From Breadth to Brevity: Focus on the Small

The ancients said that many who study TCM "begin in childhood and, with white hair, still do not grasp its source" (from the Lu preface to Jingyue Quanshu)—a way of saying how hard TCM is. After thousands of years of accumulation, TCM books are beyond counting. Even spending a whole lifetime, one cannot read all the TCM classics. Moreover, as Wang Ang said, materia medica writings make one drowsy. It is not only materia medica; most TCM classics are dry, and few read them without growing sleepy.

So the road to competence in TCM is slow and long. Ten years on the cold bench makes an expert in most professions, but for TCM it is only the beginning. To achieve reasonably good outcomes, one may need another several decades.

The ancients said: "In ten years you can produce a juren, but in ten years you cannot produce an imperial physician." Although TCM physicians like Mr. Zhang Xichun tried to train graduates who, "after three years, could all go out and save people," things in fact are far from that simple. Many TCM physicians with weak theoretical foundations and narrow insight are, under the test of complex clinical work, forced back to their studies to delve deeper.

So unless a person loves reading, it is hard to become a TCM physician with satisfying clinical results. In this day and age, most minor ailments are treated by Western medicine in hospitals; most people turn to a TCM physician only after getting a stubborn condition no doctor can cure, or a terminal illness like cancer, hoping for a gamble. Some seekers even openly admit they are "treating a dead horse as a live one," which further tests the TCM physician's theoretical grounding and clinical skill.

It has been twenty-two years since I first entered TCM. From the very first year I tried my hand, using Xiao Chaihu Tang plus Zhizi and Yinchen to cure a patient with stubborn edema. At first I could not help feeling pleased with myself and calling myself a genius. But after long practice I was beaten black and blue by countless failures: patients for whom treatment failed left disappointed; a few patients or families even made cutting remarks. All this left me feeling frustrated.

Clinical practice sweeps away a physician's arrogance and turns him into a humble, even a crestfallen, person. I venture to say that most clinicians, like me, keep their tails tucked. For in the plum grove there is no ever-victorious general—only ever-defeated ones.

On the gravestone of Dr. Trudeau, who lies buried by Lake Saranac in upstate New York, are the words: "To cure sometimes, to relieve often, to comfort always." This speaks the inner voice of almost every doctor: medicine's power is limited, and the doctor's power even more so.

Successfully curing every patient can only be a fond hope. Whenever I meet a patient or family who drapes me with the tall hat of a "divine healer" and fervently expect that I can cure themselves or their loved ones, I must summon all my energy to explain how limited my ability is, and that I cannot meet their expectations.

I was trained in science and engineering and should naturally have studied Western medicine; by chance I ended up on the TCM path. After studying TCM, I always hoped to fuse Chinese and Western medicine. In practice, having witnessed the suffering of living beings caused by "illness" and "death," I also longed to fuse spiritual philosophy with medicine. The direction is right, but the goal is too large; in my lifetime I may only touch its surface, unlikely to achieve great depth.

I say this not out of modesty but as a matter of fact. A university teacher is my patient; her allergic rhinitis had been treated by many famous doctors with little effect. Perhaps because I had a connection with her, my treatment worked. She therefore favors me and thinks my learning exceeds that of most TCM professors; she repeatedly urges me to come out and lecture, teaching more students. I do not agree. I think my own learning and insight are very limited, and I am not yet fit to be a teacher. I can manage a little elementary enlightenment for a few children; teaching more advanced students is beyond me.

One of her colleagues was referred to me and recently also urged me to write up my research as papers in TCM journals to influence more people, believing this would reduce the harm done by quacks. My reply was: one must neither overestimate oneself nor underestimate others; maybe I myself am the quack. The quack's hat may be worn by oneself, not put on others.

Saying this is not a posed show of modesty; I truly think it so. Granted there are patients whose satisfying results sing my praises, but who knows how many unsuccessful patients curse me in their hearts? I have always been clear-eyed about this. Few medical practitioners do not cherish their reputation, yet few can protect it, because medicine is an imperfect science. Physicians who take on stubborn and terminal conditions find it even harder to protect their reputations.

In the past I was also arrogant and overweening, thinking that with a little natural talent I might learn astonishing skill and cure illness at a touch. As Mr. Wang Meng said, no one's youth is a vegetarian; much less so for someone as intractable as me. But after the flames of youth have burned out, one must face reality. The real self is not the imagined self with superhuman power, and I have had to acknowledge my lowliness and inadequacy.

I do not remember in which physician's book I read an essay about visiting the veteran TCM physician Fang Yaozhong. Mr. Fang, to a young man then not yet famous, was humble and courteous, bowing and cupping his hands as he saw him to the door. From then on, the author was no longer so arrogant.

Recognizing one's own limited ability is the true beginning of scholarship. When the arrogant mind suddenly stills, one no longer pursues the great and the broad, and prefers to focus on the small. Human energy is limited; the more one delves into, the more one learns superficially. To acquire real skill, one must follow the oil-seller in Ouyang Xiu's story, pursuing "nothing but practiced hands."

So in studying medicine, there is a process from breadth to brevity, from the large to the small. General practitioners mostly treat minor ailments; larger problems are referred to specialists. A specialist needs the foundation of breadth, without which the work is hard; but a specialist cannot be broad without depth, and in the end must spend most of his energy on his own field.

So it is with a career; so it is with life. In our prime we all set lofty ambitions, each striving to be first, unwilling to lag behind. Once we see life's essence, such feelings fade. Lowly as I am, I ask for little; a place to stand and work, where I can do what I truly love, is enough.

Whether there is three feet of earth over me after death does not matter. A stinking skin bag—better, after a puff of smoke, to leave no trace. As Su Dongpo wrote: "Life goes everywhere; what is it like? Like a wild swan stepping on frost and mud. On the mud it accidentally leaves a claw print; the swan has flown east or west, what does it care? The old monk is gone, a new pagoda stands; on the ruined wall, no old inscription remains. Do you still remember that rugged road of old? Long the way, weary the man, the lame donkey brays."

Let others be brilliant! Small as I am, I wish them well.