Asian Medicine:
Tradition and Innovation
Editors

Jingjing XIANG and Nara ODA

Asia-Japan Research Institute
Ritsumeikan University

Asian Medicine: Tradition and Innovation

AJI BOOKSAsian Medicine: Tradition and Innovation
Editors
Jingjing XIANG and Nara ODA

Asia-Japan Research Institute
Ritsumeikan University
ISBN 978-4-910550-34-3 (Online)
ISBN 978-4-910550-35-0 (Print)iAsian Medicine: Tradition and Innovation

Asian Medicine: Tradition and Innovation

AJI Editorial Office
OIC Research Office,Ritsumeikan University Osaka Ibaraki Campus (OIC)
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Osaka 567-8570 JAPAN
Email: aji-eb@st.ritsumei.ac.jp

Copyright © 2023 Asia-Japan Research Institute, Ritsumeikan University
Note:
Authors’ names in this publication are ordered according to their preference andtheir surnames are capitalized.

ii

Asian Medicine: Tradition and Innovation

Contents
Editors’ Preface
Jingjing XIANG and Nara ODA

iv

Contributors

vi

Chapter 1. How to Make “Vietnamese Traditional Medicine”
More Vietnamese?: Neglected History in the Divided Vietnam(1954–75)
Nara ODA

1

Chapter 2. Expansion of the Himalayan Herbal Market: Networks
between Tibetan Medicine, the Economy, and Environmentalism
Kei NAGAOKA

13

Chapter 3. Transplanting Chinese Medicine in Early Modern
Japan: Immigrant Doctors in Nagasaki and the Flourishing of aJapanese Clinic in Osaka
Jingjing XIANG

32

Chapter 4. Scientific Study of Wedang Secang as Indonesian
Traditional Drink
Dinia Rizqi DWIJAYANTI

44

iii

Asian Medicine: Tradition and Innovation

Editors’ Preface
Asian countries have a long and rich history of traditional medicine.
It has undergone its historical development, influenced by factors suchas the culture, economy, society, ideology, and politics of each country.
Since the late nineteenth century, Traditional Asian medicine has beensurpassed by modern Western medicine, although traditional knowledge
and techniques have survived in the lives of ordinary people. Despite
criticism in some countries that it is not scientific, traditional medicine
has always played an irreplaceable role. At the same time, we cannot
ignore the fact that the introduction of Western medicine also promoted
the transformation and rapid development of traditional medicine in
Asia.
Since the end of the twentieth century, traditional medicine has
been attracting worldwide attention as an alternative medicine thatcompensates for the shortcomings of modern medicine. In particular, asinterest in self-care, or the concept of taking care of one’s own health,has increased, traditional medicine is increasingly attracting attention.
Furthermore, since the COVID-19 pandemic spread worldwide
since late 2019, there has been a growing interest in the role that
Traditional Asian medicine has played in historical epidemic outbreaks.
In this special period, we are urged to pay more attention to the roleof Asian medicine in today’s society, as well as its development andtransformation.
In this book, we explore Traditional Asian medicine from aninterdisciplinary perspective in terms of the herbal market, traditional
drinks, history, politics and the like in four Asian countries. The
first chapter by Nara Oda explores the entangled history of theinstitutionalized Vietnamese traditional medicine vis-à-vis Western andChinese medicine in the era of nation-building, with special referenceiv

Asian Medicine: Tradition and Innovation

to South Vietnam (the then Republic of Vietnam). The second chapter
by Kei Nagaoka explores the process of the marketization of medical
plants in the Himalayas essential for Tibetan medicine, focusing on the
discourses and practices of various actors in India. The third chapter
by Xiang JingJing deals with the transition of medical knowledge from
China to Japan, focusing on Chinese doctors’ migration to Japan and theactivities of Japanese doctors influenced by them in the early modern
era. The fourth chapter by Dwijayanti Dinia gives a scientific analysisof the Indonesian traditional drink called “Wedang Secang,” which local
people have developed conflicting opinions about under the growing
influence of modern medicine. These discussions show that diverse
forms of Traditional Asian medicine are embedded in each local context,
which cannot be captured by the dichotomies of tradition and modernity
or Asian and non-Asian.
The content of this book is based on the presentations given at
the 19th Asia Pacific Conference on December 4 and 5, 2021, held at
Ritsumeikan Asia Pacific University (APU), where we came together
to discuss Traditional Asian Medicine. This was our first face-to-facemeeting since the outbreak of the COVID-19 pandemic, and it was amost monumental and memorable occasion for the editors.
We are very grateful to Dr. Nagaoka, and Dr. Dwijayanti for
accepting our invitation despite their busy schedules. Their research
topics and approaches have inspired the editors greatly. At the end of
the conference, we had questions, answers, and discussions aroundeach other’s topics. These discussions provided us with a deeper
understanding of the current state of research on Traditional Asian
Medicine. We have also become more aware of the importanceof exploring Traditional Asian Medicine from Asian and global
perspectives, breaking through the limitations of nationalities.
The editors would like to convey our appreciation to Dr. NobuyukivAsian Medicine: Tradition and Innovation

Matsui for moderating our panel and discussion at the conference. We
are also deeply appreciative of the Asia-Japan Institute for providing
us with this valuable opportunity through its policy to foster a newgeneration of researchers. In particular, we would like to thank Prof.
Yasushi Kosugi and Dr. Ayaka Kuroda for their valuable advice on theplanning and selection of topics for this conference. We are also grateful
beyond words for the help we received from Prof. Anthony Brewer inediting this book.
We hope that this humble work will provide a contribution to thedevelopment of research in this field. We are planning to expand our
network with other researchers who are engaged in studies of Traditional
Asian Medicine. Our readers’ critical comments and viable suggestions
will be highly appreciated.
April 2023
Jingjing XIANGNara ODA

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Asian Medicine: Tradition and Innovation

Contributors
Dr. Nara ODA
C h a p t e r 1 : H o w t o M a k e “ Vi e t n a m e s e
Traditional Medicine” More Vietnamese?:
Neglected History in the Divided Vietnam(1954–75)
Nara Oda received her Ph.D. in Area Studies
at Kyoto University and is currently a Lecturer
at the World Language and Society Education Centre, Tokyo Universityof Foreign Studies, Japan and a Visiting Researcher of the AsiaJapan Research Institute, Ritsumeikan University. She specializes inSoutheast Asian studies, Vietnamese studies and the contemporary
history of Vietnam with regard to medical history. She received the 12th
Mishima Kaiun Academic Award (July 2023: Mishima Kaiun Memorial
Foundation) by her recent work The Making of “Traditional Medicine”:
A History of Vietnam’s Medical Policies (March 2022, Kyoto University
Press [in Japanese]). Another her recent work includes “Traditional
Medicine in the Mekong Region” in From Mekong Commons to
Mekong Community: An Interdisciplinary Approach to Transboundary
Challenges edited by Seiichi Igarashi (November 2021, Routledge).
Recently she has become interested in the Japanese exploration of
medicinal plants in the Indochina peninsula during Pacific War andhistorical research on medical practitioners during the Cold War in
Vietnam from a gender perspective, as well as gender issues including
sexual minorities.

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Asian Medicine: Tradition and Innovation

Dr. Kei NAGAOKA
Chapter 2: Expansion of the Himalayan
Herbal Market: Development of Relationships
between Tibetan Medicine, Economics, andEnvironmentalism
Kei Nagaoka majors in Anthropology andSouth Asia studies. She completed her Ph.D.
at the Graduate School of Asian and African Area Studies (ASAFAS),
Kyoto University and is currently a JSPS Postdoctoral Fellow (CPD) at
The University of Tokyo. Since 2010, she has conducted ethnographic
fieldwork in Tawang, Arunachal Pradesh and Tibetan medical
institutions in Dharamsala, Darjeeling, and Varanasi in India. Based on
the research, she published a book Cosmology of Illness and Medicines:
An Ethnography of Tibetan Medicine, Possession, and Witchcraft in
Tawang, Eastern Himalaya (March 2021, Shumpusha Publishing [inJapanese]). Recently she is interested in the marketization of Himalayan
medicinal plants, environmental movement in Tibetan Buddhism, anddigital media in the Himalayan region.

viii

Asian Medicine: Tradition and Innovation

Dr. Jingjing XIANG
Chapter 3: Transplanting Chinese Medicine
in Early Modern Japan: Immigrant Doctors in
Nagasaki and the Flourishing of a Japanese
Clinic in Osaka
Jingjing Xiang is an Assistant Professor of
Ritsumeikan Asia-Japan Research Organization.
Her recent research interests are the history of Japanese medicine in
Early Modern Japan, including epidemics in Early Modern Japan, theintellectual network of Confucian scholars and doctors, and the historyof Sino-Japanese medical exchange. She obtained a Ph.D. in Japanese
History at The Graduate School of Letters, Ritsumeikan University,
Japan, in 2020. She served as a Special Researcher (DC2) at the Japan
Society for the Promotion of Science from 2018 to 2020. She also
served as the 10th President of the Association of Thought and Cultureof East Asia (Japan) from 2018 to 2019. Among her publications: “Shuan
Kagawa’s Nichiyonoyaku: Focusing on Ippondoyakusen.” History ofMedicine, vol. 112. pp. 225–239, 2020; “On Yamawaki Toyo’s Ideology
of Medical Revival: A Discussion of the First Public Human Dissectionin Japan and Its Impact.” Chinese Medical Literature and Culture.
vol. 1. pp. 225–239, 2020; and Medicine and Confucianism: A Studyon Medical Cultural Exchange and Knowledge Circulation in Early
Modern East Asia (2023, Jinbun Shoin [In Japanese]).

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Asian Medicine: Tradition and Innovation

Dr. Dinia Rizqi DWIJAYANTI
Chapter 4: Scientific Study of Wedang Secang
as Indonesian Traditional Drink
Dinia Rizqi Dwijayanti is a Lecturer in the
Department of Biology, Faculty of Mathematics
and Natural Sciences, Brawijaya University,
Indonesia. She obtained a Doctoral degree in
the Advanced Life Science Course, Graduate School of Ritsumeikan
University, Japan, in 2020. Her research area is about the potentialof herbal medicine. Recently, she has been interested in researchingvarious kinds of herbal medicine from Indonesia (known as Jamu)
which have the potential to be anti-inflammatory and anti-diabetic. Her
recent publications: “Bitter melon fruit extract affects hepatic expressionof the genes involved in inflammation and fatty acid metabolism in
ob/ob mice,” Functional Foods in Health and Disease, vol. 10, pp.
18–36, 2020; and “Bitter melon fruit extract enhances intracellular ATP
production and insulin secretion from rat pancreatic β-cells,” British
Journal of Nutrition, vol. 2021, pp. 1–22, 2021.

xChapter 1
How to Make ‘Vietnamese Traditional Medicine’ More Vietnamese?

