Modern researchers are trying to uncover the secrets of oriental medicine.
I hold in my hands a warm, beating heart. It is a shiny, grapefruit-sized lump of scarlet, pink, and white flesh. I can feel the ventricles contract and I can feel the movement of blood that the heart is pumping. It is slippery and gives off a harsh odor.
Dereza berries, or goji berries, believed to improve sleep and athletic performance, are dried on a farm in Xinjiang Uygur Autonomous Region. Due to the high demand for these berries, the plant is cultivated in more and more territories, such as, for example, in this northwestern province of China, where the fruits grow larger than usual. However, soils and climate may not have the best effect on the healing properties of goji.
The heart continues to beat, although eight hours ago I saw Paul Iazzo cut it out of the chest of an euthanized pig in the laboratory, connected it to tubes that act as veins and arteries, and set it on with an electric shock. (This is how resuscitators bring people back to life with a defibrillator.) Although the heart is outside the body, it tenses and relaxes by itself, obeying an unknown, inexplicable, primordial force. Everything looks not only unrealistic - first of all, it is bewitchingly beautiful.
A traditional healer takes a patient's pulse at a clinic in Chengdu, China, while others wait. He will then examine the patient's tongue and body to determine symptoms, and then prescribe medication that will restore balance in the body and help fight the disease.
The pig's heart also beats because Iiazzo, a professor of surgery at the University of Minnesota, washed it with substances identical to bear bile. This partly proves the correctness of the Chinese healers, who, back in the 8th century, believed that bile could have a beneficial effect on human health. And the demand for it is still great: in Asia, bears are bred for the sake of bile, and they are kept in tiny cages, and a catheter is installed for each animal, from which valuable liquid drips drop by drop. Animal advocates condemn this undeniably brutal practice.
And while I hold a pig's heart in my hands and listen to Iazzo's story that substances that protect bear organs from atrophy during hibernation can also help a person, I am worried about the question: could bear bile save my father's heart and will it one day me or my children?
Yale University professor Yun-Chi Cheng examines false ginseng at a research center in Yunnan province. Cheng is researching treatments using ancient Chinese herbal medicines, including a cancer drug currently undergoing clinical trials.
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Few topics spark the same heated debate among professionals as traditional Chinese medicine. The work of researchers, like Iiazzo, who looks at ancient methods of healing through the prism of the latest technologies and makes unexpected discoveries, adds fuel to the fire. Many countries from the Arctic to the Amazon have developed their own methods of traditional medicine. But China, with its longest history of medical research, offers scientists the most weighty store of knowledge.
The first medical treatises in the Celestial Empire date back to the 3rd century BC, when healers began to study the human body and its functions, as well as describe the body's reactions to herbal remedies, massage, and acupuncture.
For more than two thousand years, Chinese scientists have deepened their knowledge and improved methods of treatment. The result of their work has become a whole library of medical treatises, which describe all kinds of diseases, from the common cold and venereal diseases to epilepsy. This knowledge is stored in books and manuscripts with mysterious names: "Classics of the pulse" (III century), "Recipes are worth their weight in gold" (VII century) and "Important secrets from outside the capital" (VIII century).
Ren Yanyu, a two-month-old Chengdu resident, is bathed in an herbal infusion that disinfects and cools the body during the hot, humid summer months. This method is based on Chinese philosophy, which prescribes maintaining the overall well-being of the body, rather than waiting for diseases to manifest themselves.
Of course, today Chinese doctors are trained and receive Western-style diplomas. However, traditional medicine remains an important part of the public health system. Most Chinese hospitals have wards where the old methods are used. Believing that this practice could help reduce government spending and develop innovative treatments, not to mention increase the country's prestige, President Xi Jinping made it a key element of healthcare and proclaimed this century the golden age of traditional medicine. From a research perspective, this is probably the case. Scientists from leading universities are increasingly turning to some of the traditional treatments for diseases such as cancer, diabetes and Parkinson's disease.
