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Endangered Herbs in Chinese Medicine

Posted By Eric Brand, Wednesday, April 10, 2013

In autumn 2012, another alarming media wave about endangered species in Chinese medicine hit the mainstream press. A series of raids in London focused on the sale of endangered species by a prominent Chinese medicine company in the UK, and the resulting international media spotlight was painful to behold in numerous ways. Most Western TCM practitioners are highly sensitive to our planet’s ecology and biodiversity, so seeing our profession painted with a broad brush as the foe of Mother Nature is hard to endure. However, far worse is the helpless feeling of watching a media blitz that is abundant in flashy headlines yet lacking in science and logic.

This latest endangered species media adventure followed a UK court decision issued on August 20, 2012, wherein the UK branch of the famous TCM company Beijing Tong Ren Tang was fined £21,000 for distributing products containing CITES-listed plants, notably gastrodia (tian ma), aucklandia (mu xiang), and dendrobium (shihu). The article was widely circulated worldwide, and it parallels similar articles from Australia and New Zealand that cite aucklandia seizures as though they were akin to an egregious seizure of tiger bone or rhino horn. Lost in the excitement, however, is the inescapable fact that the party that was punished was nearly certainly using mu xiang, tian ma, and shihu products that were ethically cultivated, with no connection to the endangered wild products whatsoever. Indeed, in a tragic and ironic way, in certain situations the laws intended to protect these plants are arguably backfiring on the true ecological goals for which they are intended.

Many medicinal plants have been cultivated for centuries, and approximately 150 of the most commonly used items in Chinese medicine predominantly come from cultivated sources. While some Chinese herbs remain abundant in the wild, other herbs have exceedingly scarce remaining wild populations that must be researched and preserved for the sake of biodiversity. For example, while all the baizhu used clinically is derived from cultivated sources, the plant that produces baizhu is extremely rare in the wild.

The situation is even more extreme for Asian ginseng, which is almost completely extinct in the wild but abundant in cultivation (much of what is sold as "wild ginseng” and "wild baizhu” on the market is actually a product that is cultivated in a wild environment to acquire the wild characteristics). The decline of wild Asian ginseng has been historically documented for centuries, and its relative san qi (notoginseng) is a major TCM medicinal that lives on without a single known wild specimen.

Preserving the genetic diversity of the scarce remaining specimens of plants like the ones above is essential, but laws broadly prohibiting the trade in items such as baizhu, renshen, and san qi are unnecessary and impractical, as their wild products are never encountered in trade. No one would consider restricting international trade in potatoes because one ancient Incan variety of wild potato was threatened in the Andean wild. As with the Chinese herbs above, the standard potato can be clearly identified visually, and the supply chain is not in any way contaminated by the covert sales of rare Incan potatoes masquerading as the common cultivated variety.

Given the world’s desperate need for funding to protect treasured and threatened resources such as African elephants and rhinos, it is disheartening to see the wildlife protection forces of sophisticated nations wasting their precious resources on obviously cultivated plants. Use of enforcement resources should be based on a reasonable, scientifically sound assessment of priorities, not a quest for easy headlines. In the numerous media reports devoted to the aucklandia alarm, there isn’t even mention of the fact that wild Aucklandialappa does not naturally occur in China in the first place!

Admittedly, the situation surrounding these medicinals is complex, so it is worth looking at each of these three herbs in detail.

Mu Xiang (Aucklandia/Saussurea)

Mu Xiang, also known as aucklandia, saussurea, or costusroot, is derived from a plant that is botanically known as Saussurealappa [=Aucklandialappa]. In Chinese, it is often referred to simply as mu xiang, but it is also called guang mu xiangor yun mu xiang.

In ancient times, mu xiang was a foreign medicinal that was not found in China. It was called guang mu xiang because it came from India and entered China through Guangzhou. In modern times, it is referred to as yun mu xiang because it is now cultivated in Yunnan province in China. Cultivation in China proved to be very successful, and the product cultivated in Yunnan province is regarded as high-quality, daodi medicinal material.

