TCM and Conservation
Traditional Chinese Medicine and conservation
Bone of Tiger, Bile of Bear
In the Beijing University of Traditional Chinese Medicine, there is a museum devoted to "Chinese Materia Medica". Were I to take you in there, I might ask you to close your eyes. No, I wouldn't tell you why, I'd guide you just a few paces before saying you could open them - provided, that is, you promised to look straight ahead.
Straight ahead, you would find a display case that's fairly bursting with the kinds of things you might expect to be employed in traditional medicine the world over: there are seeds, dried fruits, twigs and roots. You might be a little surprised to see a pile of mica flakes and a container holding powdered gypsum. But if these do surprise you, well, just wait.
While we're in front of the case, I might expound a little on the wonders of traditional Chinese medicine, and tell you that we can shortly go downstairs to another museum that traces its history, with needles, bottles, jars, pestles and mortars, and portraits of sages - invariably sporting intellectual facial hair - who made such discoveries as the world's first anaesthetic, and pioneered protection against smallpox.
Maybe I'd now say that while many of the plants and so forth are obscure, you've surely heard of ginseng. The Chinese call it "The King of the One Hundred Medicinal Herbs", and there's a whole display case devoted to it, right behind you. You'd likely turn, and - quick as a glimpse - you'd lose this gentle train of thought.
"Whoa!" you'd exclaim. "There's a bear!"
Yes, an Asiatic black bear, to be precise. Reared up on its hind feet, to stand taller than you or me. But it's stuffed, and in a case. Left of it, near the door, are paired cases holding a stuffed tiger and a mounted tiger skeleton. Just beyond the bear is a shoulder-high deer. We could walk to the other side of the room, and find a mounted gibbon, a green turtle, a piece of hedgehog skin. Or pause at a cabinet where a shelf holds one and a half rhinoceros horns.
I guess your first reaction might be to wonder if I'd brought you to a natural history rather than a medical museum. But you've surely heard about TCM and its appetite for rhino horn, tiger bone, bear bile and so forth. Animal ingredients have long been part and parcel of the Chinese pharmacopoeia. Museum head Professor Shen Liansheng says records from two thousand years ago tell of some twenty animals including snakes and rhinos being used in medicines. Over the centuries, more species have been added to the pharmacopoeia, a few have been dropped. Lately, however, TCM has come under fire for its use of animals, especially of endangered species. A flurry of reports and media articles have drawn attention to what seems an ever growing list of conservation problems rooted in the demands of TCM. Heading the list are poaching of rhinos in Africa, and of tigers in India and Siberia. Bears in North and South America are being killed for their galls. In the former Soviet Union, hunters are decimating herds of saiga antelope. Even seahorses are being hoovered from the wild, with tens of tonnes entering the TCM trade each year. Reports in the west mainly tell of species from outside China that are consumed by TCM worldwide. Less well known is the scale of the trade within the mainland; judging by a recent survey by a team from China's endangered species commission, it is immense. The team obtained data from 13 TCM manufacturers, which annually consumed 506 kilos of scorpions, 2796 kilos of freshwater turtle shells, 797 kilos of saiga horn, 29 kilos of bear gall powder, 25 kilos of leopard bone, 3039 pairs of geckos, and 9650 centipedes. As there may be as many as a thousand TCM manufacturers in China, the quantities used nationwide must be mind-boggling.
Small wonder, then, that TCM's use of threatened and declining species has become a major conservation issue. It's an issue that's all too easily portrayed in simplistic terms, with protaganists separated along cultural, even racial, lines. We in the west, with our modern, chemical medicines and conservation ethos, are of course the good guys. And anyone in the TCM world, with its arcane lore and evident disregard for nature, is clearly on the wrong side.
Though the real situation is far from being so straightforward, for a time it appeared the white knights of western conservation were indeed set for a showdown with the forces of TCM. Seeing treasured species being killed and sold for a medical system with more than its fair share of hocus pocus, and which piled on the ignominy by using rhino horn and so forth as - so stories went - aphrodisiacs, they prescribed a straightforward remedy. "A few years ago, when I first came to Hong Kong, conservationists were saying ban, ban, ban, ban, ban." says Judy Mills, director of TRAFFIC East Asia. And how do you think the wicked orientals involved in TCM reacted to that? Recalls Mills: "TCM practitioners were saying, 'Go away, conservation is nothing to do with us.'"
