Li Piguang (1906-1990), Internal Medicine, “Second-level Professor”, Renji Hospital, Xinhua Hospital

Introduction:

Dr. Li Piguang’s medical career was extraordinary, with his life’s work deeply intertwined with the development of internal medicine education in China. Before the Communist Revolution of 1949, he had already established himself as a prominent physician during the Republican era (1912-1949). After the founding of the People’s Republic of China, his influence grew beyond research and teaching, playing a pivotal role in advancing the nation’s medical infrastructure.

Following the political changes of 1949, Li became instrumental in rebuilding Shanghai’s healthcare system. He served as a consultant physician for the Shanghai Municipal Health Bureau, applying his expertise to improve the city’s public health services. During the 1950s, he joined the faculty of the newly established Shanghai Second Medical College, where he served as Professor of Internal Medicine, later becoming Chair of the Department. He also held leadership positions as deputy director of the Department of Pediatrics at both Renji Hospital and Xinhua Hospital. Through his innovative teaching methods and clinical expertise, Li helped shape a generation of medical professionals who would transform healthcare in China.

Medical Journey:

Li Piguang was born in 1906 in Yantai, a coastal city in northeastern China. His early years coincided with a transformative period in Chinese history, as the country increasingly embraced Western science and education. Growing up amid national challenges, Li belonged to a generation of young Chinese determined to modernize their homeland through scientific advancement.

Like many ambitious students of his time, Li pursued medical education at Cheeloo University Medical College in the 1920s. Founded by Western missionaries, Cheeloo was then one of China’s most prestigious medical schools, drawing talented students from across the country. The rigorous curriculum deepened Li’s appreciation for medicine’s complexities and solidified his passion for internal medicine—the specialty focused on the diagnosis and treatment of adult diseases.

At just 24 years old, Li earned his Doctor of Medicine degree from Cheeloo. His exceptional academic record earned him a faculty position immediately upon graduation, allowing him to begin shaping the next generation of Chinese physicians.

By 1934, Li had advanced to become director of Tianjin Municipal Hospital while also serving as a consultant at Tianjin Children’s Hospital. Tianjin, then a thriving commercial and industrial center, faced significant public health challenges. Under Li’s leadership, the municipal hospital became a beacon of hope for displaced persons and working-class residents, delivering essential care during difficult times.

In 1936, as political instability grew across China, Li relocated to Shanghai, the country’s most cosmopolitan city. He accepted a position as lecturer at the National Shanghai Medical College (now part of Fudan University), a move that would prove transformative for his career. Founded in 1927 by public health pioneer Yan Fuqing, this institution was China’s first national medical college with a seven-year program, representing the forefront of medical education in the country.

Shortly after joining the faculty, Li distinguished himself through both research and clinical work. In 1937, as Japan invaded China and war engulfed the nation, Shanghai faced severe medical shortages and public health crises. Despite these challenges, Li continued his research and published a groundbreaking paper on childhood dysentery in the National Medical Journal of China.

This study represented a significant advancement in Chinese medical research. Li conducted a comprehensive microbiological analysis of 127 pediatric cases, demonstrating that early administration of serum therapy—using antibodies to target disease-causing pathogens—dramatically improved treatment outcomes. His findings not only advanced the understanding and management of childhood dysentery but also established Li as a leading figure in pediatric medicine, foreshadowing his later leadership role in pediatrics at Shanghai Second Medical College.

Seeking to expand his expertise, Li traveled to the United States in 1938 for training in clinical biochemistry at Duke University and the University of Chicago—both institutions renowned for integrating cutting-edge research with clinical practice. During his American sojourn, Li collaborated with prominent researchers and deepened his understanding of disease mechanisms, determined to bring these advanced concepts back to China.

In 1942, he was appointed as a lecturer at Cornell University, where he was later promoted to associate professor of clinical and preventive medicine. This period marked the pinnacle of his academic career in the West, with his teaching and research garnering praise from both students and colleagues.

