A GLIMPSE OF THE TRADITIONAL MEDICINES OF ANIMAL ORIGIN

Besides drugs of vegetable origin, its basic source of medicines, Vietnamese traditional medicine makes good use of the very rich fauna of the country, as well as a number of mineral substances. Insects, molluscs, fish, reptiles and mammals are used either whole or in part and made up in either simple or complicated preparations and have proved to be effective therapeutic remedies. Some of these medical substances of animal origin have been fairly thoroughly studied with modern scientific methods, and their curative properties confirmed although not always explained. Many others have yet to be subjected to scientific analysis and tests before their real value can be judged. They will be mentioned here for information.

The prescriptions for drugs of animal origin have come down to us either from ancient medical texts written most often in classical Chinese or from formulas handed down from generation to generation within a family, a tribe or an ethnic group. They have been collected and a selection made by many researchers working either separately or collectively, and have been tested many times over to check their medicinal properties.

I. Popular Experience

Let us first briefly review the medical substances of animal origin which appear most commonly in written accounts of traditional medicine as well as in popular medicine. First the invertebrates and then vertebrates. Among the invertebrates insects should be mentioned first.

The mulberry bombyx, or the silkworm, contains many therapeutic agents. Caterpillars, treated with bobytis and dried on quicklime, are administered to children with convulsions. They are used also as an aphrodisiac. Bombyx excrement is an ingredient found in antirheumatic and antihaemorrhagic prescriptions.

The cricket, or more precisely the two species Gryllotalpa unispinolpa and Gryllodes berthellus, is used as a diuretic. The legs and wings are removed.

The cicada discharges a chitinous membrane, the periostractum cicadae, during its metamorphosis in summer, and this is collected to make an antispasmodic drug prescribed for infantile fever (otitis, bronchitis, and influenza).

The chrysalis of the Brishaspa strostigmella is found as a parasite in the stalks of graminaceous plants in winter. The stalk is split, the worm taken out and killed by immersion in salted water. It is then dried in the sun or in a drying cupboard, and after being impregnated with honey, it is dried again. It is then macerated in alcohol and the result is a tonic elixir against neurasthenia and general fatigue.

The honey of the melliferous bee is both a highly nutritive foodstuff and a therapeutic agent. Besides its general invigorating effect, it is prescribed to be taken as honey for gastric pains, dry cough and laryngitis. It is also used as a healing ointment for boils, wounds, ulcers, and burns. Bees wax serves as excipient in the preparation of various ointments, plasters and pills. (Bee poison has been collected in a special way and used recently with success in intradermal injections in acupunctural zones against rheumatism, bronchial asthma, high blood-pressure, and chronic headache.)

The xylocopa (Xylocopa dissimilis, Xilocopa phalotus) akin to the bee, lives in bamboo stalks. By setting fire to its habitat, one can kill a whole swarm of xylocopas, and the dried and pulverised insects are recommended against ailments affecting the mouth and the pharynx.

Then come the arachnids.

The Buthus martensii, boiled in salt water and then dried, is prescribed as an anti-convulsive remedy. It also cures facial paresis.

Spiders (Uroctes compactilis) that are caught alive and crushed to a paste, are applied as poultices against boils. They are also given to children to treat some nocturnal enuresis.

The bites of the scolopendra (Scolopendra morsitana) can be serious but this insect has many therapeutic uses. Macerated in alcohol, it gives an alcoholic tincture that gives relief when painted on inflammations caused by insect stings. Boils are also treated with the tincture. Pounded to powder and mixed with an equal amount of liquorice powder, it constitutes remedy against facial paresis and rheumatic pains.

Many kinds of earthworms, among them the Pheretima asiatica, have febrifugal and bronchodilating properties, and are prescribed for bronchial asthma, high blood pressure, arteriosclerosis, and chronic headache.

Next let us examine the mollusc.

Calcined, powdered oyster shell taken orally reduces gastric hyperacidity, relieves fatigue and stops haemorrhage. It is also sprinkled over open wounds and boils.

