By Sabine Wilms
Volume One, Chapter Two:
On the Sublime Sincerity of the Eminent Physician
1) Zhāng Zhàn (1) said: “The reason why the methods in the classics are so difficult to grasp in their essence is that they come from such a lofty origin.”
2) Nowadays, there are diseases that are identical on the inside but different on the outside, as well as diseases that are different on the inside but identical on the outside. Therefore, abundance or emptiness in the five zàng and six fǔ organs and the free flow or blockage of blood in the vessels and of yíng provisioning and wèi defense is certainly not something that can be observed [merely] by eyes and ears. They must first be examined by diagnosing signs:
3) At [the three positions of pulse diagnosis] cùnkǒu (inch opening), guān (bar), and chǐ (cubit), for the presence of disorder in terms of a floating or sunken, string-like or tight [pulse]; in the flow at the shù transport points, for differences in whether it is high or low, shallow or deep; and in the flesh, sinews, and bones, for differences in whether they are thick or thin, hard or soft.
4) Only those who apply their heart with sublime subtlety can even begin to talk about this!
1 張湛: A scholar from the Eastern Jīn period and author of a commentary on the Lìe Zǐ 列子 and a text called Yǎng Shēng Yào Jí 養生要集 (Essential Collection on Nurturing Life).
1) Nowadays, however, people pursue matters of utmost sublimity and utmost subtlety with minds of utmost coarseness and utmost shallowness. Is this not dangerous indeed?
2) To add to what is already overabundant or to take away from what is already empty, to penetrate further into what is already flowing freely or to impact what is already obstructed, to cool what is already cold or to warm what is already hot, this is only doubling the disorder. And looking at these patients’ life, I see their death!
3) Therefore, the difficulty and sublimity of the technical skills required for the methods of medicine and for divination by means of tortoise shell or yarrow stalks is not something that we receive from the spirits. So how do we grasp their obscure subtleties?
1) There are fools in the world who study the methods [of medicine] for three years, and it is said [of them] that there is not a single disease under heaven that they are able to treat. Only after treating disease for three years do they finally become aware that there is not a single method under heaven that they are able to use.
2) For this reason, students must comprehensively acquaint themselves to the greatest extent with the origins of medicine, tirelessly refining their understanding with diligence.
3) They may not recklessly repeat rumors and then claim that this is all there is to the Dào of Medicine! Deep indeed is their self-delusion!
1) In all cases, when you treat disease as an eminent physician, you must quiet your shén and fix your intention, you must be free of wants and desires, and you must first develop a heart full of great compassion and empathy. You must pledge your desire to rescue all sentient beings indiscriminately from their suffering.
2) If someone facing disease or disaster comes to you seeking relief, you may not inquire whether the person is nobility or low class or poor or wealthy, [or consider their] old age or youth, beauty or ugliness, or whether you detest or like them or whether they are your friend, whether they are Chinese or barbarian, a fool or a sage. You must treat all of them exactly the same as if they were your closest relatives.
3) Neither must you look to the front while turning around to cover your back, worry about your personal fortune or misfortune, and guard and cherish your own life.
4) When seeing the suffering and grief of others, you must act as if it were your own and open your heart deeply to their misery. You must not avoid dangerous mountains with rugged cliffs, any time of day or night, the cold of winter or heat of summer, hunger or thirst, fatigue and exhaustion. You must focus your heart on attending to their rescue and must not have a heart of hard labor or outward appearances. (2)
5) Acting like this, you can serve as eminent physician for the masses; acting against this, you are a horrid thief to all sentient beings.
2 無作工夫形跡之心: This phrase is quite difficult to translate. We interpret it as a warning for practitioners against the professional arrogance of indulging in a martyr’s attitude by considering your work as toil, as hard labor in dedication to others, and by worrying what your work looks like to the outside world. extreme emergencies, when there is no alternative, use them with restraint. If you can avoid using them, this constitutes great wisdom but is something that may be unobtainable.
1) From ancient times, when the famous sages treated illness, they frequently used life to rescue those in critical danger. Even though it is said that we should treat animals as humble and humans as noble, when it comes to loving life, humans and animals are the same. Regarding [the practice of] injuring another to benefit oneself, all things suffer identically in their feelings. Isn’t this even more true for humans?
2) To kill life in order to save life, this takes you even further away from life.
3) As for the methods that I am putting forth at the present time, the reason why they do not use living things as medicine is derived directly from this.
