This article is the full text of Chapter 8 of The Declaration of the Age of Physical Medicine (Yoon Jong-won). It is an academic exposition presenting the author's hypothesis of physical medicine, and the body text, figures, and citations follow the original manuscript.
Up to the previous chapter we have examined together the process of how aging and chronic disease progress. When calcium and nutrition become deficient in our body, when inflammation accumulates inside, when the environment inside the body tilts toward acidic, and when the flow of oxygen weakens, calcium leaves the bone. We called these four activating conditions DIAH, after their English initials. The calcium that leaves hardens as microcalcification on the microvascular wall. When the microcalcification exceeds a certain amount, two roads are blocked simultaneously: the road that conveys signals to the cell, and the road along which nutrition and oxygen circulate. When the two roads are blocked together, the problems that had been quietly progressing inside are no longer concealed and are revealed to the surface, and this is manifested as seven states. The state of being blocked and bursting, the state of becoming dull, the state of the signal being coated, the state of hardening, the state of overflowing and growing, the state of being severed, the state of collapsing. We called these seven states the 7M.
Following this process, we have experienced one important shift of viewpoint. Until now, medicine has looked for the cause of aging and chronic disease in hormones and receptors and signal-transduction pathways and genes. It was a precise and deep approach, but this was the downstream of the event. Before the molecular-dimension abnormality appeared, the physical event in which microcalcification piles up inside the microvasculature and blocks the flow was already occurring first. From the downstream of biology and chemistry to the upstream of physics, our gaze has moved up one step.
But one question remains. These five stages (pressure accumulating, compensation being activated, two roads being blocked simultaneously, and the result being revealed to the surface) do they operate only in medicine? They do not. Let us recall the financial crisis of the United States in 2008. Household debt and bad mortgages quietly accumulated over several years. To prevent the crisis, savings and emergency funds melted away, and under the name of loans, fixed costs hardened onto the income pathway. At a certain point, the state in which the market did not respond even when the central bank lowered interest rates and the state in which bad debt physically clogged the funding pathway came into being together. Only then did the surge in unemployment and the chain of bankruptcies surface. The same five stages we saw inside our body were repeated exactly within the economy of a nation. In the matter of a household where conversation decreases and fixed costs pile up so that the relationship collapses, and in the matter of a region where the population drains away and the commercial district dries up so that the city disappears, the same five stages progress in the same order. We call this universal law of collapse the DTDMC collapse theory.
DTDMC is the English initials of the five stages. D is the first letter of Determinants, the factor stage; the first T is Trigger, the starting stage; the second D is Dual blockade, the dual-blockade stage; M is Manifestation, the manifestation stage; and the last C is Collapse, the annihilation stage. What these five letters point to is simple and singular. It is the common path that almost everything that collapses follows.
The title of this book, The Age of Physical Medicine, has its meaning completed only at this place. What this name points to is not that medicine stops at gathering in one place the clinical facts scattered by specialty, but that medicine itself is placed upon a universal physical law of collapse. This chapter unravels the structure of that law. In the following chapter we follow, upon a timeline, how that law is manifested inside one person's body.
Let me point out that this law is not a metaphor but a verified fact. In the macroeconomic time series of 351 months of Korea and 339 months of the United States, 690 months combined, the five-stage path diagnostic method detected six independent crises without a single false positive. In every case judged as the two roads being blocked simultaneously, the system collapsed, and in every case where only one side was blocked and the system then recovered on its own, the system held out. The two Korean cases, in which an advance warning of one blockade alone led into crisis, are examined separately in the table below. The five stages formalized in medicine operated with the same accuracy in the time series of economics, an entirely different field.
This agreement is no coincidence. It is because the two fields share the same mathematical structure. The place that the calcium ion occupies in medicine is occupied in economics by cash. The place that the microvasculature occupies in medicine is occupied in economics by the funding pathway. The place where microcalcification hardens and sticks in medicine is occupied in economics by bad debt and fixed costs. The names of the media differ, but the structure is the same. This is the reason the five stages operate across fields.
