Elisabeth Hsu

Ancient Chinese Methods Are Remarkably Effective for the Preparation of Artemisinin-Rich Extracts of Qing Hao with Potent Antimalarial Activity

Ancient Chinese herbal texts as far back as the 4th Century Zhou hou bei ji fang describe methods for the use of Qing Hao (Artemisia annua) for the treatment of intermittent fevers. Today, the A. annua constituent artemisinin is an important antimalarial drug and the herb itself is being grown and used locally for malaria treatment although this practice is controversial. Here we show that the ancient Chinese methods that involved either soaking, (followed by wringing) or pounding, (followed by squeezing) the fresh herb are more effective in producing artemisinin-rich extracts than the usual current method of preparing herbal teas from the dried herb. The concentrations of artemisinin in the extracts was up to 20-fold higher than that in a herbal tea prepared from the dried herb, but the amount of total artemisinin extracted by the Chinese methods was much less than that removed in the herbal tea. While both extracts exhibited potent in vitro activities against Plasmodium falciparum, only the pounded juice contained sufficient artemisinin to suppress parasitaemia in P. berghei infected mice. The implications of these results are discussed in the context of malaria treatment using A. annua infusions.

The Senses and the Social: An Introduction

A mediators between meaning and materiality, the senses have an ambiguous status. Ethnographic research on them straddles the interface between body and mind, and between the ‘subjective’ and ‘objective’ realities of an individual. It has opened up a field for anthropological study long neglected by the disembodied discourses on meaning making in the social sciences and the empiricist assessments of matter in the natural sciences. This volume on The Senses and the Social aims to overcome entrenched culturalistic and materialistic positions with its emphasis on how people’s sensory experiences (of their bodies and the environments they interact with) are specific to social situations. Sensory experience is socially made and mediated. It would be wrong to say it is ‘culturally constructed’ and thereupon ‘inscribed in the body’ because that would presuppose the primacy of the mental over the physical. Also the opposite viewpoint that ‘bodily experience’ is ‘translated’ into ‘culturally recognizable forms’ is unsatisfactory because it presupposes that primordial bodily experience can be unconnected to cultural form. All contributors in this volume are aware of the phenomenology of perception in so far as they take the body as the source of existence that generates and shapes one’s experience of the world. They are aware of the debates as to whether or not the pre-objective is pre-cultural. While they take an individual’s experiences, as lived with one’s body, as the starting point for creating culture-specific concepts in social interaction, they view these concepts as equally significant in shaping those sensory experiences. Even though none of the authors uses the term, their articles implicitly build on the assumption of there being a ‘mutuality’ between social relations and the material world, where mutuality is a concept coined by recent research aims to overcome the historically s

Chinese Propriety Medicines: An “Alternative Modernity?” The Case of the Anti-Malarial Substance Artemisinin in East Africa

This article discusses various modes of “modernizing” traditional Chinese medical drugs (zhongyao ) and transforming them into so-called Chinese propriety medicines (zhongchengyao ) that are flooding the current neoliberal wellness markets. This article argues that the chemical procedures used in the manufacture of Chinese propriety medicines are highly culture-specific and deserve being considered as instantiations of an “alternative modernity” (e.g., Knauft 2002), rather than of “Westernization.” These Western-Chinese combinations, produced in strife toward fulfilling Mao Zedongs Communist-revolutionary vision, have a potential to represent a critical alterity to Western health policies, challenging rhetoric against such combinations. However, as is also noted in this article based on ethnographic fieldwork in East Africa, their potential alterity has been corroded for at least two reasons. First, the medical rationale for dispensing these medications has been shaped by commercial demands in ways that have worked toward transforming the formerly scholarly Chinese medical tradition (as outlined by Bates 1995) into a consumer-near and popular “folk medicine” (as defined by Farquhar 1994:212). Second, the repertoire of Chinese propriety medicines is impoverished as its efficacious “alternatively modern” drugs are being redefined as “modern” biomedical drugs. The article concludes that the potentially critical alterity of any formerly scholarly traditional medicine is more likely to be lost in those fields of health care that are both highly commercialized and polarized by the biomedical imperative to distinguish between “traditional” and “modern” medicines. As example for demonstrating how contentious the issue is, qinghaosu (artemisinin) is put center stage. It is an anti-malarial substance which in the 1970s Chinese scientists extracted from the Chinese medical drug qinghao (Herba Artemisiae annuae). Some Chinese practitioners in East Africa argued that artemisinin belonged among the Chinese propriety medicines they sold. Although according to Western biomedical criteria and the Chinese scientists who were involved in its chemical identification, artemisinin is a “modern” Western drug, their polemics deserve to be more closely analyzed as what social scientists have recognized as an “alternative modernity.”