Happily, much has changed. A dialogue has begun between TCM and conservation, with each side moving towards an understanding of the other, and searching for viable ways to ensure TCM and wildlife can coexist. Mills, a former journalist who joined TRAFFIC in 1989, setting up the Hong Kong office five years later, is a key player in the ongoing rapprochment. "We've realised we have to work together," she says. "Both sides are on a steep learning curve - a lot of people are beginning to understand that TCM can provide excellent healthcare, and there is a lot of loyalty to it; and TCM people who had thought westerners wanted to protect bears and tigers because they're cute are learning that species are endangered, and it's not just east versus west. There are creative options being looked at that have never been tried before, there is dialogue - though where it will lead, I don't know."
Crucial to the dialogue is growing acceptance by conservationists that some myths about TCM are just plain wrong (Myth Number One: rhino horn is used in TCM as an aphrodisiac), and that there is solid evidence TCM works. True, there are some doubtful medicinals, as in a Beijing TCM store where I found supposedly therapeutic wines including, for around US$10, Magical Penis Wine. But quack cures are hardly unknown in the west, and Mills likens the wines and so forth to the kinds of potions you can readily find in health food stores. Modern science is probing TCM, and showing it isn't just another of those alternative therapies like homeopathy and crystal healing that are readily derided by mainstream western medical practitioners.
Dr Paul But Pui-hay, director of the Medicinal Material Research Centre at the Chinese University of Hong Kong, well remembers the day he was approached by conservationists David Melville and Esmond Bradley Martin, asking if he could study the antipyretic (fever reducing) effects of rhino horn. But,who has a PhD in botany from the University of Berkeley and has been with the centre since the early 1980s, becoming director in 1992, is chiefly involved with the centre's core projects, which include research into central nervous system, cardiovascular and birth control drugs, as well as putting a TCM database on the Internet. Already, he was keenly aware of the TCM/conservation conundrum.
"I told them I would have a personal interest in the results because I have small kids at home," he recalls. He asked Melville and Martin to suppose one of his children had a high fever that might lead to damaging effects on the brain, and it was not responding to western medicine. "As a father, if I knew rhino horn were effective, could I leave my child in such conditions and tell him the rhinos are endangered? Would I not be tempted to risk the potential jail terms and try to use rhino horn to save my child? Would they choose to do otherwise?"
There had been several previous studies of rhino horn's antipyretic effect on animals; most had reported negative results. But and his group reasoned the contradictory results could be due to different routes of administering horn, types of preparation, dosage levels, and the way hyperthermia was induced - typically, by E. coli, a bacterial toxin that boosts temperature for a relatively short time. They opted to use higher dosage levels, and to induce hyperthermia in their study rats through injections of turpentine.
The study was in two parts. In the first, the group looked at the effects of rhino horn, and saiga antelope, water buffalo and cattle horns, which some clinical studies had reported to also have antipyretic action. Then, because rhino horn is rarely prescribed in isolation, they focused on the combined effects of horn and herbs. From 31 preparations with rhino horn that were manufactured in China in the 1980s, they chose one known as the Qingying Decoction, a blend of horn and eight herbs that was often employed in treating heat stroke, encephalitis B, bacterial endocarditis and other inflammatory diseases. They ran these tests with both rhino and buffalo horns.
The results broadly tallied with the claims of Chinese herbalists: rhino and other horns could indeed lower feverish temperatures, buffalo horn could be a viable substitute for rhino, and the horn and herb combinations were more efficaceous than horn alone. At high dosages - equivalent to over 100 times the normal human dosage of rhino horn - all four horns demonstrated antipyretic action. When the team reduced dosages by 80 percent, only rhino and saiga antelope horns produced significant temperature drops. This roughly fitted the assertions of some herbalists that, when buffalo horn is substituted for rhino, around ten times as much should be used.
Two other results don't gel so neatly with the beliefs of TCM practitioners. The effects of rhino and saiga antelope horns were apparently similar, yet in practice rhino horn is regarded as superior in cooling blood and counteracting toxins, while saiga horn is favoured for cooling liver and quenching wind. Also - in a result some conservationists have taken as showing rhino horn is unnecessary - the Qingying Decoction herbs alone produced similar temperature drops to herbs with horn. But cautions these results may have arisen from the way the experiments were conducted. "The reduction of fever in Chinese medicine has many facets - it's more profound than just reducing the temperature," he says. "In our particular assay model, inducing a fever through chemicals, it appeared a combination of herbs with or without horn may produce the same effect. There is a possibility of this, but you may need extensive research to prove it. For general practitioners, most of whom are simply technicians, it would be difficult to just take our word for it and try on their patients - more extensive clinical studies would be necessary."
