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Chapter I Introduction

From observing the instinctive self-medicating behaviors of animals to creating an original medical system based on experience and specific cases, and from studying the theological universe to exploring the relationship of human lives with nature and society, humans have developed a large number of medical theories, such as the Five Elements, the Three Body Fluids, the Four Elements, the Four Body Fluids, the Three Reikis, Yin-Yang and the Five Elements^[1], and the Four Causes^[2]. These theories, in the course of development and integration, have fallen into two medical systems based separately on reductionism and holism. The reductionist system, which I call “literature medicine”, is built on the research results of various medical specialties supported by a large amount of experimental data. It uses rigorous and standard terms and expressions to define in detail the diagnosis and treatment procedures and methods of different types of diseases. The holistic system, which I call “case medicine”, is built on human experience and successful clinical cases. It flexibly diagnoses and treats diseases through analogism.

These two systems, although relying on different theories, falling into different categories, and adopting different therapies, share the same fundamental purpose of effectively maintaining human health.

Chapter II “Literature medicine” and “case medicine” are coined from the common characteristics of law and medicine

In the history of humankind, medicine and law have been the two fundamental pillars of social development — the former maintains human health, and the latter maintains human dignity and social order. Previous studies have disclosed some characteristics shared by medicine and law. For example, law regulates individual and collective behaviors, while medicine regulates the morphology and activity of body tissues and cells. Based on this, we have explored a new way to classify medical systems to guide medicine to its fundamental purpose, promoting the development of human health.

Modern law is divided into civil law (statutory law) and common law (case law). The characteristics of the two large categories are briefly described as follows:

1. The civil law system is built on normative legal documents formulated by legislative bodies, administrative laws and regulations promulgated by administrative bodies, and international treaties that a country has participated in. In systems of civil law, judges can only apply and obey written laws, whose judicial interpretation is also strictly limited. In short, judges can only apply laws, not create them.

2. Relying on both statutes and precedents, the common law system plays an essential role in the legal universe. It applies prior judicial decisions to the trials of similar cases. Under common law conventions, judges can apply both statutes and precedents and may, under certain conditions, create new precedents through legal interpretation and reasoning. Generally, judges can not only apply laws but also create laws in a given framework.

Similarly, the medical universe is composed of two systems. One of them, guided by reductionism, is built on the research results of various medical specialties supported by a large amount of experimental data. It uses rigorous and standard terms and expressions to define in detail the diagnosis and treatment procedures and methods of different types of diseases, similar to the civil law system in which judges apply and obey written laws to cases. The other, built on human experience and successful clinical cases, flexibly diagnoses and treats diseases through analogism and allows the creation of new therapies by doctors based on experience and relevant medical documents. This is similar to the common law system in which judges apply both statutes and precedents and may create new laws. The two legal systems exist by their own characteristics while complementing each other. This paper classifies the medical universe into two similar systems and names them according to the classifications used in law.

Literature medicine — A branch of medicine which maintains human health in strict accordance with existing medical literature and documentation.

Case medicine — A branch of medicine that maintains human health according to human experience and successful clinical cases and allows medical innovations based on theories and practices.

 

Chapter III Introduction to literature medicine and case medicine

I. Overview of literature medicine and case medicine

Case medicine originated from observing the instinctive behaviors of animals, such as rescuing and medicating themselves, and studying clinical cases. From 1500s BC to 900s BC, many medical theories, such as the Five Elements, the Three Body Fluids, the Four Elements, the Four Body Fluids, the Three Reikis, Yin-Yang and the Five Elements, and the Four Causes came into being. In this process, almost every therapy and medicine was developed based on experience, from case-specific analysis to expanded practice and analysis to final popularization. As humans gained deeper insight into themselves and the world as a whole, they started to view the world from microscopic and macroscopic perspectives and thus developed reductionism and holism. Guided by these two theories, two medical systems emerged and evolved based on massive bodies of medical literature written based on experience (successful clinical cases) and analysis.

