If You Want to Be a Great Doctor, You Must Go Through Bumps and Bruises

Today, while seeing patients in the outpatient clinic, a woman came to my consultation room saying she had something important to tell me. I asked the others to step out for a moment, and then I remembered—this was the lady from Xinhua News Agency who had come for a consultation the previous week.

She told me, very seriously, that after taking a few doses of the medicine I had prescribed last week, she did indeed develop a fever—just as I had warned her might happen. However, her period was delayed by four days, and she experienced symptoms resembling menopause. She stopped taking the medicine and consulted a TCM doctor at her workplace, who told her that my prescription had damaged her yin—a serious medical error. Her assessment: my medical skills were inadequate and needed significant improvement. She would not hold me accountable this time.

My first thought was: had I really made a mistake with the prescription? Should I offer to see her again? After all, I knew best what I had prescribed. If her workplace doctor misjudged the situation and caused further harm, would the blame ultimately fall on me?

But she told me that after taking the medicine prescribed by her workplace doctor, she had already begun to recover. All I could say was, “I’m sorry. My skills clearly need improvement. Please find a good doctor and get proper treatment.”

To be honest, this was the first time in over a decade that anyone had directly questioned my medical judgment. I was completely unprepared. My mind went blank.

After returning home, I immediately pulled out the medical record from her last visit. I thought about it long and hard, and finally began to understand what had happened. The prescription I had written was as follows:

Raw Astragalus 30g   Angelica 9g   Codonopsis 9g   Poria 9g   White Peony Root 9g   Roasted White Atractylodes 9g   Prepared Rehmannia 30g   Chuanxiong 9g

Honey-fried Licorice 9g   Sweetflag Rhizome 15g   Polygala Root 9g   Spatholobus Stem 30g   Five-finger Peach 30g   Rose Flower 9g

This reminded me of a case from a few months ago—another female patient of similar age, with slightly different symptoms but essentially the same underlying pathology. After taking a comparable formula, she also developed fever, sweating, and a dry cough. The analysis was straightforward: I had over-tonified. Or, more precisely, the formula lacked sufficient herbs to promote the smooth flow of qi and blood. When I thought back to the principles behind Danzhi Xiaoyao Powder, I felt deeply ashamed of my inadequate mastery of the art.

I have always considered myself relatively clear-eyed about the realities of Chinese medicine among my peers. Whether a patient improves or not after taking my medicine, I strive to evaluate the outcome objectively. Both good results and poor ones are part of the accumulation of experience—both are necessary steps on the path to becoming a truly skilled physician. The ancient texts teach us: “Only those who apply their minds with the utmost subtlety and precision may be worthy of discussing these matters.” I have always hoped that patients would communicate with me honestly about their results, whether good or bad. For the patient, this is an act of trust; for me, it is a source of both experience and hard-learned lessons.

“Only those who apply their minds with the utmost subtlety and precision may be worthy of discussing these matters.”

No one wants to make mistakes in this line of work, and even less does anyone want to repeat the same mistake. I am sincerely grateful to every patient who has given me honest feedback about their treatment outcomes.

My first mentor warned me more than once: the longer you practice medicine, the more cautious you become, until every case feels like walking on thin ice. The lifetime of experience distilled in that wisdom is precious. I believe that every physician, at some point in the process of writing a prescription, faces moments of uncertainty. Sometimes it truly feels like a gamble—and the only way to improve your odds is through ceaseless learning, relentless reflection, and open exchange with others.

I know of doctor friends who, after experiencing similar incidents, became thoroughly discouraged. Some began writing “safe” prescriptions—ones that would neither help much nor harm much. Many more simply abandoned Chinese medicine altogether. This is truly regrettable.

For me, this incident was more like a whip across the back. It not only deepened my sense of the complexity and sacredness of medicine, but also allowed me to feel, across the span of centuries, the earnest guidance of the sages who came before us.

I hope that, going forward, I may bring benefit to even more people.

今日正在门诊看病，一女士前往诊间言有事相告，遂让他人回避之，此时我想起来，这位是上周曾来就诊过的一位新华社的女同志。

来者很严肃地告诉我，上周的药她吃了几付后果然如我所言出现了发热的情况，但是例假推迟了4天，出现了更年期的症状，遂停药，经其单位中医看过后，认为我的药伤阴了，是很严重的医疗事故，我的医术不行，要好好提高，这次就不追究责任了。

当时我在想，难道药开错了？是不是应该再给她看看，毕竟我开的药我最清楚，如果其医生拿捏不准造成更严重的伤害怎么办？要是最后全怪我头上来了那可兜不住。

但是她说吃了他们单位中医的药之后已经开始恢复了，我只能说好吧，我的医术确实还需要进步，你找别的医生好好治疗吧。

说实话，这是十多年来第一次有人直接质疑我的医疗行为，完全没有准备，大脑一片空白。

回家后，我赶紧翻出了上次的病历，左思右想，终于悟出点门道来。上次开的方子是这样的：

  生黄芪30g 当归9g 党参9g 茯苓9g 白芍9g 炒白术9g 熟地30g 川芎9g

  炙甘草9g 石菖蒲15g 远志9g 鸡血藤30g 五指毛桃30g 玫瑰花9g

这让我想起了几个月前一位女患者的情况，也是差不多的年龄，不太一样的症状，大致相同的病机，吃了类似的药方之后也出现了发热汗出，还有干咳的症状，分析原因很简单，就是补过了，或者说方中缺乏一些疏通的药物，再去回想一下丹栀逍遥散的方义，真是学艺不精，倍感羞愧。

我一向自诩是同辈中比较能看得清中医形式的人了，患者吃了药到底是好了还是不好，我一直非常客观地评价，好与不好都是经验的积累，都是成为明医所必须经历的一部分。古人教导我们”唯用心精微者，始可与言于兹矣”，我始终希望无论吃了药是好还是不好，都能与我沟通，对患者而言，这是信任，对我而言，这是经验与教训。谁都不愿意在这个问题上犯错误，更不愿意总是去犯同样一个错误，我是衷心感谢所有反馈真实疗效的病友的。

我的启蒙恩师曾不止一次地告诫我，病看得越久，胆子越小，越有如履薄冰的感觉。老人家一辈子的经验是珍贵的，我相信开方过程中谁都有拿不定主意的时候，有的时候真的就像赌博，而提高胜算的唯一方法就是不断学习，不断总结，不断交流。我接触到一些医生朋友在遭受了类似的事件后都灰心丧气，有的开起了太平方，吃不好也吃不坏，更多的则放弃了中医，令人惋惜。这件事对于我而言更像是一则鞭笞，不仅让我感到医学的复杂与神圣，更让我感受到了古今圣贤的循循之心。

希望今后能造福更多人。