There is a very interesting discussion going on over at Richard Goodman’s blog – He explains…
“…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. ”
Talking with my friend and colleague Michael Givens, he stated his conviction that this Classical passage tells us succinctly how we must proceed as Classically trained physicians. I agree! When a patient comes in to see us, we must be doing a number of things simultaneously. We must see the present complaint as it is an express of physiology gone awry, and we must situate that within a matrix of time and space that helps us understand the root of the disease as well as its potential for adverse development.
While your chronic cough may be easy to ignore and seemingly innocuous, not to mention related only to the “Lung,” as Classically minded practitioners, we need to see under, around, beyond and between that.
This asks a lot of practitioners. We need to understand physiology in all of its manifestations, with all of the conceptual systems we have to understand them. This is particularly true of the six conformations, as they are the broadest, most comprehensive, and least misleading structures we have available. But, we must also know the five element model (and all of the interrelationships therein), the complexity of the channel system (from minute luo to cutaneous regions), and yes, we can also take into account the Zangfu information (particularly as contained in the Neijing and other Classical texts) and everything else we have learned. It is my preference to stick with the six conformations and five elements, and others may have other preferences.
We need to understand the manifold ways that physiology can be disturbed, and understand the diverse ways this can express in patients. We must understand how disease progresses through time, and what factors might upset the “normal” progression.
This is to say nothing of all we must know for treatment. This is to say nothing of the intense rectification of the self that must take place in order for our true healing power to come forth. It is to say nothing of a lot of things, but a lot about a little. And that little is critically important, so important that it was enshrined in the foundational texts of our medicine.
I don’t know if I will ever “be” a superior physician – it seems to me the kind of thing that one continually strives for, a moving target that helps to keep the thirst for excellence alive. But, I do know that the rest of my life will be devoted to attempting to understand the above, and attempting to let that understanding flow into my treatment, and to let my treatment be of service to my patients.
What about you? How do you understand the above line? Do you feel prepared to strive for the “rank” of superior physician? Discuss here in the comments or on Richard’s fine site.