Patients themselves do the same: if Western medicine does not help, Americans are increasingly resorting to other methods of treatment, primarily acupuncture, which is now included in some health insurance programs, or to banks (This method was widely used in Soviet clinics. - Russian Note edition.). The Internet has spurred demand for herbal medicines, which are often cheaper than prescription drugs. The patient can, after reading about the drug online, order the ingredients on one of the shopping portals and watch a YouTube video on how to prepare it at home. As a result, the revenues of the alternative healthcare sector rose sharply: in 2017, medicinal herbs were sold in the United States for $ 8 billion - almost 70 percent more than in 2008.
Staff at a Chengdu pharmacy dispense prescription drugs in paper sachets. At home, patients will brew drugs with tea and drink.
Many doctors consider traditional Chinese medicine to be quackery, citing its most outlandish methods - say, the ancient practice of exorcising demons with fireworks or mysterious concepts that are still popular with its adepts. Among the latter is the myth of qi, the life force, the name of which literally translates as "steam that rises above rice." Others resent the use of organs from rare animals and the potential danger of poorly treated drugs.
“Few people look at the problem objectively,” stresses medical historian Paul Unschuld. A respected connoisseur of the history of Chinese medicine (and a harsh critic of many of its interpreters), he has collected and translated hundreds of ancient texts and is now collaborating with a Chinese-German startup looking for sound ideas in Chinese practices. "People usually see only what they want to see," says Unschuld, "and cannot fully appreciate the advantages and disadvantages of oriental medicine."
I first learned about the problems associated with traditional Chinese medicine when I was working on an article on how poachers kill rhinoceroses: after all, according to ancient Chinese recipes, horn powder can cure fevers and headaches. True, scientific studies have shown that rhino horn is composed of keratin (the same substance as human nails) and melanin and does not cause any pharmacological effects when consumed. After the article was published, I received letters from readers denouncing Chinese medicine as "ignorant", "cruel" and "like witchcraft."
The criticism is not unfounded: the trade in rhino horn in Asia has become a major factor leading the species to extinction. In addition to rhinos, many animals, including endangered ones, such as tigers, leopards and elephants, are hunted by poachers who want to get one or another of their organs and tissues, or they are raised in captivity, in difficult conditions.
A shop in the Chinese city of Guangzhou sells deer derivatives, including antlers, dried penises and tendons, which are used to make traditional potions. One of the reasons that Chinese medicine cannot be accepted in many countries is the outrageous use of organs from rare animals, usually obtained by poachers.
But Western medicine has more than just advantages. For example, the effectiveness of many popular antidepressants remains the subject of heated debate: some studies show that such drugs are hardly superior to placebo. However, doctors prescribe them, they are widely sold and generate billions of dollars in revenue. (However, as soon as the patient thinks that he has felt better, then the use of such a drug can be considered justified, although the reason for the recovery is unlikely lies in the chemical composition of the tablets.) If we consider other vivid examples - excessive prescription of opioids, approval of newfangled diets and unjustified operations - Western acceptance of traditional Chinese medicine may seem highly disingenuous.
You can understand the problem using the example of the story of snake oil. For a long time, it was considered synonymous with fraud, but in fact, snake oil is a traditional ointment that is made from the fat of the sea snake, a large flattail. Historians believe that such ointments were brought to the United States in the 19th century by Chinese immigrants who built railways and used the oil to treat joints and muscles. The drug acquired a dubious reputation when scammers began to sell mineral oil under the guise of Chinese snake oil. More important, however, is something else: studies have shown that fat of large flaptail contains more polyunsaturated fatty acids omega-3 than salmon. And these acids stop inflammatory processes and the development of dementia, soften depression. Today they are found in several skin care products. In the 2000s, Japanese scientistsBy including the fat of this snake in the food for mice, we found that they began to better remember the path through the maze. (True, the flattail itself, meanwhile, was among the threatened species.)
During fire treatment in Chengdu, the patient is covered with a piece of cloth soaked in alcohol and set on fire to warm the skin and open the pores; then this place is moistened with oil infused with herbs. This therapy is believed to help with joint pain and other ailments, but research has yet to confirm this.