Following World War II, Li made the significant decision to return to China in 1947, driven by a desire to contribute to rebuilding his country’s medical education system. He believed the knowledge and experience gained in America could help a nation recovering from the devastation of war.

Upon his return, Li was appointed chief of the Department of Internal Medicine at Nanjing Central Hospital and also served as a special professor at the Medical College of Central University. Drawing on his extensive international experience, he worked alongside colleagues to modernize Chinese medical education and healthcare services.

Li implemented innovative approaches that elevated both hospital care and medical education standards. He championed the integration of clinical teaching with research, advocated for preventive medicine, and promoted comprehensive patient care rather than merely treating isolated symptoms. These contributions significantly enhanced the reputation of Nanjing Central Hospital as a center of medical excellence.

Throughout his distinguished career, Li remained humble and dedicated to his patients. His unwavering commitment to advancing medical knowledge and improving clinical practice, combined with his patient-centered approach, earned him increasing respect within the medical community.

Rebuilding Post-1949 China
Following the Communist Revolution in 1949, China faced the immense challenge of rebuilding its nation. In 1951, Dr. Li Piguang was appointed Senior Medical Advisor to the Shanghai Municipal Health Bureau, where he played a pivotal role in shaping health policies to elevate medical standards for the city’s residents. His work encompassed public health initiatives, disease prevention, and healthcare administration. Drawing on his extensive medical expertise and practical experience, Li made transformative contributions to Shanghai’s healthcare infrastructure.

In 1952, with the founding of Shanghai Second Medical College (now part of Shanghai Jiao Tong University School of Medicine), Li joined the faculty, dedicating himself to advancing medical education. Leveraging his international training and domestic insights, he championed a teaching model that integrated theory with hands-on practice, establishing a robust framework for training future medical leaders. Concurrently, he began practicing as an internist at Renji Hospital.

Pioneering Cardiac Surgery and Interdisciplinary Collaboration
During this period, surgeons like Lan Xichun identified cardiac surgery as a critically underdeveloped field in China. Inspired by reports of successful heart surgeries performed by Soviet Professor Nikolai Bakulev, Lan spearheaded efforts to develop similar procedures domestically.

After Lan Xichun’s appointment as Director of Surgery at Renji Hospital in 1953, the institution’s surgical capabilities advanced significantly. Motivated by global medical breakthroughs, a specialized cardiac surgery research group was formed. As a senior internist, Li Piguang joined this pioneering team.

Through interdisciplinary collaboration, the team combined their collective expertise. Li, with his deep knowledge of clinical biochemistry, conducted rigorous research into the pathological mechanisms of heart disease, providing essential theoretical and clinical support. Their relentless dedication culminated in a historic achievement: the first successful cardiac surgery performed in China—a landmark milestone in the nation’s medical history.

In 1956, Li was honored as a Shanghai Advanced Worker in recognition of his contributions.

Groundbreaking Research in Hepatology
Li also made visionary strides in the study of digestive system diseases. Throughout the 1950s, he conducted extensive research and clinical work on liver pathologies. In 1958, he investigated the diagnostic value of serum iron in liver diseases using the Barken and Walker method, analyzing 267 serum iron samples across 171 cases of liver and biliary disorders.

His research revealed that serum iron levels were significantly elevated in viral hepatitis, likely due to iron release from damaged liver cells. Serial measurements proved invaluable for monitoring disease progression and prognosis: a decline from high to normal levels signaled halted liver cell damage and a positive outlook, while persistently high levels indicated poor outcomes. In jaundiced patients, serum iron testing effectively distinguished viral hepatitis from obstructive jaundice caused by blockages outside the liver.

This work established serum iron as a critical biomarker for assessing disease progression and prognosis in liver and biliary conditions. That same year, Li evaluated the clinical utility of blood ammonia quantification in liver diseases. Building on historical studies by Pavlov et al. (1893) on the liver’s role in ammonia metabolism, Li validated through animal experiments and clinical trials that elevated blood ammonia could trigger hepatic coma. Analyzing 226 blood ammonia measurements in 97 patients, he demonstrated that:

- Blood ammonia testing did not require fasting,

- Elevated levels often indicated widespread liver damage or portosystemic shunting,

- Ammonia metabolism disorders were a primary cause of neuropsychiatric symptoms in liver disease,

- Extreme elevations correlated with hepatic coma or pre-coma states,

- Significant differences in ammonium chloride tolerance existed between patients with and without liver dysfunction.

