8/23/2021
Poison or cure? Traditional Chinese medicine shows that context can make all the difference
Academic rigor, journalistic flair
Poison or cure? Traditional Chinese medicine shows
that context can make all the difference
August 23, 2021 8.04am EDT
Poisons have been used in traditional Chinese medicine for over two millennia. 4X-image/E+ via Getty Images
Author
Yan Liu
Assistant Professor of History, University
at Buffalo
Poisons today typically evoke notions of harm and danger – the opposite of medicines for healing. Yet
traditional Chinese medicine, which has been in practice for over two millennia, used a large number
of poisons to treat a variety of illnesses. Chinese doctors knew that what makes a drug therapeutic
isn’t just its active ingredient – it depends on how you use it.
Biomedical researchers skeptical of the safety and efficacy of traditional Chinese medicine might not
be surprised that Chinese doctors historically prescribed poisons. Some believe that the drugs used in
traditional Chinese medicine often contain hidden toxic ingredients detrimental to health.
But this blurred boundary between poison and medicine is not unique to traditional Chinese
medicine. Chemotherapy uses toxic drugs to treat cancer. And the U.S. opioid epidemic offers a
sobering reminder of how a class of FDA-approved medicines used to treat chronic pain became lethal
poisons through improper administration. Conversely, certain psychedelics deemed illegal today have
ignited new interest in the medical community as potential treatments for anxiety, addiction and
depression.
I am a medical historian who examined the therapeutic use of poisons in Chinese medicine in my
recent book. Based on my research, I believe that Chinese doctors in the past recognized the healing
capacity of poisons while being fully aware of their potential to kill. Understanding this practice
compels modern biomedicine to reconsider how “medicine” is defined today.
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Poison or cure? Traditional Chinese medicine shows that context can make all the difference
Do experts have something to add to public debate?
We think so
What is an active ingredient?
The debate on the safety and efficacy of traditional Chinese medicine often centers on the active
ingredient of a drug. The U.S. Food and Drug Administration defines an active ingredient as “any
component that provides pharmacological activity or other direct effect in the diagnosis, cure,
mitigation, treatment, or prevention of disease, or to affect the structure or any function of the body of
man or animals.”
In other words, the active ingredient is a specific chemical considered to make up the essence of a
drug. Because it carries the responsibility of curing a target disease, it’s used as the gold standard to
evaluate the utility of a drug in modern pharmaceutics.
Understanding the poison-medicine paradox opens up more doors for treatment. Mike Kemp/Corbis News via Getty
Images
There is value to identifying active ingredients in drug discovery, including those in traditional
Chinese medicine. Scientist Tu Youyou won the 2015 Nobel Prize in Physiology or Medicine for
isolating malaria drug artemisinin from an herb used in traditional Chinese medicine. In the same
vein, medical researcher Zhang Tingdong and his team identified arsenic trioxide as an effective
treatment for leukemia by studying drug formulas in traditional Chinese medicine.
Despite these success stories, reducing a medicine to a single molecule is rather limited. This
reductionist approach ignores the context in which a drug is used, which plays a crucial role in its end
effects. To appreciate this perspective, it is necessary to go back in history to see how poisons were
understood and used in premodern China.
Poisons in traditional Chinese medicine
The Chinese word for poison is “du” (毒). Unlike its negative meaning today, ancient texts written
2,000 years ago used the word to denote potency, or the ability to both harm and heal. There was no
categorical distinction between poisons and nonpoisons in traditional Chinese medicine – they acted
in a continuum defined by level of potency.
The dual potential of poisons laid the foundation for their use in medicine. Chinese doctors
strategically deployed potent poisons to cure everything from blood clots to abdominal pain to
epidemic diseases. For example, aconite (“fuzi” 附⼦), a highly poisonous herb grown in southwest
China, was one of the most often prescribed medicines in the medieval era. Mercury was another
poison used regularly in both medicine and alchemy to eliminate worms and prolong life. Overall,
poisons consistently made up about 20% of the drugs in the ever-expanding Chinese pharmacopeia
throughout the imperial era, speaking to their crucial role in healing.
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Poison or cure? Traditional Chinese medicine shows that context can make all the difference
One way Chinese doctors used poisons for healing was
through the principle of using poison to attack poison (“yi du
gong du” 以毒攻毒). In their eyes, these powerful substances
could target and eliminate specific disease entities like
worms inside the body. They believed the strong sensations
induced by poisons marked a process of purifying the body of
its harmful burdens.
The context in which a drug is used matters
Chinese doctors in the past were not looking for an active
ingredient that defined the usefulness of any given
substance. Rather, they considered the effect of each drug
highly malleable. No better example illustrates this way of
Aconite is a poisonous herb that was used
thinking than the medical use of poisons.
to treat cold symptoms in ancient Chinese
medical practice. Library of Congress, Asian
Doctors in China were keenly aware of how the effect of a
Division, Chinese Rare Books
poison varied greatly depending on how it was prepared and
administered. Accordingly, they developed a variety of
methods – such as dosage control, mixing with other
ingredients and other drug processing techniques – to
mitigate a poison’s potency but still preserve its efficacy.
Chinese doctors were also aware that poisons worked
differently from person to person. The same drug could have
different effects depending on the patient’s gender, age,
setting, emotional status and lifestyle. For example, eminent
7th-century physician Sun Simiao (孫思邈) offered remedies
specific to women and the elderly.
Using a poison outside of its prescription often proved
deadly. For instance, Five-Stone Powder, or “Wushi San” (五
Illustration of drug processing in a 16th-
⽯散), a psychedelic drug that contains arsenic, was one of
century pharmaceutical text. Wellcome
the most popular medicines in medieval China. Despite
Collection
medical recommendation that it be used only as a last resort
to treat emergencies, many at the time regularly consumed it to invigorate their bodies and illuminate
their minds. Unsurprisingly, this misuse led to numerous deaths. Going beyond its restricted usage, a
poison could easily kill.
Beyond the active ingredient
The paradox of healing with poisons in traditional Chinese medicine reveals a key message: There is
no essential, absolute or unchanging core that characterizes a medicine. Instead, the effect of any
given drug is always relational – it is contingent on how the drug is used, how it interacts with a
particular body and its intended effects.
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today.]
Medicines are fluid substances that defy stable categorization. Looking beyond the biomedical
standard of the active ingredient could help doctors and researchers pay more attention to the context
of how medicines are used. This will allow for a more nuanced understanding of healing.
Ultimately, there is more to a medicine than its active ingredient. Poisons in traditional Chinese
medicine, I hope, teach a compelling lesson.
Medicine
Pharmacology
Poison
Drugs
Traditional Chinese medicine
Medical anthropology
Biomedicine
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