A Generation's Memories in a Medicine Pouch

Medicine pouches were brought in from Japan during the period of Japanese rule. The practice of using them originated in the countryside, where medical resources were undeveloped and transportation was inconvenient. Sales representatives would leave a supply of medicinal products from pharmaceutical companies in people's homes or with retailers, making regular rounds to collect payment and replenish stocks. This type of distribution system for pharmaceutical products was once quite mainstream in Taiwan, but has been in decline since the 1980s with the advent of local pharmacies, Labor Insurance (which used to include medical insurance), and later the National Health Insurance scheme.

Medicine pouches became ever fancier due to intense competition. Some companies used animal emblems, such as Chienmin Pharmaceutical's horse and rider logo.

Epic rides and tests of skill

According to Lin Cheng-nan, who manages the over-70-year-old Mingtung Pharmaceutical Company in Taichung, the medicine pouch business was divided between distributors in a company's local area, and representatives dispatched to develop sales in other areas. To pass muster with health officials, manufacturers would supply their sales reps with company ID cards and official caps and uniforms.

Tsai Chin-hsing started to sell medicine pouches from the age of 12, at first accompanying his father on his travels. Now 56 years old, he recalls those itinerant days: "If you were caught without your salesman's ID, or with illicit medicines that you were peddling on your own, you would have all of your wares confiscated and, on top of that, be had up in court." Tsai holds up a yellowing sales license issued by Mingtung Pharmaceutical Company in 1967, a testament to his 40-plus years in the medicine pouch business.

At first, Tsai and his father went about on bikes, then on motorcycles. At 16, he began to work independently, sometimes driving a small automobile for long-distance deliveries. He covered the areas of Taichung and Miaoli Counties.

Not only did working in the medicine pouch business mean that days off were pretty much out of the question, one also had to be an expert rider, carrying loads of 70 or 80 kilograms in wooden crates, as in the early days, or in canvas sacks. On poor rural roads with lots of loose gravel and mud, a single miscalculation could result in a crash. And while one could always pick up scattered medicines, broken bottles meant restitution to the company for the damaged goods.

Chen Hua-han is the sole sales representative left in Pingchen in Taoyuan County. He started his career at age 28, working for the Ying-antang Pharmaceutical Company. During his first five years he went about by bicycle, then switched to a motorcycle. He served over 2,000 customers, and a 40-day restocking interval meant that he needed to see 30 to 40 customers every day. He would travel from sunup to sundown, in the process going through over ten bicycles and five motorcycles within a five-year period.

Chingfeng Powder, which came in a black bottle, was a favorite of mothers and grandmothers for treating childhood agitation, nighttime crying, spitting up milk, and discolored stool.

Lining up to get paid

According to Tsai, medical pouch sales representatives and their companies typically split profits 40:60. Since every location they worked in represented further potential business opportunities, sales reps gave their all to cultivate good relations with their customers. If customers liked one's service and the pharmaceutical products seemed to work well, they would pull in other customers by word of mouth. Sales reps often became good friends or even almost like family members. Customers would feel so secure that they would give reps the keys to their homes to replenish their medicinal supplies.

In some places, the pharmaceutical sales reps would leave their products at the home of the village elder, where the villagers would come if they needed medicine. Tsai recalls, "In one place a record 18 pharmaceutical companies left their medicines with the village elder. When all of the reps showed up at the same time to collect payment, they all had to wait in line just to collect their money!"

Collecting payments was a fine art that required the sales reps to have expansive knowledge of a variety of professions and when the best time to collect would be. For example, they would go and collect from rice farmers at the twice-yearly rice harvests, from pig farmers at the time of slaughter, from factory workers at the beginning of the month right after payday, and from poor families once a year. Taiwanese folk customs forbade owing money into the new year, and people tended to stockpile medicines right beforehand in case they needed anything in a period when hospitals and clinics tended to be closed. All this meant that the period before the new year was the busiest time in terms of collecting payments and restocking medicines. Sales reps often did not even have the time to celebrate the traditional New Year's Eve dinner with their families.

The Shih Te-chih Traditional Chinese Medicine Company's Lingchih Tonic, a dark brown liquid which came in six-centimeter miniature bottles and was used to treat heatstroke, would always be in short supply during the height of the agricultural season.