These five stages have three essential characteristics. The first is order invariance. The order of D, T, D, M, C is never overturned. No case has been observed in which the dual blockade is established first in a state where the start has not been activated, or in which manifestation appears first without the dual blockade. In the 690 months of economic time series as well, there was not a single reversal of stages.
The second is irreversible acceleration. The moment this path crosses a certain threshold point, it accelerates and proceeds in only one direction. After the acceleration has begun, it cannot be stopped merely by preventing additional deposition. The work of directly removing the deposition that has already piled up must follow together.
The third is domain independence. The same five stages operate with the same structure in medicine, in economics, and in various other fields as well. A law equipped with all three of these characteristics is very rare within nature.
In this chapter we unravel the structure of the five stages stage by stage, confirm that the structure is the same in the two fields of medicine and economics, point out the three essential characteristics, and examine upon what mathematics this law stands. When that unraveling is finished, it will become clear that the name The Age of Physical Medicine is not a mere expression but a formal declaration that places medicine upon a universal physical law.
The Road Along Which the Five Stages Flow
We unravel the structure of the five stages in one place. Each stage has a clear definition, has an event that occurs inside the system at that stage, has an appearance visible from the outside, and has a condition for passing over to the next stage.
The first stage, determinants, is the period in which pressure quietly accumulates. The system is still holding out, and outwardly it looks normal. In a person's body, deficiency and wrong lifestyle habits and chronic stress accumulate over decades. Yet in the standard health checkup, every figure falls within the normal range. In a nation's economy, household debt increases and fiscal deficits pile up, but the GDP growth rate is maintained and the credit rating stays the same. The most dangerous point of this stage is the fact that it is not visible at all from the outside.
The second stage, trigger, is the moment when the accumulated pressure crosses a certain threshold and the system activates compensation. The essence of compensation converges into one thing. It is melting down long-term assets to prevent the immediate crisis. In a person's body, to protect the blood calcium, parathyroid hormone is activated and draws calcium out of the bone. In a household, to make up the monthly shortfall in living expenses, the emergency fund drains away, and when the emergency fund dries up, insurance is cancelled, and finally loans begin. It has converted to a mode of melting down future assets to maintain the present normal. To outward appearance it is still normal.
The third stage, dual blockade, is the most decisive place, located at the very center of the five stages. As compensation operates, byproducts pile up, and when those byproducts cross a certain threshold, two kinds of blockade are applied together. One is the state in which the signal is not transmitted. In a person's body, the calcium signal inside the cell wavers so that the commands of hormones and immunity and nerves are not executed. In a nation's economy, the market does not budge even when the central bank lowers interest rates. The other is the state in which the pathway itself is blocked. In a person's body, microcalcification hardens and sticks onto the microvascular wall so that the flow of oxygen and nutrition is cut off. In a nation's economy, bad debt piles up in the funding pathway so that new loans and settlements are blocked.
If only one side is blocked, the system compensates with the other side and holds out. But when the two blockades are applied simultaneously, the road to compensate itself disappears. When the signal weakens, function drops; when function drops, the pathway is blocked further; and when the pathway is blocked, the signal weakens further: a self-reinforcing decline begins. Without sufficient intervention from outside, this decline does not stop. So this place is called the door of no return.
The fourth stage, manifestation, is the period in which the dual blockade progresses and compensation finally reaches the point where it cannot bear it. The problems that had been progressing only inside are at last revealed to the surface. In a person's body they appear as clinical symptoms such as rising blood pressure, blood sugar abnormality, chronic pain, and joint stiffness. In a nation's economy they appear as a surge in unemployment, the contraction of consumption, and a chain of corporate bankruptcies. The point at which we go to the hospital or encounter the crisis in the news is precisely this stage. But inside, the dual blockade has already been completed.
The fifth stage, annihilation, is the period in which the system itself terminates when manifestation continues on and intervention is not sufficient. In a person's body, cell death leads to the functional halt of tissue, the functional halt of tissue to organ failure, and organ failure to death. The direct causes of death written on death certificates number more than a thousand, but the last molecular event converges into one. It is the event in which the cell can no longer cause execution with the calcium signal.
When the five stages are gathered in one place, one fact becomes clear. It is the fact that even though the medium and the time scale differ greatly, the structure is the same. And precisely this fact becomes the ground on which the five stages operate as a universal law of the cosmos.
