Saturday, April 20, 2013

Cultural History of Medicinal Plants in a Tibetan Refugee Community

I believe this is an unedited version of my final medicinal plants paper and I had to delete several pictures because they were not functioning and the font was not cooperating but here is a small part of my final product of my India experience.

Tibetan medicine considers passion, aggression, and ignorance the cause of all disease. The Medicine Buddha sits at the heart of this painting holding a myrobalan plant. It is said that by even seeing or hearing the Medicine Buddha all disease can be cured because the myrobalan plant cures passion, aggression, and ignorance.

Tibetan medicine was developed more than 2500 years ago during the Bon era. It was collaborated and modified with the contributions of India, China, and Persia. In the 8th century Tibetan medicine was carried throughout India, China, Persia, Nepal, Kashmir, Mustang, Mongolia, and Mi-nyag and schools were developed in Tibet to teach the “art of healing”. Centuries later, Tibet was invaded by China so thousands of Tibetans sought refuge in India. Now, over 35 Tibetan refugee communities exist all over India.
To keep alive the aspect of Traditional Tibetan medicine the Men-Tsee-Khang was erected in 1961. After 51 years the Men-Tsee-Khang has branched out to over 50 clinics all over India. Due to the Men-Tsee-Khang and Astrological College Tibetan physicians are continuing to spread and offer healthcare to hundreds of thousands old and young.
In this report I will give a survey of the history of Tibetan medicine, outline the Rgyud Bzhi (their main text), explain how Tibetan medicine reached Bylakuppe, India, why Tibetans choose traditional healthcare, and review a few of the medicinal plants in the region and in North India.

How Tibetan Medicine got to Tibet
Tibetan medicine was developed more than 2500 years ago during the pre-Buddhist Bon era (Bradley 2000). Bon shamans believed that spirits were the cause of all disease so in order to cure
disease they began sacrificing animals to placate the spirits with a substitute (Arya 2009). Later, this aspect of Bon shamanism was modified and did away with animal sacrifices, eventually developing into Bon medicine. During this time Tibet was constantly at war with India, Nepal and China but Buddhism began to spread throughout most of Asia and King Songtsan Gampo (617 BC) saw the need to adopt the religion as well. King Songtsan Gampo wanted to bring peace to the hostile Tibetan people and believed that Indian Buddhism was “an antidote that could heal the inner wound caused by anger and aggressive mind” (Arya 2009). Following King Gampo’s call to non-violence, he invited prominent physicians from India, China, and Persia to share their knowledge with Tibetan physicians. The Chinese and Persian representatives returned home after a collaboration of their knowledge but the Indian representative continued to practice and teach in Tibet, thus the strong correlation of Tibetan medicine with Indian Ayurvedic medicine.
In the 8th century King Trisong Deutsan continued his father’s (King Gampo) efforts in uniting India, China, Persia, Nepal, Kashmir, Mustang, Mongolia, and Mi-nyag by inviting them to the first
international conference on medicine in Samye Monastery (Men-Tsee-Khang 2010). At this conference they discussed practices and theories, allowing Tibetan physicians to translate various medical texts and ideals into Tibetan.
From 1126 to 1202 Yuthok Yoten Gonpo the Younger traveled India, Persia, China, and Nepal to share the “art of healing.” He wrote many supplementary texts about the Four Tantras and developed a school in Tibet where hundreds of people came from Mongolia, Siberia, Nepal, Bhutan, and China to learn the Tibetan “art of healing” (Arya 2010). Tibetans in Tibet and Tibetan refugees in India currently practice the same method of Tibetan medicine taught by Yuthok Yoten Gonpo.
            In 1959 the Dalai Lama and tens of thousands of Tibetan citizens fled to India to escape the Chinese invasion (United States Bureau of Citizenship and Immigration Services 2003). The Indian Government granted refuge to Tibet by allowing them land and a place to call home. There are currently 38 Tibetan refugee communities scattered throughout India. The exile of the Tibetans by the Chinese has not yet hindered the purity of Tibetan Medicine, as the government-in-exile immediately executed plans for preserving the practice. In 1961 the Tibetan Medical and Astrological Institute was organized. The denomination changed to the Men-Tsee-Khang in the late 1990s. The institution houses and cultivates Tibetan medicine by training individuals in unique Tibetan medicine practices, treating illnesses, and researching Tibetan medicine. The organization acts under the authorization of the Governing Body and the Department of Health of the Central Tibetan Administration in Dharamsala (Men-Tsee-Khang 2010).
            Throughout India there are 50 branches of the Men-Tsee-Khang. The purpose of this organization is "to provide accessible health care to people regardless of caste, colour or creed. To provide free or concessional, i.e. subsidised health care to the poor and needy, monks and nuns, all new arrivals from Tibet, and those over the age of seventy. To produce Tibetan medicines in an environmentally sensitive manner" (Men-Tsee-Khang 2010). In the institute’s attempt to accomplish this they continue to research herbal, pharmacological, and clinical products to maintain a balanced body, energy, and mind. A few of the remedies researched include applying barley residue from Chang (Tibetan beer) to reduce swelling and using melted butter to stem bleeding, applying of apricot kernel oil to smoothe the skin, use of melandrium glandulorium as body perfume, paste of Trona (washing soda) and Ulmus punila Lin for washing purposes, administration of the mixture of honey, mineral exudate & acacia catechu to prevent the damage of skin from harsh and cold wind (Men-Tsee-Khang 2010). Tibetan medicine remains traditional as a rule, with changes being made slowly and cautiously.

