Professor Li Peisheng: A TCM Scholar Must Be Both a Bookman and a Physician

The late great Shanghan expert Professor Li Peisheng held that a TCM scholar must be both a bookman and a physician. As a bookman, one must read widely, write much, be able to go from breadth to essentials, and digest what one reads; as a physician, one must apply what one has learned, serve the clinic, and relieve patients of their suffering.

Professor Li Peisheng’s principle for TCM reading was: read the foundational books repeatedly, and read the practical books with emphasis. The foundational books are the TCM classics such as the Huangdi Neijing (Yellow Emperor’s Inner Canon), the Shennong Bencao Jing (Shennong’s Classic of Materia Medica), the Shanghan Lun, the Jingui Yaolue, the Yizong Jinjian, the Wenbing Tiaobian, and the Wenre Jingwei. To build a solid foundation, such TCM books must be read repeatedly and thoroughly, and the key passages memorized proficiently. Not only beginners should do this; even those who have practiced medicine for many years must not relax in the slightest. The practical books are those widely recognized medical works, such as Li Shizhen’s Bencao Gangmu, Zhang Jingyue’s Jingyue Quanshu, and Li Dongyuan’s Piwei Lun (Treatise on the Spleen and Stomach); these should be read with emphasis. Some books, such as the Qianjin Fang, the Zhubing Yuanhou Lun, and the Waitai Miyao, should be studied repeatedly only after one has already mastered the foundations of TCM.

I think the principles for learning TCM advocated by the elder Li are very apt and practical, but times have changed, and the book list he recommended needs updating. Besides the TCM classics, the foundational books should also include modern classics such as Shiyong Neikexue (Practical Internal Medicine), the Zhonghua Bencao (Chinese Materia Medica), and Shiyong Zhongyi Neikexue (Practical TCM Internal Medicine). Among these, Shiyong Neikexue is a Western medicine monograph; in the present day, students of TCM should have a basic understanding of Western medicine. It is of course ideal to integrate Chinese and Western medicine, but if that cannot be done, one should at least have some basic Western medical skills. Broad learning reduces misdiagnosis and misjudgment. Physicians deal with human life, and what they fear most is a wrong judgment. Once a misjudgment occurs, not only is the patient’s health unprotected, but the physician’s own professional safety is also at risk. Extra skill never weighs one down; learning more benefits not only the patients but ourselves as well.

Skills have their specialties, and modern TCM must also divide into departments. Personally, I rather dislike the claim that a single TCM physician equals a whole general hospital—that is blowing the trumpet far too loud. There are more than 25,000 kinds of human diseases; just memorizing the names of those 25,000 diseases would require memorizing more than 100,000 characters. The human brain is not that developed. Any physician can only have experience with a small subset of diseases. It is already remarkable for a physician to be proficient in treating a few dozen diseases. A doctor who claims to be able to treat anything has both medical skill and integrity that are open to doubt.

Therefore most physicians, after completing their foundational studies, gradually become specialists through clinical practice. In addition to reading the classics above, a specialist must also regularly read the professional monographs in their field. For example, since I research oncology, I need to be familiar with oncology monographs and read certain key oncology works repeatedly. These should all be treated as foundational books and read repeatedly, without exception whether the TCM scholar is junior or senior. We should allocate more than 60% of our reading time to these foundational books.

I used very much to hope that I could be familiar with all kinds of diseases, but at my present age I have gradually realized that this is an unrealistic delusion. Even a single disease like cancer needs to be approached realistically with a multidisciplinary team attitude. To imagine oneself capable of solving every health problem is pure self-deception. A person’s energy is very limited; modern society is a society of division of labor and collaboration. We must have the courage to admit that we are only one link in this division-of-labor society; being able to solve well the problems within our own specialty is already quite an achievement.

Although patients indeed expect a certain physician to be omniscient and omnipotent, solving their problems through one-stop service—among the patients and families I meet, there are even people who hope that I myself can provide one-stop service for the health problems of their whole family—the physician himself should understand that this can only ever be a beautiful wish. No physician is so formidable as to be able to solve all of a patient’s problems. If a physician takes on everything and tries to solve all the patient’s problems, that is the greatest irresponsibility toward the patient, because it means experimenting on the patient with an unprofessional attitude.

Elder Li said a physician is also a bookman and must be diligent in writing. I strongly agree with this. Physicians have an obligation to popularize medical knowledge to society. The general public lacks understanding of medicine and of the medical profession, and seeks medical care blindly. There are also some patients with rather conservative ideas who cling to notions that should have been discarded as society has developed—for example, the notion I mentioned above that one TCM physician is a general hospital capable of curing every disease is both stale and harmful. People who hold such ideas cannot see social development or the positive significance that medical progress has brought to humanity; this is very harmful. We therefore have an obligation to provide popular science education to the public and help ordinary people improve their understanding.

Elder Li believed that physicians should study diligently, write diligently, and practice diligently. Reading increases knowledge; writing helps the physician internalize what is learned into personal understanding while also helping the public. Treating patients clinically helps the physician gain true knowledge from practice. These views are all very apt.

I venture to add a line of my own: personally, I think TCM scholars must also diligently think and summarize as they learn and practice. Medical progress is slow, and the improvement of one’s own medical competence cannot be achieved overnight. Advance one soldier a day, and no effort is wasted. Physicians must understand the principle that great achievements come from deep accumulation; they must be able to immerse themselves deeply, endure solitude, and gradually improve themselves through reading, writing, clinical practice, reflection, and summarization.