The Ethics of Healing – The “Hippocratic” Oath of China’s King of Medicine, Sun Simiao

Sun Simiao (581-682) was an outstanding Chinese physician, scholar and author who lived during the Tang Dynasty. Called the “King of Medicine” (Yaowang) Sun Simiao is said to have founded Chinese gynecology, pediatrics and geriatrics as individual healing modalities. [FN-1]

The “Hippocratic” Oath of China’s King of Medicine, Sun Simiao : Chinese Medicine Living This image By 猫猫的日记本 - Own work, CC BY-SA 3.0, Wikipedia

Sun Simiao wrote the earliest medical encyclopedia in China, the Essential Formulas for Emergencies [Worth] a Thousand Pieces of Gold (Beiji Qian Jin Yao Fang), and the Supplement to the Formulas of a Thousand Gold Worth (Qian Jin Yi Fang). The first book lists about 5,300 prescriptions for medicines, the second book 2,000. Each book is composed of thirty volumes.

He is also known for his essay "On the Absolute Sincerity of Great Physicians," which has been called "the Chinese Hippocratic Oath." It is found in the opening chapter of the first of the above mentioned books. This portion of the book is still required reading for Chinese physicians. [FN-2]

Sun Simiao - China's God of Medicine : Chinese Medicine Living

Sun Simiao is also portrayed as a god of medicine, here seated on a tiger and holding a dragon above his head.
This image from itmonline.org

On the Absolute Sincerity of Great Physicians: The Healer’s Oath of Sun Simiao [FN-3]

When I go to treat an illness I first must calm my mind and make steadfast my intentions.
I shall not give way to idle wishes and desires but should first develop an attitude of compassion.
I vow to rescue all living beings from their sufferings.
If anyone comes to me because of an illness or any other difficulty I will not concern myself with whether they are powerful or humble, rich or poor, old or young, beautiful or ugly.
Enemies, relatives, good friends, Chinese or barbarians, foolish and wise, they all are the same to me. I will think of each of them of them as a close and loved relative - or indeed as if it was I who had been struck down by an illness.
I shall not worry about my own life or my fortunes or misfortunes. My purpose is to preserve the life of others.
I shall not hide away in the mountains. Day and night, in cold and heat, in hunger, thirst and fatigue, I will single-mindedly go to the rescue. If I am able to act in this manner I may approach being a great doctor for those who are sick. If I act contrary to these precepts I am no more than a great thief to those who are alive.
People all too often look with contempt on those who suffer from abominable things, such as ulcers or diarrhea, however I shall maintain an attitude of compassion, sympathy and care. Never in a great physician should there arise an attitude of rejection.
I will not glory in my reputation. I will not discredit other physicians while I praise my own virtues.
Thus I shall fulfill my responsibilities and my destiny as a physician until I am no longer capable of fulfilling my obligations, or until the end of my lifetime.

China’s King of Medicine, Sun Simiao : Chinese Medicine Living

Sun Simiao.
This image from chinaexpat.com

In many ways Sun Simiao was a product of Buddhist, Daoist, and Confucian thought.

For example, Sun Simiao’s thoughts about showing complete compassion to all living things is distinctly Buddhist. In Essential Formulas for Emergencies [Worth] a Thousand Pieces of Gold he wrote: When love of life is concerned, man and animal are equal [therefore] I do not suggest the use of any living creature as a medicine or healing agent. This does not concern the gadflies and the leeches. They have already perished when they reach the market, and it is therefore permissible to use them. As to the hen's eggs, we have to say the following: before their content has been hatched out, they can be used in very urgent cases. Otherwise, one should not burden oneself with this. To avoid their use is a sign of great wisdom, but this will never be attained.

He also shows Daoist beliefs in rejecting the praise of others. He wrote: Lao-tzu has said, When the conduct of men visibly reveals virtue, the humans themselves will reward it. If, however, men commit virtues secretly, the spirits will reward them. When the conduct of men visibly reveals misdeeds, the humans themselves will take retribution. If, however, men commit their misdeeds secretly, the spirits will take retribution. When comparing these alternatives and the respective rewards that will be given in the time after this life and still during this life, how could one ever make a wrong decision?

