In early November at a seminar titled "Toxins in Chinese Herbal Medicines," Wu Ming-ling, a clinical toxicologist at Veterans General Hospital, explained that his department had analyzed 54 cases of cancer of the kidneys, urethra or bladder and discovered that nearly 30% of these patients had used herbal medicines. Four patients had used Chinese medicine containing aristolochic acid, and three of these had suffered from kidney failure or transitional cell carcinoma (bladder cancer).

Aristolochic acid is a purified form of the active substance found in plants of the birthwort family, many of which are native to northern mainland China and Japan. It is effective at lowering blood pressure, clearing the lungs, and spurring urination. But Deng Jou-fang, director of the Poison Prevention Information Center at Taipei Veterans General Hospital, points out that in 1993 Belgian researchers discovered that a Chinese herbal weight loss prescription containing aristolochic acid could lead to kidney failure, and as a result, 11 nations, including Britain, France, America and Canada, banned its use one after another.

Among Chinese societies, where the use of Chinese herbal medicines is prevalent, Singapore restricted the use of aristolochic acid to no more than two weeks per patient, and mainland China prohibited the use of Aristolochia manshuriensis, the plant with the highest concentrations of the acid. On the other hand, Taiwan only stipulated that herbal medicines containing the acid should bear the warning: "long-term use may result in kidney failure," but clinical use and abuse have continued. Consequently, Deng has called for the Department of Health (DOH) to institute an outright ban of all herbal medicines containing aristolochic acid.

In response to these loud calls from the Western medicine community, the DOH announced it was banning five herbal ingredients that contain aristolochic acid-guanmutong (stem of Aristolochia manshuriensis), guangfangji (root of Aristolochia fangchi), qingmuxiang (Aristolochia stem), tianxianteng (Aristolochia stem), and madouling (Aristolochia fruit)-from herbal prescriptions, and revoking the licenses for 50 different medicines containing aristolochic acid. Herbal apothecaries were ordered to take these medicines off the shelves immediately and to return them within three months. Those who failed to comply would be subject to prison terms of up to five years.

Nevertheless, the DOH's quick prohibition elicited an immediate protest from the National Union Association of Chinese Medical Doctors, which criticized the DOH's ban as a rash move that resulted in a panic and great losses for the Chinese medical industry and Chinese medical hospitals.

Lin Jaung-geng, the president of the association, explained that "drugs are also poisons"-and that while aristolochic acid can be toxic to the liver, Western medicines such as antibiotics and pain killers can pose similar dangers to the liver and kidneys. Because these medicines are effective against certain diseases and conditions, they are sold with warnings about their side effects. If the DOH were to ban all medicines with side effects, Lin argued, then most Chinese and Western medicines would not be made available. The Chinese medicine community thus came out opposed to a blanket ban, arguing that imposing use restrictions was more appropriate.

With the debate over the ban still raging, Wu Ming-ling a few days later issued another report about the damage that Chinese herbal medicines inflict upon the kidneys, pointing out that a 20-month-old child that was given a Chinese herbal prescription to treat neurofibroma was brought to the hospital with fulminant hepatitis and later died. She argued that more than 100 ingredients of Chinese herbal medicines, including can'erzi (the fruit of Siberian cocklebur, Xanthium sibiricum), were toxic to the liver. This resulted in strong objections from the Chinese herbal medicine community, with nearly 100 Chinese medical doctors going to Taipei Veterans General Hospital for a protest demonstration.

The controversy between professionals of Chinese and Western medicine eased temporarily when Wu issued an apology, but questions about controls over the use of Chinese herbal medicines are still awaiting answers.

One problem is that many people have an attitude about Chinese medicine that "it cures illness when you're ill and fortifies the body when you're well," and thus consume it even when they're healthy. But the fact is that if an ingredient is a drug, it's also a poison. Secondly, there are currently extremely loose controls over Chinese medicines, so that prescriptions of uncertain origin are on the market and even advertised on radio. Using these haphazardly could result in serious physical harm. With regard to this problem, the DOH has urged the public not to buy such medicines, and has also established a joint investigation taskforce to try to figure out what to do about these sales.

The controversy over aristolochic acid has exposed contradictions and conflicts that have long existed between Chinese and Western medicine.

A China Times editorial pointed out that the two systems of medicine are quite different, and there are deep-seated divisions between them; but Chinese medicine cannot simply protest about the results of Western medical research-it must meet them head on and respond. Several years ago there was debate in Taiwan about whether or not to ban aristolochic acid. If at that time the Chinese medical community had proceeded with tests and analysis, and had outlined proper dosages and issued safety warnings, then perhaps there never would have been today's outright ban.

What's more, the drug control measures of Taiwan's DOH are also based on Western methodology, which makes them unfriendly to the Chinese medicine community. The government ought to formulate appropriate enforcement policies that protect the rights of patients in a manner that is more in keeping with the traditions of Chinese herbal medicine.