This article is the full text of Chapter 9 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.
In the previous chapter we saw that DTDMC is a universal law of collapse of the cosmos. A nation's economy, a planet's climate, and a household's relationships all collapse upon the same five-stage structure. Then what about one person's body? Does the collapse of the human body, called aging and chronic disease, also progress upon the same five stages? The answer is yes. All the medical facts unraveled in the earlier part of this book match one-to-one with exactly the same five stages as the collapse of other fields. Upon this matching, the single field called medicine takes its place as one seat of the universal law of collapse of the cosmos.
The matching is simple. If what flows in economics is cash, what flows in the human body is the calcium ion. If the pathway in economics is bank loans and the settlement system, the pathway in the human body is the microvasculature. If what hardens and sticks in economics is bad debt and fixed costs, what hardens and sticks in the human body is microcalcification. If in economics the crisis becomes full-scale at the place where monetary policy does not work and insolvency blocks the funding pathway, in the human body chronic disease becomes full-scale at the place where the calcium signal wavers and microcalcification blocks the microvasculature. Only the names of the medium and the pathway and the deposit differ; the places of the five stages are preserved as they are.
The places where the five DTDMC stages are manifested in the human body also match in one line. Stage 1, determinants, is the accumulation of the empty layer and flow and gradient examined earlier. Stage 2, trigger, is the activation of the bone-calcium outflow DIAH trigger. Stage 3, dual blockade, is the establishment of the microcalcification dual blockade. Stage 4, manifestation, is the surfacing of the 7M. And Stage 5, annihilation, is the entry into multi-axis organ failure and dying. The five letters point exactly to the five places of the collapse of the human body.
This matching lies at the core of the paradigm shift this book, The Age of Physical Medicine, proposes. Until now medicine has seen aging and chronic disease separately from the viewpoint of specialties. Atherosclerosis is the domain of cardiology, osteoporosis the domain of orthopedics, Alzheimer's the domain of neurology, diabetes the domain of endocrinology, renal failure the domain of nephrology. But seen from the viewpoint of the five stages, these five diagnostic names are five surfaces of the same one event. The event is the microcalcification dual blockade, and the surface is in which tissue that dual blockade is revealed. The work of medicine moving up one step from the viewpoint of the specialty to the viewpoint of the universal law of collapse: this work is the paradigm shift to physical medicine.
At the beginning of this book we met one mother. She is a mother in her late sixties. Here we spread out again, upon the five DTDMC stages, the thirty years of that mother who keeps getting worse even while taking five pills every morning. Thirty years ago, the mother's standard health checkup was entirely normal. Blood pressure, blood sugar, and cholesterol were all within the normal range. But within that time of normalcy, the first stage was already progressing. It was a period in which pressure quietly accumulated, and the mother's body was still concealing that accumulation with compensation.
In this chapter we unravel in turn, upon a timeline, how the five DTDMC stages are manifested as one stream inside one person's body. The accumulation of Stage 1 determinants, the activation of the Stage 2 bone-calcium outflow DIAH trigger, the establishment of the Stage 3 dual blockade, the surfacing of the Stage 4 7M, and the Stage 5 multi-axis organ failure and annihilation. And at the last we spread out one mother's thirty years upon the five stages. When that unraveling is finished, the place where medicine moves from the viewpoint of the specialty to the viewpoint of the universal law of collapse, that is, the paradigm shift to physical medicine, will become clear in one person's body.
Now we enter the mother's Stage 1, thirty years ago.
Stage 1 D: The Accumulation of Determinants
The place of Stage 1, determinants, is the period in which pressure quietly accumulates. Unraveled here, it is also the longest and quietest period in a person's lifetime. More than half of the thirty years is contained in this stage, and during that time the standard health checkup reports that every figure is within the normal range. But inside, accumulation is progressing.
Determinants accumulate along three grains. The first is the grain of the nutritional dimension. When the calcium and protein and vitamins and minerals our body needs every day are not supplied sufficiently, minute deficiencies not caught by the standard checkup accumulate. The mother's thirties and forties were that period. While working at a job or caring for the household or raising children, skipping meals was frequent, and even when meals were set out, the balance of nutrition often collapsed. Yet that deficiency did not appear in any examination.
