The Craft Lies Beyond the Medical Books
Recently some readers have consulted me about studying medicine. Being myself only half-full, I dare not play the master. I write this piece to share a few humble thoughts on studying Chinese medicine, in reply to fellow TCM enthusiasts. I am young and shallow; this modest essay is meant only to throw out a brick to attract jade. Where I am wrong, I hope readers will correct me.
There is an old Chinese saying: a scholar learning medicine is like catching a chicken in a cage. It describes how someone steeped in traditional Chinese culture will take to TCM with effortless ease. To study Chinese medicine, one must first begin by studying traditional Chinese culture. The spirit of traditional Chinese culture is, at root, a spirit of the unity of heaven and humanity and of harmony between body and mind. Whether Confucianism, Daoism or Buddhism, all value the harmonious development of human beings and nature, and inner peace and ease. Only by thoroughly grasping this, and being able to unite knowledge and action, can one grasp the true meaning of Chinese medicine.
Many people remain at the stage of paper-tiger theorizing about these ideas; they are too impatient in person and in study. This state, which runs counter to the fundamental way of Chinese medicine, makes it hard to grasp the essence of TCM. To learn Chinese medicine well, the craft lies beyond the medical books. Once one masters this essence beyond the books, TCM theory is no longer hard to understand.
Harmony with nature and inner peace require a very long quiet cultivation to achieve. I hold this view: if a TCM physician wants to learn medicine well, he must first put his own various sub-health states in order and bring his own complexion to a very good state. Only thus can he understand Chinese medicine. To heal others, first heal yourself; to heal yourself, first heal your heart. When inner restlessness has been subdued and one reaches the state in which 'the spirit is held internally, and illness whence can it arise?'—only then has one experienced the great beauty of Chinese medicine. In such a state, a person's true wisdom emerges naturally. When one possesses such wisdom, reading medical books naturally reaches the level of catching a chicken in a cage—hand to mouth, effortless.
Hence the Great Master Sun Simiao's chapter 'On the Calling of the Great Physician' (Da Yi Xi Ye Pian) specifically discusses the humanistic and medical attainments a physician should possess. The original text is excellent; I transcribe it here:
'Whoever would be a great physician must be thoroughly versed in the Suwen, the Jia Yi (Zhen Jing), the Huangdi Zhen Jing, the Mingtang Liuzhu, the twelve meridians, the three regions and nine indicators of pulse diagnosis, the five zang and six fu, the exterior-interior channels and acupoints, the materia medica and herb pairs, and the classical formulas of Zhang Zhongjing, Wang Shuhe, Ruan Henan, Fan Dongyang, Zhang Miao, Jin Shao and others. He must also subtly understand yin-yang, destiny and the various schools of physiognomy, as well as tortoise-shell divination, the six yaos of the Zhouyi, and the ren method; and he must master them proficiently. Only thus can he become a great physician. Otherwise he is like a person walking at night without eyes, forever stumbling and falling. Next, he must read these formulas thoroughly, ponder their subtle principles, and attend to them diligently before he can speak of the Way of medicine. He must also range widely among the many classics. Why? If he does not read the Five Classics, he will not know the way of benevolence and righteousness; if he does not read the Three Histories, he will not know the affairs of ancient and modern times; if he does not read the masters, he will observe things yet be unable to understand and record them silently; if he does not read the inner Buddhist canon, he will not know the virtues of compassion, joy and generosity; if he does not read Zhuangzi and Laozi, he will not be able to abide in authenticity and embody the Way, so that auspicious and inauspicious taboos will arise at every step. As for the flourishing and declining of the five phases and the astronomy of the seven luminaries, he must also probe their profundity. If he can study all these together, then in the Way of medicine there will be no obstruction, and he will reach perfection.'
Sun Simiao's passage sets out the body of knowledge a good TCM physician should possess—a standard that borders on the omniscient. On top of this, the TCM physician should have the spirit of 'illuminating ancient principles and blending new knowledge,' studying broadly and bringing forth the new from the old. Today, to achieve great things, a TCM physician would best also master modern medicine, psychology, science, philosophy and other fields. All this knowledge transcends medicine itself. The physician should be among the most learned, versatile and gifted people in the world. Because the physician must deal with all kinds of patients, and in dealing with them needs the Buddha's ability of 'skillful means' (shanshuo fangbian); this ability cannot be mastered merely by learning a little surface skin.
Only when a physician's humanistic, scientific and medical attainments have all reached the highest stage can he be called a good doctor. If he is confined to mastering some small technique and bound by the views of one school, he is easily led to bias.
On the specific question of medical attainments, I hold another view: the physician should be a skeptic. Throughout ages and lands, many medical theories are merely hypotheses humanity has formulated to better understand medicine; some can be verified in practice, others cannot. Even those verifiable in practice never reach a hundred-percent efficacy in clinical application. Hence a person studying medicine should learn like Huo Yuanjia learning boxing: as he learns, he must forget the sectarian views, cast aside his own biases, and apply flexibly.
A physician's knowledge rests on day-by-day accumulation; the improvement of a doctor's skill is not a matter of a morning or an evening. After studying medicine, one must have a lifelong reading plan; accumulate deeply so as to release slowly. Do not go everywhere seeking shortcuts. On the Way of medicine, every shortcut may be a trap leading one into bigotry. The physician must most avoid chasing quick fame and profit; he should consciously set his growth plan as a five-year plan, a ten-year plan, a twenty-year plan—not, as in ordinary trades, expecting great growth after a few months' work. Doctors trained in haste, when they treat patients, kill or injure them; this is the greatest disrespect for life.
In the study of Chinese medicine, the cultivation of one's heart and nature is of great importance. The growth of heart and nature requires an enormous volume of reading and constant reflection and settling to achieve. When knowledge has accumulated to a certain degree and reflection has reached a certain realm, then more reading and clinical practice, over time, will naturally raise the medical skill.