Health and Healing: Ep 3 Transcript
Episode 3
Hosts: CJ Passarella and Nick Jaeger
CJ
Hello, and welcome to another episode of Significant Stories, the History of Science podcast
from Harvard University. This is episode 3 of a 3 part series on Health and Healing. I’m CJ
Passarella
NICK
and I’m Nick Jaeger, and today we are going to be talking about the historical process of
discovery of what is known in Traditional Chinese Medicine as ma huang, or Ephedra.
CJ
As we’ve heard in our first two episodes from Maia, Judy, Chris and Kamil, questions of what it
means to discover a drug and who is credited as a discoverer have serious social, legal, and
ethical implications for who gets access to the drug and, of course, who can profit off of it — in
other words, who “owns” a drug?
NICK
By looking at Ma Huang, we hope to shine a light on how these processes of discovery have
taken place historically, and why questions surrounding the ownership of drugs and medicines
can get quite complicated. We also hope to emphasize the importance of recognizing the origins
of medical knowledge and ways of knowing found across the world by highlighting the variety
of discovery processes occurring during a long time-frame
NICK
But, before we get deeper into the history of the plant and its medicinal use, of course, it would
be helpful to talk a bit more about what this plant is like.
Transition Sound
CJ
So now, for this portion of the episode, I want you to relax. Take a deep breath, maybe even
close your eyes, and allow yourself to visualize the following. You’re an experienced hiker, truly
seasoned, and you also happen to be quite interested in all things botanical. As a new challenge
for yourself heading into the new year, you decide to take a trek through the Himalayas — don’t
ask how you funded it. One day, midway through your journey, you stumble upon, of all things,
the ma huang plant. The avid gardener you are, you’re able to recognize the plant easily,
recalling that it is a shrub native to China, Pakistan, Mongolia, and northwestern India. You
reach for the plant journal in your backpack and immediately begin to take note of the plant’s
atypical features. “What an unusual bush!” You write for yourself. “Low, straggling, and
evergreen perennial,” you say under your breath, writing furiously. “This shrub keeps its leaves
during the winter, how lucky. And its leaves, how strange they are! Few and far between on the
plant, spiraled around the branchlets and only around a single centimeter in length — how short!
Oh, and the stems!” These stems are the plant’s key medical components, you remember from
your traditional medicine encyclopedia. You describe them as tough but flexible, and marvel at
their role as the source of photosynthesis. You tower over the plant, which is only about a foot
high, although you know from experience that some can grow up to four feet. Right as you get
ready to go, you notice something on the plant that resembles berries. You snap a photo,
marveling at their beauty, before realizing that those berries are actually poisonous red cones!
Close call, you think to yourself, as you go about your way and resume your hike.
Transition Sound
NICK
So this plant, this rather unique plant, was first discovered in China thousands of years ago,
before undergoing “re-discoveries” in Japan and the West that, eventually, made it one of the
most well-known and well-studied drugs of the ancient world. A particularly early treatment in
the Traditional Chinese Medical cannon, it was referenced in the “ShenNong BenCaoJing,”
which is considered to be a foundational book in Chinese medicine written around 200 CE. Even
earlier than that, Shen Nung, a Chinese emperor who lived around 2700 BCE catalogued 365
herbs by their bitterness. Ma Huang was included and it was classified as medium. It was known
at the time to treat asthma and common colds and It’s believed that, for those uses, it has been a
part of Chinese medical knowledge for up to 5000 years.
CJ
Yeah. (GOOD PLACE FOR SOUNDS) The way that this drug was administered in TCM, a
person would take a handful of crumbled stems from dried Ma Huang plants and make them into
a tea. If you want to envision these dried stems, picture the head of a broom. (Sound of stems
breaking). You can hear that now, that’s the sound of these “broom-heads,” or stems, being
broken as they are mixed into the tea. They are hard, and coarse, and a brown-green color. They
were dropped into cold water, which was then boiled and strained. This process was repeated
every two to four hours until symptoms improved, at the same interval that one would take
DayQuil.
NICK
While this first discovery dates back thousands of years, the Chinese understanding of this drug
did not stop developing after this first discovery. In the 16 th century, Li Shih-Chen’s famous
dispensatory the Pents’ao Kang Mu highlights its uses as a circulatory stimulant, a diaphoretic,
an antipyretic and an anti-tussic - clearly research was ongoing, and the discovery process
continued to evolve as more uses were found. And, --- for listeners like me with less medical
knowledge, a diaphoretic is a drug that induces sweating, an antipyretic is a medicine that
reduces fevers and an anti-tussic is a cough suppressant.
CJ
Yes, and while this development of understanding is happening, the earliest known date of
export for Ma Huang was also in the 16 th century, where we’ve found documentation that
indicates that dried stems were shipped to Japan. So, now Ma Huang has moved out of just
China, where it has been in use for thousands of years by now but is still undergoing research,
and it’s being sent over to Japan. Despite that, Japanese research into Ma Huang did not actually
get started until the late 19th century.
Transition Sound
NICK
This second process of discovery, in 19th century Japan, was instigated by Nagayoshi Nagai, a
scientist and the first person to isolate ephedrine from the Ma Huang plant. Nagayoshi, and a
colleague of his, K Miura, continued to study Ephedrine and its impact on animals.