[Figure 1] The Five DTDMC Stages at a Glance
| Stage | Abbreviation | Name | Essence | State visible from outside |
|---|---|---|---|---|
| Stage 1 | D | Determinants | Pressure quietly accumulates | Asymptomatic, standard indicators normal |
| Stage 2 | T | Trigger | Compensation activated, outflow of long-term assets begins | Outwardly normal, compensation operating |
| Stage 3 | D | Dual blockade | Signal and pathway cut off simultaneously, entry into irreversibility | Minute abnormality, standard examination cannot catch it |
| Stage 4 | M | Manifestation | Compensation limit exceeded, damage surfaces | Clinical symptoms become visible |
| Stage 5 | C | Collapse | Multi-axis failure, system termination | Recovery impossible, system halted |
The Same Law, Different Media
Let us look more closely at the fact that the five stages operate with the same structure across fields. The core is one thing. When the field changes, only the names of the medium and the pathway and the deposit change; the places of the five stages themselves are preserved as they are. What flows, through where it flows, and what hardens and sticks and blocks. These three places are maintained as they are even when the field changes.
Let us first place a person's body before us. The flowing medium is the calcium ion. The pathway is the microvasculature. What hardens and sticks inside the pathway and blocks the flow is microcalcification. Only when calcium is absorbed into the cell and causes execution is that cell in a living state. When the state in which the microvasculature is blocked by microcalcification and the state in which the cell cannot absorb calcium are established together, the system collapses.
Let us place a nation's economy in the same frame. The flowing medium is cash. The pathway is the funding pathway leading through bank loans and the settlement system. What hardens and sticks inside the pathway is bad debt and fixed costs. Only when cash flows all the way into the neighborhood shop and causes employment and reinvestment is the economy in a living state. When the state in which the funding pathway is blocked by bad debt and the state in which the shop cannot absorb consumption are established together, the system collapses.
If we place a household in the same frame, what flows is conversation and emotion, the pathway is the everyday time spent together, and what hardens and sticks inside the pathway is conflict piled up while left unspoken. Only when each family member conveys their own emotions and thoughts to the other family members and is received is the household in a living state. When the state in which the pathway is blocked by conflict and the state in which the place of receiving has closed shut are established together, the household collapses.
If we place a planet's climate in the same frame, what flows is the carbon cycle, the pathway is the sinks of forest and ocean and wetland, and what hardens and sticks is the carbon dioxide accumulating in the atmosphere. A review published by Lenton and others of the University of East Anglia in the United Kingdom in the Proceedings of the National Academy of Sciences identified the tipping elements of the Earth, including the Greenland ice sheet, the West Antarctic ice sheet, and the Amazon rainforest. The Sixth Assessment Report of the United Nations Intergovernmental Panel on Climate Change also organized the fact that when the carbon accumulation in the atmosphere exceeds a certain limit, irreversible consequences follow.
In each field the name of what flows differs, the name of the pathway differs, and the name of what hardens and sticks differs. But the structure is the same. This sameness is the ground on which the five stages operate across fields.
[Figure 2] Mapping of the Media of the Five Stages by Field
| Place | A person's body | A nation's economy | A household | A planet's climate |
|---|---|---|---|---|
| Flowing medium | Calcium ion | Cash | Conversation, emotion | Carbon cycle |
| Pathway | Microvasculature | Funding pathway | Everyday time, the place of being together | Forest, ocean, wetland sinks |
| Deposit | Microcalcification | Bad debt, fixed costs | Unspoken conflict | Accumulated atmospheric carbon dioxide |
| Essential unit | One single cell | One neighborhood shop | The daily meeting of one married couple | Earth tipping element |
| Result when blockade is established | Multi-axis organ failure | System collapse, national default | Severance and dissolution of the relationship | Passing an irreversible tipping point |
There is evidence in which this structural agreement has been confirmed by actual measurement. In the macroeconomic time series of 351 months of Korea and 339 months of the United States, 690 months combined, the five-stage path diagnostic method detected six independent crises without a single false positive. In the U.S.-originated global financial crisis, the two blockades were established together, and the system collapsed in earnest. The Korean foreign exchange crisis and the Korean credit card insolvency incident are, by the measured verdict, cases in which a single-blockade advance warning of the signal blockade alone led into crisis (a measurement under the observational limit of the 25 gauges then in operation). On the other hand, in the U.S. dot-com bubble collapse, the U.S. credit rating downgrade, and the rapid U.S. interest rate hike, it stopped at one-sided blockade, and the system held out. The COVID-19 shock was a crisis that suddenly struck from outside, but the moment the two blockades were established together, the system collapsed within a short period.