The pearls from oysters are highly appreciated in jewellery but few people suspect their therapeutic qualities. Topical ocular medicine uses them to remove keratoses; they have some anti-inflammatory effect on conjunctivitis

Cuttlefish bones, the inside shell of this mollusc, is given to young birds in European countries to sharpen their beaks on. In Vietnam, it has a recalcitrant for rickets, as a healing agent in the treatment of gastro-intestinal troubles, as a local anti-haemorrhagic, and is an anti-infectant in cases of otitis.

The flat shell of the haliotis or sea-ear with its iridescent inside is powdered and taken orally to improve visual acuity to remove keratoses and to counteract hemeralopia.

There are better drugs of animal origin in Vietnamese traditional medicine to be found among the vertebrates than among the invertebrates. Small animals are generally used whole, but often only some parts of larger ones, like wild beasts and the cervidae are used, such as their skin, horns, bones, gall bladder, etc.

A bone jelly called cao can be made of the bones of certain animals. One of the most highly-valued drugs in Vietnamese traditional medicine is undoubtedly tiger-bone piece (cao ho cot or cao ho) made with bones from the entire skeleton The bones are completely cleaned of flesh and ligaments, carefully washed, and broken to remove the marrow. Then they are immersed in a tincture of ginger, which takes away their smell, before being put into a big cooking-pot filled with water, and boiled for 24 hours, when more water is added to compensate for the quantity that has evaporated. Two hours later the first liquid is taken off. A second, then a third operation of the same kind is repeated. The liquid obtained as a result of the three operations are boiled together over a slow fire until the mixture has the desired glue-like consistency. The semi-liquid is poured onto a tray coated with oil to avoid sticking, and when cool it is cut into 100-gram pieces. The yield is 30 kg of cao ho for 100 kg of bones. Tiger-bone pieces are above all prescribed for rheumatic pains, and as a supertonic. They are used per se or macerated in alcohol with various plant therapeutic agents. An original way to administer this valuable medicine is to put 1~20g of it in the abdominal cavity of a small chicken with a small glassful of alcohol. Steam the chicken until the bones soften and press the liquid out of the bird. This is recommended for convalescents.

Other animals' bones can also be used for the production of cao, such as bears, leopards, mountain goats and macaques. Their bones are used to make medicaments which are used for different purposes. Macaque-bone for instance is primarily prescribed for the treatment of gynaecological ailments, while the others are used as general tonics.

The superficial growths of animal are also used in different ways in traditional therapeutics.

First of all, there are horns such as those of stag antler or deer antler, which is made in the same manner as the tiger bones. It is a general tonic, an anti-rheumatic, and polyvalent anti-haemorrhagic to be prescribed for haemoptysis, haematuria, metrorrhagia, and too heavy menses. It is used in dried pieces or in an elixir, i.e. macerated in alcohol.

The antler-shoots of stags or deer are a very highly valued tonic. At the end of each summer, many cervidae lose their antlers, which grow again in the spring of the following year. These young antlers are not yet ossified, and when they are five to ten centimetres long, they are very soft and have a velvety appearance. They are sawn off, (care is taken to stop bleeding), immersed in alcohol, and dried on sand before being macerated in brandy. The elixir obtained is a strong tonic prescribed for asthenia, low blood-pressure, and in periods of convalescence.

The squamae of pangolins (Manes pentadacyla) which are a kind of feather rather than "scales" as they are wrongly called, appear in many prescriptions for boil plasters. They are grilled on a sand-bath and sprinkled with vinegar while they are still hot, and given to mothers who produce insufficient milk. They are also effective in clearing obstruction of galactophorous ducts of children and as a polyvalent anti-haemorrhagic. It is dissolved in boiling oil and mixed with lead minium and other therapeutic agents to give an anti-haemorrhagic, anti-inflammatory, and healing plaster.

The skins of certain animals also have therapeutic value.

An elephant skin preparation taken orally heals wounds and persistent boils. It is carbonised or grilled with talc and powdered and applied externally for the same purposes.

Donkey-skin, with the hair removed, is cut into small pieces, and made into a glue, in a similar way to the bone-glues. The liquid obtained is purified with potassium alum and evaporated on a slow fire. Sugar and alcohol are added to give the gluey consistency. Donkey-skin glue is a tonic and a polyvalent anti-haemorrhage. It also calms nervous ailments and can be used to prevent abortion.