These findings cemented blood ammonia quantification as a vital tool for evaluating liver function and neuropsychiatric risk in patients with liver disease, solidifying Li’s reputation as a leading clinical researcher.

In 1958, Shanghai Xinhua Hospital was founded—the first comprehensive hospital independently designed and built in Shanghai after 1949. As a preeminent internist, Li dedicated the latter half of his career to Xinhua. Under the leadership of Gao Jinglang, he collaborated with scholars like Guo Di to establish and develop the hospital’s pediatrics department, further shaping China’s medical landscape.

Modernizing Traditional Medicine

During his time at Renji Hospital, Li distinguished himself not only through his expertise in Western medicine but also through his comprehensive research into traditional Chinese medicine (TCM). He masterfully blended Eastern healing practices with Western medical methodologies, creating a more diverse and effective range of treatment options for patients.

Li methodically examined TCM remedies for various common ailments. By applying rigorous scientific methods to evaluate these traditional therapies, he helped establish a foundation for evidence-based integrative medicine. His work challenged conventional views and demonstrated how traditional practices could complement modern healthcare systems.

In the 1950s, the herb Rauvolfia (known in Chinese as Shegengcao) was widely used despite the absence of standardized treatment guidelines. Through his clinical observations, Li discovered that this herbal remedy could trigger gastric ulcers in some patients. While most side effects were limited to mild nausea, vomiting, or diarrhea, he documented several cases involving severe stomach pain and black, tarry stools (a condition known as melena) that led to ulcer diagnoses. Li’s research revealed that Rauvolfia increased stomach acid production and digestive activity, creating conditions that could lead to ulcer formation—symptoms that typically disappeared when patients stopped taking the herb. His published findings brought much-needed attention to these potential risks.

Li also broke new ground with his research on Aristolochia debilis (Qingmuxiang in Chinese) as a treatment for hypertension. Beginning in 1956, under the auspices of the Shanghai Health Bureau, he partnered with Shanghai’s Eleventh People’s Hospital to investigate the herb’s effects. After monitoring 50 patients over a six-month period, he confirmed its substantial effectiveness in lowering blood pressure. (Note: Subsequent research has identified safety concerns related to aristolochic acid found in this plant.)

Li determined that Aristolochia debilis produced gradual but long-lasting effects, typically requiring about three weeks to show significant results. While patients experienced some temporary fluctuations in blood pressure, their readings generally remained below initial levels. Notably, many patients maintained stable blood pressure even after discontinuing treatment, which allowed for reduced dosages.

These groundbreaking studies offered valuable contributions to modern pharmacology and played a significant role in advancing China’s medical landscape. Li’s work exemplifies how traditional healing wisdom, when examined through scientific rigor, can enhance our understanding of therapeutic options and create bridges between Eastern and Western medical traditions.

Legacy and Final Years

Li retired in 1966. During the Cultural Revolution (1966–1976), he yet remained dedicated to medicine. Under his leadership, Renji Hospital, Shanghai Ninth People’s Hospital, and Xinhua Hospital achieved significant advancements in internal medicine.

Li Piguang passed away on April 22, 1990, at the age of 84. His life epitomized scholarly innovation, educational commitment, and clinical excellence. He mentored generations of medical leaders who advanced healthcare in China, leaving an indelible mark on the nation’s medical landscape

Editor: 
Chen Qing @ ShanghaiDoctor.cn

Note: Chinese Sources from “The Path of Benevolent Medicine” which was published in 2024. It records 90 important medical figures in the history of Renji Hospital. Yewen Renyi (ShanghaiDoctor.cn) team was one of the major writers of the book and is authorized by Renji hospital to create English version on the website of ShanghaiDoctor.cn