On the Absolute Sincerity of the Great Physician
Tang · Sun Simiao
Zhang Zhan said: "The mastery of classical formulas has always been hard." Today, diseases may share the same inner cause yet show different outward signs, or have different inner causes yet share the same outward signs. The fullness and emptiness of the five storehouses and six bowels, the patency and blockage of the blood vessels and ying-wei, cannot be perceived by ear and eye alone — one must first diagnose carefully. At the wrist cun-guan-chi, there is the confusion of floating, sinking, wiry, tight; at the acupoints and channels, there are differences of high and low, shallow and deep; in the skin, sinew, and bone, there are differences of thick and thin, hard and soft. Only one whose mind is fine and subtle can speak of these things. To approach a subtle matter with a coarse and shallow mind — is that not perilous? If one supplements where it is already full, drains where it is empty, opens where it is open, blocks where it is closed, cools cold and warms heat — this is to double the illness while hoping for life. I have seen only death come of it. Therefore medicine and divination are among the arts hardest to perfect. Not having been bestowed by spirits, how is their subtlety to be reached? In this world there are foolish ones who, after reading formulas for three years, say there is no illness under heaven they cannot cure; then, after treating illness for three years, know there is no formula under heaven they can use. So the student must broadly exhaust the sources of medicine, work hard without weariness, and never declare his medical path complete after hearing things by the wayside — deeply deceiving himself!
When a great physician treats illness, he must settle his spirit and steady his will, without desire and without seeking. First let arise the heart of great compassion and pity, with the vow to save all sentient beings from suffering. If one suffering comes to seek rescue, he must not ask whether the patient is noble or base, rich or poor, old or young, beautiful or ugly, enemy or friend, kin or stranger, Chinese or foreign, foolish or wise — all are one and the same, all are to be regarded as nearest kin. Nor may he look ahead or behind to weigh his own fortune or misfortune, or guard his own life. Seeing another's suffering, he must take it as his own; with a heart of deep sorrow he must not shrink from day or night, cold or heat, hunger or thirst, fatigue — with one mind he goes to save, without thought of the appearance of his merit. Such a one may be called a great physician of the people; the reverse is a great robber of sentient beings.
From of old, famous worthies treating illness often used living beings to save the gravely ill. Though it is said that animals are base and humans noble, when it comes to loving life, humans and animals are one. To diminish another's life to benefit oneself — all creatures share this aversion, how much more between humans! To kill a life seeking life is to depart yet further from life. The reason my prescriptions here do not use living beings as medicines is precisely this. As for horseflies, leeches and the like, when the market already has them dead, they may be bought and used — these are exceptions. As for things like chicken eggs: because the substance is undivided, there must be cases of great urgency where, unable to avoid it, one bears it and uses one. To be able to do without — that is great wisdom; and even that I have not reached. As for those suffering from sores, ulcers, or diarrhea, foul and unbearable to look upon, what people loathe to see — let only shame, pity, sorrow, and concern arise in the heart, never the slightest grudge. This is my aim.
The bearing of the great physician should be: clarify the spirit and look inward; in aspect grave; broad and vast; neither dazzling nor obscure. In examining and diagnosing, with full attention and deep mind, detail every sign without losing a hair's breadth; in prescribing needles and medicines, allow no inconsistency. Though it is said disease should be quickly saved, what is required is not to be confused when the moment comes — only careful inspection and deep thought. On the matter of life and death, one must not rashly show off cleverness to win a name. That is most inhumane. And when going to the patient's home: though embroidered silks fill the eye, do not look about; though strings and pipes reach the ear, do not give the appearance of being amused; though rare dishes are set before you, eat as though tasteless; though precious objects are displayed, regard them as if absent. Why? Because when one person turns toward the corner in grief, the whole hall is unhappy. How much more so when the patient's suffering does not leave him for a moment, and the physician would sit at ease and amuse himself, proud and self-satisfied. This is what gods and humans alike scorn, what the perfected do not do — and this is the original meaning of medicine.
The rule of being a physician: do not talk and jest much, do not chatter loudly, do not speak of right and wrong, do not comment on persons, do not flaunt one's name, do not slander other physicians, do not boast of one's own virtue. If you happen to cure one case, do not lift your head and face high with a self-approving air, claiming yourself peerless under heaven. This is the deadly disease of a physician.
Therefore the physician must not rely on his own strength to scheme single-mindedly for wealth, but only with a heart to save suffering. In the dark workings of destiny, blessings come of themselves. Nor, because a patient is rich and noble, should he prescribe rare and precious medicines hard to obtain, displaying his own skill — that is not the way of loyalty and forbearance. My aim is rescue, so I lay these things out in detail. Let the student not be ashamed of these plain words.
Selected from Beiji Qianjin Yaofang.