Cai Yan (1931-), Neurology Specialist, Professor, Former Director of the Department of Neurology, Renji Hospital

Introduction

He was a pioneer in the world of medicine, dedicating his life to the pursuit of excellence in neuroscience. Within the field of neurology, his profound expertise and deep academic insights provided invaluable contributions to global medicine.

His career was defined by continuous exploration and discovery. From foundational neuroanatomy to complex disorders of the nervous system, he unraveled the mysteries of the brain through rigorous scientific research and innovative thinking. His findings not only advanced the medical community’s understanding of neurological diseases but also opened new avenues for clinical treatment.

On the international academic stage, he collaborated with experts from around the world, bringing advanced medical concepts back to China to foster the development of its domestic neuroscience community. In medical education, he championed the philosophy of “Give a man a fish and you feed him for a day; teach a man to fish and you feed him for a lifetime,” mentoring and training generations of outstanding medical talent.

Reflecting on his life’s work, one sees a path defined by an unwavering commitment to and passion for medicine.

The Path to Medicine

In 1931, Cai Yan was born in Shanghai. As a child, he chased playmates through the city’s historic longtang (alleyways), his days marked by a carefree spirit. As the years passed, however, the shadows of war loomed over the city. Cai Yan witnessed the turmoil of conflict and the collective yearning for peace and stability.

It was during this time that a passion for medicine took root in his heart. He resolved to become a doctor, driven by a desire to save lives and safeguard the health and well-being of his fellow citizens. This conviction only grew stronger with time.

In 1947, at just 16 years old, Cai Yan was admitted to St. John’s University School of Medicine in Shanghai, embarking on a seven-year journey in medicine. In an era defined by transition and scarcity, educational resources were limited, making his academic path arduous. Yet, his profound love for medicine and an unquenchable thirst for knowledge propelled him forward.

In medical school, every book was a key to the unknown, and every internship an opportunity for growth. He immersed himself in his studies, often remaining in the laboratory late into the night, absorbed in his work.

In 1952, amid a nationwide restructuring of universities, St. John’s School of Medicine, Aurora University School of Medicine, and Tongde Medical College merged to form Shanghai Second Medical College. Cai Yan continued his studies at the new institution.

After graduating in 1953, he began his internships at major hospitals. Every diagnosis and every treatment was a test of his skills and an opportunity to strengthen his resolve.

During his neurology rotation at Shanghai Huashan Hospital, Cai Yan met Dr. Wang Jinyuan from Shandong Medical College. They discovered they were kindred spirits in medicine, spending hours discussing cases and exchanging insights. In an age before mobile phones or the internet, their bond was forged through face-to-face conversations and letters. They became lifelong companions and professional supporters.

In 1954, Cai Yan officially joined the Department of Neurology at Renji Hospital, formally launching his medical career. It was here that he would encounter both challenges and opportunities, beginning a new chapter in the field of neurology.

The Dedication of Renji Physicians

Upon joining Renji Hospital, Cai Yan dedicated himself completely to his work, making it his life’s mission.

Under the leadership of Professor Zhou Xiaoda, the Department of Neurology at Renji was establishing itself as a burgeoning center for neurology in China. At a time when understanding of neurological diseases was still limited, Cai Yan ventured into this unknown territory with a relentless thirst for knowledge.

Beginning in the 1960s, the neurology team at Renji treated countless patients and achieved significant research breakthroughs. Cai Yan delved into the pathological mechanisms of neurological disorders, with a particular focus on epilepsy and the neurological complications of hypertension. His findings enriched the treatment strategies available in neurology.

A team led by Zhou Xiaoda, Cai Yan, and Chen Junning studied 110 patients with temporal lobe epilepsy, establishing more precise criteria for its classification and diagnosis. Their research highlighted the value of electroencephalography (EEG) in identifying specific EEG patterns linked to the condition, providing clinicians with a powerful new diagnostic tool. This work marked a milestone in the history of Chinese neurology.

