Chapter 316: Chapter 271 Diagnosis
"Master, dinner’s ready."
"Okay, coming right now."
In the study of Golden City Square, Li Ang, who was triple-tasking and feverishly finishing his homework using telekinesis to hold the pen, let out a long sigh, stood up, and walked towards the living room. Casually, he asked, "What’s for dinner?"
"Everything you asked for, Master: sour cabbage pork stew with vermicelli, stir-fried celery with meat, braised fish..."
"Uh."
Upon hearing the words "sour cabbage," Li Ang’s face involuntarily stiffened, and an unpleasant sense of déjà vu arose in his mind. "The sour cabbage is homemade in our jars, right?"
"Yes, it is. It’s the one you made this winter with that kind of cabbage."
Chai Chai, puzzled, said, "Is there a problem?"
"No problem."
Li Ang breathed a sigh of relief. Previously, he had disliked the slippery texture of kui cai and had taken the opportunity to try crossbreeding Southern mustard greens with Northern turnips to create a kind of cabbage. Now, it seemed he had some success. "By the way, let’s not buy sour cabbage from outside anymore. We will make it all at home from now on."
"Mm."
Chai Chai didn’t understand why but still nodded in agreement, listening to Li Ang’s strange grievances about "home-fermented sour cabbage and intentional smoke curing" as they sat down at the dinner table.
Just as they were about to eat, they heard a knocking at the courtyard door.
"Who is it?"
"It’s me," came Qiu Feng’s voice.
Chai Chai tilted her head in confusion, while Li Ang, as if expecting Qiu Feng’s arrival, stood up from his chair and walked through the courtyard to open the door and welcome her.
Qiu Feng stood outside the door, her brows slightly furrowed, holding a book titled "First Edition Imperial Medical Bureau New-Style Textbook – Physics of Diagnostic Medicine," her expression less than pleased.
"Let’s talk in the study."
Li Ang, aware of Qiu Feng’s purpose, led her back into the house. Qiu Feng managed to muster a smile, greeted Chai Chai, and followed Li Ang into the study.
"Risheng,"
Qiu Feng placed the Imperial Medical Bureau textbook, with "Author: Li Ang" on it, onto the table and calmly asked, "What is this all about?"
"You mean?"
"The Imperial Medical Bureau’s reform."
Qiu Feng stated earnestly, "We were all happy about the Imperial Medical Bureau’s expansion plans. But why is there no content on Differentiating and Treating in these textbooks?"
The court’s morning session had seen approval from the Six Ministries for the Imperial Medical Bureau’s expansion and the recruitment of more medical students. The financial allocation required for this was within the court’s acceptable range. Furthermore, increasing the quantity and quality of doctors was certainly beneficial for senior court officials and various stakeholders.
Doctors like Qiu Quan from the Imperial Medical Bureau had long been troubled by a lack of funding and manpower. Naturally, they were overjoyed that Li Ang could secure more resources and personnel for them.
But, upon seeing this particular book that Li Ang had given her, Qiu Feng sensed something was amiss.
"Risheng, in this book on Physics of Diagnostic Medicine that you authored," Qiu Feng flipped to a page, "it says possible causes for fever may include internal bleeding, massive hematomas, arthritis, dermatomyositis, pulmonary embolism, necrosis of limbs, cerebral hemorrhage, etc. For fever accompanied by recurrent chills, it could be malaria or septicemia. With bleeding, it could be a hematologic disease. With chest pain, it might be myocarditis or a lung abscess. With abdominal pain, it could be a liver abscess..."
She looked up at Li Ang, speaking earnestly, "You’re directly narrowing down possible causes based on the symptoms exhibited, without any differential diagnosis or evidence collection. Risheng, what are you trying to do?"
It was no wonder Qiu Feng had such a strong reaction. She had grown up in the Imperial Medical Bureau, read through medical books from a young age, and had a deep understanding of medical principles.
The Physics of Diagnostic Medicine that Li Ang compiled seemed to use inspection, auscultation, inquiry, and palpation, but it completely lacked the process of differential diagnosis. It didn’t go through the Eight Principles.
To put it favorably, Li Ang was bold and skilled. To see it negatively, Li Ang was defying medical principles.
"Please have a seat, and let’s discuss it."
Li Ang moved a chair over with telekinesis, speaking in a calm and placating tone, "Both of us come from families of doctors. Since Zhang Zhongjing, Central Plains medical science has established the principle of Differentiating and Treating. Differentiating and Treating means using the Four Diagnostics of inspection, auscultation, inquiry, and palpation to gather evidence. Based on the evidence, one analyzes, summarizes, and clarifies the causes, nature, and location of diseases. Then, based on the results of the differentiation, one determines the appropriate treatment methods. Specific analysis for specific problems. This part I’ve got right, haven’t I?"
"Mm."
