Tag Archives: pharmacology

Transmission of drug knowledge in medieval China: A case of Gelsemium

September 2, 2019 Yan Liu Leave a comment

Syndicated from https://recipes.hypotheses.org/8065

One striking feature of classical Chinese pharmacy is the abundant use of toxic substances. Prominent examples are aconite, arsenic, and bezoar. Fully aware of the toxicity, or du, of these substances, Chinese doctors developed a variety of methods to prepare and deploy them for therapy. How was such knowledge produced in medieval China? And how did it migrate from one space to another? Here I use several medical documents from the seventh century to address these questions, focusing on gouwen 鈎吻 (Gelsemium), a highly toxic herb growing in southern China (opening image).[1]

The seventh century is a crucial moment in the history of Chinese medicine. The favorable political environment of early Tang dynasty (618-755) fostered the flourishing of medical ideas and the formation of a number of influential texts. One of them is the Newly Revised Materia Medica (Xinxiu bencao 新修本草, 659), the first state-sponsored pharmacological text produced in China. Compiled by more than twenty court officials, the text reflects the government’s effort to standardize medical knowledge. Gelsemium is one of the 850 drugs in the book (Fig. 1). Defined as warming, pungent, and highly toxic, the root of the herb could cure, among others, wounds inflicted by metal weapons, ulcers, swelling, and convulsion. The authors also stressed the great danger of the herb by showing that drips squeezed from one or two leaves would suffice to kill a person. But not a goat. Quite the contrary, its sprouts could make the animal grow large. It must be, the authors mused, the case that everything in the world submits to something else.

Figure 1. The entry of *gouwen* (Gelsemium) in the *Newly Revised Materia Medica* (659).
This copy of the text is from Dunhuang (P. 3714), dated to 667 or later. Image courtesy of Bibliothèque nationale de France (Gallica).

Gelsemium was also embraced by doctors at the time. Sun Simiao 孫思邈 (581?-682), one of the most famous doctors in Chinese history, incorporated the drug into his Essential Formulas Worth A Thousand in Gold for Emergencies (Beiji qianjin yaofang 備急千金要方, 650s). The toxic herb appears in nineteen prescriptions in the text, primarily for topical treatment. In one case, Sun presented a formula called “Ointment of Gelsemium” to treat toxic swelling, pain and numbness in the limbs, ulcers, weak feet, among other conditions. At the end, he warned: “This formula should not be given to vulgar people. Be cautious.”

Why did Sun keep the formula away from vulgar people, a term probably referring to commoners? Two possible reasons. First, handling Gelsemium was a delicate matter. Due to its high toxicity, any misuse of the herb could result in dire, if not lethal, consequences. Commoners may not possess the proper knowledge of deploying the herb, hence they should refrain from taking this formula. Second, because Gelsemium straddled medicine and poison, laymen might easily use it to harm others. By restricting its access, Sun tried to prevent such malicious misuse. Contemporary sources echoed Sun’s concern. According to an eighth-century statute of medical practice, private families were forbidden to possess Gelsemium. The government tightly controlled the access of the toxic herb to prevent it from falling into the wrong hands.

This begs the question whether the plant was actually used as a medicine. At the high level of the society, this is likely the case. The evidence came from a precious collection of medicines preserved in the Todaiji Temple in Nara, donated by the Empress Dowager Komyo in 756 as a gesture of benevolence. Because of the vibrant cultural interaction between China and Japan at the time, many drugs of Chinese origin travelled eastward. Gelsemium was one of them (Fig. 2). It is possible that the herb reached Japan as an item of exchange between the two imperial courts that appreciated its medicinal value.

Figure 2. Gelsemium root preserved in the house of Shosoin in the Todaiji
Temple in Nara, dated to the eighth century. The roots are 0.5-2.0 cm in diameter and 17-24 cm in length. Image courtesy of the Imperial Household Agency website.

