When I interviewed Professor Tu Youyou in 2005 — in her office at the Chinese Academy of Traditional Chinese Medicine, the work unit within which she had spent her entire life after completing a doctorate in chemistry at Beida (the University of Beijing) — I did not expect her to receive any further awards, and certainly neither the Lasker nor the Nobel prize. It was not that she was not already an award holder or that her achievements did not strike me as worthy of a Nobel Prize. Quite the contrary. But she was a woman and a scientist of Maoist China.
In the early 1970s Professor Tu Youyou and her team had used a standard Western cold extraction method for producing an Artemisia annua plant extract which they fed to malaria-infected mice, thereby establishing its antimalarial activity. In 1975 Professor Tu Youyou made crucial inroads into research on this extract’s antimalarial principle, a chemical substance known as qinghaosu in Chinese and Artemisinin in English. Through what her colleagues have called “clever chemistry”, she identified key aspects of its molecular structure. She therewith initiated research into a new class of antimalarials which, thanks to a heat-sensitive peroxide bridge, are able to attack the parasitic plasmodia in the blood stream by causing an “explosion” of the infected red blood cells. This results in fever clearance in a few hours with hardly any side effects.
After this interview I realized that I would not have the nerve to research how Artemisinin was discovered, and why it took so long for the WHO to acknowledge its efficacy. The field was too contentious. When the book detailing Communist China’s secret military project for finding antimalarial substances under the code name “523” was published, first in Chinese and then in English (Zhang [2006] 2013), alongside a publication by a former USAID officer (Dalrymple 2012), I was naturally curious about the information they contained but did not spend too much time investigating them, well aware that they reflected particular viewpoints that required additional critical research into the sociology of science.
My contribution would not be with research into the “re-discovery” of qinghao nor with research into the application of Artemisinin as an antimalarial in Africa (which has been the research topic of several colleagues, e.g. Meier zu Biesen 2013). Rather, the molecule of the antimalarial substance Artemisinin and the plant from which it had been extracted, Artemisia annua L., needed to be culturally re-contextualized and studied in their socio-historical context. I had become aware of qinghao in 2001 while doing ethnographic fieldwork on Chinese medicine in Africa, as Chinese tablets of Artemisinin and its derivatives were among the most frequent drugs sold over the counter to an urban middle-class African clientele. As I began to review the literature on qinghao, I found that while many thousands, if not tens of thousands, of articles had been written on the purified chemical substance qinghaosu and its pharmacokinetics, chemical structure, clinical effects, and side effects, hardly any concerned the traditional Chinese medical practices of working and living with the herb, which is already mentioned as qinghao in a manuscript text unearthed from a grave closed in 168 BCE.
The anthropology and history I have ever since set out to write examines pre-modern textual materials and foregrounds the importance of culturally-specific techniques regarding the practice of preparing herbal remedies and the corresponding sensorially attuned social practices for appreciating their effectiveness. In recent months I have also been working towards a Gestalt-psychological reading of the polypharmacies in which qinghao is mentioned.
My research has reinforced my conviction that we have much to learn from pre-modern practitioners on how to work with plants in everyday life and medical practice, both on the level of fundamental understandings and on the level of a myriad of details. Today plants stand, as Dr. Tara Kelly put it her doctoral thesis, “in the shadow of their chemicals”, that is, they are valued only for the chemical substances that can be extracted from them with Western extraction methods. However, as history and ethnography demonstrates, people have lived and worked with plants in far more diverse ways than that. For example, Professor Tu Youyou has mentioned that it was a text written circa 340 CE by the famous alchemist and physician Ge Hong which gave her the idea to undertake a cold extraction. While qinghao had been among the first plants Tu Youyou had screened, in her first efforts she had applied the usual Western hot extraction method, which destroyed the active principle — the peroxide bridge. Ge Hong’s compilation contains the following entry on qinghao:
又方 青蒿一握 以水二升漬 絞取汁 盡服之
Another recipe: [take] one bunch of sweet wormwood (qing hao). Use two sheng [2 × 0.2l in the Western Jin dynasty] of water to soak, and wring it out to obtain the juice. Administer in its entirety.
