Chapter 317: Chapter 272: Evidence-based
"I seek rational, quantifiable, standardized, and evidence-based methods to optimize medicine, thus transforming medical skill from empiricism to rationality. This is known as evidence-based medicine," Li Ang stated. "Traditional Differentiating and Treating relies on personal experience, which is why quacks proliferate, good doctors struggle to supplant them, and the industry finds it hard to cleanse itself. Everyone has their own version of what’s right. Some effective treatments, unknown to the public, are shelved away, while some ineffective, even harmful treatments, such as cutting one’s own flesh to feed relatives, are widely propagated and used long-term, causing severe and lasting damage.
Evidence-based medicine, however, is different. Its very name signifies following the evidence.
Take malaria as an example. It’s said that malaria is caused by an external evil. So, what is this external evil? Is it wind, cold, summer heat, dampness, dryness, or fire? If you expose someone to a gale, will they get malaria? If you leave someone out in the summer heat, will they contract malaria? If you strip someone bare and place them on an icy surface, will they get malaria? The answer is clearly no."
Li Ang shook his head. "Doctor Qiu Jing should have mentioned in the Imperial Medical Bureau how malaria was prevented in Chang’an back then. They did not immediately adopt my suggestions but instead followed my method and gathered extensive evidence. For instance, by going door-to-door, they found that people living in low-lying, mosquito-infested areas had a higher overall probability of contracting malaria than those living in higher elevations. People in homes with mosquito nets had an even lower probability of catching malaria. Evidence of this nature was found piece by piece. Subsequently, measures included cleaning stagnant water, sealing canals, stocking fish in those channels, actively eliminating mosquito larvae, and ensuring every household hung mosquito nets... After implementing these targeted measures, the incidence of malaria in Chang’an that year significantly decreased.
Therefore, it can be said that malaria is related to mosquito bites. Mosquito bites are the true culprits behind malaria, not factors like wind, cold, summer heat, or dryness.
And now, with the microscope and the Mind Silk Detection Method, we can delve even further and find more evidence, such as identifying the Malaria Parasite within mosquitoes as the specific cause of malaria.
Layer by layer, we continue to search for evidence and categorize it based on its strength and reliability, much like solving a mathematics problem by narrowing down the range of possible answers. This is evidence-based practice. Who can say that this method, which doesn’t rely on the Eight Principles, is irrational or doesn’t align with true medical principles?"
"..."
Qiu Feng frowned, sensing something was amiss but not knowing how to refute him.
Li Ang smiled slightly at her reaction, unconcerned that Qiu Feng might misunderstand. The appeal of evidence-based medicine lies in its rationality, and she, too, was a disciple of the Academic Palace.
"Furthermore, evidence-based medicine can also be subjected to falsification and self-correction," Li Ang added. "If anyone doubts that malaria is caused by mosquitoes, they can conduct a reasonable experiment. For instance, placing a person with a group of mosquitoes whose proboscises have been removed to observe if the subject reacts. Or having someone listen to the sound of mosquitoes flying without being bitten.
Or, to test the effectiveness of Artesunate, three different substances could be administered to three groups of people with roughly similar health conditions: Artesunate, Potassium Antimony Tartrate, and physiological saline as a placebo. In such a trial, neither the administering doctor nor the patients would know who received which substance. Finally, by observing the long-term survival rates and quality of life of the patients, one could determine whether Artesunate is truly effective.
Through such prolonged and extensive verification, a complete set of data and evidence can be compiled. Doctors can then prescribe what is theoretically the most effective treatment, based on previous medical cases, their own experience, and the patient’s specific condition. Everything is rooted in evidence that can be replicated, widely applied, and tested. I am confident that evidence-based medicine, grounded in anatomy and pathology, is just as potent as medicine based on the principles of Differentiating and Treating."
Li Ang placed his hand on the textbook of physical diagnostics and spoke earnestly.
Qiu Feng’s brow furrowed deeply. "Even if it contradicts existing medical theory?"
