Patient Compliance and the Role of Education in TCM: Insights from Ben Qiao's Six Incurable Patients
Bian Que (扁鹊) was a famous physician in ancient China who lived during the Warring States period (475 BCE – 221 BCE). He was known for his medical skills, as well as his ability to persuade and advise rulers on matters of state. According to legend, Bian Que was born with a special mark on his forehead, which was said to be a sign of his future greatness.
According to one story, Bian Que became a doctor through a mysterious encounter with an older resident of the inn he ran. This person recognized Bian Que's potential and gave him a book and some herbs to take for 30 days, which granted him the ability to understand the secrets of nature and see through the human body. From this point on, Bian Que devoted himself to the study and practice of medicine.
His account is recorded in the book "The Grand Scribe's Records: The Memoirs of Han China" by Sima Qian. His surname is Qin, and his first name is Yueyin. Although his exact date of birth is unknown, he is believed to have been born around the 5th century BC. He is known for his contribution to the compilation of the anthology "Huang Di Nei Jing." While some scholars argue that Bian Que may not have been an individual's name but rather a common noun referring to great doctors of that time, because various books from different time periods mention same name Bian Que. "Que" means "crow," which in ancient East Asia was regarded as wise and spiritual, similar to the owl in ancient Greek culture.
Four Pillars
Bian Que's most significant contribution to Chinese medicine was his development of the four pillars of examinations, which are still used in modern Chinese medicine today. These four pillars are diagnosis by observation, diagnosis by interrogation/inquiry, diagnosis by hearing and smelling, and diagnosis by palpation (pulse taking). These pillars provide a comprehensive approach to diagnosing and treating illnesses, which is a testament to Bian Que's expertise and understanding of the human body. There is a legend regarding his diagnostic skill. Bian Que once visited the State of Cai and diagnosed the lord with a disease that he claimed was only affecting his skin. Despite Bian Que's warnings, the lord dismissed the diagnosis as he had no symptoms at the time, and accused Bian Que of trying to exploit people's fears. Bian Que continued to visit the lord and informed him on each visit that the disease was worsening and spreading throughout his body, from the skin to the organs. On his last visit, Bian Que observed the lord from a distance and immediately left the palace, explaining to an attendant that the disease had reached the marrow and was incurable. The lord passed away soon after.
Stories about Bian Que
In addition to his medical knowledge, Bian Que was also known for his legend as a good doctor. One story tells of a conversation between Bian Que and a king, who asked him to identify the best physician among his brothers. Bian Que replied that his oldest brother was the best, as he focused on prevention and treated problems before they even appeared. His second brother was better than him, as he treated people at the first sign of a disease. Bian Que, on the other hand, was known for treating people as a last resort when they were already very sick, often using the strongest herbs and even surgery. While he couldn't always help his patients, he was sometimes able to save a life, which made him famous.
One of the legends surrounding Bian Que claimed that he performed the very first heart transplant in history. The procedure was known as the "exchange of hearts," and it was said to have been a great success. According to the story, Bian Que administered a anesthetic to two men, and then he opened their chests and exchanged their hearts. Remarkably, both men survived, and their energies were said to have been balanced.
Legend has it that Bian Que visited the foreign country and found people grieving the death of the princess. Suspecting something was amiss, Bian Que investigated and discovered that the prince was in a coma. He used acupuncture on the prince's head and prescribed herbal medicine, leading to his full recovery within twenty days. When people praised him for bringing the dead back to life, they said, I can not revive the dead one, I just treated the patient who can live("越人非能生死人, 此自當生者 越人能使之起耳), so we can see that he was a doctor with humble virtue.
In another tale, a great man named Zhao Jianzi had fallen unconscious for five days. The officials of the court became worried and called upon Bian Que to help. With his incredible gift of insight of prognosis, Bian Que accurately foresaw that Zhao Jianzi would recover within three days. True to his word, Zhao Jianzi regained consciousness three days later, and as a reward, Bian Que was given a vast expanse of land.
Bian Que battled against shamans who believed that those who relied on them and not doctors could not be cured(信巫不信醫者不治). He is credited with introducing Traditional Chinese Medicine as a replacement for shamanic healing at the earliest stage of medicine in China.
Woodcut By: Gan Bozong (Tang period, 618-907)
The Six incurable patients
There is a passage in Sima Qian's "Shiji" (史記) that includes "The Biography of Bian Que" (扁鵲倉公列傳) which states:
扁鵲故病有六不治，也就是有六種病人他不給治，是哪六種呢？
"There are some patients who cannot be cured by acupuncture. These six types of patients cannot be cured even by the legendary doctor Bian Que. What are these six types of patients?
第一種 驕恣不論於理
The first type of incurable patient identified by Bian Que is the arrogant and reckless individual who refuses to acknowledge the principles of medicine. These individuals are not willing to learn or accept the advice of their doctors, and as such, no physician can cure them. Today, such individuals are prevalent in society, as they blindly follow the advice of popular doctors without proper research and knowledge. They often fall prey to the commercialization of medicine, which prioritizes profit over the well-being of patients.
第二種 輕身重財
The second type of incurable patient is the one who values wealth more than their health. Such individuals are willing to risk their lives for money, and they prioritize their financial goals over their physical well-being. This type of individual is commonly observed in modern society, where people often neglect their health due to their busy lifestyles and monetary goals.
第三種 衣食不能適
The third type of incurable patient is the one who refuses to control their diet and clothing. These individuals often indulge in excessive eating and drinking, which can lead to various health problems. They ignore the advice of their physicians and continue to indulge in unhealthy habits, despite knowing the consequences.
第四種是陰陽幷藏氣不定
The fourth type of incurable patient is the one who ignores the symptoms of their illness until it is too late. These individuals often delay seeking medical attention until their condition has deteriorated beyond repair. They may also refuse to take medication or follow their physician's advice, which can lead to irreparable damage.
第五種 形羸不能服藥
The fifth type of incurable patient is the one who has inherited the illness from their ancestors. These individuals may have a genetic predisposition to certain diseases, making it challenging to cure them completely. However, this does not mean that they cannot be treated or managed effectively.
第六種 信巫不信醫
Finally, the sixth type of incurable patient is the one who has exhausted all available treatments without success. These individuals have tried various remedies and treatments, but their condition remains unchanged. In such cases, physicians can only provide palliative care and manage their symptoms.
Ben Qiao's classification of the six types of incurable patients in traditional Chinese medicine provides valuable insights into the patient-doctor relationship. It emphasizes the importance of patient compliance and education regarding Yang Sheng practices. Without proper Yang Sheng, diseases cannot be cured even by the most legendary doctor. Therefore, TCM doctors should not only focus on treating the disease but also educating their patients about healthy lifestyle habits that promote overall wellbeing.
Hyungsuk Choi, PHD