This famous passage contains a word that the copy editor of my first article on qinghao deleted. The same thing happened when that article was translated into German; the translator did not translate it. The word is: 絞 jiao and it means ‘to wring out’. Naturally, I insisted on the publication of my literal translation, however clumsy it sounded and although the copy editor and translator both said the word made no sense. Years later an ethno-botanist working in the Amazon, Dr. Francoise Barbira-Freedman, commented on this word: people in the Amazon regularly twisted and wrung out fresh plants to squeeze out their sap and spread it out over wounds and other sores. In a so-called ethno-archaeological experiment on Artemisia annua, plants grown in Oxfordshire were soaked and then wrung out or pounded with a pestle in Bradford, and fed to mice in the Swiss Tropical Institute of Basel. The efficacy of Ge Hong’s formula was demonstrated to be 96%. Naturally, the sample size was minimal, as is to be expected of a pilot study, and, despite repeated attempts over the past decade, it has proved impossible to obtain funding for further research.
These events highlight how conversations with scientists working in other disciplines are key to the emergence of good ideas. As a young Western scientist working in Maoist China during the 1950s, Professor Tu Youyou was forced to attend classes of “Western medical doctors learning from Chinese medical doctors”. At the time she apparently hated every minute of the exercise, and found it a waste of time. Yet years later, perhaps after bumping into a Chinese medical historian colleague in the same work unit, she was reminded of Ge Hong’s fourth-century text. One need not learn to speak the language of another discipline with great eloquence, but it is important to have a basic understanding of how it works. The problems of the twenty-first century cannot be solved without fostering a sociality of mutual respect — not necessarily one of inter-disciplinarity, but rather a mindset that is able to be inspired by multi-disciplinarity and can appreciate or translate other approaches to a problem into their own research.
Yes, of course, the Chinese materia medica (see Bensky et al. [1986] 2004) contains other antimalarial minerals (on arsenic, see Obringer 2001) and herbs (on Dichroa febrifuga, see Lei 1999), and remains a treasure house for finding future efficacious substances, which like qinghao will have antimalarial alongside other beneficial effects (anti-bacterial, anti-fungal, etc.). However, the main message we can learn from Professor Tu Youyou’s Nobel Prize is that we need to look beyond the rim of our silos and let ourselves be inspired in our own research by making connections across disciplinary boundaries.
References
Further readings on historically-known Chinese materia medica with antimalarial properties:
Bensky D., Clavey S. & Stöger E. (compiled and translated, with A. Gamble) [1986] 2004. Chinese herbal medicine: Materia medica. Seattle: Eastland Press.
Lei H.L. 1999. “From Changshan to a new antimalarial drug.” Social Studies of Science 29 (3): 323-58.
Obringer F. 2001. “A Song innovation in pharmacotherapy: some remarks on the use of white arsenic and flowers of arsenic.” In E. Hsu (ed.) Innovation in Chinese medicine. Cambridge: Cambridge University Press, 192-213.
Wright, C. W., Linley, P. A., Brun, R., Wittlin, S., & Hsu, E. (2010). “Ancient Chinese methods are remarkably effective for the preparation of artemisinin-rich extracts of qing hao with potent antimalarial activity.” Molecules, 15(2), 804-812.
Further readings on the re-discovery and current usage of Artemsinin (qinghaosu):
Dalrymple, D. G. 2013. Artemisia annua, artemisinin, ACTs and malaria control in Africa: tradition, science and public policy. Printed by Politics and Prose Bookstore, Washington D.C.
Meier zu Biesen, C. 2013. Globale Epidemien-Lokale Antworten: Eine Ethnographie der Heilpflanze Artemisia annua in Tansania. Frankfurt a.M.: Campus.
Zhang J. [2006] 2013. A detailed chronological record of Project 523 and the discovery and development of qinghaosu(artemisinin). Houston: Strategic Book Publishing.
Elisabeth Hsu is Professor in Anthropology at the Institute of Social and Cultural Anthropology of the University of Oxford, and a Fellow of Green Templeton College. Her research interests lie within the fields of medical anthropology and ethnobotany as well as language and text critical studies. They concern Chinese medicine; the transmission of knowledge and practice; pulse diagnosis; body and personhood; and touch, pain, feelings, emotions, and sensory experience. Since 2001 she has published a number of articles on qinghao, the latest of which is “From social lives to playing fields: ‘the Chinese antimalarial’ as artemisinin monotherapy, artemisinin combination therapy and qinghao juice,” in L. Pordie and A. Hardon (eds), Special Issue, Anthropology and Medicine, 2015.