The second is the grain of the lifestyle-habit dimension. Lack of exercise weakens the flow of the microvasculature, lack of sleep reduces the time of recovery, chronic stress accumulates acidosis and inflammation, and smoking or drinking chronically stimulates the tissue. The mother had no time to exercise. She could not sleep enough either. She always lived as though chased by something. But she herself accepted all of it as merely an ordinary daily life, and no signal at all was caught in the checkup.
The third is the grain of the aging dimension. As time passes, the elasticity of the microvasculature falls little by little, and the ability to recover when tissue is damaged decreases little by little. This grain is a grain that progresses naturally in everyone. But when it accumulates together with the preceding two grains, the speed of aging quickens.
Even when these three grains accumulate together, the standard health checkup reports normal. The figures in the laboratory are all within the normal range, and both doctor and patient are reassured. But minute deficiency piles up a little every day, wrong lifestyle habits put a little burden on the microvasculature every day, and aging progresses a little every day. The place where pressure accumulates is merely invisible; it is progressing.
The most dangerous point of Stage 1 is the fact that it is not visible at all from the outside. Since no signal is caught in the standard checkup, neither patient nor doctor has a motive to intervene. There is no one who did wrong. Accumulation is simply progressing. This period continues over five to thirty years. It is long and quiet and invisible.
But this accumulated pressure determines all the events of the next stage. In a person whose accumulation was small, the trigger activation is delayed, and in a person whose accumulation was large, the trigger activation is hastened. It is the place where the amount of accumulation determines the time scale of all five DTDMC stages. So Stage 1 is the longest and quietest period, but at the same time it is also the most decisive period.
Figure 1 is a self-check matrix by which one can inspect how the accumulation of Stage 1 determinants is progressing in oneself. It gathers in one place the items of the three grains of nutrition and lifestyle habits and aging. The work of honestly pointing out where oneself stands in each item becomes the first step toward delaying the point of passing over to the next stage.
[Figure 1] Stage 1 Determinants: Self-Check Matrix
| Category | Item | Clinical meaning | Self-check question | Degree of accumulation |
|---|---|---|---|---|
| Nutrition | Calcium and mineral shortage | Mobilization from bone begins | Frequency of intake of calcium-rich foods | □ Low / □ Medium / □ High |
| Nutrition | Protein and vitamin shortage | Decline of tissue recovery capacity | Frequency of balanced meals | □ Low / □ Medium / □ High |
| Lifestyle habits | Lack of exercise | Decline of microvascular flow | Exercise three or more times a week | □ Low / □ Medium / □ High |
| Lifestyle habits | Sleep and stress | Accumulation of acidosis and inflammation | Seven or more hours of sleep, stress management | □ Low / □ Medium / □ High |
| Aging | Decline of microvascular elasticity | Decrease of recovery ability | Regular checkups and early intervention | □ Low / □ Medium / □ High |
Stage 2 T: The Activation of the Bone-Calcium Outflow DIAH Trigger
The place of Stage 2, trigger, is the place where the pressure quietly accumulated in Stage 1 crosses a certain threshold and the system activates full-scale 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 that long-term asset is calcium, and the place where that asset is stored is the bone.
In our body calcium is in two places. Ninety-nine percent is stored in bone and teeth, and one percent flows in the blood and inside the cells. That one percent is the place of flow. Every event in which a nerve transmits a signal, a muscle contracts, a hormone is secreted, and blood coagulates occurs upon the flow of this one percent of calcium. If the blood calcium concentration wavers, life itself wavers.
So our body has an intricate device that maintains the blood calcium concentration within a very narrow range. Three hormones (parathyroid hormone, vitamin D, and calcitonin) are at the center of that device. If the blood calcium drops even slightly, parathyroid hormone is secreted and draws calcium out of the bone to restore the blood concentration. The bone is a huge calcium storehouse, and parathyroid hormone is the key that opens that storehouse.
