Get Involved
About Us
Our Members
Medicinal Use of Threatened Animal Species and the Search for Botanical Alternatives

Medicinal Use of Threatened Animal Species and the Search for Botanical Alternatives

By Courtney Cavaliere

A wild, 13-year-old tiger within Bandhavgarh National Park, Madhya Pradesh, India. Photo ©2010 Photographer: Aniruddha Mookerjee; Source: International Fund for Animal Welfare

The Chinese calendar considers 2010 the “Year of the Tiger.” As such, it may be an appropriate time to pay homage to the majestic animal’s strength and beauty, while also lamenting its endangered status. Although long revered by many cultures, the tiger has also experienced a sad history of exploitation by humankind. Among other uses, various components of the tiger’s body have served as ingredients within traditional medicine systems—and like many other animal species, the tiger continues to be a victim of medicinal demand.

Zootherapy, the use of animals and products derived from them in healing, has been practiced by most ancient cultures throughout the world, and it continues to be prevalent within many contemporary societies.1,2 Within Traditional Chinese Medicine (TCM), more than 1,500 animal species have been identified as having therapeutic use.3 At least 109 animals have reportedly been used for traditional medicine by India’s different ethnic communities. In Northeast Brazil, at least 250 animal species are used medicinally.1

Animal-based remedies are important therapeutic resources within many cultures, and in some instances, the medicinal use of animal species has led to the development of pharmaceuticals for global markets. A component of snake venom, for example, served as the basis for angiotensin-converting enzyme (ACE) inhibitors, which help relax blood vessels and are used to treat high blood pressure and other conditions.4 Several compounds of fish and amphibians have also served as important leads for biochemical research and drug development.

Not all animals are harmed when used as sources of medicinal ingredients. Remedies consisting of animals’ fur, feathers, urine, excrement, or by-products are used within some cultures, and such medicinal ingredients can be collected without injuring or killing the animal.3,5 The antler of the European red deer (Cervus elaphus, Cervidae), which has been widely traded and researched, can be harvested without any apparent adverse effects on the animal.6

More frequently, however, animal parts used in traditional medicines require the animal’s death.3,5 The killing of animals for medicinal use has significantly contributed to the rarity of certain animal species, and some societies continue to use endangered or threatened animals for medicinal purposes.2,3,5,7,8 Although international trade of many rare species is regulated under the Convention on International Trade in Endangered Species (CITES), and use and trade of such species is often banned nationally through laws of individual countries, trafficking frequently continues through illegal channels.8

“Increasingly, animal parts are traded internationally—often because of local depletions but also because globalization means distance is no barrier,” said Richard Thomas, PhD, communications coordinator for the wildlife trade monitoring network TRAFFIC (e-mail, December 4, 2009). “Some powerful national and international regulations certainly exist—CITES is potentially a very powerful Convention. However, the Convention rarely seems to impose the punitive measures at its disposal against those countries that fail to comply to its regulations.” He added that, likewise, other laws meant to prevent wildlife trade are not sufficiently enforced. “Sometimes this is because of a lack of an appreciation of the seriousness of wildlife crime, as well as a lack of capacity amongst enforcement bodies to police the regulations adequately,” he said.

The illegal trade of wildlife is estimated as being worth at least $6 billion (USD) per year, and it is also considered one of the fastest growing areas of international crime.8 Demand for wildlife for medicinal and other uses has led poachers, particularly within impoverished countries, to continue trafficking threatened animal species and their parts. China is one of the main destinations for illegal wildlife, and demand from other Asian countries seems to be increasing. As wealth within Asian countries continues to rise, there are fears that increased purchasing power could put wildlife in even greater jeopardy.

In addition to depleting species, other problems have been associated with the use of some animal-based remedies. Whereas botanical therapies have been increasingly studied for their safety and effectiveness, far fewer studies of animal-based remedies have been conducted.1,3,7 The supposed medicinal benefits of these species have thus rarely been scientifically verified; many remedies appear to be primarily based on folklore and superstition.5,8 The suffering inflicted on medicinally-used animals—including the painful (and often lethal) capture, transport, and “harvesting” of animals’ medicinal parts—also raises strong ethical concerns.2,7,8 In addition, illness can be transferred from animals to humans, causing some concerns over the safety of animal-based therapies.1,2,7

In light of such factors, efforts have been made over the years to find and promote alternatives, particularly for those animals now considered endangered. Alternatives to endangered species used in TCM seem to be especially studied, undoubtedly due to the widespread use of TCM throughout the world and its reliance on so many animal species. In many cases, banning the use and trade of particular animals and promoting substitutes has had positive results. However, as the situations of the animals profiled below indicate, continued efforts in finding and promoting substitutes may be warranted, as may additional campaigns toward protecting animals with medicinal use.

A tiger from the Xiongsen Bear and Tiger Mountain Village, a tiger farm in Guilin, China.Photo ©2010 Save the Tiger FundTigersPanthera tigrisFamily: Felidae

One of the world’s most beloved and iconic species is also one of its most endangered: the tiger. Tigers have been listed in Appendix I* of CITES since 1987. The world’s population of wild tigers, which was approximately 100,000 a century ago, has fallen to an estimated 3,200 or fewer today, and a recent analysis indicates that tigers occupy a mere 7% of their historic range.9 The main factors fueling the decline of tiger populations are loss and fragmentation of habitat, loss of available prey, and poaching of tigers in order to sell their parts for medicine, clothing, and decoration.10

Tiger bone has been used for centuries in TCM to treat conditions associated with bone and muscle pain, such as rheumatism and arthritis, as well as limb spasms, lower back pain, and chills.11 Other parts of the tiger—including blood, tail, and eyes—have also sometimes been used for medicinal purposes.10

China’s wild tiger populations were decimated to support the country’s medicine industry; it is suspected that 50 or fewer tigers currently survive in the wild in China.12 Tiger populations from other range states were also heavily poached to provide for tiger bone markets in China and elsewhere—severely reducing tiger populations in those areas as well.

“Until 1993, there were huge manufacturing industries in both China and South Korea that were making mass market medicines from tiger bone,” said Judy Mills, moderator for the International Tiger Coalition and health security advisor for Conservation International (oral communication, August 18, 2009). According to Mills, these countries imported tiger skeletons and exported pills, wines, and tea balls made from tiger bone to international markets.

Mills explained that in 1993, CITES and the United States threatened trade sanctions against China and South Korea due to those countries’ continued trade in tiger and rhino parts, which finally led the 2 countries to stop the manufacturing of these medicines, put bans into place to prevent sales of products claiming to contain tiger parts or derivatives, and remove tiger bone from their national pharmacopeias.

