Medicine - Heliomance/Uncharted-Horizons GitHub Wiki

_{Focus Areas · Design document §3}

Available from: G03 (Herbal Medicine) + SO04 (Writing)

22 breakthroughs — CORE 3 · STANDARD 12 · UNCOMMON 3 · RARE 2 · UNIQUE 2 — Ancient – Space

Builds on: Foraging (5) · Observation (2) · Social Organization (2) · Animal Husbandry (1) · Philosophy and the Arts (3) · Water Management (1) · Mechanics (1) · Thermodynamics (1) · Chemistry (4) · Optics (2) · Electronics (1) · Materials Science (1) · Genetics (3)

Leads into: Animal Husbandry (1) · Computing (1) · Genetics (4) · Space Engineering (1)

_{The numbers count prerequisite links between this focus and the other. How to read the tables.}

flowchart LR
  n_MD01["MD01 Surgical Techniques"]:::STANDARD
  n_MD02["MD02 Quarantine Protocols"]:::STANDARD
  n_MD07["MD07 Anaesthesia"]:::STANDARD
  n_MD09["MD09 Trepanation Tradition"]:::RARE
  n_MD03["MD03 Anatomy Study"]:::CORE
  n_MD04["MD04 Vaccination"]:::STANDARD
  n_MD05["MD05 Germ Theory"]:::CORE
  n_MD06["MD06 Antibiotics"]:::STANDARD
  n_MD11["MD11 Gene Therapy"]:::STANDARD
  n_MD13["MD13 Cryogenic Preservation"]:::UNCOMMON
  n_MD_V01["MD-V01 Vital Essence Medicine"]:::STANDARD
  n_MD20["MD20 Phage Therapy"]:::STANDARD
  n_MD21["MD21 Engineered Phages"]:::STANDARD
  n_MD08["MD08 Prosthetics"]:::UNCOMMON
  n_MD12["MD12 Cybernetic Enhancement"]:::RARE
  n_MD10["MD10 Traditional Medicine Integration"]:::UNIQUE
  n_MD15["MD15 Contagion Experiments"]:::CORE
  n_MD16["MD16 Miasma Engineering"]:::STANDARD
  n_MD17["MD17 Humoral Medicine"]:::STANDARD
  n_MD18["MD18 Humoral Pharmacology"]:::STANDARD
  n_MD19["MD19 Temperament Engineering"]:::UNCOMMON
  n_MD14["MD14 Hot Spring Healing Tradition"]:::UNIQUE
  n_MD01 --> n_MD02
  n_MD03 --> n_MD04
  n_MD03 --> n_MD05
  n_MD05 --> n_MD06
  n_MD01 --> n_MD07
  n_MD03 --> n_MD08
  n_MD01 --> n_MD09
  n_MD03 --> n_MD10
  n_MD06 -.-> n_MD11
  n_MD18 -.-> n_MD11
  n_MD16 -.-> n_MD11
  n_MD08 --> n_MD12
  n_MD11 --> n_MD13
  n_MD03 --> n_MD15
  n_MD15 --> n_MD16
  n_MD15 --> n_MD17
  n_MD17 --> n_MD18
  n_MD18 --> n_MD19
  n_MD05 --> n_MD20
  n_MD20 --> n_MD21
  n_MD18 -.-> n_MD_V01
  n_MD06 -.-> n_MD_V01
  n_MD16 -.-> n_MD_V01
  classDef CORE fill:#dbeafe,stroke:#1d4ed8,color:#0b1b3b
  classDef STANDARD fill:#f1f5f9,stroke:#64748b,color:#0f172a
  classDef UNCOMMON fill:#dcfce7,stroke:#15803d,color:#052e16
  classDef RARE fill:#fef3c7,stroke:#b45309,color:#3b2005
  classDef UNIQUE fill:#fae8ff,stroke:#a21caf,color:#3b0a3f

_{Prerequisites within this focus. Box colour is the tier (blue CORE, grey STANDARD, green UNCOMMON, amber RARE, purple UNIQUE); dotted arrows are alternatives (“or”); a line can pass behind another box, so follow it from its start. 21 of these 22 breakthroughs also need breakthroughs from other foci, which the overview above lists.}