Chapter 1
How to Make “Vietnamese Traditional
Medicine” More Vietnamese?:
Neglected History in the Divided Vietnam(1954 – 75)
Nara ODA
1. Background
Medical philosophy reflects the choices made by society, its people,
and its governing bodies. Especially, when we look at traditional
medicine, we see that it has been historically affected and transformedby social, economic, and political factors.
During the Cold War, the Indochinese Peninsula was a place of
conflict and competition. In 1954, Vietnam was divided into its Northand South territories by the Geneva Agreement. Previous studies
claim that while North Vietnam (the Democratic Republic of Vietnam)
created a policy for the improvement of Vietnamese medicine as an
institutionalized medicine, South Vietnam (Democratic Vietnam) took
no such initiative.
In Vietnam, there are three elements in the institutionalized medical
system. Thuoc Nam (thuốc nam, 南薬), Vietnamese original medicine,
thuoc bac (thuốc bắc, 北薬), which derives from Chinese medicine, andthuoc tay (thuốc tây, 西薬), western medicine. Thuoc nam and thuoc bac
are now positioned as one concept of traditional medicine, Dong y (Đôngy, 東医) [Oda, 2010].

1

Asian Medicine: Tradition and Innovation

Fig 1. A pharmacy specialized in Dong y in Hanoi.
Source: Photograph by the author, March 2009.
During the independence movement of the late 1940s and 1950s,
North Vietnam experienced a lack of medicine and medical resources.
Therefore, to make the most of the local medical resources, thuoc nam
received considerable attention. Even after the independence movement
and the First Indochina war, North Vietnam promoted the use of thouc
nam [Thompson, 2003: 114–118]. Moreover, it began 1) promoting theuse of thuoc Nam and thuoc Bac, and 2) integrating them with western
medicine into one medical system [Hoang, 1999; 2012].
In this context, scholars have argued that nationalism has played
an important role in reinforcing traditional medicine, similar to how
other countries have attempted to demonstrate their superiority anduniqueness through medicine.
However, most of the research has overlooked the situation in South
Vietnam. This is partly because Vietnamese historiography tends to beobserved from the perspective of North Vietnam when constructing its
national history, as present-day Vietnam is established on the foundationof North Vietnam.
2

Chapter 1
How to Make ‘Vietnamese Traditional Medicine’ More Vietnamese?

Fig. 2. Vietnan after the Geneva Accords in 1954
Source: https://commons.wikimedia.org/wiki/File:Vietnam1954.jpg#file
This paper will consider the idea of Vietnamese traditional medicine
within the official medical system of the South Vietnam (Democratic
Vietnam) during the time that Vietnam was divided, from 1954 to 1975.
In this chapter, medicine will be defined as a whole system of medical
practices.
In doing so, I will show 1) how South Vietnam institutionalized/
promoted its own traditional medicine after being influenced by Frenchcolonization, and 2) what important problems to the government faced
in institutionalizing and defining Vietnamese traditional medicine within
the medical system.
3

Asian Medicine: Tradition and Innovation

2. Regulations for Dong y (Đông y) Practitioners inSouth Vietnam(1) Ngo Đinh Diem’s Period
The first era is the time of Ngo Dinh Diem (Ngô Đình Diệm). He
became the first Vietnamese president with the support of the UnitedStates. He has often been regarded as a puppet of the United States;
however, recent studies propose that he was both an anti-communist anda nationalist, and sought to build a modern Vietnam that would not beaffected by either Western or Communist influences [Miller, 2013].
The Ngo Dinh Diem administration did not provide the opportunity
to exploit traditional medicine within its medical system, or have anan appropriate authorization system, and was still exercising a decree
enacted during the colonial period. The decree mentioned here is “Arrete
du 17 Juillet 1943,” enacted under the name of Governor General
Decoux on July 17, 1943. The decree (hereafter Decoux’s decree)
regulated the import and practice of Vietnamese/Chinese medicine andits products in French Indochina. Moreover, it prohibited selling “toxic
medicine,” that was, 13 kinds of minerals, 36 plants, and 2 kinds ofanimal products used as medicine [Sặc Luật số 9/64, 1964 (Decree No.
9/64. 1964)].
(2) Post-Diem Period: Amendment of the French Colonial Law
It was after the coup against Diem in 1963 that the government andthe Ministry of Health began to consider bringing traditional medicine
into the modern medical system. In April 1964, the Ministry of Healthdecided to enact a law based on Decoux’s decree of 1943. The new act
had a new list of “toxic” medicinal products, as in Decoux’s decree;however, it only allowed practitioners to use medicinal products for twodays [Sặc Luật số 9/64, 1964 (Decree No. 9/64. 1964)].
4

Chapter 1
How to Make ‘Vietnamese Traditional Medicine’ More Vietnamese?

Behind the amendment of the 1943 decree, traditional medical
practitioners’ groups supported the idea of promoting traditional
medicine. For instance, a magazine published by medical practitioners“Đông y Dược” referred to Vietnamese traditional medicine as “A
special science for the Vietnamese” and declared that, “A decree on
July 17, 1943, by Decoux colonial government must be abolishedand replaced by a new condition for Eastern medicine in the Republicof Vietnam….” As it became more difficult to obtain medicine from
North Vietnam and China, the practitioners’ groups also claimed
that “Everybody had been united so as to repeal Decoux’s decree.
Everyone in the organization of Eastern medicine wants to reconstruct
the knowledge of Đông y, Eastern medicine” [Đông y Dược, February1957].
(3) Reorganizing Practitioners’ Occupations
At the same time, the government officially approved Dong ypractitioners within the medical system for the first time. In doing so,
the government divided medical practitioners into several professional
occupations.
Except for healers whose knowledge was transmitted throughfamily tradition (gia truyền 家伝), all types of Dong y practitioners (Đôngy sĩ 東医士, Sinh dược viên 生薬員, Thực dược viên 実薬員, and Đôngdược sĩ 東薬士) were required to have Vietnamese nationality and to beover 25 years old. They were also required to have graduated from apublic or overseas Đông y medical school that provided a license [SặcLuật số 9/64, 1964 (Decree No. 9/64. 1964)].
In other words, those qualified to prepare, sell, and examine
medicines had to have Vietnamese nationality. Merchants who sold
pharmaceuticals at the market and family-transmitted practitioners wereallowed to be non-Vietnamese.
5

Asian Medicine: Tradition and Innovation(4) Why Nationality Mattered
Why did Nationality matter? To answer this question, we must examine
the history of South Vietnam’s integration into the whole “Vietnam” thatwas caused by the strong influence of ethnic Chinese people.
The majority ethnic group in Vietnam is the Kinh, Viet people.
However, the southern part of Vietnam was not originally the Kinh
people’s land. The Viet (Kinh) political forces expanded from North to theSouth around the fifteenth century. This expansion to the South continued
until after the latter half of the seventeenth century [Li, 1998: 12–16].
Modern immigration from China to Vietnam began after the endof the nineteenth century, particularly migration from southern China
to Cochinchina, the southern part of French Indochina. One statistic in
1931 shows that more than 10% of the total population of Cochinchina
was Chinese, whereas in the Northern part of Vietnam, only 5 to 10%of the population was Chinese, and they were especially concentrated in
the Hai Phong area. It is thought that most of the overseas Chinese lived
in Cochinchina because the majority were either merchants or engaged
in the rice trade [Mantetsu East Asia Economic Survey, 1939: 55].
According to statistics from 1928, before the Indochina War, halfof the Saigon population consisted of ethnic Chinese, which totaled
approximately 319,000 people [Engelbert, 2008: 193; Li, 2011: 53].
Many of them soon engaged in the rice economy and gained power inthe market, selling rice, goods, and medicine.
During the era of division from 1954, they still had distribution
power and influence in the rice polishing industry. After the mid-1950s,
it was estimated that South Vietnam monopolized nearly 90% of nonEuropean capital [Tran, 1993: 23–28].
Against this backdrop, Diem came to power in 1955. His
administration tightened control on overseas Chinese who were Chinese
residents. The Diem administration imposed Vietnamese nationality on the6Chapter 1
How to Make ‘Vietnamese Traditional Medicine’ More Vietnamese?

residents, and imposed various restrictions on their freedom of employment
if they did not choose Vietnamese nationality. For example, Decree No. 53
was issued stating that only Vietnamese nationals were allowed to work in
11 occupations in which many Chinese people were engaging.
In tandem with this trend against the Chinese, the restriction on
Dong y practitioners’ nationality can be seen as an attempt to strengthen
the management of the Dong y industry in the southern part of thecountry. I suggest that this change in the restrictions could have beena strategy to define Vietnamese Dong y by drawing a line between
specialists of Vietnamese and non-Vietnamese nationality, as a strong
presence of Chinese people could be seen in the Dong y industry.

Fig. 3. Chinese medicine town in the largest Chinese town in Saigon
around the 1960s.
Source: Online image. Flikr. https://www.flickr.com/photos/13476480@
N07/36951531545/ by Manhhai. “CHOLON - Ngã tư Khổng Tử Phùng Hưng nhìn về ngã tư Trịnh Hoài Đức - Phùng Hưng”. Uploaded
on September 1, 2017.
7

Asian Medicine: Tradition and Innovation

We can see the Chinese influence in Dong y as follows. During the
French colonial rule, one of the major goods imported from China to
Vietnam through their commercial transactions was medicine [Mantetsu
East Asia Economic Survey, 1939: 116]. Even in 1974, the proportionof South Vietnamese capital which belonged to the Chinese was high. It
is said that the investment of Chinese capital accounted for 16% of thetotal. Among the total number of business establishments and stores,
500 business establishments of Chinese origin involved Chinese herbal
medicines, and the amount of investment in Dong y was $730,000. Theseestablishments of Chinese origin accounted for about 80% of the total
investment in Eastern medicine [Tran, 1993: 43]. For another example,
in Hue before 1975, traditional Dong y practitioners would obtain herbal
drugs from Hong Kong through an agent in Cholon, Saigon. In Dong
Nai, medicine was imported from Hong Kong via Saigon.1
When we take a look at Dong y in the official medical policy, theDiem administration and the following administration set a nationality
clause. Given the enormous Chinese influence on the medical market, thegovernment needed to differentiate Vietnamese medicine from Chinese
medicine. However, this was nearly impossible as long as the medical market
was mostly occupied by the Chinese. Therefore, it can be said that the
government differentiated the practitioners’ by their backgrounds. This wasto differentiate Vietnamese medicine as practiced by Vietnamese nationals,
for which the government could take responsibility, from non-Vietnamese(mainly Chinese) for whom the government could not take responsibility.

