Could Asia's traditional medicine chest hold the cures to age-old ills-and can Western science finally unlock its secrets?
<br>
아시아의 의학류가 만성명에 대한 치료를 할 수 있으며 서양 의학이 그 비밀을 밝혀낼 수 있을까?
<br>
<br>
When the 38-year-old former soldier came down with a headache and fever last year, he couldn't afford a doctor. He was no richer when blood appeared in his urine, sputum and excrement. One morning in December he collapsed. "The doctor said the virus had already entered my brain," says the gaunt, hollow-eyed Sarun. The diagnosis: advanced cerebral malaria
<br>
38세의 전직 군인이 지난해 두통과 열로 고생하고 있을때, 그는 병원에 갈 형편이 못 되었다. 그의 소변, 타액, 변에 피가 보였을 때도 역시 병원에 갈 수 없었고, 그는 12월 어느날 아침 쓰러졌다. 야위고 눈이 쾡한 사런씨는 "의사가 이미 바이러스가 뇌까지 침범했다고 말했다"라고 했다. 진단은 진행된 뇌성 학질이었다.
<br>
<br>
In the past, that would have been a death sentence in Pailin, where the malaria parasite is resistant to all the main forms of quinine, the once miraculous antimalaria agent discovered in the bark of a South American tree four centuries ago. But Sarun's doctor wielded a potent new weapon, a non-quinine-based drug called artemisinin. After a week of daily shots, Sarun was back squatting in the muddy river, sifting rock and sand.
<br>
과거에는 이런 질병은 페이린 지역에서 사형선고였을 것이다. 이곳에서는 그 말라리아 기생충은 모든 종류의 말라리아 치료제(키니네) - 수세기 전 남아메리카 나무껍질에서 발견된 한때 기적의 말라리아 치료제라고 불렸던 약 - 에 저항력이 있다. 그러나 사런의 의사는 아테미시닌이라는 비키니네 성분의 말라리아 치료제를 사용했다. 사런은 일주일간 매일 치료를 받은 후 일상으로 돌아갈 수 있었다.
<br>
<br>
In the world of disease and medicine, artemisinin is like a gem discovered in a riverbed. For thousands of years, the plant it is derived from was used in traditional Chinese medicine to subdue fever. During China's brief war with Vietnam in 1979, the Chinese government gave its soldiers a crudely distilled antimalaria pill based on artemisinin뾞nd it worked.
<br>
질병과 의학의 세계에서 아태미시닌은 강바닥에서 발견된 보석과 같다. 수천년 동안 이 성분이 추출된 식물은 전통 중국 의학에서 열을 내리기 위해 쓰인 식물이다. 1979년 베트남과 중국의 전쟁기간 동안 중국 정부는 군인들에게 대충 정제한 아테미니신 성분을 기반으로 한 말라리아 퇴치약을 주었고, 그 약은 효과가 있었다.
<br>
<br>
Today, scientists at the Shanghai Institute of Materia Medica, where artemisinin was first isolated, have further refined the compound into what is now "simply the most effective antimalarial drug we've ever had," says FranCois Nosten, a physician who has spent 16 years combating malaria on the Thai-Burmese border under a program run by Mahidol University in Thailand and Oxford University in England.
<br>
오늘날 아테미시닌을 최초로 분리한 샹하이 말라리아 치료 연구소에 있는 과학자들은 아테미시닌을 현재 지구상에서 가장 효과가 높은 형태의 치료제로 재정제 하였다고 스란 코이스 노스텐은 전한다. 이 사람은 타이랜드의 마히돌 대학과 영국의 옥스포드 대학에서 운영하는 프로그램에 참가하여 타이랜드와 버마국경에서 말라리아를 연구하는데 16년을 보낸 사람이다.
<br>
<br>
After a five-year delay caused in part by skepticism that a drug based on a Chinese herbal remedy could be effective, the World Health Organization recently gave official backing for the distribution of an artemisinin-based medicine in Africa. "We have the drug that will save lives," Nosten says. "Now it is a question of getting enough cash to pay for it and then getting it to the people who are sick."
<br>
세계보건 기구는 중국의 약초 처방을 기반으로 한 약이 효과가 있을까 하는 의구심으로 5년이나 허비한 연후에 최근 아프리카에 아테미니신을 기반으로 하는 약의 배포에 공식적인 지원을 했다. " 우리는 생명을 구할 약을 갖게 되었습니다. 이제 우리는 이 약을 구입해 환자들에게 전해줄 자본만 구하면 됩니다"라고 노스틴은 말한다.