In the local community, the situation was different. We get a clue from a seventh-century manuscript from Dunhuang, a town located in the far west of the Tang Empire on the Silk Road. The manuscript contains miscellaneous formulas, many for external application. One, called “Ointment of Illicium,” merits our attention (Fig. 3). It closely resembles Sun Simiao’s formula that I showed above, but with an important variation: it doesn’t use Gelsemium. Underneath the ingredient Phytolacca (danglu 當陸), we find an explanation: “The original formula uses Gelsemium. Nowadays it cannot be obtained, so one uses Phytolacca to replace it.” We can posit why this happened, given Gelsemium’s habitat in southern China, which is far away from Dunhuang, and its restricted access to commoners, as explained earlier. By contrast, Phytolacca was a local herb whose medical function substantially overlapped with that of Gelsemium, making it a reasonable substitute for the distant, unattainable plant.

Figure 3. Drug substitution in a seventh-century manuscript from Dunhuang (P. 3731). The formula of the “Ointment of Illicium” is highlighted by the blue box. The arrow points to the note, written in small characters, that specifies the substitution of Phytolacca for Gelsemium. Image courtesy of Bibliothèque nationale de France (Gallica).

This example of drug substitution is telling. Compared to social elites, lay people in local communities faced the challenge of limited medical resources. Consequently, they sought alternative options. The rise of authoritative texts at the imperial center thus went hand in hand with its fluid transformation as it moved in various geographical and social domains. Medical knowledge, upon transmission, was destabilized, begetting varied practices in society.

Notes

[1] This illustration of gouwen (Gelsemium) is from a late sixteenth-century pharmaceutical text (Buyi leigong paozhi bianlan, 1591). Reprint from Buyi leigong paozhi bianlan, ed. Zheng Jinsheng (Shanghai: Shanghai cishu chubanshe, 2008), vol. 1, 241.

Chinese & East Asian Medicines, Research & Teaching

New Digital Tools for the History of Medicine and Religion in China

September 27, 2016 Michael Stanley-Baker Leave a comment

This is a syndicated post that first appeared at www.cpianalysis.org.

When we do textual research on China, we rely on canons that were made with paper. The gold standard for a digital corpus is that it is paired with images of a citeable physical text produced in known historical conditions: at a specific time and place, by a known author or community, or as close to that as possible. Even more, the basic organisation of our wonderful modern databases is structured according to the catalogue and chapter headings of the original collections, which are essentially finding tools for paper archives. While these categories organised the literature and made it easier to find, they also profoundly influence how we, in turn, organise our own research, and how we write history.

The problem is that the categories of researchers change with time. As we analyse our sources in new ways, we give priority to certain texts or features over others, effectively re-indexing them to suit our purposes. Usually, textual scholars will privilege a few texts as case-studies for close study, because we lack the tools for large-scale analysis of textual corpuses to make summative statements about a field of knowledge, or to track changing patterns of a field over time. We can perform thorough and extensive searches for single or a few terms across wide sets of literature, but the long lists of results that are returned are unreadable by humans.

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Figure 1: Search result for a single term, gancao 甘草 (liquorice) in a major text collection

We have a problem of too much information, and too few ways of making sense of it.

In my digital work in the combined histories of Chinese medicine and of Chinese religions, I wish to make a critical intersection into how we theoretically interpret, and digitally analyse our sources. The history of Chinese religions has recently taken on some new directions in the theory of practice. In order to better understand the ways in which historical actors creatively combine aspects of “different” religions, such as Buddhism and Daoism, some scholars have started modelling religions as “repertoires of practice.” This has a very productive overlap with actor-network theory in Science and Technology Studies (STS), which also sees knowledge as produced by “clots” or “assemblages” of people and things, practices, thoughts and institutions and many more. Furthermore, the concept of “situated knowing” that came out of STS argues that different actors organise knowledge differently; there is no single, authoritative perspective on a particular field of knowledge.

This theoretical conjunction raises an important methodological question: How can we identify, sort through and organise a history of “repertoires of practice,” as they are enacted by historical actors of different stripes? Especially when these practices are disparate and escape the cataloguer’s eye? How can we tell when and which practices are being combined and deployed, in concert or separately, and whether concentrations of practices remain constant across different sectarian affiliations, or whether they change in significant ways? Can we identify patterns of change or stability?