But has also looked at bear gall bladder, which has a wide range of uses including treating convulsion, conjunctivitis, fevrile diseases, chronic summer diarrhea, hemorrhoids and pain. Several pharmacological and clinical studies had confirmed the value of the bladders for treating gallstones and other liver diseases, and shown the same conditions could be treated with components of bear bile including ursodeoxycholic acid (UDCA). As its name implies, this chemical is something of a bear speciality. Among mammals, only bears other than the panda - which some consider more closely related to raccoons - produce significant quantities; a synthetic version is widely used in modern medicine for dissolving gallstones and treating other liver diseases.
But opted to investigate some other therapeutic effects of bear gall bladder, and to compare it with pig gall bladder, which contains a trace amount of UDCA and is already used in TCM for similar ailments. Through tests on mice, he and colleagues found that both bear and pig bile had anti-inflammatory, anticonvulsion and analgesic [pain relieving] effects, and could prolong survival time in hypoxic conditions. With the results indicating that pig bile could be employed as a substitute for bear bile in many areas of TCM, they concluded that further studies are called for.
Though the research by But is hardly comprehensive - "We don't find it easy to get research grants; not too many people are concerned about this," he says - his and other studies should put paid to any notions that the way to solve the conservation dilemma is simply to ban the use of rarities, proclaiming that notions they are effective are hogwash. Other solutions are needed, and needed quickly.
China's State Administration for Traditional Chinese Medicine doesn't seem the kind of place you would expect to generate the "creative options" to the dilemma referred to by Judy Mills. Its headquarters are in a utilitarian building, with a security guard at an old wooden table in the entranceway, posters about water conservation and a room with a pool table by the lift lobby. At the time of my visit, the driveway is being torn up, and I have to ask three passers-by before even finding the building. Once past the security guard, I take the lift to the floor where SATCM is based, and am ushered to a large reception room. Seven people are already waiting at the roughly oval table. I'm seated facing all but one of them. Green tea is served, introductions are made, name cards exchanged: those of my hosts typically announce each is a vice-director, deputy director or director general of either a department or of SATCM itself.
Yet however much it may appear - and perhaps is - bureaucratic, conservative , and even sluggish (it took over a year of faxes and phone calls before I received an invitation to visit), SATCM is too big a player to discount in any attempts at harmonising TCM and conservation. Its responsibilities include regulating and developing TCM throughout China, where, I am informed by news department director Dr She Jing, there are around 2500 TCM hospitals, and some 200 million cases are treated by TCM each year. "Many of the herbal medicines are from natural resources," says She, "and the Chinese government has encouraged the development of TCM and the protection of natural resources."
This point is echoed by Chen Heng, director of SATCM's department of production and circulation. A native of Sichuan province in southwest China, she remembers learning of traditional medicine as a child - many Chinese can recognise medicinal plants, she says, the lore being handed down through generations. After studying chemistry at university, and working in the chemical industry, she moved into administration and joined SATCM. "The government and the TCM industry pay great attention to protecting natural resources," she says. "We've done a lot of work in this field."
Reading answers to questions I have faxed in advance, Chen tells me that, after assessments of national and international regulations on endangered species, coupled with population data, China has listed 58 plant and 18 animal species that are used in TCM and require conservation measures.
"We use different methods to protect these endangered species," says Chen. "For example, we might farm animals, or try to move them to certain areas for protection, and we protect them in situ. The main method is protecting them in their ranges, with regulations for numbers harvested for TCM. For plants, we mainly cultivate them, though there are technical difficulties with some, which we try to protect in the wild." Ginseng is prevalent among over 400 herbs that are cultivated: some 4000 tonnes are harvested each year. Animals are similarly farmed, though with mixed success. "There are a lot of deer in farms - 400,000 altogether," says Chen, "so we don't use wild deer for antlers any more." Bear farming began in the 1960s, but techniques were only developed during the 1970s and farm bears now supply more than enough bile for China's needs. Pangolins breed too slowly for viable farming. A tiger farm was set up, but China banned sale of tiger bone in 1993 and the tigers were moved to a safari park, where visitors help support their upkeep.