            The Rgyud Bzhi as revised by Yuthok Yoten Gonpo remains the fundamental text for Tibetan medicine today (Kletter and Kriechbaum 2001). Tibetan medicine is a way of providing relief from suffering through balance in both diet and behavior. Rgyud Bzhi is comprised of the Four Tantras:  the Root Tantra, the Explanatory Tantra, the Oral Tradition, and the Last Tantra.
            Root Tantra briefly gives an outline of Tibetan medical teachings by comparing the body to a tree. The First Root of the tree bears two stems, which represents a healthy and sick body. The healthy body continues to be symbolized by branches and leaves, each symbolizing balancing aspects of the body including the 3 humors and excretion of unnecessary products. The Second Root is the root symbolizing methods for diagnosis such as questioning and observing various symptoms. The Third Root entails methods for treatment including therapeutic methods, diet, behavior, or medical treatments (Kletter and Kriechbaum 2001). 
            The second tantra of the Rgyud Bzhi is the Explanatory Tantra, which is concerned with the life cycle from birth to death. It deals with anatomy, signs of death, classifications of disorders, and how diet and behavior can help maintain health. It is the code that doctors should observe and practice in their profession (Donden 1986).
            The third tantra is the Oral Tradition Tantra. This section of the book contains types of disorders, and the cause, condition, symptoms and treatment for the disorder (Donden 1986).
            The fourth tantra is the Last Tantra, which consists of methods of diagnosing, commonly urinalysis and pulse taking (Kletter and Kriechbaum 2001).
            As part of the Rgyud Bzhi there is a study of rlung, mkhris pa, and bad kan, also known as the three humors. These terms can also be translated as wind, bile, and phlegm, which are the main principles in maintaining a balanced body. These terms are closely related to the five elements that organize the cosmos -- earth, water, fire, air, and space.
            Rlung (wind or air) is connected with the mind, nervous system, respiratory system and bodily excretions. It functions with body to think, reason, and connect mind and body. The rlung is localized to the lumbar and hip regions of the body (Kletter and Kriechbaum 2001).
            Mkhris pa (bile or fire) deals with regulation of heat within the body, vision, motivation, catabolism, digestion, and hunger. This humor is generally located near the liver, gall bladder, and mid-section of the body.
            Bad Kan (earth and water) is associated with the brain and upper part of the body. Its functions are related to body structure, body fluids, anabolic functions, sleep, and tolerance (Bradely 2000).
            The three humors are key to maintaining and improving good health. When the humors fall out of balance then bodily disorders occur. Disorder in the sense of Tibetan medicine is the disruption of harmony between body, energy and mind (Ngak Mang Insititute 2012). When any type of imbalance occurs it is treated by adjusting diet, life-style, medicine and external therapies.