CJ
Interestingly enough, even after this process of discovery was facilitated in Japan, it took another
20 years for other Japanese scientists, H Amatsu and S Kubota to suggest medical uses for
Ephedrine, likening the substance to Tyramine and Adrenaline and suggesting that it was capable
of relaxing bronchial smooth muscle as a potential treatment for Asthma.
NICK
It’s interesting that the physical material was passed from China to Japan without really any
knowledge of its medical uses.
CJ
Yeah. And at this point, ma huang is virtually unknown to the wider world, including the West.
Despite Nagayoshi spending part of his education in Berlin, the reason why this information and
his research didn’t really spread was because all of the papers were written in Japanese. There
were limited Japanese speakers in the west at that point, so rather than the open collaboration we
hope to see today, instead what we got was a third, again fairly-independent discovery of ma
huang, this time taking place in the West in the 20th century. So first and foremost it's worth
noting that insular nature of the research process.
Transition Sound
NICK
This third discovery process was kicked off by Ko Kuei Chen and Carl Schmidt when they took
up posts as lecturers at the Peking Union Medical College in 1920. Both were trained in
physiological techniques for measuring blood pressure, heart rate, and bronchial muscle tone in
the United States and were unaware of Nagai and Miura’s findings.
CJ
And so they started off with dogs and cats. And ended up coming to a lot of the same
conclusions that were made in the previous two discovery processes, which should not be too
surprising because, remember, the 19th century Japanese researchers also focused on its impact
on animals.
NICK
In any case, their paper in the Journal of the Society of Experimental Pharmacology and
Therapeutics lit up the pharmacological world of the west. This followed the discovery of
adrenaline, which was an effective but somewhat limited treatment for Asthma. Ephedrine was
thought to be a better and easier to administer version of adrenaline. Not surprisingly this excited
corporate America. From 1924-30 there was an onslaught of patents being filed in the US and
Europe for the preparation of the plant extract and for the synthesis of the active alkaloid. An
American pharmaceutical giant ended up trying to buy up all the Ephedra supply in China to
corner the market.
NICK
I think it's also worth mentioning that in 1920, Merck started marketing Ephedrine in China,
which marked the beginning of mass production of ephedrine in China. From 1926 to 1928
ephedrine exports from China to the West grew from 4 to 216 tonnes. For reference, Merck is a
German founded company that has since migrated its headquarters to the United States.
CJ
So, this is the story of ma huang, an interesting and unique shrub with quite a history of its own.
If you’re from the west, I imagine that you were more likely familiar with the name Ephedra or
Ephedrine as opposed to Ma Huang. In many ways this speaks to the way that scientific
discovery is valued. Priority is given to the synthesis and isolation of ephedra from Ma Haung, as
opposed to valuing the organic discovery process that occurred in China when the existence of a
plant was turned into a wide ranging medical understanding. There were numerous patents in the
west on the process of extraction and synthesis of Ephedrine, despite all of the treatment
information having been discovered in China 1000s of years earlier.
NICK
In sum, we really hope that this brief oral history of the plant gave you an idea into how plants
and medicines can be re-discovered by different cultures in very different ways. Our
contemporary and global medical infrastructure may already seem complicated, but in many
ways, this complexity only expands beyond the surface level. As one delves deeper into the
history of the development of medical knowledge, there is so much more to be learned. Modern
medicine is often thought of as “modern” in the sense that it was developed in the last couple
hundred years. However, this is far from true. Modern medicine and in particular modern
western medicine is deeply rooted in a global tradition that incorporates knowledge from many
other traditions. As we come to conclude this podcast I want to reference a paper by George
Basalla, a Harvard graduate in the History of Science. I believe this paper will shine a light on
why many people conceive of the modern medical infrastructure in the aforementioned manner.
George Basalla’s 1967 paper titled “The Spread of Western Science'' essentially attempts to
outline a methodology for how science has spread across the globe. He attempts to create a
heuristic that emphasizes how science supposedly originates from ITaly, France, England, the
Netherlands, Germany, Austria and the Scandanavian countries. Basalla’s thoroughly criticized
paper claims that scientific countries, i.e. the western countries, diffused science to the
non-scientific countries, i.e. the non western countries. The leading criticisms of Basalla’s work
highlight how his paper ignores the fact that European science cannot be isolated in the manner
that he attempts as there is no pure european science but rather a polyglot mix of varied scientific
traditions heavily mixed with middle eastern and asian traditions. Basalla further ignores the
cross cultural exchange. As we enter the conclusion of this podcast I wanted to bring up
Basalla’s work because, as much as it has been highly criticized since its publication, many of
his sentiments still prevail both overly and subliminally in our culture. The complexity of the
modern medical infrastructure is such that it is easy to turn a blind eye to the true history of our
current medical system, which is deeply rooted in medical knowledge that was developed around
the globe. In our first episode Maia and Judy brought you a segment on biopiracy, which we
hope is able to highlight some of the devastating effects of this eurocentric perspective. Next we
brought you to Djibouti with Kamil, who, in his interview with Chris, was provided his deep
knowledge of the sophisticated medical tradition in Djibouti. And finally, CJ and I hope that this
episode of our podcast was able to offer you insight into the diverse processes of discovery that
have come to compose our modern medical infrastructure. Thank you for being here with us, and
we hope that this podcast was able to offer some more insight into what modern medicine
actually means.
CJ
Yes, and on behalf of everyone that has worked on this Health and Healing podcast, Thank you
all so much for listening and for wrapping up this health and healing discussion with us, we
certainly had fun, we hope all of you had fun, too. Until next time, that’s it from us.