3. A Chinese Practitioner’s Case
To be an officially authorized Dong y practitioner, one was also
1 An interview with Lê Hữu Mạch, Dong y practitioner in Hue on December
25, 2014.
8

Chapter 1
How to Make ‘Vietnamese Traditional Medicine’ More Vietnamese?

required to have graduated from a public or overseas Dong y medical
school that provided a license [Sặc Luật số 9/64, 1964 (Decree No.
9/64. 1964)]. Individuals who wished to study Dong y overseas would
have studied either in Hong Kong or Taiwan, as these two places wereallies under the Cold War regime. In addition, there may have beensome practitioners among the elder generation who had studied inmainland China before the 1949 establishment of People’s Republic ofChina. Having said that, it does not seem as if these rules surrounding
education were strictly applied.

Fig.4. Left: Membership card of Dong y practitioners’ association.
Right: L’s clinic.
Source: Photographs taken by the author on March 15. 2016.
For example, Dong y practitioner L, who was of Chinese ethnicity
and resided in Ho Chi Minh city, recalled that his father never received
a degree at a medical school, but rather studied traditional medicine
intermittently in his youth in mainland China. L’s father was born in1928 in Fujian and moved to Beijing and Nanking. Eventually, hemoved to Saigon from mainland China in 1952. He taught mathematics,
physics, and chemistry at a British school before starting his career
as a licensed Dong y practitioner in Saigon. We do not know when heobtained Vietnamese nationality; however, he was practicing Dong y in9

Asian Medicine: Tradition and Innovation

1960 at the earliest.2

4. Conclusion
The South Vietnamese government approved and defined thelegalized Dong y practitioners by categorizing them as well as
distinguishing them according to their nationality. Ethnic Chinese
populations were targeted, as they were unable to practice advanced
medical care without Vietnamese nationality due to the professional
subdivisions which had been created, separating the professions ofdiagnosing patients and mixing medicines. This allowed the government
to recognize and manage Dong y practitioners. In the late years of the
Republic of Vietnam, the government attempted to institutionalize
Dong y primarily by professionalizing practitioners and differentiating
Vietnamese practitioners from those of other nationalities.
Although the name Dong y emerged and gained popularity
within the framework of the East/West dichotomy, this chapter has
shown that “Eastern medicine” had several meanings for Vietnamese.
Geographically, South Vietnam is far from China; however, as far as
officially establishing Vietnamese traditional medicine, or Vietnamese
Dong y was concerned, it was quite a significant and difficult problem todifferentiate it from Chinese medicine.
Acknowledgment
This research was supported by JSPS KAKENHI Grant numbers
10J03931, 19K20523 and 16H03310, and for further discussion, see:Oda, Nara, <Dento-igaku> ga tsukurarerutoki: Betonamu Iryo-seisakushi (The Making of “Traditional Medicine”: A History of Vietnam’s
Medical Policies) [In Japanese] (Kyoto: Kyoto University Press, 2022)
22 An interview with Dong y practitioner L on March 15, 2016.
10

Chapter 1
How to Make ‘Vietnamese Traditional Medicine’ More Vietnamese?

ReferencesĐông y Dược. 1957 (February).
Engelbert, Thomas. 2008. Vietnamese-Chinese Relations in Southern
Vietnam during the First Indochina Conflict. Journal of Vietnamese
Studies, 3(3), pp. 191–230.
Hoang, Bao Chau. (ed.). 1999. Vietnamese Traditional Medicine (Second
edition). Hanoi: The Gioi Publishers.
———. 2012. The Revival and Development of Vietnamese Traditional
Medicine: Towards Keeping the Nation in Good Health. In
Monnais-Rousselot, Laurence, Thompson, C. Michiele, and
Wahlberg, Ayo (eds.), Southern Medicine for Southern People:
Vietnamese Medicine in the Making. Newcastle upon Tyne:
Cambridge Scholars, pp. 113–152.
Li, Tana. 1998. Nguyễn Cochinchina: Southern Vietnam in theSeventeenth and Eighteenth Centuries. Ithaca: Cornell University
Press.
———. 2011. In Search of the History of the Chinese in South Vietnam,
1945–75. In Chan, Yuk Wah (ed.), The Chinese/ Vietnamese
Diaspora. New York: Routledge.
Mantetsu East Asia Economic Survey（満鉄調査局）. 1939. FutsuryoIndoshina ni okeru Kakyo (Chinese in French Indochina). Tokyo:
The East Asiatic Economic Investigation Bureau. [In Japanese]
Miller, Edward. 2013. Misalliance: Ngo Dinh Diem, the United States,
and the Fate of South Vietnam. Cambridge: Harvard University
Press.
Oda, Nara. 2010. Betonamu Kingendaishi ni okeru Dento-igaku:
Minzoku igaku no tanjo (‘Traditional Medicine’ in the Modern
History of Vietnam: Invention of ‘National Medicine’). Tonan
Ajia: Rekishi to Bunka (Southeast Asia: History and Culture), 40,
pp. 126–144. [In Japanese]11

Asian Medicine: Tradition and Innovation

Sặc Luật số 9/64, Ấn Định Thể Lệ Hành Nghề Đông Y Dược. (Vietnam
National Archives No.2, file PTT29.316).
Thompson, C. Michele. 2003. Medicine, Nationalism, and Revolution
in Vietnam: The Roots of a Medical Collaboration to 1945. East
Asian Science, Technology, & Medicine, 21, pp. 114–148.
Tran, Khanh. 1993. The Ethnic Chinese and Economic Development in
Vietnam. Singapore: Institute of Southeast Asian Studies.

12Chapter 2
Expansion of the Himalayan Herbal Market

Chapter 2
Expansion of the Himalayan Herbal Market:
Networks between Tibetan Medicine,the Economy, and Environmentalism
Kei NAGAOKA
1. Introduction
This study explores the expanding marketization of Himalayan
herbs associated with Tibetan medicine. From the perspective of
medical anthropology, I have studied the institutionalization of Tibetan
medicine and bodily experiences of illness in India for several years[Nagaoka, 2021]. Additionally, I have recently started working on
my new research project focusing on the marketization of Himalayan
medicinal herbs as the primary ingredients in Tibetan medicine. The
term marketization is used here to refer to the formation of an economic
network through the commercialization of goods and their distribution
over a wide area.
Tibetan medicine (bömen) [bod sman]1 refers to medical knowledge
and practices historically used by Tibetan Buddhist communities in
the Tibetan and Himalayan regions and Central Asian regions. Tibetan
medicine, like Traditional Chinese Medicine (TCM) and Ayurveda,
is a codified system that considers illness to be an imbalance of vitalelements and treats it by restoring balance using various medicinal
1 Tibetan terms are italicized and phonetically transcribed, followed by atransliteration using the standard Wylie system on the first use.
13

Asian Medicine: Tradition and Innovation

herbs and other ingredients. The basic theory of this medicinal system
is described in the authoritative medical text Gyushi [rgyud bzhi], orthe Four Tantras, codified in the twelfth century and in commentaries
on it written in later periods. Medical practitioners are called amchi [amchi] or menpa [sman pa] in Tibetan, and beginning in the seventeenth
century their medical training was conducted at Chagpori Medical
College in Lhasa and various monasteries under the patronage of theDalai Lama’s regime.

Fig. 1. Amchi (right side) and patient
Source: Image of e-book cover in Sowa Rigpa Journal #3: The Art
of Diagnosis published by International Academy for Traditional
Tibetan Medicine, 2020. (It is a partially processed painting from theseventeenth century in Tibet.)
In the late twentieth century, Tibetan medicine became known to
the Western world after the Chinese annexation of Tibetan regions in
the 1950s, when many Tibetan refugees were exiled to India and Nepal.
Western travelers, journalists, and researchers have witnessed the14Chapter 2
Expansion of the Himalayan Herbal Market

medical practices at the Tibetan refugee settlements in India and Nepal
and published books and articles about them since the 1980s. Thisknowledge and practice, which until then had been referred to simply
as “medicine” (men) [sman] among locals in their everyday lives, wasdescribed as “Tibetan medicine” or “bömen.” Having developed a newnationalist sensibility, Tibetan refugees have come to emphasize theexpertise of medical knowledge based on their culture in their diasporicsituation. However, different terms — such as “Himalayan medicine,”“traditional Bhutanese medicine,” and “Amchi medicine” — are also
used in northwestern India, Nepal, and Bhutan. These terms are deeply
related to the political position and contexts regarding the cultural
ownership of knowledge and practices in regions and countries.
Recently, a growing number of practitioners and institutions
adopted the broader term “Sowa Rigpa” (sowa rigpa) [gso ba rig
pa] translated as “science of healing.” Sowa means to enhance, feed,nourish, strengthen, heal, or cure, while rigpa refers to a field ofknowledge, science, or academic or monastic discipline [Craig &Gerke 2016: 94–95]. Sowa Rigpa is viewed as a unifying term to givethe practitioners in Tibetan and Himalayan regions a sense of belonging
in a transnational identity and to retain their diverse and more localized
subjectivities. Furthermore, after India recognized Sowa Rigpa as an
official name of a medical system in 2010, this term brought a senseof legitimacy and authority internationally. Although Tibetan and
Himalayan practitioners still debate this term, Sowa Rigpa has a brandvalue as the name of a globally circulating medical system [Craig andGerke 2016].

2. Tibetan Medicine in the Himalayan Herbal Market
Himalayan medicinal herbs, one of the unique components of15

Asian Medicine: Tradition and Innovation

Tibetan medicine, are wild alpine plants that grow in cold habitatsat altitudes of 3,000 meters or higher in the Himalayas. Well-known
varieties include Himalayan blue poppies (Meconopsis species) and
Himalayan rhododendrons (Rhododendron species), which include
the national flowers of Bhutan (Meconopsis horridula) and Nepal(Rhododendron arboretum), respectively. Historically, these plants havebeen marketized and are closely linked to the institutionalization of
Tibetan medicine.

