Preface to Wusuozhu Ji (Collected Writings on Non-Abiding)

The Diamond Sutra says: "Abiding nowhere, the mind arises." This is the core thought of the Diamond Sutra, the briefest expression of Buddhism's ultimate spirit, and the essence of Eastern philosophy.

"Non-abiding" is a state of not being constrained by any thing or thought; in philosophy this state can be described by the term "negation of negation."

A person's understanding of the world passes from the unknown to affirmation, from affirmation to negation, and from negation to "negation of negation." After these three stages, one's cognition becomes harmonious and inclusive.

Chinese Chan Buddhism has a legend describing the process of cognitive change through three stages: "seeing the mountain is a mountain; seeing the mountain is not a mountain; seeing the mountain is still a mountain."

To reach the state of "non-abiding," one needs very rich life experience and broad horizons; this requires the accumulation of time.

Confucius said, "At forty I had no more doubts." The Buddha also attained enlightenment around the age of forty. So even these great, original minds reached perfection only after long struggle through the river of years.

Our understanding of the world is the result of deep accumulation and gradual release. Even a person of the highest intelligence has a long process of learning and growth. Chan's "sudden enlightenment" is the moment when, after long "gradual cultivation," the waters finally reach the channel. In cognitive ability, no one can leap to the summit in a single bound.

Harvard Medical School is the best medical school in the world. Among the famous physicians who graduated from it, many first did undergraduate degrees in other fields, then entered Harvard to study medicine, and became giants of medicine. In China we have an idiom for such people: "becoming a monk halfway."

In our cultural tradition, calling someone a "halfway monk" carries a whiff of disdain for their professional depth. But from my own life experience, I have come to feel that becoming a monk halfway is actually a good state.

Becoming a monk halfway frees one from the confines of a narrow professional vision. Only after seeing a wider world does one realize the narrowness of one's own.

The world is vast, yet people often see it as small. The self is tiny, yet people often see it as huge. Prejudice and arrogance arise from this. The broader a person's horizons, the more they realize how narrow their own "small self" world is.

Since I began studying medicine, I have witnessed many partings and deaths. My understanding of what medicine is has gradually changed.

Any medical textbook will likely tell us that people fall ill, in most cases, not from a single cause. Human health relates to the natural environment, social environment, family and marital situation, interpersonal relationships, personal living habits, diet, heredity, religious belief, climate, and many other factors.

But regretfully, the vast majority of medical textbooks only tell us how to solve a patient's problem through some technique, rather than comprehensively addressing the patient's actual condition.

So we regretfully see many patients who go to the doctor full of hope, only to leave the hospital as if battered—worse than when they entered, both mentally and physically.

Or, after the patient's perceived symptoms ease for a while, it is not long before the illness relapses, more severely than before.

It must be said that many patients end up worse after doctor treatment than before.

Once, an old TCM physician announced he would take on disciples. I went there out of admiration; along with me was a Western doctor. I asked him why he had abandoned Western medicine to study TCM.

He told me that most of the seriously ill patients on his ward were in far worse condition at discharge than on admission, yet he had to write again and again in the medical record things like "patient's condition improved; evaluated and approved for discharge." This broke him spiritually, and he began to doubt the value of the life path he had chosen.

Another time I was invited to the home of a TCM family to help a cancer patient; nearly every family member was trained in TCM. But apart from the patient himself, who still believed in TCM, all the other members were deeply averse to it—they had studied TCM themselves but did not believe it could cure disease.

Another old TCM physician, when he himself developed esophageal cancer, chose Western treatment. He told his family that TCM could not possibly treat esophageal cancer, and he died not long after surgery.

He had written a book of his lifelong clinical insights but could not publish it. Before dying, he very much hoped someone would carry on his art through these writings, so he asked his daughter, who had not studied medicine, to find an inheritor.

The day before I wrote this article, a 78-year-old Western-medicine physician came to me, asking me to treat his melanoma with TCM. He had developed melanoma four years earlier; having spent his whole life in the medical system, he knew its pros and cons, so from the moment he discovered the melanoma he refused all modern medical treatment. He read TCM books on his own and visited famous TCM physicians to treat his melanoma.

Not coincidentally, Dr. Atul Gawande of Harvard Medical School, author of the bestseller Being Mortal, also chose to turn away from medical textbooks when his father developed a tumor.

Dr. Gawande is a surgeon, and both his parents were doctors. The Gawande family had operated on many people. But when the elder Gawande was diagnosed with a malignant tumor, they chose not to operate at once and not to treat, letting the disease run its course and delaying surgery as long as possible. Only years later, when the tumor affected the elder Gawande's daily life, did they operate once.

After surgery, the elder Gawande strongly rejected radiotherapy and chemotherapy; in fact, the chemo and radiotherapy later given did not benefit him much and instead made him suffer terribly.

I now focus on researching cancer treatment. Occasionally I wonder: if one day I myself got a malignant tumor, what would I choose? Believe the textbook? Follow current medical guidelines? Or treat purely with TCM?

A sentence in Dr. Atul Gawande's book resonated with me: he said that he and his parents together had 120 years of medical experience, but the moment his father was diagnosed with a malignant tumor, they too were at a loss, not knowing what to choose.

I have now treated many doctors—both Western and TCM—as well as various self-styled wellness gurus who dismiss medicine. When they themselves develop malignant tumors, all of them deeply distrust the medical knowledge they once learned.