“You shouldn't throw your baby out with the water,” smiles Yung-Chi Cheng, a professor of pharmacology at the Yale School of Medicine. “People forget that one of the oldest and most effective scientifically approved drugs comes from healers. It's aspirin. " The ancient Egyptians used dried myrtle leaves as a pain reliever, and Hippocrates, a Greek physician who lived in the 5th – 4th centuries BC and considered the father of Western medicine, advised treating fever with willow bark extract. Only in the 19th century, scientists found out that salicylic acid is an active compound in both myrtle and the bark and synthesized it. Today, penny aspirin is probably the best drug in the world in terms of value for money. “It all started when people noticed that willow bark has healing properties,” Cheng says."In this case, science followed practice, and not vice versa."
Aspirin is not the only medicine created on the basis of folk remedies. In 1972, when Cheng graduated in pharmacology from Brown University, Chinese chemist Tu Yuyu announced the discovery of a malaria drug based on a plant mentioned in a 4th century recipe. During the Vietnam War, Tu was involved in a secret project to help Viet Cong people fight malaria, a disease that wiped out about a quarter of all deaths in their country. In the West, they also tried to find a cure for malaria, having tested more than 200 thousand substances. However, Tu risked turning to ancient treatises: after testing several plants used to treat fever, she found what she was looking for - wormwood. The drug derived from this study, artemisinin,saved millions of lives and earned Tu the 2015 Nobel Prize in Medicine.
For more than two thousand years, Chinese healers have used many herbs, flowers, fruits, animal derivatives and even the human placenta for their medicines. Thousands of natural ingredients continue to be used both in China and in other countries of the world. Banks 1, 8, 15, and 22 (first column) contain the original ingredients for a promising cancer drug from Yale University, code PHY906.
(1. Dyestuff safflower. 2. Spikelets of a cut cattle. 3. Abalone shells. 4. Milky-flowered peony root. 5. Dried seahorses. 6. Tall pot-bellied rhizome 7. Lotus leaf. 8. Reed root. 9. Angelica root. 10. Far Eastern soft-bodied turtle 11. False ginseng 12. Broad-leaved rush 13. Hawthorn fruits 14. Scutellaria baikal root 15. Zest 16. Paper wasp nest 17. Cicada larvae 18. Poria coconut mushroom 19 Root of ligusticum 20. Human placenta 21. Stems and roots of lofaterum (cereals) 22. Cuttlefish shells 23. Iesian beauty 24. Ziziphus true 25. Horny goat weed leaves 26. Hilocereus wavy 27. Boswellia resin 28. Fruits of the trichozant.)
When I, accompanied by Cheng, begin to inspect the labyrinth-like laboratory at Yale, where his team analyzes the healing properties of various plants, my nose is subjected to a real torture: different liquids sizzle and gurgle around, and I catch one scent after another: black and red pepper, rosemary, camphor, ginger, cinnamon and other smells that I cannot describe.
On Cheng's desk is a Chinese dummy - a gift from his colleagues: he is dressed in a suit, not the baggy sweater Cheng usually wears, but the resemblance is captured correctly - the same brooding look, thinning hair and large earlobes, which are usually considered in China a sign of a predisposition to long life. At first glance, Cheng may seem like a typical apologist for traditional medicine. Even though he moved from Taiwan to the United States 50 years ago, he still speaks English with a strong accent, and at 74 he is a typical Chinese generation that still holds on to ancient traditions. "True, I don't know much about Chinese medicine," he admits, adding that even as a child, his parents took him to regular doctors.
Cheng's research on antiviral drugs was also consistently conducted with strict scientific methods. However, at the same time, he was always interested in whether other plants were mentioned in ancient treatises, waiting for re-discovery, as wormwood was waiting for him? And he did discover a drug that could revolutionize cancer treatment. Cheng opens the jar and puts a pinch of the powder, a four-herb mixture he calls PHY906, in my hand.
“Try it,” he suggests, and I put a few crumbs on my tongue. The taste of the powder is bitter, with a hint of licorice (licorice).
In the 1990s, Cheng drew attention to the fact that many cancer patients refuse chemotherapy due to side effects such as diarrhea and intolerable nausea. Patients who received full chemotherapy tended to live longer, and Cheng realized that relieving side effects could increase patients' life expectancy. And he knew that Chinese medicine uses herbal remedies for diarrhea and nausea.
