The Five Failings of Physicians from the Yellow Emperor’s Classic

HUANG Di began by saying, "Alas! The knowledge of life is deep as an abyss and boundless as the fleeting clouds. The ancient sages practiced medicine by following natural principles combined with their insightful deductions along with the utmost compassion and ethical conduct. Their way embodies the ideal physician. Do you know, Lei Gong, what are the five failings and the four virtues regarding a physician?"

Lei Gong arose, bowed respectfully, and replied, "I am young and ignorant. Will you please enlighten me."

Huang Di nodded and said, "The first failing occurs in diagnosis. When a physician overlooks factors such as a patient's social and material status that could contribute to the development of disease, that physician ends up making an incorrect assessment. A patient who previously held a respectable social status and enjoyed decadent material existence will most likely develop illness from internal causes, such as emotional toil, even in the absence of external pathogens, once he falls from grace and becomes impoverished. Lack of such observation is a loss to the physician of a valuable link that is essential in the accuracy of the diagnosis.

"The second failing occurs in treatment. When a physician neglects a patient's emotional experiences, which can affect the patient's health greatly, and indiscriminately tonifies or sedates the patient, the consequence is further injury to the patient. It is significant to know the patient's lifestyle and emotional state because emotions such as anger damage the yin, while over excitement scatters the yang. Treatment without understanding the principles of tonification and sedation may cause further exacerbation to a patient's condition.

"The third failing occurs when the physician lacks deductive reasoning. Much information about a patient's condition is gathered, in addition to careful observation of the body signs and inquiry of patient's symptoms, from lifestyle, occupation, social and family circumstances, emotional stress, and immediate environment. After gathering the pieces of information, it is the physician's task to utilize to his knowledge and analyze through deduction the entire picture of the patient's illness. Inability to do this limits the physician's effectiveness.

"The fourth failing occurs in counseling. When a physician lacks compassion and sincerity, when a physician is hasty in counseling and does not make the effort to guide the patient's mind and moods in a positive way, that physician has robbed the opportunity to achieve a cure. So much of all illness begins in the mind, and the ability to persuade the patient to change the course of perception and feeling to aid in the healing process is a requirement of a good physician.

"The fifth failing occurs when a physician is simply inept and careless when administering medical care. A physician who is incompetent in medical skills fails to stem the patient's disease from deteriorating. Consequently, when the condition becomes grave, the physician gives a prognosis of death or incurable when the disease actually could have been reversed earlier. This kind of behavior is completely intolerable.

"These five failings form the basis for medical malpractice and are generally due to a physician's superficial grasp of medical principles, techniques, and sociopsychological reaming. When the sages practiced medicine, they were certain to have understood the laws of nature and principles of disease, to have mastered diagnosis, to have accomplished techniques of acupuncture and moxibustion, to have been well reamed in herbal medicine, and to have attained insights into human relationships and individual temperament. As a result, they delivered their medicine in a thoroughly holistic way.

"The key to effective medicine is to determine the cause and rectify the imbalance of the yuan/original qi of the body. Study the ancient medical classics well. Follow the correct treatment principles and perform your healing with the utmost care and attention. Conduct yourself with the highest virtue and always have compassion toward your patients. In this way you will be outstanding in your cures and never cause malpractice. This is the way of the sage physicians."

From The Yellow Emperor's Classic, pg292