The shells of the freshwater tortoise (Amyda sinensis) and the land-tortoise (Chinemys reevestii) are medical materials in great demand. They are administered in the form of powdered decoction or glue made in the same way as the bone glues. The shell of the fresh water tortoise is a general tonic prescribed in cases of overwork; it cures vesical calculi and amenorrhoea. The shell of the land tortoise, also a general tonic, is used in cases of persistent coughs, spermatorrhoea, leucorrhoea, and lumbar and rheumatic pains. It is also administered in cases of chronic dysentery, recurring malaria, asthenia and adynamia, haemorrhage, maternal, prenatal and post natal complaints rickets and many others.

The gall of certain animals is reputed among ordinary people to have miraculous curative virtues.

Bear's gall is very valuable commercially because of its special therapeutic properties. There are two species of bears whose gall has the necessary properties: the tall Selenarctos thibetanus, recognisable by the V-shape white crescent on its chest, and the smaller Ursus arctus listotus. The gall-bladder is dried in the shade and afterwards kept in a hermetically sealed container with some quicklime as a desiccant. People have long used bear's gall to treat gastric and muscular pains, indigestion, jaundice, poisoning and other ailments. But because of the high price of the medicine a family will normally only have a small piece for treating sprains, wrenches and ecchymosis. A small quantity of gall (about the size of a grain or rice) diluted in purified water is used as an eye-lotion to bathe conjunctivitis and other external eye inflammations (extemporaneous preparation). A tincture, five percent bear's gall in alcohol, is used as a ointment for pains and sprains and to reduce ecchymosis. Bear's gall has an entry in the Vietnamese Codex (First edition - 1971).

Ox gall is used in the same way as in European medicine: being chologogic and choleretic, it is also prescribed for constipation.

Hog's gall has the same properties as that of oxen. A dried extract of hog's gall is also administered in the basic treatment of bronchial asthma.

Cock's gall is employed in popular medicine as a cure for whooping-cough.

Snake's gall is highly valued in the traditional medicine of the scholars. There are three kinds of snakes whose gall is used combined in drugs: the Cobra naja-naja, the Bungarus fasciatus, and the Ptyas-mucosus. The extraction lakes place in winter, from all three snakes together. It is advisable that the snakes be left without food in a closed basin for a few days; the gall is unusual in being hardly bitter at all. It leaves a sugary after-taste in the mouth, reminiscent of liquorice. It is also to be noted that snake's gall is not in the least toxic. In traditional medicine, the three snakes' gall combined with old tangerine skin make a very efficacious remedy against coughing. Snake's gall is also used for its anti burn properties, in the treatment of rheumatic pains, and amenorrhoea.

Gall-stones are considered a valuable medicine and fetch high prices. The gall-stones of oxen, known as Bezoar orientalis on the international market, is the major active element of a well-known remedy for fever and convulsions, primarily for children. The gall-stones of macaques (Macaca mulatta and Macaca rhesus) has febrifugal, anti-spasmodic, purifying, anti-oedematic, cough-relieving and anti-asthmatic properties.

The flesh of certain animals is also very appreciated both as a remedy and a tonic.

The toad's flesh is widely used in popular medicine to combat infantile dyspepsia and athrepsia. Patients are fed the dried and powdered flesh that is left after carefully removing the head, skin, viscera and other interior organs, and gives the patient the result as food.

Snake's flesh is much appreciated in the traditional medicine of the scholars. The three species Cobra naja, Bungarus fasciatus and Pytas mucosus form an invariable trio in their writings. The three snakes are decapitated and disembowelled, and their flesh and skin are macerated in ten litres of 30o- 40o alcohol along with plant therapeutic agents. The snake elixir, with its tonic and anti-burn properties, is a powerful tonic and is especially prescribed for rheumatic pains.

The human placenta is one of the components of a tonic. Aseptic placentae from healthy women are used, and are administered either as powder, or in maceration (either in alcohol or in honey, where it completely dissolves within one or two months due to the action of proteolytic diastases). Powdered or macerated placenta is the principal ingredient of a pharmaceutical preparation called "Ha sa dai tao" which is very effective as a general tonic, and is prescribed in convalescence and in the treatment of broncho-pulmonary ailments, rheumatism, and spermatorrhoea.

Certain animals' secretions and excretions also have curative properties.