1. Reductionism believes that various complex phenomena can always be understood by decomposing them into basic building blocks and interactions and that different branches of science, which describe different levels of reality, are fundamentally built on physics, the most basic science of reality.^[3] Guided by reductionism, medicine has broken down the human body’s systems based on experiments to reveal its intrinsic nature and the law of evolution at the level of “elementary particles”, to identify disease “targets”, and finally to remove these “targets”. In this process, technological discoveries such as X-rays, ultrasounds and chemical analysis and testing methods such as blood and body fluid tests have been used as important means of clinical diagnosis. As a result, a complete medical system — literature medicine — has been created based on a written tradition with standard terms and expressions. In this system, diseases are diagnosed and treated in strict accordance with the requirements of medical literature, and medical behaviors are restricted by relevant diagnostic statutes.

Literature medicine comprises mainly traditional Egyptian medicine, traditional Babylonian medicine, biomedicine, clinical medicine, and molecular medicine.

2. Holism is a way through which humans view the world. From a holistic perspective, people tend to think more, understand more and find more through analogism. Guided by holism, doctors have created many new diagnosis and treatment methods through practical experience. Case-based analogism is the process of deducing the possible similarities between different cases that are similar or identical in some aspects, thereby revealing the links between complex and changeable symptoms and their law of evolution. Case medicine emerged and evolved as part of human history and has been promoted by the development of holism, as proven by a large amount of medical literature and successful cases. Case medicine focuses on the reference to precedents and allows the creation of new therapies based on studies of precedents, including those written into the literature.

Case medicine comprises mainly traditional Chinese medicine, traditional Jewish medicine, traditional Greek medicine, traditional Roman medicine, traditional Indian medicine, and empirical medicine.

Literature medicine and case medicine are like twins with the same “blood” — sharing the same purpose of maintaining human health, they have been developing in different environments independently while affecting each other.

II. Characteristics of literature medicine

1. Literature medicine creates standards with quantitative indicators. Guided by reductionism, literature medicine breaks down the human body system into various disciplines (e.g., dermatology, cardiology and urology) for analysis based on experimental data, and the analysis results are summarized into medical literature written with standard terms and expressions. In literature medicine, doctors strictly follow theories, drugs and therapies specified in the medical literature to diagnose and treat diseases damaging human health. Standards created by the system with quantitative indicators (e.g., the normal fasting blood glucose level for healthy people is 3.9-6.1 mmol/L^[4]) are easily recognized and accepted by the public and thus widely trusted and promoted.

2. Literature medicine is a rigorous and normative system that requires axiomatic logical thinking and formal logical reasoning in the process of exploring nature and the human body system. ^[5] In terms of clinical diagnosis, its practice heavily relies on physical tools such as X-rays, ultrasounds, chemical analysis and testing methods such as blood and body fluid tests. In its rigorous and normative framework, literature medicine takes a very cautious attitude toward unfamiliar diseases, as well as therapies not recorded in medical literature, not recognized by their pharmacological properties, or not supported by relevant data.

3. Literature medicine is taught in disciplines by colleges following a set of standardized procedures. Medicine is taught as both basic medicine and clinical medicine, which are further divided into the courses of human anatomy, tissue embryology, physiology, biochemistry, pharmacology, preventive medicine, surgery, medical ethics, medical genetics, medical imaging, diagnostics, pediatrics, obstetrics and gynecology, internal medicine, epidemiology, psychiatry, dermatology, etc. After finishing these courses, students need to receive standardized training as residents at hospitals and obtain a medical license before starting their professional careers.

4. Literature medicine strictly distinguishes and defines the duties of practitioners in different specialties. Currently, in China, clinical practitioners mainly fall into physicians, surgeons, obstetricians and gynecologists, pediatricians, medical imaging technicians and radiologists. There are also practitioners specializing in stomatology, public health and nursing. The duties of various specialties are defined by a range of regulations, such as the Code of Conduct for Healthcare Workers, Management Practices for the Safe Use of Medical Devices, Duties of Residents, and Outpatient Management Regulations.

5. Literature medicine heavily relies on technical science. In the Middle Ages, medical teaching at western medical schools was mainly around Avicenna’s The Canon of Medicine and the works of Galen and Hippocrates. Teachers strictly followed these works without making any improvements^[6], until the emergence of the Renaissance and the Industrial Revolution starting in the 18th century, during which the rapid progress in natural science greatly promoted the development of medicine. New technologies have enabled the creation of new therapies. As this momentum continues, an increasing number of research results have been achieved, applied and promoted.

