432- 595). There he examines four irresolvable issues: whether the world has a beginning in time; whether composite substances consist of simple parts; whether a causality of freedom operates in the natural world; and whether an absolutely necessary being exists. Later I will argue that these correspond to the quaternity consisting of gua 15, 22, 36, and 52. The opposite quaternity, consisting of gua 5, 9, 48, and 57, similarly corresponds to four ways of understanding motion, which Kant discusses in Metaphysical Foundations of Natural Science (1786): phoronomy, dynamics, mechanics, and phenomenology. A longer version of this paper will first explore these two quaternities; but here I shall go directly to the synthetic quaternity, consisting of gua 11, 18, 26, and 46, and identify medicine as the key discipline that governs and protects human freedom.
“复合易经”阴阳（医学）象限的两个“四位一体”简述如下，首先，康德描述的自由思想，提升了传统形而上学的范畴，即自我宇宙论。 第一个批判的辩证法中， 在矛盾论中（CPR A405-567/B432- 595），他考量了四个不可解的问题：世界是否有开始；复杂物质是否由简单部分组成；自由是否来自自然；存在是否必然。接下来我将论证相应的“四位一体”15卦、22卦、36卦、52卦。与之相反的“四位一体”5卦、9卦、48卦、57卦，类似于理解运动的四个方式，康德在《自然科学的形而上学基础》（1786）讨论了这四种方法；运动、动力、机械和现象。本文大部分将首次探索这两个“四位一体”；但在这里，我先提一下合成“四位一体”11卦、18卦、26卦、46卦，将医学鉴定为管理和保护人类自由的关键学科。
Two years ago, at the previous conference in this series, I presented a paper introducing a book project I have been working on for several years, in which I employ the Yijing «易經» as a map for elucidating the logical relationships between the various a priori theories defended in Immanuel Kant’s Critical philosophy.
Rather than repeating all of that introductory information this year, I wish to build on it by illustrating how the mapping system actually works. I have therefore provided a detailed abstract, together with a handout giving the main details necessary to understand the way this project works. This enables me to jump directly into the concluding step of the fourth and final application of this system of mapping Kant onto the Yijing. In a longer version of this paper, I first demonstrate (in two previous sections) how Kant’s four antinomies and his theory of the four ways of understanding motion correlate with the gua in the first and second quaternities of the yin-yang (i.e., the medical) quadrant of what I call the “Compound Yijing”. My presentation today consists merely of the concluding section of that longer paper; I relate the four gua in the third, “synthetic” quaternity of the medical quadrant to a fourfold theory of medical health that Kant introduced in one of his last published works.
Part Three of The Conflict of the Faculties (1798) consists of a short essay entitled “On the might of the mind to be master of its morbid feelings through bare resolve [durch den bloßen Vorsatz]”. The essay is an open reply to a medical doctor, Professor Hufeland, who in December of 1796 had sent Kant a copy of his book, On the Art of Prolonging Human Life. In his cover letter Hufeland had suggested that Kant might like the book, because it claims “that moral cultivation is essential to the physical completion of human nature” (quoted in 7:97). Kant’s open reply acknowledges Hufeland’s view about the role of moral cultivation but neither affirms nor denies it. Instead, he offers, in a mostly anecdotal fashion, several illustrations of how to maintain good health through the application of a special form of philosophical will power that he calls “bare resolve”.
Remaining silent about the moral application of this human capacity, which he develops elsewhere (see note 3), Kant focuses instead on the benefits for physical health that he has found to be effective in his own attempts at adopting a healthy regimen. In what follows, I shall explore the extent to which four of Kant’s central claims about medicine resonate with the components of the synthetic quaternity of the Compound Yijing’s yin-yang quadrant: gua 46 ( ), 26 ( ), 18 ( ), and 11 ( ).