Tibetan Medicine in Exile 
            Bylakuppe is the largest Tibetan refugee community in India, with approximately 15,000 Tibetans. The Men-Tsee-Khang opened in 1961 in Dharamshala and later spread to Bylakuppe in 1977. The Men-Tsee-Khang’s main goal is to give accessible healthcare to those in the area whether young or old. “This health care facility has benefitted many people from different walks of life. With the positive impact of Tibetan medicine, there [are] overwhelming demands for Traditional Tibetan medication from the community. Hence, in order to meet these demands and to apply the unique Traditional art of Tibetan Wellness techniques and mild-therapies, further expansion of this clinic into a fully equipped healthcare unit [is] felt by administration in order to provide better health care facilities” (Men-Tsee-Khang 2010). The expansion of the Men-Tsee-Khang from a clinic to an outflank hospital is estimated to cost 1.2 million US dollars. Currently, there are 114 physicians and 16 astrologers practicing in the Men-Tsee-Khang Institute and 3 of the physicians and 1of the astrologers are located in Bylakuppe( Men-Tsee-Khang 2010). The Men-Tsee-Khang governing board in Dharamshala hopes to expand the availability of Traditional Tibetan medicine in India and is pursuing this by first expanding the Men-Tsee Khang and Astrological College in Dharamshala allowing 60 students to graduate per year instead of 25 students every 3 years.
            The students at the Men-Tsee-Khang and Astrological College train for five years at the college where they learn about the concepts in the Rgyud Bzhi (memorizing three of the four texts contained in the Rgyud Bzhi), traditional techniques such as pulse taking and urinalysis, and learn traditional medicines. After the five years in the college students transfer to a clinic to do two six-month internships. In Bylakuppe there were two interns shadowing the doctors.
            The doctors at the Men-Tsee-Khang in Bylakuppe work from 9 a.m. to 5 p.m Monday through Saturday. In a typical day a doctor will see about 40 to 50 patients. In my observations with Dr. Migmar Lhamo, the lady doctor, I saw about 90 percent of patients come before 11 a.m.. Traditional Tibetan medicine teaches that the best time for getting pulse reading is around sunrise but considering the time constraints of the clinic patients take full advantage of coming as early as possible. Every patient who enter the doctor’s office receive pulse reading. Dr. Lhamo explained that
by reading a patient’s pulse, asking questions, and taking the time to discuss behavior with a patient nearly all causes of disease can be diagnosed. Urinalysis is a little less common (maybe 2 in 40 patients will bring a urine sample) because most illnesses are better read through pulse readings. In a pulse reading the doctor can diagnose wind, bile, and phlegm pulses by simply feeling the radial artery of the patient. Results are best read when the patient refrains from too much strenuous work, too much or too little sleep, food that is extremely nutritious or very warming or difficult to digest, and restricts worry and anger. When urinalysis is done all the above must be held as well as proper time for analysis and the right vessel must be used.
                        In taking a patient’s pulse the doctor begins by placing their three middle fingers on the opposite wrist of the patient (ex: doctors right hand on patients left wrist) approximately one inch from the crease in the patents wrist. The doctor feels around for the patient’s radial artery and applies
varying pressures upon the artery to read the pulse. Each finger is used to read the different organs of the patient. As seen in the picture above, the doctor’s right ring finger half reads the womb/seminal vesicle and the other half reads the left kidney, half of the middle finger reads the stomach and the other half reads the spleen, and on pointer finger half reads the large intestine (female)/small intestine (male) and the other half reads lungs (male)/ heart (female). The left hand reads other organs such as the bladder, right kidney, gall bladder, liver, small intestines (female), large intestines (male), lungs (male), heart (female). The female and male pulse is read on opposite hands for the pointer finger. By reading the pulse a Traditional Tibetan doctor can identify whether an organ or constituent of the body is hot or cold, or unbalanced between phlegm, wind, and bile (Donden 1986).
When testing urine a Tibetan doctor looks at the physical aspects of the urine. Is it frothy? Does it have a vapor, odor, or particular color to it? The doctor has to take into consideration when the urine was collected and the temperature of the sample.  Each of these different qualities of the urine will help identify hot and cold disorders as well as wind, bile, phlegm disorders.

