Don't Let TCM Be Defeated by Chinese Herbs
— An Interview with Famed TCM-Pharmacology Professor Jin Shiyuan
"Don't let TCM be defeated at the hands of Chinese herbs." This line has been heard in recent years. But from the mouth of nationally known pharmacology and clinical-drug evaluation expert Professor Jin Shiyuan, its weight is not the same. Senior TCMs often grumble the pattern is true, the formula is right, the medicine is dull. Has the quality of Chinese herbs truly worsened, even to the point of harming TCM's name?
Facing the reporter's question, Jin spoke freely. "Herbal quality is truly unsatisfactory, with no shortage of problems." Chinese herbs have their distinct character and innate complexity; place of origin, growing season, processing, paozhi, transport, storage — a problem at any link can affect quality. Today's herb trade handles over a thousand kinds, with more than 500 in common use; to want not the slightest error is impossible. Already in the Qin-Han Shennong Bencao Jing there was record of distinguishing counterfeit and inferior herbs — the problem is ancient. But in old times this was mainly because TCM has many same-family, same-genus, same-name-different-substance herbs, and the aim was to prevent mistaken gathering and use, not to guard against deliberate counterfeit. Today's "fake medicines" really began after the 1980s: the herb market opened; herbal materials became "agricultural sideline products." No one any longer guided the peasant in what to grow; he grew what he wished, in any quantity. For a time, large numbers of new drug plants sprang up across the country; and with the population doubling and tripling, drug use surged, the herb trade boomed. In the past, only rare and short-supply herbs saw fake-and-bad goods; later, anything that could sell could be counterfeited.
"Where do our Chinese medicines come from? The herb market. The market's biggest buyers are drug companies, the TCM pharmacies of big hospitals, and the commercial chains. They know the state forbids markets to process and sell yinpian, yet they still buy — because it is cheap. Think: without the testing equipment, can the yinpian bought from market peasants be of certain quality?" Of the market Jin spoke gravely. After Liberation, of 117 herb markets of every size, he visited more than half. Now past seventy, he is still invited to nationwide inspection teams. "The market's main body is the peasant — from planting and gathering to processing and selling, he holds the initiative. What sells, he grows; what brings money, he sells. Huangqin is to be five cun long for use; the market wants it now, so at one cun he digs it up. You say no fertilizer, no pesticide — for more yield and faster growth he uses them in secret. Worse, some unscrupulous merchants, drunk on profit, deliberately adulterate, making fakes that look like the real. Without years of experience and instruments, the naked eye cannot tell."
Jin notes that whole, raw herbs are easier to identify; processed yinpian harder. And yinpian margins are higher than raw herbs — so in recent years many have begun to play tricks with yinpian; the yinpian problem is worse than that of raw herbs. State-run yinpian factories follow norms; costs are higher; prices relatively higher. Some drug companies, pharmacies and stores, eyeing profit, do not buy from them but go to market for cheap, unsure-quality yinpian. With demand comes supply: of the 17 markets remaining after consolidation, every one trades yinpian; 70% of yinpian come from peasants; sales of yinpian cannot be stopped. As for peasant-processed yinpian, Jin says: paozhi is a great science, with dozens of categories, used variously to raise effect, reduce toxicity, transform medicinal nature, each with its own technique. Can untrained peasants master so complex a craft? Jin gives an example: at Anguo market, a peasant processing yinpian told him personally, "I first soak the herbs; when the fieldwork at home eases, I will then process." "How could that work? The active constituents are all soaked away!" The lifelong herb man Jin grieved.
"Today many who buy and sell drugs do not know drugs," Jin said. "What is Guan-fangfeng, Liao-wuweizi, Hang-juhua — can you recognize? Can you tell the same herb from different places? Which is counterfeit, which inferior — can you say?" The seller is a peasant, the buyer not expert, no test equipment — how can the quality of medicines so bought be assured? Jin says TCM pharmacology is highly practice-based; today the training is cut off from practice. The relevant colleges and secondary schools keep cutting TCM-pharmacology classes; herb identification, paozhi, preparation, dispensing — the foundational courses — are cut nearly in half; the identification textbook lists over 300 herbs, in practice only over 100 are taught, and only raw herbs, not yinpian; nor are differences of place or grade taught. The student touches raw herbs and yinpian very little. So today's pharmacy graduates and TCM-pharmacy clerks are weak in practice — many do not know the medicines, do not know the drugs.
There is another matter that fires Jin: after the medical-insurance reform, some pharmacies became insurance-reimbursable; nationwide TCM stores leapt to 120,000 — even grocery and grain shops have been turned into drug shops. The country has only 20,000-some licensed pharmacists, Chinese and Western combined. How is this gap to be filled? No wonder the strange tales: aconite peel sold as aconite; first-decoct given as added-last; even a fistful of dirt handed the patient to fry up at home. "If we do not hurry to train real pharmacy talent — can this go on?" Jin stressed.
The state's competent bodies are now actively promoting GAP (Good Agricultural Practice for herbs), mulling a yinpian approval-number system, further strengthening market oversight. We hope facts will soon allay Jin's and the senior TCMs' worry of don't let TCM be defeated by Chinese herbs, and let the people of the country truly take medicine at ease.
Originally in Health News, 21 August 2001, page 3.