A Comparative Study on Medical Humanistic Thoughts between “On the Absolute Sincerity of Great Physicians” and Hippocratic Oath

: Sun Simiao, as a master of ethics of traditional Chinese medicine, crafted a comprehensive framework of medical ethics and behavioral norms with the opening classic “On the Absolute Sincerity of Great Physicians” in his work Essential Formulas for Emergencies (Worth) a Thousand Pieces of Gold . Hippocrates is revered as the father of Western medical science, whose oath is enshrined as a pledge at the graduation ceremony of countless Western medical universities. Their medical humanistic thoughts represent the Chinese and Western medical ethics concepts respectively, each garnering endorsement and transmission across generations of doctors. These principles continue to illuminate the path for contemporary practitioners and serve as both a moral compass and a steadfast code of conduct, which plays an indispensable role in guiding doctors to practice.


Introduction
From the origin of medicine, the realm of medicine has witnessed an inseparable union between the art of healing and medical humanism.The medical genesis finds its essence intertwined with humanism and morality of cherishing and caring for life and health.The most influential ones in medical ethics are Sun Simiao in China and Hippocrates in ancient Greece.
A discerning examination of Sun Simiao's "The Study and Practice of Great Medicine" and "On the Absolute Sincerity of Great Physicians" alongside the Hippocratic Oath, reveals a striking congruence in their thoughts.These literary treasures are immortal masterpieces of ethics in the history of human medicine.Therefore, while Hippocratic Oath stands as the opening work of Western medical ethics, Sun Simiao's "The Study and Practice of Great Medicine" and "On the Absolute Sincerity of Great Physicians" lay a robust foundation for Chinese medical ethics [1] .
Their shared tenet in medical ethics underscores that adeptness in both skill and character serves as the criterion of being a qualified doctor and that patients must be treated equally.Nevertheless, they also have different medical humanistic thoughts.

Summary of common medical humanistic thoughts
2.1.Medical ethics reveal simple medical ethics feelings.

The concept of equality and fairness
"If someone afflicted seeks assistance, one must not ask their social status, wealth, age, appearance, social relations, ethnicity, or intelligence.All are to be treated equally, akin to one's own kin. [2]" Sun Simiao emphasized that doctors should cultivate a profound sense of compassion and empathy, vowing to alleviate the suffering of all sentient beings.He put forward "four forbidden questions" that doctors cannot ask any patient: about their social status and wealth; about their age or appearance; about their social relations with kin or friends; about their ethnicity or intelligence.All patients should be regarded as equals, just like one's closest kin.This principle of "treating all equally", akin to Confucius' "teaching without discrimination", embodies Sun Simiao's emphasis on "treating without discrimination" in medical practice.In other words, medical personnel should treat patients uniformly with the same attitudes towards their dearest kin, regardless of their social standing, age, appearance, relationships, ethnic background, or intelligence.
In Hippocratic Oath, it is stated that "Whatsoever house I may enter, my visit shall be for the convenience and advantage of the patient; and I will willingly refrain from doing any injury or wrong from falsehood, and (in an especial manner) from acts of an amorous nature, whatever may be the rank of those who it may be my duty to cure, whether mistress or servant, bond or free. [3]".Both works require the most basic and simple medical ethics of doctors, that is, the concept of equality and fairness.