Fig. 2. Himalayan blue poppy
Source: [Tomiyama 2020: 69]

Fig. 3. Himalayan rhododendron
Source: [Yoshida 2005: 317]

Previous studies on Tibetan medicine criticize the dichotomous
perspective of “traditional” versus “modern” and discuss theinstitutionalization, standardization, and industrialization of Tibetan
medicine in contemporary contexts [e.g., Pordié ed. 2008; Adams,
Schrempf, and Craig eds. 2010]. These studies focused on the
manufacturing of medicines as a process of pharmaceuticalization from16

Chapter 2
Expansion of the Himalayan Herbal Market

individual decoctions to mass-produced pills, as well as their connection to
Buddhist rituals and identity politics of Tibetanness [Kloos 2017a; Adams,
Schrempf, and Craig eds. 2010; Madhavan 2017]. In addition, there is
growing research on the relationship between Himalayan medicinal herbs
and the national or global markets [Blaikie 2013; Kloos 2017b; Saxer
2009, 2013].
However, these studies have yet to adequately examine the broader
historical processes of the marketization of Himalayan herbs and theirinteraction with Tibetan medicine. In contrast with these previous studies,
my study argues that the Himalayan herbal market expanded not in amonolithic and linear process of “modernization” but through multiple
networks and practices entangled with Tibetan medicine, the economy, andenvironmentalism. Specifically, the following questions are examined inthis article: Why did the marketization of Himalayan plants occur? How
was this marketization linked to Tibetan medicine? What impact does
Western environmentalism have on this market?
This study was based on research conducted intermittently between
2010 and 2016 at Tawang, an eastern Himalayan border region innortheastern India, and at two Tibetan medical institutions: the Central
Institute of Higher Tibetan Studies (CIHTS), formerly called theCentral University of Tibetan Studies (CUTS), in Varanasi, and MenTsee-Khang (MTK) in Dharamsala, both in northern India. Regarding
the structure of this article, I explain the emergence of Himalayan plant
marketization during the colonial period. I then discuss the expanding
marketization by focusing on Tibetan medicine and the practiceof collecting herbs in Tawang. Finally, I examine the relationshipbetween the marketization of Himalayan herbs, Tibetan medicine, andenvironmentalism.

17

Asian Medicine: Tradition and Innovation

Fig. 4. Map of research area
Source: It is made by the author. The upper photo was taken by the author in2015 and the lower one was used from the website of Tibetan Journal http://
www.tibetanjournal.com/tag/sowa-rigpa/ (last access date: 2022/09/02)

3. Early Marketization of Himalayan Plants in
Horticulture
Alpine plants have been commonly used in treatments and rituals
by Himalayan villagers for themselves and their livestock. Although theplants were locally distributed in the Trans-Himalayan trade between Tibet
and India, the marketization of Himalayan plants did not occur on a large
scale until India’s colonization.
Since the sixteenth and seventeenth centuries, European countries
began experiencing a horticultural boom, with botanical gardens
collecting and growing exotic plants extracted from their colonies not
only for food and medicinal purposes but also ornamentally. In theearly nineteenth century, British officials and explorers visited India and
Nepal and began surveying and collecting Himalayan plant specimens.
The Royal Botanic Gardens, Kew and other botanical gardens in the18

Chapter 2
Expansion of the Himalayan Herbal Market

United Kingdom employed plant hunters to survey the Himalayan flora,
who collected a variety of plants and sent them to the botanical garden
in Kolkata, India, which was under British control [Shirahata 2005].
For example, Joseph Dalton Hooker (1817–1911), a botanist and planthunter who later became Director of the Royal Botanic Gardens, Kew
traveled across India and the Himalayas between 1847 and 1851, collecting
specimens and seeds of 25 new Rhododendron species in the kingdomof Sikkim in the eastern Himalayas [Edwards 2022]. These evergreen
rhododendrons, with their bright red flowers, became wildly popular with
British gardeners beginning in the 1850s and later in the United States.
Numerous cultivars were created from the plants Hooker had introduced
and distributed commercially in the nursery trade.
Furthermore, in 1924, a British plant hunter named Francis (Frank)
Kingdon-Ward (1885–1958) located one of the rare blue poppies (Meconopsis
baileyi, later reclassified as Meconopsis betonicifolia) during his botanical
expedition in eastern Tibet and successfully brought a large quantity ofits seeds to England [Kingdon-Ward 1960]. In 1926, blue poppy flowers
bloomed from the seeds he collected and were shown to the public for
the first time at the Royal Horticultural Society’s Chelsea Flower Show in
London. This became a sensation in the Western horticultural world because
blue poppies had never been seen in Europe. Although botanists had been
studying blue poppies through the specimen since the nineteenth century,
public interest in them as exotic and rare horticultural plants was sparked.
With the Himalayan plant boom in horticulture through the introduction
and cultivation of colorful alpine varieties such as rhododendrons andblue poppies, Himalayan plants began being marketized through botanicalgardens, plant hunters, nurseries, and gardening enthusiasts in Westerncountries. This marketization began in the form of horticultural plants in
Europe and was closely related to the history of colonial rule. Botanicalgardens were centers for the marketization of exotic plants, establishing a
19

Asian Medicine: Tradition and Innovation

global plant network connecting sovereign and colonial countries under thepolitics and economics of colonial rule [Kawashima 1999].

Fig. 5. Chelsea Flower Show in 1926-1927
Source: Website of Gardens Illustrated
https://www.gardensillustrated.com/chelsea/history-of-chelsea-flowershow/ (last access date: 2022/09/02)

4. Marketization of Herbs as Tibetan Medicines
In the second half of the twentieth century, Himalayan plants began
to be linked to the institutionalization of Tibetan medicine. After the
WHO proposed the concept of primary healthcare and recommended
incorporating traditional medicine into national health policies, different
traditional medicine such as Ayurveda, Unani, Yoga, and Siddha were
institutionalized and protected by the Indian governmen. Regarding
Tibetan medicine or Sowa Rigpa, four medical institutions were
established by Tibetan refugees between the 1960s and 1990s. These
institutions began collecting various medicinal plants in the Himalayan
20Chapter 2
Expansion of the Himalayan Herbal Market

mountains of India to produce manufactured medicinal pills.

Fig. 6. Manufacturing Tibetan medicines in India
Source: Website of Men-Tsee-Khang
https://www.men-tsee-khang.org/index2.htm (last access date:
2022/09/02)
As the number of branch clinics of Tibetan medical institutions
increased throughout India, the medicines were used not only by Tibetan
refugees but also by regular citizens, including Himalayan Buddhists andthe Indian middle class (non-Buddhists) who took great interest in herbal
medicines and health. For the mass production of medicinal pills, Tibetan
medical institutions dispatched amchi to a broad area from northern tonortheastern India to collect alpine plants that had not yet been marketed.
In addition to the horticultural network, alpine plants were manufactured
into Tibetan medicines, expanding the distribution throughout India.
After their legalization in 2010, Tibetan medicinal pills became
subject to India’s Drugs and Cosmetics Act of 1940 and patent laws.
These laws facilitated their official entry into the global pharmaceuticalmarket, and the marketization of Himalayan herbs as medicines andhealthcare products, such as teas and cosmetics, subsequently expanded[Kloos 2017b]. Presently, the Indian government and Tibetan medical
institutions are working on the Traditional Knowledge Digital Library
21

Asian Medicine: Tradition and Innovation(TKDL) project, which aims to prevent biopiracy by foreign companies
and digitize knowledge of Himalayan herbs.
In the meantime, China has also legalized Tibetan medicine aspart of its national traditional medicine, and many institutions andpharmaceutical companies based on Tibetan medicine have emerged[Saxer 2013]. Through the pharmaceuticalization of Tibetan medicine
for the global market in both India and China, patent applications
and clinical research are on the rise [Madhavan 2017]. Thus, themarketization of Himalayan herbs in the form of Tibetan medicines
has been gradually expanding from domestic distribution to the global
market since the late 2000s.

5. The Practice of Collecting Herbs in Tawang
Through the manufacturing of Tibetan medicines, Himalayan
locals began to be more closely connected to the marketization ofthese plants, although they had been indirectly related to horticultural
marketization in their work as guides or laborers for plant hunters
during colonial times. Tibetan medical institutions must collectcertain quantities of Himalayan herbs from the mountains every
year to manufacture the various medicines in their factories, which
requires the cooperation of the locals.
In the case of Tawang, Himalayan herbs in forests and highmountain regions have generally been used in folk medicine for treating
humans and livestock, and in rituals to purify the land for peacefulcoexistence with local deities and spirits. More specifically, locals in thisarea make use of fragrant plants such as the Himalayan rhododendron(Rhododendron arboreum), the Himalayan fir (Abies spectabilis), andblack juniper (Juniperus indica). These plants are burned outside thehouse every morning for purification purposes. Additionally, when22

Chapter 2
Expansion of the Himalayan Herbal Market

plowing fields or building houses, these plants are burned as a way of
asking land deities for permission to work on the surrounding land.

Fig. 7. Fragrant plants collected for purification rituals in Tawang
Source: The photos were taken by the author in 2014
Tawang residents began forming a relationship with MTK, the Tibetan
medical institution, by collecting medicinal herbs in the 1980s. At the timeof my research, Himalayan blue poppies, Himalayan gentians (Gentiana
species), and other herbs were being collected by Thupten (a Monpa manin his 40s and amchi at the MTK branch clinic) and 20 local nuns every
year. These plants were subsequently sun-dried and processed by local
pastoralists who camped on the mountain during the summers. Thupten
then sent them to MTK’s pharmaceutical factory in Dharamsala.
Local cooperation is essential for the amchi’s work at Tibetan
medical institutions. The 20 local nuns perform this duty as a social
service, and as such they do not accept monetary compensation as atoken of his appreciation. Thupten provides each of them with a packet
of a dozen expensive medicines called rinchen rilb [rin chen rilbu]
or “precious pills” containing various plants, minerals, and precious
jewels that is blessed by the Dalai Lama in a ritual, in addition to freemeals during their work of collecting herbs. Furthermore, Thupten
23

Asian Medicine: Tradition and Innovation

pays local pastoralists with money as a reward, and he also exchanges
homemade wine fermented with barley, finger millet, and vegetables forthe pastoralists’ homemade cheese and butter based on the traditionalbarter system in Tawang. Thus, locals play an important role in the
expanding marketization of Himalayan herbs as medicines through thecontemporary institutionalization network of Tibetan medicine.