• Tier: STANDARD · Era: Ancient
• Prerequisites: G03 (Herbal Medicine)
• Unlocks: Surgeryⁿ [20/0; requires a Herbalist in this city; ⟨[Military] Units adjacent to this city heal [+10] HP per turn when healing⟩]. (Hospital moves to Germ Theory, MD05, in §7 — its +5 Food is a Modern-era yield.)
• Notes: Surgery predates comparative anatomy by millennia — trepanation is Neolithic — so it rests on herbal medicine; the Medicine focus's own route (Herbal Medicine + Writing) keeps it Ancient.
• Leads to: AH11 Veterinary Medicine, MD02 Quarantine Protocols, MD07 Anaesthesia, MD09 Trepanation Tradition

• Tier: STANDARD · Era: Classical
• Prerequisites: MD01 + SO08 (Census)
• Unlocks: Quarantine Stationⁿ [25/0; ⟨[+10]% growth [in this city]⟩].

• Tier: CORE · Era: Classical
• Prerequisites: O03 (Animal Behavior Study) + G03 (Herbal Medicine) + O06 (Natural Philosophy — Alcmaeon's and Aristotle's dissections)
• Unlocks: Medical Schoolⁿ [50/1; requires a Library in this city; Scientist ×1; ⟨[Military] Units adjacent to this city heal [+5] HP per turn when healing⟩]. Foundation of advanced medicine. The body learned by dissection, animal first: Aristotle compared animals, Herophilus dissected human bodies at Alexandria, and Galen's anatomy was largely of apes and pigs (Comparative Anatomy, merged here in v3.116).
• Leads to: MD04 Vaccination, MD05 Germ Theory, MD08 Prosthetics, MD10 Traditional Medicine Integration, MD15 Contagion Experiments, CP11 Neural Interface, GN04 Cloning, GN12 Vital Essence Isolation

• Tier: STANDARD · Era: Early Modern
• Prerequisites: MD03 + AH02 (Herd Animal Domestication — the milkmaid observation) + PH04 (Scientific Method — Jenner's trial)
• Unlocks: ⟨[+10]% growth [in all cities]⟩ — the plague years end. Also discoverable through Animal Husbandry (the milkmaid observation).

• Tier: CORE · Era: Modern
• Prerequisites: MD03 + PH04 (Scientific Method) + OP03 (Telescope — the microscope)
• Unlocks: Hospital; ⟨[+10]% growth [in all cities]⟩ (sanitation). Grants DISEASE_THEORY token if validated. Frontier Question FQ10: resolved by MD15. In Germ worlds (~60%) MD05 validates; in Miasma/Humoral worlds it dead-ends and MD16/MD17 serve instead.
• Notes: In most universes, the microbe is the culprit.
• Leads to: MD06 Antibiotics, MD20 Phage Therapy, GN02 DNA Structure, SE01 Life Support Systems

• Tier: STANDARD · Era: Atomic
• Prerequisites: MD05 (Germ Theory validated) + CH07 (Organic Chemistry)
• Unlocks: Medical Lab; ⟨All newly-trained [Military] units [in all cities] receive the [Medic] promotion⟩. Germ-exclusive. Grants MASS_MEDICINE (germ route). The primary of the infection Competing Solution; Phage Therapy (MD20) is its alternative. The canonical Medical Lab gains ⟨Remove [Phage Institute] [in this city]⟩ through the ruleset derivation: a city holds one or the other, and switches by building the other.
• Notes: The magic bullet — but only if microbes are the enemy.
• Leads to: MD11 Gene Therapy, MD-V01 Vital Essence Medicine

• Tier: STANDARD · Era: Modern
• Prerequisites: MD01 + CH04 (Distillation) + CH05 (Oxygen Theory — the pneumatic chemists' gases)
• Unlocks: ⟨[+5] HP when healing⟩ — surgery in the field.

• Tier: UNCOMMON · Era: Modern
• Prerequisites: MD03 + MC03 (Gearing)
• Unlocks: ⟨All newly-trained [Land] units [in all cities] receive the [Medic] promotion⟩ — the wounded return to the line. Prerequisite for Cybernetic Enhancement (MD12).
• Leads to: MD12 Cybernetic Enhancement

• Tier: RARE · Era: Ancient
• Prerequisites: MD01
• Unlocks: ⟨[+15]% Great Person generation [in all cities]⟩ (lives lengthened); ⟨[+1 Culture] [in capital]⟩.
• Notes: What if early trepanation led to neurosurgical tradition?