When the pressure accumulated in Stage 1 reaches a certain point, this device begins to operate in earnest. The accumulated deficiency and inflammation and acidosis and hypoxia shake the availability of blood calcium, and to restore the shaken availability, parathyroid hormone is activated and draws calcium out of the bone. This activation is the place of the trigger. The bone calcium has begun to flow out.
The DIAH triggers are activated together at four places. These four places, called DIAH after their English initials, are the D of deficiency, the I of inflammation, the A of acidosis, and the H of hypoxia. Earlier we also called this activation the door of death, because once it begins it hardly stops, and we also called it the four gateways, after the shape of the four places opening together. The event that occurred in the mother's early fifties was precisely this activation of the DIAH triggers. When she received her first diagnosis of high blood pressure, the doctor prescribed her one pill. But what that pill calmed was only the surface called blood pressure; inside, the bone calcium had begun to flow out in earnest.
Figure 2 organizes upon a timeline at what point the accumulation of Stage 1 crosses the threshold and the trigger is activated. In the thirties and early forties, when accumulation piles up little by little, compensation is operating sufficiently so the trigger is not activated. But upon reaching the late forties, when accumulation approaches the limit of compensation, the D of deficiency is activated first, and then the I of inflammation, the A of acidosis, and the H of hypoxia join in turn. By around the late fifties, all four places come to be in an activated state.
[Figure 2] Accumulation → Threshold → DIAH Activation Timeline
| Period | State of accumulation | State of compensation | DIAH activation | Clinical signal |
|---|---|---|---|---|
| 30s | Slight accumulation | Sufficient compensation | No activation | Checkup normal |
| Early 40s | Gradual accumulation | Compensation in operation | D activated | Checkup normal |
| Late 40s | Clear accumulation | Approaching compensation limit | D, I activated | First signal appears |
| Early 50s | Approaching threshold | Compensation limit | D, I, A activated | Medication prescription begins |
| Late 50s | Threshold breached | Full-scale mobilization | D, I, A, H all | Multiple medication prescriptions |
When the DIAH triggers are activated, calcium flows out of the bone in earnest. The calcium that has once flowed out cannot return to its original place, and after flowing along the blood vessels it deposits somewhere. The place where it most frequently deposits is the microvascular wall. When cholesterol medication was added in the mother's fifties, the place where that cholesterol was piling up was in fact the microvascular wall, and there the deposition of microcalcification was already progressing together.
Figure 3 organizes how the four places of DIAH operate together and converge into one. Deficiency and inflammation and acidosis and hypoxia look like different stimuli, but the way our body responds to these four stimuli is one and the same. It is drawing calcium out of the bone to restore the availability of blood calcium. So the four places converge into one, and that convergence is the essence of the trigger stage.
[Figure 3] The DIAH 4 Triggers: Deficiency, Inflammation, Acidosis, Hypoxia
| Place | Kind of stimulus | Place it shakes | Our body's response | Place of convergence |
|---|---|---|---|---|
| D Deficiency | Calcium and nutrition shortage | Blood calcium availability | Parathyroid hormone activated | Calcium mobilization from bone |
| I Inflammation | Chronic inflammatory stimulus | Acidosis acceleration | Calcium availability wavers | Calcium mobilization from bone |
| A Acidosis | Accumulation of acidic environment | Ion equilibrium | Calcium availability wavers | Calcium mobilization from bone |
| H Hypoxia | Decline of oxygen supply | HIF pathway activated | Calcium availability wavers | Calcium mobilization from bone |
| Common | The sum of the four stimuli | Converges into one place | One single response | Restoration of blood calcium |
Stage 3 D: The Establishment of the Microcalcification Dual Blockade
Stage 3, dual blockade, is the most decisive stage, located at the very center of all five DTDMC stages. If one cannot see accurately what occurs here, one cannot understand why aging and chronic disease hardly stop once they have begun. Let us see at which place on the timeline the microcalcification dual blockade unraveled earlier takes its seat.
When the DIAH triggers are activated in Stage 2 and calcium begins to flow out of the bone, that calcium begins to harden and stick onto the microvascular wall as microcalcification. At first it is a minute deposition of about one grain, one grain at one place. It is not visible on imaging. The figures in the laboratory are also close to normal. But the deposition piles up a little every day.
