godfather of surgery

Chapter 1314 Dialogue with the Body
The regulatory theory of the Yellow Emperor's Inner Classic is consistent with K therapy, and its concept is undoubtedly advanced. However, Yang Ping's theory is merely a hypothesis, and it is by no means easy to verify it through experiments. His K therapy is the practice of this hypothetical theory, but the treatment of only a few types of tumors is not enough to demonstrate the universality of this theory.

Yang Ping decided to apply this theory to other non-tumor patients, but it was not that simple. He had to be able to integrate and communicate with some existing medical theories about the disease, so the selection of non-tumor patients was extremely strict.

Professor Mannstein then called from Berlin.

“Professor, I may have found the best case to verify your theory,” Mainstein said seriously on the other end of the phone. “A 27-year-old woman with Lynch syndrome.”

Yang Ping immediately sat up straight. Lynch syndrome—hereditary nonpolyposis colorectal cancer syndrome—is caused by germline mutations in DNA mismatch repair genes, giving patients an extremely high risk of developing multiple cancers throughout their lives, including colorectal cancer, endometrial cancer, and stomach cancer. It's a disease with a systemic defect: the body's cells are inherently deficient in DNA repair, leading to the accumulation of mutations and ultimately causing cancer.

Indeed, this is an excellent case.

“She doesn’t have cancer yet,” Mainstein continued, “but genetic testing shows she carries a pathogenic mutation in the MSH2 gene, colonoscopy revealed dozens of adenomatous polyps, and gastroscopy revealed early atrophic gastritis with intestinal metaplasia, all of which are precancerous lesions. According to standard guidelines, she should immediately undergo prophylactic total colectomy and regular endoscopic monitoring.”

“But she refused the surgery,” Yang Ping guessed. “Want to try a new method?”

Mannstein pulled up the patient's complete medical record. "She's a violinist who just signed with a top European symphony orchestra. The surgery and subsequent recovery will severely impact her career. More importantly..." He paused, "She wants to try your theory after hearing it, and she doesn't care if she fails. It's not too late to consider traditional treatments then."

"Does she want to try the application of K therapy for other diseases?" Yang Ping asked.

“Yes, she wanted to try what you mentioned in your article about ‘regulatory systems to prevent errors,’” Mainstein said, speaking a little quickly. “She read all your articles in the journal *Medicine*, including that philosophical paper. She said, ‘If you really find a way to communicate with the body, I want to be that communicator.’”

Yang Ping paused for a moment: "But Factor K is currently only used for diagnosed cancers, and specifically for tumors that overexpress TIM. Her condition is not very suitable, and if she were to undergo treatment, it would be entirely experimental."

“Her colon polyp biopsy showed that all adenomatous cells abnormally overexpressed TIM-F family members, and the expression pattern was very unstable, with some cells expressing high levels and others low levels, which is exactly the ‘identity confusion’ you mentioned.” Manstein pulled up the single-cell sequencing data. “More importantly, her normal colonic mucosal cells also showed significantly higher TIM expression levels than healthy individuals, and these levels fluctuated.”

Yang Ping's eyes lit up: "Does this mean that the entire identity system of her colonic epithelial cells is in an unstable state?"

"Our initial understanding is that DNA repair defects lead to the accumulation of mutations, which may interfere with the expression regulation of genes related to cell identity maintenance, resulting in TIM system disorder. A disordered system is more easily hijacked, just like a building with a security system full of loopholes, which is more easily occupied illegally."

“So you think,” Yang Ping thought quickly, “that if we could adjust this unstable identity system before it becomes cancerous and restore its stability, perhaps we could prevent cancer from occurring? And even cure the disease.”

“That’s what she wanted to verify,” Mainstein nodded. “And she was willing to be part of this experiment, with regular biopsies, blood monitoring, whole-body multi-omics analysis, and even implanted sensors to monitor changes in the local microenvironment.”

Yang Ping took a deep breath. This was an unprecedented challenge: to intervene in the precancerous state using regulatory methods, with the goal of prevention rather than treatment; the patients were young and did not have the urgency of patients with advanced cancer, but the requirements were higher, not only to be effective, but also not to affect their normal life and work.

However, this disease is indeed very suitable for expanding K therapy beyond tumors, because it is currently in an intermediate state between tumors and non-tumors. If successful, it will pave the way for advancing K therapy into the non-tumor field.

“I need to discuss this with my team,” Yang Ping said. “This is a perfect case study. If regulation can really prevent cancer from developing, it will be more significant than treating existing cancer and will further validate my hypothesis.”

