In the day-to-day grind of clinical practice, it can be easy to lose touch with our deeper aspirations. Most of us initially pursued medicine out of a sincere desire to help people – not just ourselves or those we are close to, but humanity at large. This aspiration, to live a life for the benefit of all, is increasingly rare.
Strong cultural forces teach us from an early age that the key to happiness is to pursue our own narrow self-interest, often at the expense of others. Even in medicine, the tendency to view practice primarily as a way to earn a living, using our patients as means to attain these ends, is strong.
But this self-orientation comes at a cost. Most people find that the more time they spend worrying about themselves, the less happy they tend to be, and psychological research supports this. The reverse also appears to be true: The more we focus on benefiting others, the happier we are.
The motivation behind our practice of medicine is important, impacting not just our experience but also the experiences of those we treat. It is perhaps for this reason that the aspiration to help not just some, but all beings heal, has historically been an important part of the medical tradition.
To explain this, we need to consider how medicine is interwoven with other social domains. It has long been a trend within Chinese medicine to identify the tradition’s genealogy as a unique lineage, distinct from other schools of practice such as Daoism, Buddhism and Confucianism, though connected in various ways with all of them.
Comprised of key doctors and their textual contributions, the construction of such genealogies has created the notion of medicine as a distinct domain of knowledge since very early in Chinese history. Although Chinese medicine did grow into a distinct lineage, such genealogies, when read out of context, can be misleading, for they make us forget just how deeply integrated Chinese medicine has been with the spiritual traditions with which it co-evolved.
Due to the disciplinary divisions that organize modern academia, scholars have sometimes contributed to a misunderstanding that considers “religious” and “medical” traditions as largely separate and distinct. However, the idea that medicine is a secular discipline, operating in a social realm clearly delineated from religion, is profoundly modern, even in the West.
In most cultures throughout human history, medicine was deeply intertwined with spiritual sensibilities and religious convictions, and this was certainly the case in China. Notably, studies of surviving texts from early medieval China have found that mention of herbal medicine in Daoist and Buddhist texts far surpasses that of the texts that are today considered part of the narrow genealogy of the medical tradition.
This should not be surprising; throughout Chinese history, Daoism and Buddhism formed the context within which medicine was practiced, the worldview it was an expression of, and the principles that organized the life of doctors and patients alike.
In the contemporary field of Chinese medicine, the impact of Buddhism is especially overlooked. Although not present in Chinese medicine’s earliest stages of development, Buddhism strongly influenced the tradition shortly after its arrival in China. This early impact is perhaps most famously embodied in Sun Si-Miao, the great Tang Dynasty scholar-doctor and “King of Medicine,” who, in addition to being a Daoist cultivator, was deeply influenced by Mahayana Buddhism.
A pioneer in acupuncture, herbology, pediatrics, obstetrics, and gynecology, it is in Sun’s writings on medical ethics that the influence of Buddhism on his thinking is most apparent. In them, he admonishes practitioners of medicine to “first develop a heart full of great loving-kindness and empathy.” A doctor, he continues, “must vow to desire to rescue all sentient beings indiscriminately from their suffering.” In doing so, they must not concern themselves with whether their patients are young or old, attractive or unattractive, rich or poor, Chinese or foreigner, fool or sage. Rather, they must “treat all patients exactly the same, as if they were [their] closest relative.”
It is with these words that Sun Si-Miao connects the practice of medicine to the ideal of the bodhisattva – a being who, out of profound compassion, dedicates themselves to the benefit of all sentient beings.
Having entered China with the transmission of Mahayana Buddhism, the ideal of the bodhisattva had a major impact on the culture at large, influencing Buddhist and non-Buddhist doctors alike. The vision is vast: One whose commitment to helping others spans infinite lifetimes, who has cultivated a mind that views the suffering of others as essentially identical to their own, and whose strong wish for others to be well overrides their own concerns with self-benefit and even self-preservation.
In this way, the bodhisattva pledges to support beings in awakening to their true nature, helping them get out of the constricted and confused self-centered orientation that has led to their suffering.
Buddhist texts remind us again and again that, in the endless round of rebirths, at some point each and every sentient being we come into contact with was our mother, and at some point we were their mother. In this way, we are invited into a profoundly relational view of existence, and reminded that if we are to be aligned with reality, we ought not get caught up too much in liking some clients and being averse to others, but instead seek to cultivate a love that encompasses everyone as though they were our own mother.
The fundamental source of everyone’s awareness is understood to be the same (in Chinese medical terminology – there is one original shen that each individual shen is but a part), and for this reason through loving any single person we are cultivating our love for all.
Reflecting on the bodhisattva ideal can be a great gift for us as clinicians, helping us to counter cynicism and disconnection, and encouraging us to strive for our full potential as healers. After all, at the end of the day we are all in this thing together – rich and poor, sick and healthy, beautiful and ugly, human and non-human. We all find ourselves in the same exact existential situation of seeking peace and wanting to avoid suffering; and we are all somewhat confused about how exactly to accomplish this.
In a culture that seems to increasingly propagate an attitude of self-centered concern, it is important as Chinese medicine practitioners that we affirm we are here to strive for everyone’s benefit. In this way, we can aim to do more than simply practice medicine; we can aim to embody it. In the healing words of the 2nd-century Indian Buddhist sage Shāntideva, ”For all those ailing in the world, until their every sickness has been healed, may I myself become for them the doctor, nurse, the medicine itself.”