When the deposition of microcalcification exceeds a certain amount, two kinds of blockade are applied together. One is signal blockade. It is the state in which the calcium signal inside the cell wavers so that the commands of hormones and immunity and nerves are not executed. Earlier we called this CAM. The other is pathway blockade. It is the state in which the microcalcification of the microvascular wall exceeds a certain amount so that the flow is cut off, and we called this DLT.
When the two blockades occur separately, the system holds out. Even if only the signal weakens, if the pathway is open it compensates by another route, and even if only the pathway narrows, if the signal system is alive it holds out with bypass commands. But the moment the two blockades are applied together, the system loses the road to compensate itself. It is the place of the dual blockade, that is, the gravitational point of irreversibility.
The event that occurred in the mother's late fifties was precisely this establishment of the dual blockade. The period when cholesterol medication was added and just before diabetes medication was prescribed. The figures in the laboratory were falling because of the medicine, but inside the mother's microvasculature, microcalcification was taking its seat together at the place of the signal and the place of the pathway. The medicine was pressing down the figures, but the underlying reality was progressing all the while.
Once the dual blockade is established, a self-reinforcing decline begins. When the signal weakens, function drops; when function drops, the pathway is blocked further; and when the pathway is blocked, the signal weakens further. Without sufficient intervention from outside, this decline does not stop. So this place is called the door of no return.
The most important fact at this stage is that the dual blockade is not caught on imaging. The macrocalcification caught on chest CT is already a state in which Stage 4 manifestation has begun, and long before that macrocalcification becomes visible, the dual blockade of microcalcification has already been established. The underlying reality that imaging cannot catch is at this place, and here also lies the reason specialty medicine has not been able to have the dual blockade as a formal diagnostic name.
Figure 4 organizes how single blockade and dual blockade differ in the possibility of recovery. In the case where only signal blockade, or only pathway blockade, has occurred, the possibility remains for the system to recover while compensating by another road. But when the two blockades are established together, the road of compensation disappears, and the system enters the irreversible stage. This difference is the most decisive place that divides recovery from annihilation.
[Figure 4] Single Blockade and Dual Blockade: The Difference in Possibility of Recovery
| Type of blockade | Place of signal | Place of pathway | Possibility of recovery |
|---|---|---|---|
| No blockade | Normal | Normal | Normal |
| Single signal blockade | Wavering | Normal | Possible (compensation) |
| Single pathway blockade | Normal | Microcalcification | Possible (compensation) |
| Dual blockade (CAM × DLT) | Wavering | Microcalcification | Entry into irreversibility (recovery impossible) |
Stage 4 M: The Surfacing of the 7M
The place of Stage 4, manifestation, is the period in which the dual blockade established in Stage 3 crosses the limit of compensation. It is the period in which the events that had been progressing only inside at last rise to the surface. The point at which the patient visits the hospital, the doctor makes a diagnosis, and medicine is prescribed is precisely this stage. But the underlying reality has already been settled long before.
Earlier we saw that manifestation occurs in seven forms. The 1M that is blocked and bursts, the 2M that becomes dull, the 3M in which the signal is coated, the 4M that hardens, the 5M that overflows and grows, the 6M that is severed, and the 7M that collapses. Unraveled upon the timeline, these seven forms are all the surfacing of the same one event in different organs. The event is the microcalcification dual blockade, and the place is in which tissue that dual blockade progressed.
The event that occurred in the mother's sixties was precisely this manifestation. In the blood vessels the 1M atherosclerosis was revealed to the surface, at the place of the insulin signal the 3M diabetes was manifested, in the bone the 7M osteoporosis began, and in the joints the 4M joint stiffening was progressing. The doctors attached four diagnostic names from four specialties to the mother and prescribed four medicines.
Seen from the viewpoint of specialty medicine, these four diagnostic names look like different events. Atherosclerosis is the domain of cardiology, diabetes the domain of endocrinology, osteoporosis the domain of orthopedics, and joint stiffening the domain of rheumatology. But seen from the viewpoint of the five DTDMC stages, these four are four surfaces of the same one event. The dual blockade that progressed inside the mother's microvasculature surfaced at four places under four diagnostic names, according to in which tissue it progressed.