Kant begins his response to Hufeland by agreeing that what a good doctor needs most is, “along with the skill to prescribe what cures, the wisdom to prescribe what is also duty in itself” (7:97-98); through the latter, “morally practical philosophy…provides a panacea which, though it is certainly not the complete answer to every [physical] problem, must still be an ingredient in every prescription.” “This panacea,” he adds, “is only a regimen to be adopted: in other words, it functions only in a negative way, as the art of preventing disease.” Hufeland had contrasted this negative discipline with the positive discipline of “therapeutics or the art of curing [illness]” (7:99). Kant accepts Hufeland’s claim that the negative (and essentially philosophical) regimen consists in “the art of prolonging human life.” The starting point of Kant’s own argument is his claim that “the wish for long life is unconditioned”—to the extent that even a sick person who longs for death, in order to be released from many years of unrelenting suffering, will want to put off death’s final respite for a bit longer (7:99). In supporting Hufeland’s basic claim, Kant points out that “[t]he duty of honoring old age” arises not out of the fact that older people are typically more frail than younger people, but rather because of the bare fact that enduring a long life is “something meritorious” in itself (7:99): “This is the reason why old people should be honored, as long as no shame has stained their lives—simply because they have preserved their lives so long and set an example.”
This first (or preliminary) step in what might be called Kant’s “moral metaphysics of medicine,” whereby the path to a long life is paved by the firm resolve to prevent disease, corresponds to gua 46 ( ), “Pushing Upwards” (Shêng, 升). The two trigrams that make up this hexagram represent wood and earth, respectively. As such, the gua depicts the growth of a healthy plant upwards through the earth’s soil. This “vertical ascent”, as applied to a successful human being, “is associated with effort of the will.”
The Judgment emphasizes (p.178) that such “pushing upward is made possible not by violence but by modesty and adaptability.” The commentary on the Image adds (p.179): “Adapting itself to obstacles and bending around them, wood in the earth grows upward without haste and without rest.” The commentaries on the individual lines add still further insights to this initial symbolic support for Kant’s opening claim regarding the philosophical panacea of a “firm resolve” to be good. For example, the third line (proceeding upward from the bottom of the gua) assures us that, once one adopts such firm resolve (p.180), “Things proceed with remarkable ease.” The fifth (broken) line suggests (p.180) that “calm, steady progress, overleaping nothing, leads to the goal.” And the sixth line concludes (p.181) by urging us “to be constantly mindful that one must be conscientious and consistent and remain so. Only thus does one become free of blind impulse, which is always harmful.” Although the text does not refer explicitly to medicine or to a regimen for maintaining health over a long life, it does refer explicitly to several notions that Kant also appeals to in developing his philosophical panacea for medicine: as we shall see in what follows, those who wish to “push upwards” towards the goal of living a long life must train themselves to suffer the consequences of living in the right way, by avoiding the extremes of both overwork and laziness.
On the basis of this fundamental desire for a long life, and in order to make sense of why we wish for such a fate, Kant proposes a philosophical “principle” that leads him to make two concrete suggestions—one negative and the other positive—for the type of regimen that will enable people to fulfill not only the wish for a long life but also the equally important wish “to enjoy good health during it” (7:99). He calls his principle “Stoicism (sustine et abstine)” (7:100) and says that it “belongs, as the principle for a regimen, to practical philosophy not only as the doctrine of virtue but also as the science of medicine.” The philosophical principle that undergirds all medical science (7:101) is that “the sheer [or bare, bloßen] power of man’s reason to master his sensuous feelings by a self-imposed principle determines his manner of living.” Kant is quick to add that often doctors must also use other, “merely empirical and mechanical” means (such as “drugs or surgery”) to rid their patients of certain negative sensations. But this philosophical principle, which essentially comes down to having the firm resolve to respond well to the various difficulties we inevitably encounter, due to the exigencies of our physical life, is the panacea that philosophy can add to all merely medical cures.
Corresponding to this philosophical principle for all medicine is gua 26 ( ), “The Taming Power of the Great” (Ta Ch’u, 大畜), which occupies the ++ position on the synthetic quaternity of the Compound Yijing’s yin-yang quadrant. In this case the lower trigram represents heaven (i.e., the creative force) while the upper trigram represents a mountain (or “keeping still”). The overall meaning, therefore, quite appropriately symbolizes a “sage”who is “holding firm” (and thus taming) his great intellect (as represented by the three solid lines) in three specific ways (p.104): “holding together” the ideas that are needed to think such great thoughts; “holding back” from vigorously pursuing every desire and whim;and “holding firm in the sense of caring for and nourishing.” It is quite remarkable that the gua corresponding to Kant’s principle that we must establish a firm resolve to be good as the key to a philosophical regimen for health should be the very gua for which the Yijing commentary repeatedly affirms the need for firm resolve! The mountain trigram, above, “indicates firmness and truth” (p.104), while both trigrams, taken together, suggest the need for “the daily renewal of character” that can lead a person to a long life: “Only through such daily self-renewal can a man continue at the height of his powers.” It is interesting that Kant quotes a saying of Epictetus in defending this principle, for the commentary on the Image of this gua states (p.105):
Thus the superior man acquaints himself with many sayings of antiquity
And many deeds of the past,
In order to strengthen his character thereby.