Reinhart and Rogoff of Harvard University in the United States, in a work organizing the history of financial crises across eight centuries, showed with wide-ranging empirical evidence the fact that crises appear each time with a different face but that the same structure repeats within them. The five stages are an organization of the formal form of that repeating structure. The fact that the five stages, which set out from medicine, operated with the same accuracy in the 690-month time series of economics, an entirely different field, points to this being not a model of medicine alone but a law that crosses fields.
[Figure 3] Major Cases Classified by the Five-Stage Diagnostic System in the 690-Month Time Series
| Case | Time point | Field | Type of blockade | Result |
|---|---|---|---|---|
| Korean foreign exchange crisis | 1997 | Korean macroeconomy | Single-blockade advance warning (signal blockade alone; observational limit: 25 gauges) | Full-scale collapse |
| U.S. dot-com bubble collapse | 2001 | U.S. macroeconomy | Single blockade | Held out |
| Korean credit card insolvency | 2003 | Korean macroeconomy | Single-blockade advance warning (signal blockade alone; observational limit: 25 gauges) | Full-scale collapse |
| U.S.-originated global financial crisis | 2008 | U.S. macroeconomy | Dual blockade | Full-scale collapse |
| U.S. credit rating downgrade | 2011 | U.S. macroeconomy | Single blockade | Held out |
| COVID-19 shock | 2020 | Macroeconomy of both nations | Dual blockade (exogenous) | Same-month diagnosis, short-term collapse |
| U.S. interest rate shock | 2022 | U.S. macroeconomy | Single blockade | Held out |
The Three Essential Characteristics of the Five Stages
The ground on which the five stages take their place not as a mere model but as a universal law of the cosmos lies in three essential characteristics. They are order invariance, irreversible acceleration, and domain independence. If these three are pointed out in one place, it becomes clear what weight of law the five stages carry.
The first characteristic is order invariance. The order of D, T, D, M, C is not overturned. A case in which the dual blockade is established first when the trigger has not been activated, a case in which manifestation appears first without the dual blockade, and a case in which annihilation arrives without manifestation have not been observed anywhere. In the 690 months of economic time series there was not a single reversal of stages. It is the same in medicine as well. In a state where the DIAH triggers have not been pulled, the microcalcification dual blockade is not established, and without the dual blockade the 7M does not surface.
This order invariance becomes a very powerful tool in diagnosis. When any one of the 7M is observed in the clinic, the fact that all the stages before it have already progressed follows automatically. The manifestation seen in one patient is only the surface; beneath that surface the dual blockade already lies, beneath that the trigger, and at the deepest place the accumulated determinants.
The second characteristic is irreversible acceleration. The moment the five stages cross a certain threshold point, they accelerate and proceed in only one direction. Before the threshold point, the system has both directions of possibility, and when the pressure is withdrawn it returns to its original place. But the moment it crosses the threshold point, the system accelerates in only one direction.
The physical ground of this acceleration lies in nonlinear accumulation. As a standard cardiovascular physiology textbook organizes, within the microvasculature of a person's body the flow is proportional to the fourth power of the radius of the tube. According to this law organized by Poiseuille of nineteenth-century France, when the radius of the tube decreases by half, the flow decreases to one-sixteenth. It seems the tube has narrowed only a little, yet the flow decreases sharply. Here lies the reason a crisis feels as though it progresses slowly and then suddenly strikes.
The third characteristic is domain independence. The same five stages operate with the same structure in medicine, in economics, and in various other fields as well. The reason this agreement is possible is, as we examined earlier, that although the name of the medium differs by field, the structure is the same.