Fig. 8. Amchi (right side) diagnosing a patient at an MTK branch clinic in Tawang
Source: The photo was taken by the author in 2011

6. Himalayan Herbs as Biological Resources
In addition to the horticultural and medicinal networks, theHimalayan herbal market encountered Western environmentalism in
the late twentieth century. Environmental activists have emphasizedthat Himalayan herbs are endangered biological resources andhave started to intervene in the market networks for horticulturaland medicinal products to prevent overexploitation. International
environmental groups such as the World Wildlife Fund (WWF) and24

Chapter 2
Expansion of the Himalayan Herbal Market

The Mountain Institute (TMI) have begun projects for cultivating
medicinal and aromatic Himalayan herbs to transform markets andprotect the environment.
The Western framework for environmental thought is said tohave undergone a major shift in the late 1960s and 1970s, from oneof nature conservation for human interests to environmentalism
as a broad philosophy, involving actions and policies that show
concern for protecting and preserving the natural environment for
its own sake.2 After the Himalayan region was named a biodiversity
hotspot, Western environmentalists grew increasingly interested
in the region’s flora and fauna in the 1980s. The term biodiversity
hotspot was proposed in 1988 by Norman Myers, a British
environmental scientist, to designate areas with over 1,500 endemic
plant species, but where over 70% of the original habitat had been
lost and therefore where conservation was of high importance[Myers et al. 2000]. Conservation International (CI) selected 34
hotspots worldwide and emphasized the need for conservation
efforts. International environmental groups began surveying
Himalayan plants as significant biological resources requiring
protection, designating many of them as endangered [Singh et al.
2021].
Given this backdrop, Tibetan medical institutions could not ignore
the new environmentalist view of Himalayan herbs. By taking it
into account, they aimed to show the global value and reliability of
their manufactured pills based on Tibetan medicine in the health and2 Kay Milton [1993] pointed out that environmentalism is essentially aquest for a viable future pursued through the implication of culturally defined
responsibilities. According to her, these responsibilities arise from the recognition
that “the environment,” as the complex of natural phenomena which we sharewith the universe and on which we depend, is affected by human activity and that
controlling the activity will secure a viable future [Milton 1993: 2–3].
25

Asian Medicine: Tradition and Innovation

pharmaceutical markets. These institutions started projects to cultivate
Himalayan herbs in the late 2000s in the Indian regions of Tawang and
Ladakh.3

Fig. 9. Mountain forest around villages in Tawang
Source: The photo was taken by the author in 2015

7. Cultivating Herbs for Creating a Sustainable Market
Projects to cultivate Himalayan wild herbs have created a network
between the Indian government, Tibetan medical institutions, andTawang locals. CIHTS started a project entitled “Establishment andDevelopment of Medical Herbal Garden (EDMG), Tawang” in 2008
by means of a government grant, with the following objectives: (1) toconserve endangered species by establishing techniques for cultivating
medicinal plants, (2) to standardize the quality of herbal medicines
3 Ladakh is a western Himalayan border area located in northwestern India.
26

Chapter 2
Expansion of the Himalayan Herbal Market

to ensure their stable supply, regardless of climate change, and (3) tocreate a mechanism for villagers to earn cash incomes through thecultivation of medicinal plants, thereby contributing to the social andeconomic development of the northeastern region of India, which isconsidered underdeveloped. In other words, it is a long-term project
involving measures for coping with environmental changes, marketizing
medicines, and protecting local livelihoods, such as ensuring a stablesupply of medicines and returning profits to the locals.
CIHTS’s amchi researched plants in Tawang and hired a village
resident who was knowledgeable about local medicinal herbs.
After building herbal gardens at three different altitudes, they begancultivating Himalayan medicinal plants and comparing their growth.
They cultivated 15 species in 2010, which increased to 131 in 2014.
These plants were selected based on their prices in the Chinese herbal
market, as alpine plants used in Tibetan medicine fetch high prices in
China. At the time of my research, this cultivation project was still in
the preliminary stage, consisting of the amchi and only four locally
employed people. Teachers and students also participated in the projectto experiment with planting herbs at their schools.

Fig. 10. Cultivation project of Tibetan medicinal herbs in Tawang
Source: The photos were taken by the author in 201427

Asian Medicine: Tradition and Innovation

Currently, the Himalayan region is an important experimental
ground for testing the compatibility between environmental protection
and the economy for the government, Tibetan medical institutions, andenvironmental activists through herb cultivation projects. For residentsof Tawang and other Himalayan areas, this practice of cultivatingwild herbs was a different experience compared to the environmental
movement in earlier decades. Previous environmental movements, suchas the anti-dam movement, involved people fighting the government andcompanies to prevent them from depriving them of their livelihoods.
However, in the case of the Himalayan herb cultivation project, they
are required to participate and collaborate through a project managed
by the government and institutions. Unlike agricultural development
projects for cultivating cash crops, the basic framework for cultivatingwild Himalayan herbs remains unclear. Negotiations between locals,
the government, and institutions are ongoing in order to establish
sustainable Himalayan herbal markets.

8. Conclusion
Multiple networks for Himalayan herbs have expanded during their
historical process of marketization. The herbs first attracted interestas rare horticultural plants not found in Europe, which expanded thehorticultural network to include botanical gardens, plant hunters,
nurseries, and gardening enthusiasts in Western countries during colonial
times. Since the late twentieth century, Himalayan herbs have become
important ingredients in medicinal pills manufactured by Tibetan
medical institutions, which formed a network of medicines between
professional institutions, medical practitioners, and locals. Furthermore,
Himalayan herbs were defined as endangered biological resources fromthe perspective of biodiversity hotspots, leading to the formation of a28

Chapter 2
Expansion of the Himalayan Herbal Market

network for wild herb cultivation involving environmental activists, thegovernment, Tibetan medical institutions, and locals. The contemporarytransformation of Tibetan medicine is closely related to the historicalmarketization process of Himalayan herbs and their multiple networks.
These broad networks connect with various actors, including not
only professionals but also laypeople engaging with these Himalayan
herbs as horticultural plants, medicines, and biological resources. The
expansion of these networks has created a transnational negotiation
between Tibetan medicine, the economy, and environmentalism in the
Himalayas.
Acknowledgments
This research was supported by a Grant-in-Aid for JSPS Research
Fellows (14J02820 and 20J00336) and a research grant from the Kyoto
University Foundation in 2013.

References

Adams, Vincanne, Schrempf, Mona, and Craig, Sienna (eds.). 2010.
Medicine between Science and Religion: Explorations on Tibetan
Grounds. Oxford, New York: Berghahn Books.
Blaikie, Calum. 2013. Currents of Tradition in Sowa Rigpa Pharmacy.
East Asian Science, Technology and Society: An International
Journal, 7(3), pp. 425–451.
Craig, Sienna R. and Gerke, Barbara. 2016. Naming and Forgetting:
Sowa Rigpa and the Territory of Asian Medical Systems. Medicine
Anthropology Theory, 3(2), pp. 87–122.
Edwards, Ambra. 2022. The Plant Hunter’s Atlas: A World Tour of
Botanical Adventures, Chance Discoveries and Strange Specimens.
London: Greenfinch.
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Kawashima, Akio. 1999. Shokubutsu to Shimin no Bunka (Culture of
Plants and Citizens). Yamakawa Shuppansha Ltd. [In Japanese]
Kingdon-Ward, Frank. 1960. Pilgrimage for Plants. With a BiographicalIntroduction and Bibliography by William T. Stearn. London:
George G. Harrap.
Kloos, Stephan. 2017a. The Politics of Preservation and Loss: Tibetan
Medical Knowledge in Exile. East Asian Science, Technology andSociety: An International Journal, 11(2), pp. 135–159.
———. 2017b. The Pharmaceutical Assemblage: Rethinking Sowa
Rigpa and the Herbal Pharmaceutical Industry in Asia. Current
Anthropology, 58(6), pp. 693–717.
Madhavan, Harilal. 2017. Below the Radar Innovations and Emerging
Property Right Approaches in Tibetan Medicine. The Journal ofWorld Intellectual Property, 20(5-6), pp. 239–257.
Milton, Kay. 1993. Environmentalism and Anthropology. In Kay Milton(ed.), Environmentalism: The View from Anthropology. London:
New York: Routledge, pp. 1–17.
Myers, Norman, Mittermeier, Russell A., Mittermeier, Cristina G., daFonseca, Gustavo A. B., and Kent, Jennifer. 2000. Biodiversity
Hotspots for Conservation Priorities. Nature, 403, pp. 853–858.
Nagaoka, Kei. 2021.Yamai to Kusuri no Kosumorojī: Himāraya Tōbuni okeru Chibetto Igaku, Hyōi, Yōjutsu no Minzokushi (Cosmology
of Illness and Medicines: An Ethnography of Tibetan Medicine,
Possession, and Witchcraft in Tawang, Eastern Himalaya).
Yokohama, Japan: Shumpusha Publishing. [In Japanese]
Pordié, Laurent (ed.). 2008. Tibetan Medicine in the Contemporary
World: Global Politics of Medical Knowledge and Practice.
London: Routledge.

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Saxer, Martin. 2009. Herbs and Traders in Transit: Border Regimes andthe Contemporary Trans-Himalayan Trade in Tibetan Medicinal
Plants. Asian Medicine, 5, pp. 317–339.
———. 2013. Manufacturing Tibetan Medicine: The Creation of an
Industry and the Moral Economy of Tibetanness. New York:Berghahn Books.
Shirahata, Yōzaburō. 2005. Puranto Hantā (Plant Hunter). Tokyo:
Kodansha. [In Japanese]
Singh, Chhaya, Chauhan, Neha, Upadhyay, Sushil Kumar, Singh,
Raj, and Rani, Anju. 2021. The Himalayan Natural Resources:
Challenges and Conservation for Sustainable Development.
Journal of Pharmacognosy and Phytochemistry, 10(1), pp. 1643–
1648.
Tomiyama, Minoru. 2020. Aoi Keshi: Mekonopushisu. (Blue Poppies:
Meconopsis in the Wild). Tokyo: Bun-ichi Co.,Ltd. [In Japanese]
Yoshida, Toshio. 2005. Himaraya Shukubutsu Daizukan. (Himalayan
Plants Illustrated). Tokyo: Yama-kei Publishers Co., Ltd. [InJapanese]31Asian Medicine: Tradition and Innovation

Chapter 3
Transplanting Chinese Medicine in Early
Modern Japan: Immigrant Doctors in
Nagasaki and the Flourishing of a Japanese
Clinic in Osaka
Jingjing XIANG
1. Introduction
Early modern Japanese medicine
had a close relationship with the
medicine of the Ming and Qing
Dynasties. Given this relationship,
the first phase was the migration of
medical practitioners during the MingQing transition [Nakamura,1914; Li,1999], and the second was during
Yoshimune Tokugawa’s regime [Oba,1980]. First, during the 40 years of
turmoil that followed the fall of the
Ming Dynasty in China, many doctors
came to Japan to escape the war [Xu,2018]. They worked in Nagasaki andother places. It was suggested thatFig.1. Harbor of Chinese Boats in Nagasaki (Painted by Hiroshige Utagawa II)
Source: National Diet Library Digital Collections <https://dl.ndl.go.jp/
info:ndljp/pid/1309786>
32

Chapter 3
Transplanting Chinese Medicine in Early Modern Japan

there was a network that made this possible.
Yoshimune Tokugawa 徳川吉宗, who became shogun in 1716,
actively introduced books and other Chinese cultural relics to Japan
from 1720, and sent a variety of orders to Nagasaki. Thus, many
doctors came to Japan during the Kyoho Era (1716–1736) based on
Yoshimune’s order, which attracted Chinese doctors who were excellent
in both learning and treatment [Oba, 1980: 35–36; 184–186].
In addition, it should be noted that during the Ming and Qing
dynasties, as well as the period of the Yoshimune administration, mostof the doctors came from Suzhou, Ningbo, and Fujian which were theports from which Chinese ships set sail.

