Traditional Chinese medicine shows how it is possible to use poisons to treat illnesses. However, the context in which they are used is crucial to their effectiveness.
Today, poisons evoke notions of harm and danger—the opposite of healing medicines. However, traditional Chinese medicine, which has been in practice for more than two millennia, used a large number of poisons to treat a variety of ailments.
Chinese doctors knew that what makes a medicine therapeutic is not just its active ingredient — depends on how it is used.
Biomedical researchers skeptical about the safety and efficacy of traditional Chinese medicine may not be surprised that Chinese doctors have historically prescribed poisons. Some believe that medicines used in traditional Chinese medicine often contain hidden toxic ingredients that are harmful to health.
But it’s thin boundary between poison and medicine is not exclusive of traditional Chinese medicine. Chemotherapy uses toxic drugs to treat cancer. And the opioid epidemic in the United States reflects how a class of FDA-approved drugs used to treat chronic pain has become a lethal poison due to inadequate administration.
On the other hand, certain psychedelics considered illegal have now sparked new interest in the medical community as potential treatments for anxiety, addiction, and depression.
In the book “Healing with Poisons,” Yan Liu examined the therapeutic use of poisons in Chinese medicine. Based on his research, the author believes that Chinese doctors in the past recognized the healing ability of poisons although they were fully aware of its potential to kill. Understanding this practice forces modern biomedicine to reconsider how “medicine” is defined today.
What is an active ingredient?
The debate over the safety and effectiveness of traditional Chinese medicine often focuses on the active ingredient of a medicine.
The US Food and Drug Administration defines an active ingredient as “any component that provides pharmacological activity or other direct effect in diagnosing, curing, mitigating, treating or preventing disease, or that affects the structure or any function of the human or animal body.”
In other words, the active ingredient is a specific chemical substance considered to constitute the essence of a medicine. Because it has the responsibility to cure a target disease, it is used to assess the usefulness of a drug in the modern pharmaceutical industry.
It is important to identify the active ingredients in drug discovery, including those of traditional Chinese medicine. Scientist Tu Youyou won the 2015 Nobel Prize in Physiology or Medicine for isolating the malaria drug artemisinin from an herb used in traditional Chinese medicine.
Along the same lines, 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 drug to a single molecule is quite limited. This reductive approach ignores the context in which a drug is used, which plays a crucial role in its end effects.
In the past, Chinese doctors didn’t look for an active ingredient that defined the usefulness of a particular substance. Instead, they considered the effect of each drug highly malleable. No example better illustrates this way of thinking than the medical use of poisons.
Doctors in China knew very well how the effect of a poison varied greatly, depending on how it was prepared and administered. So they developed a variety of methods — such as controlling dosage, mixing with other ingredients, and other processing techniques — to mitigate a poison’s potency but still preserve its effectiveness.
Chinese doctors also knew that poisons work differently from person to person. The same drug may have different effects depending on the sex, age, environment, emotional state and lifestyle of the patient. For example, the 7th-century physician Sun Simiao gave specific remedies to women and the elderly.
Using a poison outside your prescription used to be deadly. For example, the powder of five stones, or “Wushi San”, a psychedelic drug that contains arsenic, was one of the most popular medicines in medieval China.
Despite the medical recommendation that it be used only as a last resort to treat emergencies, many at the time used it regularly to invigorate the body and enlighten the mind. Unsurprisingly, this misuse led to several deaths. Going beyond its restricted use, a poison can 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 immutable core that characterizes a drug. Rather, the effect of any medication is always relational—it depends on how the drug is used, how it interacts with a specific body, and its intended effects.
Medicines are fluid substances that defy stable categorization. Looking beyond the biomedical standard of the active ingredient can help clinicians and researchers pay more attention to the context of how medicines are used.
Ultimately, a drug is more than its active ingredient. The poisons in traditional Chinese medicine teach a compelling lesson.
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