Production of Chinese Medicinal Herbs in North America: Challenge and Reconciliation : Chinese Medicine and Culture

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Production of Chinese Medicinal Herbs in North America: Challenge and Reconciliation

Giblette, Jean✉,

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Chinese Medicine and Culture 5(4):p 234-240, December 2022. | DOI: 10.1097/MC9.0000000000000037
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Abstract

1 Introduction

Since 1990, in the direct experience of the author and her colleagues, a small social network of Chinese herbal medicine practitioners, horticulturalists, and farmers in the United States (US) has investigated agricultural production of a few hundred of the plant species listed in the Chinese Materia Medica.1

A strong rationale with phyto-geographical, historical, and cultural roots supports these efforts. Changes in medical philosophies along with parallel changes in attitudes toward food and farming have occurred in the past 50 years. However, economic obstacles encumber farmers who would undertake production. This is a current problem without an apparent solution, yet impending changes may bring about a favorable resolution that will further the worldwide acceptance of traditional Chinese medicine (TCM).

The historical context as well as ecological and agronomic factors of this problem are described as follows. Economic barriers are analyzed and, in conclusion, prospects for development of this emerging industry are assessed.

2 Historical context: the loss and reclamation of botanical medicine in the United States

Native Americans possessed extensive knowledge of medicinal plants that continues to be a focus of study.2 After the European colonization of North America, botanical medicine was practiced widely, with schools such as the Thomsonians and the Eclectics established during the 19th century.3

By the early 20th century, public health victories over various epidemics and the rise of the American Medical Association led to a restructuring of medical education. In 1910, the Carnegie Foundation commissioned a report from educator Abraham Flexner concerning the quality of American medical schools. The resultant Flexner Report advised that only schools adhering to an orthodox definition of science should be supported by private foundation funding.4 Botanical medicine was considered to be folklore, therefore unscientific. Based on this recommendation, divergent forms of medical education began to disappear. The last college of Eclectic Medicine closed in the 1930s.5 Without market demand for the herbs used in botanical medicine, there was no motivation for farmers to cultivate these plants.

German physician and scientist Paul Ehrlich (1854–1915) introduced an arsphenamine compound in 1906, leading the way for pharmaceuticals. The first Pure Food and Drug Act, passed by the US Congress that same year, recognized the pharmacopeia standards. Botanicals became a minority in the US Pharmacopeia by 1910,6 with wholly synthetic drugs dominant by 1950.

A popular reaction to the established practice of medicine occurred in the United States during the 1960s. Various practices that arose in the 19th century were recalled and brought forward, including homeopathy and osteopathy. Grassroots interest in herbalism was influenced by writers who recalled the old ways such as Jethro Kloss (1863–1946) whose popular book Back to Eden was self-published in 1939 and then re-published by others several times.7 Many people began to search for alternatives to pharmaceutical medicine and industrial agriculture. Within this social context, botanical medicine was reclaimed and the popular acceptance of traditional Chinese medicine took form.

3 Sociological context: the rise of traditional Chinese medicine

Acupuncture was recognized in the 19th century, studied by a few European and American physicians of the time.8 However, it was primarily Chinese immigrants who brought a more complete set of traditional medicine skills and herbal materials to North America. An outstanding example is Dr. Ing Hay (1862–1952) who operated a clinic in eastern Oregon beginning in the 1880s. His wooden clinic building, complete with herbs and artifacts, remained intact in the dry climate and is now maintained as a National Historic Landmark.9

The process of adoption of acupuncture in the United States, with Chinese herbal medicine added on later, may seem peculiar to those familiar with TCM in China. The practice of acupuncture attracted widespread public attention in 1971 when an American journalist, traveling in advance of President Nixon’s trip to China, was hospitalized with appendicitis, treated with acupuncture, and wrote an article about his experience published in the New York Times.10 After that sensational report, medical doctors (MDs) were among the early adopters of acupuncture in the United States. As their training and historical bias favored “scientific” medicine, they discounted herbs as folklore. Nearly two decades passed before Chinese herbal medicine and dietary therapy received appropriate recognition as central to TCM.

