1. Is the "toxicity" of traditional Chinese medicine really toxic?#
In traditional Chinese medicine theory, traditional Chinese medicines have inherent properties, including cold, heat, warm, and cool. Traditional Chinese medicine emphasizes "treating heat with cold, treating cold with heat, blocking leads to purging, dispersing leads to solidifying," etc. The corresponding medicine should be used for corresponding symptoms. If a warm medicine is used for a heat syndrome, in most cases, it is no different from taking poison; one cannot expect one plus one to equal zero.
The meaning of toxicity in traditional Chinese medicine should be divided into three types: 1. Traditional meaning of toxicity: referring to the severity of the medicinal properties, thus also categorized as "highly toxic," "toxic," "slightly toxic," and "non-toxic"; 2. Toxicity in traditional Chinese medicine theory: referring to the ability of the medicine to treat diseases, all medicines with therapeutic significance can be called toxic. The "Jingyue Quanshu" states: "All that can dispel evil and stabilize the body can be called a toxic medicine." The famous Ming dynasty physician Zhang Jingyue believed: "Medicines treat diseases, and toxicity is their efficacy"; 3. Toxicity under modern research: referring to substances that have a small safe dosage, and slightly exceeding the usual amount can cause harm to the human body, even leading to death. Traditional Chinese medicine has always advocated the theory of "using poison to attack poison," where the first "poison" should refer to powerful medicines, not narrowly defined harmful substances.
Many toxic components in traditional Chinese medicine are actually effective components for treating diseases. The late renowned national TCM physician Li Keshan used Aconite, a toxic substance, as a lifesaving medicine. He believed, "Aconite is a powerful heart remedy, and its toxicity is precisely where its life-saving properties lie." A 65-year-old male patient had an enlarged heart, could not lie flat, had difficulty breathing, a gray complexion, cold hands beyond the elbows, cold feet beyond the knees, sweating profusely, a red tongue with no coating, a floating, weak, and rapid pulse (260 beats/min), and undetectable blood pressure, on the brink of death. Li Keshan prescribed three doses of medicine: the first dose contained 200 grams of Aconite, with no change in condition; the second dose increased Aconite to 400 grams, slightly stabilizing the condition; the third dose increased Aconite to 500 grams, and the condition began to ease, limbs warmed, pulse slowed (90 beats/min), blood pressure measured at 160/70 mmHg, and the patient was discharged after a week of treatment.
2. Discussing toxicity without considering dosage is "playing tricks"#
Whether modern chemical medicines, traditional Chinese medicines, or modern TCM, there are guidelines for medication and dosage control in clinical use. For example, the "Chinese Pharmacopoeia," compiled by the state, details the medication standards for various drugs. Moreover, toxic traditional Chinese medicines are not used alone but are combined with other medicinal ingredients to ensure that the overall efficacy of the compound medicine is achieved while minimizing the potential toxicity of individual ingredients. When using medicines, reasonable long boiling and detoxification while retaining efficacy is a reliable experience among many practitioners using toxic traditional Chinese medicines. After prolonged boiling, toxic components can be volatilized or hydrolyzed, while effective components can still be retained for therapeutic effects. For example, after soaking or boiling Aconite, its effective yet toxic components, bisbenzylisoquinoline alkaloids, can be hydrolyzed into less toxic monoester alkaloids or nearly non-toxic amino alcohol alkaloids, thus preserving medicinal efficacy while reducing toxicity. Not only boiling, but also processing and combining traditional Chinese medicines can achieve the effect of reducing or eliminating toxicity and enhancing efficacy.
Importantly, whether using toxic or non-toxic traditional Chinese medicines, one should start with small doses and gradually increase the dosage, stopping when the condition improves, and not exceeding the recommended dosage. Most incidents of bodily harm caused by traditional Chinese medicine are due to excessive consumption.
3. Facing the "toxicity" of traditional Chinese medicine#
With the rise of modern medicine, pharmacology has gradually gained attention, while traditional Chinese medicine is often based on empirical use, with pharmacological research being a shortcoming. This has led to criticism of traditional Chinese medicine and has become a major point of attack for those against TCM. The toxicity of traditional Chinese medicine can sometimes be ineffective components, while at other times, it can be precisely the active components, such as the highly toxic arsenic. Professor Zhang Tingdong from Harbin Medical University has become a pioneer in using arsenic (arsenic trioxide) to treat leukemia through research and utilization of its "toxicity," earning multiple awards for his contributions. A concept of toxicity should be established for traditional Chinese medicine, with a safe medication attitude. One should not reduce the dosage below the effective amount in pursuit of safety due to the presence of high toxicity, which could lead to worsening conditions. Emphasizing and vigorously researching the toxicology of traditional Chinese medicine is one of the essential paths for TCM to move towards safety and internationalization.
References:
- Zhao Jun-ning and Ye Zu-guang. "The Scientific Connotation of the Traditional Chinese Medicine Toxicity Classification Theory and Suggestions for the Revision of the 'Chinese Pharmacopoeia' (Part One)." (2012).
- Zhang Shuai-nan, Li Xu-zhao, Lu Fang, & Liu Shu-min (2015). New Directions in Traditional Chinese Medicine Toxicity Research: Discovery of Potential Toxicity in "Non-toxic" Medicines.
- Chen Shi-kui (2017). The Pioneering Research of Integrating Traditional Chinese and Western Medicine in China and Its Implications (Part Nine) — Research by Professor Zhang Tingdong and Others on the Integration of Traditional Chinese Medicine and Arsenic in Treating Acute Promyelocytic Leukemia.