By Eric Brand

When most Chinese medicine practitioners think of bing lang (betel nut), we think of a dried cross section of a seed that is used to kill parasites, downbear qi, and disinhibit urination. Few practitioners know that betel nut is also chewed as a mild psychoactive drug in Taiwan and other parts of South and Southeast Asia. In fact, one of the most unexpected sights for many foreigners upon arriving in Taiwan is the presence of thousands of little shops selling betel nut. The shops are often brightly lit with Vegas style flashing lights, and they are commonly staffed by young women wearing bikinis. These shops are especially common in the southern part of Taiwan, particularly in rural areas.

How did we get from a Chinese medicine for intestinal worms to flashing lights and bikinis?

...

As it turns out, betel nut consumption has a long history in Chinese society that goes beyond its medical use. As early as the Song dynasty (which started around a thousand years ago), we find poems that illustrate that betel nut was chewed as a recreational drug. In fact, the first character in the name for Bing Lang (pronounced Bin Lang in Taiwan) contains the word “Bin” or “guest.” This alludes to the fact that Bing Lang was offered to guests as a ritual nicety, somewhat akin to the offer of a beverage to a guest in modern Western society. Over time, the non-medical consumption of betel nut has largely disappeared from most parts of China, but an intact betel nut culture remains in Hunan, Taiwan, and Hainan.

Betel nut can be chewed fresh or dry. There are a variety of preparations for it, most of which involve the use of the areca nut itself, limestone paste, and the leaf of a plant called Piper betle. Global estimates are difficult to determine, but some researchers estimate that there are over 600 million betel nut users worldwide, making it the most popular psychoactive drug in the world beyond alcohol, nicotine, and caffeine. Though it has a somewhat pleasant if powerful "herbal" taste, chewing betel nut is regarded by many as a disgusting habit because it causes the user to spit copious amounts of dark red saliva while chewing the betel quid. It also damages the teeth and gums and is closely linked to oral cancers, so its use is on the decline amongst young people. Usage spans across India and Southeast Asia, and a stunning variety of spiced and seasoned preparations exist. In Chinese society, it is somewhat isolated to a few southern regions.

The habit of chewing fresh betel nut is only seen in Chinese society on the islands of Hainan and Taiwan. In Taiwan, research shows that betel nut is chewed by about 9-13% of the population, with southern regions having higher consumption rates. It is common across all age groups, and is particularly prevalent among bus drivers, truck drivers, and indigenous populations. The difference between betel nut consumption in Taiwan and Hainan is striking, and many of these differences can be traced to outside cultural factors.

In Taiwan, betel nut consumption was banned during the Japanese occupation of Taiwan, which lasted for roughly 100 years and ended in the mid-20th century. Prior to the Japanese ban, betel nut consumption had a long history of traditional use in Taiwan. After the Japanese occupation ended and the ban was lifted, betel nut consumption came back with a passion, but it was divorced from its original cultural roots. When betel nut came back into fashion, it emerged without its ritual aspect in traditional culture and became more like a recreational drug. Taxi drivers, manual laborers, and others seeking alertness and mild stimulation took to betel nut, and the slightly sexualized marketing phenomenon of “bing lang xi shi” (betel nut girls, the ones in bikinis that sit in windows surrounded by flashing lights) emerged. Of course, everyone knows that the girls in bikinis sell inferior Bing Lang- the best stuff comes from little old ladies that prepare the nuts in nondescript little roadside stalls.

By contrast, Hainan never had a prohibition on betel nut, and it has maintained a traditional betel nut culture to this day. Betel nut is featured in wedding rituals and other cultural festivities, and it is commonly chewed by little old ladies rather than truck drivers. Betel nut is associated with complex and rich symbolism, and it is an important element of traditional Hainanese culture.

The symbolism of betel nut is interesting, without a doubt. First off, it is a product that requires the interaction of an animal, plant, and mineral working together. The principle active ingredient, arecoline, is found in the areca nut, but it requires chewing by a human in the presence of limestone paste in order to efficiently achieve a psychoactive result. It is further potentiated by the leaf of the Piper betle plant, which is said to contribute to its cognitive effects. Thus, it contains a seed (the most yin aspect of the plant, the part that stores its essence) and a leaf (the most yang aspect of a plant, growing at the surface and taking in the sunlight) in addition to requiring a mineral (limestone) and an animal (the human chewing it).