One can stimulate toads electrically or mechanically to secrete a venom through its skin that is contained in glands situated behind its auricular orifice. This venom is scraped off the animal and dried. Used in very small doses of a few milligrams toads' venom proves very efficacious in the treatment of boils, laryngitis, and toothache.

The male musk-bearer (Moschus moschcifera) has a gland containing an odoriferous substance of high commercial value, known on the international market, where it is valued as a fixer in the perfume business, under the name of Tonking musk (Tonking was the name given by the French colonialists to the northern part of Vietnam). In traditional medicine, musk is used for the treatment of neurasthenia, giddiness, coma and certain ocular ailments. It is also a component of a great number of pharmaceutical products.

The civet (Viverriculala malaccensis) has also a musk gland producing civet musk, which is used for the same purposes as Tonking musk.

The excrement of certain kinds of bats have curative properties when administered to people suffering from xerophthalmia, hemeralopia, and diminished visual acuity.

Drinking fresh urine of boys' under 12 years old, utilised orally, is said to relieve chronic headache, stop haemorrhage, and alleviate thirst. It is also used as an ointment to treat sprains and contusions. Urine is also drunk with certain plant drugs, such as the rhizome of Cypernus rotundus, to give them supplementary pharmacological properties.

Let us now look at the animals that are used as a whole. As we have noted above, these are generally small animals.

The Hemidactylus frenatus (a lizard) is a remedy against tuberculous adenitis. Some patients take it alive. The gecko, another reptile of the same family as the Hemidaclylus frenatus which owes its name to the cry of the male, is gutted and dried to make a strong tonic, the therapeutic value of which, according to popular experience, is comparable to that of Panax ginseng. It is used powdered, as pills or as an elixir, in the treatment of precocious ejaculation, persistent coughing and, neurasthenia.

The hippocampus or sea-horse is an aphrodisiac and is administered either powdered or in pills in cases of either male impotence or female sterility.

II. A Scientific Approach

It is to be noted that like oriental medicine, occidental medicine uses drugs of animal origins. Before the successful synthesis of cortisone, folliculin, and their derivatives, European medicine made use of extracts of the cortiso-suprarenal glands and the ovaries of mammals. Although the total synthesis of insulin has been achieved, the pancreas remains the major source of this hormone. Post-hypophyse extract is still employed to treat insipid diabetes and to combat uterine inertia.

Dehydrocholic acid, a classical cholagogue, is synthesised from cholic acid extracted from ox gall.

Gelatine is extracted from the skin and the bones of animals.

The venom of vipers is administered to rheumatism sufferers in the form of ointment.

Both traditional and modern medicines use honey for the same therapeutic objectives. Ox gall likewise. Ha sa dai tao based on human placenta, is matched in European medicine by extract of placenta which is injectable or drinkable and is made according to the Filatov method. Explanations offered by traditional medicine are not always convincing, but these drugs have survived over the centuries, even for thousands of years; their effectiveness has been proved. It is now our task to retrieve this national heritage, with a view to:
- verifying the pharmacological effects of the drugs in order to see whether they correspond to the ancient texts;
- studying how the drugs work;
- studying and isolating the active principles that result in the pharmacological action.

Over the past twenty years, many scientific studies of this nature have been done in our country. We have also made used of the results of similar research done in other countries, particularly in China and Japan. The overall information available is still scanty but the first results are encouraging.

III. A Chemical Approach

The effect of a certain number of pharmaceutical preparations can be easily explained by the chemical composition of the drug. The soothing properties of the cuttlefish shell in cases of gastralgia, for example, can be explained by the presence of carbonate and phosphate of calcium. To neutralise gastric hyperacidity, one also makes use of calcinated oyster shell, and here the relevant active ingredient is composed of oxide of calcium with alkaline reaction. Glue made from animal skin and bone is mainly constituted of gelatin; gelatin is also used in European medicine, in drinkable or injectable form or as a local dressing, to stop haemorrhage.

The results of the chemical analysis of the flesh of toads reveal that it contains 53.37% protein and 12.66% lipid. Toad protein contains many fatty acids, such as asparagine, histidine, glutamic acid, glycocol, threonine, aminobutyric acid, tyrosine, methionine, leucine, isoleucine, phenylalanine, tryptophane and cysteine. These give toad flesh its high nutritive value in prescriptions in cases of dyspepsia and infantile athrepsia.