“I brought her to Nandu in three days,” Mainstein said. “Her name is Elena Volkova, a German of Russian descent. Incidentally, she also has a PhD in molecular biology, specializing in cell fate determination, so she fully understands the risks and uncertainties involved.”

After hanging up the phone, Yang Ping sat quietly in his office for ten minutes.

Then he opened the Yellow Emperor's Inner Classic and turned to the Suwen Chapter on Regulating the Spirit in Accordance with the Four Seasons: "Therefore, the sage does not treat illness that has already developed, but rather illness that has not yet developed; he does not quell disorder that has already occurred, but rather disorder that has not yet occurred... To administer medicine after illness has already developed, or to quell disorder after disorder has already occurred, is like digging a well when thirsty or forging a weapon when already in battle—is it not too late?"

The text, written two thousand years ago, now carries immense weight, revealing such advanced theories that perfectly align with the hypothesis he discovered.

That day, Yang Ping gathered his team members together.

Yang Ping briefly introduced Elena's condition: 27 years old, MSH2 mutation, multiple adenomas, refused preventative surgery, and requested to try systemic K therapy.

Then, getting straight to the point: "Should we use a regulation-based intervention program on this Lynch syndrome carrier who has not yet developed cancer, with the goal of preventing cancer from developing?"

“The standard treatment is surgery,” Song Ziming spoke first. “She refused the standard treatment and chose experimental intervention. Is this ethically permissible?”

After a moment's thought, Tang Shun said, "The prerequisites are: first, she is fully informed and gives her consent, understanding the advantages and disadvantages of standard treatment and the risks of experimental intervention; second, the experimental intervention has a reasonable scientific basis and is not a blind attempt; third, she did not make the choice because of economic reasons or information asymmetry. Based on the available materials, she meets these conditions; she is a PhD in biology and has conducted in-depth research on her own."

“But we need to design entirely new Factor K for prevention. We have never studied a Factor K therapy for this disease, nor do we have any experience in designing such a Factor K,” Lu Xiaolu worried. “Besides, there are many more problems. Even if we design Factor K, how do we determine the dosage? How long is the treatment course? The side effects are unknown. What if she develops cancer during the intervention period if the intervention is ineffective?”

“That’s the challenge,” Tang Shun also worried. “We need to use the professor’s hypothesis to design a completely new plan. The biggest problem is that my theory is currently defined as a hypothesis, even though this hypothesis has been fully verified in several cancer treatments.”

Yang Ping pulled up the data model: "I don't think this is a problem. We have already accumulated data on tumors, and now we are just applying it to precancerous lesions. Based on Elena's TIM expression profile, we can design a 'mild regulation program' that uses the lowest effective dose of TIM modulators, supplemented by microenvironment regulation and metabolic regulation. The goal is to reduce system disorder, rather than to eliminate existing diseased cells."

"How do we evaluate the effectiveness?" Song Ziming asked. "The evaluation criteria for tumor treatment are shrinkage or disappearance, but what are the evaluation criteria for prevention?"

Yang Ping wrote on the whiteboard:

The assessment dimensions for preventive regulation focus on the following aspects:
System stability indicators: TIM expression volatility decreased, and the expression profile of identity-related genes tended to normalize.

Pathological reversal indicators: reduction or regression of the number of adenomas, and improvement of atrophic gastritis.

Mutation accumulation rate: The growth rate of mutation abundance in circulating tumor DNA slows down.

Quality of life indicators: No treatment-related adverse reactions, maintaining normal work and life.

Long-term endpoint: delaying or preventing cancer development
“This requires long-term follow-up,” Tang Shun said, “five years, ten years, or even longer.”

“Elena agrees,” Yang Ping said, showing her email. Lu Xiaolu then asked, “If the treatment fails and she develops cancer, will we be held responsible?”

"The plan will clearly state: this is scientific research exploration, not standard treatment; she can withdraw at any time and switch back to standard treatment; we will provide the most rigorous monitoring, and intervene immediately once signs of cancer are detected," Yang Ping replied. "Moreover, full-process tracking and evaluation are required."

The discussion lasted for two hours.

Supporters see this as a valuable opportunity to advance medicine; those who are concerned argue that the risks are too great and that failure could damage the credibility of the entire hypothesis.

In conclusion, Yang Ping stated: "I am aware of the risks, but if we only ever verify theories within safe limits, we will never achieve a breakthrough. Elena is not a passive patient; she is an active explorer, paving the way for the future of medicine with her own body. We should respect this courage and accompany her with the most rigorous science, the most meticulous plans, and the most humane care. Most importantly, the risks of our experimental treatment are controllable, at least in my opinion. I have confidence in my hypothesis."

Voting results: 9 votes in favor, 3 votes against, and 1 abstention.