The clinical fact that several 7M patterns are manifested together in one patient directly shows this fact. That an atherosclerosis patient has osteoporosis, and that a diabetes patient carries the risk of Alzheimer's, is no coincidence. It is because the same underlying reality has been manifested together at several places. Specialty medicine attaches diagnostic names each in its own place, but the underlying reality is at one place.
Figure 5 organizes at which period, on average, the seven places of the 7M surface upon the timeline. The 1M Obstruction & Rupture is the pattern that surfaces earliest, and the 2M Dysfunction also frequently appears in the 50s. The 4M Hardening and the 7M Collapse become full-scale in the 60s. And the 6M Disconnection and the 5M Overflow & Burst often surface in the late 60s and the 70s.
[Figure 5] The Surfacing Points of the 7M on the Timeline
| Average surfacing period | 7M pattern | Representative clinical | Specialty medicine diagnostic name | The mother's case |
|---|---|---|---|---|
| Early 50s | 1M, 3M | Blockage, coating | Onset of high blood pressure, diabetes | First medication prescription |
| Late 50s | 1M, 2M, 4M | Blockage, dulling, hardening | Hyperlipidemia added | Two pills |
| Early 60s | 3M, 4M, 7M | Coating, hardening, collapse | Kidney, joint, osteoporosis | Five pills |
| Late 60s | 5M, 6M added | Overflow, disconnection | Risk of tumor, dementia | In progress |
There is one more fact that must be pointed out. It is that the period of manifestation differs from the period of the dual blockade. The dual blockade was already established in the 50s, but the manifestation revealed to the surface is diagnosed only upon reaching the 60s. This time gap is one of the places explaining why specialty medicine has not seen the underlying reality of chronic disease. At the point when the doctor makes the diagnosis, the underlying reality has already been settled ten to twenty years before.
So the prescription of medicine at the manifestation stage becomes the work of pressing down the result. The underlying reality is progressing all the while, and when the medicine is stopped, the figures rise again. So the medicines gradually increase. The place where the mother went from one pill to five pills in twelve years is precisely this place.
Stage 5 C: Multi-Axis Organ Failure and Annihilation
The place of Stage 5, annihilation, is the stage unraveled for the first time in this book. If Stage 4 manifestation continues on and intervention is not sufficient, it is the period in which the system itself terminates. In medicine this stage is called multi-axis organ failure, and it is also called MODS after its English initials. It is also the last period in a person's lifetime, that is, the period of dying.
Annihilation begins at the cellular dimension. When the 7M of Stage 4 crosses a certain limit in some tissue, the cells of that tissue can no longer cause execution with the calcium signal. Even if the signal comes in, the cell cannot respond, and the cell that cannot respond enters the road of death. At first it is the death of one cell, but the dead cell is not recovered, and the burden of one cell is transmitted just as it is to the cell beside it.
When dead cells accumulate, a change at the tissue dimension follows. The function that tissue was in charge of halts or drops greatly. When the glomeruli of the kidney die, the glomerular filtration rate falls. When the hepatocytes of the liver die, liver function falls. When the myocardial cells of the heart die, cardiac output falls. Specialty medicine attaches the diagnostic names of renal failure, hepatic failure, and heart failure at this place.
The failure of one tissue does not stay in one place. When the kidney weakens, blood pressure wavers; the wavering blood pressure puts a burden on the heart; the burdened heart has a falling output; and when the output falls, the blood flow going to the kidney decreases further. A self-reinforcing circuit is made in which the failure of one organ calls forth the failure of another organ. The name multi-axis organ failure points to this state.
At the last stage, death arrives. The direct causes of death written on death certificates number more than a thousand. Heart failure, renal failure, respiratory failure, sepsis, hemorrhagic shock, the last place of various tumors. But the last molecular event of these thousand diagnostic names converges into one. It is the event in which the cell can no longer cause execution with the calcium signal.