III. Characteristics of case medicine

1. Case medicine relies greatly on precedents. In this system, when treating a disease, doctors tend to use the therapy and medicines that have been successfully applied to this disease in the past. Prior successful cases can usually ensure satisfactory outcomes.

Yunnan Baiyao, a traditional Chinese medicine (TCM) widely used in China to treat traumatic injuries and bleeding, is a good example. Developed by Qu Huanzhang, a doctor from Yunnan, China, in 1902, the medicine is known as the “Treasure of China” and “Panacea for Wound Healing”, and its formula is still a top proprietary trade secret kept by the government. Although its formula and mechanism of action have not been disclosed, the medicine has still been widely used in internal medicine, surgery, gynecology, pediatrics, ENT, dermatology, etc., in the forms of powders, capsules, aerosols, plasters, tinctures, and band-aids. Most Chinese families have Yunnan Baiyao at home so that they can treat minor injuries and bleeding by themselves without seeing a doctor. The use of Yunnan Baiyao is a typical practice of case medicine — a medicine is used according to prior practice that has been widely accepted. In 2020, the Yunnan Baiyao Group registered RMB 32.743 billion in operating revenue and RMB 5.516 billion in net profit. ^[7]

2. An accidental discovery can become a successful solution. Using a smallpox vaccine to protect people from smallpox is a typical example. In the 18th century, 440,000 people died of smallpox in Europe each year. British doctor Edward Jenner (1749-1823) accidentally noticed that people who had gotten cowpox were protected from smallpox. Through a series of experiments, he successfully developed a cowpox vaccine to prevent smallpox, saving countless lives, and that is how the word “vaccination” was coined.^[8] (Scientists did not determine the genome sequences of vaccinia and smallpox viruses until 1990, meaning that the mechanism of protection was not understood at first.^[9]) This example indicates that an accidental discovery may become a widely used successful solution, even if the vector of disease is not clear. This is a typical practice characteristic of case medicine.

3. Innovation is a highlight of case medicine. Soon after the COVID-19 outbreak, the National Administration of Traditional Chinese Medicine launched the “Selection of CTMs (Chinese traditional medicines) for the Prevention and Treatment of COVID-19” on January 27, 2020, under “clinical emergency, practicality and utility” guidance. The Qingfei Paidu Decoction^[10], as part of the project, was trialed in the four provinces of Shanxi, Hebei, Heilongjiang and Shaanxi to treat COVID-19. Statistics showed that as of 0:00 on February 5, 2020, 214 patients had been covered by the 3-day course during the clinical trial, and the total clinical efficiency was above 90%, among which more than 60% of the patients had significant improvements in symptoms and imaging findings, and 30% of the patients were stabilized without further complications. According to experts, the Qingfei Paidu Decoction is an optimized combination of several classic prescriptions for treating febrile diseases caused by exogenous pathogenic factors recorded in Shanghan Lun (Treatise on Cold Damage Disorders) compiled by Zhang Zhongjing of the Han Dynasty. This reasonable and mild composition is effective in treating patients with mild, common, and severe COVID-19 symptoms and may also be used to treat critically ill patients as the case may be.^[11] These data have well demonstrated the innovative features of case medicine — new therapies may be created through an optimized combination of existing therapies to treat new diseases.

4. Case medicine has a long history and flexibly combines a wide range of medicines. The clinical practice of case medicine is not limited to existing medical measures — a wide range of medicines, including plants, animals and minerals, can be combined flexibly. One of the more well-known medical therapies from TCM is qing hao (artemisia annua), from which Tu Youyou (winner of the Nobel Prize in Physiology or Medicine) and her colleagues extracted artemisinin based on the TCM book Zhou Hou Bei Ji Fang (Emergency prescriptions kept up one’s sleeve), which says that juice squeezed out of qing hao may be used to treat febrile diseases. ^[12] According to research, Zhou Hou Bei Ji Fang was written by Ge Hong in the Eastern Jin Dynasty in the 3-4th century AD. Qing hao has been used to treat malaria for more than a thousand years, with simple administration and significant efficacy. Qing hao is a wild plant growing in areas with an altitude of approximately 500 meters and a temperature range of 18°C-25°C.