In 1964, Cai Yan pioneered research on spinal cord compression as a neurological complication of leukemia, filling a critical gap in medical knowledge. Recognizing its profound impact on patients’ quality of life and prognosis, he meticulously analyzed four cases: two patients with leukemia and two with chloroma (granulocytic sarcoma), all of whom exhibited symptoms of spinal compression.

He documented each patient’s age, gender, clinical symptoms, hematological findings, and myelography results. His detailed descriptions traced the progression of symptoms—from mild back pain to severe paraplegia and bladder dysfunction. Notably, these neurological symptoms often preceded the hematological signs of leukemia, enabling earlier diagnosis and intervention.

Cai Yan emphasized that neurological symptoms related to leukemia were often non-specific, highlighting the need to rely on hematological tests, bone marrow smears, and cerebrospinal fluid (CSF) analysis. He underscored the critical importance of detecting leukemia cells within the CSF.

He explored various treatments, including medication, radiotherapy, and surgery. While corticosteroid therapy offered temporary relief, the disease often progressed regardless.

This study raised awareness of the neurological complications of leukemia, providing clinicians with invaluable diagnostic and therapeutic insights. His work influenced contemporary medical practice and laid the foundations for future research in the field.

Bridging Eras, Pioneering the Future

The Cultural Revolution (1966–1976) devastated China’s education and research sectors. Renji Hospital faced unprecedented challenges, yet many of its physicians and scholars remained resolute in their commitment to medicine and scientific inquiry.

After the turmoil subsided, Cai Yan, along with other experts at Renji, joined the national effort to rebuild the country’s research and educational infrastructure. He focused on restoring and enhancing neurology services at the hospital and reassembling its research teams.

In the late 1970s, Cai Yan specialized in the neurological complications of hypertension. He argued that hypertension was not merely an isolated disease but a critical factor in a range of cerebrovascular syndromes.

He classified hypertension-related cerebrovascular syndromes into two distinct categories:

Atherosclerosis involving the major extracranial and skull-base arteries. He noted that extensive atherosclerosis could occur even in the absence of hypertension.

Syndromes caused directly by hypertension itself.

His research offered new perspectives on how hypertension interacts with other factors to cause cerebrovascular lesions, with a particular focus on thrombotic and embolic strokes. This enabled clinicians to evaluate and treat hypertension-related cerebrovascular diseases more comprehensively, emphasizing multifactorial risk assessment to create precise treatment plans.

As technology advanced in the late 1970s, cardiopulmonary resuscitation (CPR) became a common procedure in emergency and ICU settings. While improved survival rates were a victory, they also revealed a wide spectrum of neurological outcomes, from full recovery to persistent vegetative states.

Patients who regained consciousness quickly after CPR typically avoided long-term neurological deficits. For those who remained comatose, neurologists played a critical role in prognostication, family counseling, and treatment planning. Cai Yan stressed the need for comprehensive assessments—including neurological exams, neuroimaging, and electrophysiological studies—to optimize patient care.

As China embraced its “Reform and Opening-Up” policy, Cai Yan gained broader international exposure. In 1980, as a World Health Organization (WHO) visiting scholar, he studied at the University of New Mexico School of Medicine, an experience that expanded his global outlook and strengthened his research foundation.

Upon his return in 1982, he established the Neurobiology Laboratory at Renji Hospital—one of China’s earliest neuroscience research institutions—cementing the hospital’s reputation as a leader in the field.

In 1984, Cai Yan succeeded Professor Zhou Xiaoda to become the second director of Renji’s Department of Neurology, leading its continued growth and development.

In 1985, the department was approved to host one of the nation’s first doctoral programs in neurology, with Zhou Xiaoda as professor and Cai Yan as associate professor.

The following year, as department director, Cai Yan participated in a landmark epidemiological survey of neurological diseases across six Chinese cities: Beijing, Changsha, Chengdu, Guangzhou, Harbin, Shanghai, and Yinchuan. This study provided vital data on disease prevalence and risk factors among China’s urban populations.

Using WHO-standardized questionnaires, researchers conducted door-to-door interviews with 63,195 residents. The survey covered cerebrovascular diseases, epilepsy, brain tumors, migraine, and extrapyramidal disorders. All positive screenings were verified by senior neurologists to ensure accuracy.