Different preparations of betel nut are found in different regions. In Hainan, fresh mature areca nuts are chewed. The mature nuts are very large and must be split into quarters; they are stronger but less tender than the smaller immature nuts. In Chinese medicine, we use the sliced, dried version of these mature nuts as Bing Lang. In Taiwan, they chew the fresh, immature nuts, which are milder but more pleasant to chew. Taiwan is one of the only regions in the world that chews the fresh, immature nuts.

Hunan province is one of the only places on the Chinese mainland that has a big betel nut culture. In Hunan, the item that is chewed is not actually Bing Lang but rather its husk, which in Chinese medicine is known as Da Fu Pi. This dried betel nut husk is sold as a commercial preparation in shrink wrap similar to candy, and the dried husk is processed with flavorings, sweeteners, and limestone. It is much milder than the fresh nuts that are chewed in Taiwan and Hainan, and is ubiquitous throughout Hunan province.

In the photo above, we see three different preparations of betel nut from Taiwan. On the left, the type known as Chay-Ya can be seen. This type is known by its Taiwanese name (in Mandarin it would be called qing zai) and consists of a small, tender areca nut that is cut lengthwise and stuffed with the flower inflorescence of the Piper betle plant. It has a red limestone paste that gets its color from the Chinese medicinal Er Cha (Catechu). The specimen in the center is known as Bao Ye (wrapped leaf), which is made by wrapping a whole, slightly more mature nut in a Piper betle leaf that contains a white limestone paste inside it. The calyx at the top is discarded before consumption. Finally, the one on the right is called “Shuang Zi Xin,” it consists of two small nuts that are wrapped in a Piper betle leaf with white limestone paste.

According to Chinese medicine, the Piper betle leaf is warm and acrid. It dispels wind and dries dampness, and kills worms and relieves itching. It treats wind-cold cough, stomach pain, wind toxin leg qi, pregnancy swelling, scab (jie) and lai sores, eczema, lichen (xian) of the foot, and scalds. The betle pepper itself is warm and acrid; it warms the center, downbears qi, disperses binds, and disperses phlegm. It treats cold pain in the in the abdomen and region of the heart, vomiting and diarrhea, worm pain, and counterflow qi ascent manifesting as cough.

In terms of its pharmacology, betel nut is often compared to amphetamine and is regarded as a stimulant. However, it is very mild and short-acting- the effects rapidly dissipate once one is no longer actively chewing a betel quid. Subjectively, it causes one’s heart to beat quickly and often produces palpitations, flushing of the face, and sweating. The effects are not terribly powerful or interesting, so it is a bit like nicotine in the sense that it is hard to see why millions of people get addicted to it. Like cigarettes, it is not healthy, not attractive and not profoundly psychoactive, but nonetheless many people use it daily.

If you can look past the rather unattractive copious red spit, betel nut has a nice herbal taste and it gives a pleasant if not particularly enlightening buzz. The one truly positive betel nut experience I had involved chewing the nuts while driving across the island of Taiwan- it was easy to stay awake and stay engaged in conversation with my friend in the driver’s seat, and the effects wear off quickly so you don’t arrive at your destination wired and unable to sleep like you would if you were drinking coffee the whole way home.

I remember that my first Chinese teacher in Taiwan said it is a folk medicine that is believed to prevent the onset of common cold by warming the body and promoting sweating. I can attest to this property as well. One of my friends in Taiwan did his anthropology PhD dissertation on the betel nut culture of Taiwan, and he encouraged me to try chewing two nuts of different types simultaneously. I sweat easily anyway, but chewing betel nut can cause pouring, dripping sweat that is quite remarkable. In this particular instance, my friend (in a typical California fashion) looked at me and said “dude, your head is steaming!” There truly was steam coming off my head as verified by several observers, which of course sent my anthro friend straight to his notebook to log the observation. Pretty warming stuff.

While betel nut is primarily only important to us from the perspective of Chinese medicine, I think practitioners should also be exposed to its cultural background beyond Chinese medicine. Unfortunately, some Western governments have started restricting the use of betel nut in Chinese medicine because habitual consumption of chewing betel nut is associated with oral cancer. In my mind, it is a tragedy that the responsible use of betel nut in herbal medicine is being restricted because lawmakers fail to recognize the difference between responsible, safe use of the decocted nut in medicine and the daily consumption of massive doses of the nut as a recreational drug. It is no surprise that chewing 50 nuts daily until the gums are stained and the teeth fall out is associated with oral cancers and other problems, but there is simply no evidence that the occasional use of Bing Lang in professional Chinese medicine poses a significant cancer risk. Unfortunately, betel nut is high on the list of things that we are steadily losing access to in Western countries. Understanding its cultural background and the differences between its medical use and its recreational use is critical to protect our access to this important medicinal product.