Snake flesh contains 113 fatty acids, 7 of them being vital to humans, namely: lysine, threonine, valine, leucine, isoleucine, arginine, and histidine. These fatty acids are found in the elixir of snake used as a tonic. As for the anti-inflammatory properties, they might be due to the presence of flavonoids in the snake skin, which were recently discovered during work at the Hanoi College of Pharmacy.

However, chemical analysis can by no means provide a satisfactory explanation of curative properties in every case. The isolation of an active principle in substances of animal origin is far more difficult than in plant drugs. It is difficult to explain the tonic action of bone glues by the presence of gelatine. At present we are unable to explain by chemical analysis alone why the glue of the bones of one animal has different therapeutic uses from those of another one, for the analysis reveals almost identical nitrogen, fatty acids, ashes, arsenic, chlorine, calcium, phosphate, etc, content.

IV. Pharmacologic Approach

Answers to the question are therefore often sought in the pharmacological approach.

Research done in the Soviet Union shows that budding stag or deer antlers increase appetite, are sleep inductive, reduce feelings of fatigue, increase diuresis, help the movements of the intestine and the stomach, aid digestion of proteins and fats, and speed up the healing of wounds and sores. There is a special pharmaceutical product in the USSR called "Pantocrine" - in solution to be taken orally or injectable solution made from budding stag antlers which is highly appreciated as a general tonic.

Japanese researchers have found that Bezoar orientalis (gall stones of oxen) inhibits stimulation by camphor, caffeine and picrotoxin without suppressing the spasmodic stimulation caused by strychnine. But when Bezoar orientalis has been administered for a long period it actually prolongs the tranquillising effects of hydrate of chloral, or urethane or barbital in hypodermic injection given to inhibit the centage in haemoglobin in the blood and has no use of Bezoar orientalis as an antispasmodic in traditional formulas.

The use of the gecko as a tonic was demonstrated in vivo by the Hanoi College of Pharmacy early in the 1960's: the gecko elixir promotes growth, increases the number of haematocytes and the percentage in haemoglobin in the blood and has no influence on the leucocytes.

The work done in recent years at the college has been aimed at verifying the pharmacodynamic properties and effects of the gall and the flesh of snakes. Published results show that the snake gall of the three above mentioned species combined is not toxic when administered orally or parenterally to animals, the whole content of a cobra gall-bladder introduced by intravenous Injection into rabbit provokes no toxic reaction. Likewise, no abnormal manifestation is observed on rats weighing 250-300 grammes after they have been injected with the contents of a whole gall-bladder of a cobra. Electrocardiograms of the animals that undergo the experiment do not show any appreciable change.

The anti-inflammatory action of snake gall has been demonstrated by the following method: an inflammation is provoked in the paw of a white mouse by the injection of a suspension of kaolin. The inflammation is measured by comparing the volume of the normal paw with that of the paw subjected to the experiment. The paws of the mice that are given snake-gall orally (both separate galls and a mixture of the galls of the three kinds of snake) have always returned to normal more rapidly than the paws of the control mice.

Clinical studies made in several hospitals in Hanoi have proved the efficacy of snake-gall as an anti-rheumatic and anti-asthmatic remedy. In order to verify the therapeutic effect of the flesh and the skin of snakes particularly in cases of rheumatism and articular pains, a study has been made of the following pharmacological effects: growth-inducing effects, anti-inflammatory effects, and anti-histaminic effects. Experiments have been done on extracts of snake flesh with skin, extracts of flesh without skin and extracts of snake-skin. Experiments relating to growth have been done on laboratory rats. Very probative results have confirmed the use of the elixir of snake as a tonic. The anti-inflammatory effects have been tested by the same method of injection of kaolin into the paw of a mouse. The results have shown that all extracts of snake have properties which cure experimentally provoked inflammation and that the snake-skin extract was the most effective. Experiments on the antihistaminic effects have been done on guinea pigs, which have been injected with snake extract in the peritoneum. The lethal dose of histamine given to guinea pigs injected with snake extract is found to be larger than that given to the control animals, the difference being statistically significant.