In the Drugs Across Asia project, Chen Shih-pei and I are developing a pilot platform to test how to do exactly this. With generous support from Department III of the Max Planck Institute for the History of Science (MPIWG), in collaboration with the Research Center for Digital Humanities at National Taiwan University (NTU), and with Dharma Drum Institute of Liberal Arts (DILA), we are undertaking a pilot study to analyse all Daoist and Buddhist Canon and most medical sources up through the Six Dynasties (to 589 CE) for the presence of drug terms.

In stage one, I use a statistical tool developed by NTU to analyse the texts to identify where drug knowledge is located among the set of sources. NTU have uploaded all the texts for analysis as separate juan in the form of *.txt files. I have selected a combination of open source texts from various sources, primarily drawing from Kanripo. I then upload a large list of known drug terms (11,000!), which the tool uses to analyse which drugs appear in which juanaccording to frequency, and produces a list like this one.

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Figure 2: Chapters from Buddhist and Daoist Canons, according to Drug Term Frequency

From this list, I select the juan for further analysis. It is somewhat self-selecting, as I sort according to how many terms appear per juan. After this, I analyse whether or not the found terms are homonyms for other things, such as relics, deities, or other terms. In this method, more hits is a good thing, because a high concentration of terms per juan is an indicator that drugs are an important topic in that text.

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Figure 3: Drug terms in Buddhist monastic codes

From this data set, I can already begin to compare drug repertoires of different communities. For example, the graph above shows clusters of drug terms from five different Buddhist monastic codes. The terms that appear between the clusters are shared between two or more texts. When compared to an early Chinese materia medica, as in the graph below, it is visibly clear how different the drug lore from China and from India was. There are only a very few common terms between the Chinese text and the five Indian texts. These terms need to be more thoroughly analysed to explain these differences and correlations, but the foundations of a research paper are already here.

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Figure 4: Buddhist Codes compared to Chinese Materia Medica

In the second stage, we mark up individual juan. It is exciting how easy MARKUS makes it to do this work. Using Keyword Search, I can paste my entire list of drug terms into MARKUS, and with one click identify which of those 11,000 terms appears in the text and where. This lets me quickly and easily see where the “action” is, where the drug knowledge is concentrated, without having to read through the entire juan first. I can then go and review how drug knowledge is framed and organised in that text in particular.

This way of organising reveals the “ontology” of the drug knowledge in the juan. Does it mention other important data like disease terms, drug properties, anatomical terms, or material practices like decocting, chopping, or roasting? Geographic terms? Famous people or locations? These are all important for how drug knowledge is figured. I scan through the text to pick out a representative section, and use Manual markup to highlight these salient features. Having been captured by MARKUS, they can be produced as a data table. Through this process of reading and marking up terms, MARKUS enables the ontology of each text to emerge as a data structure directly from the organisation of the text itself.

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Figure 5: Ontology marked up in MARKUS

I then work closely with DILA to mark up the texts. DILA are responsible for producing CBETA, one of the foremost digital humanities projects in East Asia, and thus have extensive experience with marking Buddhist texts. I forward them the file, and they clean up the automatic marking, and use the sample ontology I’ve provided to continue to manually identify corresponding features throughout the rest of the text. I check over the results, and forward the marked file to NTU to upload into the analysis platform.

NTU are currently developing a platform called DocuSky , based on the engine behind the Taiwan History Digital Library. This platform will enable detailed analysis of the resulting markups. It will incorporate detailed meta-data for each text – telling when and by whom a text was compiled or written, in what literary genre, with what sectarian identity, and if available, in which geographic location. By analysing this detailed meta-data along with the markups, I will be able to analyse through which communities what drug knowledge travelled, and, given enough meta-data, at which times and places. The platform will also be capable of visualising the data on a GIS map and dynamic timeline, as in the existing MPIWG platform, PLATIN.