“This probably saved wild tigers,” said Mills. “We might not have had one left today had it not been for those bans.”

According to Mills, many TCM consumers were initially outraged at the loss of tiger bone medicines, but after a few years, the TCM community had largely accepted the ban. Many had even become actively involved in encouraging substitutions in place of endangered medicinal ingredients. Researchers for TRAFFIC conducted a survey in 2005 and 2006 of retail Chinese medicine shops and pharmacies to evaluate the effectiveness of China’s 1993 ban.12 They found that only 2.5% of 518 shops still claimed to stock tiger bone.

Bones from other animals, such as pigs or dogs, have often been promoted as substitutes to tiger bone.10,13 According to Lixin Huang, president of the American College of Traditional Chinese Medicine (ACTCM), many herbal ingredients and formulas that are described as having a “warm function to improve circulation” can be used as replacements for tiger bone (oral communication, August 26, 2009).

A survey of 301 practitioners certified in Chinese herbology was conducted in 2002 to obtain information about use of endangered species in TCM and possible replacements for those species, and that survey’s results were profiled in the book Mending the Web of Life.Fifty-three respondents to that survey provided recommendations for replacements for tiger bone, although there was little consensus. The most frequently cited substitution, with 12 citations, was wu jia pi (Acanthopanax gracilistylus, Araliaceae), an herb closely related to eleuthero (Eleutherococcus senticosus, Araliaceae; syn. A. senticosus), formerly sold in the United States as “Siberian ginseng.”

A study commissioned in 2001, meanwhile, by the Department for Environmental Food and Rural Affairs (DEFRA) and International Fund for Animal Welfare (IFAW) Charitable Trust, investigated plants with TCM properties and functions similar to tiger bone.11 The study’s authors found that tiger bone may possess some anti-inflammatory properties, and some of the investigated herbs also demonstrated potential anti-inflammatory actions.

That report, released in 2006, ultimately identified 15 herbs as potential alternatives to tiger bone: Saposhnikovia divaricata (Apiaceae) root, Clematis chinensis (Ranunculaceae) root and rhizome, Angelica pubescens (Apiaceae) root, A. sinensis root, Ligusticum chuanxiong (Apiaceae) rhizome, Gentiana macrophylla (Gentianaceae) root, Epimedium sagittatum (Berberidaceae) aerial parts, Atractylodes lancea or

A. chinensis (Asteraceae) rhizome, A. macrocephala rhizome, Cinnamomum cassia (Lauraceae) bark, C. cassia twigs, Morus alba (Moraceae) young branches, Taxillus chinensis (Loranthaceae) stem and bark, Spatholobus suberectus (Fabaceae) root and stem, and Chaenomeles speciosa (Rosaceae) fruit.

The herbal company Mayway (Oakland, CA) is committed to supporting the preservation of endangered species and humane treatment of animals, for which the company discontinued the sale of products with tiger bone and bear bile many years ago. After joining WWF’s Save the Tiger educational campaign in 2001, Mayway compiled a list of several of the company’s botanical products with similar functions as those attributed to tiger bone for WWF’s use in promoting substitutes to practitioners.15 That list included such multiherb products as Great Corydalis Teapills for pain due to acute injury and Yao Tong Pian tablets for strengthening sinews and bones and for pain due to chronic deficiency, obstruction, or acute injury.

But despite great strides in removing tiger bone from markets and identifying substitutes, illegal trafficking and other problems associated with tiger trade persist. In particular, tiger farms—facilities that typically masquerade as tiger conservation sites—threaten to counteract tiger preservation efforts and reinvigorate trade in tiger parts. Tigers are bred, caged, and offered as attractions to visitors at these “farms,” while carcasses of dead tigers are often stored in giant freezers so that they can be sold if trade in tiger parts is reopened.16,17

A report submitted by China to CITES in 2007 noted that the population of farmed tigers throughout the country had reached 5,000 by the end of 2006, with more than 800 new cubs born every year.18 “That means that China could have 6,000 to 7,000 tigers now in captivity,” said Grace Ge Gabriel, Asia regional director of IFAW (oral communication, August 31, 2009).

The farms are backed by very powerful businessmen and investors who want trade in farmed tiger parts to be legalized. The idea was presented to CITES in 2007, but CITES member nations decided that such trade should not be allowed. They further recommended that the number of tigers in these farms be reduced to levels more appropriate for conservation goals. According to Gabriel, further discussions regarding tiger farms have taken place in the years following that CITES meeting, but China and the few other countries that contain smaller-scale tiger farms have not made any efforts to limit or end tiger farming.

Moreover, some facilities in China have already begun manufacturing and selling tiger bone wine using the bodies of farmed tigers, despite China’s ban and in violation of CITES.17,19 The organization IFAW visited 5 of China’s biggest tiger farms from 2005 to 2007, as well as a wine factory associated with one of the tiger farms.17 According to a report released by IFAW, a manager of the wine factory claimed that hundreds of its wine containers held full tiger skeletons steeped in an alcoholic brew with medicinal herbs, and the investigators were shown a tiger skeleton within one of the wine vats.

In order to circumvent China’s law against tiger trade, wine currently being produced from farmed tiger parts is not clearly labeled as “tiger bone wine.”17,19 It is packaged and sold, however, in ways that convey the endangered ingredient (such as in tiger-shaped bottles or under the name “bone protecting wine,” which denotes the product as tiger bone wine through a play on words). These wines are promoted as tonics, rather than as medicines, so that they do not require special regulatory permits.

According to Gabriel, wines promoted as tiger bone wine are sold at the tiger farms, in retail stores, in airports, and in other locations, as well as over the Internet. One wine factory manager told IFAW that as many as 100,000 bottles of that factory’s tiger bone wine were sold in 2006 alone.17

Gabriel noted that one of the reasons tiger farms are able to sell these tonics is because they tap into long-held cultural beliefs regarding the medicinal effectiveness of tiger bone.

Mills likewise stated that, “Every Chinese person of every age knows tiger bone is supposed to be good for aches and pains and broken bones, so there is residual demand.”

Such demand is evident from the results of a 2007 survey of 1,880 Chinese adults, in which 43% of respondents claimed to have used some product thought to contain tiger derivatives, and 90% of those consumers claimed to have used them after the 1993 ban was enacted—many claimed within the previous 2 years.20 (In the same survey, however, 93% of respondents agreed that China’s ban of tiger products must be maintained to protect wild tigers.)

