Taiwan Today

In Taiwan, there are basi­cally two ways to treat a cold. The sufferer can visit a Western doctor, who will probably take a quick look and prescribe one or two pills, perhaps an antihistamine and a cough suppressant, to be taken for a few days. Or the pa­tient can make a trip to a tradi­tional doctor of Chinese medicine or the neighborhood herbal phar­macy. Here the treatment will in­volve determining exactly what kind of cold it is, depending among other things on body tem­perature, complexion color, tongue condition, type of cough, and recent changes in the weather as well as the personal life of the patient. The prescription will likely be a sack­ful of small white packages, each containing a powdered mixture of eight to ten herbs, roots, or berries. The patient will be told to take the medicine, downing each package with a glass of warm water or as a boiled concoction, for several weeks.

Whereas the Western pills might put a quick end to a runny nose or a cough, a Chinese doctor is not so concerned about re­lieving immediate symptoms. The goal rather is to get to the root cause of the illness—to find out why the patient’s body has become susceptible to catching a cold and to get it back in balance using various natural remedies.

In concocting these rem­edies, a Chinese pharmacist can choose from thousands of ingre­dients, many of which have been in use for centuries—everything from lotus seeds, ginseng, and powdered pearls, to deer antlers, dried lizards, and, yes, ground rhinoceros horn.

Although rhino horn is only one of the numerous possible in­gredients—and is being used less and less by traditional pharma­cists in Taiwan—it has, along with tiger bone and several other products made from rare or en­dangered animals, given Chinese medicine a bad name.

In fact, most people in Tai­wan, particularly those under forty, know little about rhino horn. They may have heard that it is sometimes used as an ingre­dient in Chinese medicine, but they have never seen it, let alone used it. Many of them are sur­prised that it has come to be at the center of such a big contro­versy, bringing on Taiwan the wrath of environmentalists from around the world.

What exactly is the story be­hind rhino horn? There is no doubt that it has a long history of use in Chinese medicine, going back to at least the third century A.D., when it was recorded in Shen Nung’s Medical Canons (神農本草經), one of the oldest known books on Chinese medi­cine. It is said to have a bitter, sour, and salty taste and is con­sidered in the category of “cold” foods and medicines, or those ca­pable of reducing body tempera­ture. It is known to reduce fever, cool the blood, and control con­vulsions. Traditionally, it has been used to treat hyperthermia, upper respiratory infections, and encephalitis B. In addition, it stops bleeding and can help heal ulcers as well as external wounds. It is usually prescribed in a powder form that is mixed with ten to fifteen other medici­nal ingredients.

The best-grade horn, called “fire rhino horn,” smells fresh and is a glossy pitch-black, with no cracks. The tip of the horn is con­sidered the best part. This type comes from the Asian rhinoceros species found mostly in India, Sumatra, and Java. The next best, known as “water rhino horn,” is from species found in Africa. The third type, which is the least ex­pensive and most often used, is actually water buffalo horn, al­though in Chinese medicine it is still included in the rhino-horn cat­egory because it has the same ef­fect. “Buffalo horn powder is a common and acceptable substi­tute. It is not counterfeit,” says Chang Hsien-cheh (張賢哲), a professor in the Department of Pharmacy at the China Medical College in Taichung, central Tai­wan. Its antipyretic effect has also been documented in studies appearing in the Journal of Ethnopharmacology.

Most customers buying the lowest-priced rhino horn powder will not even know that they are actually getting water buffalo horn. As Chang explains, certain substitutes have always been considered acceptable in Chinese medicine. In the past especially, it was often difficult for a doctor in a certain geographic area to find the exact kind of animal or plant listed in a medical book. So another item with a similar effect would be used. Particularly in a compound prescription, it is ac­ceptable for one of the ingredi­ents to be a substitute. In addition to water buffalo horn, the horns of the antelope or any other ani­mals with double-cleft hooves can be substituted for rhino horn. The main content of these horns is keratin, a type of protein found in hair. They also contain cal­cium carbonate and calcium phosphate.

Several decades ago, rhino horn was a convenient, non-pre­scription medicine that regularly appeared in family medicine cabinets, along with traditional remedies for pain, intestinal dis­comfort, fatigue, and other com­mon ailments. At that time, Taiwan’s public health system was in its early stages, and there were only a handful of well­-equipped hospitals. Few people, especially in rural areas, had easy access to physicians trained in Western medicine. When some­one in the family became seri­ously ill, traditional medicines such as rhino horn were usually the only option available. “Rhino horn is especially effective in re­ducing high fever or bringing someone out of a fever-induced coma,” says Chang. “Twenty years ago, if a child had encepha­litis—which is always accompa­nied by a high fever—the parents would ask for rhino horn.” It was purchased either powdered or in solid form. Eighty-two-year-old Mrs. Chen, whose family has run a Chinese medicine pharmacy for one hundred years in Changhua, central Taiwan, re­calls that many people used to grate the horn with the sharp edge of a broken bowl, then boil it in water and drink the liquid.

At that time, rhino horn was already a precious commodity, al­though at roughly US$3 per gram it was not unaffordable. But the price shot up in the mid-1980s­—to as much as US$49 per gram for the highest quality horn—as a re­sult of the Board of Foreign Trade’s 1985 ban on the importa­tion (but not yet sales) of rhinoc­eros and tiger products. A once rare commodity became even rarer, and its use declined consid­erably. “The price of the best rhino horn is even more expensive than gold,” Chang says. “Because it is so expensive, it has not been used in Chinese medicine as much as people think.”

Before 1986, when the De­partment of Health (DOH) stopped accepting the registra­tion of new medicines containing rhino horn, only thirty of thirteen thousand such applications is­sued to pharmaceutical compa­nies used rhino horn as an ingredient. And from 1989 to 1990, the Chinese medicine divi­sion of the China Medical Col­lege Hospital dispensed only slightly more than one hundred grams of rhino horn among its annual 240,000 outpatients.

