Tibetan Medicine Study in Amdo, by Lucy Jones

Tibetan Medicine Study in Amdo, by Lucy Jones

(Please vis­it Lucy’s Blog for the orig­i­nal posts and plen­ty of infor­ma­tive arti­cles: myrobalanclinic.wordpress.com)

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This sum­mer I ful­filled a life­long dream of trav­el­ling to Tibet. Many peo­ple assumed that I had already been there as I had stud­ied Tibetan Med­i­cine with Khen­po Troru Tse­nam in the 1990’s, but this, although an amaz­ing expe­ri­ence in itself, was based at Samye Ling Tibetan Cen­tre, a lit­tle Tibetan enclave in the Scot­tish bor­ders.  Dur­ing my Tibetan Med­i­cine train­ing at Samye Ling it had been orig­i­nal­ly planned that course mem­bers would trav­el to Tibet in order to study med­i­c­i­nal herbs in situ and to learn about mak­ing Tibetan Med­i­c­i­nal for­mu­lae. There was even a sug­ges­tion that we might spend time in Lhasa doing clin­i­cal stud­ies and sit exams there. How­ev­er, as the Samye Ling course evolved, var­i­ous obsta­cles to this arose and the Tibetan side of the study was put on hold while we con­cen­trat­ed on the pre­cious oppor­tu­ni­ty to study the Gyushi with Khen­po Tse­nam.

I had always hoped that there would be a way for me to con­tin­ue my clin­i­cal stud­ies in Tibet but the respon­si­bil­i­ties of moth­er­hood and the demands of build­ing a herbal prac­tice meant that I had pret­ty much let go of the idea. Of course just when you let go of some­thing com­plete­ly life has a habit of pre­sent­ing you with oppor­tu­ni­ties you weren’t expect­ing. I had met Dr Nida Chenagt­sang last year in Lon­don and as a result of this meet­ing I attend­ed the Inter­na­tion­al Acad­e­my of Tra­di­tion­al Tibetan Med­i­cine Con­gress in Esto­nia in April.  Some­how the idea of me join­ing the 2016 Sorig Tour group was seed­ed as a result of these events.

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The plan for Sorig Tour 2016 was for the group to spend time gain­ing clin­i­cal expe­ri­ence at two dif­fer­ent loca­tions in Amdo and to spend three days at high alti­tude study­ing the native med­i­c­i­nal flo­ra.  This involved camp­ing at 3800m and we were instruct­ed to bring a very thick sleep­ing bag. Thank good­ness for Google and inter­na­tion­al cli­mate data in order to select an appro­pri­ate lev­el of insu­la­tion.  I nev­er knew there was so much involved in choos­ing a sleep­ing bag.

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Most peo­ple were spend­ing just over 3 weeks on the tour but I opt­ed to fly back after 17 days. Bet­ter a short­er time than to not go at all I told myself.  Even cut­ting the trip a lit­tle short meant that, with trav­el of two days each way, I was away from my clin­ic for 3 weeks.  It was very hard work prepar­ing for my absence in terms of sched­ul­ing extra appoint­ments and mak­ing more med­i­cines than usu­al, but the upside of this is that it allowed for a mag­i­cal con­trast between a very ‘full on’ sched­ule before leav­ing and the expe­ri­ence of sit­ting on an emp­ty and remote moun­tain­side sur­round­ed by graz­ing yaks a few days lat­er.

I left the UK on the 23rd July and after a fun jour­ney involv­ing three plane con­nec­tions (and plen­ty of sleep I am glad to say) I arrived in the bustling city of Xin­ing on the 25th July.  I found that I was the first to arrive so I had plen­ty of time to rest and accli­ma­tise. We were already at the begin­nings of high­ish alti­tude (2275m) and the organ­is­ers had wise­ly sched­uled two days in Xin­ing for us to rest.  This gave me the chance to final­ly meet my dear ‘twin dhar­ma sis­ter’ Karen who hap­pened to be in Xin­ing at the same time from her home­land of Aus­tralia.  We spent three hours talk­ing non stop (as well as eat­ing deli­cious Tibetan food) and it felt as though we had known each oth­er for our whole lives!

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As the rest of the Sorig Tour group arrived I knew that this trip was going to be a won­der­ful expe­ri­ence.  What a warm and love­ly group! It felt good to be amongst friend­ly folk with a deep love of Tibetan Med­i­cine and its Bud­dhist roots.