Rhino horn trade was banned along with tiger bone. For these, and some other endangered animals, Chen says, "We have to try to find substitutes. Sometimes we use the same active compounds - as with an artificial musk. Sometimes we substitute with other animal species - instead of rhino horn, we use buffalo horn." Chen shows me the latest official pharmacopoeia, a fat tome with a red cover. It omits tiger bone, and rhino horn, that two thousand year stalwart of TCM. China's search for a substitute for the horn long predates the realisation in the west that demand for TCM threatened rhinos. "In the late 1950s, we couldn't import rhino horns, and rhinos were rare within China," says Chen. "We began research in the 1960s, conducting laboratory tests and clinical trials, and found buffalo horn was as effective. In 1973 the Ministry of Health officially approved buffalo horn as a substitute."
But are there any grounds for the notion that TCM uses rhino horn as an aphrodisiac? Chen departs from the script, saying, "There is nothing like this in the laboratory tests or in historical records. Its effect is cooling, for treating high fever and high blood pressure.
"When people criticise Chinese people for using medicines, they should do so according to laboratory research, rather than without foundation," says Chen. "We are criticised for using rare animals, like tigers, bears, musk deer, snakes - our first impression is that the critics don't look at the full situation. Although we use plants or wild animals, not drugs, we are treating diseases and protecting people's health, just like western medicine. It's not like people say, that we like to kill wild animals."
Even if people don't say exactly that - Chen's defensiveness probably stems from media articles with titles like "Endangered species slaughtered for potions" - there is surely a widespread impression that TCM cares barely a jot for animals. It's an impression fed by those traders and practitioners who still deal in illicit goods like tiger bone, and bolstered by the mainland TCM industry, particularly by its encouragement of bear farming.
I guess you saw the images from bear farms that were broadcast around the world in 1993. They showed bears in cramped cages, some so small they could move only their paws. There were bears with pressure sores, and with ulcers from the faeces and urine they could only lie in till the farmer hosed them down. Tubing projected from their skin; through it, they could be "milked" for their bile. The stills and video footage were heartrending - I remember my mum telling me she cried when she saw the bears on tv - and prompted an outcry, with letters flooding in to the Chinese government, and to the International Fund for Animal Welfare.
IFAW's China director, Jill Robinson, has spearheaded the organisation's campaign against the farms. It was the first two bear farms she visited that featured in the 1993 publicity; you might have seen her, her wavy blonde haired at odds with the squalid farm interiors, trying to comfort bears by holding their outstretched paws. Aiming to do far more than simply stir up trouble, Robinson and campaign allies have since entered into high-level discussions over the future of the farms. In November 1994, they signed an agreement with the China Wildlife Conservation Association to "work together to eliminate the 'inhumane, uncivilised' and, in many cases, 'illegal' practice of bear farming." Several of the worst farms, including the two exposed in the media, have been closed down - eight of the bears that were in the smallest cages Robinson encountered now roam a custom built compound with trees, grass, and pools they can swim in. Restrictions on bear farms have been tightened, improvements are supposedly ongoing. Even so, they remain what one observer has called, "concentration camps for bears" - and China is evidently not keen for the outside world to see just what conditions are like.
While covering this story, I looked set to visit a farm in Sichuan. Chen Heng and others at SATCM said this would allow me to witness a modern, licensed bear farm first hand. But when they contacted the farm manager to make final arrangements, he said I couldn't go. Here, then, is information from Jill Robinson on her latest visit to a bear farm, in 1995. The farm is licensed, and holds around 300 bears. Robinson found the bears were in cages they could move around in. At milking time, she says each was distracted with bowl of honey water. "Then a guy wearing a crash helmet crawled underneath the cage, put a needle round a bung the size of a pen top that was in the bear's implant, and hooked it out. He held a metal tray, and waited while about two teaspoons of bile trickled onto it."
"Many of the bears had pus trickling from their implant sites," says Robinson. "Some had pulled out their implants - they just had holes where they had been. The bears exhibited stereotypical behaviour like rocking and pacing as if they had programmed themselves. I watched one cub for an hour, as he dashed screaming up and down its cage, always putting its feet in the same places. Then he slumped on the bottom, and chewed his left arm."
But conservationists can seem a hard-nosed bunch, looking not to the good of individuals but to the survival of species as a whole, and the farms have supporters who say they help wild bear populations. Ministry of Forestry officials, for instance, claim they annually save the lives of 10,000 bears that would otherwise be killed to supply TCM. Others like Judy Mills are sceptical. "They aren't working," she says. "Bears aren't reproducing as they should be, and they are dying young - we're not sure the farm populations can be sustained without taking bears from the wild. And we're worried the farms may be stimulating people to begin using bear bile, which is now widely available and inexpensive, and that they'll eventually want the champagne of bear bile, from wild bears."
