The Root of Disease and Its Treatment
As the days of COVID-19's rampage have lengthened, clinicians have discovered an ever-growing list of aftereffects it can induce. Recovering patients are left with breathing difficulty, pulmonary fibrosis, hair loss, brain fog, memory decline, fatigue, depression, Alzheimer's disease, loss of taste, loss of smell, and a host of other new ailments. Before 2019, no one imagined that a new coronavirus would appear that would not only damage our respiratory system but also our digestive, urinary, and nervous systems.
The latest research finds that some COVID-19 patients develop symptoms of depression and Alzheimer's disease after recovery. Some scholars believe this is related to viral encephalitis induced by SARS-CoV-2 damaging the brain. The brain is composed of nerve cells, also called neurons. Although the brain weighs only 1.5 kg, it contains 100 billion nerve cells, plus another 100 billion glial cells. If some of these 200 billion cells are damaged, the brain may suffer permanent injury. How can we accurately identify which of these 200 billion cells are damaged and repair them? Perhaps we never will.
The brain is our most important organ; our thinking, emotional experience, and all our responses to the outside world occur in the brain. When a doctor diagnoses brain death, it is effectively equivalent to declaring the person dead. No one predicted that a novel coronavirus would emerge at the end of 2019, and that this coronavirus would actually invade the human brain. In older medical textbooks, COVID-19 could not possibly be listed as a cause of depression or dementia. But in future medical textbooks, this cause will appear.
A person who was originally clear-headed and positive survives a sudden infection by a new virus, but from then on his brain is frequently clouded by brain fog, he can no longer take interest in life, even loses his libido, and prematurely develops symptoms of dementia. His transformation from a basically healthy state to this state occurred solely because the virus changed his body. Fragments of the virus have now permanently become part of his genome; if he has offspring, these fragments may be inherited by them, and what new genetic diseases might they induce? No one knows yet.
I describe this process not to frighten anyone with COVID-19. In fact, this is an experience humanity has repeated throughout our long evolutionary history; our genome contains thousands of viral fragments. Besides viruses, bacteria and fungi also share our bodies. We think our bodies belong only to ourselves, but this is an illusion; they also belong to the countless microorganisms parasitizing within us. Though invisible to the naked eye, they have always been there.
In August 2020, a high school classmate of mine suddenly contracted a very strange illness. After he was admitted to hospital, doctors could only give the diagnosis of "viral fever of unknown origin." He died soon afterward. To this day we still do not know what virus he was infected with; we only know that no one around him was infected. The virus may have jumped from some creature he encountered into his body through some purely accidental opportunity. Every year a large number of such cases of viral infection of unknown cause appear.
Patients often ask me to help analyze the cause of their illness. I try to understand what they have been through by reviewing their medical records and talking with them, and then look for the most likely cause that triggered their disease. But honestly, I am not so certain of my own judgments. I have devoted my life to researching a single disease, yet in clinical diagnosis I may not reach even 70% accuracy, let alone successful treatment.
How will future people treat the depression and Parkinson's disease caused by COVID-19? Should doctors treat COVID-induced depression and Parkinson's separately from the same diseases caused by other factors? What causes other patients' depression and Parkinson's? Is it also infection by some virus? Genetic factors? Or accidental brain injury? Will COVID-19 induce some kind of tumor?
If you delve deeply into medical research, you will find your mind filled with all kinds of questions that are hard to answer. Our 100 billion neurons and 100 billion glial cells are constantly responding to these questions. We seek solutions to disease problems through all kinds of animal experiments and pharmacological trials. We also try solutions on human beings, and from this arose medicine and its various methods of treating disease.
But regrettably, more than half of patients may find that doctors cannot help them much, and some patients' conditions even worsen while being treated. Doctors are also distressed; treatment failures leave them feeling frustrated, and they worry that patients may overreact.
In the face of disease, the most powerful and wealthy people throughout history have been helpless. Emperor Zhezong of Song was a headstrong man, but when tormented by illness, he listened obediently to every treatment suggestion offered by imperial physicians and his ministers. Yet no matter how readily he accepted good advice, in the first month of his 23rd year he passed away. Before his death, none of the children he fathered survived; doctors were helpless against the illnesses of Emperor Zhezong and his children.
The succession to the Song throne shifted at Emperor Zhezong; his younger brother Emperor Huizong inherited the throne. This prince, who had never been destined for power, had originally wanted only to immerse himself in artistic creation for the rest of his life — which would also have been his best way of lying low. But he was too immersed; after his brother's untimely death he was still absorbed in art. Because he had not been groomed as crown prince, his statecraft was poor; under his rule the Song court steadily declined, and soon the "Jingkang Humiliation" occurred, with the emperor taken captive.
The Song dynasty was the golden age of Chinese medicine; the medical resources the imperial family could command were beyond comparison with those of ordinary people, and there was no such thing as Western medicine ruining a patient and then handing them over to Chinese medicine to clean up the mess. Yet even in such an era, an emperor and his offspring could not escape dying young from illness. To this day, lovers of Chinese medicine still indulge in the fantasy that ancient Chinese medicine was omnipotent, and patients and TCM enthusiasts often place unrealistic hopes on me. Sometimes I honestly tell them that Chinese medicine has limited capabilities and that my own abilities are limited, but they refuse to accept it.
Modern medicine also has strong limitations. In the two-plus years of fighting COVID-19, the whole world has seen how powerless medicine is in the face of a new infectious disease. In fact, most of the time doctors can only exhaust every means to relieve patients' suffering; curing disease is very difficult. Among the diseases I have studied, the patients who can be cured are a tiny minority.
How do we cure the brain damage caused by COVID-19? Will this question be solved a hundred years from now? How do we cure the immunodeficiency caused by AIDS? How do we cure cancer? In reality, it is very hard for us to grasp the laws by which these diseases develop in the human body. We can only offer patients very limited help: alleviating their depressed mood, protecting their fragile immune systems, reducing the various complications caused by cancer, and making patients feel as much better as possible during their remaining years compared with no treatment. And we must fully take into account the patient's personal wishes and financial situation.
Perhaps you have also read books like XX Cures Ten Thousand Diseases, The Source of Ten Thousand Diseases, or Tricks for Curing XX Disease. From their titles alone, such books already smack of deceiving readers. If one day you became a doctor and used the techniques in these books to treat disease, you would find that out of a thousand patients, perhaps ten or twenty respond. How would you face the other patients who did not respond? If you were a doctor, you would undoubtedly look for more reliable, peer-validated regimens with higher efficacy. Because if another approach helps three or four hundred out of a thousand patients, the embarrassment of ineffective treatment is far less. This is just a simple math problem; even someone who has never attended school can get it right by instinct.
Anyone can criticize medicine to pieces, because medicine is indeed very imperfect. Every doctor has a large number of failed treatments in their history, so attacking them is easy. But this is the reality we have to face. The causes of disease are extremely complex and hard to predict; the development and prognosis of disease follow general rules, but there are always exceptions. Medicine is far from precise, and its development is slow. Yet without the help of imperfect medicine, humanity's condition would be far worse.