The Essence of Compassionate Care: Harmony Talks with Dr. Steven K.H. Aung

It's a natural cycle: One thing gives way; another emerges. The form of medicine that has served us in the West is now on the cusp of a dramatic change. Time has moved on and health-care needs have changed. The spectacular advances in technology that have shown us so much about the human form have come full circle. We are now in need of ways to understand and heal what ails the human spirit. Eastern medicines have for millennia understood the role of mind, emotions and spirit in the healing process; it's natural we turn to them for their insight and guidance.

What will this new medicine look like? What will it be like? Many of us have seen something of its shape already—emerging in the forms of natural and traditional medicines and spiritual wisdom that have poured into the West in the last several decades. Exactly how these forms will merge with and impact the current practice of Western medicine is still an open question. Times of transition always have a degree of uncertainty about them, yet there are always clear voices that show us the way—if we listen.

Recently, Harmony spoke with Dr. Steven K.H. Aung, a geriatric and family physician and a traditional Chinese medicine (TCM) practitioner. Dr. Aung's lifelong work has been to change the way medicine is practiced in Canada. He has continually promoted the integration of TCM and Western biomedicine in the spirit of creating a natural and compassionate approach to health care. At the University of Alberta, Dr. Aung is an associate clinical professor in the departments of Medicine and Family Medicine, and an adjunct professor in the faculties of Extension and Rehabilitation Medicine. He is a founding member and current president of the World Natural Medicine Foundation as well as an advisor on acupuncture to the World Health Organization. Dr. Aung has received numerous professional awards, including the Physician of the Century Award in 2005 and the Order of Canada in 2006.

Harmony: The subject of your opening keynote address at the 2007 Building Bridges conference is "Integrative Compassionate Care in the 21st Century and Beyond." What is the essence of compassionate care in your view?

SA: Healing can only take place between people who respect and love each other. When there is no feeling, there is no medicine; when there is no medicine, then there's no healing. So that's a very important thing for medicine to take place. The interesting thing about medicine is not only the treatment, but also the intention of treatment. In the intention of treatment, the person who treats should be not just the therapist, but also a healer. And in order to become a healer, one has to cultivate himself or herself to be, what we call in spiritual terms, purified, and at the same time treat with good intentions and loving-kindness.

Harmony: And that becomes more effective, in terms of healing, for the patient as well?

SA: That's right. You know, I met with His Holiness the Dalai Lama in 1991, and at that time I asked His Holiness several questions. One was, "What is the difference between integrative medicine and the rest of medicine?" And he said, "The difference between integrative medicine and other medicine . . . the main key is not different—the aim and the objective is to help people and to make people well, to heal the people. The key thing is that when you are giving the medicine, give it with loving-kindness and with mantras and blessings. . . ." And to me, this is so important—that the healing comes with good intentions.

I don't know whether you have read about Dr. Emoto—the secret message from the water. [Dr. Masaru Emoto is a Japanese researcher who has studied the effects of emotion on the shape of water crystals and published his findings in the book The Secret Life of Water.] Dr. Emoto is a good friend of mine, and he has been trying to prove from a scientific point of view how this is the reality: By using the water crystals and the changes of the water crystals, it was proven that intention is very important, and treatment depends on the heart and love of the therapist. That's why every time when I treat my patients, I treat with loving-kindness and blessings. Even if I do acupuncture, before I put a needle into anybody, I wish them well, I wish them to recover quickly, I wish them happiness, and so forth. I put the needle in and then I can see the change in the patient is tremendous. Most of my patients are referred to me by various specialists. Most of them are very tired, having gone through many hardships and difficulties, and even in that kind of condition, the best way to turn the key of those big difficulties is compassionate loving-kindness. That's why I believe medicine should be turning towards compassionate care in this century and beyond. So loving-kindness is very important in the healing arts.

Harmony: And is the heart the factor that makes the loving kindness so powerful? It stimulates something in the healer and also the patient?

SA: The heart is so important. The heart makes everything move. When you treat a patient wholeheartedly the healing really gets started. You do it with internal spirit. If you just treat a patient as responsibility, things will turn out good, but the healing will not start completely. So we need to have passion while doing this. That's why it's called "compassionate care"—passion comes together with medicine to create healing.

You see, we have to treat patients like our own teachers or even our ownparents. When you become a practitioner, the best teacher is your patient, who comes and teaches you every day until you understand it. The most difficult patient is the best teacher! So in order to make the healing process happen, the practitioner should give respect, loving-kindness, and treat the patient as his or her own teacher. In that way, the healing arts come from a place of mutual respect. Treating a patient is a two-way job: for every action, there's always an equal but opposite reaction, as we know from physics. In reality, how you treat your patient will react back to you. We think that we are treating the patient, but the reality is, the patient is treating us back—we just don't realize it. The more you treat, the better you are and the better knowledge you have, and the more experienced you become. And not only that, this approach gives you feedback on the healing, so you become a healer.

