FOLLOWING the second Opium War, which ended in 1860, Britain and other
colonial powers demanded that China legalise the opium trade. The Chinese
refused. In retaliation British troops ransacked the Summer Palace in Beijing.
Some of China鈥檚 greatest artistic treasures were destroyed.
Echoes of this historic clash reverberate in contemporary confrontations
between conservationists and the people who trade, prescribe and use traditional
Chinese medicine (TCM). Many of the latter regard foreign demands for regulation
of TCM to protect endangered species as a form of cultural imperialism. 鈥淚 agree
that all herbalists have duties to protect the endangered animals,鈥� says one
Hong Kong TCM trader. 鈥淗owever, we are equally obliged to use these antidotes to
cure the patients. In my opinion, human lives are much more important than those
of the animals.鈥� Faced with such views, conservationists feel discouraged.
Meanwhile, a treasure trove of natural heritage is under threat.
Last year, China was among 136 nations to sign a formal resolution
recognising that the uncontrolled use of wild species in traditional medicine
threatens their survival and the continuation of these medical practices. The
resolution, drawn up by the UN Convention on International Trade in Endangered
Species (CITES), aims to initiate new partnerships in conservation. It sees
education as crucial to prevent the overexploitation of medicinal species. At
the same time, it acknowledges the importance of traditional medicine. Finding a
sustainable way to practise TCM is crucial because it is by far the biggest of
the many systems of traditional medicine that use animals and plants, and it
exploits a huge range of natural ingredients.
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At least a quarter of the world鈥檚 population, including ethnic Chinese on all
continents, Koreans and Japanese, use medical practices based on TCM. Trade in
Chinese medicines was worth around $2 billion to China in 1994, and is
growing rapidly. About 85 per cent of these medicines are derived from plants,
with 13 per cent coming from animals, and 2 per cent based on minerals. Up to 12
of these ingredients are mixed to give an individually tailored prescription.
TCM sees the body as a microcosm of the natural world. Illness results when
there is an imbalance, and equilibrium is restored through medication, rest and
exercise. It is one of a handful of alternatives to Western medicine that are
endorsed by the WHO.
Western notions of TCM are confused. It is commonly stigmatised as mere
superstition yet it provides the basis for some successful Western medicines.
Artemisin, for example, extracted from daisies and used by TCM practitioners for
1500 years, is now a very promising antimalarial drug in the West. Ephedrine,
prescribed for the treatment of asthma, comes from a plant that has been used in
Chinese medicine for millennia. One TCM cure for eczema proved so successful in
recent trials at London鈥檚 Great Ormond Street Hospital that a pharmaceuticals
company has patented its own version. A key ingredient is root from the
slow-growing tree peony, which could rapidly become overexploited in the
wild.
While Western medicine quietly assimilates traditional Chinese cures, TCM is
also evolving. China has an official policy of running two healthcare systems in
parallel. A doctor might use a CT scan to check for blood clots in a stroke
patient, and then prescribe traditional medicines to disperse them. Although the
philosophy of TCM remains traditional, treatments are changing in response to
new diseases and approaches, often at the expense of wildlife. The earliest
known pharmacopoeia, dating from the first century BC, lists 365 different
plants, animals and minerals. The number is now 11 559. Add to this an exploding
demand for TCM, in part due to increased prosperity in Southeast Asia, and the
effects on wildlife can be devastating.
Field surveys assessing conservation risks posed by TCM deal almost
exclusively with the few medicinal mammals. The results are disheartening.
Continued demand for tiger bones makes overexploitation a greater threat than
habitat loss. Similarly, medicinal use of rhinoceros horn has accounted for much
of the animal鈥檚 decline in numbers. Between 1970 and 1993, 95 per cent of the
world鈥檚 population of black rhinoceros disappeared, and Javan and Sumatran
rhinos hover on the brink of extinction. Demand for bear bile still threatens
Asian bears, even though there are now regulations on international trade in all
species.