5. Case medicine is taught through family tradition, apprenticeships, or self-study. Fan’s Deyitang TCM Pharmacy located in Quantang Town, Xiangxiang City, Hunan Province, China, is a good example. Founded by Fan Zihua in the 1940s, the pharmacy has a history of more than 80 years, managed successively by the same family for three generations. Founder Fan Zihua was apprenticed to Zou Zhiming from Zhanggongqiao Village, Daping Township, Xiangxiang City. Fan passed skills to his daughter-in-law Ding Yumei, whose apprentice is her daughter-in-law He Qiying. The family was known for their excellent skills in setting fractures without using any tools, and the exact repositioning was proven by X-ray scanning results. Splints made of cedar bark are used to hold broken bones, and some herbal medicines, mainly panax pseudoginseng, turmeric, phellodendron, radix clematidis, and peach kernels, are used both externally and internally. Approximately 2,000 patients benefit from this family’s treatments every year,^[13] and the therapy, which lasts for only around one month, basically causes no pain or infections. This example shows the practice of case medicine handed down in the process of family education.

6. Case medicine is region-specific and reflects local cultures. The birthplaces of case medicine branches can be easily told from their names, such as TCM, traditional Indian medicine, traditional Korean medicine, Miao medicine, Tibetan medicine, and Mongolian medicine. Affected by the ways to pass down skills, every branch of case medicine has a strong influence within a specific region and thus contains the local culture. In my hometown, 50% of elderly people know how to treat at least one common disease based on their experience and learned skills. For example, if someone caught a cold, he or she would decoct ginger, green onion roots, and perilla leaves or perilla stems (common vegetables or condiments) for half an hour, then add brown sugar and pepper, drink it hot, and then sleep. After sweating heavily, he or she will be basically cured. (Colds are usually caused by viruses; although none of the medicinal ingredients can independently kill the virus, their combination has the effect).

The Indian government has long supported the development of traditional medicine and is committed to promoting the combination of its traditional medicine systems (e.g., Ayurveda, Yoga, Unani, Siddha Medicine, Naturopathy, and Homeopathy^[14]) with modern medicine. As of 2012, India had built more than 2,420 traditional medicine hospitals and more than 15,000 traditional medicine pharmacies nationwide.^[15] The diagnosis and treatment methods and medicines included in traditional Indian medicine have distinct regional and religious characteristics.

7. Case medicine is relatively independent, relying less on basic science. Featuring independent diagnosis and treatment methods that rely less on basic science, case medicine always focuses more on case studies to analyze and improve skills during its development and thus is not susceptible to outside influence.

TCM is an example of how this developmental process works. In the period from the Three Sovereigns and Five Emperors to the Zhou Dynasty (1046 BC-771 BC), China witnessed the emergence and development of the world’s first hospital and first medical system.^[16] In the following dynasties, including the Qin, Han, Southern and Northern Dynasties and the Tang, Song, Yuan, Ming, and Qing Dynasties, when China adopted isolationist policies and faced domestic strife and foreign aggression, there was almost no progress in basic science. However, this did not hinder the development of TCM, which, instead, made significant improvements, as proven by much medical literature and great doctors with far-reaching influence, such as Li Shizhen, who wrote the famous Bencao Gangmu (Compendium of Materia Medica).

IV. Comparison between literature medicine and case medicine

Guided by reductionism, literature medicine provides quantitative indicators for the methods and mechanisms of diagnosis and treatment, relying on developments in science and technology, especially the development of anatomy. Moreover, literature medicine is taught at colleges to develop professionals. These helped build the dominance of literature medicine and a standard evaluation system. In contrast, holistic case medicine, which is built on a good deal of influential literature and successful precedents, has enjoyed a strong reputation since its emergence in modern times. However, limited by its methods of teaching, subjective factors, and regional boundaries, case medicine is difficult to popularize and promote currently, degrading to a marginal medical system.

