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.

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.

Working with calcite: potency as a process

By Barbara Gerke and Jan van der Valk

As part of our project, we ethnographically documented a case study of Sowa Rigpa medicine making (sman sbyor) techniques that reveals ideas of potency (nus pa) in practice. This involved apprenticing with a medical practitioner in Ladakh to process calcite or chongzhi (cong zhi). We chose the example of calcite rock, of which many types exit, because they can undergo a “hot,” “cold” or “wild” form of processing. This directs their potency to either increase the digestive heat (me drod) of the patient, or to having cooling properties that help calm stomach acidity.

Processed calcite powder is used both as an ingredient and as a pill coating in certain medical formulas. However, skillfully working with chongzhi is not just about finishing a pill, it is also “a phase in the life-story” of a substance—in our case a piece of rock that “grows” in remote mountain areas from where it is collected by amchi. We documented, for instance, how it was transformed during the full moon of the eighth Tibetan month into “moon ray calcite” (cong zhi zla ’od). This specific processing is said to enhance its cooling potency.

We are inspired by anthropologist Tim Ingold and historian of science Pamela Smith, who have shown that historical divisions and definitions of “making” and “growing,” “organisms” and “artefacts” in various societies are not as preordained as they seem at first glance. As stated in Ingold and Hallam’s edited volume titled Making and Growing, the maker or artisan “effects an ontological transformation in the material, not through the application of exterior force to inert substance, but through intervening in a play of forces and relations both internal and external to the things under production” (p. 4).

Many types of chongzhi are mentioned in Tibetan medical literature. They reveal the importance amchi give to the different environments from where they source their substances, as well as the importance of sensorial qualities and local lineage instructions.

Five types of chongzhi samples at the Sowa Rigpa School in Choglamsar, Ladakh. From left to right: pho cong, ma ning cong, mo cong, cong zhi pho cong, mo cong,

Moon-ray chongzhi processing

We visited Amchi Tsültrim’s clinic in Leh in September 2018. He is a Gelukpa monk from Nubra and was trained at the Men-Tsee-Khang, graduating in the third batch of 1973. In September 2018, during full moon, Amchi Tsültrim allowed us to process calcite with him, which is made only once a year, during the most auspicious full moon of the eighth month in the Tibetan calendar, which typically falls into late August or September, when the moon is considered the brightest.

Amchi Tsültrim said it is the easiest to process. Crushing and grinding pearls, turquoise or lapis lazuli is a lot more difficult. Properties of materials are not merely ideas; they are real properties that amchi work with.  We first spent hours crushing chongzhi rocks into small pieces by hand.

Jan is crushing chongzhi rocks into smaller pieces

Then we boil twenty kilos of crushed chongzhi rocks several times in water on a gas stove in a large aluminum pot. Amchi Tsültrim changes the water after each round of boiling, until after four rounds, the water looks clear.

Amchi Tsültrim pours out the water after the second round of boiling chongzhi

This process of boiling (cong zhi dug ’don) only removes the duk (dug) which is not poison in this context, but “what we don’t want”: dirt, other minerals, impurities of all kinds. Through this boiling, the chongzhi becomes clean, tsangma (gtsang ma) Amchi Tsültrim said: “We don’t use unclean materials in medicine, this makes the medicine rough and difficult to digest.”

Five days later we were back, for another two days of grinding. This time the boiled chongzhi rocks had to be ground into fine white powder.

Grinding the pre-boiled and dried chongzhi pieces by hand into fine powder

On the day of the full moon, Amchi Tsültrim had organized six liters of fresh dzomo (yak-cow hybrid) milk, which had been boiled. He started mixing some of the white chongzhi powder with six liters of dzomo milk in a large metal bowl. Amchi Tsültrim explained that the coolness we felt was a combination of the mixture’s exposure to the cold night air, and to moon light, which “is always cold.” Indeed, the aim of our kneading was primarily to expose every particle of the mixture thoroughly to the moonlight, while reciting the Medicine Buddha mantra.

Amchi Tsültrim mixes milk into the pre-processed and powdered calcite under full moonlight

It was around 11:30pm when we stopped the kneading and prepared sheets of washed plastic to place the round chongzhi cakes on that we formed by hand in uneven ways.

We form chongzhi cakes together, which are exposed to moonlight until dawn

Making chongzhi daö with Amchi Tsültrim showed us that only by doing and making we could get a sense of the intricacies of the amchi’s skills, dexterity, and empirical knowledge, as well as practical necessities, limitations, and their dynamic interactions with the substances.