A few young American scholars studied in Macau and Taiwan of China during the 1970s and brought back a more holistic picture of traditional Chinese medicine. In 1986, the first English translation of the Chinese Materia Medica was published in the United States.11 Soon after, the National Certification Commission for Acupuncture and Oriental Medicine (NCCAOM) created the national certification exam in Chinese herbal medicine. Currently, three separate certifications are recognized by the US Department of Education: in Acupuncture, Chinese Herbology, and Oriental Medicine.12

The first colleges of acupuncture were founded in Maryland and Massachusetts in the early 1970s. At present the Council of Colleges of Acupuncture and Herbal Medicine (CCAHM) lists 52 accredited colleges in 21 states.13

In the US, the states license health professionals. The first acupuncture practice law was enacted in Nevada in 1973.14 Earlier practice laws focused on acupuncture; some of these were subsequently amended to include Chinese herbal medicine. Over the past thirty years, the number of states with practice laws has increased from 22 to 47 (plus the District of Columbia). Now, two-thirds of the state laws incorporate Chinese herbal medicine in the scope of practice.15

After the 1994 Dietary Supplement Health and Education Act (DSHEA) of the US Congress, which amended the Food and Drug Act, herbs were defined as dietary supplements. Licensed acupuncturists, even without certification in Chinese Herbology, were allowed to recommend dietary supplements. However, they are advised not to make claims in advertising that the herbs can mitigate, treat, or cure disease or symptoms.16

To Chinese practitioners of TCM, the blurring of certification status, together with the diversity in state practice laws, may appear inharmonious. To Americans considering the prospect of domestic production of Chinese herbs, the ambiguity reduces to the problem of market research needed to determine what portion of the huge dietary supplement market consists of herbs dispensed by Chinese herbal medicine clinicians to their patients.17

Since the early 1990s, the number of licensed practitioners of TCM increased nearly 700 percent, from approximately 5,500 to 38,000.18 This growth was fueled by popular demand with treatments paid out-of-pocket. At present, only a few medical insurance companies reimburse acupuncture treatments.

A current preferred term for US practitioners is not necessarily TCM but also East Asian Medicine (EAM), incorporating the Korean and Japanese variants. The phrase “Chinese herbal medicine,” however, persists in the nomenclature despite differences in certification status.

4 Ecological basis of the Chinese Materia Medica in North America

Since the time of Carl Linnaeus (1707–1778), botanists have recognized a remarkable similarity in the flora of eastern Asia and eastern North America.19 Hypotheses regarding this geographical distribution anomaly point to disruption of a continuous range of species due to glaciation, beginning about two million years ago.20

These floristic relationships are highly relevant to the potential for North American production of Chinese medicinal species, because the plant genera are familiar to farmers and horticulturalists. The ecological niches in which these plants thrive are well known and widely distributed on the continent.

At least some of the analogous species have been used for similar medicinal purposes by the Chinese and Native Americans. In 1985 two botanists who traveled extensively in China compared databases of usage and identified 130 genera with vicariad species (eg, Arisaema, Coptis, Nepeta, and Tsuga), then published a two-volume reference set.21

Today, several Chinese herbal medicine practitioners in the United States have voiced the opinion that the analog species be tested clinically as substitutes for the Asian species. If herbal products produced domestically are accepted for clinical use, then a systematic test of North American analog substitutes is possible. Conditions of scarcity could prompt such investigations.

The US growers network, over the years, has developed a list of 150 species that are prioritized for production. This unpublished list is in draft form, circulated among the grower network, and is considered proprietary. The priority factors include: availability of reliably identified germplasm, suitability to various ecological niches available on member farms, and the level of interest or demand among the customer base. Priority species can be adapted to the wide range of production systems available on American organic farms.

Half of the 150 priority species were present in the United States prior to 1990. These include analog species accepted in the Chinese Materia Medica, such as Chui Xu Shang Lu (垂序商陆Phytolacca americana L.) or Mei Guo Ling Xiao [美国凌霄Campsis radicans (L.) Seem].

Of those species present but not currently listed in the Chinese Materia Medica, the active constituents and clinical efficacy of the medicinal portions have yet to be tested. The lack of research and data is a component of the economic obstacles to the development of production.

