by Bob Flaws

Within traditional Confucian society in China, there was a long-running debate over whether the practice of medicine was a so-called big or little Dao. A big Dao meant a path to self-cultivation, a spiritual practice if you will, a means to self-transcendance, while a little dao meant a mundane art, craft, technique, or profession. In Old China, one way of answering this question on an individual basis was whether or not the practitioner made their living by it or simply practiced medicine part-time and without payment out of Confucian filial piety and ren (compassion). Thus some Confucian scholar-doctors only treated their clan or family members based on filial piety. Others treated non-family members but still did it for free out of the virtue of compassion. However, by the Qing dynasty, the lines between Confucian scholar-doctors and professional practitioners had blurred. (See Volker Scheid's excellent Currents of Tradition in Chinese Medicine 1626-2006.) Nevertheless, the debate on the Confucian status of medicine continued as evidenced by Zhong Shan's medical testament from the early 20th century in which he unequivocally states that medicine is a large Dao since, even when practiced full-time as a profession, it should ultimately be based on a motivation of universal compassion and, only secondarily, on earning a living. (For instance, Zhong Shan says not to charge Buddhist monks or Daoist priests.)

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People who have followed my writings (or ramblings) over the last three decades know that the issue of whether or not the practice of Chinese medicine is a big or little Dao has been an important one for me. I began the study and practice of Chinese medicine as a Buddhist looking for a means of right livelihood compatible with my Bodhisattva vows of universal compassion. So, for myself, I have always tried to see my practice as part of my larger spiritual Dao or big-P Path. However, when one consciously and deliberately makes their practice of medicine a large Dao, something very deep changes about that practice. Now, every patient becomes a spiritual learning experience (and not always a pleasant or happy one, at least not short-term). What I'm saying is that, in my experience, the very nature of one's practice is different from those who only practice as a job, a gig, a way to put food on the table. In looking at those kinds of practices (if I can be so presumptous as to say I can recognize them), things seem to go smoother; there is less sturm und drang, less drama, and, consequently perhaps, less spiritually meaningful learning. In other words, karma, kismet, the universe, whatever seems to throw up different experiences for different people depending on what ultimately they are working towards. The loftier the goal, the steeper and more difficult the path. Some people have ordinary patients with ordinary problems also with ordinary results. Others have a constant stream of challenging and difficult patients, each one sent as if they were a specific piece of homework by the Dao.

So, after three decades of practicing this medicine, here's what I have to say on whether the practice of Chinese medicine is a big or little Dao. Whether Chinese medicine is a big or little Dao is entirely up to the individual. In my experience, you already have to have a big Dao in your life for the practice of medicine to also be a big Dao. If you do have such a practice, then everything you do automatically becomes a part of that big Dao. In other words, there is only one big Dao in your life and all parts of your life are included in that. If you don't already have a big Dao, then your practice of medicine will only be a little dao. (That's not to say that a little dao might not eventually evolve into a big Dao as the person evolves spiritually.) Many, in fact most, people don't have a big Dao (at least not in this lifetime). They are worldy, mundane people content with the seeming status quo, unconcerned (at least in any real, meaningful, exertional way) with the human existential dilemma. They put one foot in front of the other hoping for the best and trying to avoid as far as possible the central issues of suffering and death. So be it. We each have our karma. However, if you make the practice of medicine into a big Dao or, perhaps more accurately, you consciously and deliberately make it a part of your big Dao, then be prepared for all the hard knocks that typically accompany any kind of true learning and self-development. Now everything becomes a revelation, a symbol, a lesson to be learned on that Path.

Good luck and best wishes.

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