Herbal Pharmacology in the People’s Republic of China - Section 1 — Page 1 The Southwest School of Botanical Medicine http://www.swsbm.com NOTICE The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the Councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. The members of the Committee responsible for the report were chosen for their special competence and with regard for appropriate balance. This report has been reviewed by a group other than the authors according to procedures approved by a Report Review Committee consisting of members of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. Library of Congress Catalog Card No. 75-39772 International Standard Book No. 0-309-02438-2 Available from: Printing and Publishing Office National Academy of Sciences 2101 Constitution Avenue, N.W. Washington, D.C. 20418 Printed in the United States of America Herbal Pharmacology in the People’s Republic of China - Section 1 — Page 2 The Southwest School of Botanical Medicine http://www.swsbm.com PREFACE The Committee on Scholarly Communication with the People's Republic of China sponsored the visit of a twelve-member Herbal Pharmacology Study Group to the People's Republic of China from June 1 to June 26, 1974. In China, the group was hosted by the Chinese Medical Association. This report is a compilation of the findings of the group members, whose task was to discuss research on natural products for therapeutic use, identification of medically effective elements, and development of synthetic drugs with those elements. The group visited Peking, Tientsin, Shanghai, Nanking, Hangchow, and Kwangchow. The Committee on Scholarly Communication with the People's Republic of China is sponsored jointly by the American Council of Learned Societies, the National Academy of Sciences, and the Social Science Research Council. It was formed in 1966 to promote scholarly communication between the two countries in the natural sciences, medical sciences, social sciences, and humanities. Herbal Pharmacology in the People’s Republic of China - Section 1 — Page 3 The Southwest School of Botanical Medicine http://www.swsbm.com INTRODUCTION During the month of June 1974, twelve U.S. specialists in chemistry, medicine, pharmacology, pharmacognosy, pharmacy, and Chinese culture visited a series of major Chinese cities for the purpose of assessing the current status of herbal pharmacology (both basic and clinical) in the People's Republic of China.1 We hoped, by visiting medical schools (both traditional"2 and Western-type), research institutes, hospitals, pharmacies, pharmaceutical plants, and plantations, to learn something about current Chinese approaches to the use of herbal medicines and to the detailed study of such medicines in man and animals, as well as to identify types of plant materials that might justify prompt attention from Western scientists and physicians interested in developing important new drugs from natural products. Our group was selected with the following points in mind: (1) a complement of scientific disciplines appropriate to our mission; (2) geographic distribution so as to include scholars from different areas, schools, and institutes in the United States; (3) representation of academia, industry, and government; and (4) the presence in the delegation of China scholars as well as scientists with a working knowledge of the Chinese language. Scholars who had visited the People's Republic of China in the previous 5 years were not considered. Problems It soon became obvious that certain factors - some predictable and others not - were to make our mission more difficult than many of us had suspected. One of the first of these was inseparability of politics and medicine in China. No society possesses a scientific establishment independent of non-scientific forces in the culture, but the relationships in China seem especially complex. In the People's Republic politics takes command, and science is made to serve the people. Great emphasis is placed upon the need for technological self-reliance, and scientists are taught that they must combine what is useful from the West with native devices and discoveries in order to meet the needs of the nation. In pharmacological work this effort is expressed in Mao Tse-tung's formula calling 1 The itinerary and the Chinese whom we met are listed in the Appendix. 2 By "traditional medicine" we mean the mixture of traditional Chinese medical practices with Western training methods that is now called "Chinese medicine" (Chung-i) in the People's Republic of China. Herbal Pharmacology in the People’s Republic of China - Section 1 — Page 4 The Southwest School of Botanical Medicine http://www.swsbm.com for the union of Western and Chinese medicine. Pharmacology particularly lends itself to this attempted union because of classical China's rich materia medica and pharmacopoeia. The Chinese consistently refer to their herbal remedies as being "the product of two thousand years of the people's struggle against disease," and cite the millennial endurance of these medicines as adequate empirical proof of their effectiveness. Yet Chinese drug therapy did not emerge from an empirical tradition based on pharmacological properties alone. Magic and ritual also played a large role in drug formulas, and abstract cosmological terms distinguished the Chinese traditional cures from simple folk medicine. As historians of Chinese science have remarked: The heterogeneous character of Chinese materia medica begins to make sense only when we realize that the tradition of the great pharmacopoeias (which is parallel to that of the great theoretical and therapeutic treatises) is anything but folk medicine. It is a comprehensive and highly rational body of theory and practice held together by the most fundamental concepts of classical natural philosophy, which have been refined, modified, and elaborated to incorporate the phenomena of health and sickness. The very fact that the materia medica was so closely linked with Confucian cosmogony gravely jeopardized traditional medical practitioners when China began a selective process of modernization in the late nineteenth century. As more and more Western-style physicians were trained in the twentieth century, and as Confucianism itself came to be seen as an expression of China's "backward" and "feudal" ancien regime, traditional Chinese medicine was attacked for being superstitious and nonscientific. Although traditional doctors continued to abound, their status remained outside the regular medical profession during the years of Kuomintang (Nationalist) rule. In areas controlled by the Chinese Communist Party, however, traditional physicians were mildly encouraged by the authorities, and Chinese herbal medicines were manufactured to supplement modern pharmaceuticals. The Chinese Communists initially supported traditional medicine because Chinese- style physicians were an important available resource and because the tradition itself seemed to stem from popular folk roots. At that time, the Party's leadership intended to westernize traditional practitioners - not sinify Western-style doctors. In 1944 Chairman Mao urged modern doctors to "unite with and help reform Chinese doctors," and five years later, when the People's Republic was established, Herbal Pharmacology in the People’s Republic of China - Section 1 — Page 5 The Southwest School of Botanical Medicine http://www.swsbm.com Chinese-style physicians were encouraged to elevate the standards of their own profession. Western-style doctors nonetheless continued to dominate clinical and laboratory research. Although the Minister of Culture in 1950 urged that the two styles of medicine be united, the traditionalists were denied research centers as well as membership in the Chinese Medical Association. In 1954, however, there was a dramatic shift in emphasis. After launching a campaign to exalt traditional medicine, the government founded research institutes to explore this valuable cultural legacy, and in 1956 it implemented a policy to train more Chinese-style physicians. These moves were opposed by some Western-style physicians. In 1957 the Dean of Pharmacy at Peking Medical College accused the Ministry of Public Health of "dragging pharmaceutics back to the eighteenth century," and there were many other signs that traditional physicians remained second-class professionals in the eyes of modernists. Yet the government continued to support traditional medicine and, during the Great Leap Forward in 1958, initiated programs to train Western-style doctors in Chinese medicine. These programs continued through the Cultural Revolution (1966- 1970) and were strengthened under the aegis of the campaign to criticize Confucius and Lin Piao (the former Minister of Defence who plotted against Mao Tse-tung). As we shall see later in this report, the marriage of Western and Chinese medicine still shows signs of strain, though divorce certainly seems unlikely in the near future. One major cause of continued strain is the theoretical incompatibility of Western and purely traditional medical systems. As Cooper and Sivin have pointed out: Modern medicine evolved in the closest possible consonance with a scientific method that originated in physics. Chinese medicine is a rational construction originated from basic conceptions of the universe and its