“Potency” and “poison” in the making of medicines: A visit to a private Tibetan pharmacy near Dharamsala

Barbara Gerke

During my fieldwork in India, and in preparation for this project, I encountered the following explanations of duk (dug), the Tibetan term for “poison,” which in the context of making of medicines means a range of things. The way they are listed here reflects how Sowa Rigpa practitioners (amchi) spoke about them during interviews, informal conversations, and practical demonstrations.

Duk refers to those parts of medicinal substances that (1) would be difficult to digest by the patient, (2) would weaken the potency of other parts of the same substance, (3) are too “rough” or tsup (rtsub) in their potency, or (4) are actually poisonous and would cause symptoms of poisoning in the body. A piece of a bark that is not poisonous or toxic as such can for example be duk, as it would weaken the potency or nüpa (nus pa) of the plant when digested. It is therefore removed as part of the cleaning process in medicine making called dukdön (dug ’don, lit. “expelling poison”), often translated by English-speaking amchi as “purification” or “detoxification,” or simply as ”removing the harmful parts.” A visit to a small private pharmacy, in Tibetan menjorkhang (sman sbyor khang), revealed some of the practical aspects of dukdön.

Dr. Thokmey Paljor welcomed me to his menjorkhang in Salugara, in the foothills near Dharamsala, Himachal Pradesh, in May 2015. I had known him from his time at the Men-Tsee-Khang, when he was head of the Translation Department. After early retirement, he chose to manufacture medicines and trained privately with senior Men-Tsee-Khang amchi. On one of my previous visits to his residence, I had expressed my wish to visually document his practice of dukdön, to which he happily agreed. He made only herbal compounds, so this was a good opportunity to understand dukdön practices involving plant substances.

Fig 1: Dr. Tokmey Paljor explaining the dukdön of plant material. In the background herbal pills are drying on racks in the shade.

Dr. Paljor had prepared several samples to show me the entire range of dukdön of plant materials: fruits, seeds, roots, leaves, flowers, and branches (Fig. 1). While cutting open a piece of chebulic myrobalan fruit (a ru ra), taking out its seed, he explained: “We have to take out the seed. The seed is the poisonous part of the fruit. The seed is the duk. Duk here does not mean a poison or any kind of toxic form. Any part that gives a harmful effect has the name of duk” (Fig. 2). “Does ‘harmful’ here relate to the taste or to digestion?” I asked, feeling the hardness of the seed. “Harmful effect means it harms the digestive system. When the digestive fire—we call it medrö (me drod)—is harmed, the entire bodily constituents are harmed. So, you do not have to relate it to taste. It is the rough part that harms the digestive function,” he explained.

Fig 2: The arura myrobalan fruit has to be opened and the seed, which is the duk, taken out.

We looked at the seeds of the three types of myrobalan. All of them were hard in texture, but so were the dried fruits. “From all the fruits that are used in Tibetan medicine, all inner seeds have to be taken out. Aru, baru, kyuru [a ru, ba ru, skyu ru, the three myrobalan fruits] are only an example (Fig. 3), There is one exception, nyingshosha (snying zho sha). In this case the seed is the main medicine. You can use all of it, cover and seed, there is no duk” (Fig. 4).

Fig. 3: The inner seed of the barura myrobalan fruit is considered duk, and has to be removed.
Fig 4: Nyingshosha, meaning “heart strength,” is an exception among the fruits, where the pit is also a beneficial part called men (sman) or “medicine.” The entire fruit can be used and does not have any duk.

Our conversation transitioned into a discussion on the roughness of duk. “Can you taste the duk?” I asked, knowing that taste was one of the main criteria to investigate the potency of plants. Dr. Paljor explained: “What is mentioned in the text is that the duk parts have the quality of roughness (rtsub). It has nothing to do with taste.”

