The Famous Qing Physician Wang Qingren and His Medical Errors Corrected (Part 2)
Wang Qingren (1768–1831) was born in Hedong Village, Yahongqiao, Yutian County, Hebei Province. His other name was Quanren, and his courtesy name was Xunchen. From his courtesy name one can see that his parents hoped he would enter politics, establish merit, and bring glory to his ancestors. Wang Qingren was a military xiucai of the Qing (i.e., a graduate of the military examinations); later he donated funds to obtain the rank of qianzong (a military title, Wulue Qiwei). His ancestor Wang Ningji was a famous local physician. As a boy, Wang Qingren studied both martial arts and medicine, so that when he grew up he was bold and resourceful, exceptionally far-sighted, and open and upright in character.
Wang Qingren first practiced medicine in his hometown and later moved to Beijing. Because of his outstanding efficacy he gained a considerable medical reputation, became friendly with the Fourth Efu (imperial son-in-law), and lived in the Efu's household for several decades. Because of these connections, Wang was frequently invited by high officials to treat them at home. His status then was equivalent to that of a medical specialist treating senior central-government cadres today.
What set Wang Qingren apart was his extraordinary courage and his spirit of seeking truth from facts. Over the past two thousand years China has had no lack of TCM physicians, but probably no one has surpassed Wang in these two qualities. Not only in the past; even now, people as bold in seeking truth and innovating as Wang Qingren are rarely seen.
He went among the piles of the dead to pull apart human internal organs in order to study human anatomy, and discovered that the descriptions of human organs in works like the Huangdi Neijing and Nanjing were mostly incorrect. He also dared to defy universal disapproval; in his book he criticized the over-praised medical sages and classics. Because his criticisms were well-founded, his book attracted wide attention as soon as it appeared.
In Wang Qingren's own account there is this passage: "In the Dingyou year of the Jiaqing reign, I was thirty years old. In early April I was visiting Daodi Town in Luanzhou. At that time children there were stricken by epidemic rash and dysentery, and eight or nine in ten died. Families without means mostly buried them wrapped in substitute mats—a substitute mat being a mat used in place of a coffin. Local custom did not bury them deep, intending that dogs would eat them, which was thought favorable so that subsequent births would not die. So in each common burial ground there were more than a hundred children daily whose bellies were broken open and exposed. Each day I rode my horse past; at first I could not help holding my nose. Later, reflecting that the reason the ancients got the viscera wrong was that they had never seen them for themselves, I set aside my aversion to filth and went each morning at dawn to the common graveyard to examine carefully the exposed organs among the children. Of what the dogs had left, most had intestines and stomach, and fewer had heart and liver; comparing them, among ten I saw no more than three complete ones. For ten days running I examined no fewer than thirty complete bodies. Only then did I realize that the pictures of the viscera in medical books did not correspond at all to human viscera; even the number of organs did not match. Only the diaphragm in the chest, a membrane thin as paper, was of the utmost importance; by the time I saw it, it was already broken, and I could not verify whether it lay above or below the heart, or whether it slanted or was straight—that was my greatest regret. In the sixth month of the fourth year of Jiaqing, I was in Fengtian Prefecture. A woman from Liaoyang, twenty-six years old, had beaten her husband and father-in-law to death in a fit of madness; she was taken to the provincial capital to be executed by lingchi. I followed to the west gate, but suddenly, realizing she was not a man, I could not bear to step forward. In a moment the executioner brought out her heart, liver, and lungs past my face; examining them closely, they matched what I had seen before. Later, when I was in the capital, in the Gengchen year of Jiaqing there was a woman who had beaten her mother to death, executed by lingchi south of the suspension bridge outside Chongwen Gate; I was able to go near, but though I saw the viscera, the diaphragm was broken and I still could not see it. On the fourteenth day of the fifth month of the Daoguang reign, the rebel Zhang Ge'er was executed by lingchi; when I reached the place I could not get near. I thought to myself that, lacking this one basketful, I could not stop. Unexpectedly, on the night of the thirteenth day of the twelfth month of the ninth year of Daoguang, the household of Heng at Banchang Hutong on Andingmen Street invited me to see a patient. In the course of conversation I mentioned the diaphragm matter, on which I had spent forty years without being able to verify it clearly. Among the company was Heng Jinggong, the Jiangnan administrative commissioner, who said he had once garrisoned Hami and led troops in Kashgar, had seen the bodies of executed rebels more than anyone, and knew the diaphragm best. Delighted beyond measure, I bowed and asked him; moved by my earnestness, Commissioner Heng explained its shape in detail."
This passage describes in detail the process by which he personally studied human anatomy. Most TCM practitioners through the ages have merely echoed what others say, learning from classics like the Huangdi Neijing and Nanjing the knowledge of the internal organs described by the ancients; before Wang Qingren almost no one doubted these descriptions, and no one personally verified whether they were right or wrong. Wang Qingren studying medicine in the piles of corpses—this courage and this spirit of seeking truth are precisely what Chinese medicine most lacks.
Ancient China once had anatomy. Song Ci's Xiyuan Jilu (Collected Cases of Injustice Rectified), a forensic work of the Southern Song, can be called the earliest work related to anatomy. Even earlier, during Wang Mang's reign in the Han, people had once dissected the bodies of executed prisoners to study human anatomy, though too little written record survives. Song Ci's Xiyuan Jilu is a specialized forensic work and contains little actual anatomical knowledge. The diagrams of the internal organs in Wang Qingren's Yilin Gaicuo are China's earliest reliable anatomical reference material.