Etiquette of respecting individuals with courtesy and privacy
"The demeanor of an exemplary doctor should reflect a mind of purity and introspection, appearing dignified and composed.Their presence is marked by generosity, never subservient or haughty."Sun Simiao proposed that medical staff should exhibit an air of solemnity and grace, not being subservient or arrogant.When entering patients' homes, "they should avoid being distracted by luxuries, not seeking personal entertainment amidst the surroundings of opulence.Despite the sumptuous feasts presented, the flavors should not stir delight. [4]" This approach extends beyond mere joy and self-indulgence in the patient's home; it entails empathizing with their suffering and understanding the complex emotions of their family members.When a patient is in pain and distress, medical staff should approach with humanitarianism, empathizing with the patient's perspective, addressing their urgent needs, and wholeheartedly alleviating their suffering.
In the Hippocratic Oath, the declaration "Whatever, in the course of my practice, I may see or hear (even when not invited), whatever I may happen to obtain knowledge of, if it be not proper to repeat it, I will keep sacred and secret within my own breast."aligns with the principles of "On the Absolute Sincerity of Great Physicians" which states that, "In the practice of medicine, one should not engage in excessive chatter, jesting, gossip, discussing right and wrong, criticizing individuals, flaunting reputation, or belittling other doctors."Both emphasize the etiquette of respecting individuals with courtesy and privacy.Medical confidentiality, which respects patients' privacy rights, stands as a crucial tenet in medical ethics and a cornerstone of professional conduct.

Wholehearted dedication to the professional duty of saving lives
Sun Simiao pursued his lifelong goal with unwavering dedication and commitment to saving lives and emphasized that when treating patients, one cannot dwell on his own gains and losses, but rather focus on "not looking ahead and behind, not worrying about good or bad, but cherishing life."Witnessing the suffering of patients, as if one experiences their pain himself, one should feel deeply saddened.He put forth the "five unavoidable issues": first, "do not avoid danger and difficulties"; second, "make efforts regardless of day and night"; third, "do not avoid cold or heat"; fourth, "do not avoid hunger or thirst"; fifth, "do not avoid fatigue".The approach should be a wholehearted dedication to saving lives, devoid of pretense, without wasting time or offering polite rejections, which leads to becoming a great healer for the masses, while neglecting these principles would be akin to harboring a sinister intent.Similarly, in the Hippocratic Oath, it is stated, "With regard to healing the sick, I will devise and order for them the best diet, according to my judgment and means; and I will take care that they suffer no hurt or damage."This also underscores the imperative of considering the well-being of patients and utilizing one's abilities and judgment to provide assistance.

Both are restricted by the ideology of the times
Every thinker is inevitably a product of a specific historical era, and every social theory is undoubtedly a response to a particular societal existence.
For example, as seen in the beginning and end of Hippocratic Oath, it is still necessary to swear in the name of the gods: "I swear by Apollo the physician, and Aesculapius the surgeon, likewise Hygeia and Panacea, and call all the gods and goddesses to witness, that I will observe and keep this underwritten oath, to the utmost of my power and judgment.";"If I faithfully observe this oath, may I thrive and prosper in my fortune and profession, and live in the estimation of posterity; or on breach thereof, may the reverse be my fate!"In the Hippocratic era, medicine was still shrouded in witchcraft and religious atmospheres, and it was inevitable that Hippocrates himself was influenced by theology.
In "On the Absolute Sincerity of Great Physicians", it is stated, "Laozi said: When people perform virtuous deeds in the open, they receive their own reward; when people perform virtuous deeds in secret, spirits and deities reward them.When people commit public sins, they bring calamity upon themselves; when people commit private sins, spirits and deities bring harm upon them.Exploring these two aspects, positive deeds yield positive responses, and vice versus.Is this a deception?Therefore, a physician should not rely solely on their expertise to pursue wealth, but rather harbor the intention to alleviate others' suffering.When passing into the realm of the afterlife, they will indeed be deemed fortunate individuals."Sun Simiao's proposition of cause and effect, that doing good leads to blessings, clearly reflects the influence of Buddhist and Taoist thought.

