On the Correct Practice of Medicine (IV) —— Medical Humanities and Humanistic Medicine

Fan Daiming, Xijing Digestive Disease Hospital, Air Force Military Medical University

Medical practice is inseparable from medical humanities. Humanism is the highest realm of human culture and an important part of medicine. People and animals have life and share a material world. There is a fundamental difference between human beings and animals, that is, human beings have their own language and writing, which has created a unique cultural world. Health is related to humanities, and the object of medicine is people, so medical practice cannot be without humanities. It is a necessary quality for doctors to grasp the correct direction of medical development. Humanistic medicine, like scalpels and pills, is an important tool for disease diagnosis, treatment, prevention and control, and a necessary skill for doctors.

First, the development status of medical humanities

Anthropology is divided into four parts: sociocultural anthropology, linguistic anthropology, archaeology and physical anthropology. China has incorporated them into sociology and ethnology, national language and linguistics, history and biology respectively. In my opinion, both the whole volume of anthropology and the various volumes of anthropology are closely related to medical humanities, and many of the knowledge is an important part of medicine. This knowledge is also a magic weapon to explore the mysteries of human body and life, and to diagnose and prevent diseases. It is a great pity that these medical humanistic knowledge or technologies, which occupy an important position in ancient Chinese and foreign medicine and have made important contributions, have been ignored, neglected or even abandoned in recent decades.

With regard to anthropology and medical humanities, before liberation, there were still a group of scholars who had done teaching and research work in colleges and universities after returning from abroad, and there were also a number of achievements. However, after liberation, due to the influence of a series of political movements, China’s social science was once in shock and suffering, and its progress was very slow. It didn’t recover until the 1980s. Judging from the published papers, only 3 papers were published in 1980-89, 24 in 1990-99, 59 in 2000-09, and only 180 in 2010-19. Therefore, overall, in the past 100 years, China has made progress in science and technology and improved democracy, but its morality has declined. What about medicine? Medicine is progressing, medical skills are developing, and humanities are declining.

The development of anthropology in China after the reform and opening up mainly depends on five thrusts. 1. Translation and introduction of medical anthropology works. Professor Kaibowen of Harvard University has been devoted to the anthropology research in China and made important contributions to anthropology in China. 2. Since 2001, some anthropologists have taken the initiative to engage in AIDS prevention and treatment, and studied the AIDS epidemic from the perspectives of drug abuse, blood selling, sex industry and female reproductive health. 3. Attaching importance to ethnic medicine and the diversity of ethnic minority areas, and analyzing field work data from a cross-cultural perspective has achieved some results. 4. Some scholars go abroad to carry out cooperative research. A large number of scholars who are enthusiastic about medical humanities have emerged. They have held academic seminars, founded magazines and published monographs. Nowadays, medical humanities has established its important position not only in the field of social sciences in China, but also in the field of medical specialty.

Second, the possible differences between medical humanities and humanistic medicine

Humanistic medicine and biomedicine belong to the medical category and serve human health, but the emphasis is different. Humane medical research aims at goodness, while biomedical research aims at truth; Humanistic medicine takes the integrity of the body as the object, while biomedicine takes the local structure and function of the human body as the research path. For Medical humanities (medical
Humanity) and Humanistic medicine (humanistic)
Medicine), domestic scholars put forward different concepts. For example, medical humanism is the revelation of "humanity" in medicine, while humanistic medicine is the excavation of "human culture" in medicine; Medical humanities means that humanists look at medicine, and humanistic medicine means that doctors look at medicine; Medical humanism is medical theory, while humanistic medicine is medical skill; Medical humanistic spirit is the command of the medical world and grasps the development direction of medicine, while humanistic medicine belongs to medical humanistic spirit and care, and uses humanities as a tool to achieve medical goals. Regarding the difference between medical humanities and humanistic medicine, Professor Du Zhizheng in China thinks: 1. The historical development origins are different, medical humanities are earlier and humanistic medicine is later. 2. There are differences in connotation. Medical humanism focuses on value judgment, which is manifested as a spiritual concept, such as great doctor sincerity, while humanistic medicine focuses on concrete practice, such as humanistic care. 3. The scope involved is different, with wide medical humanities and narrow humanistic medicine. 4. The foothold is different. The foothold of medical humanities is humanities, while the foothold of humanistic medicine is medicine. 5. Different contexts and academic categories are used. 6. Different situations and occasions are used.Only humanistic spirit and humanistic care can make medicine have human attributes and involve the essence of medicine. Professor Liu Hong put forward that it is necessary to hold high the humanistic attribute of medicine, show the humanistic spirit of medicine, cast the humanistic quality of medicine, provide humanistic care of medicine and construct a harmonious doctor-patient relationship to reflect the essence of medicine.