Many of the species are maintained in botanical garden collections. These specimens provide a potential source of germplasm to enable clinical research. Others were introduced as ornamentals or for other uses. A few of these in the last category escaped from management in the 19th or early 20th century and naturalized, gradually becoming notorious invasives, such as Ge Gen/Hua [葛根/花Pueraria montana var. lobata (Willd.) Maesen & S. M. Almeida ex Sanjappa & Predeep] or Hu Zhang (虎杖Reynoutria japonica Houttuyn).

5 Agronomic context: changes in US agriculture

Synchronous with popular acceptance of Chinese herbal medicine in the United States, knowledge of the failures of industrial agriculture based on toxic chemicals became widespread. The public was shocked by the publication of Rachel Carson’s Silent Spring in 1962.22 The resulting popular environmental movement included a number of idealistic young people, some without much experience in farming, who went “back to the land” and founded organic agriculture as it exists today.23

Organic or ecological agriculture drew on earlier scientific reports. Franklin H. King’s Farmers of Forty Centuries published in 1911 was, and continues to be, an important influence.24 Thanks to early advocates, this book has never gone out of print. Dr. King (1848–1911) was a scientist with the US Department of Agriculture who traveled to China, Korea, and Japan to document long-standing ecological farming methods. He described an ancient system of agriculture, without the use of toxic chemicals, that now is being updated for contemporary needs. Sir Albert Howard (1873–1947) was another prophet of organic farming, a British scientist who worked in India and was influenced by Chinese ecological agriculture.

Thus, the impetus for US domestic production of Chinese medicinal herbs comes from two convergent cultural streams, traditional medicine and traditional agriculture, both originating in China.

This synchronous revival of traditional practices is due to expanding knowledge of the complexity of natural systems, and how they are negatively impacted by toxic chemicals. Food production methods and government dietary recommendations have been constantly challenged during the past half-century. For example, questions regarding the practice of pasteurization have led to a campaign for raw milk resulting in some form of legal access in most states.25 Substantial popular resistance to products highly profitable for industrial agriculture, such as genetically modified soybeans (94% of soy acreage26) and margarine (trans fats), continues to support demand for organically grown food.

If Americans question the use of toxic chemicals in their food supply, they tend to be more likely to question synthetic chemicals used as medicine and become motivated to seek alternatives in the form of dietary supplements and herbal medicine.

Doubts remain concerning the reliability of organic certification itself.27 These uncertainties led to yet another popular movement known as “localism” or “know your farmer.” Various forms of direct marketing continue to reinforce this value, including farmers’ markets and Community Supported Agriculture.28

Agriculture is an applied science, like medicine. In the last 50 years, ecological methods were retrieved from past experience, tested, and modified by these organic farmers in a popular, grassroots movement. Not only were their pest problems few despite the organic prohibition on the use of toxic chemicals but also the quality of their direct-marketed products gained repeat customers. Lower costs and higher prices made small farms more profitable.

Constant growth of the organic food industry, during US economic recessions in each decade since 1970 to the present, is sustained by popular demand. US organic sales resumed double-digit annual growth in 2020 when the COVID-19 lockdowns led to more cooking at home.29

The significance of the organic agriculture and localism developments for US production of Chinese medicinal herbs rests on farmer innovation and popular acceptance. The response of the land grant (agricultural) university system, state and federal governments has been uneven and insufficient, as described in the next section.30

6 Economic obstacles to domestic production of chinese herbs

Access to capital for farming operations has been a constant problem in the US since the European colonization. Commodity export crops, originally cotton and tobacco, remain the center of the national farm economy while specialty crops continue to receive little public support. For example, the current US Farm Bill, 2019–2023, funds commodity programs at $30 billion while the Specialty Crop Block Grant Program is at $425 million.31

The population of the US was primarily rural until the 20th century; family farms grew their own food crops and traded locally. Currently, there are approximately two million farms in the United States, only one-third the number before World War Two. Ninety-eight percent of current farms are family-owned; 90% are small and own 49% of the land in agriculture. Of small farms, 41.4% have a family member working off farm and 10.7% are owned by retired people.32

These statistics indicate that choices of crops and cropping systems are made by individual farm families, some of whom can afford long-term planning for an income stream from a perennial crop.