I grew up in a Buddhist country [Burma, now called Myanmar], and my teacher taught me five different qualities: metta, karuna, dana, mudita and uppekha. Metta means loving-kindness. You should love everybody unconditionally, without regard to race, color, and so forth. There's no differentiation; everybody should be treated equally—they are all human beings. Karuna means compassion—you should treat everybody as your own blood; the same as if they were your sisters or brothers. And dana [or sulleka-dhamma] means you should treat everybody without expectation; you should treat them wholeheartedly. It's not because they pay you money that you should treat them well. And then mudita means you should be happy, all the time. When the patient gets better, when people are successful, you are very happy for them. And upekkha means equanimity—you treat everyone equally and evenly. These are the qualities I learned when I was very small—around the age of seven. I always remember these words and their meaning, and I realize that they are still treasures for me—ones that I use in my practice.

And I believe another very important thing is that we have to cultivate ourselves to be healthy—not only physically, but mentally and spiritually, so that we can heal people rather than just treat patients. In order to heal other people, we have to not only be healthy, but also have good energy. And not only have good energy, but purify our energy. And not only purify our energy, but have an understanding of exchanging energy from the negative to the positive. You touch a patient and right then all the suffering of the patient comes to you and then goes into your body, and then you exchange negative energy into positive energy and then send the positive energy back to the patient to heal. And not only through touch, but also through sight, with the right eye absorbing suffering and the left eye looking back and giving positive energy. Sometimes you can also use breathing exercises: the right nostril absorbing all the negative energy and the left nostril giving back all the positive energy. In that way, you help heal people. Everybody should take care of themselves to make sure that they are healthy and very well balanced and in harmony, not only physically, but also spiritually. That's one of the important things we call human responsibility.

Another human responsibility is not only taking care of yourself, but also taking care of all the people around you. You should be helping them out wholeheartedly. You should help those people who are really in need of help. People who are stronger have to help the weaker ones. People who are suffering are helped by healers. That way, the whole universe will become very balanced, harmonious and full of happiness. This is the second human responsibility.

And the third responsibility is we should take good care of our environment. Our environment is just like a home for us. We have to take good care of our environment. In that way, it will be good for the next generations to live in—it will be a wonderful place. It's just like a house, a wonderful home where your kids can spend really good time there. So our duty is to make this environment become a wonderful and beautiful place to live in for all generations. So everybody has a responsibility for taking care of the environment—to make this environment clean, healthy, to make it a healing place, to make this environment a place where it can make people happy—all these things.

That's why we went to Brazil to build a Buddhist stupa [pagoda]. We put our efforts into building this stupa not only for Brazil to heal, but also, because Brazil is in the center of South America, it creates a positive Qi, or energy, that can change the negative energy of the environment, and not only physically clean it, but also spiritually clean it. So our group (IPPP—International Peace Pagoda Project) of Canadians—from here, we were almost 40 people—built a monument about forty feet high for world peace and harmony, and so that area becomes positive and a healing place.

Harmony: Where is that located in Brazil?

SA: In the state São Paulo—in the Amazon forest. Why did we choose the forest? Because the forest provides energy, and this energy becomes a healing place so that it is not only good for the people from São Paulo, but also for all the people in Brazil, and not only Brazil, but the people in South America and the whole world. We made this effort and a lot of our friends and colleagues got together and built a monument there to create a place with good Feng Shui.

Harmony: Can efforts like that help rebalance the climate?

SA: Building these kinds of things—not only Buddhist, but also, you might know the big statue of Jesus in Rio de Janeiro [a 100-foot statue of Christ the Redeemer with outspread arms, referred to in Rio as "Corcovado," after the 2,400-foot mountain atop which it stands—now listed as one of the wonders of the world]—are just like acupuncture to the Earth, to create meridian balance. Just like when we do acupuncture to human beings, the key is to balance the body, so the body will take care of its own physiological imbalance. The same thing goes for the Earth—what we call Mother Nature—it can also be acupunctured. And it's not necessary to do it one way only. If you are Buddhist, you do it the Buddhist way; if you are Christian, the Christian way; Muslim, the Muslim way; and if you are Hindu, you do it the Hindu way. Everybody contributes something to the world to make it become peaceful.

Harmony: It's the intention of a symbol of something pure.