Despite the fact that mu xiang is now an exclusively cultivated medicinal, it remains classified as a CITES Schedule I substance because it is endangered in the wild in India. While trade is permitted for cultivated specimens of mu xiang, the process is expensive and cumbersome. Its restrictive classification is credited in a TRAFFIC report as a barrier to its successful wide-scale cultivation in its native India (causing India to instead rely on imports from China). Numerous efforts have been made to re-assess its scheduling, but the process appears to be bogged down by decades of political wrangling between India, Pakistan, and China. A border war between China and India initially cut off China’s importation of mu xiang from India in 1962 (which led to the cultivation progress in China), and Pakistan and India, to which it is native, have been arguing with one another about it ever since their inclusion into the CITES discussions.

Given that mu xiang has been revered in both China and India for centuries, it is a tragedy that even its exclusively cultivated form is now increasingly unavailable to patients throughout the world. Unfortunately, beyond the human cost measured in patients that cannot access the herb, there is also an ecological cost to consider. The difficulty of international trade in mu xiang has not only discouraged Indian farmers from cultivating mu xiang, it has caused many manufacturers to depend instead on chuan mu xiang (vladimiria root), a traditional mu xiang substitute from a different genus that grows in Sichuan.

In many Western nations, chuan mu xiang is already the only form of mu xiang available. Although it is currently abundant in the wild, chuan mu xiangis generally sourced from wild-harvested plants, and over decades it may become depleted if trade in standard cultivated mu xiang continues to be discouraged. There is a certain irony that a law intended to protect wild species results in a situation in which we cannot buy the original cultivated plant and are instead forced to use a wild plant with finite resources as a substitute.

Tian Ma (Gastrodia)

Tian ma, also known as gastrodia, is another item that is extensively cultivated for use in Chinese medicine. Effective cultivation techniques for gastrodia were only developed in the modern era, so for much of history, Chinese medicine depended on the use of wild gastrodia plants. As the human population grew, the wild gastrodia population became greatly depleted by the 1970s, and now the product that is used in Chinese medicine comes from exclusively cultivated sources.

In the field of Chinese medicine, it is not uncommon to encounter the simplistic idea that wild products are superior to cultivated products. In truth, the situation is far more nuanced. For example, the di huang (rehmannia) product used in medicine has been exclusively a cultivated product for centuries, and there is no interest in wild di huang for use in medicine (despite the fact that it is abundant in the wild environment). In other instances, the wild-crafted vs. cultivated nature of the product determines its fundamental identity. For example, chi shao (red peony) and caowu (wild aconite) are exclusively wild-crafted products, while baishao (white peony) and chuanwu (Sichuan aconite) are exclusively cultivated products.

Despite the overly simplistic and sometimes erroneous assumption that wild products are inherently better than cultivated products, we find that some uninformed or unscrupulous vendors in Chinese wholesale markets still label products for sale as "wild tian ma.” In actuality, wild tian ma is exceedingly rare, and it does not exist on the commercial market in any significant quantity. The large bags of tian ma that are sold as "wild” are not genuine; rather, they are cultivated roots that have been deprived of nutrition, causing them to appear shriveled and wrinkled (to create an appearance similar to the wild product). Some experts say there is no wild tian ma left, others say there is only a trace amount left in the wild, but all agree that there is no wild tian ma that is slipping into the inexpensive commercial supply chain.

Tian ma is an unusual plant that mystified ancient people due to its difficulty in propagation. It requires the presence of a symbiotic fungus in order to grow, and its cultivation techniques did not develop until the 1970s. In the 1970s and 1980s, it became extremely scarce until cultivation advanced, and all tianma that is now sold on the market is cultivated.

Shi Hu (Dendrobium)

Shi hu is an orchid product that comes from one of several species of dendrobium. All species of orchids are controlled by CITES regulations and permits are required for trade. The shihu used in Chinese medicine is exclusively cultivated and the wild product is not found in general trade, so the use of shihu in everyday clinical Chinese medicine does not have any negative ecological impact in terms of endangered species. Damage to wild populations continues through exotic flower collectors or seekers of rare, overpriced exotic objects, but the average modern TCM practitioner will never encounter wild dendrobium products in their lifetime.