His colleague Shwu-Hui Liu, a pharmacological chemist fluent in ancient Chinese, searched the rich collection of ancient treatises held in the Yale University Library. In a book entitled A Treatise on the Dangers of Cold, printed on slightly cracked bamboo paper, she discovered an 1,800-year-old recipe for skullcap, licorice, peony, and Chinese date (ziziphus) to treat “diarrhea, abdominal pain, and burning in the anus..
And Cheng's team began to test different combinations of powders from these plants. Over the past 20 years, they have gone from trials in mice to trials of drugs on cancer patients under the supervision of the US National Cancer Institute. As Cheng had hoped, nausea and other gastrointestinal distress subsided in almost all of the patients taking the drug. Moreover, their tumors began to shrink faster than those who did not take medication.
“I didn't expect this,” Cheng admits. "Now we want to understand: what is the reason?"
According to Cheng's son Peikwen, after studying tumors in mice that were given the new drug, the researchers noticed a significant increase in the number of white blood cells - white blood cells that absorb cancer cells. Obviously, this process is stimulated by the action of substances contained in plants. "This is the answer to the secret of the recipe," said Stanford graduate Peikwen. - PHY906 is a chemical mixture and in this it is similar to those drug mixtures with which it became possible to effectively fight HIV. We are simply identifying the original formula and re-creating it for evidence-based treatment.” To date, Peikwen continues, PHY906 has been tested in eight patients with cancer of the colon, liver and pancreas and undergoing chemotherapy and radiotherapy. "We hope,that PHY906 will be the first multi-ingredient herbal formulation approved by the US Food and Drug Administration "…
Soon, Paykwen and I are racing through the heart of China on a high-speed train. The train rides surprisingly smoothly, as if flying over the rails. And outside the window, landscapes float, little changed since ancient times: an endless patchwork quilt of peasant fields under a gray winter sky. Peikwen agreed to take me to where his suppliers live, on condition that I do not disclose their names and tell them exactly where they work. He and his father consider this information a trade secret.
All I can say is that this part of China resembles Kansas: a flat plain with carefully cultivated fields stretching over the horizon. However, among the sea of wheat, rice and rapeseed there are areas sown with medicinal plants. Thousands of peasants process them. The demand for medicinal raw materials in the world is growing, and the Chinese are allocating more and more acreage for herbs. In 2017, the total revenue from the cultivation of medicinal plants in China was about $ 25 billion.
However, it takes a lot of courage to give up the usual activities and master the cultivation of medicinal crops. After all, the healing properties of any plant can vary greatly depending on the mineral composition of the soil, the position of the fields in relation to sea level and the time and method of harvesting. There is also the problem of varieties that can be exactly like each other, but have slightly different chemical compositions. Talk to a coffee maker and he will tell you that the caffeine content of Arabica beans grown in different parts of Ethiopia can vary sixfold; Moreover, the same beans emit different amounts of caffeine depending on the grinding and cooking method.
These difficulties are the reason that the US Food and Drug Administration has approved only two herbal medicines as prescription drugs so far: a remedy for genital warts based on green tea extract and for diarrhea based on the juice of Croton, a South American tree whose resin known as "dragon blood". Each of these drugs is made from just one plant, while PHY906 is made from four. This means that in order to create a quality product, it is necessary to keep more variable factors under control. “This complexity is one of the reasons the agency has yet to approve any multi-ingredient herbal remedy,” Peikwen explains.
When we finally get to one of the fields where plants for PHY906 are planted, I honestly feel a little disappointed. Apart from the fact that the owner of the field, Chen, speaks Chinese, he is absolutely no different from any farmer from Kansas: a baseball cap, a warm Alaska, and mud-splattered boots. Taking an iPhone out of his pocket, he asks Siri to translate the name of the plant he grows into English. "Peony" - the program replies.
Cheng's group raised this polypore, Ganoderma tsugae, at the Yale Lab. The fungus has been found to help reduce colon tumors in animals. “The Chinese have used tinder fungus as a medicine for centuries, - says Cheng. - Scientists have yet to find out what substances and why have a healing effect in it."