The total prevalence of neurological diseases was 5,382 per 100,000 (5.4%), a figure comparable to age-adjusted rates in the United States from 1960. Case-control analyses further identified risk factors for four major diseases, offering crucial clues for prevention and treatment. This survey fundamentally transformed the understanding of neurological disorders in China.

Forging a New Path in Medical Education

In 1988, Cai Yan invited the renowned American neurologist Professor Larry E. Davis to Shanghai for a six-month academic exchange. Davis conducted weekly ward rounds, led case discussions, and shared his expertise freely. His handwritten neurology lectures and continuing medical education seminars opened a window for Renji’s physicians to global advancements and professional self-improvement.

Davis—a distinguished professor at the University of New Mexico and chief of neurology at the Veterans Affairs Medical Center—had trained at Stanford and Johns Hopkins. With over 200 peer-reviewed papers and 60 book chapters to his name, he was named an “Outstanding Neurology Teacher” by the American Academy of Neurology.

This collaboration accelerated the professional growth and English proficiency of young physicians, fostering a vibrant international environment. Under Cai Yan’s leadership, the department became a hub for global exchange, attracting eminent neurologists from around the world. He also actively encouraged young doctors to pursue training opportunities overseas.

Cai Yan’s approach to clinical teaching was distinctive. He favored a heuristic method, eschewing one-way knowledge transfer. Instead, he encouraged questions and guided physicians to find answers independently. During bedside discussions, he would pose thought-provoking questions to cultivate critical thinking. Embracing the philosophy that “if you give a man a fish, you feed him for a day; if you teach a man to fish, you feed him for a lifetime,” he empowered doctors to solve problems autonomously.

His passion for medical education was central to his teachings. He believed that only those who truly loved clinical work and served patients diligently could become outstanding physicians—and that such physicians formed the bedrock of clinician-scientists. He often reminded his colleagues to respect their patients, to trust their experiences, and to learn from them.

Cai Yan’s lectures were a masterclass in pedagogy. In neuroanatomy classes, he transformed complex concepts into engaging narratives, making even intricate neuropathological processes accessible. His teaching went beyond the transfer of knowledge; it ignited wisdom. By teaching students how to think, he fostered a spirit of innovation that would serve them throughout their careers.

Thursday clinical case discussions became a cherished Renji tradition. His cramped “Office 301” would overflow with physicians and trainees—from seasoned veterans to visiting scholars. Everyone was encouraged to share their insights, creating an open and dynamic learning environment.

Cai Yan also launched the “National Advanced Neurology Workshop,” a unique continuing medical education program. He invited experts from related departments and other hospitals to lecture on cutting-edge topics, providing invaluable opportunities for neurologists nationwide. Trainees returned to their home institutions as catalysts for the development of neuroscience.

He viewed education as a long-term endeavor requiring both patience and wisdom. Its goal, he believed, was not just to impart knowledge but to spark curiosity, creativity, and critical thinking—while allowing educators to grow alongside their students. His principles set a shining example for medical education.

On December 8, 2018, at the Shanghai Medical Association Neurologists Branch Annual Conference, Cai Yan received the “Lifetime Achievement Award” for his extraordinary contributions to neurology in Shanghai and across the nation. In his acceptance speech, he reflected on his decades-long career, sharing insights from education, clinical practice, and research. His words, imbued with a lifelong love for medicine and a deep compassion for patients, inspired everyone in attendance.

Over the decades, Renji Hospital’s Department of Neurology became a beacon of academic research, nurturing generations of outstanding physicians. These doctors, carrying forward Renji’s spirit, continue to excel in their roles, elevating the department to new heights.

Cai Yan’s students now lead in their fields, achieving breakthroughs in clinical neurology, education, and research. They earn global recognition and play pivotal roles in preserving and advancing Renji’s legacy.

Today, a new generation of physicians infuses the department with hope and vitality. Armed with open minds and innovative thinking, they are driving neuroscience forward and delivering superior care to patients.

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