The historical context of "On the Absolute Sincerity of Great Physicians"
The Tang Dynasty has long been acclaimed as the "Prosperous Tang," characterized by political stability, economic prosperity, pluralistic thoughts, and cultural advancement within a tranquil social environment.The field of medical education flourished, contributing significantly to the progress of medical ethics education.
In the seventh year of Tang Gaozu's Wude era (624 AD), the Tang Imperial Medical Department was established in Chang'an, making it the earliest known and largest institution for medical education in world history.It made great contributions to the inheritance and development of traditional Chinese medicine.While the predominant methods of medical ethics education still revolved around the apprentice-style Q&A and familial transmission, there was a growing emphasis on integrating theory with clinical practice, which gradually highlighted the importance of medical ethics education in clinical practice.In the teaching content, the Tang Dynasty first integrated moral education into normal teaching content and trained students' morality.This method not only cultivated medical students' sound medical ethics but also made the country's ideology rooted in students' minds.The Tang Dynasty's ideological landscape encompassed Confucianism, Buddhism, and Taoism, with Confucianism prevailing as the dominant ideology, championed by the state.This had a significant impact on the medical thought and philosophies of that era.
Before studying medical skills, medical practitioners immersed themselves in classical literature, gaining insights into the essence of Confucianism, Buddhism, and Taoism, which had a notable influence on their medical practice.They possessed not only exemplary medical ethics but also a humble demeanor in their medical endeavors.On one hand, they honed their medical ethics through personal practice; on the other hand, they contributed to the field through written works and blended traditional wisdom with daring innovation, marking a fresh chapter in the development of traditional medical ethics.One of the most exemplary figures is Sun Simiao, known as the "King of Medicine", who demonstrated remarkable medical skills and noble medical ethics.He wrote "The Study and Practice of Great Medicine" and "Great Medical Sincerity" in Essential Formulas for Emergencies (Worth) a Thousand Pieces of Gold, which comprehensively discussed the medical ethics issues such as the purpose of studying medicine, dedication, service attitude, and moral cultivation.

The historical context of Hippocrates
Hippocrates pointed out that disease is a natural phenomenon, contrary to the prevailing belief in ancient Greek medical tradition since the time of Homer that diseases were divine "condemnations".Hippocrates believed that there was no so-called "sacred" or mysterious disease, and the root cause of all kinds of diseases could be identified.While these notions may appear commonplace and self-evident today, before Hippocrates, people staunchly held the belief that disease was caused by spirits and deities, physicians were mere representatives of God, and recovery depended on blind faith in sorcerers or religious figures.Hippocrates completely changed the concept of witchcraft and religion in medicine at that time, abandoned the role of God, and replaced it with scientific clinical observation and treatment, introducing medicine into a brand-new historical field.