Fig.2. Chinese Settlement
Source: National Diet Library Digital Collections <https://dl.ndl.go.jp/
info:ndljp/pid/1307088>

33

Asian Medicine: Tradition and Innovation

2. Shanghan Lun

Fig.3.Title Page of Shanghan Lun Published in the Edo Period
Source: Kyoto University Rare Materials Digital Archive <https://rmda.kulib.
kyoto-u.ac.jp/item/rb00003125>

Among the ports from which Chinese ships embarked, Suzhou andNingbo were the most advanced areas in medicine at that time.
Many famous doctors worked there and focused on the research of
Shanghan Lun (Treatise on Cold Damage Diseases 傷寒論), a famous
Chinese medical Masterpiece edit by Zhang Zhongjing 張仲景 [Wu etal., 2000: 16–17].
This book was brought to Japan and had a great influence on
Japanese medicine and pharmacology [Mayanagi, 1997]. It is no34

Chapter 3
Transplanting Chinese Medicine in Early Modern Japan

exaggeration to say that Shanghan Lun is one of the most important
medical books for Japanese Kampo medicine even today.

Fig. 4. Zhang Zhongjing
Source: Baidu BaikeFor example, Tsumura Corporation, a pharmaceutical company
formulates many of its current products, including the popular Kakkonto,
based on Shanghan Lun.

Fig. 5. Kakkonto
35

Asian Medicine: Tradition and Innovation

Presently in Japan, a clinical trial of Kampo medicine is being
conducted for the treatment of Coronavirus disease (COVID-19),1 and it
is said that many of the herbal medicines used for the treatment of mildcases are also based on the Shanghan Lun.
From the above, in early modern Japan, Zhang Zhongjing’s works
were propagated by these people, which led to the flourishing of thestudy of Shanghan Lun. Consequently, early modern Japanese medicine
was established under these communications in East Asia.
The Chinese doctors first landed in Nagasaki and began their
medical practices. They not only discovered drugs and interpreted
Chinese medical books, but also devoted themselves to medical
treatment and communicated with Japanese doctors. In this way, theMing and Qing doctors left behind significant achievements in thehistory of medical exchange between China and Japan. They played
an important role in the development of medicine in early modern
Japan.

3. Yushoshi Kitayama’s Research of Shanghan Lun
Let us examine the impact this movement of doctors and medical
books had on Japanese medical thought. As an example, I will make abasic study of the medicine of one of the children of a Ming physician,Yushoshi Kitayama 北山友松子 (1640–1701), the son of Chinese medicalfamily who promoted original medical research by using this network.
He studied in Nagasaki and built a clinic in Osaka.
Yushoshi Kitayama, also known as Juan 寿庵, was the son of Ma
Rongyu 馬栄宇 (?–1654) and a prostitute in Maruyama, Nagasaki. Ma
was an exile from the Ming’s Fujian Prefecture who came to Japan
1 https://www.yomiuri.co.jp/medical/20210729-OYT1T50443/ Viewed
October 23, 2021.
36

Chapter 3
Transplanting Chinese Medicine in Early Modern Japanbetween 1624 and 1627 to avoid thewar and chaos at the end of the Ming
Dynasty [Hong, 2017: 132]. He wasactive as a herbalist and stayed inJapan for around thirty years, where
he engaged in importing Chinese
medical books and Chinese herbal
medicine, and providing medical
treatment to the public.
In 1627, he was appointed tothe post of Totsuji 唐通事 by the
Shogunate. In the process of buildingt h e S o f u k u - j i Te m p l e 崇福寺 i n
Fig. 6. Yushoshi as a baby with his Nagasaki, he traveled between Fujian
motherand Nagasaki several times, and madeSource: Kinsei Kijinden, 212
great efforts to build this temple.

Fig. 7. Sofuku-ji Temple in Nagasaki
Source: © NPTA <https://www.nagasaki-tabinet.com/houjin/photo/284>

37

Asian Medicine: Tradition and Innovation

Being born into such a bilingual family environment, Yushoshi wasfluent in both Chinese and Japanese and also used the Fujian dialect
fluently. From an early age, he visited many Chinese immigrant doctors
in Nagasaki to learn from them. In the spring of 1660, he met the Fujian
monk Shoei Kerin 化林性偀 who was naturalized in Japan, and as he
was impressed by Shoei Kerin’s medical skills, he decided to study
Shanghan Lun under him [Asada, 1880].
Besides Kerin, Yushoshi also learned Huangdi Neijing 黄帝内経
and herbology from Shoeki Dokuryu 独立性易. He was also learning
Japanese traditional medicine from Japanese doctors. It can be inferredthat Yushoshi was also taught the Fujian local medicine by his father
Ma, as well as his teacher Kerin. In this way, he would have been able
to interact smoothly with the Chinese doctors who came to Nagasaki,
and would have grasped the situation of the latest medical science andmedical books in China at the same time [Asada, 1880].

Fig. 8. Shoeki Dokuryu (Painted by Nobumitsu Kurihara)
Source: National Diet Library Digital Collections <https://dl.ndl.go.jp/
info:ndljp/pid/1287846>
38

Chapter 3
Transplanting Chinese Medicine in Early Modern Japan

After mastering various medical techniques, Yushoshi settled in
Doshomachi 道修町 in Osaka, where he opened a clinic and was well known
in Osaka for his erudition and knowledge at that time. In addition to helping
the daimyo of each clan to cure their diseases, he also helped the poor
people to treat their diseases for free. In addition, he gave rice to the poor
people. For this reason, he was called the “physician sage” at that time.

Fig. 9. Text page of Kitayama Ian
Source: National Diet Library Digital Collections <https://dl.ndl.go.jp/
info:ndljp/pid/2567920?tocOpened=1>

Before his death, he installed a life-size stone statue of Fudo Myoo
不動明王 at Taiheiji 太平寺 in Tennoji-ku, Osaka, where he was buried
after his death. He left many professional works, including Kitayama
Ian 北山医案, etc. In particular, Kitayama Ian is a representative workof his own clinical trials. After his death, this work was edited by his
grandson, Doshu Kitayama 北山道脩 and published in 1745. This book39

Asian Medicine: Tradition and Innovationis considered as a great collection of Yushoshi’s actual clinical skills.
Moreover, Yushoshi also added his commentaries and supplements tomedical works written by Japanese and Chinese doctors. According to
his books, he cited and emphasized the medical practice of Four Great
Medical Experts In Jin & Yuan Dynasty,2 and he placed particularemphasis on the prescriptions in Zhang Zhongjing’s Shanghan Lun[Yasui, 2014].

Fig. 10. A life-size Stone Statue of Fudo Myoo with Yushoshi in Taiheiji Temple
Source: Photo by author

Fig.11. Taiheiji Temple in Tennoji-ku, Osaka
Source: Photo by author
22 Zhu Danxi 朱丹渓, Li Dongyuan 李東垣, Xue Ji 薛已, and Yu Chang 喩昌.
40

Chapter 3
Transplanting Chinese Medicine in Early Modern JapanThe studies of Huangdi Neijing were widely read among theJapanese doctors at that time, but the Shanghan Lun did not attract muchattention. At that time, the medical science of Li Dongyuan 李東垣 and
Zhu Danxi 朱丹渓 was extremely influential. However, Yushoshi neverstuck to contemporary Ming medicine techniques; he actively studied
the Shanghan Lun and tried to set Zhang Zhongjing’s medicine as thestandard.
From the sixteenth to seventeenth century, there was a boom inthe study of Shanghan Lun in China, and many research books were
written and published. Among them, for example, such as Shang Han
Shang Lun Pian 傷寒尚論篇 and Shang Hanlun Houtiao Bian 傷寒論後条弁 were brought to Nagasaki through trade and the arrival of Chinese
doctors. Due to their relationship with his father Ma Rongyu, Yushoshi
had a lot of contact with the Chinese doctors who came to Nagasaki
during the time he was living there, and he would have been able toobtain information on the new medical books imported from China
at the earliest possible time. In addition, according to the research of
Hiromichi Yasui 安井廣迪, the number of reference books that Yushoshi
listed among his books was enormous, and he often read even the latest
medical books at that time [Yasui, 2014]. In this way, he paid attention
to Shanghan Lun earlier than other doctors of the Original Chinese
Medical Treatment. According to his records, he treated diseases suchas fever, pox, and syphilis, and most of his patients were from the Kinki
region, including Ki-shu, Osaka, Kyoto, Hyogo, and Kawasu.
As we have seen above, Yushoshi’s medicine incorporated the latest
Chinese medicine of his time in China. In particular, it can be said that
his emphasis on the Shanghan Lun, which Japanese doctors at the time
had not yet emphasized, was revolutionary. This was deeply related tohis early understanding of the research situation of the Shanghan Lun in
the Ming Dynasty and the research books on the Shanghan Lun that had
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Asian Medicine: Tradition and Innovation

come to Nagasaki, as well as the background of the communication on
medicine between China and Japan.

4. Conclusion
As we have shown in this article, when considering the relations
between Ming and Qing medicine and early modern Japanese medicine,the role played by doctors, Ming vassals, and Qing Chinese doctors whocame to Japan during the Ming-Qing transition and Yoshimune period,in addition to the arrival of medical books, are worthy of attention,
especially the existence of this network between Chinese doctors andJapanese doctors. Yushoshi’s medicine, which is presented in thischapter as an exploratory study, was cultivated through a close networkwith Ming vassals.
Furthermore, the results of these Sino-Japanese medical exchanges
were not completed only in Japan. Interestingly, Chen Cunren 陳存
仁 (1908–1990), a modern Chinese physician, traveled to Japan andcollected 93 Japanese books on Chinese medicine, which he publishedin China in 1936 as Huanghan Yi Xue Cong Shu 皇漢医学叢書, andKitayama Ian 北山医案 was included in this book. In other words,
Yushoshi’s medicine was returned to China.