The commentary on the individual lines of gua 26 emphasizes in different ways that the principle of firm resolve must be applied cautiously and with wisdom. Thus, on line 4, we read (p.106): “A good way to restrain wild force is to forestall it.” The commentary on line 5 adds: “wild force should not be combated directly; instead, its roots should be eradicated.” And regarding line 6, we read what seems to imply that a person who lives by such a Stoic principle of restraint will store up the energy needed to extend one’s life (p.107): “The energy long dammed up by inhibition forces its way out and achieves great success.”
Before proposing two general rules for applying his principle, Kant points out that the most important feature of a regimen is not that it merely causes a person to feel healthy, but that it actually enables a person to live a long life. He testifies (7:100): “I have outlived a good many of my friends or acquaintances who boasted of perfect health …, while the seed of death (illness) lay in them unnoticed, ready to develop.” Although in a sense “[f]eeling…is infallible,” it tells us only whether a person is enjoying life and “that he is apparently in good health.” But “the cause of natural death is always illness, [and] causality cannot be felt. It requires understanding” (7:100). That is why every doctor should prescribe a philosophical regimen as well as specific medicines to address each individual’s particular illnesses. The first way in which Kant suggests that people should apply his philosophical principle to a personal regimen is to rid oneself of the “bad habits of a life of ease”—most notably, those relating to “[w]armth, sleep, and pampering ourselves when we are not ill” (7:101). Kant devotes a paragraph to explaining each of these bad habits. In a nutshell: (1) parts of the body that are “far removed from the heart”, such as “the head and feet”, should not be kept artificially warm, merely to enhance a person’s comfort, for these parts need to be cold for the maximally efficient functioning of the blood vessels; (2) sleeping for longer than the body requires to rejuvenate itself (which Kant takes to be at most one-third of a day) might spare a person “much of the inconvenience that waking life inevitably brings with it”, but as a comfortable “means to a long life”, it “contradicts its own purpose” (7:101), for “it is rather odd to want a long life in order to sleep most of it away”; and (3) it is illusory for people to think they “can prolong their lives if they conserve their energy by avoiding discomfort” (7:101-102), because any such unnecessary coddling (whether by oneself or by another person) actually “brings about the direct opposite: premature old age and a shorter life.” The health danger inherent in all these bad habits can be summed up in a single word describing the unhealthy condition they promote: “boredom” (7:103).
Gua 18 ( ), “Work on What Has Been Spoiled [Decay]” (Ku,蠱), corresponds to this first (negative) application of Kant’s principle, whereby he admonishes us to beware of seeking after an easy life. The decay implicit in this gua (p.75) “has come about because the gentle indifference of the lower trigram [representing “wind”] has come together with the rigid inertia of the upper [representing “mountain”], and the result is stagnation.” Although nowhere in the commentary does the Yijing relate these symbolic meanings explicitly to health, the correlations with Kant’s theory are nevertheless quite evident. The Judgment encourages us to recognize that this stagnation has occurred through “an abuse of human freedom” (p.75): “What has been spoiled through man’s fault can be made good again through man’s work.” This is precisely the point of Kant’s initial, negative reflections on his general principle for a heathy regimen: “We must first know the causes of corruption before we can do away with them” (p.76), and when it comes to illness, those causes, all too often, are an aversion to hard work or a reluctance to endure suffering. The Yijing offers the remedy as explicitly as if Kant had written it himself: “Decisiveness and energy must take the place of the inertia and indifference that have led to decay, in order that the ending [i.e., in this case, illness] may be followed by a new beginning [i.e., restored health].” As is so often the case with the Yijing, the commentary on the individual lines focuses mainly on political applications of its wise advice, so much of it seems irrelevant to the theme of medical health. But there are a few notable exceptions. A comment on the first line states (p.77): “Only if one is conscious of the danger connected with every reform will everything go well in the end.” And on the third line (p.77): “too much energy is better than too little.” And as we shall now see, when Kant makes a positive application of his principle, he too suggests that it is better for one’s health to work too hard than too little, but also warns that either approach, taken to an extreme, can be medically dangerous.