"On the Absolute Sincerity of Great Physicians" proposes great compassion and shame.
The preface of Essential Formulas for Emergencies (Worth) a Thousand Pieces of Gold states, "One's life is of paramount importance and worth more than a thousand pieces of gold; a single prescription can save a life, which is the ultimate virtue."Using the metaphor of valuing life more than gold, it emphasizes that life is the most precious thing in the world, and saving lives is the most sacred endeavor.Respecting and cherishing human life becomes the cornerstone of medical ethics.In "On the Absolute Sincerity of Great Physicians", it is noted, "In the treatment of diseases by great physicians, they must first calm their minds, eradicate desires, and cultivate a heart of great compassion and empathy, with the sincere wish to alleviate the suffering of all sentient beings."It means that when treating diseases, morally and professionally skilled doctors should maintain mental composure, free themselves from desires and expectations, and foremost, manifest a heart full of compassion and sympathy, dedicating themselves to relieving the pain of humanity.Treating patients as if their suffering underscores the importance of healthcare professionals possessing empathy.
Sun Simiao emphasized the word "heart", that is, great compassion.He mentioned that even when facing conditions like festering wounds, diarrhea, and repulsive odors that others find revolting, one should feel no disgust, but rather a sense of shame, sympathy, and concern.He emphasized that this heart should be free from even the tiniest trace of selfishness.This notion, especially the intertwining of compassion and shame, is worthy of our attention.Confucius stressed benevolence, and his direct descendant and later disciple, Meng Ke (Mencius), placed significant emphasis on compassion and empathy.The term "Compassion" refers to sympathizing with the suffering of others, which forms the foundation of benevolence.In the book "Mencius", there's a saying, "The feeling of sympathy is the beginning of benevolence."At the beginning of this article, Sun Simiao also talked about compassion, saying that compassion should be generated first, and then the suffering with spirit can be saved.Therefore, the ideas of Sun Simiao and Mencius are indeed aligned.However, Sun Simiao went beyond compassion and further put forward the word shame, which carries profound significance.
It runs deep in at least two aspects: First, throughout history, there has been no record of anyone discussing the concept of shame concerning the esteemed profession of medicine.The Hippocratic Oath is hailed as the ethical cornerstone of ancient Greek medicine, yet it does not touch upon shame.Despite numerous writings and works exploring medical ethics and categorizing its principles into various domains such as "pure-heartedness, tireless dedication to saving lives, treating all equally, diligence, proper conduct, humility, discretion, detachment from fame and fortune, and guarding secrets", none of them explicitly mention the word "shame".Second, the emergence of the sentiment of "shame" is closely tied to the advent of medicine.The origins of medicine have been a topic of diverse interpretations, with compassion and wisdom interplaying.In the early 20th century, the renowned Italian historian of medicine, Castiglioni, noted in History of Medicine that "medicine was born from humanity's earliest expression of suffering and the initial desire to alleviate this suffering." This simple yet profound explanation outlines the birth of medicine and simultaneously places a significant responsibility upon those practicing medicineto alleviate physical suffering.If a patient's physical pain is not promptly alleviated through proper treatment, not only does it cause bodily distress, but it can also erode their dignity.Any conscientious physician would naturally feel a sense of shame, reflecting their enduring moral compass.This is a profound lesson illuminated by "On the Absolute Sincerity of Great Physicians" and a crucial facet of the compassionate physician's character.Compared to the sentiment of empathy, the concept of shame adds another layer, intricately intertwined with the inception of medical practice.

Influence of different philosophical views
Throughout Chinese and Western traditional medicine, Hippocratic Oath was influenced by ancient Greek simple natural philosophy, while "On the Absolute Sincerity of Great Physicians" was impacted by Confucianism, Taoism, and Buddhism.
"On the Absolute Sincerity of Great Physicians" integrates the benevolence of Confucianism, the desirelessness of Daoism, and the compassion and virtuous deeds of Buddhism.It stands as the earliest comprehensive and systematic article on medical ethics in the history of Chinese medicine, representing a glorious chapter in our nation's medical ethics heritage.Sun Simiao led by example, embodying these ethical principles in his behaviors throughout his medical practice.He is hailed as the "Father of Medical Ethics" in Western scientific circles and is counted among the world's three eminent figures of medical ethics, alongside Hippocrates.Sun Simiao believed that a true healer, dedicated to treating and saving lives, must not only possess exceptional medical skills but also uphold noble characteristics.Medicine is a "benevolence" discipline, as he stated, "One's life is of paramount importance and worth more than a thousand pieces of gold; a single prescription can save a life, which is the ultimate virtue."(Sun Simiao, Essential Formulas for Emergencies (Worth) a Thousand Pieces of Gold).Therefore, "a physician, without benevolence and compassion, cannot be entrusted; without wisdom and insight, cannot be relied upon; without integrity and virtue, cannot be trusted."(Yang Quan, Theory of Things).

Conclusion
Medical workers encounter different morbid patients every day.Without a broad-minded and compassionate perspective, they risk being trapped in a cycle of desensitization or negative emotions, ultimately harming both the patients and themselves.When doctors approach patients with their professional skills and the dignity of their occupation, empathizing and standing alongside them in times of challenge, it helps alleviate tensions between doctors and patients.The humanistic thoughts in "On the Absolute Sincerity of Great Physicians" and Hippocratic Oath provide us profound insights, which require us to genuinely uphold these principles from within our hearts.