<br>
<br>
The payoff could be huge. In Africa, where resistance to quinine is spreading rapidly, 2 million people, mostly children, die from the disease annually. Artemisinin is the biotech world's moniker for qing haosu, a crystalline compound extracted from sweet wormwood, a weedy plant indigenous to China.
<br>
그 결과는 대단할 것이다. 말라리아 치료제인 키니네에 대한 저항력이 급속히 확산되고 있는 아프리카에서 매년 2백만명이 죽어가고 있다. 아테미니시닌은 중국의 토착 잡초과 식물인 쑥으로 부터 추출한 결정인 칭하오수에 대한 생명과학계의 별칭이다.
<br>
<br>
The curative powers of such plants are the basis of Asian traditional medicine and from China through the rest of the continent there are literally millions of plants, combinations, shamanistic traditions and household remedies claiming to beat disease or boost health.
<br>
이러한 식물의 치료상 효력은 아시아 전통적 의학의 기반이다. 중국에서부터 대륙 전역에는 말그대로 질병을 치료하거나 건강을 증진시킨다고 알려진 수백만의 식물, 여러 식물을 함께 조제하는일, 미신적인 전통 그리고 가정에서의 치료들이 있다.
<br>
<br>
The vast majority of Asians believe in them, and many use them loyally. For decades, however, this seemingly blind faith has sparked deep suspicion among Western scientists.
<br>
아시아의 대다수 사람들은 그 효능을 믿고 있으며, 그 중 많은 사람들이 그 효능을 깊이 신뢰하고 있다. 그러나 수십년에 걸친 이런 맹목적 신뢰는 서구 과학자들 사이에 깊은 의구심을 일으켰다.
<br>
<br>
In some cases, such skepticism is richly deserved. Consider the 30 fretful souls lined up outside a shabby row house in a suburb of Malaysia's capital, Kuala Lumpur. They're waiting eagerly on this steamy afternoon to see a man they call simply Shifu, or master. Inside, a ponytailed Chinese man in his late 50s sits at a wooden table
<br>
일부 경우에 이런 의심은 충분히 근거 있는 것이다. 말레이시아 수도 쿠알라 룸프 교외의 허름한 집 중 한집앞에 30여 명의 사람들이 자기 차례를 기다리고 있다고 생각해보자. 그들은 이 찌는듯한 오후에 시후 라고 불리는 즉 선생이라는 한 사람을 보기위해 이렇게 열심히 기다린다. 안에는 50대 후반의 댕기머리를 한 중국인이 나무 테이블에 앉아있다.
<br>
<br>
Each interview, conducted in full view of the expectant throng, takes just minutes. There's a quick feel of the pulse and blood pressure, a scan of the face and eyes, a pause to hear what's wrong, followed by a grim diagnosis ("your intestines are full of toxins, very dirty, your liver is gone, you are full of worms") and a prescription for medicine that will "detoxify" the patient.
<br>
진료는 기대에 찬 군중들이 훤히 보는 앞에서 단 몇분 안에 끝이난다. 진료는 간단히 맥을 짚고 안색을 살피고 문진을 한 후 당신 장에 독이 가득하다거나, 아주 탁하다거나, 간이 상태가 나쁘다거나 하는 가차없는 진단을 내린후 환자를 '해독'한다는 약을 처방해주는 것이 고작이다.
<br>
<br>
The Shifu mixes his own medicine upstairs (strictly no entry). He doesn't reveal his ingredients and his patients don't ask; they just glug down the brown liquid obediently. "I think I feel better," ventures a woman in her 40s after three weeks of this daily sludge and little else. "Anyway, I lost weight, though that might be because I spent so much time going to the toilet after I took the medicine."
<br>
그러면 시후는 출입이 엄격히 제한된 윗층에서 약을 제조한다. 그는 약의 성분을 알려주지 않으며, 환자들도 묻지 않는다. 환자들은 순순히 갈색의 액체를 마시고 "훨씬 나아진것 같다"
<br>
<br>
Self-appointed herbal healers like this have long epitomized the world of traditional Asian medicine for many Western scientists: a chaotic, unregulated realm where for every legitimate practitioner who spent years studying such texts as the "Taiping Royal Prescriptions"-first published in 992 and containing 16,800 formulas"-here is some street-corner charlatan sweeping dried leaves and God-knows-what into jars that sell like crazy. All of which has led Western skeptics to dismiss much of traditional Asian healing as little better than witch doctoring.
<br>
이런 스스로 약효를 봤다고 생각하는 사람들은 서구의 과학자 들에게는 동양 의학계의 전형 -몇년씩 '중국 황실 처방'이란 책을 공부하고 정식 개업의가된 사람들이 보기에 무질서하고, 검증되지 않은 -이 되어왔다. 이 모든 것들이 서구의 의심많은 사람들을 동양의 전통 의학을 마녀의 치료와 별반 다르지 않다고 생각하게 만든다.