References

Asada, Sohaku. 1880. Sentetsu Iwa. Kyoto University Rare Materials
Digital Archive.
Ban, Kokei and Mori, Senzo. 1940. Kinsei Kijin-den (Biographies ofModern Eccentrics). Tokyo: Iwanami Shoten.
Hong, Tao. 2017. Kampo-i Ma Rongyu no Kenkyu (A Study of Ma
Rongyu, a Medical Doctor from China). KGU Hikaku Bunka
42

Chapter 3
Transplanting Chinese Medicine in Early Modern Japan

Ronshu (The KGU Journal of Comparative Cultural Studies), 8,
pp. 125–153
Li, Jingwei, 1999. History of Medical Exchange between China andForeign Countries. Hunan: Hunan Education Press.
Matsuura, Akira. 2009. Kaigai Johou kara miru Higashi Ajia (East Asia
from Overseas Information). Osaka: Seibundo Shuppan.
Mayanagi, Makoto. 1997. Edo-ki Torai no Chugoku Isho to sono
Wakoku (Chinese Medical Books Introduced to Japan in the Edo
Period and Their Japanese Engravings). In Yamada, Keiji andKuriyama, Shigehisa (eds.), Rekishi no Naka no Yamai to Igaku(Disease and Medicine in History). Kyoto: Shibunkaku Shuppan.
Nakamura, Kyusiro. 1914. Kisei Shina no Nihon Bunka ni Oyoboshitaru
Seiryoku Eikyo (The Influence of Modern China in Japanese
Culture). (Series 6). Shigaku Zashshi (Historical Journal), 25(10).
Oba, Osamu. 1972. Hakusai Shomoku (List of Chinese Books imported
to Japan in Edo Period). Osaka: Institute for Cultural Interaction
Studies, Kansai University.
———. 1980. Edo Jidai no Nitchu Hiwa (Japanese-Chinese Secret
Story of the Edo Period). Tokyo: Touhou Shoten.
Wu, Zhongping and others. 2000. Influence of Famous Practitionersof Febrile Diseases in the South Region of Yangtze River in the
Ming and Qing Dynasties on Classic Formula School of Chinese
Medicine in Japan. Journal of Shanghai University of Traditional
Chinese Medicine, 14(4), pp. 16–19.
Xu, Xingqing and Liu, Zufeng (eds.). 2018. East Asian Cultural
Exchange in the 17th Century. Taipei: Taida Chuban Zhongxin.
Yasui, Hiromichi. 2014. Kinsei Kampo Chiken Senshu 5 Kitayama
Yushoshi (The Selection of Clinical Trial of Early Modern Chinese
Medicine 5, Kitayama Yushoshi). Tokyo: Meicho Shuppan.

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Asian Medicine: Tradition and Innovation

Chapter 4
Scientific Study of Wedang Secang as
Indonesian Traditional Drink
Dinia Rizqi DWIJAYANTI
1. A Short History of Wedang Secang
Secang (sappan wood; Caesalpinia sappan L.) is a native plantof China, India, Malaysia, Myanmar, and Thailand (the green area in
Figure 1), while it is an exotic plant in Indonesia, Papua New Guinea, thePhilippines, the Solomon Islands, Sri Lanka, Taiwan, and the US. Initially,
the red coloring of sappan wood was widely used as a natural dye. Thensappan wood is believed to have been used as a traditional medicine toincrease stamina, to warm the body during cold weather, and sometimes
to prevent colds. With these benefits, it is not surprising that since theseventeenth century, sappan wood was included among the popular spicecommodities exported from Southeast Asian nations (especially Thailand)
aboard by Shuinsen (trading ships licensed by the shogunate) to Japan.

Figure 1. The distribution of sappan wood worldwide
Source: [Orwa et al., 2009]44

Chapter 4
Scientific Study of Wedang Secang as Indonesian Traditional Drink

In Indonesia, sappan wood has been used as the main ingredientof wedang secang (Figure 2). Wedang secang is a traditional red
drink that comes from the natural dye of sappan wood and has a fresharoma. Wedang secang consists not only of sappan wood but also
other herbal plants such as small ginger (Zingiber officinale var.),cinnamon (Cinnamomum verum J. Persl), and lemongrass (Cymbopogon
flexuosus). Wedang secang is a typical drink from Trowulan, Mojokerto,
East-Java, Indonesia. Wedang secang also became the favorite drink of
the kings in the Majapahit Kingdom.

Figure 2. Wedang secang
Source: Shutterstock.com/Ariyani Tedjo

2. Wedang Secang, Local Wisdom and the Problem
Indonesia is rich not only in biodiversity but also in local wisdom.
One such traditional custom is the consumption of wedang secang in
local communities. Wedang secang can be served hot or cold as needed.
In the rainy season, wedang secang is delicious when served as a hot
drink that makes the body feel fresh and warm. Wedang secang can
45

Asian Medicine: Tradition and Innovation

also be served cold during the day in the hot season. In the midst of thedominance of drinks with various types and brands, this traditional drink
is still very much in demand, because apart from being a traditional
heritage, wedang secang is believed to be highly beneficial for health.
This drink is traditionally used to warm the body, relieve a sore throat,
treat diarrhea, and enhance the immune system. Recently, this drink
has also been one of the drinks chosen to enhance the immune system
during the COVID-19 pandemic in Indonesia.
Uniquely, in the past, this drink was said to only have been enjoyedby relatives of the royal family. However today, wedang secang canbe enjoyed by all levels of society and is even served to teenagers inmodern cafes. It can be bought very easily and is widely traded in an
instant tea-bag form. While such products are distributed from large
factories, there is also a growing home industry. Nowadays, everyone
is free to mix their own wedang secang using the ingredients that are
widely available in the traditional market. The type and amount of
the ingredients used to make wedang secang also vary from region
to region, even among the sellers of the wedang secang concoctions.
Wedang secang can be made by simply washing all the ingredientsneeded until clean, and then boiling them over a low flame so that thesubstances contained can be completely extracted. After the mixture
becomes brown and smells good, sappan wood is added and the pot iscovered until the water boils and turns reddish. As a sweetener, sugar orhoney can be added according to taste.
Unfortunately, the widespread production of wedang secang by alarge number of undocumented sources has become a big problem inthis modern era. Many people are starting to doubt its efficacy, and areworried about its possible toxicity because, as explained above, there
is no standard recipe, and its composition, and dosage have not beenmeasured accurately.
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Chapter 4
Scientific Study of Wedang Secang as Indonesian Traditional Drink

3. Scientific View of Crude Drugs
Besides synthetic drugs, the use of crude drugs has long been
popular in the community. Based on a scientific view, before use, crude
drugs have to pass several tests. The first is the efficacy test which canlater be used to determine indications or claims of their benefits. The
second is the study or isolation of the active compounds, which is not
only to know what active compounds are responsible for the healingmechanisms, but also to find out the contraindications of the compounds
contained in them. The third is the toxicity test which is very important
to determine the right dosage because the use of crude drugs with anincorrect dosage can be toxic and damage our organs such as the liverand kidneys which function to filtrate toxins in the body. These threetests are important to do as a preliminary study before making anefficacy claim for some crude drugs.

Figure 3. The classification symbols in the packaging of thecrude drugs in Indonesia
Source: [BPOM, 2004]
In Indonesia, three different levels of crude drugs have been announced
by the Food and Drug Monitoring Agency (Badan Pengawasan Obatdan Makanan; BPOM), namely (Figure 3): traditional medicines(including jamu), standardized herbal medicines (obat herbal terstandar;
47

Asian Medicine: Tradition and Innovation

OHT) and phyto-pharmaceuticals (fitofarmaka). We will discuss theircriteria in the following parts.
(1) Traditional Medicines (Jamu)
Traditional medicine is derived from plants, animal materials,
and mineral materials, or preparations of extracts or mixtures of thesematerials, which have been used for generations for treatment. Jamu
is one example of a form of traditional medicine. Jamu must meet thefollowing criteria:
1. It is safe in accordance with the requirements set.
2. Claims of efficacy are proven based on empirical data.
3. It meets the applicable quality requirements.
4. The type of claim of use must begin with the words: “Traditionallyused for …”
In jam u the r e s hould be no c la im s o f eff i cacy u s i n gpharmacological/medical terms such as jamu for hypertension, jamu
for diabetes, jamu for hyperlipidemia, jamu for tuberculosis etc.
(2) Standardized Herbal Medicines (OHT)Standardized Herbal Medicines (OHT) are crude drugs that havebeen scientifically proven to be safe and effective by preclinical testing(on experimental animals) and the raw materials have been standardized.
OHT must meet the following criteria:
1. It is safe in accordance with the requirements set.
2. Claims of efficacy are scientifically proven / preclinical (inexperimental animals).
3. Standardization of raw materials used in finished products has
been carried out.
4. It meets the applicable quality requirements.

48

Chapter 4
Scientific Study of Wedang Secang as Indonesian Traditional Drink(3) Phyto-pharmaceuticals (fitofarmaka)Phyto-pharmaceuticals are natural medicines that have beenscientifically proven to be safe and effective by means of pre-clinicaltests (on experimental animals) and clinical trials (on humans),
standardized raw materials and finished products. Phytopharmaceuticals
meet the following criteria:
1. They are safe in accordance with the requirements set.
2. Claims of efficacy have been proven scientifically/pre-clinical (inanimals) and clinically (in humans). Indeed, phyto-pharmaceuticals
are crude drugs that are prescribed by doctors considering that they
have been tested on both animals and humans.
3. Standardization of raw materials used in finished products has
been carried out.
4. They meet the applicable quality requirements.
5. The type of claim for use is in accordance with a medium to highlevel of evidence.
Based on these classifications, currently research on the certificationof jamu is aimed at bringing the level of jamu to OHT (as minimum
target) or phyto-pharmaceuticals (in long term) so that it can be usedsafely. Unfortunately, this classification is not widely known by the
public, especially in traditional communities, even though it is very
important to understand before using the crude drug itself, and thisincludes the use of wedang secang which is under the traditional
medicine classification (jamu) and has also been one of the local
wisdoms in Indonesia since the seventeenth century. Scientific studies
are not intended to abolish local wisdom, rather, the scientific studyof wedang secang is actually important for the preservation of local
wisdom. It is hoped that in the future people can continue to enjoy
wedang secang safely.
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Asian Medicine: Tradition and Innovation

4. Scientific Study of Wedang Secang
As I have explained, wedang secang is a kind of jamu which
consists of several herbal compositions, namely: sappan wood
(Caesalpinia sappan L.), small ginger (Zingiber officinale var.),cinnamon (Cinnamomum verum J. Persl), and lemongrass (Cymbopogon
flexuosus). Therefore, each of these plants is thought to provide efficacy
that may work synergistically to provide the efficacy of wedang secang
as claimed empirically by the traditional community. Here we will
discuss the efficacy of each plant and its popular active compounds toelucidate the possible mechanism of action of wedang secang according
to the scientific view.
(1) Sappan Wood (Secang; C. sappan L.)
Pharmacological researches have revealed that sappan woodhas many bioactivities, such as the inhibition of melanin production,
anti-inflammation, antioxidant and antibacterial effects, and immune
regulation. In addition, the ethyl acetate, methanol, and water extractsof sappan wood exhibit strong antioxidant activity by the method of
DPPH and nitric oxide. It has also been reported that the extract ofsappan wood inhibits cancer cells in vitro and in vivo. It has also beenfound that methanolic and 50% ethanolic extracts of sappan woodshowed inhibitory effects on Propionibacterium acnes and lipase
activity. Chemical constituents and pharmacological investigations ofsappan wood showed that the main bioactive components of sappan
wood were phenolic compounds such as brazilin and sappanchalcone(Figure 4).