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Figure 6: PLATIN Place and Time Navigator

With this tool, I should be able to quickly identify identical and similar drug recipes at scale, as well as when, where and with whom they travelled, and how they were interpreted. This will provide a much broader and more complex picture of who knew what about which drugs than can currently be known from studying materia medica (bencao 本草) literature. I should be able to track changes in properties of drugs and recipes as they circulated through historical communities, and to do so at scale. It is a mainstay of medical history to compare different community interpretations of a single drug or recipe, but no one has compared large-scale patterns of change and transfer before. By identifying which communities possessed and transmitted which drug knowledge, this platform will facilitate a large-scale picture of one important feature of the relationship between medicine and religion in the Six Dynasties.

While this model is custom-tailored to do research on drugs, it is highly adaptable. In the future, researchers should be able to change their categories and term sets to search for any “repertoire” or “assemblage” of terms. This could include medical data such as anatomical locations or disease names. But it could also be used to capture divinatory arts, health cultivation exercises, pantheons of gods, philosophical terms – anything you can develop a good term list for. I hope this set of tools will enable the fields of religious studies and medical history to come to much more nuanced descriptions of the histories of material (and immaterial) practice.

Sowa Rigpa & Himalayan Medicines

“Slow” Medicine in Fast Times

February 29, 2016 Sienna Craig Leave a comment

This is a syndicated post that first appeared at savageminds.org

Only those who regard healing as the ultimate goal of their efforts can, therefore, be designated as physicians.
—Rudolf Virchow

When Gyatso called to give me the list of medicines I was in the library, writing another one of these blogposts. I answered his call, speaking as quietly as I could in Tibetan but hoping he would still be able to hear me, across the planet. A few students looked up, annoyed, as my weird banter broke their concentration. Once outside, I greeted this familiar voice with enthusiasm. Gyatso, a Tibetan doctor or amchi with whom I have worked for many years, was calling from his home in the ancient walled city of Lo Monthang, in Nepal’s Mustang District.

Pleasantries passed and then Gyatso got down to work. Do you have a pen and paper? He asked. I pulled out my notebook and he began to rattle off the names of about 30 different Tibetan medical compounds. Most I recognized as common formulas with as few as five and as many as twenty-five ingredients: plants, animal products, and minerals from across the Tibetan plateau, high Himalaya, and subtropical South Asia. As I wrote down these names, sensory memories flooded in, of dried pomegranate and green cardamom, of eaglewood and Chinese gooseberry, of calcium carbonate and bamboo pitch. The names of these formulas also brought forth a string of symptoms: sleeplessness and anxiety, blood and bile disorders, digestive irregularities, weakened life force. A few of the named medicines were rinchen rilbu, precious pills. These highly complex pharmacological endeavors include detoxified precious and semi-precious stones and metals. They are used sparingly, if also as panacea.So as not to fully deplete Gyatso’ own medical supplies, with which he treats his own rural community, I had brokered donations of Tibetan medicines from a reputable doctor with her own small pharmacy in India. The doctor would package up this precious cargo and send it by bus from Delhi. Gyatso, along with his brother, heads up a school and medical clinics in Mustang and Pokhara. He was beginning to mobilize several of his senior students along with a few local youths who would then head to the Village Development Committee from which one of their former students and the cook at their school hails: a region in Dolakha District that was severely damaged in the April 28 quake and then further impacted by the May 12 event. After some initial questions about where they should go, they decided on a closely hewn response: help those you know, or those you can trust to help you reach people they know. This sort of practical wisdom turns stereotypes about Nepali propensities to privilege ‘one’s own people’ (aphno maanche) on its head.

As our conversation continued, the structure and form of what will likely be the first of several Amchi Medicine Clinics to emerge in response to the Nepal earthquakes took shape. These clinics aim to provide not only Tibetan medicines and food but also to offer support through ritual practice to honor the dead and protect the living. The idea for these camps was suggested by various amchi soon after the first earthquake. Although their strategies regarding where and when to and who to send go varied, these practitioners presented a single-pointed vision when it came to the purpose of such an endeavor. They would provide culturally astute, mindful care for people living with and suffering from forms of embodied trauma that can be well served by this medical tradition. They understood that without enough to eat, medicines would bring less benefit. They knew that people would value the lighting of butter lamps, but would not necessarily have the butter to offer. The anticipated ongoing physical trauma from the work of dismantling homes but also the needed work of clearing away the spiritual pollution evoked by so many violent, untimely deaths. They spoke of the need to appease local deities of place and to reconsecrate damaged structures.

