Abstract / Summary
Objective To construct a formal framework of second-order metaphilosophy of medicine for registering the acts by which medicine measures, diagnoses, treats and normalises its own objects, and for characterising the residue that such acts generate and that first-order methods cannot dissolve. Methods Seventeen meta-axioms (MM-A1—MM-A17) serve as the core, supporting a seven-axis architecture (plus one working candidate axis), thirty paradigmatic theorems with three working candidates, six hidden strata (Q0—Q5), a four-valued bearing axis (Π0—Π3) with four extension candidates, three cross-cutting dimensions (X/Y/Z), and three incommensurable medical variables (S_pain, C_care, H_bio). A three-tier evidential model is adopted—original (O), mediated (M1), and registering (M2)—together with five canons of mediation and five criteria for co-reference, ensuring that absorption of first-order literature enters no proof chain and contributes nothing to the count of external validation. A formalisation kernel (F-1—F-12) is also given: Tarskian language stratification L₀–L₃, the KΠ modal system, the Alexandrov topology and pseudometric on Ω, the strict weak partial order on S_pain with six hidden-stratum σ-ideals, the non-Archimedean ordered field W for Δ⁻ weights, the Knaster–Tarski fixed point of audit recursion, the AP-MM state machine, and natural-deduction proof sketches for all thirty theorems. All constructions are the sole work of the author, without external formal review (n=0) and without mechanical verification. Materials Three corpora totalling 15,992 publications (1,928 Chinese; 14,064 English) were integrated into three mediated texts with abstract coverage of complete, approximately 97%, and approximately 26% respectively. From these were derived 164 absorption entries (gross numbering; 163 net active), 68 heterogeneity co-reference clusters, 91 reflexivity registrations, 260 thesis registrations, and 92 mirror registrations. Results The system yields twenty-four numbered original propositions, O-01—O-24 (no rating is assigned; twenty independent propositions after merging homologous items), and establishes ten direction anchors, DA-01—DA-10 (direction anchors, not ratings). The former range declaration "MM-S-00—MM-S-46, 47 items" was a bare range statement never written out item by item; it is deregistered as of this edition (deregistration registered as K-206). The system also establishes nine ethical red lines, seven categories of exclusion zones, an adjudication protocol (AP-MM), and fourteen auditing laws. Its public function is expressly delimited to boundary registration, excluding any right of transformation. A second-order critique covering ten domains and one hundred specific systems of global medicine achieved a hit rate of 58% (34 pierced + 24 hit); a further fourteen rounds were voluntarily withdrawn on grounds of category mismatch and are not counted in the hit rate. Conclusions The common boundary of global medical systems lies not in the refinement of method but in the silence of the ledger: metric substitution unstated, foreclosure unregistered, hidden strata unacknowledged as uncodable, and the intersection of bearing position with power structure unmarked. The force of a second-order theory consists in illuminating that silence, not in supplying first-order treatment. The mirror does not heal; the drug does not reflect. Limitations All conclusions are unvalidated; external validation n=0; inter-rater agreement (Kappa) is unreported; no independent third party participated. This paper assigns no proposition rating and the honesty indicator H has been withdrawn. It constitutes no first-order clinical evidence and enters no first-order decision chain. Formalisation is not validation (K-250): the constructions above improve precision of statement and carry no correctness guarantee; formal review n=0.