A law equipped with all three of these characteristics is rare within nature. The second law of thermodynamics operates across fields but does not speak of the order of the five stages. The critical transition theory published by Scheffer and fellow researchers in the journal Nature precisely pointed out the location of the threshold point but does not speak of the whole path leading up to that threshold point. The financial instability hypothesis organized by the American economist Minsky showed how internal accumulation within the economy gives rise to crisis, but it does not apply directly to medicine or climate.
The five stages fill all three of these places. They specify the order, organize the irreversibility of the acceleration, and operate across fields. This qualification makes the five stages a universal law of the cosmos. And this qualification makes possible the work of placing medicine upon that law.
[Figure 4] The Three Essential Characteristics of the Five Stages
| Characteristic | Definition | Verification, ground | Significance |
|---|---|---|---|
| Order invariance | The order D, T, D, M, C is not overturned | 0 reversals in the 690-month time series | The appearance of one place simultaneously points to all the places before it |
| Irreversible acceleration | One-directional accelerating progression after crossing the threshold point | Deposition proportional to the power (about 4) of the trigger intensity | Cannot be stopped by blocking additional deposition alone |
| Domain independence | The same form operates across fields | The same multiplicative structure confirmed in the two fields of medicine and economics | Fulfills the qualification of a universal law |
Why Multiplication: The Universal Mathematics of the Dual Blockade
The dual blockade located at the very center of the five stages stands upon one simple but powerful mathematics. It is multiplication. The fact that signal blockade and pathway blockade combine by multiplication forms the core of the five stages.
Let us first point out the property of the form called multiplication. When two numbers are multiplied, if one side is near 0, then however large the other side is, the product is near 0. Only when both numbers are sufficiently large does the product become a meaningful size. This simple principle operates decisively in the dual blockade.
This form of multiplication is the mathematics of simultaneous conditions commonly observed within nature. For a fire to occur, fuel and oxygen and an ignition source must be present simultaneously. If even one of the three is missing, the fire does not start. The dual blockade has the same structure.
Let us see how this multiplication appears in a person's body. Microcalcification piling up in the microvasculature so that the pathway narrows is one side's value. The calcium signal inside the cell wavering so that commands are not executed is the other side's value. If only one side progresses, the system compensates with the other side. Even if the pathway narrows, if the signal is alive a bypass route operates, and even if the signal weakens, if the pathway is open compensation is possible. But when the two values grow simultaneously, it becomes a state in which there is neither a route to bypass nor a signal to issue the bypass command.
The same multiplication operates in economics as well. Bad debt piling up in the funding pathway so that new loans are cut off is one side's value, and the market not responding even when the central bank lowers interest rates is the other side's value. An analysis published by Brunnermeier of Princeton University in the United States in an American economics journal organized that the liquidity crisis and credit crunch between 2007 and 2008 occurred precisely at the place where these two values grew simultaneously.
This multiplicative structure has one more important meaning. It is that recovery is also multiplication. The work of preventing deposition from piling up further is called suppression, and the work of physically removing the deposition that has already piled up is called removal. If only suppression proceeds, it merely buys time and does not prevent irreversibility. If only removal proceeds, it improves temporarily but the cause remains, so it piles up again. Only when suppression and removal proceed together does recovery at last become possible.
[Figure 5] Why Recovery Requires the Simultaneous Operation of Two Variables
| Scenario | Suppression of additional deposition | Removal of existing deposition | Result | Case in medicine |
|---|---|---|---|---|
| A. No intervention | None | None | Progresses to annihilation | Ignoring the warning |
| B. Suppression only | Yes | None | Only delays time, cannot prevent | Stopping at lifelong medication |
| C. Removal only | None | Yes | Temporary recovery, recurrence | Restenosis after stent procedure |
| D. Simultaneous | Yes | Yes | Recovery possible | Combination of procedure and blocking the cause |
What this table shows is clear. The reason one does not get better even taking medicine for a lifetime, the reason that with quantitative easing additional insolvency is blocked but the accumulated insolvency remains as it is so that recovery is slow, and the reason that in marital counseling new conflicts decrease but the already hardened conflict remains so that the relationship does not recover, are all explained at the same place. It is because only one side operated.