No./Category	Literature medicine	Case medicine
1. Practice basis	Medical literature (e.g., medical classics, medical regulations)	Human experience and successful medical precedents (medical literature may be used for innovation)
2. Basic principles	Focusing on evidence, logical and reductive reasoning[17], microscopic changes to the human body system	Focusing on a holistic view of the human body system, impacts of geographical condition, climate and environment on the body and mind, syndrome differentiation, and patient-specific treatment
3. Treatment methods	Science-based diagnosis, treatment with chemical or synthetic drugs, legal regulations control the treatment process	Flexible treatment with natural medicines and therapies
4. Practitioner development	University education in disciplines according to standardized processes and models	Apprenticeships, family education, self-learning
5. Practice method	Treatment according to existing research results, requirements of the literature, and standardized processes	Treatment according to successful precedents when the pathogenic mechanism and mechanism of action are unknown, giving priority to outcomes
6. Generation of academic outcomes	Only medical experimental results that have been evaluated and certified by higher-level medical professional institutions or organizations can be deemed as innovative outcomes.	With a high level of public engagement, case medicine allows any participants to become discoverers or inventors.
7. Dependence on basic science	Relying heavily on and being greatly affected by the development and innovations of basic science	Relatively independent in development, relying less on basic science
8. Medical standards	Standards with quantitative indicators, which can be easily recognized and accepted by the public, and widely applied and promoted.	Disease/patient-specific, results-oriented, regional standards which are not easily applied and promoted widely

Chapter IV Purpose and significance of classification

 

I. Current profiles of literature medicine and case medicine

The previous chapter indicates that literature medicine and case medicine defined using the same principles as legal studies can be understood as Western medicine or modern medicine and a collection of nonmainstream medical systems, such as traditional medicine, empirical medicine, and ethnic medicine, respectively.

1. Current profile of literature medicine

In its history of evolution, literature medicine has grown into a mature medical system regulated by standards and well-defined processes, particularly thanks to the rapid development of natural science and technology in modern times. In this system, medical institutions and practitioners are all subject to performance evaluation standards with quantitative indicators. As the statutory medical system that plays a dominant role in most countries and territories, literature medicine has built its dominance in international medical systems.

2. Current profile of case medicine

The history of case medicine is as long as that of humankind. Case medicine in its evolution has broken into three traditional medical systems, guided by corresponding theories. Among them, TCM and traditional Indian medicine are relatively complete and influential. Although the two systems are widely applied, official attitudes toward them are still unclear, stagnating their development.^[18] Moreover, due to the lack of management systems and standards, some traditional therapies and medicines have been pushed to the edge of disappearance. Greek-Arab medicine has almost merged with modern medical systems due to geographical and political factors. Currently, in many countries, the authority of case medicine is not recognized academically or legally, and most medicines and therapies are not included in healthcare insurance programs. The practice of case medicine worldwide is very limited.

II. Purpose and significance of classification

 (I) Purpose of classification

Many medical systems currently coexist in the medical universe. They use different therapies and medicines to treat the same diseases and thus produce different manifestations and outcomes. Since these systems are not subject to common standards and guides, the standards of the dominant system are used in treatment and to restrict other systems. In the process of exploring and understanding the world, we have learned that inclusiveness and adherence to the fundamental purpose are essential for development. The fundamental purpose of medicine is maintaining human health. Achieving this requires simplification at the practical and theoretical levels to promote medical development, contributing to human health.

1. At the practice level, different medical systems need different management systems and standards.

Literature medicine and case medicine use different diagnosis and treatment methods and thus cannot be governed in the same way. With Fan’s Deyitang TCM Pharmacy mentioned above as an example, it is evident that, on the one hand, the pharmacy has cured many patients using case medicine solutions; on the other hand, it has been inspected by government regulators many times, who deemed it unsatisfactory, sealed its medicines and charged large fines for malpractice. ^[19] The regulators govern case medicine in the regulatory framework of literature medicine. This is unfair and unscientific.

2. Literature medicine and case medicine should be recognized academically and legally.

The fundamental purpose of medicine is to maintain human health. Each existing medical system has a long history and thus is the sum of knowledge, skills and practice related to theories, beliefs and experiences in the corresponding cultural system. Therefore, regardless of whether it can be explained by the terms of other systems, it exists to maintain human health, including preventing, diagnosing and treating physical and mental diseases.^[20] Every medical system, as long as its practice results are of universal value, should be recognized academically and legally. The paper breaks apart the larger field of medicine into the categories of literature and case medicine — two medical systems coexisting in the universe of medicine — by reference to the mature classification of law. By the same token applied to the legal system, as mentioned above, case medicine should also be recognized academically and legally with the same respect as is accorded its dominant peer — literature medicine.