Third, medical humanities’ understanding of human life

(A) from the evolutionary history of the universe to see the evolutionary history of life

There is no life on the earth, and the phenomenon of life is from scratch, from simplicity to complexity, which is the result of long evolution. The formation of life has gone through two closely connected stages: 1. The formation of primitive life depends on two necessary conditions: one is the physical, chemical and biological changes required for the production of living substances; The second is a relatively stable natural environment suitable for the survival of primitive living materials. 2. The evolution of subsequent life: firstly, the interaction between the original life and the environment has changed; Second, these changes can be preserved and transmitted through reproduction, so the evolutionary history of life is full of two processes: heredity and variation. According to the evolution history of the universe, we can infer the formation of today’s biological world, and life follows this road and has today. If we go upstream, life on earth will undoubtedly disappear. This is the case with the extinction or near extinction of some animals, plants and microorganisms. In addition to their own genetic and mutation problems, some living things are more caused by changes in their living environment, endangering their natural forces and homeostasis, and the body is too late or unable to repair it.

(2) Medical humanities’ understanding of individual life and its value

Some scholars believe that human life can be divided into two kinds of life and quasi-life. This kind of life starts from the fertilized egg and is the life given by parents to their offspring. Life-like starts from the newborn, and it is a self-created life. This kind of life is the material carrier of life-like, and it is self-consciousness that promotes the qualitative change of the whole life process of individual development, that is, when individuals develop to produce self-consciousness, human life begins to develop into human life-like and become a new life in society. When people’s self-consciousness is irreversibly lost, it reverts to human life (vegetative) or both disappear at the same time. However, the loss of self-awareness does not necessarily mean the complete disappearance of human life. For example, although the vegetative person’s self-creation ability of life-like beings no longer exists, that is, his psychological consciousness no longer has an impact on the natural forces in the body and on society and even members, his social roles such as parents and children still exist, but life-like beings have been at a secondary level, succumbing to life-like beings and becoming life-like ones.

There is unity between species of life and species of life, but some individuals are not always unified. A species of life with high quality may not have a species of life with high quality, and vice versa. For example, some strong people are heinous criminals, and their life-like quality may be zero or even negative. On the contrary, although some disabled people or patients have a low quality of life, their quality of life, that is, the value of life, is not less than that of normal people, such as Hawking. We can’t completely deny the existence and significance of a kind of life because of its low quality or disappearance, nor can we deny the quality and value of a kind of life because of its damage or reduction, let alone deny the dignity and sacredness of a kind of life because some patients have no self-awareness and poor quality of life. This is humanitarianism.

As the subject of life, man is neither a "spiritual entity" of pure thought nor a "mechanical entity" of pure extension. But Embodied existence. From the concept of life and life-like, human beings are first physical, physical and physiological, and then rational, cultural and social. As the starting point of self-construction, the body is neither a pure body nor a container of the soul. It is a place for people to communicate with each other and a unity of freedom and self-action. Life is unified in time and space, and life cannot exist without time and space, so the definition of life should consider two factors: time and space. Human life is only an attribute of human beings. Besides, human beings have many other stipulations, such as playing a specific social role, taking due social responsibilities and obligations, and abiding by social ethics and laws and regulations. People’s life is the foundation of being human. Without life, people can’t be called human. The whole of medical research must have life. The whole medicine with life is called body, and the whole medicine without life is called corpse.