The fact that the structure called multiplication operates in the same manner across fields supports the universality of the five stages at the last. The blockade is also multiplication, and the recovery is also multiplication. Even when the medium differs and the time scale differs, the structure of multiplication is preserved as it is.
The Empty Place This Law Fills
If the five stages are a universal law, it is necessary to point out what relationship they have with the scientific laws that already exist. It is because the question may arise whether this is not merely repeating the same words in a different language.
The second law of thermodynamics says that if sufficient energy does not enter from outside, the disorder inside a system increases. It is an answer to the question of in which direction it collapses. But it does not say in what order it collapses.
The critical transition theory published by Scheffer and fellow researchers in the journal Nature says that there are advance signals a system sends when it approaches a threshold point. It is an answer to the question of where the threshold point is. But it does not say through what path the system passes to reach that threshold point.
The financial instability hypothesis organized by Minsky says that in a period of stability debt piles up, and when that debt crosses a limit a crisis bursts. It is an answer to the question of how internal accumulation within the economy gives rise to crisis. But this hypothesis operates only within the single field of economics and does not apply directly to medicine or climate.
The general system theory organized by the Austrian biologist Bertalanffy pointed out the principles of systems in general. But it did not handle the concrete path when a system collapses.
The five stages answer one question that these laws did not answer. It is the question of which stage comes after which stage when a system collapses, which place becomes the turning point of no return, and how far that flow is the same across fields.
The five stages do not compete with the existing laws. They proceed in the same direction as the direction thermodynamics points to, position the threshold point Scheffer pointed out at the third place among the five stages, and position Minsky's accumulation at the first place. They fill the empty place that the existing laws did not fill, and operate together with them.
The reason this positioning becomes possible lies in the three essential characteristics the five stages are equipped with. Order invariance specifies the causality between the stages, irreversible acceleration organizes the flow after the threshold point, and domain independence places medicine and economics, and other fields besides, upon the same form.
[Figure 6] The Place the Five Stages Fill: Comparison with Existing Grand Theories
| Theory | Question it answers | Question it does not answer |
|---|---|---|
| The second law of thermodynamics | In which direction does it collapse (entropy increase) | In what order does it collapse |
| Critical transition theory (Scheffer) | Where is the threshold point and what advance signals are there | The whole path the system passes through up to the threshold point |
| Financial instability hypothesis (Minsky) | How does internal accumulation within the economy lead to crisis | Does it apply to fields other than economics |
| General system theory (Bertalanffy) | What are the principles of systems in general | The concrete path when a system collapses |
| The five stages (DTDMC) | In what order does it collapse, and how is it the same form across fields |
The Place of Physical Medicine
The fact that the five stages unraveled in this chapter are a universal law makes clear at the last what the title of this book, The Age of Physical Medicine, means. What this name points to is the work of not leaving medicine as a discipline that gathers molecular-dimension facts, but placing it upon a universal physical law of collapse.
Until now medicine has shown its deepest form at the molecular dimension. Hormones and receptors, signal-transduction pathways and genes. Specialty medicine has organized verified facts in its own domain. But those domains were the downstream of the event. For the events occurring inside one person's body in the same period to be explained in one place, one layer beyond that downstream was needed. The name of that one layer is physics, and the name of the medicine located upon that physical layer is physical medicine.
This positioning does not make medicine smaller but makes it larger. All the verified facts that specialty medicine has organized find their own place upon the five stages. Deficiency and inflammation and acidosis and hypoxia are located at the second stage, the microvascular microcalcification dual blockade is located at the very center of the third stage, and the seven damage patterns are located at the fourth stage. The facts that had been scattered are connected upon one line.
At the same time, through this positioning medicine comes to stand upon the same structure as other fields. The work of diagnosing one person's chronic disease and the work of diagnosing one nation's macroeconomic crisis operate together upon the same five-stage structure. It becomes clear that medicine is not an isolated discipline but a discipline that operates at one place of a universal physical law.
In the following chapter we follow, upon a timeline, how these five stages are manifested inside one person's body. It is the thirty years of one mother whom we met at the beginning of this book. Thirty years ago, when that body came out normal in the health checkup, the first stage was already beginning.
References
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