(II) The significance of classification

1. Solving complicated medical problems in a simpler way

Literature medicine strictly follows the requirements of medical literature, while case medicine follows more flexible and simple processes. The two systems may complement each other. Problems that cannot be solved by literature medicine may be solved by case medicine in a simpler way; likewise, those that cannot be solved by case medicine may be quickly and effectively solved by literature medicine, relying on its mature system and advanced tools with which the causes of these problems may be accurately identified in a simpler way.

2. Promoting medical innovation

In today’s society, rapid economic and social development has brought the largest amount of medical technologies ever available to humans but has also identified the widest scope of health concerns in history.^[21] According to the principle of medical ethics, in the case of any emergency, for example, when an unrecorded mutated virus appears, the top priority is to save lives. Therefore, if literature medicine cannot solve the problem, the successful precedents of case medicine may be borrowed to develop an innovative solution, the efficacy of which may be increased through constant improvement. In this way, problems are solved as part of medical innovation.
        3. Developing more versatile medical professionals

Currently, literature medicine develops medical professionals at colleges and requires them to complete residency and obtain licenses before officially starting their careers. In contrast, case medicine develops practitioners mainly through family education, apprenticeships, and self-study. Some countries and territories have established case medicine colleges; however, due to the lack of a corresponding teaching model, they have to use that of literature medicine instead. Apparently, literature medicine has dominated the training of medical professionals as well as the general medical field, but the absence of case medicine will necessarily lead to some biases and limitations in the development of new professionals. That is why a new approach to classification is needed. When the two systems enjoy equal status, their enhanced interactions will improve the knowledge of medical professionals, broaden their minds, and further diversify diagnosis and treatment methods. Moreover, this will promote research in relevant fields, such as natural medicines and therapies.

4. Making fuller use of natural resources

Under the rigorous regulations set by literature medicine, the development of new drugs — mainly chemical and biological — is extremely complex, costly and time consuming. In contrast, case medicine uses natural medicines (e.g., animals, plants and minerals), which are more inexpensive and readily accessible. Humans have been closely related to nature since the very beginning of evolution. Therefore, while protecting natural resources, we should also make full use of natural medicines, which is also a way to reduce our dependence on chemicals and suffering from the side effects of medicines.

5. Protecting and inheriting medical wealth more effectively

Medicine is the common heritage of all humankind as a result of generations of accumulation and communication within different nations. When a tough medical problem occurs, literature medicine requires a significant amount of labor and money to analyze and study it, which increases not only the pressure on practitioners of literature medicine itself but also the treatment costs of patients. Case medicine can always provide a solution, but due to its low academic status and special traditions of education, different case literature branches tend to exclude it (such as keeping it secret or denying it) and even isolate themselves. This has prevented the popularization and promotion of case medicine. In the current context, the whole world is calling for the protection of endangered species and intangible cultural heritage by law, and case medicine skills and resources, which improve and extend people’s lives, should be better protected and maintained.

Affected by modern information theory, system theory and cybernetics, literature medicine tends to focus too much on analysis while ignoring holistic structures and functions, which will undoubtedly limit its development. Similarly, case medicine, represented by TCM, focuses too much on subjective sensations, which make its objective quantification and qualification difficult. Literature medicine is evidence-based and focused on microscopic analysis, while case medicine is disease-specific and macroscopic. With the help of literature medicine, the system for diagnosis and treatment of case medicine will be more objective; in return, case medicine will remove some biases and limitations hindering the development of literature medicine. The combination enables the two systems to benefit from each other while maintaining their independence. This is one of the feasible roads for medical development.

In the 2nd century, the Roman physician Galen, based on the academic findings of Hippocrates, created a series on medical literature. The existing 83 books discuss evidence-based medicine from the perspectives of anatomy, physiology, pathology, hygiene, pharmaceuticals, etc. In the same century, Chinese physician Zhang Zhongjing of the Han Dynasty compiled the Shanghan Lun (Treatise on Cold Damage Disorders) based on medical outcomes achieved before the Han Dynasty and his own clinical experience. This book improved the theoretical system of TCM based on syndrome differentiation.^[22] Galen’s literature is consistent with the main characteristics of literature medicine, and Shanghan Lun is a typical representative of case medicine. History has proven that the two medical systems can develop together while maintaining their own characteristics. Their combination will have a profound impact on the development of medicine.

The classification of medicine into literature and case traditions provides an academic basis for effectively distinguishing medical practices. When a medical phenomenon or disease cannot be explained by existing knowledge and technology, we should seek other ways to find a solution. The fundamental purpose of medicine is to maintain human health. Focusing too strictly on standard methods and processes is actually ignoring this fundamental purpose.