If trade in farmed tiger parts is officially legalized in China, poaching of wild tigers is likely to increase. The International Tiger Coalition has pointed out that poaching is less costly than farming tigers, poachers could easily launder illegally obtained tiger parts by claiming that they are from farmed tigers, and demand is unlikely to be satisfied by farmed tigers alone.21 Additionally, Asian consumers typically believe that medicines made from wild animals are more potent, which would further encourage poaching.20,21

Poaching of wild tigers may already be increasing. Gabriel said that she receives information on tiger poaching and confiscations practically every day. “In recent years, seizures of tiger parts from wild tigers have increased in frequency,” she said. “According to the World Customs Organization, actual seizures of contraband only represent 10% of the actual trade.”

In India, the bodies of 88 tigers killed by poachers were found in 2009—double the amount found the previous year.19 Some of India’s tiger reserves now have no tigers, and poaching is considered a likely cause.22

“If trade is reignited among more than a billion people in China, then those who can afford it will go for the wild tiger bone—and wild tigers will go very quickly,” said Mills.

Legalized trade in farmed tiger parts would also likely cause practitioners and consumers to abandon use of tiger bone substitutes. “If the ban were lifted, there wouldn’t be any incentive to look for alternatives,” said Gabriel. “It would undermine conservation efforts for the past 20 years.”

African white rhinoceroses. Photo ©2010 Photographer: Renaud Fulconis;
Source: Save the Rhino International

RhinocerosesAfrican white (Ceratotherium simum), African black (Diceros bicornis), Indian (Rhinoceros unicornis), Javan (R. sondaicus), Sumatran (Dicerorhinus sumatrensis)Family: Rhinocerotidae

Like the tiger, the rhinoceros has had a long history of use in TCM, and rhino populations have suffered because of it. Fewer than 25,000 rhinoceroses currently survive in the wild,23 and rhino species have been listed in either Appendix I or II of CITES since 1977.24

The horn of the rhinoceros is unique from that of other animals in that it is composed entirely of keratin, the same substance as hair and nails, with dense mineral deposits at its center.25 Although many of the rhinoceros’ body parts have been utilized in TCM, the animal’s horn has been particularly prized as a medicinal ingredient. Rhino horn has been used for thousands of years in TCM to treat fever, convulsions, and hemorrhagic conditions.11,13 It is also popularly used to relieve dizziness, build energy, nourish the blood, and cure laryngitis, among other uses.26

Asian rhinoceroses were once widely distributed throughout southern and southeast Asia, but overwhelming demand for rhino horn for TCM led to their sharp decline.24 African rhino species have also been heavily poached, both for traditional medicinal use in Asia and for use in making traditional daggers in Yemen. Even after the rhinoceros’ listing in CITES, poachers continued to decimate rhino populations during the 1980s and early 1990s, causing rhino numbers to reach their lowest levels in history.27 As with tiger bone, some countries instituted their own bans on use and trade of rhino horn, including China in 1993.

TCM practitioners have therefore been encouraged for many years to substitute other ingredients in place of rhino horn. In the early 1990s, conservation groups encouraged substituting rhino horn with the horn of the saiga antelope (Saiga tatarica, Bovidae)—a well-intentioned plan that had disastrous results.28 Over a million saiga antelopes roamed Russia and Kazakhstan in 1993, but fewer than 30,000 (mostly hornless females) remained by 2003 due to rampant poaching and use in TCM. After experiencing one of the most rapid and dramatic population crashes of any mammal, the saiga antelope was added to the Red List of critically endangered species in 2002, and TCM practitioners are now actively discouraged from using saiga antelope horn, as well. The horns of water buffalo and cows are now commonly promoted as alternatives to rhino horn.13

During the 1990s, Paul But, PhD, then a professor at the Chinese University of Hong Kong, performed experiments in rats to test the effectiveness of rhino horn and some of its alternatives.8 His study found that rhino horn and high doses of water buffalo horn could reduce fever and counter toxins, as could a combination of herbs without any type of horn. In a 1993 paper, the Chinese Association of Medicine and Philosophy recommended Rehmannia glutinosa (Scrophulariaceae) and Coptis chinensis (Ranunculaceae) as acceptable botanical substitutes for rhino horn, based on Dr. But’s study.29

The 2002 survey of herbal practitioners featured in Mending the Web of Life, mentioned earlier in this article, noted potential botanical replacements for rhino horn.14 Of the 83 respondents who provided suggestions for replacing rhino horn, the second most cited suggestion (after water buffalo horn) was sheng di huang (Rehmannia glutinosa). Respondents also recommended Uncaria rhynchophylla (Rubiaceae) as a potential alternative for “clearing heat and arresting tremors”—a specific action assigned to rhino horn.

For the 2006 report commissioned by DEFRA and IFAW, also mentioned previously, both rhino horn and plants considered as having functions similar to rhino horn were investigated through assays.11 Rhino horn did not demonstrate anti-bacterial or anti-inflammatory properties through testing, but most of the herbs selected as possible alternatives demonstrated some anti-bacterial activity and/or potential anti-inflammatory properties.

The report identified 9 potential botanical alternatives to rhino horn, based on tests conducted by the authors and evidence from published TCM and other scientific literature: Rehmannia glutinosa root, Scrophularia ningpoensis (Scrophulariaceae) root, Paeonia suffruticosa (Paeoniaceae) root,

P. veitchii or P. lactiflora root, Arnebia euchroma (Boraginaceae) root, Isatais indigotica (Brassicaceae) root, Lonicera japonica (Caprifoliaceae) flower bud, Forsythia suspensa (Oleaceae) fruit, and Salvia miltiorrhiza (Lamiaceae) root. After the early 1990s, some rhino populations—primarily African rhino species—grew substantially. White rhino populations increased from 7,095 in 1995 to 17,500 by the end of 2007, and black rhino populations increased from 2,410 in 1995 to 4,240 by the end of 2007.27,30

Unfortunately, increased poaching within the last decade threatens to undo such progress. According to a 2007 report, the amount of rhino horn entering illegal trade from Africa has significantly increased since 2000.27 That report noted that at least 664 rhino horns from Africa were acquired with the intention of illicit trade during 2000-2005.

Moreover, in July of 2009, the International Union for Conservation of Nature (IUCN), WWF, and TRAFFIC released a new report indicating that rhino poaching has seemingly increased to its highest level in 15 years.31 According to the report, the poaching stems from demand for rhino horn in Asia, and evidence indicates ongoing involvement of Vietnamese, Chinese, and Thai nationals in the illegal trafficking of rhino horn out of Africa. The report adds that Vietnam only recently became a major destination for illegally traded rhino horn, and research suggests that rhino horn is currently being promoted in that country for medical uses that go far beyond applications described in traditional literature. For instance, rhino horn appears to be used in Vietnam for treating a range of life-threatening illnesses, such as cancers.