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Chapter 4
Scientific Study of Wedang Secang as Indonesian Traditional Drink

Figure 4. The chemical structure of Brazilin and Sappanchalcone
Brazilin has potential pharmacological properties such as anti-tumor,
anti-cancer, anti-inflammatory, anti-diabetic, and immunostimulant
effects. Brazilin, the principle component of sappan lignum has beenfound to exhibit hypoglycemic properties and to increase glucose
metabolism in diabetics rats. It improved glucose metabolism in cultured
rat hepatocytes, and also increased basal glucose transport in 3T 3L1
fibroblasts and adipocytes, but insulin stimulated glucose transport was
not influenced. It was also found that brazilin possessed a stronger antiinflammatory effect than hematoxylin and berberine hydrochloride.
Brazilin also exhibited hypoglycemic effect in diabetic animals throughamelioration of glucose metabolisms in insulin-responsive tissues.
Another study also found that brazilin could reduce the BrCCl3-induced
toxicities on hepatocytes and depress BrCCl3-induced microsomal
calcium sequestration.
Not only brazilin, but also sappanchalcone contained in sappan
wood is responsible for its anti-inflammatory properties. In therheumatoid arthritis mice model, the levels of pro-inflammatory
cytokines (TNF-α, IL-6, and 1L-1β) were significantly lower in theserum of sappanchalcone-treated mice as compared with the control
group and suggest that sappanchalcone could be used as an antiinflammatory and bone-protective agent. Another research showed theanti-cancer properties of sappanchalcone isolated from sappan wood.
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Asian Medicine: Tradition and Innovation

Based on that data, sappanchalcone treatment decreased the proliferationand further promoted apoptosis in HCT116 cells compared with thefindings in SW480 cells. Sappanchalcone triggered phosphorylationof p53, which is involved in the activation of caspases and increased
expression of Bax in HCT116 cells.
(2) Small Ginger (Jahe emprit; Z. officinale var.)
In recent years, ginger has been found to possess biologicalactivities, such as antioxidant, anti-inflammatory, antimicrobial,
and anti-cancer activities. In addition, accumulating studies havedemonstrated that ginger possesses the potential to prevent and manage
several diseases, including neurodegenerative diseases, cardiovasculardiseases, obesity, diabetes mellitus, chemotherapy-induced nausea
and emesis, and respiratory disorders. As grounds for these efficacies,
many bioactive compounds in ginger have been identified, suchas phenolic and terpene compounds. The phenolic compounds aremainly Gingerenone-A, gingerols, shogaols, quercetin, zingerone,
6-dehydrogingerdione and paradols which have the responsibility forthe various bioactivities of ginger.

Figure 5. The chemical structure of Gingerenone-A and [6]-Paradol
Photographic and quantitative assessments of intracellular lipid
content by Oil red O staining revealed that Gingerenone-A (Figure5) had the most potent anti-adipogenic effect of the tested ginger
compounds at the same concentration without affecting cell viability. The
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Chapter 4
Scientific Study of Wedang Secang as Indonesian Traditional Drink

treatment was with non-toxic concentrations of Gingerenone-A reduced
lipid accumulation in a dose-dependent fashion. Consistent with theseresults, protein expression levels of adipogenic transcription factors
such as PPARγ and C/EBPα, and lipogenic protein FAS in cells treatedwith Gingerenone A were lower than those in MDI only differentiatedcells. Moreover, Gingerenone-A also possesses the anti-inflammatory
properties by inhibiting the expression of CCL-2 and TNF in co-culturesof differentiated 3T3-L1 adipocytes and Raw264.7 macrophages in thecontact system. Those studies showed that Gingerenone-A suppressed
the development of obesity and adipose tissue inflammation by reducing
adipocyte hypertrophy and inhibiting macrophage infiltration.
Furthermore, another study showed the anti-inflammatory, antidiabetic, and anti-cancer effects of [6]-paradol (Figure 5) isolated fromginger. When [6]-paradol was added to cultures of BV2 microglia after
they were exposed to LPS for 24 h, [6]-paradol reduced NO production
and increased cell viability. The reduced NO production by [6]-paradol
was mediated by the attenuation of LPS-induced iNOS upregulation.
[6]-paradol blocked the secretion of cytokines TNF-α and IL-6 in aconcentration-dependent manner in stimulated microglia. In addition,[6]-paradol also significantly reduced blood glucose, cholesterol andbody weight in high-fat diet-fed mice. In another study, they proved that[6]-paradol suppressed the proliferation and metastases of pancreaticcancer by decreasing EGFR and inactivating PI3K/AKT signaling.
(3) Cinnamon (C. verum J. Persl)
Cinnamon has been reported to have many different healthproperties, such as its antioxidant content and its effect on diabetes
and neurological, microbial, and cardiovascular diseases due tothe properties of bioactive components. Cinnamon was reported to
upregulate anti-autoimmune Tregs and Th2, suppress autoimmune Th17
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Asian Medicine: Tradition and Innovation

and Th1, inhibit inflammatory infiltration, and reduce the expression of
pro-inflammatory molecules. Furthermore, cinnamon extract exhibits
hypolipidemic activity in hypercholesterolemic albino rats. Daily
administration of the extract reduced serum levels of total cholesterol,
triglycerides, and low-density lipoprotein cholesterol. Numerous
studies have shown the presence of biologically active compounds in
cinnamon, mainly cinnamaldehyde and eugenol (Figure 6). However,
the efficiency of the compounds in the extracted cinnamon oil depends
on the separation methods, solvents, and all the parameters related to theextraction/separation process, such as time, temperature, and pressure.

Figure 6. The chemical structure of Cinnamaldehyde and Eugenol
Looking further at the benefits of cinnamon, cinnamaldehyde andeugenol have been reported to play a role in protecting the gut frominjury from conditions of inflammation, infections, and oxidative
stress. In addition, cinnamaldehyde has been reported as a factor that
decreases the production and expression of nitric oxide (NO), IL1β, IL-6, and TNF-α in LPS-activated BV2 microglia and is therefore
thus indicating that it has an anti-neuroinflammatory effect. Moreover,it has been reported to aid in neuroprotection due to its potential toinhibit tau protein aggregation, the hallmark of Alzheimer’s disease.
Cinnamaldehyde also has the potential to control harmful fungal andmycotoxin contamination of agricultural commodities. Cinnamaldehyde
is a predominant compound in the bark oil extracted from Cinnamon. It
54

Chapter 4
Scientific Study of Wedang Secang as Indonesian Traditional Drinkseems to reduce plasma glucose levels more effectively than metformin,
which is commonly used in traditional medicine. The bioactive
compounds of cinnamon oil enhance the expression of proteins thatplay key roles in glucose transport, insulin signaling, and the regulationof dyslipidemia. More to the point, cinnamaldehyde and eugenol havealso shown positive results in the treatment of leukemia and lymphoma.
These compounds have also been used as nutraceuticals in fightingcolon and liver cancer cells.
(4) Lemongrass (C. flexuosus)
The plant is used as a fragrance and flavoring agent and in folk
medicine as an antispasmodic, hypotensive, anticonvulsant, analgesic,
antiemetic, antitussive, anti-rheumatic, antiseptic and as a treatment for
nervous and gastrointestinal disorders and fevers. The plant is also used
as an antibacterial, antidiarrheal, antioxidant and anti-inflammatory.
Methanol or water extracts, infusion and decoction of lemongrasswere shown to have free radical scavenging effects by measuring thebleaching of the DPPH radical, scavenging of the superoxide anion
and inhibition of the enzyme xanthine oxidase and lipid peroxidationin human erythrocytes. The hot water extract of the dried leaves
administered intragastrically to rats was active when compared withcarrageenin-induced pedal edema, as an inflammatory model. A fresh
leaf aqueous extract of lemongrass administered in normal rats lowered
the fasting plasma glucose, total cholesterol, and triglycerides.

Figure 7. The chemical structure of β-sitosterol and citral55

Asian Medicine: Tradition and Innovation

Lemongrass contains various constituents such as flavonoids andphenolic compounds, terpenoids and essential oils, which may be responsible
for the different biological activities, but the mode of action for the different
bioactivities has not been studied in detail. β-Sitosterol (Figure 7) is oneof the compounds contained in lemongrass. Several studies have shownthat β-sitosterol has a wide range of anti-inflammatory effects in peripheral
tissues. More specifically, it has a certain role in inflammation models
such as chronic obesity-related inflammation, ovalbumin-induced lunginflammation, TNBS-induced colitis, and rheumatoid inflammation in mice.
Furthermore, Citral (Figure 7) is an essential oil from lemongrassthat possesses anti-inflammatory properties, since it enhances TNF-α asa target for the prevention of inﬂammatory events induced by chemicals.
Citral oil inhibits an increase in TNF-α levels in RAW 264.7 cells thatare stimulated with lipopolysaccharide (LPS). In the same way, it wasobserved in the literature that citral oil reduced the TNF-α relative
expression compared to treatment with LPS. Another study showed thattreatment with citral oil in mice with lung injury induced by LPS inhibited
TNF-α, IL-1β, and IL-6 levels both in vivo and in vitro, demonstratingthat the citral oil can inhibit a possible inﬂammatory response.

Figure 8. The relationship between chemical purity of the crude drugs
and their pharmacological potency. Source: Author
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Chapter 4
Scientific Study of Wedang Secang as Indonesian Traditional Drink

Based on the scientific study explained before, the bioactive
compounds isolated from the herbs contained in wedang secang
have been proven to have several efficacies especially for antioxidant, anti-inflammation, anti-diabetes, anti-obesity and anti-cancer
treatments. However, it should be emphasized that these studies wereconducted mainly by using pure compounds. Figure 8 shows therelationship between the chemical purity of the crude drugs and theirpharmacological potency. It means that, even though there is a highpossibility that wedang secang has several efficacies as an anti-oxidant,
anti-inflammation, anti-diabetes, anti-obesity and anti-cancer treatment,
an experiment on whole wedang secang using experimental animals is
still needed to show its potency and toxicity when it is consumed in awhole form as a decoction.

References

Badan Pengawas Obat dan Makanan (BPOM). 2004. Keputusan Kepala
Badan Pengawasan Obat dan Makanan Republik Indonesia Nomor
HK.00.05.4.2411 tentang Ketentuan Pokok Pengelompokan dan
Penandaan Obat Bahan Alam Indonesia. Jakarta : Sekretariat
Negara.
Orwa, C., Mutua, A., Kindt, R., Jamnadass, R., and Anthony, S. 2009.
Agroforestree Database:A Tree Reference and Selection Guide
version 4.0. <http://www.worldagroforestry.org/sites/treedbs/
treedatabases.asp>

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Asian Medicine: Tradition and Innovation

Asia-Japan Research Institute, Ritsumeikan University

Editors Jingjing XIANG and Nara ODA

ONLINE ISBN 978-4-910550-34-3
PRINT ISBN 978-4-910550-35-0