Chapter V Prospects for literature medicine and case medicine

Medicine, law, and other sciences are closely related to humans. Their development has enabled humans to improve their living conditions, seek the value of life, and create social value. The classification of medicine into literature and case medicine considers both the history and current development of medicine, providing a new way to promote communication between different medical systems. In the new classification model, the two systems will complement each other while maintaining their advantages, promoting overall medical development.

1. Reasonable integration will help lower healthcare costs across the world

Many countries now face a severe shortage of medical resources, and the problem of how to address healthcare costs has become a worldwide challenge.^[23] Literature medicine relies heavily on medical devices for diagnosis and imposes high professional requirements for the development and administration of therapies. Case medicine features extensive public participation, strong geographical adaptability, simple diagnosis and treatment, low costs and a wide choice of drugs. From the 1950s to the 1970s, when China had no complete healthcare system, the “needle plus grass” (acupuncture and herbal medicines) model played an essential role in public healthcare.^[24] At that time, the government encouraged “barefoot doctors” to be farmers in the busy season and doctors in the off-season. The wide practice of case medicine benefited hundreds of millions of people, addressing the lack of healthcare access caused by economic underdevelopment (there are currently 1.14 million rural doctors across China^[25]). This shows that the reasonable combination of low-cost case medicine with literature medicine can greatly increase the supply of medical resources and lower healthcare costs.

2. Science and technology development will increase healthcare access, promote the development of literature medicine, and speed up the standardization of case medicine.

The rapid development of the new generation of internet technologies represented by artificial intelligence, big data and cloud computing will greatly improve the efficiency and quality of healthcare services. The growing online access to healthcare resources enables the public to acquire and use them easily to treat minor diseases at home. Big data enables a more accurate comparative analysis of clinical cases and facilitates the practice of medical systems. These technologies will promote the development of literature medicine and expand the practice of case medicine from a certain region to the whole world.

Ancient Egyptian medical regulations required that each doctor treat only one disease^[26]. This also applies to the practice of case medicine. Disease-specific treatment facilitates the collection and analysis of relevant data, and successful practices may be spread online for reference. Based on the data collected, the treatment standard for each specific disease may be developed, similar to the development of a judgment standard for a specific type of case based on precedents in common law countries. As the saying goes, “the path does not simply appear; paths are made by walking”.^[27]

3. Medical integration will be of great significance for the treatment of chronic and intractable diseases.

In regard to the treatment of chronic and intractable diseases (e.g., high blood pressure, high cholesterol, diabetes, weight-induced metabolic disorders), literature medicine still cannot address some significant side effects due to technological limitations. In contrast, natural drugs used by case medicine may have fewer side effects on the human body, but case medicine cannot explain the mechanism of action of a disease or of the therapy, especially when several drugs are used together, also due to technological limitations. The integration of the two systems — studying the mechanisms of action in effective case medicine solutions in the context of the mature evaluation system of literature medicine and promoting those qualified solutions — will surely play a greater role in maintaining human health.

4. Integration will promote the “preventive treatment of diseases”

For many diseases, prevention is more important than treatment. This is a global consensus. In the literature medicine system, preventive medicine and nutritional medicine actually fall into the scope of “preventive treatment of diseases”. Case medicine always focuses on health maintenance and disease prevention. This can be seen in Huangdi Neijing (The Yellow Emperor’s Inner Classic), which says, “A superior doctor prevents diseases”. Literature medicine considers all factors affecting health to study medicine comprehensively. Case medicine views medicine from a holistic perspective. The two systems can complement each other well.

“Preventive treatment of diseases” covers three healthcare aspects: preventing a disease from occurring, preventing any worsening of a disease that has occurred, and preventing the resurgence of a disease. A WTO investigation shows that under the same health standard, the cost ratio of prevention to regular treatment to emergency treatment is 1:8.5:100. This means that 1 yuan of prevention may save 8.5 yuan of regular treatment costs and 100 yuan of emergency treatment costs.
          5. Medical development is inseparable from culture and promotes cultural expansion

There were times when surgeries, especially heart and brain surgeries, were forbidden. However, now, these impossibilities have become possible. This proves that cultural taboos may be removed, and even deep-rooted concepts may be overturned. Medicine has been evolving under the guidance of culture and, at the same time, promoting cultural development and expansion.

