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Journal of Ethnopharmacology ∎ (∎∎∎∎) ∎∎∎–∎∎∎ 1 Contents lists available at ScienceDirect 2 3 4 Journal of Ethnopharmacology 5 6 journal homepage: www.elsevier.com/locate/jep 7 8 9 10 11 12 What is past is prologue: The challenges of integrating a historical 13 perspective of Chinese medicine and the treatment of recurrent 14 15 urinary tract infections 16 a b a,n 17 Q1 Vivienne Lo , Andrew Flower , Penelope Barrett 18 a China Centre for Health and Humanity, Department of History, UCL, Gower Street, London WC1E 6BT, United Kingdom 19 b Complementary and Integrated Medicine Research Unit, Faculty of Medicine, University of Southampton, Aldermoor Health Centre, Aldermoor Close, 20 Southampton SO16 5ST, United Kingdom 21 22 23 article info abstract 24 25 Article history: Ethnopharmacological relevance: Chinese herbal medicine (CHM) has a recorded history of over 2000 26 Received 7 August 2014 years that may be used to authenticate and guide modern treatments for disease, and also identify 27 Received in revised form neglected but potentially useful treatment strategies. However this process is often based on over- 7 November 2014 simplistic conceptions of tradition and history that fail to take into account the dynamic nature of these 28 Accepted 7 November 2014 29 ‘traditions’ and underestimate the importance of contextual factors in their interpretation. fi 30 Materials and methods: As part of a process of de ning good practice for a clinical trial of CHM for Q2 Keywords: recurrent urinary tract infections, a selective review of classical Chinese medical texts was undertaken to 31 Chinese herbal medicine investigate the historical treatment of urinary diseases specified by the traditional category of Lin 32 Historical review diseases. Clinical trial 33 Results: The historical review provided interesting insights into the evolution and meaning of Lin 34 Urinary tract diseases Bioprospecting diseases and how pertinent data may be found, precisely, outside the boundaries of the categories on 35 Historical ethnopharmacology which the original investigation was premised. Although there were interesting parallels and continuities 36 History in the classical and modern understandings of the aetiology, pathophysiology and treatment of urinary 37 Pre-modern diseases, there were also important divergences. 38 Food Conclusions: It became apparent, in the search for ‘traditional’ herbs to treat a particular modern 39 syndrome it is essential to contextualise remedies, including as far as possible the intertextual, social, 40 cultural, and gender context, and conditions of practice. Historical ethnopharmacology adds a level of 41 subtlety and complexity to over-simplistic attempts at bioprospecting. Some insights that emerged from this historical review could inform the proposed clinical trial but these had to be filtered through the 42 constraints of modern regulatory procedures. Further research is required on how best to integrate the 43 wealth of data that exists in historical texts with the desire to produce effective herbal products for the 44 modern world. 45 & 2014 Published by Elsevier Ireland Ltd. 46 47 67 48 68 1. Introduction entity, carrying with it thousands of years of empirical knowledge 49 69 (Heinrich et al., 2006). Thus in tailoring traditions to modern clinical 50 70 One of the assumptions of any ‘traditional’ medicine is that it has research, it is essential first to interrogate the imagined long history 51 71 a long history. That history is often conceived as unchanging over the of the therapeutic use of any particular substance. 52 72 millennia. In contraposition, modern attention to the history of both Equally essential is to understand the relationship between mod- 53 73 ‘medicine’ and ‘tradition’ showsusthatbothareconstantlytrans- ern disease terminology and the ancient naming of diseases. We must 54 74 forming, making and remaking themselves in order to survive and be be extremely wary of the presumption that pre-modern people were 55 75 Q3 successful in a changing world (Lo and Renton, 2011; Taylor, 2005). treating the same signs and symptoms of disease that we treat today, 56 76 This fact potentially presents a challenge to any modern randomised evenifthediseasessharethesamename.Ancientphysiological 57 77 controlled trial that assumes a traditional medicine to be a static theories, inasmuch as they mediated disease and therapy, may now 58 78 be lost in contemporary traditional medicines (intentionally or not). 59 79 Equally, modern treatment protocols may be very different from those 60 80 n in the past and be delivered in vastly different ways. 61 Corresponding author. Tel.: þ44 7961911811. 