• Tier: UNIQUE · Era: Classical
• Prerequisites: G03 + MD03 + Diverse biome (3+ terrain types)
• Unlocks: Apothecaryⁿ [75/1; +1 Happiness, +1 Gold; ⟨[Military] Units adjacent to this city heal [+10] HP per turn when healing⟩]. Civ unique: ⟨[+1 Happiness] [in all cities]⟩; +25% Insight to Medicine.
• Notes: Chinese-inspired.

• Tier: STANDARD · Era: Atomic
• Prerequisites: GN03 (Genetic Engineering) + MASS_MEDICINE token (MD06 germ, MD18 humoral, or MD16 miasma)
• Unlocks: ⟨[+25]% Great Person generation [in all cities]⟩ (long lives); the Designer Baby choice via Events.json.
• Leads to: MD13 Cryogenic Preservation, GN06 Human Genetic Enhancement

• Tier: RARE · Era: Atomic
• Prerequisites: MD08 + EN03 (Integrated Circuit) + MS01 (Composites)
• Unlocks: All Military units gain the Augmentedⁿ promotion (⟨[+10]% Strength⟩); ⟨[+1 Production] from every specialist [in all cities]⟩; augmentation dilemmas via Events.json.

• Tier: UNCOMMON · Era: Space
• Prerequisites: MD11 + TH02 (Refrigeration — cryogenics)
• Unlocks: Cryo Chamberⁿ [190/1; ⟨[+25]% Great Person generation [in this city]⟩].

• Tier: UNIQUE · Era: Ancient
• Prerequisites: G03 (Herbal Medicine) + Volcanic region or Mountain biome
• Unlocks: Thermal Bathⁿ [55/1; +2 Happiness, +1 Culture; ⟨Must be on [Hill]⟩ or ⟨Must have an owned [Volcanic] within [2] tiles⟩]; Hot Springⁿ [improvement on Hill and Volcanic; 5 turns; +1 Gold, +1 Culture]. Civ unique: ⟨[+1 Happiness] in cities on [Hill] tiles⟩.
• Notes: Japanese onsen, Roman thermae, Icelandic hot springs.

• Tier: CORE · Era: Early Modern
• Prerequisites: MD03 (Anatomy) + PH04 (Scientific Method)
• Unlocks: Contagion Laboratoryⁿ [national wonder; 200/0; +2 Science; on completion ⟨Triggers a [Contagion Experiments] event⟩ and Reveals this world's medicine: Germ Theory (MD05, ~60%), Miasma Engineering (MD16, ~20%) or Humoral Medicine (MD17, ~20%)]. The decisive experiment for FQ10 — the swan-neck flask and controlled exposure. Clear report either way.
• Notes: Pasteur's flask. In some worlds the broth stays clear; in others, the air itself sickens, or the body's humours rule.
• Leads to: MD16 Miasma Engineering, MD17 Humoral Medicine

• Tier: STANDARD · Era: Modern
• Prerequisites: MD15 (Miasma validated) + WM02 (Aqueduct)
• Unlocks: Sanitation Worksⁿ [500/3; requires an Aqueduct in this city; +3 Food; ⟨[25]% Food is carried over after population increases [in this city]⟩ — stores kept sweet in clean air]; ⟨[+1 Food, +1 Production] from [Marsh] tiles [in all cities]⟩ (drained fens); ⟨[+25]% Strength <for [Siege] units> <vs cities> <when attacking>⟩ (miasma bombardment). The miasma world's Hospital and Medical Lab in one, an era before the Germ world's Medical Lab. Only in Miasma worlds. Grants DISEASE_THEORY and MASS_MEDICINE (miasma route).
• Notes: Only in Miasma worlds (FQ10). The sanitationists were right for the wrong reason — except here, it's the right reason.
• Leads to: MD11 Gene Therapy, MD-V01 Vital Essence Medicine

• Tier: STANDARD · Era: Modern
• Prerequisites: MD15 (Humoral validated) + G03 (Herbal Medicine)
• Unlocks: Balancing Clinicⁿ [375/2; +2 Food; ⟨[Military] Units adjacent to this city heal [+15] HP per turn when healing⟩] — bloodletting, purging and diet genuinely cure here. Only in Humoral worlds. Grants DISEASE_THEORY.
• Notes: Only in Humoral worlds (FQ10). Galen was right for two thousand years — here, forever.
• Leads to: MD18 Humoral Pharmacology