SA: That's right. These statues and all these kinds of things are different, but the intention is the same thing: peace. That's why we have to treat not only human beings and animals, but also the environment—the Earth—and make it have good Feng Shui and be healing place. This is what I call environmental medicine. To make the environment a healing place for all creatures, not only for humans but also for all sentient beings.

Harmony: One of the themes of our conference is the family. Of course, globally we're a human family, but we all come from individual families. What is your perspective on the role of family in the health of individuals?

SA: The role of family is very significant. A family starts from ancestors and is composed of grandparents, parents, and then children—brothers and sisters. The family has to keep its harmony—they have to help each other and heal each other. And everybody is responsible for their own health—for keeping themselves healthy. Family unity is very important. If one is suffering then the other will suffer also. So healing the whole family is also key. That's why sometimes when small children are sick, the mother also gets sick because she loves the child and is suffering from seeing her child not well. Sometimes you treat the mother and the child gets better; the mother has a healing effect on the child. You look at children and their parents: parents love their children, and when their kids are sick, the best therapist is the parent, the best thing is loving-kindness.

If a health problem goes beyond the level the family can heal, then they can go see a practitioner. For us, as practitioners, the main thing is we have to let the family know how to take care of themselves. It's called self-care, preventive care, and it's so important. We have to teach each family member how to take care of themself, starting from a young age up until old age, in a physical, mental and spiritual way. We have to be not only physically healthy, but mentally healthy—stable and strong—so we understand how to live in this beautiful universe. And not only that, we should cultivate ourselves, so spiritually we help and heal each other and interact in a positive way.

Harmony: What is the best way to begin to teach this? Do you see it as something that could be taught in schools, for example? Or is it the responsibility of healers to teach people on a larger scale?

SA: Actually, I've found that the teaching, in reality, should be started prenatally—during the pregnancy. So that when we are pregnant we take care of ourselves, not only physically, but also spiritually. What I mean is that you do a lot of good things in your life and that is transformed during the pregnancy to the baby. All these beautiful things should be implemented during the pregnancy, and then the quality will come out in the children. And when they are growing up you show them an example—everyday you practice things like Qigong—and then they follow you automatically.

And I think that the schools should not only be teaching the standard form of education, but also how to be a healthy human being. Schools should emphasize this. We have to train from childhood. At school we have physical education, but we should promote some of these body, mind and spirit exercises and teach children from a very young age until they finish university. My feeling is that we have to do all of these things when children are very small—just like a tree when you plant it: you care for it and it grows up to be a beautiful tree. We need to cultivate that when children are very small and create good habits of how to learn properly. I think habit is very important with children—even just simple teaching. If you know how to go out, you know how to come back; if you know how to open, you have to know how to close. And even just very simple things, like every morning when you get up, you put your pillow nicely, your blanket nicely, and arrange everything. This is a discipline. You have to teach children how to calm their mind, how to love themselves, how to listen to themselves. Self-cultivation is so important. It's essential to give them some understanding of the value of life, of how to take care of themselves with things like Qigong. Our world depends on later generations for leadership. So we have to have good, healthy, balanced and harmonious young people.

In the morning I usually do Qigong and Taiji, and the children will follow me in doing this. And slowly, later on, my neighbors will follow me. All my neighbors come down and we do Taiji together. You show them and they find it so fascinating, and then they join you in doing it. And then finally, you are taking care of your family, and then gradually your community, which gradually becomes the whole city, and that gradually becomes the whole province, which then becomes the whole place! So in that way, I think we can spread the good habit of education. I believe that self-care and preventive medicine are major features of the way to cut down the costs of health care.

Harmony: They've done studies that show that the effects of a positive thought are much stronger than a negative one. . . .

SA: That's right! First, we have to create positively from individuals to the family. And then the whole family is positive—the energy is so positive, so purified in one family, then two families, and slowly, a whole community becomes very positive and understanding, showing loving-kindness to each other, respecting each other, and helping each other. That way, the universe would be a beautiful place to live in—with no fighting or hatred or anger. Then we will be in a totally harmonious place with loving-kindness. And that way, the whole planet becomes a beautiful, wonderful, loving thing.

Harmony: Many of the people who attend the Building Bridges conference are Western acupuncture and TCM students. There's such a great difference between the way Eastern and Western people think. Eastern thought patterns tend to be more circular, and it's more natural to think in terms of the group, which you've been talking about—individual builds the family, family builds the community, and so on. Westerners tend to be much more individualistic and think in a linear way. Chinese medicine grew out of the culture and the spirit of Chinese people, which is to think in terms of a group. How can Western students learn the true spirit of Chinese medicine? How can they really tap into the spirit of TCM if they don't change their mindset?