Sowa Rigpa Clinics in Boudha, Kathmandu, Nepal

The great stupa of Boudhanath covered with monsoon clouds in the background, August 2019
A steady stream of Buddhist devotees and tourists on the khora, circumambulating the stupa

The great stupa of Boudhanath, situated in Kathmandu’s northeastern outskirts, has been a crossroads of long-distance trade and Buddhist pilgrimage for many centuries. It is said by Tibetans to fulfil the sincere wishes of travelers who first lay their eyes upon it. In the tight circle of three-storied buildings around the stupa alone, three Tibetan medical clinics attract the attention of passers-by with multi-lingual signboards including Tibetan, English, Nepali and Mandarin Chinese. During a five-week stay in Boudha, I discovered ten active clinics within twenty minutes walking distance from the stupa. Although Sowa Rigpa has centuries-old roots in the Himalayan mountain regions of Nepal as the dominant scholarly medical tradition, this profusion of urban clinics, some of which cater increasingly to tourists from both ‘East’ and ‘West’ , is a more recent phenomenon. In this blogpost, I briefly introduce three quite different Boudha clinics.

Amchi Wangchuk Lama is Kathmandu’s most senior practicing amchi. He still oversees the production of his own medicines, in powder and pill form, including several highly complex precious pills which are individually wrapped in colourful silk fabric. Amchi-la was born in Kyirong in the water-horse year, in 1942. He learned Sowa Rigpa at Drakar Taso (Brag dkar rta gso) monastery and was a monk for many years. Amchi Wangchuk’s clinic is not that easy to find and he does not speak English. He is highly respected, especially for his expertise and skill as a medicine maker. His Nakpo Gujor protective pills, to be worn around the neck, are popular, and monastics also come to purchase compounds for ritual purposes.

Pure Vision Sorig is the name of Dr Sherab Tenzin Barma’s clinic. It is affiliated to his main Healing and Research Center near Pharping, about an hour’s drive from downtown Kathmandu. Dr Sherab hails from Bhutan, where he studied Buddhist philosophy as well as medicine. After a five-year training, he graduated from Chagpori Tibetan Medical Institute in Darjeeling. His clinics offer a range of external therapies, including various types of kunyé massage, herbal steam baths and cosmetic treatments. Besides the prescription-based medical formulas, he also designed a product line of liquid herbal extracts.

Dr Jigme (also know as Jixian Jia) heads the Youthok Tibetan Medical Clinic on the second floor of a building on the khora itself. A large bright room with four windows overlooking the stupa houses six hospital beds, where several elderly patients are getting IV drips. Acupuncture needles are also applied regularly, including by his wife and three assisting amchi in white lab coats. Dr Jigme got his Rabjampa college degree at Qinghai University Medical School, which included an internship in the large integrative hospital nearby. The consultation and dispensing room also has an altar with offerings, thangkas and photographs of important Buddhist teachers, which includes a picture of his young son, who was recognised as a reincarnation of Druptop Rinpoche. Dr Jigme prefers medicines imported from Tibet, because he believes herbs harvested there have higher potency, and since they are manufactured and packaged according to strict GMP procedures.

An amchi family’s old medicine room in Tingmosgang, Ladakh

Amchi Tashi Stobgais, who works at the National Research Institute for Sowa Rigpa (NRIS) in Leh, kindly invited us to his parental home in Tingmosgang to spend the weekend early September last year. We reached there in half a day’s drive along the Indus river valley.

Now a quiet village with dotted with apricot orchards, and some homestays and guesthouses for tourists, Tingmosgang is of considerable historical importance as witnessed by the ruins of a 15th-century royal castle, as well as centuries-old monasteries. Amchi Tashi can trace back three generations of amchi in his family before himself, but the family title ‘Lhajenpa’ and ‘Lharjé’ indicate that he probably hails from a line of royally appointed physicians. His father was trained by his grandfather and so on, but Tashi chose to study at Men-Tsee-Khang in Dharamsala.

We were honoured to speak to Tashi’s father, and to visit the old family shrine room where Mémé Yutok – Amchi Tashi’s grandfather, a famous amchi known across the entire Sham Valley, who traveled around on horseback – had installed a special Medicine Buddha statue, and where he passed away in tukdam.

Going through a small door adjacent to the shrine entrance, we were astonished to find the medicine making room (menjor khang) with its many bottles and instruments. Out of use since his father retired, this small room with its wooden floor and three shelves is like a museum full of treasures: a large grinding stone, wooden medicine containers, bottled locally harvested blue gentian flowers, copper and horn cupping implements, minor surgical instruments, leather medicine pouches, and a large medicine bag lined with snow leopard skin!

a large leather medicine bag lined with snow leopard fur, used by Mémé Yuthok, Amchi Tashi’s grandfather