Fourth, medical humanities’ understanding of the limits of medical intervention

The human body exists with Wholeness and Noumenon; It is a whole life that can neither be Deconstruction nor Reconstruction; It is an inherent whole of the human body, which cannot be designed or manufactured by external forces, nor can it be artificially given or increased or decreased. The idea of human integrity emphasizes that the human body is composed of many dimensions, such as physical property and spirituality, body and spirit, sensibility and rationality, and the loss or injury of one dimension will cause the whole disability or destruction. The ontological thought of the human body holds that the human body, like the elements that make up the world, such as water, fire, earth and gas, has the characteristics of ontological existence. The existence of the human body is an inseparable, unchangeable and unrepeatable unity of Spirituality, Personality and Nature, which respectively represent the spirituality, sociality and purity of the human body. Therefore, the rule and essence of medical intervention is to help the human body correct deviation and restore hyperstability, and not to overstep the spiritual limit, personality limit and authenticity limit. From the time of Hippocrates until the 1950s, western medical intervention generally developed within a reasonable limit, and was constrained by two theoretical foundations. One is his thought of natural force of human body, and the other is the thought of homeostasis of French physiologists Bernard and Cannon. Both of these ideas advocate respecting, protecting and relying on the natural forces of the human body. Only in a few patients, the deviation of steady state continues to expand.Medical intervention is necessary when the body’s repair mechanism is too late to deal with and endanger life. However, after the 1960s, due to the great progress of science and technology and its application in the medical field, especially the brilliant achievements in the prevention and treatment of infectious diseases, medical intervention was no longer satisfied with the track of helping to correct deviation and restore steady state, and no longer followed the rules and regulations, but went over the wall and deviated from the rules, resulting in a serious situation of attacking the human body on a large scale. Medicine respects, protects and relies on the natural forces of the human body, corrects the deviation of vital signs in the body, repairs the structural defects and functional imbalance of organs, and directly rushes to manufacture and install some organs of the human body, and even recreates the human body and even life. All kinds of events that go against nature or even human nature continue to occur, causing widespread doubts and unprecedented threats to human safety. Liu Hong summed up this serious improper medical intervention into the following five common characteristics: 1. Ignoring unknown risks, brazenly conducting in-vivo tests; 2. Making use of technological breakthroughs to hit the ethical bottom line; 3. Walk the evasive route and circumvent the legal constraints; 4. Make it a fact and seize the opportunity of scientific research; 5. Under the guise of benefiting patients, seek fame and fortune.

Serious and improper medical intervention is a kind of medical violence, which intentionally, unintentionally or maliciously tramples on or oversteps the spiritual limit, personality limit and true limit, resulting in serious consequences that endanger human body. At present, there are two kinds of the most serious ones.

One is the head transplant. The skull is an important organ of the human body that determines individual identity, thinking and behavior, emotion and cognition, and determines physiological characteristics, psychological characteristics and personality characteristics. Head transplantation is the transplantation of "I" and a process of transplanting "I" to "He". In 2017, Italian neurosurgeon Canavero and domestic orthopedic surgeon Ren Xiaoping of Harbin Medical University completed the surgical model of the first human head transplant on the fresh remains, which triggered a wide debate in academic and social circles.

The second is human body reconstruction. For example, 1. Three-parent baby. On October 19th, 2016, the world’s first three-parent baby was born in the United States. It is to take out the defective mitochondria from the mother’s eggs and replace them with those from another egg donor, thus treating diseases caused by the congenital defects of mitochondrial DNA. 2. In 2017, the world’s first implantable artificial intelligence chip was used to treat paralyzed patients. 3. In 2018, the world’s first genetically edited baby was born in China. Some people say that "after human beings realize creation through technology, they will inevitably move towards creating human beings, which is the highest goal of technological innovation", and "it is necessary not only for people to conquer nature, but also for people to conquer people". Obviously, this kind of thinking and practice is not correct in medicine, is not conducive to human health, and even brings disaster to mankind. You know, human genes have been basically stable and normal through millions of years of evolution. To change a gene, it may cause an artificial mutation. You know, all human genes are useful. Changing the different mutations brought by any gene is abnormal for the normal human body.

Fifth, medical humanities’ understanding of life spirituality

(A) life and spirituality

Human beings are born with three abilities. 1. Perceptual ability. The ability of human beings to produce perceptual knowledge of nature with their senses (perception of the world). 2. Rational ability. In the process of practice, human beings gradually conceptualize things, make judgments and reason rationally (know the world). 3. Spiritual ability. The ability of human beings to create, transform and conquer the world (transform the world).

Spiritual English is Spirituality. In the eyes of ordinary people, the spiritual world is "beyond control" and an illusory world of "things and wandering". Spirituality often has an indissoluble bond with religion, and some people directly put Spiritual response (spiritual)
Coping) is synonymous with Religious coping. But 1. Spirituality tells human beings to discover the truth, while religion tells the truth by doctrine (To solve problem.
vs. to answer
question); 2. Spirituality enables human beings to be liberated independently, while religion enables human beings to find support; 3. Spirituality is to let human beings create their own path, while religion is to ask human beings to follow their journey; 4. Religion can not only help people to practice spirituality, but also often restrict people’s pursuit of other spiritual spaces because of exclusiveness. In fact, religion is only an organized and mechanized interpretation and practice of spiritual beliefs and experiences, while spirituality is related to the experience of human beings seeking the meaning, purpose and value of things, which may or may not include the concept of unknown (that is, existing but unexplained) or transcendental power. Spirituality is the ability of human beings to surpass themselves. For those who look up to the unknown world, spirituality is the experience of their relationship with the unknown world; For humanists, spirituality is a self-transcendence experience of getting along with others; For common people, spirituality may be a harmonious and identical experience with nature and the universe.

