Dr. Shen spoke of three levels of doctor, referencing the classical concept of the upper, mid, and low-level physicians. The first, and lowest, does not understand the disease or the cause, but treats only the symptoms, and the results are not very good. In Dr. Shen’s opinion, this is the level at which much Chinese medicine is practiced, both in the West and, in modern times, in the East as well. The second level of doctor understands the condition (pattern), but not the cause, and can often treat successfully. The highest level of doctor understands the individual cause of disease in every patient, and can work to return each person to a true state of health and balance.
The first-level doctor who treats just symptoms is a ‘hit and miss’ practitioner, and is successful only if the symptoms and the underlying condition happen to coincide.
A second-level doctor who understands the condition may be successful because, if a patient is strong enough, he can heal himself after some movement and building of Qi and Blood.
However, a third, or upper level doctor will succeed more consistently. By removing the causes of a patient’s underlying condition, he is able to treat the person, and not just his symptoms. More often than not, these causes are Lifestyle issues. The most obvious of these are diet, working practice, cigarettes, substances, or ‘wild, wild women’ (in the words of Dr. Shen), but shock and trauma, an impaired constitution, or lifetime experiences all play a role in causing illness.
In my wish to become the highest-level doctor I could, diagnosis became a focus of my professional life. I studied with Dr. Shen, a master Chinese medical diagnostician, several days a week for eight years, and then during a continued association over the following two decades. The principle focus of my ‘training’ was his pulse diagnostic system. Although Dr. Shen further developed and refined this system, making it more suitable for the modern world, it was originally passed to him by other members of the Ding-Menghe lineage, the tradition of which he was a student. This important family lineage has existed in China for at least five centuries, and with its pulse diagnosis, Dr. Shen also passed on many of his other diagnostic skills, especially those classified as ‘Looking’.
I have now practiced, taught, and written about this pulse work for the past forty years. I have discovered that what a practitioner feels with his fingers is closer to the patient’s real issue than what he may tell you, and usually more accurate a pointer than symptoms. Students in my classes, and other practitioners who seek my advice, compare my pulse findings with the patient’s history as though they are testing the worthiness of the pulse reading, expecting the pulse to confirm the symptom picture. In reality, the opposite is true: the pulse reveals the root issues, the Ben, while the symptom/history reveals just their manifestations, the Biao.
While all of the ‘signs’ – the tongue, eyes, nails, face and hand color, etc. – are explanatory and helpful, the pulse is so much more comprehensively revealing, and much more profound.
As practitioners, we want to relieve patients’ suffering: relieve their symptoms. However, it is vital to remember that we also want to do two other things. We want to resolve the cause of our patients’ symptoms, and we want to prevent these issues from recurring. Sadly though, I am overwhelmed by the frequency with which practitioners view the Biao (manifestation), rather than the Ben (root), as the principle object of healing.
I had a recent clinical experience that underlines and emphasizes the importance of the concept of the upper-level doctor. A very experienced and accomplished practitioner consulted me about a case she was having difficulty treating: a patient with a chronic lung condition. Her pulse confirmed the lung condition, but also revealed a dangerously-deficient True Qi, that she had endured a severe shock, and that she was deeply fearful.
Upon hearing this, the practitioner verified the pulse findings, but then announced rather loudly that the patient’s real problem – the one she could not solve – was chronic COPD, intimating that I had missed the real issue.
Diagnostic skill is not meant to reveal what is obvious. The practitioner already knew her patient’s symptom; she was already aware of the Biao. She did not need to know this from me, especially as she had already been unsuccessfully treating the patient for COPD for some time. What she did not know, but what she could have learned, was that the patient’s deep-seated shock and fear, and her severe depletion, were the Ben – the probable cause of her symptoms, and that it was those issues that should have been the focus of the practitioner’s therapeutic work.
For a practitioner to be a highest-level doctor, and for him truly to help his patients, he must be willing to look beyond the obvious, and able to consider new and different perspectives. He must be able to use and trust his senses, and understand that each patient is an individual, requiring an individual diagnosis. An upper-level doctor always strives toward awareness: of his patients, and of himself.