Little or nothing is known about the biology, trade or conservation status of
thousands of other nonmammalian medicinal species. And the speed at which
Chinese medicine is growing means that some species newly recruited to the
pharmacopoeia could become threatened even before outsiders, and some
practitioners, realise they are being used. For example, sea moths鈥攕mall
marine fishes that, like seahorses, are used to treat many conditions from
respiratory problems and impotence to general malaise鈥攈ave been a
recognised TCM medicine for less than 30 years. Now they are actively traded by
China, Hong Kong, Indonesia, the Philippines and Vietnam. How this might affect
the species鈥� survival remains uncertain because so little is known about their
ecology.
Medical practitioners often do not need ecologists to tell them that trade in
a species is taking its toll on wild populations. They know, for example, that
trade in seahorses boomed in the mid-1980s, following China鈥檚 economic
restructuring. Traders in China estimate that sales are still increasing by
between 8 and 10 per cent a year, with a global total of at least 20 million
dried seahorses traded in 1994. Southeast Asia鈥檚 seahorse populations have
slumped by up to 70 per cent in the past decade. Greater demand and dwindling
supplies are forcing TCM merchants to seek stock from as far afield as Ecuador
and Mozambique. And this is not an isolated example鈥攖rade networks
throughout Southeast Asia supply China鈥檚 demand for turtles and tortoises.
Conflicting interests
As demand increases and supplies decrease, prices rise. So do conservation
concerns. Rare or depleted species with inflated price tags are especially at
risk because their value makes it worthwhile for suppliers to collect even the
very last animal or plant from the wild. This already seems likely with the
Chinese three-striped box turtle, according to a recent report from TRAFFIC, the
trade-monitoring programme of the World Wide Fund for Nature, and the World
Conservation Union. Highly coveted species often become important sources of
income: seahorses now support thousands of subsistence fishers in Asia, many of
whom could not otherwise make a living.
The growing use of prepackaged patent medicines has made matters worse.
Consumers increasingly rely on proprietary medicines because they are easier to
use than traditional, individually tailored prescriptions of raw materials. This
places more pressure on target species. Seahorses, for example, once had to be
of a certain size and quality before they were accepted by practitioners and
consumers. But declining availability of the preferred large, pale and smooth
seahorses has been offset by the shift towards prepackaged medicines, which make
it possible for TCM merchants to sell previously unused juvenile, spiny and
dark-coloured animals. Today almost a third of the seahorses sold in China are
prepackaged.
Most countries where TCM is practised are well aware of conservation issues
and have legislation to control exploitation of threatened species. Enforcing
these laws is difficult, however. The vast majority of medicinal animals and
plants are collected from the wild, making regulation of suppliers an unwieldy
task. All seahorses are caught at sea by hand or in nets. And about 80 per cent
of the 1000 plant species most commonly used in TCM come from wild populations.
The China Plant Red Data Book lists 388 endangered species, of which 22 are
still harvested from the wild virtually unchecked.
Slow to grow
One solution is to farm medicinal animals and plants. Chinese officials have
promoted this as a way of guaranteeing supplies as well as protecting endangered
species. And there have been some successes鈥攏otably with plant species,
such as American ginseng鈥攚hich is used as a general tonic and for chronic
coughs. Red deer, too, have for centuries been farmed for their antlers, which
are used to treat impotence and general fatigue. But growing your own is not a
universal panacea. Some plants grow so slowly that cultivation in not
economically viable. Animals such as musk deer may be difficult to farm, and so
generate little profit. Seahorses are difficult to feed and plagued by disease
in captivity. Other species cannot be cultivated at all.
Even when it works, farming usually fails to match the scale of demand.
Overall, cultivated TCM plants in China supply less than 20 per cent of the
required 1.6 million tonnes per annum. Similarly, China鈥檚 demand for animal
products such as musk and pangolin scales far exceeds supply from captive-bred
sources.
Farming alone can never resolve conservation concerns, as government
authorities and those who use Chinese medicine realise. For a start, consumers
often prefer ingredients taken from the wild, believing them to be more potent.
This is reflected in the price, with wild oriental ginseng fetching up to 32
times as much as cultivated plants. Then there are welfare concerns. Bear
farming in China is particularly controversial. Around 7600 captive bears have
their bile 鈥渕ilked鈥� through tubes inserted into their gall bladders. According
to Chinese officials, 10 000 wild bears would need to be killed each year to
produce as much bile. But many Westerners argue that bear farming is cruel.