Best-selling medicines

Tsai recalls a time when living and sanitary conditions were not good, and young children often suffered from intestinal parasites and worms. Symptoms included a pale or greenish complexion and weight loss. In the 1950s, the Mingtung Pharmaceutical Company came out with "Ai'er cai," a plant-based medicine for intestinal parasites. It became a bestseller. Many who were born in the 1960s still remember the bitter, acerbic taste of this powerful anti-parasitic medicine.

The Shih Te-chih Traditional Chinese Medicine Company's Lingchih Tonic, a dark brown liquid which came in miniature six-centimeter-tall bottles and was used to treat heatstroke, would always be in short supply during the height of the agricultural season. Mingtung Pharma-ceutical's Pain Relief Tablets and Juisheng Cold Powder were favorites for colds. Chingfeng Powder, which came in a black bottle, was a favorite of mothers and grandmothers for treating childhood agitation, nighttime crying, spitting up milk, and discolored stool. Taihe Grotto Tablets were used to treat coughs, and Chengkung Tablets, also called "stinky pellets," were used to treat stomach maladies.

Moreover, every family seemed to have well-known topical remedies such as Chianming Pharmaceutical's mint drops, East Asia Pharmaceutical's red ointment, as well as tiger balm, which was manufactured by a number of different companies.

Tsai Chin-hsing, 56, began running medicine pouches when he was 12. After more than 40 years, he continues to deliver medicines to his old customers in the remote Tatushan area of Taichung.

Pouch designs and their times

Pharmacist Huang Ta-chin, who heads up the Chinta Pharmacy in Tainan and is a collector of old-style medicines, relates his knowledge of the different historical styles of medicine pouches. Those of the 1940s and 50s were in simple, two-color designs, while those from the late 1960s featured color printing. Because of the fiercely competitive market, manufacturers began to produce more and more beautiful graphic designs and printing styles for their packaging, hoping thereby to attract more customers.

During the period of Japanese rule, all medicine pouches were printed with the words "Authorized by the Office of the Taiwan Governor General." After the war, this wording was changed to "Authorized by the Taiwan Health Department." During WWII, medicine pouch designs were filled with martial ardor. One might see an image of a mother and child holding aloft a Japanese flag, or Japanese soldiers stepping onto China's Great Wall, all images that proclaimed Japanese imperial might. After the war came images of Nationalist soldiers, tanks, and the C-119 transport plane, affectionately nicknamed "Mother Hen," all designed to publicize the government and its national defense forces.

Moreover, pharmaceutical companies made use of their locations and famous landmarks or historic sites in their graphic designs. Companies in the Changhua area would use the great Buddha statue on Mt. Pakua. Those in the Hsiluo area would adopt the great bridge at Hsiluo as their emblem. Others employed animal emblems, such as the Tanfeng Pharmaceutical Company's phoenix, the Chienmin Pharmaceutical Company's horse and rider, or the Tungjung Pharmaceutical Company's tiger. Still others used images of deities and buddhas to attest to the divine efficacy of their medicinal products.

There are many funny stories that stem from people's lack of understanding of the medicines they were utilizing. In one of these, a villager was said to have brought some fever medicine to the village elder, asking whether he should take the medicine before or after a meal. After a moment of reflection, the village elder confidently replied that the medicine should be taken after the meal. Since the illustration on the medicine pouch showed the heroic Lord Guan with his very sharp Green Dragon Crescent Moon Blade, he reasoned, the medicine must be very powerful indeed, and should only be taken after a meal, to avoid harming the stomach!

Aside from their symbolism, the images on medicinal containers also cleverly served the purpose of informing the consumers as to their contents, since many in the countryside were poorly educated or illiterate back then. With one glance at the images on the packaging, customers would be able to tell what kind of medicine was contained within. This became the cleverly adopted guiding principle of the pharmaceutical companies.

For example, medicine for wheezing and coughing might display an image of a shrimp, a turtle, and a broom, which when identified aloud in Taiwanese would yield a homonym for "wheezing and coughing." Simple cough medicine might display a broom only, to indicate medicine for "coughing," or an image of a person violently coughing. Diarrhea medicines featured an image of a man in distress, trousers down, crouching at the toilet. Fever medicines showed bedridden figures under heavy blankets with bags of ice at their heads. Children's fever medicines would feature a mother holding a child, the child crying and red-tongued. Images of a person in pain or holding their head meant headache medicine, of a person holding the sides of their face meant toothache medicine, and of a person clutching their stomach, indicated medicine for stomach pains and bloating.

Inside every medicine pouch was a form to record the types and quantities of medicines consumed, which made it easier for sales reps to keep records current.