6. Integration will promote medical development.

Medicine, in its historical development, has gone through many stages, such as primitive accumulation, the coexistence of medicine with witchcraft, and empirical medicine, which have necessarily led to the diversity of medical systems. Western medical systems represented by traditional Greek and Roman medicine have transformed into modern medical systems. ^[28] This transformation somehow impacted the evolution of other traditional medical systems^[29], such as traditional Egyptian medicine and traditional Mesopotamian medicine, whose development saw discontinuities. Traditional Indian medicine has also undergone several changes.^[30] Only TCM has been evolving continuously due to many factors.

Medical systems, whether they are Eastern or Western, traditional or modern, have all contributed to human healthcare, despite their differences, similarities, and efficacy. Diversity is essential for medical development because this means more drugs and therapies that benefit human health. In the fight against COVID-19 in China, both case medicine and literature medicine have played important roles. Their integration is a success.

A Russian report indicated that at a video conference of the Council of Heads of Government (Prime Ministers) of the SCO (Shanghai Cooperation Organization) Member States, Indian Vice President M. Venkaiah Naidu said, “We propose to create an expert group on traditional medicine under the annual SCO health ministers meeting. We have noticed the limitations to modern medical systems and the tremendous pressure imposed by the spread of COVID-19 on them”. He stated that a set of supplementary medical systems that can provide effective and inexpensive alternative treatment options are needed to save lives in the region.^[31]

 

Chapter VI Conclusion

The classification of medicine into literature and case medicine seeks to promote the scientific development of medicine based on the evolution and current profiles of medical systems. The complementarity between civil law and common law has promoted legal practices following the principles of fairness and justice. This paper innovatively classifies medicine by reference to this legal precedent, in the hope of providing clearer guidance to literature medicine and case medicine at the practical and theoretical levels and promoting medical development through the integration of the two systems.

TCM believes that elements in the universe reproduce and restrain each other;^[32] therefore, hazardous substances in nature are surely restrained by other substances — for example, qing hao (artemisia annua) restrains malaria. This conclusion has been proven by many recorded cases occurring in the past few thousands of years. Actually, literature medicine and case medicine reproduce each other at the practice level, although their differences in theories, priorities and development make them seem to “restrain” each other. As the rule indicates, the two systems complement and restrain each other.

At a press conference of the WHO-China Joint Mission on Coronavirus Disease, Dr. Bruce Aylward, senior advisor to the WHO director-general said, “China’s method is the only one we currently know that has been proven successful”. He added, “In the face of a previously unknown virus, China has rolled out perhaps the most ambitious, agile, and aggressive disease containment effort in history. The combination of old solutions with modern technology has produced greater effects and output”.^[33] This combination will be increasingly proactive and productive as it continues and may ultimately lead to a mixed medical system or systematic integrated medical system that guides medicine to its fundamental purpose of maintaining human health and promotes medical development across the world.

 Postscript

On the evening of August 27, 2021, my assistant and I arrived at Guidong, a county with the highest average altitude in Chenzhou City, Hunan Province, to finish the last part of this article. Staying far away from the hustle and bustle of the cities, I felt calm and relaxed in the embrace of nature, and the expression “referring to precedents”, the core of the practice of case medicine, came into my mind. On the way back on August 30, winding down the mountain road from an average elevation of 881 meters, I was intoxicated by the fresh air full of negative oxygen ions mixed with singer Teresa Teng’s sweet voice. Suddenly, I thought about various impersonation shows which have become a growing trend over these past few years. “Impersonation” also applies to the practice of case medicine. At impersonation shows, people impersonate celebrities in entertainment, sports and other areas and even political leaders. People are interested in impersonation, and in this process, they observe, learn, imitate and create, which are exactly the practice steps of case medicine. There are no indicators or data that an impersonator may use to exactly reproduce the movements and expressions of the original; however, as long as the impersonator captures the essence, the show is successful. The same is true of the practice of case medicine. The point is not that a doctor knows “why”, but to capture the similarities (in symptoms, therapies and medicines) between a case and successful precedents, thereby reproducing success by referring to the precedents.

Written in Xiangtan City, Hunan Province, China

On the evening of August 30, 2021