<br>
<br>
Even when a herbal prescription has centuries of use behind it, and when its production and sale are closely supervised by government agencies, things can go horribly wrong. Several dozen Japanese died in the late 1990s after taking a popular liver tonic called shosaikoto, which the national health insurance program had certified.
<br>
한약처방이 수세기 동안 사용되었고, 그 보급이 국가기과에 의해 엄중히 관리될지라도, 끔찍한 결과를 초래할 수 있다. 1990년대 후반 일본에서 수십명이 쇼사이코토라고 불리는 간기능 강화제를 먹고 죽는 일이 있었다. 이 약은 국립건강보험계획의 인증은 받은 것이었다.
<br>
<br>
In the past few years, a quiet but historic campaign has been under way to subject traditional Asian treatments to rigorous scientific scrutiny. Governments in China, Singapore, Taiwan and Hong Kong are pouring money into hard research on long-accepted cures. In his 1998 annual policy address, Hong Kong Chief Executive Tung Chee-hwa vowed to make the city the world leader in research on traditional remedies, a drive that bore fruit with the opening in 2001 of the Institute of Chinese Medicine. Not to be outdone, Taiwan unveiled a $100 million plan that year, aimed at transforming itself into a "traditional Chinese medicine technology island" by 2006. Research into traditional cures is also blossoming at universities and other institutions outside Asia. The U.S. government's National Institutes of Health will spend $220 million on research and training in alternative medicines this year, a chunk of which will go toward the study of Asian remedies.
<br>
과거 몇년 동안, 조용하지만 역사적인 동양의학을 과학적으로 규명하는 운동이 일고있다. 중국, 싱가폴, 타이완, 홍콩의 정부에서 오랫동안 치료에 쓰인 방법들을 규명하는데 돈을 들이붓고 있다. 홍콩의 대통령인 텅 취-화가 1998년 연간 정책 발표에서 홍콩을 전통 의학의 선두주자로 만들것이며 2001년 중국의학 연구소를 여는 것으로 그 결실을 맺겠다고 성명을 발표했다. 이에 뒤처지지 않기위해 2006년까지 타이완을 "전통 중국 의학기술의 섬"으로 바꾸기 위해 10억만 달러를 투자할 것임을 밝혔다. 전통 동양의학에 대한 연구는 아시아 밖의 대학이나 연구기관에서도 이슈가 되고 있다. 미국의 국립보건센터는 올해 연구와 대체의약품 개발에 22억만 달러를 들일것이며 그 중 일부가 동양의학 연구에 투자될 것이다.
<br>
<br>
The forces driving the burst of interest in Chinese medicine vary from national pride to pure intellectual curiosity. And, of course, money. Herbal and other alternative medicaments clocked up a stunning $40 billion in sales in the U.S. alone last year.
<br>
동양 의학에 관심이 쏠리는 원동력은 국가적 자존심 문제에서 부터 지적 호기심 까지 다양하다, 그리고 물론 금전적 문제도 빠지지 않는다. 한약과 그 외의 대체의학은 미국에서 단 일년만에 40조 달러를 벌어들이는 기절초풍할 만한 기록을 세웠다.
<br>
<br>
Whatever the reasons, there is mounting evidence that these efforts to unlock the secrets of Asian remedies could produce tangible benefits for sufferers of diseases that have confounded both Western and Eastern schools of medicine-everyone from menopausal women to cancer patients. A number of new drugs spawned by this recent research boom are currently undergoing trials across Asia.
<br>
이유야 어떻든 간에, 폐경기 여성부터 암 환자까지 광범위한 치료효과를 보여 동, 서양의 의학도들을 놀라게한 동양 의술의 비밀을 밝혀내야할 근거는 이미 잔뜩 쌓여있다. 최근의 이런 연구로 개발된 약품들이 아시아와의 법정싸움에 자주 회자된다.
<br>
<br>
The ailments they aim to treat range from the awful side effects of chemotherapy to the crippling pain of arthritis. As with all drug trials, the odds are heavily stacked against success. But if just one of these drugs makes it to the pharmacy shelves alongside artemisinin, the world's medicine chest, compartmentalized for centuries, will have grown immeasurably richer. And it will be yet another sign that what once seemed like two fundamentally opposed approaches to healing have finally begun to work in tandem.