SA: You know, what's important is to show people an example of what is different and how wonderful it is to become holistic rather than just an individual like that—compartmentalized. Just to give you one example: When you go to a dinner party, the Western way of eating is to eat individually—we have our own steaks and we use our fork and knife to eat. If you go to a Chinese restaurant, people are eating together at the same table with different meals, and you can pick up what you like to eat from each dish. This is showing that you're right—in the West, we are thinking mostly "I": "This is my plate, my steak." It's definite, individual. In China we eat at the table with a whole group of people, laughing and enjoying, and you taste every single dish with chopsticks and without permission! This style is according to a more holistic way. When you eat like this, in the Chinese style, psychologically you step into the culture and you don't even realize it! And another thing, look at all the Chinese healing arts: our approach is more holistic, preventive and with self-care—the art of healing. The Western way is more specialized, individualized.

Harmony: Just like a separate Western menu!

SA: People don't realize there's a connection. Just like, for example, the eye specialists should also be taking good care of the Liver because the Liver is associated with the eyes. And, another example, an Ear, Nose and Throat specialist should understand how the Kidney affects the ears—the Kidney and the ears are connected. So it's very important that we should be giving this kind of education to medical professionals to give them the understanding of the connection and cooperation in the body. The body is one body, but inside there are so many organs. They function individually, but they are also connected with the others. We have to let medical practitioners know this.

I give medical grand rounds, and in terms of the residents who attend, I teach them how to understand the body as a whole rather than individually. Sometimes, when they only understand it individually, they think, "Oh, there's something wrong with the eyes," when the reality is there is a big problem with the Liver, which is causing the eyes to have trouble. All medicines are trying their best to help the patient out, but it's nice to cooperate with each other. Western medicine is high-tech and is very useful for precise and accurate diagnosis—for instance, exactly where a tumor might be located, but in Chinese medicine there is a holistic understanding of how things are connected and how things affect each other, not only physically, but mentally and spiritually. And this is a very valuable thing that Western physicians should learn also.

So we should be exchanging each other's knowledge, energy, appreciation, respect, and so on. We should cooperate with each other, have a dialogue going on; we should do research together. And then Chinese medicine will be sharing with Western medicine the art of healing and the beauty of body, mind and spirit—a holistic understanding. And Western medicine can help Chinese medicine understand the scientific way, with high-tech things like a precise diagnosis, how high the blood sugar is, how high the blood pressure is, and so on. In that way, we can make the whole universe become a healing place. We should be looking to create well-being rather than just treating disease. Treating disease is acting once a problem has developed, but we should be targeting medicine toward general well-being before it gets worse. That's why Lao Tzu, the Taoist teacher, said, "When things are very small, you should treat them well so they don't get worse." We need more preventive treatment.

Harmony: The superior physician treats the patient before he or she gets sick.

SA: That's right! As practitioners, we have to take care of ourselves to become a healing place, a healing body. If the patient is healthier than you, how can you heal the patient? As practitioners, we should be taking care of ourselves every day, every minute, every second—aware of what we are doing, cultivating ourselves to be in a state where we can heal people, help people, where we can touch them, see them, speak to them, and heal them. As practitioners, we have the responsibility of taking care of ourselves to become healers rather than just technicians.

Harmony: Dr. Aung, what is your perspective on medical Qigong?

SA: I have found in my life that Qigong is the best thing for me. No matter which profession you are in—a teacher, an acupuncturist, a chiropractor, a surgeon—you have to have good Qi. A lot of people think of Qigong as just exercise, but it's an exercise of body, mind and spirit. It's not only physical exercise, but also mental exercise—to become stable and harmonious in our mental attitude.

Qigong is a health discipline through which you can help not only yourself, but also give a person who is not well the ability to create his or her own well-being. So Qigong is not only self-cultivation alone, it can help a person become ready for treatment. And when you need to go to a practitioner, he or she readjusts any imbalances for you and you become healthy once again. Patients who practice Qigong make it easier for a practitioner to treat them because they are already well-aligned. Then all you need to do is just give them a tiny bit of healing and it goes right in! That's why I have found Qigong a very important thing for the community. Everybody should practice Qigong every morning just like they brush their teeth and wash their face. In this way, everyone can become responsible for his or her own health.

By doing Qigong in the environment, the environment becomes a healing place. For example, a hospital could not only treat a sick patient sent to the hospital, but this hospital could become a real healing place where people enter into the hospital and get better because it has good Qi. Here in Canada, my responsibility has been to make medicine move toward a wellness model, toward more preventive health care and self-responsibility.

