An introduction to Sowa Rigpa accessory tools used for medicine making in Spiti

By Stuti Singh and Barbara Gerke

In this blogpost we discuss some of the accessory tools that Stuti Singh came across during her fieldwork with Sowa Rigpa medical practitioners (amchi) in Spiti in the summer of 2023. We present images and explanations of medicine making (menjor) tools that are used to sieve ground-up substances, store, and measure them. We discussed material characteristics of menjor tools while preparing our co-authored article titled Menjor Tools and the Artisanal Epistemology of Making Sowa Rigpa Medicines in Spiti for a forthcoming book on Tibetan Materialities (edited by Emma Martin, Trine Brox, and Diana Lange), currently under review. Here are some of the accessory tools that were not included in the book chapter.

Accessory tools such as sieves, clippers, brushes, spatulas, and pouches play an important role in the preparation of medicine powders among Sowa Rigpa practitioners in Spiti. Amchi primarily prepare powders called chéma (phye ma), which can be turned into round handmade pills called rilbu (ril bu). These tools are passed on across generations, and while their materiality remains, their size, meaning and utility might change in tandem with the changing socioeconomic and climatic environments that amchi find themselves in.

Sieves

Previous generations of amchi used handmade sieves with relatively large holes, whereas the present generation relies on ready-made finer sieves that can filter larger quantities of ground-up materials. In the past, practitioners would often visit patients at their homes, particularly during winter, preparing small amounts of formulas on the spot after diagnosis. They would carry their own tools for this process. Nowadays, marketplaces provide factory-made accessory tools. Amchi have adapted to using  what is available in local markets, reflecting both changes in technology and economic factors influencing traditional practices.

Amchi Chhering Dorje from the village of Kibber used a plastic sieve to separate coarse from fine powder and a paintbrush to brush up the powder on the grinding stone (Fig. 1A). Plastic sieves are cheaper and thus more economical for amchi than metal or stainless steel sieves. Amchi Sonam Dorje used a larger plastic sieve (Fig. 1B) but said these plastic sieves are not as good as cotton cloth for filtering coarse substances.

Figure 1. A) The plastic tea sieve and paintbrush used by Amchi Chhering Dorje, Kibber village. B) Amchi Sonam Dorje uses a larger plastic sieve in Ka village.

Fox and rabbit legs

Fox or rabbit legs were the traditional brushes before plastic brushes became available. We saw them in both Spiti and Ladakh. Amchi Sonam Dorje from Ka village showed Singh an animal leg brush while grinding medicine for her during a personal consultation (Fig. 2). He explained the use of a rabbit leg in menjor as follows:

“You know, a rabbit has four limbs but it can only use three of them, because the remaining limb was given to the rabbit as a tool for medical practitioners. Therefore, throughout its life a rabbit cannot use it. When a rabbit dies that remaining leg will be used as a tool to brush off the ground-up medicines from the mandah. (…) The rabbit leg does not lose hair, thus it is a perfect brush. However, I am using a fox leg which I got from a dead fox which I found in my water tank in winter. It was almost decomposed and I decided to chop off its legs and use it as a brush for my practice. In Sowa Rigpa we do not waste materials, we have to respect these materials for ethical practice.”

Amchi do not kill animals for these brushes and only use them from dead animals they find in their fields, which is a rare event, Thus most leg brushes are inherited. Rabbit leg brushes are preferred due to their ability of not losing hair. This illustrates how amchi carefully interact with their environment to source material for menjor.

Figure 2. Amchi Sonam Dorje uses a fox leg to brush the ground-up medicine, Ka.

While some tools lose their significance, others are still valued. Amchi Chhering Norbu from Sagnam village inherited a rabbit leg brush and an iron sieve from his father (Fig. 3A and B). He still used the brush, explaining that the rabbit leg does not leave hair in the medicine. However, he prefers using a plastic sieve as it is easily available in the market. Moreover,  the sieve hand-crafted by his father is smaller in size. He added that replacing the older sieve with a plastic one preserves his father’s sieve as a valued artifact.

Figure 3. A) A rabbit leg brush. B) An iron sieve inherited by Amchi Chhering Norbu from his father, Sagnam.

Amchi Lobzang Tanzin from Mane Gogma inherited two hand-made sieves made by his father and kept in his pharmacy. He brought the wood-framed sieve (Fig. 4A) to his house for cleaning raw materials and sieving pounded items. The larger tin sieve (Fig.4B) is no longer in use and was replaced by a plastic one.

