The highest good is like water;
Water is good at benefiting the ten thousand things and yet
it does not compete with them.
It dwells in places the masses of people detest,
Therefore it is close to the Way.In dwelling, the good thing is the land;
In the mind, the good thing is depth;
In giving, the good thing is being like Heaven;
In speaking, the good thing is sincerity;
In governing, the good thing is ability;
In activity, the good thing is timeliness.It is only because it does not compete,
that therefore it is without fault.- Lao-Tzu
The meaning of service in Chinese medicine is like water. True service is done for its own sake. From this selfless directive, "the ten thousand things" benefit. From the lines of Lao-Tzu, we learn the nature of the Tao of service: simply to do, to give.
"It dwells in places the masses of people detest, therefore it is close to the Way." The practice of medicine is, in its full realization, a place where the masses of people refrain. Indeed, many people who graduate from medical schools never practice for this reason.
The true Tao of medicine is service. One puts one's very health and, sometimes without realizing it, one's life on the line. Sick patients may carry virulent and highly contagious diseases. In some cases, the sickness is in the mind or the spirit. The toxic energy of the patient affects the practitioner's center, his or her place of peace. This lends significant meaning to Lao-Tzu's words: "dwelling in places the masses of people detest."
Some patients have few financial resources and may not pay us. This, in our materialistic culture, is certainly a place where most of the masses would refuse to dwell!
The next part of Lao-Tzu's passage, "In dwelling, the good thing is land; In the mind, the good thing is depth ..." informs this nascent practitioner of Chinese medicine about the importance of spending time in nature. Depth of mind is cultivated in contemplative time spent in nature, i.e., one is unlikely to develop much depth of mind while competitively hiking, skiing, cross-country biking, etc. But when one treads this earth at the pace of an ancient sage to listen, smell, touch and observe - then one begins to be infused with the wisdom of Tao.
Paradoxically, one cannot venture into the back country with an agenda of attaining wisdom from Tao. It simply happens. Gifts are presented. I once sat by a stream with my feet in the cool water on a hot summer day. Most of my attention was drawn to the water skiers, the trees, the rocks and the birds. Then, my dog Shi Shi stirred. Our attention was drawn to the sound of debris coming from the steep slope above. In a moment, the silent and beautiful shape of a bobcat appeared above us. His quiet walk across the ridge disrupted my thoughts, allowing me to dwell in the eternal peace of the moment. He submerged my mind into a deeper awareness of the Tao. Most experiences are like this; they come unbidden. But Tao is rich with them, if we have the patients to simply be.
In my opinion, the greatest service we can share is helping our patients find that oasis of peace, that connectedness with Tao that is their true birthright. Lao-Tzu goes on to write: "In giving, the good thing is being like Heaven; In speaking the good thing is sincerity ... ." Heaven gives unconditionally. The sun provides warmth and light; the rains and snow moisten the land; the cloud formations, sunrises and sunsets fill our spirits with the magnificence of creation; and the stars and moon illuminate the night. These treasures are ours every day of our lives.
Giving our patients the best we have is to be like Heaven. To give without ego is to give as Heaven gives. Sincere giving potentiates our healing work, bringing the level of our service to a higher plateau.
Good intentions are, however, insufficient tools for serious illness. In this regard, the meaning of service is also one of attaining mastery of the arts of healing. To this end, Lao-Tzu wrote, "In governing, the good thing is ability; In activity, the good thing is timeliness ... ."
Our ability to diagnose and treat appropriately are skills the practitioner of Chinese medicine must continually improve upon through study and practice. To become complacent about one's skill is to provide a disservice to one's patients. The obverse of that coin is to provide service to patients with the full knowledge that they would be better served by another practitioner with better or different skills and abilities. This lends special meaning to the words "In activity, the good thing is timeliness." At the moment we are treating someone, we must provide the best care possible, or have the depth of character to refer that person to someone who can.
This section of the Te Tao Ching closes with the line: "It is only because it does not compete, that therefore it is without fault." The life of renowned martial artist Bruce Lee is told in the movie "Enter the Dragon." Throughout most of the tale, Lee is haunted by a family curse. His awakening and freedom from the phantom occurs when he faces and surrenders to his own mortality. At his moment, he realizes that the "dragon" is within himself.
In medicine, as in all endeavors, each person has unique skills and abilities, as well as shortcomings. We are all merely human. The best service one can provide to one's fellow human being is a practice built upon honest self-awareness. To offer with humility that which we have to offer leaves us without fault. It also sets an example to our patients that may help them to live their lives more peacefully.
One of the most endearing passages His Holiness the Dali Lama of Tibet wrote comes to mind, for he recounts his weakness for watches and his short temper as a child. Having been blessed with two opportunities to see him in person, I know the power of the peaceful mind that dwells within his being. There is no doubt that this great teacher and holy man has faced and defeated his dragons. To experience the profound sense of peace that radiates from His Holiness is to know the power of Heaven. He reminds me, as Lao-Tzu does, to be true unto myself and offer my healing gifts to the best of my ability.
If we provide the best we have on a moment-by-moment basis, we will have no regrets, and the work we do will be a true service to our fellow humans. In this regard, I dedicate this article to my teachers, who have given so much of their lives to illuminate Chinese medicine to their students. It is a gift of immeasurable value.
A research letter in the Journal of the American Medical Association (JAMA) provides early findings from the most recent (2022) survey on the use of complementary health approaches (CHA). The findings include data from the National Health Interview Survey (NHIS), which conducts interviews both by phone and in-person. The CHA results have been published in 2002, 2012 and again in 2022.
When learning traditional East Asian medicine, we are taught the four pillars of diagnosis: inspection, auscultation and olfaction, inquiry, and palpation. When it comes to palpation, there is often a quick mention of feeling the acupuncture channels, and then the focus moves on to pulse diagnosis. Little to no time is spent palpating the channels – or the skin for that matter.
Topical analgesics (TAs) are effective. In fact, the American Geriatric Society recommends the use of topical agents for localized neuropathic and non-neuropathic pain as a front-line measure. The benefit of TAs is their high compliance, ease of use, direct application to the painful site, and limited systemic cross-reactions. The real challenge is choosing the appropriate topical for each patient given the myriad choices available.
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