81 Conversely, there may be strong parallels between ancient and 62 E-mail addresses: [email protected] (V. Lo), [email protected] (A. Flower), 82 [email protected] (P. Barrett). modern practices. To a modern clinician, an historical investigation 63 83 64 http://dx.doi.org/10.1016/j.jep.2014.11.014 84 65 0378-8741/& 2014 Published by Elsevier Ireland Ltd. 85 66 Please cite this article as: Lo, V., et al., What is past is prologue: The challenges of integrating a historical perspective of Chinese medicine and the treatment of recurrent.... Journal of Ethnopharmacology (2014), http://dx.doi.org/10.1016/j.jep.2014.11.014i 2 V. Lo et al. / Journal of Ethnopharmacology ∎ (∎∎∎∎) ∎∎∎–∎∎∎ 1 like the present study not only serves to train the eye on the and severity of recurrent UTIs and to establish the feasibility of 67 2 nature and value of a tradition and relevant aspects of its authen- administering CHM via GP practices. 68 3 ticity, but also has the potential to identify innovations of the past An essential prelude to this kind of trial is a process of trying to 69 4 that have been lost along the way and to underline the creative establish what constitutes ‘good’ practice of CHM. We define ‘good 70 5 nature of productive traditions (Hsu, 2001). practice’ as being logical within the framework of CHM, consistent 71 6 This complex interplay of past and present has become appar- with at least one thread of traditional practice, having some evidence 72 7 ent in the project described in this paper where medical historians of clinical effectiveness, being biologically plausible, and perceived as 73 8 were commissioned by clinical researchers investigating the a reasonable approach by a peer group of experienced practitioners. 74 9 possible role of Chinese herbal medicine (CHM) in the treatment The practitioner-researcher (AF) who is co-ordinating this trial 75 10 of recurrent urinary tract infections (RUTIs) to explore historical contacted two experienced Chinese medicine historians (VL and 76 11 treatments of disorders related to the term lin淋, a key term in the PB) with the aim of investigating traditional practices that may have 77 12 classical Chinese conceptualisation of urinary disorders. The aim been used to treat RUTIs. 78 13 of this collaboration was to provide an account of good practices The initial purpose of this historical review was to provide material 79 14 that could be important in optimising clinical effectiveness for a on the treatment of urinary disorders in the past, specified by the key 80 15 clinical trial. term ‘lin’ 淋, and thereby identify a range of substances relevant to the 81 16 As has been noted, in exploring ethnobotany and ethnophar- symptoms and problems suffered by the women in this trial. During 82 17 macology as tools for drug discovery, ‘surprisingly little attention the preparatory research, it became evident that there was much more 83 18 has been paid to the historical development of… orally trans- to be learned from this process regardingunderlyingassumptions 84 19 mitted, indigenous knowledge systems’ (Heinrich et al., 2006). about the potencies of foods-herbs-medicines and about disease 85 20 This paper aims to make a small contribution to redress this categories. 86 21 deficit. We hope that the findings of this interdisciplinary project In conducting the review, we set out to trace the disease categories, 87 22 will be of significance to the design of future initiatives in clinical the substances, and their linkages both back from current categories 88 23 research, bioprospecting and bioinformatics. With regard to the and forward from the earliest relevant historical texts. 89 24 themes of this special issue, the present article is obviously con- Any historical enquiry into Chinese medicine presents unique 90 25 cerned with new uses for old traditions. It also encounters regulatory opportunities and challenges inasmuch as there is an unparalleled 91 26 issues that come to bear on the food-herbs-minerals continuum, and written tradition to prospect. The library of China Academy of 92 27 the ownership and authenticity of medical knowledge. Foods and Chinese Medical Sciences alone holds more than 5000 ancient 93 28 medicines are not substances for which we can assume stable medical texts, containing hundreds of thousands of prescriptions 94 29 qualities, but are, rather, the outcome and nexus of processes of (IITCM: www.cintcm.ac.cn/opencms/opencms/xxfw/dzzn/intro.html, 95 30 trade, transformation, appropriation, and use, which require careful accessed 10/07/2014). Most of that material survives in printed books 96 31 and, above all, locally situated historical and cultural studies, espe- dating to the Song period (960–1279) and after. However, in the last 97 32 cially when being translated into modern scientificprotocols. 30 years or so, large quantities of silk and bamboo manuscripts
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