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chinese medicine

Advice to the Healer: Plant Apricots

RICHARD COLGAN, MD University of Maryland 

Dr Colgan is associate professor and vice chair of medical student education and clinical operations in the department of family and community medicine at the University of Maryland School of Medicine in Baltimore, Maryland. He is the author of Advice to the Young Physician: On the Artof Medicine by Springer. For more information, go to www.advicetotheyoungphysician.com. His second book, Advice to the Healer: On the Art of Caring, will be released by Springer in November 2012. 

colganChinese medicine can proudly point to the lives of the Three Divine Doctors of Jian An as being exemplary in showing care for others. From the perspective of Dr Marta Hanson, Professor of History of Medicine at Johns Hopkins University, the accounts of the Three Divine Doctors of Jian An are more literary and mythological than historical. 

Dr Hanson notes, “Nonetheless it is still worthwhile to look at the lives of these three physicians, since even as mythic figures they have had a great deal of influence on ideas of how physicians should behave morally. Although based on historical figures, these three physicians have become mythologized to represent morally exemplary physicians.”

ZHANG ZHONGJING

apricotsZhang Zhongjing (150 to 219 AD) is considered to be one of the greatest Chinese physicians in history and well known to those practicing modern Chinese medicine, yet very little is known about him. He learned medicine by studying from a local mentor, reviewing the medical literature available at that time, and gleaning
the prescribing habits of others far and wide. His major work, “Treatise on Cold Pathogenic and Miscellaneous Diseases,” was lost during the many wars that took place in the era of the Three Kingdoms (220 to 280 AD).

Zhang made great contributions to traditional Chinese medicine including “On Cold Damage,” which revealed how to treat rampant epidemic fevers, and “Essential Prescriptions of the Golden Coffer,” an overview of his clinical observations. The latter was written some 700 years earlier than the Arabic physician Avicenna’s Canon of Medicine. Zhang’s book contained over 100 typical prescriptions and close to 400 curative methods and disease postulates from which many of today’s traditional Chinese medicine treatment principles are derived. An interesting observation attributed to Zhang has some relevance even today perhaps: “In terms of the high level, medicine is for curing nobles of their diseases; in terms of the lower level, it is used to save the poor from disaster; in terms of the middle level, it is used to keep us in good health.”1

Zhang Zhongjing, like other ancient traditional Chinese medicine doctors, viewed being a physician as a sacred privilege as opposed to an occupation. Even though Zhongjing was promoted to a high municipal office in recognition of his worth, he continued to see patients while practicing his official duties. His commitment to serving others was so profound that he resigned his position as Governor of Changsa when those around him criticized him for attempting to do both, rather than give up his care for his patients.

HUA TUO

Hua Tuo (ca. 140 to 208 AD) lived during the late Han Dynasty and Three Kingdoms era. Hua Tuo is described in the Book of Later Han as the first Chinese physician to use anesthesia. By using combinations of wine, herbs, and narcotics, patients were made intoxicated (if not insensate), which allowed for surgery. Fan’s biography of Hua Tuo lists medical cases that spanned internal medicine, surgery, gynecology, and pediatrics.2 He reportedly treated ulcers and sores, performed abortions, and removed parasites. Hua Tuo was also popular for promoting disease prevention and recommending that people exercise to strengthen their health. Hippocrates would later take up this same cause. Hua Tuo developed the “Exercise of the Five Animals,” incorporating differing types of body movements imitating movements of the tiger, deer, bear, monkey, and crane.3

Hua Tuo is one of the Three Divine Doctors of Jian An who was committed to his patients and considered medicine a higher calling. He turned down being a military officer several times so as to follow medicine. He would later lose his life for this belief. Hua Tuo successfully cared for the government leader of the day, Cao Cao, who was demanding and frequently ordered Hua Tuo to attend to him. On one occasion Hua Tuo stood his ground and made excuse after excuse, replying that he could not come right away because he had to attend to matters at home. His failure to return when summoned led to his being brought to Cao Cao against his will, imprisoned, and put to death for his insubordination.

DONG FENG AND HIS APRICOT TREE FOREST

apricotsDong Feng rounds out the list of the Three Divine Doctors of Jian An, and he is the reason I chose to add Chinese medicine to Advice to the Healer: On the Art
of Caring
. I include him because of the great compassion and love he showed for his patients, and even more, however, he is included because of his acknowledgement of the importance of caring for the community at large, particularly those who could not afford medical care.

Dong Feng reportedly enjoyed equal fame to Zhang Zhongjing and Hua Tuo and was a highly skilled doctor in the era of the Three Kingdoms as well. He practiced medicine in the Lushan Mountains, where his skill and deeds became legend. He treated his patients but did not charge them a fee. If he cured someone with a serious illness, he asked him to plant five apricot trees on the mountain slope. If he cured someone of a general illness, he would ask him to plant one tree.

Because of his fame, people came from far distances to be cared for by him and over time the apricot trees became a forest with many thousands of trees. He reportedly posted a sign that read: “Those who want to buy apricots do not need to tell me, but could just leave a liter of rice in exchange for a liter of apricots.”4 The rice that was exchanged for apricots helped those who were having financial difficulties or refugees fleeing famine. Dong Feng is credited with having saved and helped over 20,000 people in his lifetime. People later came to refer to traditional Chinese medicine as “Apricot Tree Forest.” He was so beloved that upon his death people built an apricot altar for him. Apricot trees still grow in the place where Dong Feng practiced medicine 1800 years ago.

LEARNED, WISE, AND CARING HEALERS

The Three Doctors of the Divine Era were learned, wise, and caring healers who showed the art of caring by serving others without consideration for their own personal gain or welfare. They realized that what they were doing was more important than who they were. Learning what they could from those who came before them, using whatever resources they had at hand, and being mindful that each person has within themselves resources for self-betterment was important. Lastly, we have seen from
Chinese medicine that the health of the individual and the health of one’s community are both to be cherished. 

References

1. Zhang Zhongjing. China culture http://www.chinaculture.org/gb/en_aboutchina/2003-09
2. Wai FK. On Hua Tuo’s position in the history of Chinese medicine. Am J Chinese Med. 2004;32(2):313-320.
3. Association for Asian Research. Hua Tuo: a miraculous healer in ancient China. http://www.asianresearch.org/articles/895.html
4. DeWoskin KJ. Doctors, Diviners and Magicians of Ancient China: Biographies of Fang-shih. New York: Columbia University Press; 1983.