Thus the chemical and pharmacological approaches allow us to partly explain the tonic, anti-rheumatic, and anti-allergic effects of the snake elixir, one of the anti-rheumatic preparations widely used in our country and in great demand as an export product.

V. Prospects

Vietnam's fauna constitute a self-replenishing source of drugs. But will it continue to be a medicinal supply source? In the face of a myriad of medicines of chemical origin used by modern medicine, will the drugs of animal origin pass into disuse, mentioned only in treatises on the history of medicine? We do not think so. In European countries, in the past century, drugs of plant origin have gradually become less important compared with those of chemical origin. But in recent years, there has been a resurgence of interest in plant drugs. In our case, a combination of favourable historical and socio-economic factors has led to the continuous transmission of this national heritage; we are just as interested in animal and plant drugs as past generations have been. We do not apply all the reasoning and practice of our predecessors mechanically and dogmatically. The work done to exploit and valorise this national heritage is as yet limited, but it allows us to foresee the course to be followed.

First of all we have to take precautions to protect our natural environment and maintain the ecological balance. While we appreciate the beneficial effect of tiger-bones or bear-gall we will not go to the length of permitting intensified hunting of these animals and thus threaten their existence. Necessary measures have been taken for their protection. One of these measures consists in rearing the wild animals used in medicine. There is now a special monkey island; and on the outskirts of Hanoi, a whole village specialises in breeding snakes. In Nghe An and Ha Tinh province and on the High Plateau stags and deer are reared. Another measure is to develop the use of substitutes. In some Chinese provinces, buffalo horns are used to replace those of rhinoceri; a mixture including cholesterol, cholic acid, biliary salts, calcium salts, is known under the name of "artificial Bezoar". In Vietnam, we have begun to use the bones of domestic animals (pig, ox, cock, etc.) to make a glue as good at that made of the bones of tigers or other wild beasts. Both domestic and mountain goats can be used in making medicines.

The Hanoi College of Pharmacy envisages the possibility of using sea-snakes for medicines in the same way as land snakes are used. A solution of acetic acid has been used in place of traditional vinegar in making certain drugs; child's urine can also be replaced by a solution of urea and natrium chloride with which to impregnate the Cyperus rotundus when this operation is truly indispensable as required by old medical texts.

We shall know in due course whether the replacement of rare animals and complicated pharmaceutical techniques, by domestic animals and chemical products or by simplified techniques, is rational or not. It seems, for instance, that the superior curative value of bear gall compared with the gall of other animals is due to the presence of ursodesoxycholic acid, the principal constituent of the bear-gall, and this biliary acid is only found in negligible quantities in other animals. Does the Ursodesoxycholic acid synthesised and marketed by the Japanese have all the properties of bear-gall and can it be considered a substitute for bear-gall, as the Japanese researchers claim? For medical purposes, is the Rauwolfia serpentina of India comparable to reserpine, tea to caffeine, quinquina to quinine, the root of pana ginseng to its glucosides, the isolated or synthesised chemical substances they contain being only part of the constituents of the entire original drugs? Considerable study will be necessary before we can make final decisions on any particular drugs.

Pharmacist NGUYEN XUAN THU

Note: there are some incorrect names in the above article. Correct names are:
Panthera tigris, tiger
Panthera pardus, leopard
Oreamnos americanus, mountain goat
Ursus arctos lasiotus, brown bear
Ursus thibetanus, Asiatic black bear
Cervidae spp., deer
Manis pentadactyla, Chinese pangolin
Elephas maximus, Asian elephant or Loxodonta africana, African elephant
Equus asinus, donkey
Pelodiscus sinensis, Chinese softshell turtle VU
Chinemys reevesii, Chinese pond turtle EN
Bos taurus, cattle
Sus scrofa domestica, hog
Gallus gallus, chicken
Naja naja, common cobra
Bungarus fasciatus, banded krait/golden banded snake
Ptyas mucosus, dhaman/oriental rat snake
Macaca mulatta, rhesus macaque Toad – prob.
Bufonidae spp.
Moschus moschiferus, Siberian musk deer
Viverricula indica, Small Indian civet
Hemidactylus frenatus, house gecko
Hemidactylus spp., gecko
Hippocampus spp., sea-horse