While we inspect the fields of peonies and skullcap belonging to Chen, he talks about crop rotation, about the analysis of the chemical composition of soil and water, about the rules of harvesting. Before his produce is exported, Chen says, experts run a variety of tests to make sure it's the right variety, that the plants are free of dangerous impurities, and everything else is fine.
“You've probably heard the 'from field to table' saying?” Peikwen says. - So here we have - "from the field to the hospital bedside table." “Sounds like an advertising slogan,” I answer. "But it's true," Cheng notes. “Most herbal medicine companies, unlike us, do not get their raw materials straight from the field. They buy them in Bozhou City."
On the morning of the day I arrive in Bozhou, the market, which resembles a domed stadium, is already buzzing like a disturbed hive. I walk along endless corridors, looking first into one shop, then into another. They all look like caves filled with barrels, sacks, pallets, and wheelbarrows filled with potions made, it seems, from all plants, minerals and animals that only exist on the planet - including dried deer penises and seahorses, human placenta and water buffalo bones, even from millipedes.
Leaving the market, I notice a shelf next to the antlers, lined with bottles of yellowish liquid. I ask the merchant what it is, and he asks his colleague from a nearby shop to help with the translation. “From a bear,” he says. - Very well.
Paul Iazzo loves bears. A big outdoor enthusiast who grew up in Minnesota, this tall, thin, gray-haired man has always shown a keen interest in clubfoot. And as head of the Heart Monitoring Laboratory at the University of Minnesota, he is very interested in the unique physiology of these animals, which allows them to hibernate.
Iazzo, who has teamed up with the Minnesota Department of Natural Resources, lists the mysteries associated with bears, animals that spend up to six months a year in complete immobility without any harm to their health. Their breathing slows down to two breaths per minute. The body temperature drops by 10 percent - in humans, this would lead to hypothermia. Bears regularly lose more than half of their fat - but muscle tissue is not affected. The heart can pause for 20 seconds, but the blood does not clot - and in a person, cardiac arrest for just a few seconds can lead to a blockage of blood vessels. “And yet the bear's heart doesn't care about anything,” explains Iazzo.
He is confident that on the basis of bear bile it is possible to develop methods of treatment for patients suffering from muscular dystrophy, and patients who are bedridden and lose up to half of their muscle mass in three weeks.
Iazzo identified three groups of components in bear bile that are most likely to trigger hibernation and are likely to help patients with heart disease: fatty acids, bile acids, and delta opioids. During the operation, which was discussed at the beginning of the article, before removing the beating heart of a pig, he injected these substances, only artificially synthesized, into the wall of the heart to keep the organ working for an hour - until it is removed.
In hundreds of experiments, Iazzo observed how human-sized pig hearts continue to beat outside the body twice as long as normal. This means that it will be possible to keep the donor organs viable longer (today, the heart must be transplanted no later than six hours after removal from the donor's body - and in the USA alone, without waiting for the transplant, 300 people die every year.)
I ask if drinking bear bile is really beneficial, and everyone should follow the example of the Chinese here. “Yes,” Iazzo replies, explaining that the components of drunk bile can penetrate the bloodstream and enter the heart and other organs with it. But he does not justify keeping bears in captivity for the sake of bile: the same substances can be synthesized artificially.
The pork heart continues to beat many hours after it was removed from the body at the University of Minnesota, thanks to the fact that it was injected with an artificially synthesized analogue of the acid contained in bear bile. For over a thousand years, Chinese healers have prescribed bear bile to treat epilepsy, heart pain and other ailments.
James Harrison has used acupuncture and other Chinese medicine for pain relief throughout his recently ended 16-year career in the National American Football League. “If it makes me feel good, - explains the athlete, - I don't need scientific proof."
Holding a pig's heart in my hands, I can feel its pulsation slowing down. Eventually it stops. The pig died a few hours ago, and now it's time for her hearts. It seems that its color is beginning to fade. Maybe, I think, this is due to the fact that he was abandoned by the same force that the ancient Chinese called "qi"? I remember a day in the hospital when I squeezed my father's hand and felt his pulse slow down and eventually freeze. Suddenly, I feel my own heart beating in my chest, and I wonder what other secrets ancient recipes might hold.
Text: Peter Gwynne Photo: Fritz Hoffman