The place of the mother after her seventies still remains. At the time of writing this book the mother is in her late sixties, and she is at a place that has not entered Stage 5. But at the place of specialty medicine she already has five diagnostic names, and the possibility is visible that the pills will increase to seven. And those pills do not block the underlying reality.
So the annihilation of Stage 5 is not a fixed destiny. If the accumulation of Stage 1 decreases, the trigger of Stage 2 is activated later; if Stage 2 is activated later, the dual blockade of Stage 3 is established later; if Stage 3 is established later, the manifestation of Stage 4 surfaces later; and if Stage 4 surfaces later, the annihilation of Stage 5 arrives later, or does not arrive at all. The places that determine the time scale of the five DTDMC stages are the two places of Stage 1 and Stage 3. If accumulation is reduced at Stage 1, and intervention is made before the dual blockade is established at Stage 3, the annihilation of Stage 5 grows distant.
Figure 6 organizes in one place the clinical flow of the annihilation stage. It is the flow in which death at the cellular dimension leads to functional halt at the tissue dimension, functional halt at the tissue dimension to failure at the organ dimension, and failure at the organ dimension to failure at the multi-axis dimension. The road to block this flow is not in Stage 5 itself. It is before Stage 5, that is, in Stage 1 and Stage 3. So in the following chapter we unravel the place where recovery and annihilation are divided even after passing through the same five stages, that is, the place of the fork in the road.
[Figure 6] The Clinical Flow of the Annihilation Stage
| Dimension | Event | Clinical meaning |
|---|---|---|
| Cell | Halt of calcium-signal execution | Cell death |
| Tissue | Accumulation of dead cells | Functional halt |
| Organ | Failure of one organ | Compensation limit |
| Multi-axis | Simultaneous failure of several organs | Self-reinforcing decline |
| Death | Convergence of the molecular event | Halt of the calcium signal |
One Mother's Thirty Years: The Recovery of the Book's Title
Lastly, we spread out one mother's thirty years upon the five DTDMC stages. It is a time for seeing how the thirty years in which the mother keeps getting worse even while taking five pills every day are connected as one stream upon the five stages.
The mother's thirties were the period of the accumulation of Stage 1 determinants. The standard checkups were all normal, and neither doctor nor patient felt any signal. But the accumulation of the three grains of nutrition and lifestyle habits and aging was progressing a little every day. That accumulation continued through her early and mid forties. There was no one who did wrong, but the accumulation was progressing.
In the mother's early fifties the first pill was prescribed. The diagnosis was essential hypertension. Seen again upon the five stages, that point was the point of the activation of the Stage 2 trigger. It is the point at which the DIAH triggers were activated and calcium began to flow out of the bone in earnest, and it is also the point at which the calcium that flowed out began to deposit on the microvascular wall. The medicine pressed down the surface called blood pressure, but it did not block the underlying reality. In her late fifties cholesterol medication was added, and at that point the dual blockade of microcalcification had already been established. It was the place of Stage 3.
As the mother entered her sixties, Stage 4 manifestation became full-scale. The pills increased to five, and specialty medicine attached five diagnostic names to the mother. High blood pressure, hyperlipidemia, diabetes, osteoporosis, and the suspicion of mild cognitive decline. Seen from the viewpoint of the five stages, these five diagnostic names are not different events. They are the event in which the same one underlying reality, that is, the microcalcification dual blockade, was revealed at five places as five surfaces. Here lies the reason the mother keeps getting worse even while taking five pills every day. The medicines are merely pressing down five surfaces; they do not touch the one underlying reality.
The title of this book, The Age of Physical Medicine, here clearly shows the form in which it is manifested in medicine. The work of noticing that the five diagnostic names specialty medicine saw separately are the surfacing of one underlying reality at five places, the work of noticing that that underlying reality is a physical event progressing inside the microvasculature, and the work of noticing that that physical event is seated upon the timeline of the five DTDMC stages: this is the new viewpoint this book proposes. But one question remains. Even after passing through the same five stages, some people recover and some people are annihilated. Even meeting the same dual blockade, one person walks out of the hospital on two feet and another does not recover consciousness. What makes that difference? In the following chapter we unravel the places that decide that fork in the road.
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