THE RECEPTION OF WESTERN MEDICINE IN CHINA: EXAMPLES FROM YUNNAN

Much has been written on the European and later mainly American activities that introduced Western medicine into China1. How this foreign practice was perceived and eventually accepted by the Chinese and how these forms of knowledge, grounded in Western science, were transformed by folk belief and practices of traditional professionals, is only mentioned briefly in the available literature. Chinese were probably not interested pointing out how Western medicine was modified, because they wished to stress progress and possibly foreign advocates of development were likewise not inclined to draw attention to the adulteration of cosmopolitan medicine with local practice.

Afterword: On Naming and the Politics of Practice

Anthropological and historical studies on Sowa Rigpa (“the science of healing”) have multiplied in the last ten years. Unlike other revived Asian medical traditions whose names reflect the nationalistic fervor of the early and mid-twentieth century, the revival of the Tibetan medical currents of learning commenced more recently, at a time when its study can benefit from the expertise of globally mobile scholar-practitioners. This globalizing of scholarship opens up exciting possibilities for engaged research, but it also warrants reflection.

From social lives to playing fields for “the Chinese antimalarial”: Artemisinin monotherapies, Artemisinin Combination Therapy and the herbal Artemisia annua juice

With the tenth anniversary of the landmark publication Social Lives of Medicines (Whyte, van der Geest, and Hardon 2003), new avenues arise for exploring the ‘thinginess of things’ (Latour 2000). This paper, based on fieldwork carried out between 2001 and 2008, discusses how ‘the Chinese antimalarial’ as an over-the-counter medicine in petty enterprise clinics of East Africa became a biotechnological bulk item for Chinese import-export traders in a highly subsidised antimalarial health field after the WHO recommendations of 2005 and 2006. These observations are put in perspective with reflections on a practical engagement with the plant itself, i.e. Artemisia annua L. Rather than taking an ‘ego-centred’ and transactionalist viewpoint that follows the drug through a string of ‘regimes of value’ (Appadurai 1986), this paper underlines that a things thinginess is ontologically constitutive of its playing fields.

Medical anthropology in Europe: shaping the field

‘Europe’ has been a point of reference for medical anthropologists previously (e.g. Lock 1986; DelVecchio Good et al. 1990; Pfleiderer and Bibeau 1991), and also in more recent years (e.g. Saillant and Genest 2007 [2005]). In this issue, ‘Europe’ refers to teaching and research at European Universities, and their intellectual outreach. To be sure, a ‘European’ as opposed to a ‘North American’ or ‘Japanese’ medical anthropology does not exist. Nor are there distinctive national styles of doing medical anthropology; diversity prevails even within a single language community. Rather, medical anthropology has emerged as an academic field on an international playing ground, and trans-Atlantic exchanges have always drawn on a serious engagement with research in Asia, Africa, Mesoand South America. Considering that medical anthropology is now taught in a rapidly growing number of graduate and undergraduate courses in Europe (Hsu and Montag 2005), while recently compiled anthologies honour almost exclusively authors working in North America (e.g. Good, Fischer, and Willen 2010), this publication may provide a cautious ‘corrective’ (naturally with no claim to representativeness of all medical anthropology in Europe). When one works within such a dynamic field that is also very polymorph, questions arise about how it all began. Reflections on origins are always linked to issues of self-definition and future developments. This special issue of Anthropology & Medicine attends to questions about the past and future in two parts. In the first part, six pioneers in the field (all currently in retirement) speak about their experiences when they started research and teaching, some 40 to 50 years ago: Tullio Seppilli, Gilbert Lewis, Jean Benoist, Sjaak van der Geest, Armin Prinz, and Verena Kücholl/Münzenmeier. Their essays capture pieces of oral histories of the times when there was not yet a field as such. The second part of the special issue attends to current issues, and its introductory paper – asking quo vadis? – aims to identify core themes that have defined the field from the early days to the present. It identifies ‘the practice of care’ as one of the most well-researched themes by medical anthropologists in Europe, and explains this in light of the well-known tension in medicine between competence and care. Accordingly, studies into medical care, which often contained an implicit critique of medicalisation, countervailed earlier studies into ‘the problem of knowledge’ – a

Medical anthropology in Europe--quo vadis?