<br>
이런 약들의 치료 목표는 관절염의 심각한 통증을 치료하는데 있어 화학약품을 사용할 경우 생기는 부작용을 방지하는 것이다. 의약품 분쟁에서의 결과는
<br>
<br>
It ought to be easy: take drug combinations that have been used for thousands of years and apply strict scientific tests to them to find out what makes them work. Then distill the active compound and make a pill. But life isn't that simple. The very fact that traditional remedies have been used successfully for centuries-precisely what should make them invaluable signposts to researchers-means that drugs developed from those formulas can't be patented. That, in turn, means that no international drug behemoth is driving this research. "Large pharmaceutical companies will only be interested if you can prove the medicine is a new treatment or you can derive new compounds from the traditional form," says Professor Ricky Man, who heads the department of pharmacology at the University of Hong Kong. Another daunting challenge, drugmakers say, lies in getting approval from the notoriously strict U.S. regulatory agency, the Food and Drug Administration (FDA). "The FDA requires that we prove how a certain medicine affects the body," explains a China-based executive with Swiss drug giant Roche. "That's easy with Western medicine but traditional Chinese medicine is like a recipe: you can't prove to the FDA what each ingredient does." Despite such obstacles, a few pharmaceutical titans, including Roche and Merck, do maintain small research projects in China. "We're very interested in traditional Chinese medicine, and we're acting on it," says an executive at Merck. "We're testing some plant ingredients to see how they affect the body."
<br>
<br>
There are theoretical hurdles too. Western science can't figure out what makes some of the most effective traditional methods work. Take acupuncture. While there is no longer any serious doubt in Western scientific circles that it works in alleviating pain and even lowering blood pressure, there is no convincing explanation of how it does so. As advocates of traditional Asian medicine see it, the West's narrow scientific approach misses the point of such ancient practices, which attempt to treat the body as a complex whole instead of trying to heal a specific illness. This quest for precision leads scientists to disassemble complex formulas in the hope of isolating a single compound that could cure one specific disease. That's anathema to Asian healers. "If you want to be true to traditional medicine, it is mixtures rather than one chemical that work," says Richard Eu, CEO of Singapore's 122-year-old traditional medicine maker Eu Yan Sang.
<br>
<br>
Western medicine approaches diseases in a "direct and unilateral way," says Ryoo Byung Hwan, vice president of life-science business planning for SK Chemicals, a pioneer company in herbal remedy research. Even when it works, says Ryoo, it fails to take into account the human body's complexity. By contrast, traditional cures are effective in combating chronic diseases caused by a variety of factors. "Traditional medicine doesn't analyze or attack the disease directly but it tries to return the body to balance, to its normal state."
<br>
<br>
<br>
In 1995, Ryoo launched the Joins project to develop a new way of treating arthritis, which afflicts 10% of the world's over-60 population. Ryoo decided to submit traditional Korean herbal remedies to stringent tests based on Western scientific methods. "Western medicine can't completely cure arthritis because they don't know its exact cause," he says. Ryoo began by analyzing the causes of arthritis using traditional methods. His studies showed there were three major causes: "wind," "coldness" and "wetness." Imbalance in these three conditions, along with "dryness," is considered the root cause of all diseases in traditional medical practice. Ryoo then scoured the 600 herbs used for centuries in Korea, performing a long screening process that included tests on animals, and finally narrowed the field to three herbs. Ryoo combined them into a yellow pill the size of an aspirin and christened it Joins.
<br>
<br>
After some encouraging initial results, Ryoo decided to compare Joins with the toughest competition from the West, Voltaren, a powerful anti-inflammatory drug widely prescribed for arthritis. (In 2001, Voltaren raked in sales of more than $500 million for its Swiss manufacturer, Novartis.) Ryoo was sure Joins would produce fewer side effects than Voltaren, which can cause severe gastric problems, but feared it might not match up as a painkiller: "Comparing the efficacy of a herbal medicine with a chemical medicine like Voltaren is risky. Chemicals are like sharp knives: if you use them properly they will do their jobs perfectly, but if you miss your target, they might cause serious side effects. Herbs are like dull knives-they are not as swift, but they have fewer side effects."
<br>
<br>
Tests by five major Seoul-based hospitals showed Joins was as good a painkiller as Voltaren and did indeed produce fewer side effects. Ryoo now wants to prove that Joins can also protect the joints, curing arthritis instead of just relieving its symptoms. In vitro experiments conducted at Seoul National University and Cardiff University in Wales show Joins may reduce joint tissue degradation.