Exquisite glass bottles

According to Huang, pharmaceutical companies invested much into their packaging despite the high cost of materials. "Perhaps people were influenced by legends of the gods and immortals bringing down lifesaving medicines in gourd-shaped containers. Thus, gourd-like shapes were particularly popular," he says. Makers of traditional Chinese medicinal pills or powders would take pains to create exceptionally shaped glass bottles to showcase the quality of their contents, and create a strong first impression. Even eyedrops were placed in glass containers, with rubber knobs to dispense their contents. But it was the black bottle of Chingfeng Powder that left the most lasting impression in those days of industrious patriotism, when people were encouraged to have more children to strengthen the motherland. Back then, that medicine was a must-have for mothers caring for their young children.

Not only were medicine bottles specially designed, even the pills inside were rendered in special colors to attract the attention of consumers. Gold and silver were the most often used colors, with gold signifying supernatural efficacy, nourishment and replenishment. Most unforgettable were the little silver pellets, called rendan, taken to combat dizziness and promote alertness. Their silvery hue and cool, sweetish taste made them favored snacks for children, who would secretly take this medicine or feign illness to get some.

"Most medicines were wrapped in paper packaging. Some came in wooden cases, while metal tins were reserved for the pricier products," says Huang. In those days, locally manufactured medicines could be up to tens of times cheaper than their imported counterparts, many from Hong Kong, Macao, Singapore, Thailand, and Malaysia. These usually came in metal tins labeled with unintelligible text, a format that allowed a number of suspect products to make their way into the Taiwanese market.

Hejung Dragon and Phoenix Plasters, which began to be produced during the period of Japanese rule, were considered almost divinely efficacious. Also popularly known as diaogao, these plasters featured a translucent wax paper base topped with a black medicinal paste. The smell of these plasters still brings back memories among those who suffered skin ailments as children.

Panacea for aches and pains

The commercial jingle for the medicated patch Salonpas, sung by 1950s Taiwanese pop goddess Chi Lu-hsia, went like this: "We all have our physical limits, but one shouldn't have to suffer pain. If you have a toothache, stick Salonpas on your cheek. If you have a stomachache, stick it over your belly button. If your eyes hurt, apply it on your eyebrows." While today, customers can choose from a dizzying array of medicinal patches that fill the marketplace, back then there was only one such patch in the medicine pouch, the much-vaunted diaogao patch that was said to cure all aches, pains, and promote the removal of pus and regeneration of skin.

Huang takes out a diaogao patch called the Hejung Dragon and Phoenix Plaster, produced during the time of Japanese rule and renowned for its almost supernatural efficacy. The plasters featured a translucent wax paper base topped with a coat of black medicinal paste. The sturdy patch came in a half-moon shape, and needed to be gently heated before being opened up and applied as a circular patch on the ailing part.

According to Huang, "During heating, people would often carelessly burn off the layer of wax paper, so later the patches were made with a red cloth base. Still others claimed that the patch had to be applied immediately while still hot, often leading to burn injuries!" People who were children back in those days and suffering from skin ailments will remember the adhesive paste, and the smell of the red candles being burnt for the heating process. Today, the diaogao patch has been replaced by various types of oil- or water-based patches that can be conveniently applied at a moment's notice. The old-style patches can only be found in Chinese pharmacies or martial arts schools.

A sales rep's canvas bag might be full of medicines, a client list, and an abacus for calculating payments.

Promoting family pouches

Huang relates that the medicine pouches of that era contained individual doses of medicine, with children under 12 taking half a packet. It was a system that worked well for people. Today, the government tends to encourage people to go see a doctor and not self-administer medicines. From his standpoint as a pharmacist, however, Huang thinks that the idea of a family medicine kit containing prescribed or over-the-counter medicines is a good idea that deserves wider circulation.

Says Huang, "It would be overkill to go to the emergency room in the middle of the night for a slight stomachache, diarrhea, toothache, or fever. One could take some pain relief, diarrhea, or fever medicine at home to ease the symptoms and see the doctor in the morning." There should be no problem doing this given the high quality of Taiwanese pharmaceutical products, products that have been exported to America and Europe, so long as one did not misuse them or take them for an extended period of time.