• Tier: STANDARD · Era: Modern
• Prerequisites: MD17 + CH04 (Distillation)
• Unlocks: Pharmacopoeiaⁿ [250/1; requires a Balancing Clinic in this city; ⟨[+10]% growth [in this city]⟩; ⟨[20]% Food is carried over after population increases [in this city]⟩]; ⟨[+5]% growth [in all cities]⟩. The humoral answer to antibiotics. Grants MASS_MEDICINE (humoral route).
• Notes: Distilled bile and tincture where another world reaches for penicillin.
• Leads to: MD11 Gene Therapy, MD19 Temperament Engineering, MD-V01 Vital Essence Medicine

• Tier: UNCOMMON · Era: Atomic
• Prerequisites: MD18 + SO08 (Census)
• Unlocks: Four halls, one per city — the Choleric Hallⁿ [125/1; requires a Balancing Clinic in this city; ⟨[+15]% Production when constructing [Military] units [in this city]⟩; ⟨Regimen Hall⟩ (tag); ⟨Remove [{Regimen Hall} {non-[Choleric Hall]}] [in this city]⟩], the Sanguine Hallⁿ [375/2; requires a Balancing Clinic in this city; +2 Happiness; ⟨[+10]% growth [in this city]⟩; ⟨Regimen Hall⟩ (tag); ⟨Remove [{Regimen Hall} {non-[Sanguine Hall]}] [in this city]⟩], the Melancholic Hallⁿ [125/1; requires a Balancing Clinic in this city; ⟨[+25]% Great Person generation [in this city]⟩ — the temperament of genius; ⟨Regimen Hall⟩ (tag); ⟨Remove [{Regimen Hall} {non-[Melancholic Hall]}] [in this city]⟩] and the Phlegmatic Hallⁿ [125/1; requires a Balancing Clinic in this city; ⟨[-25]% Unhappiness from [Population] [in this city]⟩; ⟨Regimen Hall⟩ (tag); ⟨Remove [{Regimen Hall} {non-[Phlegmatic Hall]}] [in this city]⟩]. Each retires the others when it is completed, so a city holds one temperament at a time, and changes it by building another. Choose each city's temperament — a governance lever no germ world has.
• Notes: The body politic, literally balanced.

• Tier: STANDARD · Era: Modern
• Prerequisites: MD05 (Germ Theory validated) + OP03 (Telescope — the microscope)
• Unlocks: Phage Instituteⁿ [250/1; requires a Hospital in this city; ⟨[+15]% growth [in this city]⟩; ⟨[15]% Food is carried over after population increases [in this city]⟩; ⟨Remove [Medical Lab] [in this city]⟩] — a library of bacteriophages, each matched to one strain. Grants MASS_MEDICINE (the phage route). The trade: no empire-wide effect — antibiotics are broad, cheap and mass-produced, and that is why they usually win; phages must be matched city by city, and an Institute occupies the slot a Medical Lab would. What phages keep is a future: engineered, they grow stronger (MD21). Competing Solution (§1.2): the alternative to Antibiotics (MD06), detour margin ×1.5 while Antibiotics exists in this world; if Antibiotics is discovered first this is never developed, and if it arrives later this persists — a city chooses between a Phage Institute and a Medical Lab, never both. Germ worlds only (FQ10).
• Notes: Félix d'Hérelle was treating infections with phages in the 1920s; the Eliava Institute in Tbilisi kept the practice alive after the West chose penicillin, and resistance has brought it back.
• Leads to: MD21 Engineered Phages

• Tier: STANDARD · Era: Space
• Prerequisites: MD20 + GN05 (Synthetic Biology)
• Unlocks: ⟨[+15]% growth [in all cities] <in cities with a [Phage Institute]>⟩ — phages designed rather than found: the Institutes double in worth. The late payoff for the harder road, and only for cities that took it. Germ worlds only.

• Tier: STANDARD · Era: Atomic
• Prerequisites: (MD18 or MD06 or MD16) + GN12 (Vital Essence Isolation)
• Unlocks: Essence Clinicⁿ [250/1; ⟨[Military] Units adjacent to this city heal [+10] HP per turn when healing⟩; ⟨[+25]% Great Person generation [in this city]⟩]. Only in Vitalist worlds (FQ11); layers on any disease paradigm. Also discoverable through Genetics.
• Notes: Where life itself is a substance, medicine becomes alchemy.