According to Susie Ellis, PhD, executive director of the International Rhino Foundation (IRF), the increased rate of rhino poaching could ultimately cause African rhino populations to crash to the same low levels of previous decades, if not lower (oral communication, November 16, 2009). She stated that a number of factors appear to be contributing to the increased rhino poaching, including China’s burgeoning economy and a rise in well-armed and highly organized poaching gangs. She added that there is a breakdown in the enforcement chain, which is enabling poachers to traffic rhino horn with little threat of punishment in African countries and allowing rhino horn to enter Asian markets despite bans on the ingredient. “People trying to conserve rhinos are having to physically move them in order to protect them,” she said.

IRF and TRAFFIC are planning to initiate a study to better understand the present demand behind rhino poaching. According to Dr. Ellis, they plan to investigate where rhino horn is being trafficked, what it’s being used for, and other factors relating to the current black market trade. “We need to know what’s going on before we figure out how to solve the problem,” said Dr. Ellis.

She added that rhino horn’s long-standing reputation as an effective medicinal ingredient has made it particularly difficult to completely wipe out demand, despite the fact that there is little scientific basis for using rhino horn and that modern synthetic products for alleviating fevers, such as aspirin, acetaminophen and ibuprofen, are readily available. “We hope that people would use [modern alternatives] rather than a product that requires the sacrifice of these magnificent animals,” said Dr. Ellis.

Asiatic black bears Jasper (front) and Pooh at Animals Asia Foundation’s sanctuary in China. Jasper spent 15 years in a crush cage being milked for bile. After months of surgery and rehabilitation, he has recovered to lead a healthy, happy life. Photo ©2010 Animals Asia FoundationBearsAmerican black (Ursus americanus), Asiatic black (U. thibetanus), brown (U. arctos), polar (U. maritimus), sloth (Melursus ursinus), spectacled (Tremarctos ornatus), sun (Helarctos malayanus)Family: Ursidae.

All eight of the world’s bear species are listed in either Appendix I or II of CITES. Several bear species have experienced dramatic population declines over the past few decades, and some are considered to be in danger of extinction. Some of the main factors fueling losses of bear species include habitat loss and illegal or unmanaged hunting—for sport, fur, medicinal use, or other purposes.32 The only bear species not hunted for its gallbladder, for use in traditional medicine, is the giant panda (Ailuropoda melanoleuca, Ursidae).

Bear bile has been an ingredient in TCM for thousands of years, used to treat fevers and inflammation, liver disorders, convulsions and spasms, ophthalmological disorders, and various other conditions.33,34 It is sold in the form of pills and powders, ointments, lozenges, eye drops, hemorrhoid creams, wines, and teas.34,35 Bear bile contains a relatively high amount of ursodeoxycholic acid (UDCA); this and other acids are considered the principle medicinal components of bear bile.33 Modern pharmacological research has shown that bear bile has antimicrobial, anti-inflammatory, anti-hepatotoxic, anti-tumor, anti-convulsant, and other beneficial properties.

After realizing that the country’s wild bear populations had become severely depleted, bear farms were established in China during the 1980s.33,35 These farms, at which bile is extracted repeatedly from living, captive bears, were intended to provide a sustainable supply of medicinal bear bile and discourage further killing of wild bears. According to official government figures, approximately 7,000 bears are currently kept on farms in China. However, some non-governmental organizations (NGOs) suspect that the number is closer to 10,000, if not more. Additionally, nearly 4,000 bears are held on farms in Vietnam, where the practice is technically illegal. Around 1,400 bears are farmed in South Korea, where it is illegal to extract bile from living bears but bears can be raised for several years and then slaughtered for their gallbladders. Some bear farms have also been established in other Asian countries, such as Laos.

“We estimate that in Asia as a whole, there could be around 16,000 to 17,000 bears kept on farms,” said Jill Robinson, founder and CEO of Animals Asia Foundation, a charity organization that helps to free bears from farms and relocate them to bear sanctuaries (e-mail, September 6, 2009).

Bears on Chinese and Vietnamese farms are typically kept in small cages with barely enough room to move.35,36 Farmers extract bile by inserting catheters or hypodermic needles into the bears’ gallbladders, or they carve a hole into the bears’ abdomen and gallbladder, allowing the bile to drip out into basins under the bears’ cages. Both the close confinement and bile extraction are clearly painful to the bears, as the animals often show signs of distress and resort to biting or banging their heads against their cages. Bears typically spend around 10 years trapped in these cages, many enduring daily bile extraction.

In addition to the suffering inflicted on the bears, the products produced from these farms pose serious health concerns to consumers. Bile taken from farmed bears is frequently contaminated by blood, urine, feces, and pus.36 Further, bears that have been “milked” for their bile on such farms are likely to develop cancer. According to Robinson, “Captive bears that have never been milked for their bile almost never develop liver cancer unless they are very old, and even then, only about 10% develop it. But in previously farmed bears, we are seeing it at an alarming rate of about 35%—and we’re seeing it in young bears rescued from the farms.

“Our vets have no doubt that cancer cells must be seeping into the bile that is later consumed by people around the world,” she continued. “Surely it is time the Chinese government took this seriously. Other countries whose citizens take this bile should be asking some serious questions too.”

The existence of bear farms has also not reduced poaching of wild bear populations. Wild bears continue to be killed for their gallbladders, and some bears are taken from the wild to restock bear farms.36,37

More humane and sustainable alternatives to bear bile are readily available. Gallbladders from cattle or pigs are often promoted as substitutes.13 A synthetic version of UDCA is also widely available, used in Western medicine for dissolving gallstones.33 It has been estimated that 100,000 kg of synthetic UDCA is consumed each year in China, Japan, and South Korea, and global consumption may be double this figure. Many herbal alternatives have also been identified.

In 1994, the Association of Chinese Medicine and Philosophy and EarthCare released a report identifying 54 herbs that could be used as alternatives to bear bile. According to Robinson, such herbs included chrysanthemum (Dendranthema x grandiflorum, Asteraceae), rhubarb (Rheum x hybridum, Polygonaceae), sage (Salvia officinalis, Lamiaceae), peony (Paeonia officinalis, Paeoniaceae), verbena (Verbena officinalis, Verbenaceae), and Japanese thistle (Cirsium japonicum, Asteraceae).