I touched the myrobalan samples and inquired: “Is roughness detected through touch? The fruits and the pits are both rough by touch. How do they know this is a men and this a duk?” “Yes, how do they know? This is a problem,” he responded. I suggested: “Maybe by experience?” He laughed and explained: “Tibetan medicine was taught by Yutok Yönten Gönpo, who was an incarnation of the Medicine Buddha. The entire Gyüzhi [Four Treatises] was given through the eyes of wisdom, and then just revealed and written down. How can it fail? There were no experiments, no scientific investigations.”

He then showed me four types of roots, where the outer bark had to be peeled off with a pocket knife to remove the duk. With the leaves it is the petiole or stalk (ngar pa), also called stem or yuwar (yu bar), that has the duk and has to be removed. With the flowers it is the tiny sepals that hold the flower buds that are duk. I realized that dukdön is very labor intensive and has to be done by hand. Dr. Paljor has three to four assistants to help with the dukdön. “The aim is to make it smooth,” he said, showing me the smooth surface of the Ashwaganda root (Fig. 5). “Wherever you find duk in herbal substances, all the time there is the same explanation: the roughness has to be made smooth.” Pointing to some white flower petals he had just plucked from their sepals, he explained: “This is already called men, even though the jorwa [sbyor ba = compounding] has not been done, because it has the nüpa inside.”

Fig. 5: Dukdön of roots: the outer bark has to be removed with a knife.

Then he took a branch from a thorny bush, which was a type of Berberis (skyer pa), a “wood medicine” (shing sman). “I am going to take out the thin outer part of this plant. And then I take out the middle soft spongy part (Fig. 6). The real medicine is the middle part (Fig. 7).”  In this case the soft consistency of the pith did not translate into the smoothness of a men, but was considered a duk, just like the outer thorny layer.

Fig. 6: Removing the inner part from a Berberis branch. The outer thorny part also has duk.
Fig. 7: Both the outer thorny part and the middle soft part have duk. The remaining middle part (bar shun; to the right of the image) is considered a men.

Thinking about the typically bitter tastes of poisons, I asked: “If you taste the duk part, would it be bitter?” “Not necessarily. The taste it similar to the good part.” He let me taste a part of kyerpa. It was very bitter. “All of kyerpa is used: fruits, leaves, branches, all are men. Most parts are bitter. Only the fruits have different tastes during different stages of ripening. You cannot taste the duk.”

He then showed me a branch of tikta (tig ta, Swertia chirata) to demonstrate the dukdön of branches (yal ga). “Any branch with nodes has duk, which is the node. Again, even if you use the smaller branches, these are the nodes and they all have to go, all for the same reason, because they are too rough.” (Fig. 8).

Fig. 8: The nodes of the branches have duk and need to be removed.

None of the samples he showed me were considered poisonous plants. Still, they had duk that had to be removed by hand with hours of hard labor. Only the myrobalan fruits could be purchased without seeds in the herbal markets of Amritsar, where he bought many of his plant materials. The rest had to be done by hand before compounding.

“Roughness” and its opposite “smoothness” are among the seventeen qualities (yon tan bcu bdun). Quite different from to the general practice of Tibetan physicians analyzing the potency of plants by taste, duk does not necessarily depend on taste but on the rough quality of the plant part that would weaken the digestive heat. This perception of roughness does not always depend on texture, as the example of kyerpa showed, where the soft, spongy part was also considered duk.

To summarize some insights from this visit with Dr. Paljor, the sensory evaluation of raw substances used in medicine is based on a variety of factors. Duk, the harmful part in substances, cannot be detected by taste. Its roughness and heaviness are qualities not necessarily visible or tactile, but deemed efficacious in Sowa Rigpa. They need to be made “smooth” for the substance to be potent and digestible. Duk needs to be known in its effect on the body and especially on the digestive heat.

Duk is not always equal to “poison,” and many substances can have various types of duk that can be removed through washing, taking off the bark, and so forth. The practice of dukdön of raw materials is a very important part of Sowa Rigpa menjor practice. It is a form of pre-processing that then allows the mixing of multiple substances into compound medicines that unfold their potency or nüpa in synergistic ways.

All photos are by the author.

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.