Not only were my fel­low course par­tic­i­pants a love­ly bunch but we also had a fab­u­lous team of trans­la­tors, guides and helpers. Just as well there was help with the lan­guage aspect. Although I had been study­ing Amdo dialect on Skype with the very patient Gyamt­so (who was one of the trans­la­tors on the trip), my grasp of Amdo dialect was still pret­ty rudi­men­ta­ry and I was only able to under­stand peo­ple when they spoke very slow­ly. I had been strug­gling to ‘undo’ my pre­vi­ous learn­ing of the Lhasa Tibetan dialect, embed­ded some­how in my brain from my time study­ing Tibetan Med­i­cine at Samye Ling and a series of tuto­ri­als while I was liv­ing in Oxford.  Even now I still find that I nat­u­ral­ly resort to Lhasa pro­nun­ci­a­tion as a fall-back posi­tion.  Clear­ly much more work would be need­ed for me to be pro­fi­cient in Amdo dialect but I knew a few con­ver­sa­tion­al phras­es and sev­er­al med­ical expres­sions and I was opti­mistic that I would improve through expo­sure.

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After two days in Xin­ing we head­ed out towards Mal­ho, a jour­ney which took the best part of a day. I was so excit­ed to see that Tibetan cul­ture was thriv­ing in the area to which we were trav­el­ling.  The jour­ney was marked with ‘firsts’ – my first herd of yaks seen from the win­dow of the bus, the first prayer flags on moun­tain tops, the first stu­pa, the first mani stones, the first prayer wheels, the first peo­ple dressed in tra­di­tion­al nomadic out­fits, the first Tibetan mas­tiffs guard­ing flocks of sheep and the first gold­en roofed tem­ple on the hill­side. I was also ridicu­lous­ly excit­ed about watch­ing the alti­tude read­ing climb­ing steadi­ly high­er on my lit­tle alti­tude meter.


Part Two – Clinicals

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Clin­i­cal stud­ies were based in the small town of Mal­ho at around 3600m alti­tude. On the dri­ve from Xin­ing we had climbed steadi­ly high­er and had dri­ven through ter­raced agri­cul­tur­al areas with crops of bar­ley, pota­toes, peas and sun­flow­ers. I smiled to myself when I realised just how ingrained my habit of ‘spot­ting the crop’ was from my time study­ing agri­cul­ture at Oxford all those years ago.

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Mal­ho had the feel of a wild west town. It was most def­i­nite­ly set in the grass­lands, not a crop to be seen, and traf­fic con­sist­ed of hors­es as well as motor­bikes and cars. The wide expanse of open grass­lands with moun­tains beyond could be seen from all parts of the town and it felt very ‘Tibetan’. The pop­u­la­tion of Mal­ho was tem­porar­i­ly increased due to the upcom­ing Nadaaam fes­ti­val, a once a year get togeth­er of the nomadic peo­ple fea­tur­ing horse rac­ing, archery, wrestling, danc­ing and live­stock judg­ing with a good deal of social­is­ing and match mak­ing thrown into the mix.  The town was filled with nomadic peo­ple who seemed as fas­ci­nat­ed by us west­ern­ers as we were with them.  A few times I was stopped in the street by peo­ple ask­ing to take a pho­to of me. Per­haps they were inter­est­ed in the maroon high­lights in my hair but I felt that this fash­ion choice of mine was dull in com­par­i­son to the beau­ti­ful hair braids, dec­o­ra­tive coral neck­laces and heavy belt orna­men­ta­tion that the local ladies were wear­ing.

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Our hotel was con­ve­nient­ly near the town’s tem­ple and this allowed for ear­ly morn­ing kora (cir­cum­am­bu­la­tion) of the prayer wheel hous­es around the out­side. I was sur­prised at how much phys­i­cal effort was required to get these heavy and ornate prayer wheels to start mov­ing from a stand­still, but once mov­ing they con­tin­ued steadi­ly, all the while emit­ting mil­lions of prayers for the ben­e­fit of sen­tient beings. It was a great priv­i­lege to join the stream of peo­ple, mala in hand, walk­ing around the tem­ple keep­ing these prayer wheels turn­ing. The pace was quick­er than I expect­ed. Any slight dal­liance result­ed in the imme­di­ate for­ma­tion of a tem­po­rary fast lane which divert­ed around the obstruc­tion and then went back to turn­ing the prayer wheels with no inter­rup­tion to the recita­tion of mantras.