In the 2002 survey of herbal practitioners from Mending the Web of Life, 46 respondents recommended alternatives to bear bile.14 One of the most frequently suggested alternatives, with 9 citations, was xia ku cao (Prunella vulgaris, Lamiaceae). Other botanicals were also recommended as replacements for specific actions of bear bile, including Paeonia lactiflora and P. suffruticosa for “clearing heat and alleviating spasms,” Ligusticum chuanxiong for alleviating pain, and Cassia obtusifolia (Fabaceae) for benefiting the eyes.

The World Society for the Protection of Animals (WSPA) published a report in 2005 listing numerous herbs considered to have some of the same indications as bear bile.38 For example, the report noted that, like bear bile, Lobelia chinensis (Campanulaceae) and Hedyotis diffusa (Rubiaceae) are used for “clearing heat and detoxifying,” Gentiana spp. is used for “clearing liver fire,” and Lycium spp. (Solanaceae) and Ligustrum lucidum (Oleaceae) are taken to “brighten eyesight through nourishing the liver.” Since releasing that report, WSPA has been encouraging traditional medicine groups worldwide to support a statement saying that there are good herbal alternatives to bear bile.

“Seventy-one traditional Asian medicine associations from 8 countries have already expressed support for the statement,” said WSPA Global Wildlife Programs Manager Chris Gee (e-mail, October 2009-January 2010). “These include 3 from within mainland China.” He added that the Korean Association of Herbologists published a report promoting herbal alternatives to bear bile in October 2009.

The 2006 report commissioned by DEFRA and IFAW, mentioned previously, also investigated plants with TCM properties and functions similar to bear bile.11 Seven herbs were identified in the report as potential alternatives to bear bile: Gardenia jasminoides (Rubiaceae) fruit, Scutellaria baicalensis (Lamiaceae) root, Coptis chinensis rhizome, Phellodendron amurense (Rutaceae) bark, Rheum palmatum (Polygonaceae) root and rhizome, Anemarrhena asphodelides (Anthericaceae) rhizome, and Andrographis paniculata (Acanthaceae) aerial parts. Additionally, 2 Kampo prescriptions were proposed as possible bear bile alternatives: Orengedokuto and Dia-Orengedokuto (both of which contain combinations of the 7 above-listed herbs).

Recent research has particularly highlighted the potential of Coptis spp. to replace bear bile. According to an article published in the Journal of Ethnobiology and Ethnomedicine in 2009, extensive studies have shown that Coptis has many pharmacological actions, including antibacterial, antiviral, anti-inflammatory, anti-hypertensive, and cholesterol-lowering properties.33 The herb is considered a promising potential drug candidate for treatment of liver injury, and in vitro studies indicate that extracts of it can suppress cancer cell lines.

According to Robinson, the lead investigator of the recent Coptis research, Prof. Yibin Feng of the University of Hong Kong, explained during a 2008 symposium how he and his colleagues have been comparing extracts from 2 species of Coptis against raw bear bile and purified active ingredients from bear bile. “The tests showed Coptis to be far more effective than bear bile at killing cancer cell lines,” said Robinson. “These initial results are very exciting. Further tests are planned to compare Coptis and its extracts with bear bile for their effectiveness against a variety of liver conditions.”

Robinson noted that Prof. Feng’s research could ultimately assist in ending the bear bile industry. Some organizations, including Animals Asia Foundation and WSPA, have spent years lobbying to end bear farming and use of bear bile.

After years of lobbying and negotiations, Chinese authorities signed an agreement with Animals Asia Foundation in 2000, pledging to help end bear bile farms and rescue 500 bears. The Vietnamese government promised to help phase out bear bile farming in 2005, and it signed an agreement with Animals Asia Foundation in 2006 to help the organization rescue 200 bears. As of March 2010, Animals Asia Foundation had rescued 318 bears—266 from farms in China and 52 from Vietnam.

According to Robinson, many of China’s worst bear farms have been shut down. The Chinese government claims that there are now 68 farms in the country, down from 480 in the 1990s. However, Animals Asia Foundation believes that the actual number of Chinese bear farms is higher. “In addition, many smaller farms have been consolidated into bigger ones, so the number of bears remains roughly the same or could even be increasing,” she added.

Official figures in Vietnam indicate that the number of farmed bears has been decreasing, but Gee stated that such figures need further verification. WSPA has assisted in microchipping all bears in the country’s bear farms, to ensure that no new bears enter the industry. WSPA has also been supporting Vietnam’s Forest Protection Department in its efforts to monitor farms and punish those found breaking the law. “Progress does seem to be being made with owners of illegal bears being fined and confiscations of bears,” said Gee.

Organizations such as Animals Asia Foundation and WSPA continue to lobby the governments of bear farming nations to permanently shut down the industry, as well as lead campaigns to increase global awareness of the issue. Animals Asia Foundation initiated a new campaign in February 2010, encouraging Chinese pharmacies to pledge to never stock and supply bear bile products in the future, and WSPA launched a new webpage in March 2010, encouraging US audiences to become involved in efforts against bear farming (see sidebar).

Robinson noted that bear farms persist due to lingering demand from older consumers and because of new marketing ploys by the industry. “It’s mainly the older generation that is still using bear bile, and we’re happy to see that the younger generation is far more aware of the suffering involved and they are rejecting it,” she said. She added that the industry promotes bear bile as a cure-all and, increasingly, as the magic ingredient in products such as shampoo, toothpaste, and wine. “As the younger generation turns away from consuming bear bile, the industry looks for new ways to encourage them to take it.”

Gee noted that changing the habits of consumers requires widespread support, including support from governments. “There is a need for authorities to come out and clearly support those good alternatives to bear bile,” he stressed.

Sidebar: How TCM Purchases in Western Markets Can Impact Bear Farming Practices in Asia

American consumers and herbal practitioners may unintentionally be providing economic support to bear farming activities through their choice of TCM products. Many significant Chinese medicine manufacturers produce bear bile products as a small percentage of their product lines for domestic consumers. These companies sometimes also sell a range of other products within US markets.

The World Society for the Protection of Animals (WSPA) launched a new webpage in March 2010 to help US consumers and herbal practitioners find out whether the TCM products they purchase are produced by Chinese companies involved with bear farming. The webpage allows users to send customizable e-letters to US retailers of Chinese-made TCM products, asking them if their Chinese suppliers produce any bear bile products. These e-letters include a link through which contacted retailers can learn more about bear farming and obtain a template letter (in English or Chinese) that they can use when asking Chinese companies about their bear bile policies. Consumers and practitioners who send e-letters will be able to post retailers’ responses to the webpage.