Spirituality in medicine originated from Spiro in Latin. In the book On Soul, Avicenna, a medical philosopher, believes that the soul is a function without form, which can not be perceived, but can be perceived and understood. The English name of the Soul is Soul, and the Greek word Psyche. The root of psychology comes from the soul. Soul belongs to psychology? Whether it is inside or outside or spirituality is being integrated into psychology is still controversial. Most people believe that spirituality and psychology are different understandings of the same thing, sometimes qualitatively different. The essence of psychology is self-analysis, in-depth self-realization and self-realization, but spirituality requires self-transcendence and a world without self. When they meet, there are both unrelated feelings and soul-to-soul connections. We are used to knowing and testing the existence of spirituality with the existence of matter, which is only the limit of the existing scientific and technological level. In fact, sometimes things that are invisible and incomprehensible exist in large quantities. The first example of natural science, Einstein thought that gravity is a part of space-time. From the philosophical and mathematical point of view, space-time is a part of geometry, because space-time is constantly twisting and changing. The reason for the change is that space-time has gravity, but gravity is constantly moving. Geometrician Euchanho Carnaby pointed out that there is no matter in a vacuum, but if a symmetry, that is, supersymmetry, is added in it, there will be gravity. Qiu Chengtong found that many spaces have gravity without matter, which is Carnaby-Qiu Chengtong space. Of course, the understanding of spirituality is only preliminary, and there are still a lot of mysteries worth exploring.

(2) Spiritual pain

When it comes to spirituality, medicine will inevitably think of spiritual pain. The pain caused by physical pain is well known and can be solved by painkillers. And spiritual pain is not only varied and manifested differently, but also difficult to define, describe and treat. Take the mental pain at the end of a seriously ill life as an example. How did it come about? The previous growth background and educational model tell people that all efforts will have results, and efforts will be rewarded. As long as you persist in success, you will get closer and closer, and as long as you love, you will be loved. When the human body is normal, it is full of emotions, such as "Qian Shan is always in love" and "All articles in the world are always in love". Emotion is concrete and sensible. "Emotion is the forerunner, reason is the key, interest is the wing, and emotion really moves the heartstrings". However, when they are seriously ill and come to the end of their lives, all the above principles will be challenged. They will find that their efforts at this time have no results, and their efforts have no return (for example, their parents have given their love for a lifetime and there is no dutiful son before they go to bed). The consequence may be that people and money are empty. "Where does love come from? What is love? " "Where did the love go?" I am at a loss, and even I will doubt whether it is meaningful to stick to it. Therefore, it is obvious that spiritual pain should be handled and treated in another way. Those words that are usually encountered or used may be pale and powerless, because the recipient has seen through everything. What is needed at this time is spiritual exchange and spiritual trust. What is entrustment? At the wedding, when the father handed his daughter’s hand to the groom, he said, I entrusted my daughter’s happiness in this life to you. Before the operation, my daughter will hold the hand of the surgeon and say,I entrusted my father’s life to you. The former is entrusted with happiness, and the listener will get wet eyes, while the latter is entrusted with life, and the listener will cry. This is the heart-to-heart love, which is the spiritual relief of blood and tears. Being the soul of all things, a life far from spirituality is often pale and painful, and I don’t know where to go. At different stages of the disease, with the aggravation of the disease, the demand for spirituality is increasing. Spirituality is also a unique internal healing system of human body. For those who suffer from terminal diseases but cannot be cured with spiritual pain, the care for their quality of life is far more important than the extension of life length. Spiritual pain mainly comes from the incomprehension of spiritual level, and human beings are often used to putting spiritual pursuit outside real life. Sagulu said, when what you once longed for and cherished has become insignificant, it is the time when spirituality rises. Let me add that the pursuit of spirituality begins at this time when your consistent ability to change the state of life and the value of life becomes powerless.

In China, death is an unlucky and taboo topic, and we lack orthodox death education. In the cultural background, death is still a dead corner of knowledge. However, deaths often happen around us and are constantly experienced, which often makes people unprepared. All TV dramas and media describe death as dark night, thunder and lightning, stormy weather, shaking the earth … suicide, shooting and execution, and gloomy, cold and bloody words abound, which is creepy.

Spiritual treatment or peaceful care for death, Mother Teresa said, we can’t do great things, we can only do small things with great love and do small things within our power with great love. Patients in western countries usually require to live in hospice wards at the end of illness, so as to 1. stay with their families; 2. See others smile; 3. Review the happy past; 4. Talk about daily things; 5. Hold a prayer ceremony. China’s questionnaire answers are similar, adding 1. Relieve discomfort symptoms; 2. Complete the unfinished wish; 3. make up for improper mistakes; 4. Complete the memoir. They like to see medical staff wearing light white overalls, which represents sunshine. Any other color is not only redundant, but also unpleasant. Patients also like to listen, and doctors should learn to speak.