One last fairly common procedure is called cupping, which Tibetan physicians use in the case of a sore back or shoulders. Cupping is done by locating the central point of pain and sucking it out. First a physician must message the sore area and dampen it with water. A small piece of paper is then light
on fire and after it was burned sufficiently it is thrown into a copper cup. Next, the copper cup can be firmly pressed against the patients back until the cup suctions and remains suctioned for fifteen minutes. This is said to loosen the muscles and relieve the pain by sucking it out. This procedure is very common especially among the elderly and middle-aged Tibetans.
            A culmination of pulse reading and urinalysis has been just Tibet for centuries (Ashcoff 1999). These procedures are specifically designed to diagnose any disease or imblamalace of the body. Cupping was also used it Tibet and continues to be used to give muscle relief (Yeshi 1886).

Why take Tibetan medicine?
            In Bylakuppe, I asked many individuals as to why they take Tibetan medicine. A few of most prominent reasons were because it is cheap, it works very well for chronic diseases such as arthritis (which is common), and that physically their bodies are not as peppy when they miss out on taking the medicine. Most believe Tibetan medicine to have less negative side effects than allopathic medicine. Namgyal (our host that we lived with for 3 months) said his mother takes it also because of the social interaction she gets with the other elderly women. Tibetan medicine, then, is not only a physical aid but also a social opportunity.
            The procedure to receive traditional care is very simple. No appointment needs to be made and no registering is needed; all a person does is show up at the doctor’s door, takes a number and waits to be called in on a first-come, first-served basis. A consultation is 40 rupees ($0.75 US dollars) with medication added to that. The elderly (over 70) can receive care for only 15 rupees ($0.28 US dollars) for the consultation and up to 10 medications. Student such as monks and nuns also receive discounted care of 50 percent off.
            In my time there I began taking three medications, one for blood circulation, one for digestion, and one for my nerves (these medications were to help with my restless legs syndrome and celiac disease). My total cost of a one-month supply of medications and consultation (which was more costly due to it being on a monthly price scale) was 352 rupees ($6.59 US dollars). I was initially unbiased as to whether the medicine would work or not but after 2 weeks of taking the medicine I am convinced that it was helping or at least it helped boost my energy.
            Visiting a Tibetan physician can be as frequent or infrequent as the patient prefers. In order to receive medicine a patient must return every week, two weeks, or month depending on how long the doctor prescribed the medicine for (Kletter 2001).  In order to receive a renewal of a prescription it is not necessary to have a consultation again. Commonly, a patient will just interrupt the current appointment to have the doctor renew a subscription.
            Visiting the doctor is a fairly public situation. All the doors to the doctors’ offices are usually open and other patients can interrupt as they please. Privacy is extremely limited when it comes to doctors’ visits but no one seems concerned – as was mentioned before it is even considered a social affair. When I visited the Men-Tee-Khang there was no question as to whether I could observe, I just had to get permission from the head doctor.
            The Men-Tsee-Khang in Bylakuppe, India is a highly functional institution which provides Traditional Tibetan healthcare for an affordable cost and allows Tibetans to receive the basic necessary healthcare to maintain a healthy life style.

History of medicinal plants in the region
Bylakuppe, India has been the home of Tibetan refugees for 51 years. The Men-Tsee-Khang has only been in the community for 35 years. Due to the little amount of time in the community and the unavailability of traditional Tibetan plants used in Tibetan medicine there is no current use of plants from the region for the purpose of Tibetan medicines. Where do the plants used in Tibetan medicine come from? The majority of plants used in Tibetan medicine come from Rajasthan, the Punjab, Jaipur, and the Himalaya, all areas in North India. The processing center for the production of Tibetan medicine is located in Dharamshala and disperses to each of the branch clinics throughout India. In the future, the Men-Tsee-Khang in Bylakuppe intends to develop a medicinal processing center in Bylakuppe and also grow medicinal plants suitable to the region (Lhamo 2012).
Tibetan medicine generally includes ingredients such as plants, minerals, and animal products (Ngak Mang Insititute 2012). Plants are becoming of more importance to Tibetan Medicine due to the call by the Rgyud Bzhi,  "All the visible herbs growing above the ground should be used in medicine, because other ingredients, such as precious metals, minerals, odorous plants and animal parts and products, will be rare in 500 decades and will be difficult to find when needed. If they are found at all, the poor patient will not be able to afford their price. Even when they are discovered in remote mountains, they will be of no use, because by the time the doctor gets them, the patient will have already died." Knowledge of field medicinal plants is scant. Often times, only the Tibetan name of a plant is known and only a Tibetan doctor who is familiar with materia medica can identifies these plants (Kletter and Kriechbaum 2001). Approximately 500 formulas are commonly used -- each medicine containing 10 to 70 ingredients (History of Medicinal Plants 2012).
            Though traditional Tibetan medicinal plants are not located in the Bylakuppe region, one of the interns, Pen Pah, outlined and explained a few of the medicinal plants commonly used and found in the foothills of the Himalaya where the Men-Tsee-Khang and Astrological College takes their students to help them learn to identify medicinal plants (Dekhang 2008).