WSPA plans to acknowledge on its website those US retailers who agree to stop selling medicines produced by companies that manufacture bear bile medicines, and it will also include a list of Chinese companies that pledge to stop producing these products or claim to have never done so. Any companies found to violate such a pledge will also be identified on the website.

Through this campaign, WSPA hopes to illustrate to Chinese companies that participation in bear farming is detrimental to growth in Western markets. The webpage is available at:

A large green turtle on Melbourne Beach in Florida. Photo ©2010 Photographer: Richard Sobol; Source: International Fund for Animal Welfare

Turtles and Tortoises Numerous species from such Families as: Testudinidae, Bataguridae, Platysternidae, Trionychidae, Carettochelyidae, Chelidae, Dermochelyidae, and Cheloniidae

As of 2008, IUCN had reviewed the conservation status of over 1,300 of the world’s reptiles, and the organization found that 62% of 212 evaluated species of turtles and tortoises are threatened or endangered.39 Many turtle and tortoise species are listed in Appendix I or II of CITES, and most native Chinese species, in particular, have greatly declined in recent years.40 A number of threats contribute to the continued decline of turtle and tortoise populations, including large-scale trade for food and medicinal preparations, collection for the pet industry, habitat loss, and pollution.

Turtles and tortoises have been used in the traditional medicinal practices of many cultures. Turtle meat is considered to have high nutritional value according to TCM, and turtle shell is used as an ingredient in many TCM formulas and preparations. In particular, the shell is often turned into a jelly after being boiled in water with herbal and other ingredients. These products are used to treat a variety of conditions, including erectile dysfunction and even some cancers.40,41 According to the Pharmacopoeia of the People’s Republic of China, the carapace and plastron from Chinese pond turtle (Chinemys reevesii, Bataguridae) is used to treat conditions of the skeletal, renal, and cardiovascular systems, as well as mental conditions, and the carapace of Chinese softshell turtle (Pelodiscus sinensis, Trionychidae) is used to reduce nodulations and relieve consumptive fever (A. Lee, e-mail, December 22, 2009). In fishing communities in Northeast Brazil, the fat of certain marine turtles has been used medicinally to treat rheumatism, earache, sore throat, and swelling.5,42

Large commercial turtle farms were established in China in the 1980s to meet rising demand for turtle products.43 By 2002, there were nearly 1,500 large turtle and tortoise breeding facilities on record in China. A survey conducted that year of 684 of such farms found that they collectively raised more than 300 million of the 11 most commonly reared turtle species—all of which are on the IUCN Red List. Such data reflects the massive scale of turtle farming in China, particularly as many illegally operating farms are also known to exist in the county. Turtle farms are also found in other Asian countries.

Wild turtle and tortoise populations are negatively impacted by large-scale turtle farming, particularly as turtle farms are the primary purchasers of wild-caught turtles.44 These farms need wild breeders both to increase their total stock and because successive generations of farmed turtles show decreased reproductive capabilities. Additionally, illegally obtained turtles can easily be laundered as farmed specimens, and the Chinese belief that wild animals are more potent encourages poaching as these animals fetch higher prices.

Surveys in Northeast Brazil, meanwhile, indicate that marine turtles used in traditional remedies are likewise included on the IUCN Red List, as well as Brazil’s official list of endangered species.5,42 Due to decreased numbers of these turtle species, some practitioners have reported that turtle-based remedies are now rarely used in Northeast Brazil. Others, however, have stated that many species are still captured and used for food and medicine.

Due to decreased turtle populations and concerns over sustainability, some efforts have been made to use or identify alternatives. Researchers have pointed out that many different animal species are sometimes used to treat particular diseases in Northeast Brazil, which enables adaptability when certain species become less available or accessible.5 Traditional practitioners surveyed in this area have also said that some animal species can be replaced with plants or used in association with them to treat disease, and the green sea turtle (Chelonia mydas, Cheloniidae) was noted as being one such animal.

“The therapeutic properties of wild animals and plants and domestic or cultivated species overlap in many cases,” said Romulo R. N. Alves, professor at the Universidade Estadual da Paraiba and author of zootherapy studies in Brazil (e-mail, December 2, 2009). “The substituted plant depends on the diseases treated,” he continued, adding that he is not aware of which particular botanical species are used as substitutes for turtle.

In the 2002 survey of herbal practitioners from Mending the Web of Life, 116 respondents provided information on possible replacements for Asian tortoise in TCM.14 The most commonly recommended alternative was freshwater turtle, although senior practitioners pointed out that freshwater turtle would not be a good substitute since they too are endangered. Seventeen respondents suggested nu zhen zi (Ligustrum lucidum, Oleaceae) as a potential replacement. Further, for particular actions of tortoise shell, senior practitioners recommended a combination of Paeonia lactiflora and Rehmannia glutinosa for “nourishing yin and anchoring yang,” Eucommia ulmoides (Eucommiaceae) for benefiting kidneys and strengthening bones, and Sanguisorba officinalis (Rosaceae) for “cooling the blood and stopping yin deficient uterine bleeding.”

Some researchers and herbalists have argued that there is no real benefit of turtle consumption at all. Researchers from China and California recently conducted a study into the nutritional value of 5 hardshell turtle species to test some of TCM’s claims.41 After testing samples of the turtles’ meat, fat, and shell, the researchers found that turtle shell and meat have lower fatty acid concentrations than other more readily available products, that amino acids found in turtle shell are difficult for humans to assimilate, and that turtles’ selenium content is not as high as TCM indicates. They concluded that human consumption of turtles could be completely substituted by cheaper domestic animals, aquatic animals, or mineral supplements, which are widely available and affordable.

Chinese herbalist Lo Yan-Wo, who has served as president of the Association of Chinese Medicine and Philosophy, has likewise argued that the medicinal value of turtle is minimal and that the herbs used in turtle jellies are the most important ingredients.40,45 He has stated that herbs are much cheaper, so many manufacturers and merchants add turtle simply to increase the price. According to Arthur Lee of the Chinese Medicine Council of Hong Kong, there is no unique formula for turtle jelly, but Chinese herbs commonly used in such products include Smilax glabra (Smilacaceae), Rehmannia glutinosa, Artemisia scoparia (Asteraceae), Lonicera japonica, and Cannabis sativa (Cannabaceae).