On our first night in Mal­ho we were invit­ed to Dr Machik’s house for a meal.  I hadn’t met Dr Machik before but I had very much enjoyed his pre­sen­ta­tion at the Tibetan Med­i­cine Con­gress in Esto­nia and I knew of his rep­u­ta­tion as an excel­lent doc­tor with a very kind heart.  Before the meal he gave us a guid­ed tour of his clin­ic.  It turns out that he had recent­ly moved to this new place – an inte­grat­ed clin­ic and res­i­dence with dis­pen­sary and sev­er­al treat­ment rooms.   The ground floor fea­tured a recep­tion area, dis­pen­sary and the invoic­ing area.  The dis­pen­sary and billing seemed to be the domain of Dr Machik’s son and daugh­ter in law.  Patients were greet­ed and then sent upstairs to the next floor where Dr Machik had his con­sult­ing room and three treat­ment rooms, used for exter­nal treat­ments such as Ku Nye, mox­i­bus­tion and blood let­ting.  On the next floor up was Dr Machik’s fam­i­ly home, pro­tect­ed dur­ing clin­ic hours by a locked gate across the stairs.  This was home to three gen­er­a­tions of the fam­i­ly.  As we climbed the stairs we were greet­ed by deli­cious cook­ing smells.  We were shown to a table already loaded with water mel­on and freash Amdo bread. Soon plate after plate of momos, veg­eta­bles and rice were put before us. ‘So, So!’ we were urged – this means ‘Eat!. Eat!’ – one of the few phras­es in Amdo dialect that I knew.  We felt very wel­come and relaxed.

The next morn­ing our group was divid­ed up into three. Some of us were ‘sta­tioned’ at Dr Machik’s clin­ic, oth­ers were to report to the Tibetan Hos­pi­tal in Mal­ho and a third group were post­ed to the Tibetan Med­i­cine Depart­ment of the People’s Hos­pi­tal, a very impres­sive, mod­ern and shiny estab­lish­ment at the oth­er end of town.

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I was to study diag­no­sis and pre­scrib­ing ‚with Dr Machik.  As soon as I arrived there was a steady flow of patients. Dr Machik start­ed by exam­in­ing each one and he then waved them over to take a seat next to me, indi­cat­ing that I should diag­nose and then report back to him. This was chal­leng­ing as my lan­guage skills were not up to much, as I explained in Part One, but I had invalu­able help from Yang­mo Tashi, who in nor­mal life is study­ing to be a jour­nal­ist at Uni­ver­si­ty in Bei­jing. (As an aside it was inter­est­ing to find that Yang­mo Tashi, a native Amdo dialect speak­er, report­ed that it took her about a year to ful­ly under­stand the Lhasa dialect of her class mates at Uni­ver­si­ty – a fact that made me feel slight­ly bet­ter about my own strug­gles to switch from Lhasa to Amdo dialect).

Mean­while the oth­er stu­dents allo­cat­ed to Dr Machik’s clin­ic were work­ing hard in adja­cent treat­ment rooms doing Ku Nye, mox­i­bus­tion, acupunc­ture, cup­ping and, by spe­cial request of Dr Machik, one stu­dent (Mar­i­an from Poland) was work­ing won­ders using his long­stand­ing skill and train­ing in osteopa­thy. See­ing my fel­low stu­dents putting into prac­tice the exter­nal ther­a­pies which they had learnt from Dr Nida, I was remind­ed of just how effec­tive these Tibetan Med­i­c­i­nal exter­nal treat­ments are.  Dr Nida has been huge­ly influ­en­tial in dis­sem­i­nat­ing knowl­edge of these ther­a­pies amongst both west­ern and Tibetan stu­dents, includ­ing reviv­ing knowl­edge of some ther­a­pies such as Yuk Cho (stick ther­a­py) which has only been passed down by oral tra­di­tion until now.

In Dr Machik’s clin­ic Yang­mo Tashi worked cease­less­ly run­ning from one room to the next in order to trans­late for peo­ple as need­ed. We all became pro­fi­cient in ask­ing whether there was pain. ‘Ku ga?’ we would ask as we prod­ded the patients in spe­cif­ic places.  We soon learnt the term ‘Ma ku ga’ which meant ‘no pain’ and ‘deni kuga’ which meant ‘Yes a lot of pain right there!’.  Despite the patients’ dis­com­fort there was also much hilar­i­ty all round over our var­i­ous attempts to pro­nounce the phrase ‘sha heuel’ which in Lhasa would be pro­nounced more like the translit­er­a­tion I have giv­en but in Amdo this phrase was pro­nounced as a gut­tur­al out­breath for each syl­la­ble with the sec­ond part pro­nounced by rolling up the tongue and hav­ing it touch­ing the top of the palate. Iron­i­cal­ly the mean­ing of this phrase is ‘Relax!’ (it lit­er­al­ly means relax your mus­cles – the word ‘sha’ being also used for ‘meat’), but it was prob­a­bly the most unre­lax­ing phrase any of us could ever try and pro­nounce.

