Narrative medicine, which is popular all over the world, is replacing evidence-based medicine, and its philosophical basis is an important issue urgently needed to be discussed. Karen puts forward that inter-subjectivity, as the core content of his philosophical foundation, will face three difficult problems that cannot be solved: the uncertainty of subject status, the paradox of inter-subjectivity itself, and the abstract and distorted doctor-patient relationship of the doctor-patient individual. Only by absorbing the intervitality of rationalism and irrationalism, and completing the transcendence of inter-subjectivity from Marx's dialectical analysis of the natural and social attributes of life, is the core content of the philosophical foundation of narrative medicine in which doctor-patient empathy and joint decision making are made.