For every practitioner of Chinese medicine the ultimate goal of treatment should be to help patients get better and relieve suffering. In order to do this the practitioner must not only continuously seek to improve his or her skill in treating patients, but also become a whole human being who understands the nature of humanity and human suffering at a deep level.
To help patients and obtain a high level of skill in Chinese medicine all practitioners should aim to become what is referred to in the classics as a DaYi 大醫 (great physician), or Shanggong 上工 (superior physician) . The superior, or great, physician is not only adept at treating illness, but can also foresee potential future illnesses and complications, then treat them before they arise, as stated in the following passage the Yellow Emperor’s Classic of Internal Medicine: Spiritual Pivot (Huang Di Nei Jing Ling Shu 黃帝內經靈樞):
“The Shanggong 上工 (superior physician) uses needling [to treat the disease] before it arises…the Xiagong 下工 (lesser physician) uses needling [only, when the disease] is strong…”
Several dynasties later, in the Tang Dynasty (618–907 AD), the physician/scholar Sun Simiao laid out a set of principles and practices that a physician should follow to become a DaYi 大醫. In doing so he emphasized the importance of attaining a high level of skill so that practitioners could attain the knowledge to treat illness preventatively. In his book Essential Prescriptions for Every Emergency worth a Thousand in Gold (Bei Ji Qian Jin Yao Fang 備急千金要方) Sun Simiao recommends a set of ethics for dealing with patients, self-cultivation practices that nourish the health of the physician, a suggested set of knowledge about the world that helps one relate and empathize with patients, all with the goal of cultivating a beneficial therapeutic relationship that focusses on the prevention of illness whenever possible.
The most basic requirement for becoming a superior physician is in becoming a professional craftsman of sorts who sees treats all patients the same despite social, cultural, or economic status. Following this basic requirement allows the practitioner to see the patient in his/her current state of being, without judgment or negative projection.
“In one’s daily practice, one must have an attitude of self-possession and concentration; have a dignified appearance; treat all patients equally with no regard to wealth, gender, status, nature of ailment or potential rewards … while abstaining from luxuries and from criticizing one’s fellow physicians.”
The above passage is is also an example of the influence of Buddhism, and in particular Buddhism’s teachings on compassion on Sun Simiao’s ethics—as part of Sun Simiao’s ‘suggested reading list,’ he states “if you have not studied the Inner Classics [of Buddhism], you do not know the virtues of compassion, sympathy, joy and abandonment.” Buddhism places great importance on the cultivation of concentration through meditative practices, and more specifically doing so for the express purpose of relieving the suffering not only of one’s self, but also the suffering of humanity. Along with this is the practice of non-attachment to possessions, and the practice of “right speech” which is the third of the noble eightfold path of Buddhism and advises abstaining from lying, divisive speech, abusive speech, and idle chatter.
Another reference to Buddhism is found later in the text where Sun Simiao uses Buddhist language to convey how important it is for a practitioner to understand suffering and possess a high level of compassion: “He must pledge to devote himself completely to relieving the suffering of all sentient beings.” It is important to mention here that he is not saying that a superior physician must be a Buddhist, but he is using Buddhist ideas and symbolism to highlight the importance of cultivating immense compassion for every patient that enters one’s clinic.
In addition to this base level of ethics and compassion that a practitioners must possess, Sun Simiao also recommends an extraordinarily deep level of examination and diligence when it comes to the practitioner’s study of medicine:
“…students must absolutely acquaint themselves to the greatest extent with the origins of medicine, studying tirelessly with absolute diligence. They may not recklessly repeat rumors and then claim that this is all there is to the Way of Medicine!”
This passage emphasizes the importance of scholarly work and deep study. This is most obviously important in learning the medicine and learning what herbs and formulas to prescribe and when, when to apply certain acupuncture points, and how and why certain lifestyle recommendations would be made. However, according to Sun Simiao and the “Scholar Physicians” of the Song Dynasty, it is also extremely important for one to undertake deep study in the humanities so that the physician can relate to, and understand, each patient that comes through the door.
The final part of Sun Simiao’s recommendations on becoming a superior physician relates to the practice of medicine. Here, what some readers might find surprising, even after being hinted at in the initial quote from the Nei Jing at the top of this post, is the emphasis of treating the disease before it has become severe enough for the use of acupuncture and herbs. Sun Simiao and other Chinese practitioners during his time and earlier placed a huge emphasis on treating disease in the early stages and on using Chinese medicine and lifestyle recommendations as a strong form of preventative healthcare.
“When a person’s body is balanced and harmonious, you must merely nurture it well…to secure the body at the root, you must provide it with food. To rescue from the speed of disease, you must rely on medicinals…People who practice medicine must first thoroughly understand the source of the disorder and know what has been violated. Then, use food to treat it, and if food will not cure it, afterwards apply drugs.”
Although he is talking about the importance of food in this passage, he is doing so by using food and comparing it to medicinals, so in essence he is comparing lifestyle choices and recommendations to stronger medicinals. Sun Simiao places equal emphasis on the importance of other health maintenance practices known in Tang and pre-Tang Dynasty China. In addition to food therapy for maintaining good health and preventing illness Sun Simiao also recommends meditation practice, breathing exercises, physical exercise, living a balanced and tempered life, and Taoist sexual practices. In the modern day Western world correlates for all of these recommended practices are being studied as ways to prevent illness, reduce stress (which of course leads to reduced rates of illness), and lead to a better overall quality of life. Therefore, the practice of disease prevention in the Tang Dynasty as recommended by Sun Simiao is at the forefront of modern medical research.
Much can be learned about health and healthcare by studying the works of Sun Simiao and his recommendations for becoming a superior physician. His writings in this area are the Chinese correlate to the Hippocratic oath taken by Western biomedical doctors upon graduation from medical school. Both writings lay the foundation for how to think about medicine and the art of medical practice, and are of key importance to any physician or medical practitioner.
[Note: This post would not have been possible without the excellent translation work of Sabine Wilms. In fact, this post is essentially a summary of an excellent article by her on Sun Simiao entitled “Nurturing Life in Classical Chinese Medicine: Sun Simiao on Healing without Drugs, Transforming Bodies and Cultivating Life.” I highly encourage you to check out this article and support her other translation work by visiting her website at: http://www.happygoatproductions.com/ ]