Book Review: The History of Animal-Based Medicine in China

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Liz P.Y. Chee vividly remembers the first time she visited a bear farm. It was 2009, and Chee, who was working for a Singapore-based animal welfare group, flew to Laos to tour a Chinese-owned facility. The animals Chee saw “were hardly recognizable as bears,” she later wrote, “because they had rubbed most of their fur off against the bars of the cages and had grown very long toenails through disuse of their feet.”

As at countless other bear farms across China and Southeast Asia, the bears there were being held for their bile. Bear bile — which is either “milked” through a catheter permanently inserted into the animals’ gall bladders or extracted by stabbing large needles into the animals’ abdomens — is popularly prescribed across the region to treat a host of ailments, including, most recently, Covid-19. It is also marketed as an all-around health tonic. Although there is a growing animal welfare and anti-bear farming movement in China, the industry remains powerful.

BOOK REVIEW“Mao’s Bestiary: Medicinal Animals and Modern China,” by Liz P. Y. Chee (Duke University Press Books, 288 pages).

Seeing the suffering bears made Chee wonder about the cultural and historical forces that brought the animals there — a question that propelled her to conduct exhaustive research on animal medicalization in China. In “Mao’s Bestiary: Medicinal Animals and Modern China,” she details her findings, many of which are distilled from sources never before published in English. Chee, who is now a research fellow and lecturer at the National University of Singapore, also found that, until now, even scholars in China have dedicated scant attention to the history of animal-based medicine, despite the controversy associated with the topic today.

“If Chinese medicine retains an Achilles’ heel in the present century, it is the widespread perception that it is contributing to a holocaust among wild creatures,” Chee writes, “and in so doing supporting a global criminal enterprise” of animal poaching and trafficking. Moreover, she adds, such medicines are often condemned “as being as ineffective as they are unethical,” even by some Chinese physicians. Many of these products are medically useless at best, Chee writes, and in some cases, actually harmful.

Defenders of animal-based Chinese medicine often point to the practice’s 2,000-plus year history. In “Mao’s Bestiary,” however, Chee shows that the roots establishing the use of most animals as ingredients in medicine are not as deeply planted in China’s culture as many believe. Instead, the industry as it exists now was purposefully developed, expanded, and promoted over the last century. Today, it is more closely linked to politics and profit than to ancient culture and tradition. This revelation has important implications for both species conservation and for public health, Chee argues, because it leaves room for “possibilities of choice and change.”

Chee focuses on the evolution of animal-based medicine throughout the tumultuous period of modern China’s formation, from the 1950s through the 1980s. These decades encompassed the early years of the People’s Republic of China, Mao’s Great Leap Forward and Cultural Revolution and, finally, Deng Xiaoping’s reforms.

While animal-derived medicines do have a long history in China, Chee found that their use in the past was nowhere near the “startlingly abundant” level they are at today. Around 400 animals were cited in the 16th century “Compendium of Materia Medica,” for example, whereas more than 2,300 are listed today in pharmacopeias.

Many newly medicalized species exist only on distant continents, such as jaguars in South and Central America. Nor is China’s use of animals in traditional medicine solely based on Chinese innovation, Chee found; ideas, approaches, and technologies from the Soviet Union, North Korea, Japan, and the Western world all heavily influenced the industry’s development. So while animal-based products may still “hold the aura of tradition,” Chee writes, in fact, most are the products of a profit-driven expansion.

Animal-based medicines are often condemned “as being as ineffective as they are unethical,” even by some Chinese physicians.

Efforts to abolish traditional medicine and replace it with a science-based approach, primarily inspired by Japan, began in the 1920s and continued through the early days of a Communist government that was racing to build an industrialized economy. While researchers acknowledged that some especially efficacious Chinese herbs were worth investigating to find their active ingredients, animal-based remedies were “initially undervalued and underdeveloped” by the new regime as it worked to build up its pharmaceutical sector, Chee writes.

Traditional doctors pushed back on the attempt to phase out their industry, however, and argued that the synergistic effects of the plant, animal, and mineral ingredients of their practice were too complex to be nailed down in a lab. To appease both groups, the state-owned drug-making sector decided that doctors trained in Chinese and Western medicine should learn from each other, “scientizing” Chinese medicine and seeking new innovations from tradition.

“To learn from the Soviet Union” was also a popular phrase in China at this time. Following the example set by the USSR, China was especially interested in creating its own pharmaceuticals from local ingredients to become self-sufficient. Soviet interest in animal-based folk medicine and the USSR’s own practice of farming deer for medicinal ingredients soon “provided modern and scientific sanction for the Chinese fascination with faunal drugs,” Chee writes.