4) Things like horseflies and leeches, which are available in the market after they are already dead before you use them, are not affected by this rule.
5) With regard only to the substance of chicken eggs, as long as their content is still mixed and has not yet separated [into a distinguishable chick fetus], in occasions of
1) When dealing with conditions like sores or wounds, diarrhea, foul smells, or insufferable filth, which others hate to look at, to develop a sense of purpose marked by conscience, sympathy, and care and concern, and to not allow myself to initiate a single thought of resentment in my heart, this is my intention.
2) Now in terms of the appearance of the eminent physician, present yourself as having obtained a shén that is clear like settled water and as looking inward, as dignified when observed, as being in a state of bountiful abundance, and as neither too glorious nor too obscure.
3) In discerning disease and diagnosing illness, with consummate intent and your deepest heart carefully observe the signs on the body, down to the tiniest detail without missing anything. In the process of judiciously prescribing acupuncture and medicinals, you must not overlook anything or make a mistake.
4) Even though you may say that a condition must be treated with great urgency, you must acquaint yourself intimately with each case so there can be no doubt. You must attend to every detail and ponder it deeply, and may not place anything above [the patient’s] life, hastily showing off your skills with heroic speed and pandering to your fame. This is the greatest lack of humaneness indeed!
5) Furthermore, when arriving at a patient’s home, if you are being pampered with gorgeous silks filling the eyes, do not look to the right or left. Where stringed and bamboo instruments delight the ear, you must not look as if you were enjoying yourself. Feasted on delicacies in rapid succession, eat as if they had no flavor. Faced with fancy liquors lined up, look at them as if they did not exist.
6) The reason for this [rule] is that if a single person is left out, the full hall shall not be joyful. Even more so in a situation of obvious suffering, you may not stray from this requirement. To have a physician act indifferently, or [even worse] joyous and delighted, haughty and self-absorbed, this is a disgrace in the eyes of spirits and humans alike and not something a person of consummate cultivation would ever do. This then should be the real sense of purpose in medicine.
1) Now concerning the standards of medical practice, you you must not speak excessively or tease in jest, chatter and banter boisterously, pass judgment on what’s right or wrong, discuss other people’s affairs, flaunt your reputation, slander the other physicians, or brag about your own accomplishments.
2) To have cured a single disease by chance and then put on airs, acting superior to others and stating that you are unequalled under heaven, this is the achilles tendon (3) of physicians!
3) Lord Lao said: “When humans carry out acts of visible virtue, humans will reciprocate themselves; when humans carry out acts of hidden virtue, the spirits will reciprocate. When humans carry out acts of visible vice, humans will reciprocate themselves; when humans carry out acts of hidden vice, the spirits will harm them.”
4) Pursuing these two paths, how could the retribution of visible and hidden acts ever be mistaken!
3 In its literal meaning, the term gāo huāng 膏肓 refers to an area between the bottom of the heart and the diaphragm. In a more metaphorical sense, it means hard-‐to-‐reach places or, in a medical context, particularly vulnerable locations in the body or even diseases that are difficult to treat.
1) For this reason, as physicians you may not depend on your own greatness [alone] and focus your heart on official ranks and material possessions, but you must create a heart intent on relieving suffering. Then, in the midst of experiencing the obscurity of your fate, you will yourself feel blessed in multiple ways.
2) Moreover, you may not take the wealth and rank of others as a reason to prescribe valuable and expensive medicinals, making them difficult for others to seek, and bedazzle others with your own competence. I trust that this is not the path of zhōng and shù. (4)
3) Because my intention lies in rescuing and saving [people], I have discussed [medicine] by bending it and breaking it up into bits and pieces. Students must not be insulted by the vulgarity of my words.
4 忠恕之道: The two terms zhōng and shù constitute the famous pair of virtues celebrated in the Confucian tradition as the key to interpersonal relationships and the essence of Confucius’ teachings. Zhōng is the depiction of the character 中 zhōng (“center”) over a heart and refers to a quality of integrity or loyalty that allows the smooth functioning in hierarchical relationships, both up and down. Shù, on the other hand, describes a quality of reciprocity, the ability of “likening oneself to others,” as the character expresses: It is a combination of 如rǔ (“being like”) and the heart, so in other words, the ability to follow the Golden Rule or putting oneself in the other person’s shoes. James Legge has translated the pair as “true to the of our nature and t benevolent exercise of them to others” (quoted in Mathews Chinese English Dictionary, p. 215).
Qianjinfang 1.2, © Sabine Wilms, 2012