Throughout the ages, in order to illustrate spirituality and appease spiritual pain, a large number of magical realism stories have been created. For example, the description of the death process should make the events with deep imprint on life reappear. A "Qinren Cave" leads to the "Peach Blossom Garden", which is a journey from hometown to hometown. Hometown is a place where you can go back, but for the living, it is a place where you can’t go back or go back, especially for the dead. Hometown and hometown are both beautiful places, places that both the living and the dead want to go, and where spirituality belongs. The connection of the two kinds of thinking makes death no longer the cremation of the icy body or the horrible decay into mud, but "Meng Po Tang blended with honey, Naihe Bridge with tinkling springs, the yellow road paved with flowers, and the book of life and death that goes down in history". This has solved the spiritual concern of the last mile of life. The connection between magic and reality is like editing in film production. Half-truth and half-falsehood are both true and illusory, which can show chapters and realms that everyone understands and enjoys. "Meng Po Tang is also a soup" (it has the effect of forgetting worries), "Naihe Bridge is also a bridge" (a place of confession of sorrow and joy), "Huangquan Road is also a road" (the direction leading to a new world), and "The book of death (the book of life and death) is also a book" (the file of survival traces and the meaning of life). Thus, the value dialogue of truth, goodness and beauty in life is happily realized.

There is also a treatment for spiRitual pain, which is ritual therapy practiced by many ethnic groups at home and abroad.
Healing), this kind of therapy originated from the ancestors’ belief in supernatural power, which believed that life and health were given by gods (supernatural power), diseases were punished by God, and death was irresistible. This therapy holds that human beings’ pursuit of life-greed for life and resistance to death-fear of death depends on their own efforts, which is insignificant, powerless and even useless. Therefore, we should use rituals such as praying to God, asking divination, witchcraft and exorcism to get rid of diseases and protect their health. Now it seems to belong to the traditional primitive psychotherapy. According to the World Health Organization’s statistical report in 2013, in developing countries, 80% of those who are in pain still regard traditional treatment similar to ritual therapy as the most basic medical security. Incayawar found that there are about 450 million patients with mental illness in the world. Because of limited financial resources, most of them can only seek the help of traditional therapists. Ranganathan thinks that sometimes patients go to temples for ritual treatment knowing that ritual treatment is not helpful to their illness, or they may build a small society for people in the same situation and find comfort from being in the same boat. The reason is that they lack medical resources and have no money to treat diseases. Moreover, some diseases can’t be cured for a long time, and they will find another way, and sometimes they will get curative effects. Apart from psychotherapy, sometimes it is a placebo effect. These therapies are certainly unscientific, and even considered to be backward and ignorant, but they are in a desperate situation.There is no other way but to find a way out.

Vi. Fear of life and narrative medicine

(A) fear of life

Life is important for all living things. There are two essential differences between man and other living things: 1. Man is a rational animal with complete self-awareness, and can separate himself from the environment at the conceptual level, that is, he has the ability to understand the world. 2. People have free will, can use conceptual thinking to guide themselves and react to the environment, and can change the environment according to their own intentions, that is, the ability to transform the world. Other animals have little or no these two abilities. It is precisely because of these two abilities that we should fear life, not only human life, but also the life of other organisms. Humans should limit their desires and treat life equally, including crawling insects, captive animals, grass by the roadside, vegetables in the garden and trees in the mountains. Don’t think that there is nothing to be feared about these things, that they need to be hacked, hacked and killed indiscriminately, but they don’t know that if they are not feared, they will eventually bring disaster to themselves. This is called retribution.

Fear of life is a philosophical term in Chinese, which was translated by Schweizer. The English word is Reverence for life, and the German word is Ehrfurcht Vor dem.
The word leben is a verb-object phrase. Reverence(Ehrfurcht) means awe, and Life(Leben) means life. The original meaning is "When interacting with other living things (living things other than yourself, including others), you should be humble and cautious like facing a big man (or god) who controls your own destiny. Later, it developed into an individual’s will to life, and we should be full of sympathy, including treating all the will to life outside ourselves. The essence of goodness is to preserve life, promote life and make life reach the highest development; The essence of evil is to damage life, destroy life and hinder the development of life. We should "not do it because of small goodness, and not do it because of small evils".