The clin­ic was busy but Dr Machik was relaxed and kind­ly encour­ag­ing to us stu­dents. Every so often he would admin­is­ter an exter­nal treat­ment and we gath­ered around to watch and learn.  As the first day went on I realised I was quick­ly becom­ing more con­fi­dent in my phys­i­cal diag­nos­tic tech­niques since detailed ques­tion­ing was not always pos­si­ble.  It’s amaz­ing how much can be dis­cov­ered from pulse, tongue and gen­er­al phys­i­cal exam­i­na­tion when one is armed with a stetho­scope, a torch and a few sim­ple phras­es. I found it refresh­ing to be a stu­dent again.  I was learn­ing a lot, from Dr Machik, from my fel­low stu­dents and from Eric, a teacher on Dr Nida’s IATTM course and an absolute repos­i­to­ry of knowl­edge for all things East­ern, med­i­c­i­nal, cul­tur­al and spir­i­tu­al.

The con­trast between my own clin­ic and Dr Machik’s clin­ic was so much more than just the style of med­i­cine being prac­tised.  Although herbal med­i­cine is actu­al­ly very effec­tive in acute and first aid sce­nar­ios, the major­i­ty of a west­ern herbalist’s case load tends to be peo­ple with long stand­ing chron­ic con­di­tions.  Here in Amdo we were see­ing front line med­i­cine. There was a long queue of patients, none of whom had pre-booked appoint­ments. Most were in a lot of dis­com­fort. They had pain. They had fever. Some had par­tial paral­y­sis and oth­ers had severe res­pi­ra­to­ry tract symp­toms – hack­ing coughs or very sore throats.  The excess­es of food, drink and injuries sus­tained by peo­ple falling off hors­es dur­ing the Nadaam fes­ti­val also swelled the patient list.

Patients came in clutch­ing bags of med­i­cines that  they had been pre­scribed pre­vi­ous­ly.  There were elder­ly patients with lim­it­ed mobil­i­ty after years of hard phys­i­cal labour milk­ing dzomo and man­ag­ing a fam­i­ly on the grass­lands. There were young men with stom­ach pains after eat­ing too much greasy street food at the fes­ti­val, moth­ers wor­ried sick about their small chil­dren, teenagers with rash­es caused by aller­gies to cos­met­ics and mid­dle aged men suf­fer­ing from par­tial paral­y­sis fol­low­ing strokes.

At first I took notes and then pho­tographed each patient’s pre­scrip­tion in order to study treat­ment options in more depth lat­er but this soon became imprac­ti­cal due to the large num­bers of patients who came into the clin­ic for treat­ment and the fact that I couldn’t read the hand­writ­ten Tibetan script that was used to write the pre­scrip­tions.

Dr Machik was not fazed by the queues of patients or the extra demands placed upon him by hav­ing west­ern stu­dents to con­sid­er.  He was relaxed and kind to every­one. At one point dur­ing a lull we had a nice ‘chat’ in which I showed him some pho­tos of my clin­ic and my herb grow­ing and gath­er­ing activ­i­ties. Even though we only talked through the medi­um of pho­tographs, bro­ken Tibetan/English and sign lan­guage, we were real­ly able to com­mu­ni­cate.  We found that we shared Khen­po Troru Tse­nam as a Tibetan Med­i­cine teacher and, per­haps not sur­pris­ing­ly, a deep inter­est in heal­ing plants.

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The next morn­ing on report­ing to the clin­ic at the allot­ted time, I and a cou­ple of fel­low stu­dents were shown into Dr Machik’s per­son­al office.  There was a large desk and plen­ty of books and it was a very nice office indeed, but it wasn’t until he opened a door which led from the far wall of the room that I under­stood he was actu­al­ly show­ing us his beau­ti­ful shrine.  Tibetan Med­i­cine is a deeply spir­i­tu­al activ­i­ty, con­sid­ered to be a path to enlight­en­ment and so all Tibetan doc­tors do reg­u­lar spir­i­tu­al prac­tice.  I was espe­cial­ly hap­py to see a pho­to of our shared teacher in a promi­nent place on the shrine.