Wang Tzu-chin, who lives in Wuchi Township in the Taichung area, has been using his family's medicine pouch since the time of Japanese rule. Once, following his son's advice, he visited an outpatients' clinic, an ordeal that involved an hour on the road, and more than an hour of waiting before being admitted to the examination room. But "before I even had a chance to warm the seat," he says, the doctor had already dismissed him to go and stand in line for his prescription. What with the doctor's cold bedside manner and the prescription of three daily pills that came out of this trip, Wang does not believe that he could not do better for himself. Having been lifelong friends with Tsai Chin-hsing, all Wang would need to do would be to give his friend a ring to get his house call.

In an era when medical care was not easily accessible, people would learn from experience and take note of what kinds of foods, when eaten in combination, would cause adverse reactions. Almost every family had a sheet listing "mutually conflicting foods" to serve as a reminder of and provide remedies against food poisoning.

Specialists and conversationalists

Tsai is bent over his abacus, calculating a bill. Sometimes, he says, he might even get a call to make a delivery on New Year's Day. Back then, family medicine pouches were delivered as a kind of express packet for emergency care. Pharmaceutical reps played the roles of family doctor and extended family member.

"Sometimes when an elder in the house is ill or worried about something, they tell me instead of their own children. I listen and try to give timely advice," says Tsai. Tsai often hears about problems between mothers-in-law and daughters-in-law, often serving as a mediating "family member" trying to bring back harmony to the household.

From Tsai's words one can also perceive that with the migration of the young into the cities, the old people who are left behind have needs not only in terms of their limited mobility, but also in terms of lacking someone to talk to. These pharmaceutical reps delivering their medicine pouches on their regular rounds have turned out to be their most valued conversation partners.

In the 1980s, with Taiwan's economy taking off, the rise of pharmacies and health clinics, and the advent of Labor Insurance and later National Health Insurance, the unique age of the medicine pouch began to fade into the past.

Various brands of "green oil" are still a staple in households today.

Nostalgia for a bygone era

According to Tsai, early medicine pouch sales reps could enjoy higher-than-average salaries as long as they worked hard. These days, however, profit margins are fairly thin given the sharp decline in their client base. A rep may pull in only 10-15% of what he used to make. Tsai himself has only 200-odd customers left, whom he contacts by phone before laying out his delivery routes. He collects payment and replenishes stocks every two months or so. Nowadays, he also drives a taxi to make ends meet.

Chen, too, has about 200 customers left, and makes just over NT$10,000 a month. To augment his income, he plays a traditional Chinese fiddle at weddings and funerals as part of an ensemble. Whenever there is a delivery to be made, however, even if it is the only one for the day, the gray-haired Chen will still climb onto his motorcycle and make his rounds.

Tsai makes a delivery to Yamuliao in Wuchi Township. It is almost noon when he arrives. A bubbling pot of sweet soup, made with homegrown taro, sits on the stove, and the host extends a hearty invitation for Chen to join him for a taste. The host is an old friend of over 40 years, and tells Chen how his son persuaded him to make a most unpleasant visit to the hospital. On the way back, Tsai observes that in another ten years, given the aging of his customers, the practice of keeping a medicine pouch in the house will become a thing of the past. His voice is tinged with nostalgia and a sense of resignation.

In a society that is gradually losing its human touch, the medicine pouch holds deep collective memories. It has accompanied countless Taiwanese through their lives, as they think back with warm memories of revering and caring for parents, of starting a young family, and of enjoying the prime of life. A profession is slowly fading away, but the medicine pouch persists, soon to enter the realm of nostalgic remembrances of days gone by.

Back in the days when the level of education was low, the idea of "identifying the medicine by its emblem" was a central design principle for packaging medicine. For example, an image of a shrimp, turtle, and a broom would be used to create a homonym for the Taiwanese term for "wheezing and coughing."

The "medicine pouches" that were a feature of every household belong to Taiwanese people's earliest memories of medicine. This unique aspect of medicine flowered for a while, but faded with the advent of modern medical practices in the 1980s. Now, medicine pouches are only to be found in remote areas or among minority populations.

High-priced medicines would come in metal tins, as opposed to the paper packaging of most other remedies. Some companies imported foreign medicines, whose tins featured unintelligible foreign scripts, an often-unscrupulous strategy for maintaining high prices for their products, regardless of their real worth.

Pharmaceutical companies issued company IDs to their reps to satisfy health officials and provide customers with assurances that their medicines were safe.

Medicine pouch sales reps built relationships with their customers and vied for drop spots for their products. Some even became like members of the family, and might even play the role of mediator in domestic quarrels.