Discovering Changshan And Overcoming Barriers To Entry

The initial stage of discovering Changshan looked clear and simple. As Chen Guofu recalled, the starting point was when one of the school guards found in the local newspaper a prescription for treating malaria and distributed copies of this prescription to the staff members of the Central Political School. In a screenplay that he subsequently wrote to ensure public recognition of his own contribution, Chen Guofu described what followed:

At that time, the director of the school clinic, Doctor Cheng Peizhen, was in Chen Guofu's office. While Doctor Cheng was working, he mentioned to Chen Guofu that because the price of quinine had risen steeply, he was very worried about a potential shortage. Then, Chen Guofu asked Doctor Cheng why he did not use traditional Chinese drugs instead. Doctor Cheng responded that since he had no idea which Chinese drug was effective for treating malaria, he could not take advantage of Chinese drugs. (Chen Guofu, 1952, p. 264)

Two things were clear from this dialogue. First of all, Chen Guofu became interested in the problem of malaria because he saw it as an opportunity for Chinese herbal medicine to make a contribution to national medical problems. If he succeeded in finding an effective traditional Chinese drug, his success would demonstrate that, contrary to common wisdom, Chinese medicine could also contribute to solving state medical problems. As Chen Guofu's mission was to look for a substitute for quinine, the success of his project inevitably resulted in translating Chinese drugs into just another therapeutic technique in the Western-style doctors' armamentarium, rather than drawing on the theoretical framework of TCM in understanding and managing febrile conditions, of which malaria is one specific type.

Second, although the director of the school clinic claimed his ignorance as the reason why he did not take advantage of Chinese drugs, lack of information on TCM for malaria was by no means the real problem. The problem was that Western-style doctors could not accept the classical explanations for use of traditional antimalarials and considered it necessary to translate the applications and outcomes of Chinese drugs into their own conceptual framework.

The following episode illustrates the point. Some years after the antimalarial efficacy of Changshan had been established scientifically, Xu Zhifang, a chemist in the Chinese Academy of Sciences (Academia Sinica), recalled how he had cured his own malaria with jienue pills, which included Changshan as their key component. After taking the pills, which he made according to the prescription in the Bencao Gangmu (Systematic Materia Medica, 1552-93 a.d.), Xu Zhifang recovered completely. However, as he wrote:

[Because] there were no physiological and pharmacological experiments [on the efficacy], I did not dare to announce my result to the public. Moreover, since I could not figure out the chemical composition of the pill, I could not trust it myself. (Xu, 1948, pp. 31-34)

Xu Zhifang was clearly not lacking information. He not only knew of the reputed curative efficacy of the jienue pill, but had also conducted a self-experiment, which confirmed its efficacy to him. Unfortunately, this single-case experiment did not mean anything to Western-trained scientists. As long as he could not tell his colleagues and would not write a paper on his success, his success remained only a personal experience. Most importantly, Xu Zhifang's account made it clear that he could not make his personal experiment public unless the Chinese drug first went through a series of experimental stages — from preclinical through to clinical.

Chinese prescriptions for treating malaria were easily accessible for anyone who bothered to look for them. In the opening summary of his Elementary Introduction to Chinese Drugs (Zhongyao Qianshuo) (1930), Fubao Ding (1873-1950) mentioned a Chinese antimalarial prescription, including the herbal drug Changshan, and suggested that it was marvelously effective and inexpensive. In one of the most often consulted English studies of Chinese Materia Medica, F. Porter Smith (1969, p. 293) also recognised that "there is no form of the malarial fever for which Changshan is not recommended [by Chinese Materia Medica]." Furthermore, when the National Medical Journal of China, the Western-style doctors' leading journal, published a special issue on malaria, it included an article on "Historic Study of Malaria in Chinese Medicine" (Li and Woguo, 1932). In that paper, Li Tao, a historian of Chinese medicine, pointed out that a prescription of Chinese drugs (again, including Changshan) was one of four major traditional methods for treating malaria. Nevertheless, Li Tao was quick to add that "no one is sure about the curative efficacy of this prescription." It was not difficult at all to discover bits of information about Chinese drugs. However, Western-style doctors were unable to trust Chinese drugs until they had translated them into their own framework.

While Xu Zhifang did not dare to report his experience at the time, 4 years later, when he found that many poor villagers were sick from malaria and could afford neither Western nor Chinese drugs, Xu decided to produce the pills for sale. Within 8 months, Xu had sold more than 100,000 pills. Xu's inconsistency in not reporting his personal experience due to concern about the need for scientific evidence and his contrasting commercial action in selling the product to the public reflects his personal dilemma. As a Western-trained chemist, he was not permitted to proclaim the efficacy of Changshan without first translating it into a scientific framework. However, considerable financial and technical resources would have been required to do this. Xu ended up opting to use Changshan within its traditional context — i.e., making the jienue pills according to the Systematic Materia Medica and then selling them to Chinese patients accustomed to taking traditional medicines.

The director of the school clinic was under similar constraints. He was not ignorant about Chinese antimalarials but was required by his professional standards to assert ignorance of efficacy in situations where the average Chinese would think otherwise.

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