Figure 4. A) Wood-framed sieve. B) A larger tin sieve no longer in use, stored at the pharmacy of Amchi Lobsang Gyatuk’s father in Mane Gogma.

Amchi Lobsang Gyatuk from Poh inherited a small circular tin sieve, probably made from a lid, from his father, who had made it by making holes with a hot needle (Fig. 5A). He reflected on the time when his father was practicing:

“In those times, amchi were preparing less amounts of medicines and that there was no concept of preparing stocks of medicine in advance. Therefore, a smaller size sieve was sufficient.”

He does not use it anymore as he now grinds larger amounts of medicines to keep in stock, which requires a bigger stainless-steel sieve (Fig. 5B), which he bought at the local market.

Figure 5. A) The hand-made tin sieve of amchi Lobsang Gyatuk’s father. B) Amchi-la’s stainless-steel sieve, Poh.

These hand-crafted tools illustrate the different materials available in an amchi’s environment that could be turned into menjor tools. With limited access to machines, they demonstrate amchi skills and ingenuity. A hand-made tin sieve presented an innovation from the earlier cloth sieve, which was then replaced by ready-made plastic and stainless-steel sieves.

Leather bags for storing medicines

Singh also came across hand-made leather bags used to store substances and medicines. They have their own material language. In Spiti, a generation ago it was still common for amchi to sew leather or cloth pouches for storing prepared formulae. Amchi Lobzang Tanzin inherited several khomak and kowa (cloth and leather pouches, Tib. khug ma), which were crafted by his father (Fig. 6A and B). He said:

“When I have to go somewhere and I am supposed to take medicines along with me, then I carry these bags; I can also write the name of the formula on the wooden tags.”

Figure 6. A) A leather pouch. B) Cloth bags crafted by Amchi Lobzang Tanzin’s father, Mane Gogma.

Medicinal powders are stored in plastic or glass containers in the pharmacy of Amchi Sunil Bodh and Amchi Lobsang Gyatuk. In some cases, they prepare hand-rolled pills called rilbu, especially for patients living far away (Fig. 7A). According to them, rilbu have a longer shelf life than chéma, which only last one month.

Amchi Lobsang Gyatuk inherited a yak leather travel bag from his father which was brought from Tibet (Fig. 7B):

“It was brought by a monk of Tabo monastery as he wanted to give something to my father due to his commitment towards Sowa Rigpa practice. Therefore, when he went to Tibet, he brought a huge bag made of yak leather to give to my father. During those days, amchi used to travel long distances, especially during winters, to provide treatment for their patients. Therefore, they had to carry all the necessary raw materials and tools for making medicines.”

When the bag was offered to his father as a gift by the monk, it served as a travel bag. Nowadays it is used for storing materials in the pharmacy. It has transitioned from being a travel bag to a storing bag.

A multi-purpose silver spatula

We can observe a merging of properties in the multi-purpose silver spatula of Amchi Sonam Dorje, which he inherited from his father-in-law, who was his teacher (Fig. 8). This tool is unique in that it is used for measuring medicines, grating bones for use in medicine (through its rough surface), as well as for applying moxibustion. It is made from silver, which is considered a precious substance and safe to use with medicines. Amchi Sonam Dorje does not use it for grating anymore in order not to damage it, and rarely uses it for moxibustion. While packing a one-week dose of a formula for a patient, Amchi Sonam Dorje used this silver spatula. He added: “I always use this spatula for measuring the amount of medicine for my patients.”

Figure 8. The silver spatula of Amchi Sonam Dorje in Ka, traditionally used for measuring powder, grating bones, as well as moxibustion.

All menjor tools tell us stories of transformation, migration, beliefs, and practices. Tools are a medium of passing embodied knowledge to the next generation of amchi. In particular, the accessory tools introduced here have evolved over time in Spiti, some being repurposed. Several amchi preserve menjor tools of previous generations as a legacy of their lineage, taking us back to when practitioners had very scarce resources but a broad set of skills that allowed them to hand-craft what they required. Some of these tools were able to maintain their utility in contemporary Sowa Rigpa practice, while others can be interpreted as surviving witnesses of a waning tradition of highly innovative self-sufficiency.

Reflecting on a wonderful workshop experience

Barbara recently co-organized and attended a small-group interdisciplinary workshop titled “Aromatics and Epidemics”. She has written down some of her experiences and reflections in a blog post (linked below) that was first published on the Pandemic Narratives project website. Because the workshop nicely integrated pandemic issues as well as topics related to potent substances, we also wanted to share this post with you here.