"What is medical theory? If it cures patients, returning them to health, that is medical theory," Li Ang said. "Physicians administer a hundred poisons; fumigation and irrigation proceed without pause. Moxibustion masters apply their burning moxa, as fierce as a ring of hunting fire. If holding a Mugwort Fire Candle could guarantee—or at least make it highly probable—that the agony of malaria would be cured, then despite my doubts, I would assume there was something I didn’t yet understand. I would try to analyze and comprehend it until I grasped what was happening, rather than, as in past encounters with malaria, talking a great deal yet still failing to pinpoint the cause or clarify the process."
"..."
Qiu Feng finally understood Li Ang’s purpose. She took a deep breath and said in utter shock, "Risheng, are you planning to remake medicine?"
"More accurately, to advance it," Li Ang corrected. "Evidence-based medicine is a more rational form of Differentiating and Treating. It is established on quantifiable standards and is a product of Natural Science and societal development reaching a certain stage. Without microscopes, without statistical studies, without a general acceptance of rationality, evidence-based medicine could never have emerged. It’s like a person—can you say that an eighteen-year-old is not the same person they were at eight?"
"That’s sophistry." As a fellow disciple of Natural Science, Qiu Feng immediately retorted, "If this set of textbooks is distributed, after a few decades, will there still be medical students in the Imperial Medical Bureau who understand the Eight Principles?"
"A few decades should be enough time for people to grasp the general picture of something," Li Ang smiled. "Remember our practical work in the sick houses? We amassed a large number of cases, meticulously recording patients’ identifying information, the progression of their illnesses, and treatment processes in paper documents, thereby creating a traceable evidence base. We can absolutely verify this through practice. Through long-term practice, we can gather data, test the efficiency and practicality of the two methods, and compare their strengths and weaknesses. Medical students willing to learn from the original textbooks can do so, and those who want to learn evidence-based medicine can learn that. Truth becomes clearer through debate and practice. And I have enough patience and time to see the results emerge. Eventually, this will refine medicine, removing the dross to reveal the essence."
"Decades to conduct an experiment..." Qiu Feng was stunned by Li Ang’s ambition and grand plan. The expansion of sick houses across various regions had arguably laid the foundation for practical application and data collection. The seven or eight hundred states, with their population of four hundred million, were all part of Li Ang’s plan.
Did he already envision this day when he first introduced Allicin?
She looked again at the familiar yet strange young man before her and slowly said, "Risheng, have you ever considered that with your current reputation and status, you already have the final say in the Imperial Medical Bureau? In a few decades, who could possibly contend with you?"
"You could," Li Ang smiled. "It was you and I who invented Mind Silk Surgery, and it was you and I who witnessed the entire Suzhou Water Poison affair. Our debate today is entirely focused on how we can better treat and heal people. Sectarian viewpoints are only a small part of it. I believe in your medical skill, your medical ethics, and your acceptance of rationality and truth. This world is yours, and it is mine, but ultimately, it belongs to the people of the future, to our descendants."
"!!"
Qiu Feng’s face reddened visibly, and she stammered, "W-what nonsense are you talking about, descendants?"
"Er... I meant all of humanity’s descendants, not specifically ours..." The moment the words left his mouth, Li Ang realized his gaffe. His expression stiffened slightly, and he quickly waved his hands, attempting to backtrack, "Sorry, I didn’t quite think that through. My fault, my fault."
"Hmph." Seeing him flustered, Qiu Feng felt even more embarrassed and annoyed. She picked up the textbook on physical diagnostics from the table and said, her face slightly stern, "I’m going back now. I haven’t finished reading this book. You must be there when the Imperial Medical Bureau expands its recruitment. If you want to promote evidence-based medicine, you can’t very well do that without being present yourself."
"Definitely." Li Ang sighed in relief and glanced at Qiu Feng’s slightly flushed cheeks. "Shall I walk you out?"
"Mm."
Under Chai Chai’s curious gaze, the two pushed open the study door and crossed the courtyard in a somewhat subdued silence.
Li Ang stood by the door, wondering what to say as a farewell. Qiu Feng, also holding her book, slowed her steps.
"See you at the Academic Palace tomorrow..."
Before he could finish, the courtyard door was struck loudly. An urgent voice, tinged with a slight Turkic accent, called out in Chang’an Mandarin from outside, "Is this Mr. Li? I am Ashide Tumen."