In the herbal products industry during the 1990s, a boom followed by a steep decline resulted in losses to some US farmers. In response, representatives of several medicinal herb growers associations began a discussion series to share information and find solutions to problems.

They investigated Chinese herbs as a means to avoid exploitation by product makers, and concluded that direct marketing of their agricultural products (bulk herbs) to licensed clinicians could become profitable but only in the long term.33 Subsequent efforts to implement this concept involved nine farmer groups in California, Illinois, Minnesota, North Carolina, New Mexico, New York, Virginia, Washington, and West Virginia (in the author’s experience).

Only two of these, in California and New York, have survived. Recruitment of farmers interested in experimentation, typically small-scale specialty crop growers, has not been difficult. Retention of those growers over the multi-year period needed to establish production of perennial crops proves difficult.

Cooperative groups are deemed necessary to provide mutual education and support, to obtain funding from public and private sources, and to grow a wide variety of crops. Hundreds of Chinese bulk herbs imported by trusted sources are available online to US clinicians, who are trained to use herbs in formulas rather than as singles. To be credible to this market segment, farmers must present a substantial array of varieties with the promise of future additions. One farm may grow one or a few species as part of a diversified operation, but a group of farms can produce more varieties and also share propagation and processing costs.

The network of growers has received short-term financial support from state, federal and private sources. However, agricultural funding policies are directed toward job creation, annual crops, and documented results within one or two years. Grower groups have been pressured by funding agencies to make financial outlays that cannot be sustained over time. For example, a funding agency prioritized job creation which led to the hiring of employees before crop revenue was sufficient to cover expenditures. Another agency awarded funds to support the construction of processing facilities that required ongoing maintenance, while harvests were years in the future.

In the United States, agricultural cooperatives tend to fail at the beginning of the enterprise because they cannot produce enough volume to employ a coordinator. Perennial crop growers are especially vulnerable. For Chinese herb production, effective coordination is necessary to sustain farmers’ interest and commitment over many years while this emerging industry connects with its market.

In this type of agricultural enterprise, capitalization includes the farmer’s time to absorb knowledge of new crops, to experiment with production techniques, and to commit labor, land and facilities to the effort. This economic activity is usually not paid in cash although it can be quantified. The cash deficit ultimately limits participation. If the enterprise is a cooperative group, its coordination and marketing costs are extra and usually paid in advance.

At present, production volumes of US-grown Chinese medicinal herbs are very small, as groups operate without sufficient access to capital while the means to connect with the market are being tested. Strategies to overcome such obstacles are matters for debate without an apparent resolution. Also unclear, the degree to which US production will serve domestic demand, much less meet export standards, has yet to be determined.

7 Prospects for development of US production of chinese herbs

Although Chinese herb growers in the United States are hard-pressed to overcome the obstacles they face, several long-term trends can be identified that could alter the framework of the problem. These trends include continued innovation in agriculture, increasing acceptance and support from the market, disruption of supply lines for imported products whether from scarcity or increased costs.

7.1 Continued innovation in agriculture

Although Chinese herbs are a small niche category of specialty crops, farmers who are growing these herbs cite two main features of interest: ecological benefits, especially relevant to perennial crops, and long-term economic diversification. Farmers are often motivated to persist despite obstacles to preserve the farm for their children. They are aware that perennial crops or permanent agriculture is equity: wealth banked in the land or capital formation without money.

The ecological benefits of perennial polyculture are becoming more apparent. A leading edge of innovation provides new models of farming conducive to new crop development, including Chinese medicinal herbs. Regenerative practices restore the soil’s health, its capacity to hold water, and its fertility. A key tenet of regenerative farming is to maximize the presence of living roots in the soil. Perennial plants take on ecological value in such systems.

A second general area of innovation is a renewed interest in agroforestry, which includes many different practices. Understory plants, shade perennials and, of course, trees, and shrubs are desirable and useful crops. As per Table 1, of the grower network’s priority crops, 62 of the 150 have potential for agroforestry operations.