One alternative to farming involves replacing medical ingredients from
threatened species with manufactured chemical compounds. In general, this sort
of substitution is difficult to achieve because the active ingredient is often
not known. In addition, most TCM uses compounds which may act
synergistically鈥攕everal ingredients may interact to give the required
effect. Also, people prefer and trust the wild source. Tauro ursodeoxycholic
acid, the active ingredient of bear bile, can be synthesised and is used by some
Western doctors to treat gallstones, but many TCM consumers reject it as being
inferior to the natural substance from wild animals.
Second choice
The search to replace medicines from threatened species with products from
more abundant animals or plants may run into similar difficulties. In a survey
in South Korea, 80 per cent of TCM practitioners surveyed said they considered
bear bile more effective than bile from other animals. Three quarters of the
doctors also believed that bear bile is better than the equivalent chemicals
from plant sources. Similarly, some practitioners happily use substitutes for
rhinoceros horn, while others stress its essential role in TCM. Even where
substitutes are widely accepted, they may simply divert the problem. Peony and
Madagascar periwinkle鈥� alternatives to bear bile鈥攁re themselves
threatened. So is the saiga antelope, whose horn was once proposed as a proxy
for rhinoceros horn. Given the lack of knowledge about most species used in TCM,
it is usually impossible to predict the ecological impact on substitute
species.
People with a stake in TCM often seek chemical and biological alternatives to
endangered species because they realise that plants and animals lost from the
wild are also lost to medicine forever. Sustainable and controlled use of
natural resources are not just Western concepts. Chinese advice against
overexploitation of natural medicinal species dates from at least Mencius, a
philosopher living in the 4th century BC.
As in the West, however, not everyone is conservation-minded. One Hong Kong
wholesaler said there was no incentive to trade alternatives to threatened
species because rare products are more profitable. Economic arguments also fuel
opposition to trade controls. Bans on trade in rhinoceros horn and tiger bone
have cost China鈥檚 pharmaceuticals industry an estimated $2.5 million
since 1993.
Faced with evidence of increasing global demand for TCM species, many Western
conservationists are combative in discussions with TCM practitioners. The
Chinese, who commonly take a non-confrontational approach, often view
conservationists as rude and arrogant. Suggestions that TCM is hocus-pocus are
particularly galling, given its successes, including those in the West. Western
misconceptions further strain relations. One repeated fallacy is that rhinoceros
horn is used as an aphrodisiac in TCM. It is, in fact, prescribed for
life-threatening fevers and convulsions and has been clinically shown to have
fever-reducing properties.
Cultural differences add to the confusion. Chinese officials, for example,
are puzzled by criticism of bear farming, which they view as a triumph in
balancing the demands of wildlife conservation and the pharmaceuticals industry.
Many Westerners, in turn, seem not to understand the importance of TCM, or the
difficulties in substituting products. They also often fail to explain
conservation threats to TCM traders and practitioners in terms that are
believable and acceptable. Many still share the view of the Hong Kong trader who
said: 鈥淭here is no problem with turtles and tortoises. You only have to see how
many there are in the markets. The problem is that there are not enough people
to collect them in the countryside.鈥�
Despite a history of mistrust and misunderstanding, communication is
possible. Progress began in 1995 when representatives of the oriental medicine
communities in Asia met with conservationists at a symposium in Hong Kong,
organised by TRAFFIC. The two groups established a clear willingness to
cooperate through dialogue and mutual understanding. This has led to several
meetings, including last month鈥檚 First International Symposium on Endangered
Species Used in Traditional East Asian Medicine (see This Week, 20/27 December
1997, p 15).
Ethnic Chinese fear that TCM itself may become an 鈥渆ndangered species鈥� and
are weary of it being made the international scapegoat for conservation
problems. Wild animals and plants are under attack on many fronts. Rhinoceros
horn is treasured for Yemeni dagger handles, deer musk used to be much sought
after for Western perfumes, Buddhists sell turtles for the devout to release at
temples, seahorses and newts are bought as pets. Add to this the increasing
threat of habitat loss, and conservation efforts based on partnership rather
than confrontation have never been so urgent.