"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 howork 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 at, 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 homade 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 seed he had so success. "By the way, let’s not buy sour cabbage from outside anymore. We will make it all at ho from now on."
"Mm."
Chai Chai didn’t understand why but still nodded in agreent, listening to Li Ang’s strange grievances about "ho-fernted 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 ," ca 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 welco her.
Qiu Feng stood outside the door, her brows slightly furrowed, holding a book titled "First Edition Imperial dical Bureau New-Style Textbook – Physics of Diagnostic dicine," 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 dical Bureau textbook, with "Author: Li Ang" on it, onto the table and calmly asked, "What is this all about?"
"You an?"
"The Imperial dical Bureau’s reform."
Qiu Feng stated earnestly, "We were all happy about the Imperial dical 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 dical Bureau’s expansion and the recruitnt of more dical 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 dical 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 sothing was amiss.
"Risheng, in this book on Physics of Diagnostic dicine 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 dical Bureau, read through dical books from a young age, and had a deep understanding of dical principles.
The Physics of Diagnostic dicine that Li Ang compiled seed 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 dical 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 co from families of doctors. Since Zhang Zhongjing, Central Plains dical science has established the principle of Differentiating and Treating. Differentiating and Treating ans 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 treatnt thods. Specific analysis for specific problems. This part I’ve got right, haven’t I?"
"Mm."
Qiu Feng nodded in agreent.
"Good. So, the thods of dical differentiation include the Eight Principles, Qi Blood Fluids Differentiation, organ differentiation, Six ridian Differentiation, and so on. It’s like having different types of tools with the sa effect. Among these, the most universal and fundantal 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 treatnt in traditional dicine and said earnestly, "Based on the Eight Principles Differentiation, this thod 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 sa. Two patients with common cold symptoms such as chills, fever, and headache, due to different factors like lifestyle habits, health conditions, and living environnts, might have different causes of the common cold, such as Wind-Cold, Wind-Heat, Sumr-Heat Dampness, and so on. Different causes produce different prescriptions. The sa patient at different tis with the sa disease will have different prescriptions. Even for the sa patient, two doctors diagnosing at the sa ti might prescribe completely different treatnts. 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 dical Bureau and the Pharmacy Bureau, have a profound understanding of dical 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 dications 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 dical books and accumulating experience over a long ti, but also strong logical reasoning skills and the ability to observe ticulously. It is not sothing that can be done simply by reading so dical books and morizing so prescriptions. Many diocre 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 dicine based on symptoms: coughing ans expelling phlegm and stopping coughs; diarrhea ans protecting the intestines and stopping diarrhea; excessive internal heat ans nourishing Yin and clearing heat. Such practices lead to misdiagnosis or incorrect diagnosis. Consequently, patients beco ill in confusion, take dicine in confusion, and die penniless in confusion. Not to ntion 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 mont he wanted two slices of ginger and ten bamboo leaves with tips removed; another mont he wanted reed roots dug from the riverside and sugarcane that had been frosted for three years. Two years went by with no improvent in his condition, and once the doctor had taken enough money, he earnestly admitted his limits and recomnded another one, a Dr. He who was the head of the Xinglin Association sowhere. And this Dr. He prescribed even stranger drug guides, going as far as to require a pair of crickets from the sa nest, and eventually used broken drum skins to make what he called Defeated Drum Skin Pills. After several years of this treatnt, 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 extre lengths."
Li Ang’s tone remained calm, but inwardly, he finished the latter half of the story.
The patient in the story was nad 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, an that the dical 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 dical rationale, he still held their dical skill and ethics in high regard—dical skills that are effective are good dical 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. anwhile, gifted and capable doctors like Qiu Jing and Qiu Quan are rare, likely existing only in the realm of hearsay for ordinary people.
"The dical profession will always have fewer good doctors and more diocre ones. This is a fact of probability, unrelated to my likes or dislikes."
Li Ang said peacefully, "That’s why I must initiate reform."
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