Later, China scholars understood this concept. Semantically speaking, fear of life has two meanings, one is respect for life, and the other is fear of death. Fear of death is often expressed through respect for life. How to respect life, there are three principles that complement each other: 1. Inaction, that is, Obedience. Don’t treat life with an overbearing attitude, and don’t treat life with an attitude beyond nature. 2, promising, that is, Moderate. Actively promote the transformation of the natural environment to a state more suitable for life growth and development. 3. Neutralization means Harmony. Restrain selfish desires and social nature, and realize the symbiosis between man and natural environment and social environment. Humans should not be arrogant, even in the future era when science and technology are very developed, we should respect people and respect their lives. Some people say that in the era of big data and artificial intelligence, the role of people is very small, and even it is impossible to replace people. It is true that human evolution is a history of creating tools or using tools to expand human capabilities. Power tools (from axe to atomic bomb) are the external extension of human physical ability, and artificial intelligence is the external extension of human intelligence. No matter how powerful they are, they are unconscious; Even with consciousness, there is no language and no common values; Even if there is, it will take a long time, at least hundreds of years or longer. It took millions of years for human evolution. Now it is not a threat from artificial intelligence to human beings. On the contrary, it is the ethics and behavior norms of human beings, especially the ethics of life sciences and medicine.That is the fear of life.

(B) Narrative medicine

The fundamental purpose of Narrative Medicine is to fear and care for life. Narrative medicine was Rita of Columbia University in 2001.
What Dr. Charon put forward, she emphasized is doctor-patient empathy and doctor-technical reflection. Not only should we consider the disease, but also the pain (empathy between doctors and patients); We should not only consider the good function of medical technology, but also consider its side effects (medical technology reflection). The concept of narrative medicine is actually humanistic medicine, which regards narrative and humanism as medical technology, medical drugs and medical methods for disease prevention and even health maintenance. Narrative medicine requires doctors to Enpowerment themselves and realize Shared decision-making between doctors and patients.
Decision-making), the second is to translate, that is, to simplify complex medical problems so that patients can understand them.

1. Viewing the formation of narrative medicine from the three stages of medical development in the 20th century.

① From the end of 19th century to the beginning of 20th century, mathematical and physical knowledge was gradually introduced into medical education, which changed the previous situation of empirical medicine. Empirical medicine is mostly based on the experience and inference of clinicians, and medical decision-making information comes from the knowledge provided in textbooks, superior and peer doctors and their own personal clinical experience. Empirical medicine is mostly based on experience and centered on diseases and doctors, which is inevitably one-sided and blind.

② From the early 20th century to the 1980s, medicine became a subject of mathematics and physics, and some people said that "learning mathematics and physics well is not afraid to travel all over the world". Scientific rationality has become an absolute dominant position in medicine, from which evidence-based medicine has emerged. Evidence-based medicine (EBM) is a clinical medical research method based on the concepts of clinical scientific experiment, data, probability and confidence interval, and it has been designated as the first driving force for the development of clinical medicine by WHO. However, evidence-based medicine ignores perceptual factors such as subjectivity, individual knowledge, opinions and preferences, and there is a lack of humanistic elements on the cultural and spiritual levels.

③ Narrative medicine or humanistic medicine has been gradually introduced since 1980s. Narrative medicine integrates literature, biography, sociology, linguistics, psychology, psychoanalysis and narratology to serve the ultimate goal of human health. Evidence-based medicine and humanistic medicine or narrative medicine are two different thinking ways to promote the development of medicine, one is rationality and the other is sensibility. The best development method of medicine is to integrate rational thinking and perceptual thinking from the spiritual height, and gradually move towards integrated medicine.

2. Pain and disease under the concept of narrative medicine.

Illness is different from Disease. Arthur
Kleinman’s definition in his book "The Story of Pain" is that pain is the patient’s personal experience of the physical abnormality and discomfort caused by the disease, and it has the characteristics of natural narration. Disease is a term put forward and invented by doctors when they explain and recombine diseases and pains according to pathological theory. Pain is a deeper experience of the disease. But modern medicine pays attention to the disease and ignores the pain. Doctors use various professional theories to filter out the patient’s pain experience, and finally only the disease is left. Then modern medical technology is used to treat diseases, ignoring the patient’s pain experience. Medical technology has been overemphasized by doctors, and patients have become doctors’ tools to improve medical technology. Some even pursue the maximization of their own interests in this way, even ignoring the safety of patients, which eventually leads to frequent medical accidents and tense doctor-patient relationship. Marx said: "Technology was originally created by people, but in turn it became the power to rule people", which led to the reversal of people-oriented purpose. Pan Defu said, "Sickness is life illness, not physical illness". For example, asthma is an acute threat to life, while ulcerative colitis is a chronic destruction to life. Pain is a symptom of disease, which has cultural meaning, social life and environmental significance, and emotional significance. Figuratively speaking, acute diseases such as infectious diseases are more diseases, with clear causes, and treatment can be targeted. Chronic diseases are more diseases, and it is difficult to find a clear cause, which is an imbalance of internal stability. Treatment should take more adjustment measures. Western medicine is more about diseases,Traditional Chinese medicine is more about pain. For acute diseases, we can get rid of them by hand (scalpels and pills), but for chronic diseases, we should establish and accept the concept of incurable or incurable, and the purpose of treating them is to alleviate the chronic suffering of diseases and pains. Medical intervention can be understood as both the process of controlling diseases and the experience of treating diseases and pains.

