Traditional Chinese medicine employs 400,000 people in China, and is used to treat many more. But, writes Chen Long, a consumer obsession with speed and convenience has made the industry wasteful and inefficient.
Traditional Chinese medicine is used by 1.3 billion people in China, and many Chinese communities around the world. The country has 3,800 Chinese medical institutions of county level and above, which together employ around 400,000 people. Traditional Chinese pharmacies are common both in cities and the countryside, and sell huge numbers of treatments every day. Millions of hectares of land are used to grow millions of tonnes of raw materials for the production of medicines. There are almost 3,000 enterprises and 2,000 factories that produce Chinese medicine (including some that also manufacture western medicine). It is a huge industry, and the country’s medicinal resources provide many with the healthcare they need.
But China’s twentieth-century population explosion led to a massive increase in the use of these resources. The export of raw materials in exchange for foreign currency left the country's natural resources in a terrible state. Outdated, improperly-used technology in medicine has also resulted in a huge degree of waste. As a result, the supply of raw materials for Chinese medicines has become ever tighter, with the use of some ingredients being banned for their own preservation. It is a hard industry to make sustainable.
Major causes of waste include the failure to harvest medicinal herbs on time, the damage caused by poor transportation conditions and losses due to heat, moisture, pests and mould. Poor manufacturing processes also result in herbs prepared for decoction that are too thick, or crystals that are too large, affecting the absorption of active components and squandering valuable resources.
There has already been much research and debate on the subject; policies have also been introduced on cultivating new sources of Chinese medicine. But still nothing has been done to reduce this staggering loss of resources. If effective measures are not taken soon, the plight of China’s endangered species will continue to worsen and environmental protection will be held back. Consumers’ desire for “convenience”, the improper use of technology and corporate greed means the situation just keeps getting worse.
Pharmaceutical textbooks tell us that to extract active components efficiently; saturated solutions must be removed and replaced with new solutions for a second and third round of steeping. This increases the amount of work involved and the power consumed. It also lengthens the production cycle and increases costs. When faced with a choice between lowering costs and increasing extraction, the majority of enterprises opt to save money. As a result, huge quantities of active components are thrown away with the “dregs” of the production process – and the quality of the medicine is reduced. This is one reason why mass-produced medicines are not as effective as ones made to order.
A lot of waste is caused by preparations that use only one active ingredient or only one type of ingredient. In some cases, a volatile component may be obtained through distillation, while another water-soluble component is discarded. Granulated preparations have been tested and found not to contain the active components of their raw materials, which have in fact been discarded during the manufacturing process.
Many manufacturers also only extract one chemical from their raw materials, which results in a colossal waste of resources. For instance, companies that manufacture for export extract US$13 million worth of ephedrine from 30,000 tonnes of ephedra annually, 10 times the amount that is used in traditional Chinese medicine. And liquorice root is a similar case. It is clear that the environmental damage caused has little to do with the plants’ traditional use in Chinese medicine.
Another Chinese medicine, recommended for anti-malarial treatments by the World Health Organisation, has a huge market. But once the necessary component has been extracted, antibiotic components are thrown out with the “waste”. Over 5,000 tonnes are wasted annually. The use of resources in Chinese medicine needs to be overseen by a central authority.
Granulated, instant medicinal preparations first appeared in Japan and Korea before spreading to China. Their convenience has lead to widespread popularity, but animal tests have proved that the pharmaceutical effect of these compound preparations does not equal the sum of their individually-prepared parts. The nature and quality of active components change in the preparation of compound medicines. Instant preparations ignore this key characteristic of Chinese medicine and waste valuable resources.
Decocting machines are also wasteful. The pressure of modern lifestyles means that patients prefer to wait an hour or two for their 200 ml of medicine rather than prepare it themselves at home. The decoction ratio is directly related to the number of decoctions and the amount of solvent. Decocting twice usually extracts 70 to 80% of the active component (although even then, 20 to 30% is left unextracted). If that liquid is then concentrated, the volume of the dose is small and the active components are retained. But decocting machines decoct only once, and always produce 200 to 300 ml of medicine, which means 30 to 50% of the active component is lost. Tragically, this is ignored or covered up for the sake of “convenience” and speed in “modern medicine.”
But preparing Chinese medicine in microscopic powders may be a possible solution to the problem. These powders are prepared by drying, mixing and grinding. They can be taken directly with water, or dissolved for several minutes in hot water. Because powders have a far larger surface area, the rates of dispersion, dissolution and absorption are higher, and allow the digestive system to fully absorb the necessary components. This reduces the necessary dosage and conserves resources. Powdered medicines are similar to preparations used historically in times of war or natural disasters, and that experience provides the theoretical and clinical basis for their use. We now need to research dosages, storage methods and shelf-life of powdered medicines, and implement quality control standards for these preparations.
Long Chen is a professor of Chinese medicine.
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