The following is an excerpt of our discussed list:
Plant: Allium sativum L. (Garlic)
Part Used: Whole plant
Uses: imbalance, sleep disorders, loss of appetite, leprosy, skin disorders, hair loss, piles, and worms

Plant: Anaphalis contorta (Anaphalis)
Part Used: Whole Plant
Uses: Flowers and leaves are used for Moxibustion and the rest of the plant is used for glandular diseases and piles

Plant: Asparagus adscendens Roxb. (Asparagus)
Part Used: The roots
Uses: Restores strength and kidney heat, helps with itchy skin disease, pain in the lower back

Plant: Carthamus tinctorius L. (Saffron)
Part Used: Flower pedals
Uses: Anemia, liver disease, and blood pressure

Plant: Cinnamomum tamala Nees (Cinnamon)
Part Used: Tree bark
Uses: Digestion and restores body heat

Plant: Dactylorhiza hatagirea (Dactylorhiza)
Part Used: Flower and root
Uses: Restores sperm count and body strength

Plant: Meconopsis aculeate Royle (Blue Poppy)
Part Used: Whole plant
Uses: Heals wounds, treats bone ailments particularly back pains

Plant: Piper longum L. (Long Pepper)
Part Used: Fruit
Uses: Treats heat disorders, lung disorders, and spleen disorders

Plant: Fragaria nubicola Lindl (Wild Strawberr)
Part Used: The stock and roots
Uses: Treats veins, nerves and accumulated pus (Dekhang 2008)

Despite the lack of traditional Tibetan medicinal plants in the region there are still local plants available, which many use on a personal basis. Local Indian Ayurvedic medicine commonly uses local plants for medicinal purposes but this has not developed into Tibetan medicinal usages. On the Organic Research and Training Centre, a Tibetan organic farm I volunteered at for 3 months, I was able to personally see the Tibetan farmers frequently use the available medicinal plants they were experimenting with. They experimented to find how much the medicinal plants could sell for, how well they grew in the area, and to personally discover the medicinal properties. The following list is a survey of the more commonly used medicinal plants in the community.

Plant: Cymbopogam flexuosus (Lemongrass)
Parts Used: Leaves
Uses: Perfumery, cosmetics, flavoring, aromatherapies, and for the synthesis of vitamin A

Plant: Aloe Vera
Parts Used: Whole plant
Uses: Aching joints and muscles, asthma, indigestion, gastritis, burns, cuts, wounds, itching, insect bites, kidney ailments, liver ailments, pimples, and skin problems

Plant: Zingiber Officinale (Forest Ginger)
Parts Used: Rhizome
Uses: Diarrhea, blood thinning, cholesterol, treating heart disease and nausea

Plant: Cyrophos androgynous (Chakramani)
Parts Used: Leaves
Uses: Synthesis of vitamin A.

Plant: Curcuma longa (Turmeric)
Parts Used: Rhizome
Uses: Antiseptic, contraception, swelling insect stings, wound, whooping cough, internal injuries, pimples, skin tonic, blood purifier, and common cold

Plant: Ocinum tenuiflorum (Tulsi)
Parts Used: Whole plant,
Uses: Remedies for common cold, headaches, stomach disorders, inflammation, heart disease, gastric system, and urinary system

Plant:Mentha Arvensis (Peppermint)
Parts Used: Leaves
Uses: Aromatherapy, body cooling purposes, and maintaining body temperature.