3. Narrative medical practice under the concept of humanistic medicine.

Humanistic medicine is an integral part and beneficial supplement of evidence-based medicine and a necessity of medicine. Successful treatment requires full communication between doctors and patients and between doctors and doctors. To fully understand the uncertainty and comprehensiveness of medicine, medicine is not a subject that is purely specialized, standardized and specialized in technology. Western medicine advocates seeing, touching and listening, and more uses evidence-based medicine to find evidence of diseases, while Chinese medicine advocates looking, hearing and asking questions, and more uses humanistic medicine to understand the feelings of diseases and pains. There are many feelings when there is evidence. When there is no feeling, it is not necessarily called illness. If you are sick, your body is sick, but your life is not sick. When there is feeling, there is more evidence, and when there is no evidence, you should also consider being sick. This is that your body is not sick, but your life is sick.

There are both concrete and abstract things in the world, which together constitute the world and medicine is the same. The patient’s symptoms are real and concrete, and we can diagnose the disease by them, but at the same time they are abstract. We need to know who the patient really is and what kind of pain he has experienced, and the latter needs humanistic medicine and narrative medicine to answer.

Narration is the cultivation of fundamental ability in the cultivation of all medical talents. According to statistics, patients’ stories contain 75% diagnostic information, and doctors with strong narrative ability can use their narrative ability to improve the efficiency of diagnosis and treatment. Medical technology can cure physical diseases, and language and humanities can cure psychological diseases and pains. Give two extreme examples.

(1) Moliere, a French comedy writer in the 17th century, wrote a play called "Beating a doctor into a doctor". The hero’s husband, Gannalle, drinks and beats his wife all day. In order to get back at her husband, the wife deliberately deceives the noble master that her husband is a famous doctor who lives in seclusion in the mountains. The daughter of the noble master suffered from an incurable disease and was eager to seek medical treatment, so she sent servants to take Gannaler to treat the disease. In order not to be beaten, he had to treat the young lady, but he didn’t understand medical knowledge at all, so he had to communicate with the patient through language, and finally cured the serious illness that many famous doctors couldn’t cure.

(2) Russian doctor writer Chekhov also wrote a novel called "Home Visit". The 20-year-old daughter of Yarikov, a factory owner who died shortly, fell ill. She was the sole heir of the factory owner. Korolev, a famous doctor, was originally invited, but the latter sent his students to make house calls. The student has never had medical experience. When he first arrived at the patient’s residence, he couldn’t diagnose the patient, so he wandered around the factory and suddenly thought that the depressed environment around him was related to the illness of the young heir. So he shared the same feelings with the patients and paid attention to communication skills. It is not easy to open the patient’s heart. For example, when communicating with the patient, we should use the first person plural, put ourselves in, empathize with you, not call you, let alone teach or blame the patient, thus relieving her pressure and finally curing the patient.

These are two literary works. Literature originates from life and is higher than life. In fact, in our clinical practice, similar cases often occur, which is not a story, but a fact that happens every day. Humanistic medicine, including literature, is also a good medicine, which can be divided into monarch, minister and assistant, and can also play the role of monarch, minister and assistant. This is the meaning of Bibliotherapy advocated at home and abroad.

4. The position of medical humanities in medical development.

There is a literature review abroad, which summarizes the articles published in English on humanities medicine during the 40 years from 1970 to 2010. The common point is to discuss the relationship between medical humanities and medicine, which can be roughly divided into three types: ① Medical humanities and medicine are Intrinsic, that is, medicine is human science and medical humanities is an indispensable part of medicine. ② Medical humanities and medicine are Additive, that is, modern medicine itself does not have some necessary knowledge in medical practice, such as social and cultural knowledge, and medical humanities can just supplement these knowledge. ③ The relationship between medical humanities and medicine is corrective, that is, medical practice ignores some important contents, such as paying too much attention to technology and ignoring patients, and even ignoring doctors’ own wishes, interests and well-being. Medical humanities can correct these phenomena.