Historically, dendrobium orchids have been over-collected in the wild for both medicinal and ornamental applications, and the CITES regulations play an essential role in their continued preservation. CITES regulations permit trade in cultivated products, and the vast amount of international trade in ornamental orchids has allowed a generally effective management system to emerge over time. CITES exemptions for finished products from cultivated dendrobium are also periodically discussed, which would greatly simplify international trade in shihu.

While trade in shihu is permitted with the correct documentation, much of what is sold on the market as shihu in the West is actually a different plant, known botanically as Ephemeranthafimbriata (Bl.) P.E. Hunt et Summ. This plant, known in Chinese as you guashihu, is also an orchid that requires CITES documentation, but it is a relatively inexpensive substitute that is commonly used in place of genuine shihu. Many Western TCM practitioners have relatively little exposure to shihu, and its high price combined with its relative obscurity causes it to have an extremely small market in the West. Despite being a cultivated product subject to legal trade, genuine shihu is rarely seen in the West due to its small income potential relative to its high bureaucratic hassle. It can be differentiated readily from the substitute you guashihu by appearance, and it is distinctively sticky when chewed.

Chinese medicine is a new phenomenon in the West, and it is essential that TCM practitioners understand the complex issues surrounding endangered species. Although products from endangered wild animals and endangered wild plants are absent in the supply chain that Western practitioners rely upon, we must nonetheless stay well informed about the ecological background of the products that we use. It is unreasonable to expect a deep level of subject matter expertise from reporters and customs officials that work with a wide range of issues, so perhaps the practitioner community can help reach out to bring more facts into the discussion when similar articles surface in the future.

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The 9th World Congress of Chinese Medicine: An Interview with AAAOM President Emeritus Deborah Lincoln

Posted By AAAOM, Wednesday, April 10, 2013

The 9th World Congress of Chinese Medicine was held in Kuching, Malaysia on November 10th and 11,th 2012. Hosted by the World Federation of Chinese Medical Societies (WFCMS), an international world organization with headquarters in Beijing, China, the Congress provides an annual platform for practitioners of Chinese medicine from all over the world to publish clinical studies and findings and to present the latest developments in Chinese medicine. Fifty countries and regions have representatives in the Congress; five intercontinental groups and 147 national organizations that include intercontinental Asia, North and South America, Africa and the European Union. The theme for this gathering was "Traditional Chinese Medicine Contributing Factor to the Harmony of Human and Nature.”

The WFCMS mission is to "make greater contributions to the health of mankind through the following objectives: to strengthen understanding and cooperation among international Chinese Medical Societies, to promote academic exchange, to improve the professional standards of Chinese Medicine, to protect and develop Chinese Medicine, and to promote exchange and cooperation between Chinese Medicine and other medicines in the world.” The previous eight Congresses were held in Beijing, Paris, Toronto, Singapore, Macau, Melbourne, Hague and London.

Deborah Lincoln, MSN, RN, RAc, Dipl Ac, NCCAOM, president emeritus of AAAOM, attended the 9th annual Congress as a representative of the AAAOM.

AAAOM: What circumstances led to your attendance at the Congress?

DL: The WFCMS advised the AAAOM that they were seeking representation from the United States at their annual Congress and extended an invitation to AAAOM President Michael Jabbour. (Michael is the current vice chairman of WFCMS for the United States) Michael asked me to fill in for him as his obligations here would not allow him to travel abroad. So I agreed to represent our organization, and to take notes for our organization in Michael’s place. I had the kind help of the WFCMS in organizing my journey. I worked with Doreen Chen, past board member and long time AAAOM member, who acted as my interpreter through the process, our preparations to travel to the Congress as well as during the trip we took to China afterwards.

AAAOM: Tell us about your experience of attending the Congress.