During the Great Leap Forward’s period of rapid industrialization, “animals as well as plants were swept up in this nationwide project,” Chee continues. China expanded its export of high-end medicinal products like deer antler, rhino horn, and tiger bone, especially to Chinese expatriates. To meet steep quotas, authorities promoted the creation of “laboratory farms” for scaling up production. Entrepreneurs at these farms were also encouraged to find more uses for existing animal parts, and to engineer additional uses for new parts and species.

“Once a medicinal animal was farmed, there was pressure or incentive to justify the use of all of its parts, regardless of previous traditions that had often been quite selective as to which part should actually be taken as medicine, and for what purpose,” Chee writes. Medicine farms popped up for a host of additional species, including geckos, ground beetles, scorpions, snakes, and seahorses.

Chee shows that the roots establishing the use of most animals as ingredients in medicine are not as deeply planted in China’s culture as many believe.

Wildlife farming also began being presented as something benefiting conservation because it allegedly spared wild animals from being hunted. In fact, it usually had the opposite effect by stimulating the market and relying on hunters to replenish farm stocks, Chee notes. While she does not delve deeply into the impact this has had on animal populations within and outside China, many sources today argue that demand for traditional medicine all but emptied the country’s forests of tigers, pangolins, and other highly sought after species.

During the purges and upheavals of the Cultural Revolution, the export of luxury medicines such as rhino horn were scaled up to generate much-needed revenue. Back home, however, a stark lack of medical care and supplies inspired an emphasis on “miracle cures” derived from cheaper, more common animals.

Chicken blood therapy — “the direct injection of chicken blood (from live chickens) into human bodies” — was representative of this time, Chee writes. The doctor who founded the treatment claimed chicken blood therapy could cure more than 100 conditions, and it was heavily promoted throughout the country, becoming “emblematic of economical grassroots innovations” and “the very expression of ‘red medicine,’” Chee writes.

This practice started to be phased out in 1968 when news surfaced of people dying after being injected with chicken blood. But similar remedies soon took its place, including ones that used goose or duck blood, lizard eggs, or toad heads. These new remedies were marketed as magic-like cures for serious and otherwise untreatable conditions, including cancer — “an attribute that has become standard in the marketing of many animal-based drugs today,” Chee writes.

After Deng came to power in 1978, wildlife farming and animal-based medicine “became even more popular as part of the official policy to enrich farmers,” Chee continues. The government-supported bear bile industry — which was originally inspired by facilities in North Korea and continues to flourish today — was one major result of this period, as was the proliferation of tiger farms.

Policy shifts also had significant ramifications for the regulation of Chinese medicine, and its impact on consumers and the environment. The forestry ministry was “given decision-making power over wild medicinal animals,” Chee writes, “and would essentially manage China’s forests as extraction sites.” Meanwhile, the health ministry only had full regulatory control of patented drugs, so companies selling animal-based medicines could bypass health or efficacy regulations and make extravagant, unchallenged claims about their products’ curative value.

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Chinese medicine has become globalized over the last three decades, and animal-based products have “continued to play a central, if increasingly problematic, role,” Chee writes. The industry is assailed in the international media for its role in driving species declines, and clashes regularly occur within China between proponents of animal-based medicines and those who value wildlife and conservation. “Many middle-class Chinese, both on the mainland and in the diaspora, and within Chinese medicine itself, have been on the front lines in the battle to save endangered species from poaching and consumption,” Chee points out.

“Mao’s Bestiary” went to press in the midst of the Covid-19 pandemic, and Chee writes in the introduction that the likely link between Covid-19’s emergence and wild animals fundamentally changes the debate by making wildlife use a global public health issue.

Yet despite the undeniable threats posed by zoonotic diseases, animal-based traditional medicine remains an “immensely profitable, and thus politically influential” force in China, she continues. As evidence, Chinese authorities not only did not ban animal-based medicine during the pandemic, but actually promoted remedies containing bear bile for treating Covid-19.

As for shaping the industry’s future to mitigate the dangers for both wildlife and humans, Chee looks not to officials but to Chinese consumers, who can choose to boycott animal-based medicines. There is a large and growing animal welfare movement in China, so this could be more than just a pipe dream. “Whether they will reinvent the pharmacology of Chinese medicine as a practice less reliant on animals, endangered or otherwise,” she concludes, “remains a vital question.”

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Rachel Love Nuwer is a science journalist whose writing has appeared in The New York Times, National Geographic, Scientific American, BBC Future, and elsewhere. She is the author of “Poached: Inside the Dark World of Wildlife Trafficking.”