Qiu Feng nodded in agreement.
"Good. So, the methods of medical differentiation include the Eight Principles, Qi Blood Fluids Differentiation, organ differentiation, Six Meridian Differentiation, and so on. It’s like having different types of tools with the same effect. Among these, the most universal and fundamental is the Eight Principles Differentiation. It sums up all symptoms with the eight categories: Yin, Yang, Exterior, Interior, Cold, Heat, Deficiency, and Excess. Among them, Yin and Yang form the overarching principle. Exterior and Interior generalize the depth and severity of the pathological changes. Cold and Heat describe the nature of the illnesses. Deficiency and Excess describe the state of the body’s struggle against the disease."
Li Ang briefly summarized the most important aspect of differentiation and treatment in traditional medicine and said earnestly, "Based on the Eight Principles Differentiation, this method in theory can encompass and describe all diseases in the world. However, there are no two identical leaves in the world, nor are there two patients who are exactly the same. Two patients with common cold symptoms such as chills, fever, and headache, due to different factors like lifestyle habits, health conditions, and living environments, might have different causes of the common cold, such as Wind-Cold, Wind-Heat, Summer-Heat Dampness, and so on. Different causes produce different prescriptions. The same patient at different times with the same disease will have different prescriptions. Even for the same patient, two doctors diagnosing at the same time might prescribe completely different treatments. A thousand patients, a thousand prescriptions, right?"
Qiu Feng nodded, "Yes."
"That’s where the problem lies."
Li Ang continued, "Excellent doctors, such as the Directors and Imperial Attendants of the Imperial Medical Bureau and the Pharmacy Bureau, have a profound understanding of medical principles; they observe symptoms in great detail from a higher perspective and repeatedly verify their diagnoses. Even if they arrive at different conclusions and their differentiation processes vary, their medications are still effective. However, in any field, exceptional individuals are a minority. The barrier to excellence in Differentiating and Treating is too high. It requires not only extensive reading of medical books and accumulating experience over a long time, but also strong logical reasoning skills and the ability to observe meticulously. It is not something that can be done simply by reading some medical books and memorizing some prescriptions. Many mediocre doctors—whether due to a lack of talent, unrigorous thinking, or a lack of motivation—follow doctrines slavishly and rely purely on experience. They prescribe medicine based on symptoms: coughing means expelling phlegm and stopping coughs; diarrhea means protecting the intestines and stopping diarrhea; excessive internal heat means nourishing Yin and clearing heat. Such practices lead to misdiagnosis or incorrect diagnosis. Consequently, patients become ill in confusion, take medicine in confusion, and die penniless in confusion. Not to mention those who are only after how to make money. As a result, when the common people fall ill, they dare not see a doctor and resort to copying the ’Bodhisattva Sutra’ or ’Exhortation to Virtue Scripture’ to pray for blessings."
Li Ang shook his head and said, "I once heard a story. A patient who had edema struggled to find a famous doctor. This doctor tried many prescriptions with various and strange drug guides. One moment he wanted two slices of ginger and ten bamboo leaves with tips removed; another moment he wanted reed roots dug from the riverside and sugarcane that had been frosted for three years. Two years went by with no improvement in his condition, and once the doctor had taken enough money, he earnestly admitted his limits and recommended another one, a Dr. He who was the head of the Xinglin Association somewhere. And this Dr. He prescribed even stranger drug guides, going as far as to require a pair of crickets from the same nest, and eventually used broken drum skins to make what he called Defeated Drum Skin Pills. After several years of this treatment, the patient died in agony from severe edema, and his family went nearly bankrupt in the process. The harm done by incompetent doctors goes to such extreme lengths."
Li Ang’s tone remained calm, but inwardly, he finished the latter half of the story.
The patient in the story was named Zhou Boyi, and his son, Zhou Shuren.
"The complexity and holism of Differentiating and Treating, and the stringent demands it places on innate talent, logic, and observational skills, mean that the medical profession is riddled with good and bad practitioners alike, making it hard for the common people to distinguish between good and bad doctors."
In Suzhou, while dealing with Water Poison Gu, Li Ang personally witnessed doctors like Qiu Jing and Qiu Quan using acupuncture to relieve the pain of those who had ingested Potassium Antimony Tartrate.
While he did not understand their medical rationale, he still held their medical skill and ethics in high regard—medical skills that are effective are good medical skills. However, because Differentiating and Treating does not have a standard answer, quacks and charlatans like Yu Miaoshui will always find a way to make a living. Meanwhile, gifted and capable doctors like Qiu Jing and Qiu Quan are rare, likely existing only in the realm of hearsay for ordinary people.
"The medical profession will always have fewer good doctors and more mediocre ones. This is a fact of probability, unrelated to my likes or dislikes."
Li Ang said peacefully, "That’s why I must initiate reform."