Gathering, cleaning, and preparing a local herb with Amchi Nawang Tsering (Nyi, Ladakh)

By Jan van der Valk

On the morning of August 10, 2022, Amchi Nawang Tsering and I were looking at plants on our way to the old village temple when he spontaneously decided to collect some zangnyid (zangs nyid, identified as Dysphania nepalensis). It was growing all over the fallow field we were crossing, and he noted that some of the plants were already over their ideal harvesting time since they were forming immature seeds. Amchi Nawang shared that this herb was also known by locals as a remedy against bile complaints, and that he only uses it in one effective powder formula simply called trimen: “bile medicine.” He instructed me to look for fresh, verdant specimens, neither overgrown, nor small.

Before we actually began to harvest, Amchi Nawang swiftly recited Mipham Rinpoche’s Phakpa Tashi Gyépa prayer for auspicious beginnings. He then plucked and threw some tips of the plants up in the air while paying homage to Medicine Buddha and repeating his mantra. While collecting, Amchi-la continued to recite this as well as the Tendrel Nyingpo mantra that summarizes the Buddha’s teachings. As we picked zangnyid, it emitted a quite strong fragrance akin to coriander leaves.

A river irrigation channel nearby offered us the crystal clear but freezing cold water for removing any dirt from our harvest. The water was so cold that it hurt to have our hands submerged for more than a minute. We carefully washed each little bundle of green twice, taking off inferior yellowish parts. Back in Amchi-la’s pharmacy room, we then first broke the plant material into smaller fragments with a wringing movement, and then cut off any hard portions such as roots. Spread equally on a white cloth over a low rack, the zangnyid was ready for drying, which happens very quickly in this high-altitude cold desert area. The drying process took place indoors in a shaded area, corresponding to the cooling nature of the herb.

As I recall and reflect on this wonderful experience and my visits to Nyi (about a four-hour drive south along the Indus from Leh) over the past few years, it strikes me how much labor and care rural physicians such as Nawang Tsering invest in the making of medicine, and how much of this process is not written down in Tibetan medical texts. Zangnyid is not even mentioned as such in Sowa Rigpa pharmacopeias. Perhaps it is a local variant of zangtsi (zangs rtsi), which is also indicated for bile disorders. But its smell is entirely different! In the project monograph we are preparing titled Crafting Potency, we approach traditional pharmacy processes such as those introduced above through the lens of artisanship because we believe there is much to learn from how Himalayan practitioners of Sowa Rigpa engage with ingredients through their senses, and how skilled practices including ritual transform potent substances into efficacious medicines.

Potent Substances project expo: Sowa Rigpa pandemic responses

By Jan van der Valk and Barbara Gerke

The Department of South Asian, Tibetan and Buddhist Studies (ISTB) at the University of Vienna has a modest exhibition space, which has been dedicated to Sowa Rigpa since 2018.

On December 15, 2022, Barbara added the finishing touch to our small yet dense exhibition in the hallway of ISTB. Only a few steps away from our office, this expo shares some of our on-going work on how potent substances become medicine (section 1), while also focusing on the pharmaceutical responses to the COVID-19 pandemic of Sowa Rigpa physicians in the Himalayan valleys of Ladakh and Kathmandu (section 2). The expo therefore consists of two parts, of which we reproduce the introductory paragraphs here, together with some photos of the key objects we exhibited. In this blogpost we introduce section 2. You can find our separate blog entry on section 1 here.

University of Vienna students can visit the exhibition during office hours. Others who are interested, feel free to contact us for a guided mini tour!

Overview of the new left part of the expo. There are two more framed A3 sheets that introduce our project to the left of the cabinet (see above), as well as printed photos of our main fieldsites on the side.

Anti-COVID materia medica

During the height of the pandemic, amchi across the globe prepared several kinds of well-known as well as innovative medicines, herbal products, and amulets for their patients. This is a selection of different of potent products that have been put to use to protect against and/or treat COVID-19. They were collected during fieldwork by Jan in Ladakh and Kathmandu (August-September 2022), and by Barbara in Dharamsala (February 2020).

Norbu Dünthang (nor bu bdun thang), which can be translated as “7-Jewel-Decoction,” was perhaps the most frequently used formula in Nepal during the pandemic years of 2020-21. It is traditionally used to treat infectious fevers associated with common cold and flu (cham pa) in particular. Amchi found this decoction to be especially effective for mild cases and in the early stages of COVID-19. The coarsely ground herbs are usually boiled for several minutes in hot water.