The use and trade of turtles has far-reaching consequences. Some countries are increasingly relying upon imported turtles to satisfy local demands for turtles as food, medicine, pets, and other purposes. From 2002-2005, more than 30 million live native turtles were legally exported from the United States alone.39 Due to increased demands for freshwater turtles from Asia and South America, some US states have begun tightening their freshwater turtle harvesting rules—including Florida, which enacted the most restrictive turtle harvest rule in the United States in July 2009.46

Although promoting botanical alternatives to medicinally used turtle products might ease some pressures on turtle populations, it is important to bear in mind that alternatives would need to be overwhelmingly adopted for turtles’ other uses, as well. Turtles and tortoises are used as a source of protein by many cultural groups, and they are often considered a delicacy.47 According to Prof. Alves, “Many turtle zootherapeutical products are the result of hunting these animals for other purposes, and their subproducts are utilized for medicinal purposes.”


The use of endangered species for medicinal purposes is often illegal and usually not supported by licensed practitioners. Lixin Huang of ACTCM stated that products containing endangered animal ingredients would not be prescribed by TCM doctors or licensed acupuncturists. She added that many of these products are not manufactured by legitimate companies but by merchants, and they may not actually include the endangered species that they claim to contain.

Greg Livingston, PhD, a Chinese medicine physician with a clinical practice in Hangzhou, stated that most medicinal products made from endangered animal species are not easily available to mainland Chinese consumers, and most consumers are probably not even interested in taking them: “but in Asia, the population is so huge that all it takes is a tiny minority to become a large problem” (e-mail, November 19, 2009).

The continued demand by some consumers throughout the world for medicines created from endangered wildlife helps to fuel continued black market trafficking and local poaching, while the interests of various farm owners and merchants continue to negatively affect wild populations of threatened species.

Stopping the trade of endangered animal species for medicinal use is not a simple task. To do so involves addressing the socio-economic conditions that contribute to poaching in impoverished countries, rigorously enhancing enforcement of wildlife trafficking laws, and educating large numbers of people about conservation issues. Additionally, animal rights are a low priority within many countries. “In China, there are hundreds of millions of poor people, so most people here are more concerned with just taking care of the basic needs of people and consider animal welfare secondary to this,” explained Dr. Livingston.

Identifying substitutes for endangered and threatened animal species has had some positive results, but even this can prove challenging. In some countries where zootherapy is practiced, herbalists and consumers are not sufficiently aware of the threatened status of many animal species, so the importance of using substitutes is not realized. Additionally, research identifying substitutes to endangered animals is not always widely disseminated. There are also cultural beliefs regarding medicinal practice that can affect whether practitioners and consumers will accept proffered alternatives.

For instance, in TCM, domesticated animals are typically considered more appropriate substitutes to endangered animals than plants. “There is a big difference between animal and botanical substances,” said Dr. Livingston. “Chinese medicine says ‘xue rou you qing,’ which translates roughly as ‘animal substances have an affinity for the human body.’ These substances are easily absorbed, have strong effects, and can penetrate to a ‘deeper’ level of the body and thus affect physiological processes in a way that many botanical substances cannot.”

Convincing TCM proponents in Asia to accept botanical alternatives to endangered animal species may therefore prove particularly challenging, although botanical alternatives may be more appropriate for other audiences. Bria Larson, development officer of ACTCM, explained that US consumers, for instance, are often more open to botanical alternatives, particularly since many are vegetarians or believe strongly in animal rights issues. “There needs to be both options,” she said, noting that both animal and botanical alternatives are important for satisfying people of different cultural or personal belief systems (oral communication, September 1, 2009).

It is also imperative that the conservation status of suggested alternatives be monitored, lest the situation of the saiga antelope—formerly recommended as a replacement for rhino horn—be repeated. “In order to ensure the long-term abundance of Asian medicinal flora, we should definitely be researching how much can be produced sustainably before recommending it as an alternative,” said Jasmine Rose Oberste, founder of Chinese Herb Garden, a nonprofit dedicated to ensuring the sustainability of Asian medicinal plants (e-mail, October 13, 2009).

Additional research into the topic of medicinal endangered animal alternatives may be warranted, as may greater discussion of the needs for and challenges inherent to promoting substitutes. To this effect, the International Symposium for the Conservation of Endangered Species and TCM was held in Beijing in November 2009, sponsored by ACTCM and Animals Asia Foundation and held in conjunction with the World Federation of Chinese Medicine Societies’ (WFCMS) annual herbal committee meeting. The event brought together over 250 herbal vendors, practitioners, researchers, government officials, and representatives from the fields of TCM and environmental conservation. Lecturers presented data on the threatened status of various medicinally used animal species, as well as information on alternatives to endangered species.

According to Larson, the response to the symposium was very positive, and the event was successful in bringing conservation and science advocates together with a receptive Chinese medicine audience (oral communication, December 8, 2009). She added that the event seemed to offer new insight to many attendees. Although the endangered status of certain high-profile animals seems to be widely acknowledged within the TCM community, the conservation status of other animals—such as certain turtle species or the saiga antelope—do not appear to be as well known.

A working group of experts dedicated to the theme of endangered species and TCM held their first meeting at the symposium. According to Larson, this group intends to ultimately expand research on conservation topics into herbal curricula in China, as well as engage in other outreach efforts and initiate new research projects. Additionally, it is hoped that WFCMS will establish a permanent subcommittee on endangered species. Larson explained that this appears to be a very real possibility, although the process to initiate and gain approval for such a subcommittee may take some time.

As more stakeholders adopt the cause of ending medicinal use of threatened animals and promoting alternatives, there may be some hope in finding solutions to this crisis. “There’s going to be more endangered and threatened species as our global environment continues to be stressed, so it’s imperative that more research be done into conservation and substitutes for threatened species,” said Larson (oral communication, September 1, 2009).

*Species covered by CITES are listed in 3 Appendices, according to the degree of protection they need. Appendix I includes species threatened with extinction; trade in specimens of such species is permitted only in exceptional circumstances. Appendix II includes species not necessarily threatened with extinction but in which trade must be controlled in order to avoid utilization incompatible with their survival. Appendix III contains species protected in a least one country, which has asked other CITES Parties for assistance in controlling trade.

The Chinese word for “protection” is a homophone of the word for “tiger.”

‡Giant pandas do not produce UDCA, considered the main medicinal component of bear bile.


  1. Alves R. Fauna used in popular medicine in Northeast Brazil. Journal of Ethnobiology and Ethnomedicine. 2009;5:1.

  2. Alves R, Rosa I. Why study the use of animal products in traditional medicines? Journal of Ethnobiology and Ethnomedicine. 2005;1:5.

  3. Mahawar MM, Jaroli DP. Traditional zootherapeutic studies in India: a review. Journal of Ethnobiology and Ethnomedicine. 2008;4:17.

