Endeavor and Destiny

Endeavor and Destiny is the name of a chapter from the 4th century A.D. Taoist text The Book of Lieh-tzu (the most well known work of this genre is the Tao Te Ching from the 3rd century B.C.). This chapter is a commentary, told through stories and parables, on the issue of what comes through effort and what is out of our control. The excerpt below is from A.C. Graham’s translation The Book of Lieh-tzu – A Classic of Tao, published by Columbia University Press.

In the following story, Chi Liang is ill and his sons call three doctors, named Chiao, Yu, and Lu to examine him:

“Mr. Chiao said to Chi Liang: ‘Your temperature, and the filling and emptying of your vital fluids, are out of order. The illness is due to irregular meals, sexual over-indulgence, and worrying too much, and although critical it can be cured.’

‘The usual sort of doctor!’ said Chi Liang. ‘Get rid of him at once.’

Mr. Yu said: ‘At your birth there was too little vital fluid in your mother’s womb and too much milk in your mother’s breast. The illness is not a matter of one morning or one evening; its development has been gradual and is irreversible.’

‘A good doctor!’ said Chi Liang. ‘Let him stay for dinner.’

Mr. Lu said: ‘Your illness is not from heaven, nor from man, nor from spirits. Ever since you were endowed with life and a body, you have known what it is that governs them. What can medicine and the needle do for you?’

‘A divine doctor!’ said Chi Liang. ‘Send him off with a rich present.’

Soon after Chi Liang’s illness mended of itself.

Valuing life cannot preserve it, taking care of the body cannot do it good; scorning life cannot shorten it, neglecting the body cannot do it harm. Hence some who value life do not live, some who scorn it do not die, some who take care of the body do it no good, some who neglect it do it no harm. This seems unreasonable, but it is not; in these cases life and death, good and harm, come of themselves.”

This passage may seem like an unlikely one for me to choose to discuss. In fact, it seems to be completely contradictory to everything which Chinese medicine teaches and which I share with my patients. Despite this, the interactions and language are so reminiscent of my daily practice that I find myself drawn to rereading it. The philosophical perspectives of Taoism are not inherently part of Chinese medicine, and are certainly beyond the scope of both this article and my own knowledge for me to competently comment on. However, this passage does raise at least two interesting issues which are related to healthcare:

• Why and in what manner should I expend effort?
• What is under my control to change and what is fixed?

Regarding these issues, the above passage appears to advocate apathy and passivism. However, there is a deeper implied meaning in this and similar teachings. The Chinese describe a sort of action which arises spontaneously in response to the moment. It is referred to as “wu wei”, or non-action. This type of action is not contrived, not premeditated, and not the outcome of our mental decision making process. It comes without anxiety or burden, and arises out of who we are rather than what we do or think. It implies getting out of the way to let things occur naturally. Plants grow, rivers run, and lives unfold of their own accord. Thus Lao-tzu says in the Tao Te Ching, “Take no action and nothing is left undone”. Similarly, Chuang-tzu says “Just settle yourself in non-action, and things will naturally transform”. I believe this story is illustrating this concept, in this case applied to the topics of life and death, and sickness and health. It suggests for me an interesting idea – we do not need to be in control of everything, and we do not need to direct the outcome of everything. Our task is to be aware and to respond appropriately. Sometimes that means action, sometimes it means doing nothing.

The fundamental principle at work here is resonance. In Chinese, the term is “gan ying”, or literally “stimulus-response”. The implication is that from a place of center, there is a capacity to respond exactly as the situation demands. No effort is required. The key term here is “center”. We might think of related concepts such as focus, concentration, awareness, clarity and attention. Non-action leads to nothing without it. It leads to everything with it. Anyone who has ever practiced anything understands this notion. First you have to use your mind to think and learn, and then you have to put your mind aside to perform well. But if you never practice in the first place, nothing happens. So there is actually a sort of practice and effort to this approach of non-action. What we are training, and therefore the place from which we are acting, is some deeper aspect of ourselves not limited by the mind.

We associate with an ego, or an “I”, which lives inside our heads and which we believe directs everything. Regardless of our faith or our beliefs, we still believe there is someone inside running the show. But the fundamental Chinese model is that there is no one home, and that the personal sense of “I” is at best transient, if not completely illusory. I think we generally do not like this notion in the West, at least not at first. However, when we see an athlete or a musician perform well, we recognize and admire that the performance is coming from someplace other than a personal ego. We say they are “in the groove”, or “in the zone”. Sometimes in common usage, this is used to imply a sort of laziness and absence of the mind. However, the notion is one of complete present-ness, characterized by mental focus rather than discursiveness.

With regards to healthcare, I think the message is the same. When we become separate from our own experience, viewing ourselves and our lives and our illness and our actions all as separate things, we will not be able to respond appropriately or perform well. We will likely make poor choices. However, with some attention, we can respond well. We can know when we need to shift our diet, why we have neck pain, when we should get acupuncture, and when we should just do nothing in a purposeful manner. This is the deepest form of healing of which the Chinese speak.