Finally, Qigong is not only taking care physically, but also energetic alignment. We all have body, mind and spirit. Body, mind and spirit have to be well-aligned and well-focused, just like a camera. That's what it means to be healthy. If a camera is out of focus and you want to take a picture, the picture will be out of focus and unbalanced. That's how I explain it to my colleagues. When we practice Qigong, we are trying to realign ourselves in a way where we become well-aligned in body, mind and spirit. If you are a healer, you are so sharply aligned that every single unalignment becomes aligned again. In this way, the practice of Qigong is the practice of self-cultivation of body, mind and spirit to help yourself become a healer.

Harmony: Many practitioners want to learn Qigong to help their patients. What is the main thing they should know and understand about Qigong in order to teach Qigong and help their patients?

SA: Several things are very important. First, you have to be committed to take good care of yourself and other people. If you are committed you want to practice Qigong regularly, not do it today but tomorrow you are busy so you stop and don't practice. You have to be committed and do it regularly. Another thing is you have to have discipline. Every system of teaching has its own discipline. A lot of people ask me, "Which kind of Qigong should I learn?" I say to them, "In which one are you interested?" A teacher will teach you the technique and you will learn it as knowledge, but if you don't practice you'll never get the skill! So you have to practice. That's very important. That's why in order to become a really successful practitioner of Qigong, one has to be committed, have discipline, and practice, practice, practice.

Also, I learned Qigong when I was very small—at about the age of seven. And I've found that the best investment in my life is to take care of myself to become healthy so that I can help people and have an understanding and awareness about what's happening. Qigong—the energy—is the thing that has given me the most benefit in my life because I have become very calm and relaxed. I know how to heal myself if my body is not balanced, and it also gives me an understanding of how to purify myself. And it gives me the strength of energy to heal patients.

Qigong is not only breathing exercises, but also concentration exercises, movement exercises, phonation exercises, and calligraphy to cultivate Qi. That's why I'll give instruction at the conference of smooth flow of Qi through the breath and also understanding of how to make the Qi become purified in our body. Right now, I do a certain practice: exchange energy from the negative to the positive so that we can reuse it as good energy back to human beings. I very much like one beautiful word of this century: recycle. You recycle paper and so many things; I think we should be recycling all the negative things and then suffering can be transformed into a healing, beautiful thing and given back to human beings. In that way, we are not wasting anything.

Harmony: That's a beautiful concept and practice! It's perfect for the twenty-first century because up until now the tendency in the West, at least, has been to get more and accumulate. It's so appropriate because it's not looking to get more but to use what we have and reuse it in a wiser way.

SA: You know, recycling is so powerful. Look at this planet—the ocean is full of water. Look at the sky—the air is so beautiful. We have to recycle and reuse. Otherwise, we are always looking for new things. We know how to accumulate, but we don't know how to let it go! That's why a lot of people have disease—because they don't know how to let it go. I teach all my students to learn how to let it go, to learn how to recycle, and in that way they understand about the value of their own energy. Otherwise, they don't even know they have this kind of capacity and ability. That's what Qigong can convey to you: awareness about what you are, who you are, and what you are doing.

Intention is so important. You heal everyone with loving-kindness. That's integrative medicine for the 21st century: with loving-kindness what you are giving to the patient with the medicine never ends because loving-kindness is such a big, big healing thing. Students are the teachers of the teacher; patients are the teachers of the doctor. That's why we have to respect our patients and give them our blessings.

Harmony: The things you're speaking about are the gifts that the East brings to the West.

SA: That's right! I think we have so much to learn from the East, and Eastern people have so much to learn from the West. What is "universe"? Universe means only one; "uni" means one. If you walk from the East to the West, it becomes the same thing! In reality, there is not East or West! The reality is they are all part of the same universe. We, ourselves, divide it into East and West. There's really no thing called East or West—everything is in your mind, what you have created yourself.

Harmony: Do you think that's the destiny of all these medicines—that when we become more aware and have this consciousness you've been talking about, all these borders and false distinctions will disappear?

SA: They will disappear. If you look carefully, it's just like a big house: If you have no walls, you can see through everything; if you put up partitions then you cannot see through and you will be living in a small place. Medicine should be wide-open and helping people out. The key is to help people. I believe all medicines should work together, hand in hand, heart and heart, integrated and committed to working together with the goal of well-being. And I think the future of medicine is not only all these integrating medicines, but teaching the patient how to walk hand in hand and heart to heart with the therapist. They also have responsibility themselves, and in that way, the whole universe will become a very healthy, happy and harmonious place. That's my dream.

To learn more about the work of Dr. Steven Aung, visit www.aung.com.