Confucian ideology shows itself in various admonitions about the virtuous characteristics required of a physician: “In the homes of patients a physician must speak politely, and not indulge in fine food and drink.” “Wherever someone's life is at stake, one should neither act hastily, nor rely on one's own superiority and ability, and least of all keep one's own reputation in mind. This would not correspond to the demands of humaneness.”

Sun Simiao is not devoid of a sense of personal irony when he writes about physicians conceited about their own skills. “Someone who has accidently healed a disease, walks about with head raised, shows conceit and proclaims that no one in the entire world can measure up to him.” … “In this respect all physicians are evidently incurable.” When he write “all physicians” might he also be pointing a finger at himself?

In summary, Sun Simiao placed the cause and treatment of illness within a social and spiritual context. He articulated the need for a physician to understand the relationship between the art of healing and their own inner state of being and enlightenment, and the society within which they and the patient lived. He believed such understanding would help the overall effectiveness of the provided treatment, as the healer recognized and gained a deeper connection to their role in restoring the patient to health. This is the basis of his code of ethics for physicians.

Further Comments

There is another classic Oath for Chinese Physicians which was written by Hua Tuo (c.140-208) [ https://www.britannica.com/biography/Hua-Tuo]. Sun Simiao may have used it as a starting point for his code.

The Vow of Hua Tuo

Treat people equally irrespective of their high or low status, of their poverty or wealth, of their distinction or obscurity.

Do not run after riches, fear no hardships and toils, and take it as your first duty to take pity on the old and help the young. [source: Bob Flaws. Master Hua’s Classic of the Central Viscera.]

Hua Tuo - Chinese Master Physician : Chinese Medicine Living This lovely image from alchetron.com

Footnotes

[FN-1] Newland magazine. [ http://www.newlandmagazine.com.au/vision/article/429]

[FN-2] [Wikipedia, “Sun Simiao.”] https://en.wikipedia.org/wiki/Sun_Simiao

[FN-3] The translation used in this article was compiled from the following sources:

Gregory M. Casey. “Mystic Dao.” http://www.mysticdao.com/#!The-Healers-Oath/cfkc/2ECEF164-1D5B-4F27-94EE-F8600BA10F38

“Code of Ethics.” http://www.heartofhealingacupuncture.com/code_of_ethics

Albert R. Jonsen. A Short History of Medical Ethics. pp. 36-37.

“King of Medicine: Sun Simiao.” http://www.newlandmagazine.com.au/vision/article/429

“The Oath of Sun Si Miao for Physicians of Traditional Chinese Medicine.” http://www.heartofhealingacupuncture.com/code_of_ethics

“On the Sublime Sincerity of the Eminent Physician.” http://www.happygoatproductions.com/qianjinfang-ethics

Subhuti Dharmananda. Sun Simiao: Author of the Earliest Chinese Encyclopedia for Clinical Practice. http://www.itmonline.org/arts/sunsimiao.htm

Daniel Fu-Chang Tsai. “Ancient Chinese medical ethics and the four principles of biomedical ethics” [in] Journal of Medical Ethics 1999;25. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC479240/pdf/jmedeth00005-0025.pdf

Paul U. Unschuld. Medical Ethics in Imperial China, A Study in Historical Anthropology. https://books.google.com/books?id=T8mB9rfZCBMC&pg=PR3&lpg=PR3&dq=Medical+Ethics+in+Imperial+China,+A+Study+in+Historical+Anthropology&source=bl&ots=lMi2Gb4Eiu&sig=Otaed6OOK9rLv622amqw7qb58hA&hl=en&sa=X&ved=0ahUKEwjT0rOlrNvNAhWJVz4KHQpRBgAQ6AEIGjAB#v=onepage&q=whenever%20a%20great%20physician%20&f=false 1979 University of California Press, Berkeley, CA.