<br>
<br>
Of course, countless promising drugs have failed after cantering effortlessly through years of trials. But Ryoo's project shows vividly that traditional medicine's strongest advocates are now willing-indeed eager-to subject their cures to stringent scientific examination. Ryoo's method-creating a new formula from a combination of traditional herbs, then subjecting the result to clinical testing-is the reverse of most attempts to unlock the secrets of traditional medicine. The more common approach is taken by Singapore's Eu Yan Sang group. The company commissioned the Chinese University of Hong Kong to subject its best-selling product, Bak Foong or White Phoenix, to three years of scrutiny.
<br>
<br>
Bak Foong pills are made from a complex traditional formula with no less than 20 exotic ingredients, including flying squirrel feces, deer antler, black sesame seeds, essence of white-feathered chicken and cinnamon bark. Eu Yan Sang wanted to test the original concoction to see how it achieved its supposed benefits, which, aside from helping with menstrual pain, are also characterized by the company as "building resistance to colds, increasing blood and vital life force and settling extreme emotions."
<br>
<br>
Professor Chan Hsiao-chang, who led the study, says tests showed that Bak Foong pills help adjust estrogen levels, lower blood pressure and boost the immune system. While it's no miracle cure, it did prove to have a broad and benign effect on the body. That, she says, helps validate the basic principle of Chinese medicine: "to readjust and balance the elements in our bodies back to a normal and healthy level."
<br>
<br>
The question remains: How do traditional remedies achieve such results at the molecular level? Liu Jikai, a researcher at the Kunming Institute of Botany, China's premier center for the study of traditional medicine, thinks he has the beginnings of an answer. Liu, who holds degrees in both traditional Chinese and Western medicine, says the common thread running through the most effective traditional formulas is the high proportion of two classes of compounds: polyphenols and saponins. Polyphenols are famously found in wine, tea, chocolate and fruits, while saponins occur in a wide range of grains and vegetables from spinach to tomatoes.
<br>
<br>
<br>
<br>
Western laboratories are likewise scrutinizing polyphenols and saponins, which appear to play a role in preventing cancer, killing tumors, lowering cholesterol, fighting infection and even countering depression. So far, science has been unable to explain how they work. The Chinese haven't figured it out either but Liu thinks the same mechanism underlies China's ancient ways of healing: "Western medicine is like a key in a lock. But traditional Chinese medicine is nonspecific, just like polyphenols and saponins. That's why, for example, traditional medicine doctors can prescribe the same formula for different diseases. It also explains why traditional cures are better for disease prevention and the treatment of chronic conditions that are usually caused by a combination of factors, not a single virus or bacterium."
<br>
<br>
Yet Liu is also trying to develop a more focused treatment for blood clots, using a method he came across in reviewing classical formulations. Another research team at his institute has produced a treatment for HIV that is now being tested on aids patients in Thailand. Even the die-hard traditionalists at Eu Yan Sang are going modern, using the Chinese University of Hong Kong's research to produce a new herbal formula for postmenopausal women that will combine only a few of the most bioactive herbs from the Bak Foong formula.
<br>
<br>
The traditional medicine-based drug that is probably farthest down the testing road comes from Taiwan. Chemist T.S. Jiang is running a trial of a drug there called Xue Bao ("blood treasure") derived from yellow root, a purple flowering plant. Xue Bao reduces the side effects of chemotherapy on cancer patients, says Jiang, so that appetite improves, normal sleep patterns resume and hair grows back. Critically, Xue Bao has produced no side effects, unlike the two Western drugs G-CSF and EPO, which are most widely used in conjunction with chemotherapy. So far the drug has been tested on 500 patients in Taiwan and China with encouraging results. It still has to pass the third and final trial stages-but Jiang has already taken his faith to the public, floating his company PhytoHealth Corp. on Taiwan's TAISDAQ stock exchange.
<br>
<br>
"We're kind of excited," says Jiang, and no wonder: the combined market for G-CSF and EPO in 2000 was $6.8 billion. PhytoHealth's stock has dropped about 30% in value from the giddy heights of its debut on May 13, and all eyes are now anxiously focused on the results of the third-and most difficult-round of tests. "So far the phase-two study results have been pretty good," says Yu Hsiang-lin, secretary general of the government's Development Center for Biotechnology. "The real question is whether they can pass phase three safely. If they do, it's a big market."
<br>
<br>
Meanwhile, the promise of artemisinin looks richer than ever. Henry Lai, a bioengineering professor at the University of Washington, recently published a paper detailing experiments in which artemisinin killed virtually all breast cancer cells exposed to it within 16 hours, while having no impact on normal cells. "Not only does it appear to be highly effective," says Lai, "but it's very, very selective." In tests at other universities in the U.S. and Germany, artemisinin has also shown early promise in combating diseases like leukemia and bone cancer.
<br>
<!-- -->