The hospital discontinued all use of rhino horn in 1992, when the DOH announced that doctors prescribing or dispensing rhino horn prescriptions could have their licenses suspended or revoked, and anyone caught sell­ing rhino horn would be subject to a fine or jail term as prescribed in the Wildlife Conservation Law. The DOH measure came shortly after an announcement by the Council of Agriculture that the trade, use, sale, and display of rhino and tiger parts were all pro­hibited. In April this year, the DOH held four meetings around the is­land to educate Chinese medicine store owners about the new poli­cies. “We know that the ban on rhino horn and tiger bone is gov­ernment policy,” says Chen Li (陳禮), secretary-general of the ROC Chinese Medicine Asso­ciation, which represents medi­cine store owners. “We may not agree with it, but we have to go along with it.”

Changing attitudes toward traditional medicine and the easy availability of fast-working Western drugs have also had an effect on sales of rhino horn. As Chang Hsien-cheh points out, “The effect of Scanol, which is only ten U.S. cents per pill, is just as effective as rhino horn powder in reducing fever. And it’s easy to get at any [Western-style] pharmacy without a prescrip­tion.” In fact, Chang says, tradi­tional Chinese medicine is rarely used today for acute illnesses or sudden fevers, but more often for chronic ailments. “If a patient has an acute disease, he will defi­nitely go to a Western hospital. He will not look for help from a Chinese doctor,” Chang says. “And a Chinese doctor would not take a risk trying to cure a disease like encephalitis.”

But despite new laws and changing attitudes, there is no doubt that rhino horn is still being bought and sold. Although more than seven thousand traditional Chinese medicine dealers have signed affidavits not to sell rhino horn powder, there are still those who do so. Some people continue to believe that it contains some unknown, magic substance and that it can be taken, like vitamins, as a general health and energy booster. “This is a kind of belief that can’t be explained by scien­tific findings,” says Chang Hong­-jen (張鴻仁), a special projects director with the DOH.

People with this kind of atti­tude tend to be older and less educated, Chang says, and they generally believe that simply be­cause a medicine is made from an unusual animal or other rare ingredient, it must be good. “They tend to think that the rarer the species, the better,” he says. They have similar ideas about ti­ger bone, traditionally used to cure rheumatism, but now the subject of many exaggerated claims, including increased sexual potency. These are the same kind of people, Chang thinks, who were recently tout­ing urine as a great health en­hancer. “If you tell a person that drinking water will help cure an illness, he won’t believe it,” he says. “But if you tell him that drinking urine will cure him, he will definitely follow your sug­gestion. If people believe that an ingredient possesses certain magic power, it’s very difficult to stop them from using it.”

Some owners of traditional pharmacies also exaggerate the effects of rare—and costly—in­gredients. The high price that they can charge for such things are simply too tempting to pass up, despite the laws. “The profits involved in the trade of rare medi­cines like rhino horn are big, which makes medicine shops hesi­tant to stop using them,” Chang says. But medicine store owners have their own arguments, and even though many of them abide by the law, they believe it is unfair to ban a medicine unless it is harmful to the human health—the usual DOH criterion as well. “We don’t think the consumption of wildlife in Chinese medicine is the main reason for their extinc­tion,” says Chen Li of the Chi­nese Medicine Association. “We don’t kill the rhinos, we just use the horns of dead rhinos. Why blame us?”

Besides trying to crack down on violators of the ban and to con­trol stockpiles of rhino horn and tiger bone, the government is also trying to educate stores to avoid the use of other rare or endangered animals, although no legal ban has yet been announced on their use. According to the DOH, thirteen substances listed in Chinese medicine books sometimes come from rare or endangered species or subspecies. In addition to rhino horn, antelope horn, and ti­ger bone, these are bear gall bladder, leopard bone, otter liver, deer musk, dried elephant skin, the plastron or lower shell of cer­tain turtles, the scales of the pan­golin (or scaly anteater), the shell of the hawksbill (a tropical sea turtle), and the entire bodies of the gekko gecko (a small lizard) as well as two poisonous snakes, the banded krait and the hun­dred-pace snake.

For some of these, such as otter liver and hawksbill shell, a ban is not likely to meet much resistance from medicine shop owners because their use is al­ready extremely rare. In some cases, it is a matter of determin­ing whether pharmacists are actually using parts from a species that is endangered or from one that is not. One particular case that has come up is that of turtle plastron. At present, only three species of sea turtles are in need of protection, while Chinese medicine lists forty types of tur­tles, most of which are land vari­eties. Pharmacists have pledged they will not sell medicine using the three listed turtles if the DOH provides them with photographs so that they can identify them.

The DOH is also studying the consumption of medicines from original versus substitute ani­mals. For example, just as water buffalo horn is often used to re­place rhino horn, pig or dog bone is used instead of tiger bone, and pig gall bladder instead of bear gall bladder. “After knowing how much of the medicine is used,” says Chiang Shuang-mei (江雙美), a section chief of the DOH, “we may consider setting a quota on later use.” The govern­ment is also involved in trying to find further substitute medicines, including ones made from plants. “We have found several plants which have a similar effect as rhino horn,” Chiang says.

In addition to trying to change the practices and atti­tudes of Chinese medicine store owners, the government is also trying to educate the general public to avoid the use of medi­cines made from endangered species. It has distributed pam­phlets and stickers and recently began televising a public service announcement. As Chang Hong­-jen of the DOH says, “The con­sumption of endangered animals really hurts the nation’s image. We have to convince people not to consume these rare species. It may take a long time, but that’s the action we have to take.”