In the 1960s and 1970s, European Universities were affected, if not enduringly transformed, by anti-hegemonic social movements, such as the feminist movement and women’s liberation; the anti-psychiatry movements; the Prague Spring and the Spring in Paris of 1968; the Club of Rome’s dire ecological prognosis; and the antinuclear, environmental, alternative medical, anarchist and other leftist ideas, which spurned intense discussion and, sometimes, action. The economies in Europe were thriving at the time, but there was a sense that the consumer society they engendered would not be enduring; social crisis was imminent, if it had not already affected some economies. Social/cultural anthropology gained new impetus in these climates of higher education seeking for other modes of knowledge production than the bureaucratic ones institutionalised at universities. The anthropological field method was not reductionist but required full-time and long-term immersion in research that would not leave anyone personally unaffected. Its results, which were later reduced to being termed ‘qualitative’, implicitly critiqued undue reliance on numbers and statistics. Finally, its basic assumption that through the study of another society, one would become more self-aware and critical of one’s own society, drew many a student in search of a better world. The current topics ranging from ‘the practice of care’ to ‘the body politic’ and ‘the psy-dimension of personhood’, which are discussed in the second part of this special issue, owe perhaps more than is generally acknowledged to these social movements. In Europe, ‘the practice of care’ has been studied from many angles, and importantly also from a perspective that aims to overcome the somewhat artificial division between ‘applied’ and more ‘theoretically-oriented’ research often referred to. The focus on practice that it implies is best understood in light of ‘the problem of knowledge’, which was central to early discussions in the field. The second theme, on the ‘body politic’, owes much to the feminist movement, which uncovered gendered asymmetries and also led to a re-evaluation of the body (as the female counterpart to the male mind) by stressing the importance of researching the body as a cultural and socio-political project in the making. Finally, the anti-psychiatry movements, which

How Techniques of Herbal Drug Preparation Affect the Therapeutic Outcome: Reflections on Qinghao 青蒿 (Herba Artemisiae annuae ) in the History of the Chinese Materia Medica

This chapter summarises an earlier study that detailed in chronological order the translation of all the entries on qinghao 青蒿 (and its synonyms caohao 草蒿, chouhao 臭蒿, huanghuahao 黃花蒿, etc.) that Frederic Obringer and I could locate in the premodern Chinese materia medica (bencao 本草) in the time period between 168 BCE and 1596. The aim of that study (Hsu in Plants, health and healing: Berghahn, Oxford, pp 83–130, 2010) was threefold: it aimed to make a contribution to ethnobotany, the history of Chinese medicine and herbal medical practice. It underlined, first and foremost, that ‘herbal’ medications are not to be conceived of as ‘natural’ ‘herbs’ but as cultural artefacts: the entries on qinghao in the Chinese materia medica contained detailed information on the culture-specific transformation of plant parts into the drugs that the patient would then consume. This underlined that the so-called ‘herbal’ medical practice depends not only on plant classifications that are culture specific, but also on practical interventions that treat the plant as a thing. Accordingly, the study of qinghao involved not merely attending to the cultural acquisition of knowledges (epistemologies) but also to the techniques and practices of intervening with perceived realities (ontologies). Second, the study highlighted that the practical recommendations of how to use the plant and its various parts changed over time; it remains, to date, one of the first longitudinal studies on a specific item of the materia medica in the history of Chinese medicine. Finally, it evaluated the identification of qinghao and other hao 蒿 in terms of modern botanical taxonomies (as given in the Zhongyao dacidian 1986).

Traditional Asian Medical Systems

The healing systems of Asia are as diverse as its societies, cultural practices, and languages. They comprise the major scholarly traditions of China, India, and the Middle East, many of which have been institutionalized in hospitals and schools ever since the early and mid-twentieth century in a fashion reminiscent of the professionalization of medicine in Europe and North America. Some have since developed into forms of medicine that thrive on the global health market in a highly commercialized form. Yet there are many more regional and local systems that span the Western categories of religion and healing. Given this scope of traditional Asian medical systems, it is best to take a comparative approach based on major themes. Like all cultural systems, traditional Asian medical systems have distinctive features but also very fluid boundaries. They build on complex relationships between their classical texts and daily practice. They also reflect close interdependencies between notions of health, morality, politics, religion, and cosmology. Lastly, it is important to recognize that many traditional Asian drugs contain biologically active substances, capable of poisoning as well as healing. To understand both these opportunities and hazards, one must consider the broader contexts in which these medicines are practiced.