  4. Costa-Neto E. Animal-based medicines: biological prospection and the sustainable use of zootherapeutic resources. Annals of the Brazilian Academy of Sciences. 2005;77(1):33-43.

  5. Alves R, Rosa I. From cnidarians to mammals: the use of animals as remedies in fishing communities in NE Brazil. Journal of Ethnopharmacology. 2006;107:259-276.

  6. Foster S. Velvet—an emerging “herb”: a surprising look at deer antler. Herbs for Health. 2000; September/October:62-64.

  7. Still J. Use of animal products in traditional Chinese medicine: environmental impact and health hazards. Complementary Therapies in Medicine. 2003;11:118-122.

  8. Davies B. Black Market: Inside the Endangered Species Trade in Asia. San Rafael, CA: Earth Aware Editions; 2005.

  9. Dinerstein E, Loucks C, Wikramanayake E, et al. The fate of wild tigers. BioScience. 2007;57(6):508-514.

  10. Heydlauff A. Tigers. In: Call E. Mending the Web of Life. Silver Spring, MD and Yarmouth Port, MA: American Herbal Products Association and International Fund for Animal Welfare; 2006:134-141.

  11. Bell C, Simmonds M. Plant Substances as Alternatives for Animal Products in Traditional Medicines. Report submitted to the Department for Environment Food and Rural Affairs. 2006.

  12. Nowell K, Ling X. Taming the Tiger Trade. TRAFFIC East Asia Report. 2007.

  13. Chen J, Chen T. Chinese Medical Herbology and Pharmacology. City of Industry, CA: Art of Medicine Press; 2004.

  14. Call E. Survey of Replacements: Mending the Web of Life. In: Call E. Mending the Web of Life. Silver Spring, MD and Yarmouth Port, MA: American Herbal Products Association and International Fund for Animal Welfare; 2006:223-247.

  15. Stropes L. Save the Tiger Campaign. October 2001. Available at: Accessed November 4, 2009.

  16. Telecky T, Li P. Horror and hope in China. All Animals. Fall 2008;12-14.

  17. International Fund for Animal Welfare. Made in China—Farming Tigers to Extinction [report]. Beijing, China: IFAW; May 2007.

  18. CoP14 Doc. 52. Annex 1. Report on Implementing Resolution Conf. 12.5 of CITES; 2007.

  19. Jacobs A. Tiger farms in China feed thirst for parts. New York Times. February 13, 2010;A4.

  20. Gratwicke B, Mills J, Dutton A, et al. Attitudes toward consumption and conservation of tigers in China. PLoS One. 2008;3(7):e2544.

  21. Tiger farms: a ticket to extinction [press release]. Washington DC: International Tiger Coalition; May 8, 2009.

  22. Ali FM. Indian tiger park ‘has no tigers.’ BBC News. July 14, 2009.

  23. Rhinos in Crisis. International Rhino Foundation website. Available at: Accessed August 6, 2009.

  24. Rhinoceros Fact Sheet [No. 46]. WWF website. Available at: Accessed September 14, 2009.

  25. Scientists crack rhino horn riddle. ScienceDaily. November 11, 2006. Available at:

  26. Ellis R. Poaching for traditional Chinese medicine. In: Save the rhinos: EAZA Rhino Campaign 2005/6 Info Pack. London: Save the Rhinos; 2005.

  27. Milledge S. Illegal killing of African rhinos and horn trade, 2000-2005: the era of resurgent markets and emerging organized crime. Pachyderm. 2007;43:96-107.

  28. Pearce F. Going the way of the dodo? New Scientist. February 15, 2003;2382:4.

  29. Robinson J. Healing without Harm: Working to Replace the Use of Animals in Traditional Chinese Medicines [report]. Animals Asia Foundation. March 2009.

  30. Response to news preports that rhino poaching cases are at a 15-year high [press release]. London, UK and Yulee, FL: Save the Rhino International and International Rhino Foundation; July 10, 2009.

  31. IUCN, TRAFFIC, WWF. SC58 Inf. 10. Status, Conservation and Trade in African and Asian Rhinoceroses. Fifty-eighth meeting of the Standing Committee. July 6-10, 2009.

  32. Bear Trade FAQs. WWF Website. Available at: Accessed August 17, 2009.

  33. Feng Y, Siu K, Wang N, et al. Bear bile: dilemma of traditional medicinal use and animal protection. Journal of Ethnobiology and Ethnomedicine. 2009;5:2. doi: 10.1186/1746-4269-5-2.

  34. Gabriel GG. Bears. In: Call E. Mending the Web of Life. Silver Spring, MD and Yarmouth Port, MA: American Herbal Products Association and International Fund for Animal Welfare; 2006:81-92.

  35. The Unbearable Trade in Bear Parts and Bile. Humane Society of the United States Website. Available at: Accessed August 11, 2009.

  36. Bekoff M. A bile business. New Scientist. 2009;202:2706.

  37. World Society for the Protection of Animals. From Cage to Consumer [report]. London, UK: WSPA; 2007.

  38. World Society for the Protection of Animals. Finding Herbal Alternatives to Bear Bile [report]. London, UK: WSPA; 2005.

  39. The Reptile Trade. Animals Asia Foundation website. Available at: Accessed November 17, 2009.

  40. Altherr S. Asian Tortoises and Freshwater Turtles. In: Call E. Mending the Web of Life. Silver Spring, MD and Yarmouth Port, MA: American Herbal Products Association and International Fund for Animal Welfare; 2006:55-73.

  41. Meiling H, Haitao S, Lirong F, Shiping G, Fong JJ, Parham JF. Scientific refutation of traditional Chinese medicine claims about turtles. Applied Herpetology. 2008;5:173-187.

  42. Alves RR. Use of marine turtles in zootherapy in Northeast Brazil. Marine Turtle Newsletter. 2006;112:16-17.

  43. Haitao S, Parham JF, Zhiyong F, Meiling H, Feng Y. Evidence for the massive scale of turtle farming in China. Oryx. 2008;42(1):147-150.

  44. Haitao S, Parham JF, Lau M, Tien-His C. Farming endangered turtles to extinction in China. Conservation Biology. 2007;21(1):5-6.

  45. Lee S. Turtles facing extinction. Hong Kong Standard. August 1999. Available at: Accessed October 8, 2009.

  46. Florida bans commercial freshwater turtle harvest. Environment News Service. July 21, 2009. Available at: Accessed November 9, 2009.

  47. Alves RR, Vieira WL, Santana GG. Reptiles used in traditional folk medicine: conservation implications. Biodiversity and Conservation. 2008;17(8):2037-2049.