DL: I was invited to board meetings that lasted several hours and attended meetings of some special committees. Throughout these meetings it was apparent to me that people across the globe are working together as a team to increase recognition of TCM throughout the world and raise it to a level of common standardization. The issues of recognition faced by TCM are global, and we are all striving to reach the goal of inclusion of TCM with mainstream medicine. Many people approached me to make sure I knew that we are sought after as a nation for inclusion in the WFCMS. There was a great turnout; 1200 people attended the Congress. It was different than our conferences in the U.S. in terms of vendors; there were only around 20 vendor booths. Flying into Malaysia is expensive, and I think the cost affected vendor turnout.

Secretary General Li Zhenji and Deborah LincolnAAAOM: Tell us about your interactions with practitioners from other nations:

DL: I met practitioners from around the globe, including Australia, England, Germany, Italy, Malaysia, Korea, several Chinese provinces, South Africa, Singapore, Thailand, Canada and Taiwan. I was officially introduced to, and got to spend one on one time with, members of WFCMS including She Jing, chairperson of WFCMS and the vice minister of health in China, Secretary General of WFCMS Li Zhenji, and Vice Secretary of WFCMS Huang Jian Yin as well as other board members.

Thanks to the WFCMS, I was able to have many interactions with practitioners from mainland China. During the planning for this trip I was invited to visit China after the Congress for a tour of the WFCMS headquarters, a number of medical facilities and famous clinics. Journeying into China was a key experience for me in understanding what we can do as American practitioners to form better relations with China. They were incredibly gracious to me and allowed me to tour medical facilities and see the way their country practices Chinese medicine.

I was able to attend several presentations and formal lectures, which I selected from the 156 papers presented ranging from TCM development, clinical research, experimental studies, acupuncture and meridians, the study of traditional Chinese medicinals, and clinical experience.

I sat in on several pediatric classes: a clinical evaluation of the effect on asthma in children treated by a series proved prescription of TCM, 

spleen/stomach theories and application, and exploration of stagnated heat pathogenesis in syndromes of the pulmonary system. I also attended lectures on "Adult Rheumatology with TCM: How to Maximize the Therapeutic Effects,” "Chinese Medicine for Treating Ankylosing Spondylitis,” and a study of "TCM and Western Medicine Approaches to Treatment of Malignant Tumors in Taiwan.”

One of the important things I learned during the conference was that the governments of Australia and Singapore passed a law to legalize the practice of Chinese medicine inclusive of the adoption of a national exam. The national exams held by these countries are, as far as they could gather, the first in the world. Australia’s law was just passed in June 2012.

AAAOM: What did you learn about the regulatory and political difficulties faced by practitioners in other countries and how those battles relate to the ones we fight here in the U.S.?

DL: The Congress is focused on global issues, and problems within individual nations were not discussed in the meetings. I learned that the problems we face in the United States regarding AOM are similar to the problems faced by all nations who attend the Congress. We are a bit ahead in some ways through regulations regarding hygiene and standard models of care.

The WFCMS recognizes inclusion and standardization as global issues. As an organization, the WFCMS works to create a level of standardization that will enable good communication on a global scale. The Congress works through committees to address the following concerns: positive academic communications and cooperation, the regional development of TCM, the development of international standards including basic nomenclature, basic nomenclature of Chinese material medica, a coding system of Chinese herbal medicine, clinical terms for Chinese medicine, and research to establish the efficacy of TCM. These goals are being worked on through meetings that bring representatives from various countries together with representatives from China.

The Congress is only one of many conferences and forums held by the WFCMS. The organization hosts 51 specialty committees which focus on particular issues, issues within specific countries, and specific diseases. Most committees organize seminars on their own subjects and professions, and they conduct activities on technical communication and various personnel training sessions.

I was inspired to see the level of cooperation and inclusion between countries at the Congress. This experience clarified for me one of the major stumbling blocks we are facing in the U.S. The Congress has developed a combination of connections between international organizations to work toward the same goals. We need this level of connection and open communication to go forward effectively here in this country. I think participation with this organization will teach us how to accomplish better cooperation by example.