Kant’s positive rule for applying his principle amounts to “philosophizing， in a sense that does not involve being a philosopher”, as this “is a means of warding off many disagreeable feelings” (7:102). More specifically, one can avoid boredom in each of the three situations Kant warned against by keeping actively interested in whatever one may be doing; in the case of each of the three bad habits mentioned above, one can overcome the potentially detrimental effect on one’s health by applying firm resolve to withstand what seems at first to be a form of suffering. To illustrate how to correct the bad habit of unduly seeking the comfort of warmth, Kant discusses his own tendency towards “hypochondria”; such “fainthearted brooding about the ills that could befall one,” he admits, is the very “opposite of the mind’s self-mastery” (103). Consulting a doctor in such situations is pointless: the supposed disease is “fictitious”, so “only [“the self-tormenter”] himself, by disciplining the play of his thoughts, can put an end to these harassing notions that arise involuntarily” (103). “A reasonable human being…asks himself whether his anxiety has an object [Object]. If he finds nothing that could furnish a valid reason for his anxiety…, he goes on, despite this claim of his inner feeling, …and turns his attention to the business at hand.” Kant testifies that he overcame his own tendency toward hypochondria in precisely this way, and in so doing discovered that “one’s life becomes cheerful more through what we freely do with life than through what we enjoy as a gift from it” (104). In separately numbered sections, he similarly discusses sleep (104-107) and (via the topic of “food and drink”) self-pampering (107-108). In both cases, he argues, one can master one’s undue desire for laziness (i.e., too much sleep) or overeating through a firm resolve to moderate one’s desires.
This positive application of Kant’s panacea of firm resolve, which is needed to protect oneself in advance from anything in one’s physical and mental constitution that might offer a foothold to an impending disease, corresponds to gua 11 ( ), “Peace” (T’ai, 泰). Here the bottom trigram is heaven (“the creative”), consisting of all solid lines, while the top trigram is earth (“the receptive”), consisting of all broken lines. The former symbolically points upwards while the latter points downwards, so that the overall hexagram illustrates a situation of perfect balance, where “heaven seems to be on earth” (p.48). The Judgment is auspicious (“Good fortune. Success.”), inasmuch as (p.48-49): “the light [as depicted by the solid lines] has a powerful influence, while the dark [as depicted by the broken lines] is submissive…. When the spirit of heaven rules in man, his animal nature also comes under its influence and takes its appropriate place.” In other words, this gua represents precisely the sort of life situation that Kant is imagining when he describes the positive application of his personal regimen for health: the body, even for those who (like Kant) seem to suffer from numerous ailments, will submit to those who think deeply enough about their physical situation to allow their intellect, through sheer force of will, to instill healthy habits in their daily routine; these habits will effectively ward off the boredom that is likely to inflict those who regularly give in to the temptations of their animal nature. Indeed, the commentary on the second line hints at Kant’s Stoic maxim quite directly, though referring to social relations rather than physical health per se (p.50): “Bearing with the uncultured in gentleness, / Fording the river with resolution, / …: / Thus one may manage to walk in the middle.” Kant’s point is that this principle of social relationships also applies to maintaining good health: walk the middle path, bearing with the physical troubles that come one’s way, but continuing to work in moderation, despite one’s limitations.
Kant concludes his short essay on medical health by warning that even philosophizing can be taken too far. Indeed, he jokes at one point that he has kept his own essay short, lest the result be inadvertently counterproductive by causing the reader to be bored (7:103)! Even the philosopher must come to a point where we stop thinking, and lay down to rest. Likewise, the commentary on line 3 of gua 11 offers an insightful admonition (pp.50-51) that could well have served as the closing statement of Kant’s own essay on medicine: “Evil [cf. illness] can indeed be held in check but not permanently abolished. It always returns…. As long as a man’s inner nature remains stronger and richer than anything offered by external fortune, as long as he remains inwardly superior to fate, fortune will not desert him.”
（作者：中国香港 浸会大学 教授）