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.
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.
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.
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.
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.
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.
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.
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.
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!
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.
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.
(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.
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.
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.
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).
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.
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.
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!