While working on selecting texts for Volume Two of Classical Chinese Medical Texts, I found some interesting information on what constitutes a superior physician. There is also some information on what constitutes an inferior physician. I have picked three texts to look at. These three texts do not necessarily represent all that has been written on the subject, but as they are three of the older texts in Chinese medicine, namely the Ling Shu, the Nan Jing, and the Jin Gui Yao Lue, I consider them great models for one who strives toward becoming a superior physician.
Ling Shu Chapter 55
The superior physician treats that which is not yet ill. The inferior physician treats that which is already ill.
This is a fairly famous statement, which is often interpreted to be a call to preventative medicine. Modern physicians often complain that patients come in with specific complaints and it is impossible to treat what is not yet ill. I find this stance strange, as if we are to believe if someone has a disease which has already become manifest, the practitioner is prevented from treating what is not yet ill.
At any rate, the following quote from Nanjing has a completely different interpretation of the above passage:
Treating what is not yet ill means that when one sees illness in the liver (for example), this (can be) transmitted to the spleen. First fill (shi2) the spleen qi so that there is no way for it to accept the liver’s evil qi. This is what is called treating what is not yet ill.
As you can read, the writer of the Nan Jing felt that the meaning of treating what was not yet ill did not mean some psychic rendering of signs and symptoms, but a way of treating a person who comes with a specific complaint. One might go so far as to suggest that when the superior physician sees that one zang-organ has been afflicted by evil qi, the zang-organ in the control/destruction (ke) cycle of the five phases needs to be supported.
The Jin Gui Yao Lue explains this method works because when the spleen is supplemented,
it can injure the kidney. If the kidney is injured, then water doesn’t move. If water doesn’t move, then fire becomes abundant. If fire becomes abundant then the lung is injured. If the lung is injured then metal doesn’t move. If metal doesn’t move then the liver becomes abundant and is naturally cured. This is the secret meaning of supplementing the spleen to cure the liver.
As can be seen from both the Nan Jing and the Jin Gui Yao Lue, the superior physician understands the consequences of the actions of treatment through the five phase relationships. This may or may not have been the meaning intended by the Ling Shu; however, the closer a commentator is to the classic being commented, the more likely I am to take their claim to understanding it seriously.
In modern times, the five phases are relegated to old quackery that needs to be replaced with rigid diagnostic strategies and a focus on patient complaints to determine the affected system. If the five phases are not ignored, they are often taken to be central to Chinese medicine and not well balanced with the many other aspects of the medicine discussed in the classics.
In most modern schools, students are taught to observe, ask questions, palpate, form a treatment strategy based on the affected system, and then treat the affected organ or meridian directly.
This is almost the exact definition of the inferior physician from the same chapter of the Ling Shu.