Early medicine is closely related to humanities. With the development of modern medical technology, technology has gradually become the leading factor of medicine, technicalism and consumerism have become increasingly popular, and modern medicine has a humanistic crisis. China’s medical development is the same as that of the western world. Due to the great development of medical technology, medical practice has been dehumanized. It was not until the 1980s that medical humanities gradually emerged. At present, there are four levels of development: the highest level is advocating the humanistic spirit of medicine, acknowledging the limitations of medicine itself, respecting the whole person and fearing life, which is the ultimate concern for human beings and the promotion of human nature; Secondly, set up medical humanities to spread medical humanities knowledge; Thirdly, through learning, doctors and medical students internalize medical humanities into their own medical cultural qualities; Finally, it spontaneously embodies medical humanistic care, which is manifested in good deeds and good communication between doctors and patients in medical research in clinical practice, and finally condensed and sublimated into a higher level of medical humanistic spirit in the above practice, which is forming a virtuous circle at present.

Humanistic medicine is the concentrated embodiment and sublimation of doctors’ professionalism, and it is the highest level of medical humanities. There is no special, specific, established and hard-written absolute standard for humanistic medicine. It starts and ends with the kindness of doctors, which is reflected in all doctors’ active efforts for patients, and shows a strong sense of responsibility and mission, which runs through the whole process of medical rescue. The feasible choice to realize humanistic medical care is the joint decision of doctors and patients. In the common decision-making, the authority of doctors and the autonomy of patients respect each other and each has its own place, thus creating conditions for humanistic medical care. Medical ethics and empathy between doctors and patients is an important bridge between doctors and patients, and it is the oldest, most effective and most realistic art. But the rapid development and constant change of medical technology almost destroyed this bridge. Humanistic medicine regards suffering from sociology as a mechanical failure of human body, and spares no effort to repair it with medical technology, and the effect can be imagined.

As mentioned above, no matter what kind of culture, we are taught from an early age that cognitive things should follow a certain order. If we want to believe in the natural existence of this order, everything should follow the laws of order, such as front ≒ back, left ≒ right, up ≒ down, high ≒ low, big ≒ small and many ≒. A moment of confusion, showing sadness, anxiety, and even despair, is a pain. For the pain, a single technology can’t solve it, and a single thinking can’t explain it. However, modern medicine and doctors are unwilling to change their ideas and blindly pursue new technologies, so there have been technological changes and drug updates, but in the end it is counterproductive and the result is even worse. In fact, we should not only stick to the manifestations and causes of diseases, but also choose the road of humanistic medicine, so that the cognition and treatment of the above-mentioned diseases and pains may move towards a new world that is closer to the essence, more symbolic and more reflective.

Medicine is an uncertain knowledge, and there are often shortcomings in the process of diagnosis and treatment, which need to be supplemented or remedied by humanistic medicine. For the treatment of chronic diseases, humanistic medicine is indispensable, even the key to success or failure. Improving doctors’ humanistic quality and humanistic competence is the key to realize humanistic medicine, including medical motivation, pursuit of professional value, empathy, caring ability, communication art, altruism, narrative ability, professional reflection ability, knowledge and art of life/health education and death counseling, and humanistic reading level. Humanistic medicine will become the soft power and skillful strength of future medical development and competition between China and foreign countries, and it is an important symbol of the maturity of modern medicine.

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This article is divided into four parts, and I will write here for the time being. It is related to medical practice, and almost all the questions are raised, but not all the answers are given, so the word on discussion is added before the title. The discussion of these issues is not over, and it may never be over. Because medical practice pursues perfection, there is no best, only better, so the word correct is added as the pursuit goal. In particular, our discussion is not limited to the medical field itself, but has been extended to natural science, philosophy, sociology and even unknown fields in the future. Why is the span so big? Why do you want to write like this? Because of human medicine, talking about human health is no longer just about the specific problems of individual life and death. We should see, at least think, that at present, all mankind in the world is facing a series of problems that we don’t want to face but have to face. In November 2017, more than 15,000 scientists jointly signed a warning letter to mankind in the American magazine Biological Sciences. In order to express what this article wants to express, I have made some modifications and additions to their original intention, to the effect that we are facing huge material consumption and sustained population growth. Huge material consumption will be in short supply if it is not controlled, and the law of the jungle will appear if the sustained population growth is not controlled, and mankind is heading for endless man-made disasters.

I think medicine is the same.

(Reprinted from Medical Contention, No.04, 2020)