Perhaps malignant tumors are a special field, but in textbooks on many other diseases I have seen the same disappointing phrases, such as "the cause is currently unclear." Treatment of many diseases is merely symptomatic, supportive care.

For example, to date over 90 percent of psychiatric disorders still cannot be given a clear cause; psychiatrists can only use existing drugs to temporarily control symptoms, with no cure, and the patient's condition may worsen at any time.

Many dermatological and cardiovascular-cerebrovascular diseases I know are the same—only temporary symptom control. The list is endless.

What should we believe? What should our standard of treatment be? What is right and what is wrong? Who can tell the doctor? Who can tell the patient and family?

Under the torment of illness, some people choose methods that seem to us bizarre. We may criticize them as foolish, yet we ourselves cannot solve their problems. Is our criticism really as right as we think? Is our understanding of these diseases not itself another kind of folly?

It is wrong for a person to affirm only their own cognition; there must also be a process of negating it, testing old cognition through practice, and then generating new cognition on that basis. Then new practices will negate our negation of the old.

In this continual process of negation and "negation of negation," people broaden their horizons and hearts and gain deeper understanding.

A woman once told me she used Five-Element Needling to treat people, helping insomniacs sleep and relieving pain in those who suffered. I pressed her: what is Five-Element Needling? Is it a special acupuncture method?

She told me it was a therapy I could not possibly believe. Her Five-Element Needling used no needles at all; instead, drawing on the generating and controlling cycles of wood, fire, earth, metal, and water, she used language and intention to relieve patients' suffering.

Yes, she had me pegged. I thought she was talking nonsense. But some patients did benefit from her Five-Element Needling.

Another time, a patient's daughter, knowing I had some knowledge of religion, begged me to play the role of a spirit medium to help her deranged mother. I politely refused, with some displeasure. I felt that asking an atheist like me to do such hocus-pocus was an insult to my dignity and beliefs.

Actually, the family's request was quite understandable, and very correct—it matches medicine's ultimate understanding of disease. In ancient TCM there has always been the zhuyou (incantation therapy) technique; it is just that many of us TCM practitioners today, myself included, no longer master this psychotherapy technique.

Now, my experience in medicine has gradually taken me through the whole process of "seeing the mountain is a mountain; seeing the mountain is not a mountain; seeing the mountain is still a mountain." My view of medicine is now far more tolerant. In my heart there is no longer a divide between modern and traditional medicine, nor between science and superstition. Any method that helps solve the patient's problem can be called medical skill.

We solve patients' problems with pills; others solve them by other means. What reason have we, because of our own cognition, to deny others'? Which of us has the confidence to think our judgment is superior to others'?

I am a scientist-turned physician who entered medicine halfway; now I study not only TCM but also Western medicine, philosophy and history, psychology and religion. As long as my energy allows, I am willing to explore almost every field.

Dr. Atul Gawande, who studied philosophy as an undergraduate, after decades of practice and interviewing countless patients, revised his understanding of the physician's social duty.

He said he believes the doctor's duty is to bring happiness to the patient. Patients come to doctors in the midst of unhappy lives; the doctor should do everything possible to let them live as happily as possible, or reach the end of life relatively happily.

I have worked with many dying patients. There are certainly many successful cases, but also many failures.

Repeated failures broke me spiritually several times, and I felt I could hardly continue on the medical path. But I cannot get off it now, because many patients are alive because of me; their refusal to give up forces me to press on again and again, and in this persistence I achieve spiritual elevation after elevation.

The highest fruit of Theravada Buddhism is the arhat; of Mahayana Buddhism, the Buddha. Between the arhat and the Buddha is the fruit of the bodhisattva. In Buddhism the bodhisattva is also called "the one who bears the Tathagata's burden"—a Buddha carrying a load.

Only when a person walks forward bearing some responsibility can they, in that burdened state, transform themselves and achieve another self-transcendence, reaching perfection.

Studying medicine is the same.

When we say disease has broad causes, we should know that the doctor whose task is healing is absolutely not merely a medical technician with one specialized skill.

Our vision and heart should be broader; we should also possess profound knowledge and rich skills. Only then are we qualified to say we can bring happiness to patients.

The American physician Dr. Thomas, a brilliant graduate of Harvard Medical School, was also a passionate lover of rural life and owned his own farm.

When he served as medical director of a nursing facility, he saw people there, disabled by age or illness, who had lost all vitality; living in the facility was like being in prison.

He decided to try something new: he brought into the facility a hundred birds, two dogs, four cats, and many plants, and opened an area for staff children so employees could bring their kids in.

Before long the nursing home became lively. The silent patients began to talk; the inactive patients began to move about; even the dementia patients visibly brightened. Prescriptions dropped sharply, symptoms clearly eased, quality of life improved, and survival lengthened.

I personally know at least two severe depression patients who, after falling in love with plant cultivation, threw away the pills they had relied on to control their condition, immersed themselves in a world of flowers and plants, and bid farewell to the depression that had plagued them for years.

So what is medicine? Do not spend your whole life circling only within the small world you know; come out and see more.

He who studies medicine should abide nowhere, and thereby give rise to the mind.

I do not intend to define my own work as any kind of medical book, although everything I discuss in this book is professional medical knowledge.

This is the preface.