Plant:Gymnema sylvestre (Madhunashi)
Parts Used: Leaves
Uses: Diabetes, weight loss, cough, snake bite antidote, laxative, diuretic

Plant: Terminolia Chebula (A-ru-ra)
Parts Used: The fruit
Uses: Rejuvenates, laxative (unripe), astringent (ripe), anthelmintic, expectorant, tonic, appetite stimulant, leprosy (skin disorders), anemia, narcosis, piles, chronic heart disease, diarrhea, anorexia, and cough

Plant: Bacopa Monnieri (Brahmi)
Part Used: Whole plant
Uses: Enhances memory, vitality, nerve tonic, and treats rheumatism

Plant: Rosmarinus oficinalis (Rosemary)
Parts Used: Leaves
Uses: Muscle relaxer of the digestive and urinary tracts

Plant: Hemigraphis colarata blume (Tincture)
Parts Used: Whole plant,
Uses: Fresh wounds, cuts, and inflammation

Plant: Withania sonifera (Aswagandha)
Parts Used: Roots and leaves, roots
Uses: Sedative, antiseptic aphrodisiac and adaptogenic, and stress reducer

Plant: Costu ignus (Insulin)
Parts Used: Leaves
Uses: Regulates blood sugar levels

            Tibetan medicine was developed over 2500 years ago. It was collaborated by India, China, and Persia and customized by the Tibetans. King Trisong Deutsan carried it to India, China, Persia, Nepal, Kashmir, Mustang, Mongolia, and Mi-nyag and organized schools to teach the Tibetan ‘art of healing”. Now, thousands of year later Traditional Tibetan medicine has been carried across the boarders of Tibet into India where the Tibetans have found refuge from the Chinese (1959). After years of redeveloping a new home, the Men-Tsee-Khang has been established over 50 Tibetan medicine clinics across India. Dharamshala, the Home of the Tibetan Government in Exile, has been fundamental in initiating the establishment of Traditional medicinal care as well as assuring it continues on by creating the Men-Tsee-Khang and Astrological College.
            After living in Bylakuppe, India for three months I have been able see the impact the Men-Tsee-Khang has made in keeping Traditional Tibetan Medicine alive. They have kept the Tibetan ‘art of healing’ alive by educating Tibetan physicians how to read pulse, do urinalysis, and prescribe holistic medicine based on each patient’s ailments and disease. The Men-Tsee-Khang thrives, "to provide accessible health care to people regardless of caste, colour or creed. To provide free or concessional, i.e. subsidised health care to the poor and needy, monks and nuns, all new arrivals from Tibet, and those over the age of seventy. To produce Tibetan medicines in an environmentally sensitive manner" (Men-Tsee-Khang 2010). As long as the Tibetan people hold on to the culture Traditonal Tibetan medicine will carry on. Free Tibet!

Works Cited

Dekhang, Tsering Dorjee. A Handbook of Tibetan Medicinal Plants. Dharamsala, India; Tibetan Medical and Astrological Institute. 2008. Print.

Kletter, Christa, and Monika Kriechbaum. Tibetan Medicinal Plants. Boca Raton, FL: CRC/Medpharm, 2001. Print.

Aschoff, Jurgen C., and Ina Rosing. Tibetan Medicine. Ulm, Germany: Fabri Verlag, 1999. Print.

"History of Medicinal Plants." History of Medicinal Plants. N.p., n.d. Web. 17 Sept. 2012. <>.

Lhamo, Migmar. Personal Interview. 2012

"TME." Short History of Tibetan Medicine. N.p., n.d. Web. 17 Sept. 2012. <> An Introduction to Tibetan Medicine in Exile

Bradley, Tamdin Sither. Thorsons Principles of Tibetan Medicine. London: Thorsons, 2000. Print.

Men-Tsee-Khang. "Aims and Evolution of Tibetan Herbal Medicine." Official Website of Tibetan Medical & Astrological Institute. Tibetan Medical and Astro. Institute, 2010. Web. 04 May 2012. <>.

Yeshi, Dönden, and Jeffrey Hopkins. Health through Balance: An
                        Introduction to Tibetan Medicine. Ithaca, N.Y., USA: Snow Lion Publications, 1986. Print.

United States Bureau of Citizenship and Immigration Services. India: Information on Tibetan refugees and settlements, 30 May 2003, IND03002.ZNY. <
refworld/docid/3f51f90821.html>. Accessed 24 February 20