A Must-Read for TCM Treatment of Neurological Diseases: Yilin Gaicuo (Corrections of Errors in Medical Circles)
Yilin Gaicuo (Corrections of Errors in Medical Circles) is a work by the Qing-dynasty physician Wang Qingren. Wang Qingren was a physician of strong personality and a highly effective clinical practitioner. His book Yilin Gaicuo is very thin but remarkably innovative—terse and to the point. Completed in 1830, it spread rapidly through medical circles after publication, with over 70 editions appearing quickly; it was even translated into English, French, Japanese, and other languages. England's Transactions of the Royal Society published an English translation and called Wang Qingren a "modern anatomist."
Wang Qingren was born in Hedong Village, Yahongqiao, Yutian County, Hebei. His ancestor Wang Ningji was a local famous physician; from boyhood Wang studied medicine with his family while also practicing martial arts, so he was bold enough to dissect corpses. The British calling him a "modern anatomist" was not baseless: Wang is one of the very few ancient Chinese physicians with real anatomical experience. The other famous ancient Chinese anatomist was Song Ci, the forensic expert of the Southern Song.
Wang began practicing medicine at 21 and practiced for 42 years, in his home village and in Beijing. At the beginning of the fourth month of his 30th year, while traveling in Daodi Town, Luanzhou (today's Lu'nan District, Tangshan, Hebei), he happened on a local plague in which many children died of "plaque-rash dysentery" (possibly cholera). Child mortality was extremely high—by Wang's record, "eight or nine out of ten died." Many children died whose families could not afford burial; they were wrapped in straw mats and buried in unmarked graveyards, then dug up by wild dogs and disemboweled—a pitiful sight. To study disease, Wang went personally to observe, spending more than ten days carefully examining the structure of every part of the human body. Later he visited execution grounds several times to observe prisoners sentenced to dismemberment.
What he saw with his own eyes made him realize that the descriptions of the viscera in the TCM classics he had studied—the Huangdi Neijing, the Nanjing, and the Hetu Luoshu—were all wildly wrong. So he personally drew anatomical charts and, based on the anatomical knowledge he had gained in practice, re-analyzed disease pathology and on that basis made a series of major innovations. He created a new treatment method for TCM treatment of circulatory-system, nervous-system, and malignant-tumor diseases: activating blood and resolving stasis.
In ancient China, with its deep tradition of revering antiquity and disparaging the present, it was exceedingly rare for someone like Wang Qingren to have the boldness to propose innovative views.
Wang Qingren's understanding of the nervous system coincides in many ways with modern medicine's. He proposed that "the spirit of intellect and memory resides not in the heart but in the brain"—for more than two millennia before him, Chinese physicians had mostly believed that thought and consciousness arose in the "heart," and only Wang dared to propose this. He wrote: "When a child is first born, the brain is not yet complete, the fontanelle soft, the eyes not lively, the ears not hearing, the nose not smelling, the tongue not speaking. By one year, the brain gradually forms... by three or four years, the brain marrow is gradually full, the fontanelle closed, the ears can hear, the eyes are lively, the nose knows fragrance and stench, and speech forms sentences. Thus children have poor memory because the brain marrow is not full; the elderly lose memory because the brain marrow is gradually empty." He also noted: "The channels of the left half of the body cross to the right side of the head; the channels of the right half cross to the left side of the head."
Read alongside modern neurodevelopment and neurology, these passages make us even more admire Wang Qingren's astonishing powers of observation. His theories directly overturned the authoritative TCM classic, the Huangdi Neijing, and advanced his own original views; compared with the Neijing, Wang's views are far more persuasive.
Only by truly understanding the physiology of each body system can one design matching formulas. Wang observed in practice that blood stasis (including modern concepts such as thrombosis and venous congestion) was the chief culprit behind many nervous-system diseases, so he pioneered the classic formulas Tongqiao Huoxue Tang, Xuefu Zhuyu Tang, Shaofu Zhuyu Tang, and Buyang Huanwu Tang. These formulas have clear indications and reliable clinical efficacy and are still widely used today.
When Wang wrote, he broke with the untidy approach of earlier formulators, tightly anchoring each formula to pathology and listing its different indications one by one. Wang's empirical formulas are highly effective for common nervous-system diseases (stroke and stroke sequelae). Anyone studying TCM who wants to make a difference in neurology should not miss Yilin Gaicuo.
I suggest reading Wang Qingren's Yilin Gaicuo together with modern monographs such as Pathology and Neuroanatomy; this yields a deeper understanding of the book and allows more accurate clinical use and modification of Wang's empirical formulas.