Table 1 - Characteristics of 150 priority species of the grower network
Characteristics of 150 priority species
Full sun herbaceous perennial 65 43.3%
Shade herbaceous perennial 20 13.3%
Woody shrub or vine 21 14.0%
Tree 21 14.0%
Annual or biennial species 23 15.3%
Percentages do not add up to 100% due to rounding.

Perennial crops are receiving increased attention from ecologists and researchers concerned with carbon sequestration as a mitigant of climate change. For example, several species of Chinese medicinal plants are included in an extensive list of economically valuable perennial crops cited in a recent handbook, The Carbon Farming Solution.34

Although the acreage devoted to such innovations is a small fraction of the current agricultural picture, if these lines of development are continued US agriculture will increasingly resemble Native American farming practices. Perennial crop operations were once standard practice, as revealed in late 20th century archeological findings of pre-Columbian agriculture in the Ohio and Mississippi River basins.35

7.2 Increased acceptance and support from the market

Chinese herbal medicine practitioners in the United States have benefitted from the low cost and reliability of goods imported from China. A handful of importers sell only to the profession and have a long-standing reputation for quality and safety. Most practitioners rely on pre-packaged formulas made in China to enhance patient compliance. However, they do have access to dispensaries that take orders for formulas compounded from bulk herbs, then shipped directly to the patient.

While imports remain at low cost, acceptance of domestic production is limited. The growers network has received some acknowledgment and support from the EAM profession, but is far from winning general acceptance. Concerns over quality of the herbs, together with distrust of organic certification, are applicable to domestically grown products as well as the imported. To attract the market with quality, freshness, and a wide selection is necessary but insufficient. The cost factor will be the driver that leads to increasing interest in domestic production.

7.3 Disruption of supply lines

The continued worldwide acceptance of TCM, now in over 100 countries, cannot be sustained without more widely distributed production of the herbs. China has begun to import herbs from neighboring countries. For example, Gan Cao (甘草Glycyrrhiza uralensis Fisch. ex DC.) is a nationally protected species of which only twenty percent of needs are supplied through cultivation.36

Conservation imperatives include preservation of wild medicinal plants. However, cultivation using industrial methods with toxic chemicals that kill soil biology often results in an inferior product, leading to increased pressure on wild stocks. Ecological production is the answer to that dilemma. Recent research suggests that the soil microbiome helps plants adapt to a new location,37 a boon to distributed production.

More immediate concerns over supply lines have surfaced within the last two years. Beyond US tariffs on goods from China, the price of shipping container rental increased abruptly along with rising prices for fuels. US importers of the herbs worry also about the continued effects of COVID-19 lockdowns on production in China.38

The costs of global trade based on long-distance transport could prompt a re-evaluation of the potential for distributed, US-based production. The cost factor may converge with demand for clean, ecologically grown products and local control over certification. In a highly dynamic, unstable world economy, US growers eventually could become major producers by default.

8 Conclusion

The concurrent establishment of traditional Chinese medicine and organic agriculture in the United States during the past half-century was a result of popular movements. People sought alternatives to conventional medical practice and industrial agriculture, and banded together to found new institutions. Interest in the domestic production of Chinese medicinal herbs grew out of these movements, encouraged by ecological and agronomic factors.

Cooperative associations were formed to produce the herbs, but were constrained by a chronic insufficiency of financial capital. Only two of these groups remain, their production volume is very small, and they continue to face economic obstacles to further development.

Current trends could alter economic conditions in favor of distributed ecological production. Continued innovation in farming methods, increased acceptance of domestically grown products by the primary market, and disruption of supply lines with increased costs of imports may converge to promote a reconciliation in favor of US producers. In that event, the American penchant for voluntary cooperation will prove itself once again.

Funding

None.

Ethical approval

This study does not contain any studies with human or animal subjects performed by the author.

Author contributions

Jean Giblette wrote and revised the manuscript.

Conflicts of interest

The author declares no financial or other conflicts of interest.

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Keywords:

Chinese herbal medicine; Chinese Materia Medica; Ecological agriculture

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