Four types of anti-COVID pills

Here are three formulas used to treat later stages of COVID-19 (from left to right): (1) Pangtsi 12, (2) Tazi Marpo, and (3) Khyung 5. The fourth is a sample of Mani Rilbu, which are believed to protect from infection when ingested. These were collected by Jan in Kathmandu in August/September 2022.

Close-up of pills used in the treatment of later stages of COVID-19

(1) Pangtsi 12 (spang rtsi bcu gnyis)
Reformulated classical formula for nyenrim (gnyen rims) disorders, with newly added ingredients (including Rhodiola spp.) for treating COVID-19.
Produced and distributed to Sowa Rigpa clinics by Bendurya Healing Herbals (Dr. Lhakpa Ngodup)

(2) Tazi Marpo (rta zi dmar po)
Another top-ranking formula used for COVID-19. This “Red Tazi” pill is often related to Hayagrīva, and is believed to carry his blessing when consecrated.
Produced and prescribed by Yuthok Himalayan Clinic (Dr. Ngawang Choekyong)

(3) Khyung 5 (khyung lnga)
Together with Norbu Dünthang, this “Gāruḍa 5” formula was one of the most commonly used medicines for COVID-19. Khyung 5 was also used preventatively for a short period in case of high exposure.
Distributed for free during medical camps and prescribed by Snow Region Welfare Clinic (Dr. Urgyen Bhuti)

(4) Mani Rilbu (ma ni ril bu)
These small consecrated pills are imbued with the power of thousands of Avalokiteśvara mantras, and with the personal blessings or jinlap (byin rlabs) of the Dalai Lama. Dr. Tsémé ingested some once in a while while dispensing pills to sick patients to protect herself.
Distributed by the Office of His Holiness the Dalai Lama (Dharamsala), and then gifted to Dr. Tseme (Shelchoe Yuthok Clinic), who gave some to Jan.

Amchi Lobsang has treated hundreds of infected patients while wearing available protective equipment and using hand sanitizer (Shelkar Clinic, Boudha, Kathmandu)

Protective pills

Rimsung pills are usually wrapped in colored cloth and tightened with five-colored strings. They are called rimsung rilbu (rims srung ril bu), referring to pills that protect from infectious disease (rims nad). The 9-compound pill Nakpo Gujor (nag po dgu sbyor), wrapped in black cloth, is one of the many rimsung that came to the forefront in 2003 during SARS as well as during the early phases of the COVID-19 pandemic in 2020.

While on fieldwork in Dharamsala, India, in February 2020, Barbara documented the distribution of various rimsung by private pharmacies and the Men-Tsee-Khang. The Men-Tsee-Khang first produced rimsung during a plague outbreak in India in 1994; in February 2020 alone, they distributed 460,000 black rimsung pills across India and Nepal. Rimsung can be worn as amulets and smelled for protection.

While they contain medicinal substances, they are generally not ingested but worn around the neck. They are said to protect through the strong odorous effects of around seven to nine ingredients, such as garlic (sgog pa), sulfur (mu zi), black aconite (sman chen), types of myrrh (gu gul), and traditionally also musk (gla rtsi). Its history and related deity and mantra practices demonstrate medico-religious intertextualities of protective pills and their emergence around the time of the Black Death of 13th / 14th century Tibet.

During the COVID-19 pandemic, many amchi prepared rimsung pills as a first emergency response.

Variants of Nakpo Gujor

Amulets

As a student of the Tibetan medical physician and astrologer Epa Sonam Rinchen and having received initiations from Pelpung Tai Situ Rinpoché, Dr. Ngawang Damchoe (Kunde Medical Clinic) had the rare combined medico-ritual expertise to prepare two variants of Nakpo Gujor (include one wrapped in red cloth, for children), as well as a Logyönma amulet.

A black rimsung pill. It is based on a medicinal formula, but worn for protection. This one was distributed in Dharamsala, India, in 2020.

Parṇaśabarī, the Leaf-Clad Goddess (Tib. Lo gyon ma) is known for averting epidemic diseases. Her protection is embodied in astrological amulets as well as in 21-ingredient pills (Lo gyon ril bu).

Logyönma amulet

Incense

During the pandemic, Dr. Urgyen Bhuti (Kathmandu) also advised her patients to burn this incense made with high-altitude Himalayan herbs to purify the air.

Dolpo healing incense

Biographies of Precious Pills expo

Based on Barbara’s previous FWF project, this expo has now been condensed into the right side of the cabinet, where most of its content can still be viewed.