The past eight Congresses have been held around the world, and the support they have received is impressive. Attendance at the yearly Congress keeps growing; I think that is an indication of the success of the work being done by WFCMS. By comparison with 2011, this year’s Congress showed a nearly 50% growth in attendance.


From left: Loh Yang Hui, Chairman of the World Congress of Chinese Medicine representing Malaysian Chinese medicine; Jing Chen of New York, representing United Alliance of NY licensed acupuncturists; She Jing, Minister of Health China, Secretary General Li Zhenji, Deborah Lincoln and Brian Loh, vice president of the National Federation of Chinese TCM Organizations (NFCTCMO) and WFCMS board member

AAAOM: What were the outcomes of the conference?

DL: I realized through my experience that the national organizations within the U.S., which support our profession, need to learn to work more cooperatively. I also realized how important it is that we form good relationships with our international partners. We are working on many of the same professional problems, so it makes sense to participate with the WFCMS in forming solutions that work across the globe. WFCMS is working to address issues of branding and the need for an international platform for the professions of TCM. As the Congress works to define standards and set an international course for our profession, we need to include ourselves in the discussions and agreements being created.

I was invited by Li Zhenji to participate at the 10th Congress, which will be held September 21-22 in Santa Clara, California. The theme for the Congress will be "Cooperation Between Eastern and Western Medicine; Better Health Services for People Around the World” and will also celebrate the 10th anniversary of the World Federation of Chinese Medicine Societies. The AAAOM will be co-hosting the 10th Congress with the National Federation of Chinese TCM Organizations of California. I was invited onto the organizing committee for this 10th World Congress by President Angela Tu of the NFCTCMO. The WFCMS has released a call for papers for the 10th Congress. The WFCMS wants to send 300 representatives from China to the gathering of the 10th Congress here in Santa Clara, California, just south of San Francisco. They are requesting support through invitations from organizations in the U.S. that will enable them to get visas for the practitioners wishing to attend. I have passed this request to the AAAOM board.

I made new friends during the Congress, people who offer new thoughts and means of support for our profession. I gained a better understanding of global medical issues and the problems faced by members of the TCM community abroad, especially in China. My visit in China after the Congress helped me to understand many of the communication issues we face between nations. I was reminded that language and cultural barriers can create miscommunications that hamper good understanding; we need to be careful in translation and in listening to each other. It was stressed to me that the Chinese want to keep the name "Chinese medicine;” they want to keep the true tradition of the medicine and hope to show this by keeping the name. The other nations at the Congress were very respectful to the Chinese by showing respect for their cultural traditions and showing that they do not want to change the formation of Chinese medicine. The Chinese feel that if you do not call it Chinese medicine you are not practicing the same thing.

Doreen Chen and Deborah Lincoln

In closing, I want to relate my great thanks to Doreen Chen for her skills in translation, accommodations in China through her relatives, and her good company. I also want to relate special thanks to Ann Wong (AAAOM board member and CAC Representative) for her assistance in setting up all our connections in Beijing along with the leaders of WFCMS both at Kuching Conference and in China. The leaders of the WFCMS traveled from Kuching to another conference; Ann kindly guided Doreen and me to WFCMS headquarters and a number of medical facilities. We toured the Xiyuan Hospital CACMS, an integrative medicine hospital where I visited two of the many specialized wards in oncology and cardiovascular diseases. I also went to the Institute of Chinese MateriaMedica China Academy of Chinese Medical Sciences and then visited the well-known out-patient clinic, Yang Shen Tang (which translates to English as "Keep Good for Your Life”) which hosts an herbal pharmacy, acupuncture treatments, and a specialized section for acne. We visited other clinics where AOM is practiced and received a treatment by an 80-yr-old famous pulse diagnostician. I am grateful to these two women for helping to make my travels comfortable and keeping me well informed.

Look for a follow-up article with Deborah about her experiences in China in an issue of The American Acupuncturist.

To learn more about the WFCMS and the 9th Congress:

WFCMS Conference Presentation PDF

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