The situation with other TCM farms is also generally gloomy. As Chen Heng mentioned, attempts to farm pangolins were thwarted by their low reproductive rates. Musk deer farming has been touted as a success, but Mills has learned that the tiny deer are too shy, prone to die of heart failure, and not reproduce. Seahorse farming was tried in south China from the 1950s to the early 1980s, but proved difficult, and eventually ceased early this decade. Snake farms might be productive, yet at least some perhaps "launder" great numbers of wild snakes - as indicated by a Guangzhou TCM manufacturer that reported consuming 10,000 kg of snake gall bladders each year, supplied by five snake farms. Which apparently leaves Sika and red deer farming as the only real success story among animals used in TCM. As an indication of this success, the endangered species scientific commission's survey of the TCM trade revealed that of 17 commonly used animal items, the supplies of 11 could not meet demand, and the only "much sought after" item that was considered stable was antler, some 90-95 percent of which was from farmed deer.
Undaunted by all the negative reports and the pesky natures of creatures that are tough to tame, China remains committed to farming medicinal species, insisting at a CITES meeting in June that captive propagation be included in a draft resolution on traditional medicines. But even if the various problems could be overcome, there would still remain the question of how people would react to farms with animals like bears, tigers, maybe even rhinos - and to widespread trade in medicines with ingredients from them. "We will have to decide, as a global community, whether we can domesticate charismatic mega fauna for medicines," says Judy Mills.
What of the other ways of protecting endangered species mentioned by Chen? In situ conservation of species, coupled with controlled harvests, sounds wonderfully promising. After all, "sustainable yield" has become something of a mantra for anyone aiming to meld conservation and development. But the commission's survey suggests in situ conservation is not working in China. Elsewhere, too, there are problems - such as with the saiga antelope, which should be a prime candidate for conservation along these lines, as it can live in huge herds and is adapted to high mortality rates. Attempts at managing populations throughout its range in the former Soviet Union are, however, blighted by poaching, and a TRAFFIC report on trade in its horn concludes that, "The Saiga antelope is caught in a downward spiral of diminishing supply and strong demand."
Substitutes, then. Could substitutes come to the rescue? Don't you go dancing in the streets just yet, but there are indications that yes, they may well do. Albeit in a piecemeal fashion, as each is developed, tested, approved, and put into widespread use.
In December, the Chinese University of Hong Kong's Medicinal Material Research Centre and TRAFFIC East Asia cohosted the Symposium on Substitutes for Tiger Bone and Musk in Traditional East Asian Medicine. One Chinese team presented information on the synthetic musk. Another unveiled a synthetic version of tiger bone, which had received high-level government support. There was also a presentation on a bone from a grassland rodent that has also shown promise as a substitute for tiger bone.
The symposium grew from a suggestion Paul But made at the first ever TCM and conservation symposium, held in Hong Kong in October 1995. "I proposed there should be more meetings in which participants from the TCM industry could have a dialogue with conservationists," he says. "At the same time, they could review topics such as substitutes, and the values of medicines derived from endangered species." But intends it to be the first in a series of symposia, each of which will focus on one or two items. Perhaps a later symposium will feature a herbal substitute for bear bile, which the SATCM is currently searching for with funding from IFAW.
As well as seeing hope in substitutes, But believes biotechnology could help lessen TCM's impact on endangered species. "We consider cell culture is possible for a lot of medicinal plants," he says. "For animal products, we can explore tissue culture. At the same time, we may be able to imitate biosynthetic pathways. Or we may be able to clone genes - for example, inserting them into bacteria, which could be grown in bulk, synthesising large amounts of compounds."
The synthetics and cultured compounds might seem a far cry from the archetypal image of a wise old doctor searching his neighbourhood forests for herbal plants and even animals, then meticulously concocting preparations tailored to individual patients. But this image is already outdated: mainland TCM dispensaries and stores are nowadays stocked with medicines that were prepared and packaged in factories conforming to worldwide standards. Old-timers and stick-in-the-muds might not approve of artificial tiger bone, say; might even be willing and able to pay for the real thing, prolonging the poaching and unnecessary suffering. But to those TCM practitioners who hate being lumped with the endangered species' killers, they would come as a great relief. And the TCM world, itself an unlikely step closer to its core philosophy of aiming for harmony with nature, could get on with benefitting and saving human lives.
[Unpublished. This draft completed in early 1998.]