Today, poisons usually evoke notions of evil and danger – the opposite of healing drugs. Still Traditional Chinese Medicine, which has been in practice since more than two millennia, used a large number of poisons to treat various diseases. Chinese doctors knew that what makes a drug therapeutic isn’t just its active ingredient – it depends on how you use it.
Biomedical researchers skeptical of the safety and effectiveness of traditional Chinese medicine might not be surprised that Chinese doctors historically prescribed poisons. Some believe that the medicines used in traditional Chinese medicine often contain hidden toxic ingredients harmful to health.
But this blurred border between poison and medicine is not unique to traditional Chinese medicine. Chemotherapy uses toxic drugs to treat cancer. And the Opioid epidemic in the United States offers a thought-provoking recall of how a class of drugs approved by the FDA and used to treat chronic pain became deadly poison as a result of improper administration. Conversely, some psychedelics deemed illegal today have sparked new interest in the medical community as potential treatments for anxiety, drug addiction and depression.
I am a medical historian who examined the therapeutic use of poisons in Chinese medicine in my last book. Based on my research, I believe Chinese doctors have recognized the healing ability of poisons in the past while fully aware of their potential for destruction. Understanding this practice forces modern biomedicine to reconsider how “medicine” is defined today.
What is an active principle?
The debate over the safety and effectiveness of traditional Chinese medicine often centers on the active ingredient of a drug. The United States Food and Drug Administration defines an active ingredient as “any component which provides pharmacological activity or other direct effect in the diagnosis, cure, alleviation, treatment or prevention of a disease, or which affects the structure or any function of the human body or animals “.
In other words, the active ingredient is a specific chemical that is considered to be the essence of a drug. Because he bears the responsibility of curing a target disease, he is used as a gold standard to assess the usefulness of a drug in modern pharmacy.
It is helpful to identify active ingredients in drug discovery, including those in traditional Chinese medicine. Scientist Tu Youyou won the 2015 Nobel Prize in Physiology or Medicine to isolate artemisinin, an antimalarial medicine, from a plant used in traditional Chinese medicine. Similarly, the 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 reductionist approach ignores the context in which a drug is used, which plays a crucial role in its end effects. To appreciate this perspective, it is necessary to go back in history to see how poisons were understood and used in premodern China.
Poisons in Traditional Chinese Medicine
The Chinese word for poison is “from” (毒). Contrary to its negative meaning today, ancient texts written 2000 years ago used the word to denote power, or the ability to both harm and heal. There was no categorical distinction between poisons and non-poisons in traditional Chinese medicine – they acted on a continuum defined by the level of potency.
One of the ways Chinese doctors used poisons for healing was the principle of use poison to attack poison (“yi du gong du” 以毒攻毒). In their eyes, these powerful substances could target and eliminate specific disease entities like worms inside the body. They believed that the strong sensations induced by the poisons marked a process of cleansing the body from its harmful burdens. The double potential of poisons laid the foundation for their use in medicine. Chinese doctors have strategically deployed powerful poisons to cure everything from blood clots to abdominal pain to epidemic illnesses. For example, aconite (“fuzi” 附子), a very poisonous plant cultivated in southwest China, was one of the most prescribed drugs in medieval times. Mercury was another poison used regularly in medicine and alchemy to kill worms and prolong life. Globally, poisons consistently accounted for about 20% of drugs in the ever-expanding Chinese Pharmacopoeia throughout the Imperial Era, speaking of their crucial role in healing.
The context in which a drug is used is important
In the past, Chinese doctors did not look for an active ingredient that defines the usefulness of a given substance. On the contrary, they considered the effect of each drug to be very malleable. There is no better example of this thinking than the medical use of poisons.
Chinese doctors also knew that poisons worked differently from person to person. The same medicine can have different effects depending on the sex, age, background, emotional state and lifestyle of the patient. For example, prominent 7th century physician Sun Simiao (孫思邈) offered specific remedies for women and the elderly. Doctors in China were well aware of how the effect of a poison varied greatly depending on how it was prepared and administered. As a result, they developed a variety of methods – such as dosage control, mixing with other ingredients and other drug processing techniques – to lessen the potency of a poison while maintaining its effectiveness.
Using a poison outside of its prescription has often been fatal. For example, Powder of five stones, or “Wushi San” (五 石 散), a psychedelic drug containing arsenic, was one of the most popular drugs in medieval China. Despite the medical recommendation that it should only be used as a last resort to treat emergencies, many at the time consumed it regularly to invigorate their bodies and brighten their minds. Unsurprisingly, this misuse has resulted in many deaths. Beyond its restricted use, a poison could 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 medicine. Instead, the effect of any given drug is always relational – it depends on how the drug is used, how it interacts with a particular body, and its intended effects.
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Drugs are fluid substances which defy any stable categorization. Looking beyond the biomedical standard of the active ingredient could help doctors and researchers pay more attention to the context in which the drugs are used. This will allow for a more nuanced understanding of healing.
Ultimately, a drug is not limited to its active ingredient. Poisons in traditional Chinese medicine, I hope, teach a compelling lesson.
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