‘The 3 Tiers of Doctors Forum’: The Lower Tier Treats the Sick, the Middle Tier Treats People, the Higher Tier Treats the Country


Modern-day life is stimulating, to say the least—and our fast-paced routines may be accompanied by stress, tension, anxiety, and mental exhaustion. For many people, maintaining good physical health in the midst of their busy lifestyles tops their list of intentions. Dr. Yang Jingduan, a well-known Chinese psychiatrist based in Philadelphia, launched a series of lectures on the “The Three Tiers of Doctors Forum” to share his insights on the mind and body connection.

The following are transcripts from the lectures.

Lecture One: Opening Remarks

Hello everyone, this is the first of  “The Three Tiers of Doctors Forum” series. Why is it so-called? In Chinese history, there is a saying, “The lowest tier doctors treat diseases, the middle tier treats people, and the upper tier treats the country.” Put all these different tiers together—hence the title “The Three Tiers of Doctors.” This forum aims at sharing the principles of treating diseases and people and governing the country, and their respective relationships with our health.

Let me first explain the concepts of the “three tiers of doctors,” with their respective “patients.” Bian Que, an eminent doctor in ancient China, and his two siblings were all doctors. One day, the emperor called Bian Que and asked him: “You are very famous, but can you tell me who else is a better doctor than you?”

Bian said: “We have three brothers in our family. My eldest brother can see the problem before people get sick. He tells people how to live. These people are cured before they get sick, which makes it difficult for their medical skills to be recognized. So, he is not famous, except for the respect of our family, and no one else knows his true worth.

My second brother is able to detect people’s sickness in the early stage, so he cures the patient before it gets worse. People think that he is only good at curing minor illnesses, so he is not very well-known either. For myself, I am involved when the illness turns profoundly serious. There I need to use all things at my disposal, needles, medicine, and scalpels, and it seems that I always save people from death, so I am more famous than my brothers. But in fact, they are both smarter than me.”

Lower Tier Cure the Disease

Now let’s talk about the “Lowest Tier Doctors Cure the Disease.” This means treating disease at its advanced stage. At this point when a person is already sick or is indeed very sick, just how ill is the patient for it to be classified as such? The answer is that when it’s in the stage where it can be seen with the naked eye, is detectable by instruments and tests, and with all symptoms visible, or touchable on the human body, treatment is needed.

We are not dismissing “Lowest Tier” doctors as inferior because they treat diseases in the advanced or the most superficial state. In English, it is called “downstream,” which means that it is like water flowing from upstream to downstream. If we classify the early stage of the disease as upstream, then the late stage of the disease is downstream. Going to see the doctor at this stage is actually the downstream stage of curing the disease. This is not to say that downstream curing is not important. Instead, it is very important.

The reason why Bian Que is famous is that he is a doctor who engages in the later stages of treatment. In fact, all the things that hospitals and doctors do today are basically this type of work—the later stages. It should never be interpreted that they are inferior or of low level, but simply refers to the stage of the disease they treat.

Middle Tier Treat People

Next, let’s talk about “Middle Tier Treat People.” The human body is extremely complicated, and the reasons why people get sick are even more complicated. Daily life routines have a great impact on a person’s health, and mentality and mood also play a significant role. People are born with congenital factors, which are called genetic factors in the West, and congenital constitutions in the East. These all have an impact. And there are also environmental factors, which will affect one’s health too.

Therefore, treating people in such a “middle” stage refers to how to minimize some of those factors that cause people to suffer from diseases before they get sick. Middle-tier doctors (incidentally identical in writing as “Chinese medicine”) here do not refer to traditional Chinese medicine. It refers to how one should live and prevent diseases and is more appropriately called the treatment targeting the middle stage of the disease, the state between the two extremes from health to disease, and how we can minimize the factors that cause them. Dietitians, yoga teachers, qigong masters, and the like, who guide people with psychological stress reduction and counseling, life guidance, relationship counseling, and even counseling and guidance at work, all belong to this category and are also very important.

Upper Tier Cure the Country

Finally, let’s talk about “upper tier cure the country.” My understanding is: the most important thing in a country is its policy. Preventing disease and maintaining health are closely related to a country’s public health policy. And a country’s policy will affect the health of the entire population.

I remember that in China in the earlier years, students and employees had to do stretching exercises following a pre-recorded routine through a loudspeaker as a group at a set time of the day, and students had to do eye exercise routines (massaging the many acupoints near the eyes) during their recess. This is an especially important manifestation of public policy, which is of immense help to the health of the entire population. There was also the problem of smoking, which is another very typical example. When I was a doctor in mainland China, we young doctors all smoked. However, once the research that smoking could cause lung cancer and various respiratory diseases was published, some of us simply quit smoking for good.

Some people might say, “I know it’s bad for me, but I still have to smoke.” This is more to do with their personal choice. When the country starts to formulate policies that say smoking is not allowed in restaurants and public places, this is an example of “the upper-tier doctor heals the country,” because this policy affects everybody there. It includes the country’s advocacy of social morality, moral concepts, and healthy living habits, all of which involve “upper tier cure the country.”

The “Three Tiers of Doctors Forum” wants to share with you the various beneficial experiences and methods that we humans have accumulated so far from these three levels. This is a sharing of knowledge and methods, so everyone is welcome to participate in this forum and tell us your thoughts and experiences. Although we are all ordinary people, we can all contribute to the health of the whole society and the public.

Views expressed in this article are the opinions of the author and do not necessarily reflect the views of The Epoch Times. Epoch Health welcomes professional discussion and friendly debate. To submit an opinion piece, please follow these guidelines and submit through our form here.

Jingduan Yang, M.D. F.A.P.A. is a board-certified psychiatrist specializing in integrative and traditional Chinese medicine for chronic mental, behavioral, and physical illnesses. He contributed to the books "Integrative Psychiatry," "Medicine Matters," and "Integrative Therapies for Cancer." Co-authored "Facing East: Ancient Secrets for Beauty+Health for Modern Age" by HarperCollins and "Clinical Acupuncture and Ancient Chinese Medicine" by Oxford Press. Dr. Yang is also the founder of the Yang Institute of Integrative Medicine and the American Institute of Clinical Acupuncture and the CEO of Northern Medical Center, Middletown, New York, since July 2022.
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