Wang Qingren not only observed human organs and tissues; to correct the ancient medical texts' mistaken descriptions of the body's "waterways," he also personally conducted animal experiments: "Later I compared them with domestic animals. Of animals fed and then killed at once, the reticulum was full of water-bells; of animals killed after three or four days without feeding, there were no water-bells."
China sorely lacks TCM physicians like Wang Qingren who value evidence. Many students of TCM are as pedantic as Kong Yiji. Sometimes when the ancients made a typographical error, they, superstitious of the ancients and afraid to question it, can force an interpretation and explain it plausibly—it is quite absurd.
Professor Jiang Chunhua once told a small anecdote. He said the Huangdi Neijing contains the line "defense qi arises from the lower burner," which is entirely unreasonable, yet commentators through the ages have forcibly explained how reasonable it is. Later he used philological research to check it and found that the character "lower" (xia) in "lower burner" was a typo; the character should have been "upper," and "defense qi arises from the upper burner" is far easier to explain. Students of TCM through the ages have believed in the classics so unwaveringly that they could not even spot a typo, which is deeply lamentable.
My character is somewhat like Wang Qingren's and Professor Jiang Chunhua's; when I read ancient works I am especially questioning. Every biography of Zhang Zhongjing through the ages says that Zhang foresaw that Wang Can, one of the "Seven Masters of the Jian'an era," would lose his eyebrows and die at forty, using this legend to deify Zhang Zhongjing. I also used the methods of the textual scholar, cross-checking the writings of Jian'an-era literati against reliable history, and found that Wang Can did not lose his eyebrows and die at forty for refusing to take the "Five-Stone Decoction" Zhang Zhongjing prescribed; he died in a great plague in the twenty-second year of Jian'an.
The French philosopher Gustave Le Bon wrote a book titled The Crowd, in which he specifically discusses the masses' love of "making gods." Many great figures through the ages have, like Zhang Zhongjing, been made into gods. Many of the legends about the lives of these great figures are unreliable; to truly understand them one needs a certain grounding in textual scholarship.
Only by pulling these sages and classics down from their altars can we, with an ordinary mind, critically inherit the cultural heritage the ancients left us. Blank negation is no more desirable than blind superstition. Wang Qingren's spirit of not being superstitious toward authority made his career and is well worth learning from.
Wang Qingren was not only an innovative medical man himself; he also had sharp insight, and he pointed out point-blank that, among all the medical works before him, only Wu Youke's Wenyi Lun (Treatise on Epidemics) had truly found the cause of epidemic disease—a point now accepted as common sense by the TCM community, though in its day many people reviled Wu Youke as heterodox.
Wu Youke was likewise an extraordinarily rare innovative TCM physician in Chinese history. He said: "The disease called warm epidemic is not wind, not cold, not summerheat, not dampness; rather, it is caused by a peculiar unusual qi between heaven and earth." This famous physician of the Chongzhen reign of the Ming may be called the most discerning epidemiologist. He keenly perceived that what caused epidemics was not the so-called external factors TCM names—wind, cold, summerheat, and dampness—but something special that could be transmitted between people. It was just that, limited by the science of his time, he could not know that the "unusual qi" he had intuited was what is now medical common sense: viruses and bacteria.
Modern readers can easily learn this medical common sense from works like Epidemiology and A Planet of Viruses. I often advise young TCM students to read more modern medical works and learn medical common sense. Only by opening our eyes can we see how ignorant and backward we ourselves once were. There was a clinical TCM professor in our Hubei Province, Mr. Zhang Mengnong, of outstanding clinical efficacy; when he went to teach TCM to clinical Western physicians in a "Western medicine learning TCM" class, not only did the TCM knowledge he taught convince his listeners, but the Western medical knowledge he imparted left the Western physicians who heard him sighing that they could not match him. Such a senior physician's learning is admirable.
I very much regret to see that the scientific literacy and insight of many of our contemporary young people have not reached the level of Wang Qingren and Wu Youke. They cling to the ancients' doctrines that have already been proven wrong, and bitterly regard themselves as the true inheritors of traditional Chinese culture, refusing to accept medical progress—let alone doing innovative work of their own to push medicine forward.
Robley Dunglison wrote in his History of Medicine: "Historically, the progress of medical science in every age has accompanied the progress of the natural and social sciences of the time. Yet all these sciences have been stamped with the marks of myth and superstition, and so each has its own imperfections."
Science is not omnipotent, nor is it necessarily more precious than the experience of our ancestors; but science has a spirit of constant self-correction, and that spirit is what is most precious. Only guided by this spirit of ceaseless correction can a people, or a field of learning, make progress.
I champion Wang Qingren and his Yilin Gaicuo because of his spirit of seeking truth and innovating, not because his views are final truth—Wang himself never said so. On the contrary, in the preface to Yilin Gaicuo he very modestly wrote: "This book of mine, Yilin Gaicuo, is not a complete book on treating disease; it is a book recording the viscera. There will certainly still be inaccuracies and omissions in it. If later generations, encountering the opportunity to see the viscera for themselves, carefully examine and supplement it, that would be a great blessing." This spirit of acknowledging his own shortcomings and not thinking himself infallible is as precious as his spirit of bold innovation.