The plan was approved.

Three days later, Elena Volkova sat in the reception room of the Sanbo Institute. She had long, dark brown hair, grey-blue eyes, and long, slender fingers—the hands of a violinist. Professor Mainstein accompanied her.

“Thank you for agreeing to meet,” Elena said calmly and clearly. “I have read all your papers, especially ‘Medicine as Dialogue.’ That article showed me another possibility: not fighting disease, but having a dialogue with the body. I believe this is definitely the future direction of medicine.”

Yang Ping nodded: "Your violin playing is itself a dialogue, a dialogue with the instrument, with the music, and with the audience."

“Exactly!” Elena’s eyes lit up. “When I play, I don’t control the violin, but I talk to it. I apply pressure, and it responds with sound; I adjust my posture, and it changes its timbre. The best musical moments are when I become one with the violin, as if it were an extension of my body.”

She leaned forward: “I believe treatment should be like this. Doctors are not technicians who repair the body, but partners who communicate with it. The body sends signals—pain, discomfort, abnormal test results; the doctor responds to the signals—diagnosis, treatment, and adjustment. The best time for treatment is when the doctor and the body work together to restore health.”

Yang Ping was surprised by her expression, which was exactly the core concept he had been trying to articulate but always felt he couldn't quite put his words into words.

"So you refused surgery not because of fear?"

Elena chimed in, “The doctor said, ‘Your colon has a problem, remove it.’ It’s like the G string on a violin is always out of tune; instead of adjusting it, you just remove it. Maybe the pitch will be right for now, but the instrument is broken. Before your theory came out, this was the only option. Now that your theory has come out, why shouldn’t I try the new theory? What if it succeeds? And I’ve studied it carefully; even if it fails, it’s a failure I can handle.”

She paused for a moment: “I know this sounds idealistic, but when I read your theories, the cellular identity system, TIM, regulation rather than attack, I see the possibility of dialogue. Maybe we can adjust my cells instead of removing my organs.”

Yang Ping explained the treatment plan to her in detail: a personalized modulator designed based on her TIM expression profile, supplemented by metabolic regulation and microenvironment optimization, administered monthly with close monitoring. The goal is to stabilize the cell identity system, allowing the adenoma to regress spontaneously or at least not progress.

“Throughout the process, we will monitor your body’s response in real time,” Yang Ping said, pulling up the monitoring plan. “We will also monitor your blood, tissue biopsies, imaging, and your own feelings. We need your body to tell us whether the regulation is effective, whether the dosage is appropriate, and whether the direction is correct. We are exploring and working on all of this.”

Elena laughed: "It's like tuning a piano. You adjust my cells, my body responds with changes in pitch, and then we fine-tune together."

"Exactly."

“Then,” she said, extending her hand, “let’s begin this conversation. My gut tells me I will succeed.”

Yang Ping shook hands with her.

The treatment approach for precancerous lesions is the same as that for cancer, and theoretically, it is easier to treat. The new K factor only requires slight modifications to the original one. Under the premise of controllable risks, the only obstacle is ethics, but with Elena's insistence, ethics is no longer an issue.

The first K treatment was administered three days later at a precisely calculated "mildly adjusted dose," only one-tenth the dose used to treat cancer patients.

Elena lay on the treatment bed, calmly watching the medication slowly flow into her vein. Beside her were monitoring devices, the screens displaying electrocardiograms, heart rates, respiration, blood oxygen levels, blood pressure, and more.

"How are you feeling?" Yang Ping asked her.

"It's a little warm." Elena closed her eyes.

"This is a normal vascular response. Please let me know if you experience any discomfort."

"No, it's very comfortable."

The infusion lasted an hour. After it ended, Elena sat up and stretched her arms.

"how?"

“It’s amazing,” she thought, carefully choosing her words. “It’s not the feeling of the drug entering the body, but more like receiving a clear message. It’s as if the body understands what to do.”

It's not that magical; it's similar to a regular IV drip. But musicians always have a wonderful intuition and can always appreciate the beauty in ordinary things in life.

Monitoring data showed that two hours after the infusion, the levels of certain inflammatory factors in her blood decreased slightly, while the levels of several growth factors related to tissue repair increased. Preliminary analysis of the TIM expression profile showed reduced variability in TIM expression in the colon biopsy tissue.

Yang Ping said, "The early signs are positive, but the key is the long-term effect. We need to see how her colon adenoma changes."

According to the plan, Elena will stay in Nandu for two weeks for intensive baseline testing and the first post-adjustment assessment, before returning to Germany. She will visit Nandu once a month, during which time she will be continuously monitored through a remote monitoring system.

(End of this chapter)