A Nepali amchi diagnosing a patient through pulse analysis. Photo credit: Joan Halifax

Most of all, what has taken clinical psychiatry and international disaster response teams many years – and many disasters – to understand came easily for them. The awkward hyphens of bio-psycho-social meld into a different social ecology of health and illness for these practitioners, one that takes seriously the reality that the elements which make up this planet are also those which give us sentience: earth, air, fire, water, space. Amchi are at once ethnobotanists and ritual specialists attune to the living landscapes and sacred geographies of home as well as pharmacologists and physicians. The modes of knowledge transmission they represent might be considered critically endangered in an era of ‘big’ traditional pharma as well as the introduction of biomedically-derived production standards and clinical research protocols, but they know how to respond in meaningful ways at such moments of crisis. They also understood that they could perhaps be most helpful not in the immediate rescue and triage mode but in response to the settling in of suffering over these coming months, when time stretches out into new spaces of vulnerability, memory, loss.

Non-biomedical health systems and various forms of traditional medicine remain a crucial avenue through which many Nepalis seek care for chronic and acute illness, including mental health and responses to trauma. Nepalis rely on Tibetan medicine to address their health concerns, both in rural villages along Nepal’s northern border and in urban clinics, where patients represent Nepal’s ethnic and cultural diversity. Also known as Sowa Rigpa, the ‘science of healing,’ this medical practice is less formally recognized and supported by the Nepali government than Ayurveda, even as amchi work at the frontline of care for many of the country’s high mountain communities.

As Nepal’s amchi move forward with their planning, they will work closely to coordinate with other relief organizations working in these areas. Their aim is not to reproduce the infrastructure of aid delivery but to connect directly to such efforts while providing distinct forms of care. I hope that such efforts by highly skilled Tibetan medical practitioners might dissuade – or at least provide a counter-example to – those biomedical aid workers who have decided that it is acceptable to just pluck up some traditional medicines and, with rudimentary translation of symptoms and no training in proper diagnostic methods (pulse and urine analysis) or understanding of the clusters of imbalance such medicines are meant to address, hand them out to people anyway. This is another form of biomedical hubris and a certain type of cultural violence, seeping in around the edges of right motivation. Imagine the pushback if a Tibetan physician were to show up in an emergency room and begin prescribing anti-psychotics and blood thinners, willy nilly.

Although these amchi medical clinics are proposed within an ephemeral ‘camp’ structure at present, such effort may represent an opportunity to re-imagining post-quake healthcare infrastructure in ways that more directly incorporate practitioners such as amchi into the provision of primary health care. The foundation for such work exists, as amchi are marginally recognized (if not supported by) Nepal’s Department of Ayurveda within the Ministry of Health, and through the Council on Technical Education and Vocational Training. Full-scale support for and integration of amchi into public health infrastructure remains a dream in Nepal, even though this is the reality in places as politically distinct as Bhutan, Mongolia, and Tibetan regions of China.

Working with amchi on these clinics – including raising funds for them through DROKPA, an all-volunteer non-profit organization I co-founded in 1999 — has been one of the ways I’ve chosen to respond to the Nepal disasters as a medical anthropologist. I’m also incorporating younger amchi into collaborative research teams that will investigate responses to these events in three contiguous districts (Mustang, Manang, and Gorkha) through an NSF RAPID award of which I am a part.

I chose to open this blogpost with the words of Rudolf Virchow even though I know that he and many of Nepal’s amchi would see the relationship between what Virchow calls ‘faith’ and its relationship to medicine and science quite differently. Despite these epistemological divergences, I think they would all agree on fundamental premises of being of service and seeing the individual body as a microcosm of the larger social, ecological, and political worlds to which one belongs.