Tibetan medicine – Potent Substances in Sowa Rigpa and Buddhist rituals

June 24, 2024June 24, 2024

“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.

January 17, 2024January 18, 2024

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.

Figure 7. A) Pills of the Garuda 5 formula (*khyung lnga*) prepared by Amchi Lobsang Gyatuk and Amchi Sunil Bodh, stored in a glass jar to send to their patient in Lahaul. B) Amchi Lobsang Gyatuk storing raw materials in his inherited yak leather bag at his pharmacy in Poh.

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.

October 30, 2023October 31, 2023

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.

December 21, 2022

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.

December 21, 2022December 21, 2022

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.

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.

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).

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.

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.

June 9, 2020

Pre-COVID-19: A visit to Dharamsala, India (February 2020)

In early February 2020, I (Barbara) went to Dharamsala, one of the centers of the Tibetan diaspora community in India and the seat of the Central Tibetan Administration. At that point only three official cases of COVID-19 had been confirmed in Kerala, South India. But the disease was on people’s minds. A friend gifted me two pills wrapped in black cloth and tightened with five-colored strings. In Tibetan, they are called rimsung rilbu (rims srung ril bu), meaning ‘pills that protect from contagion.’ Rimsung pills are based on a medicinal formula, but worn as an amulet. The next day, I observed a queue of Tibetans gathering before the Men-Tsee-Khang branch clinic in McLeod Ganj where by 10am, the entire stock of 2,500 rimsung pills was sold out.

The Men-Tsee-Khang also sold protective amulets that contain mantras, written on the printed image of a mandala surrounded by a wild boar. This is smeared with liquid substances that are attributed protective potency against infectious diseases, called rimné (rims nad). The amulet is tied in cloth with a five-colored string in a complex way by trained specialists.

The user should recite the mantra and visualize the image for protection, which is explained on a leaflet. These were also out of stock, but I was able to photograph one.

The Men-Tsee-Khang leaflet on the protective amulet

I was intrigued by these Tibetan medical preventive responses, asked questions on Tibetan ideas of contagion and protection from infectious diseases, and documented their early responses to the coronavirus pandemic before there were any cases in northern India. Field notes merged into a Think Piece, published in Medicine Anthropology Theory in April 2020.

December 16, 2019

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.

Amchi Tashi’s father, Sonam Gyatso Lharjé

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!