The Five Grades of Physicians
Chinese medicine is a deep and difficult science — easy to learn, hard to master. A physician is by no means simply one who knows a few medicines and remembers a few formulas.
The Neijing distinguishes upper artisan, middle artisan, coarse artisan — dividing physicians into three grades. The Zhou Li · Yishi chapter likewise, by skill and by examination, decided who was artisan and who was apprentice, with rank and promotion accordingly. Today's TCM, apart from honoring the aged as senior practitioners, mostly draws no distinction. In truth, on close look, they may be divided into five grades.
First grade — the prescription-writing physician. Such a one only recites the Decoction-Head Verses and the Four-Hundred Medicines and the Verse on Drug Nature, and is in fact a layman of TCM scholarship. He keeps watch on what formulas the famous physicians like to use, and copies them gourd-fashion to use in his own practice. Treating illness this way differs little from copying a prescription. To hope it will be effective — naturally impossible.
Second grade — the medicinal-using physician. Such a one has formally studied TCM's foundational theory, knows physiology and pathology, li-fa-fang-yao, but does not apply it well. Ordinary illness he can treat; let the case grow at all complex, and he has no hand to play. Because his learning is still skin and hair, his pattern-discernment is naturally unclear. He must use drugs against symptoms: poor appetite — maiya, shanzha; headache — baizhi, chuanxiong; headache treats the head, foot pain treats the foot. With no settled view, he is rarely on target.
Third grade — the pattern-discerning physician. Such a one has been formally taught by a teacher, with a lineage; he has worked some on TCM and is fairly proficient. He has some grounding; he can discern a pattern, and is able to integrate and analyze, biàn zhèng lùn zhì. His learning has a source, but his experience is not enough — so illnesses others can cure, he can cure; illnesses others cannot cure, he cannot cure either. What today is called a good doctor mostly falls into this grade.
Fourth grade — the physician of fine detail. This one is rich in both learning and experience, and is most precious. He uses TCM theory with full fluency in biàn zhèng lùn zhì; he can independently analyze the problem and solve it. Meeting a complex case — however tangled the threads, however dangerous the situation — once it falls into his hands, his pattern-discernment is like sorting tangled silk: a gentle pull, slow twist, and the thread is found; his medicinal use is like undoing a dead knot — a steady, easy lead, striking the crux. Illnesses others cannot cure, many he can cure. A single formula, a single herb — at first glance plain, yet step by step entering the fine. In a calm and easy manner, even great cases are cured. Within this physician lies deep learning and rich experience: he may be called a famous physician.
Topmost grade. Illnesses no one else can treat, once in his hands, often turn at the touch toward spring's return. His pattern-discerning analysis is accurate and fine; his prescription and medicinal use fit the disease exactly. Alas, such a marvelous hand of the medical forest is very seldom seen today.
To understand the five grades of physicians is to know the direction of study; one must never stop at the shallowest taste. On the one side seek a teacher and friends — learn from people; on the other study the canon — learn from books; on the third practice diligently in clinic — learn from disease. Day by day, month by month, advancing in order, daring to look honestly into oneself, striving toward the finest — and one may in the end become a physician of the fourth or fifth grade. Only when the art is fine can it bring people to life. May all the world's physicians encourage one another in this.