We spent three hap­py and instruc­tive days at Dr Machik’s clin­ic. Clin­i­cal expe­ri­ence with patients was sup­ple­ment­ed by evening lec­tures on Tibetan for­mu­lae, a lec­ture on mox­i­bus­tion at the People’s Hos­pi­tal and a vis­it to Dr Wako’s clin­ic.  Dr Wako is the lat­est doc­tor in his long fam­i­ly lin­eage of doc­tors. His grand­fa­ther cre­at­ed a range of herbal for­mu­lae, still made in the fam­i­ly and used to treat patients in his love­ly lit­tle clin­ic. Dr Wako is some­one who real­ly knows his plants, gath­er­ing and dry­ing his own herbs reg­u­lar­ly and mak­ing them into his spe­cial for­mu­lae. I felt that we had a lot in com­mon as prac­ti­tion­ers and our clin­ics were quite sim­i­lar. I was thrilled to learn that he was to accom­pa­ny us on our moun­tain herb study trip.

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When we returned from herb study in the moun­tains I was assigned to study with Dr Nida at the Tibetan Med­i­cine Hos­pi­tal. On the first morn­ing the group was divid­ed into dif­fer­ent rooms – some con­cen­trat­ing on Ku Nye and oth­ers treat­ing patients with cup­ping and blood let­ting. I was grate­ful to be able to con­tin­ue my stud­ies into diag­no­sis and pre­scrib­ing accord­ing to Tibetan Med­i­cine.  I was to work with Tess, an expe­ri­enced Ayurvedic prac­ti­tion­er and stu­dent of Tibetan Med­i­cine with Dr Nida.  Many times over the next three days I had rea­son to be very grate­ful for her help and guid­ance.

Word of Dr Nida’s arrival at the hos­pi­tal had spread and we were inun­dat­ed with patients. I thought that it had been busy at Dr Machik’s clin­ic but this reached anoth­er lev­el. Dr Nida’s con­sult­ing room soon filled with peo­ple and their fam­i­lies. There were young chil­dren cling­ing to their moth­ers, old peo­ple lean­ing on rel­a­tives for sup­port, teenagers in jeans and leg­gings and tra­di­tion­al­ly dressed women accom­pa­nied by wor­ried hus­bands.  A cou­ple of monks in robes joined the queue and some­how made the scene more ‘per­fect’ to the for­eign observ­er.

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There was no time to roman­ti­cise the scene or men­tal­ly write my jour­nal though. Tess and I were imme­di­ate­ly pressed into action exam­in­ing patients and pre­sent­ing our find­ings. Dr Nida was not sat­is­fied with just pulse and tongue diag­no­sis.  He expect­ed a full phys­i­cal exam­i­na­tion, includ­ing exam­i­na­tion of the eyes and the ears.  Tess patient­ly helped me with the lat­ter as I was not famil­iar with the tech­niques involved accord­ing to Tibetan Med­i­cine. It was also extreme­ly help­ful to be able to com­pare notes on puz­zling cas­es, dis­cussing what we had each picked up in the pulse and what our con­clu­sions were.  Report­ing our find­ings was fit­ted into slen­der gaps in the pro­ceed­ings, we some­times had to retain infor­ma­tion for a cou­ple of patients before being able to report on them due to the large vol­ume of patients.  Dr Nida was encour­ag­ing and help­ful, but he didn’t hold back if he felt that we had missed some­thing in our con­sid­er­a­tion of the case. His teach­ing style remind­ed me of my dear west­ern herbal teacher of clin­i­cals, Ifan­ca James.  It was a great way to learn and I was hav­ing he time of my life.

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A few times I wished that I could have my herbal dis­pen­sary avail­able as I knew of a spe­cif­ic treat­ment for an issue with which a patient pre­sent­ed.  After a while I did men­tion a treat­ment pro­to­col that I would choose if I was treat­ing this patient in my own clin­ic and Dr Nida kind­ly expressed an ready open­ness to this. He sug­gest­ed that I would have to come back next year and bring sup­plies.

Although I had come to Amdo in order to learn and improve my clin­i­cal skills in Tibetan Med­i­cine, I was real­is­ing that our pres­ence there was all about help­ing to alle­vi­ate the suf­fer­ing of the patients in front of us even if it was just for a short time. The pedan­tics of which sys­tem was being used, whether the med­i­cine was tra­di­tion­al or allo­path­ic, Tibetan or West­ern didn’t mat­ter. What mat­tered was help­ing patients to feel bet­ter.


Part Three – Herb Study

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As I write this it’s been just over half a year since our group head­ed out from ‘wild west town’ of Mal­ho to the moun­tains for the herb study part of the Sorig Tour.  I had so far put writ­ing this third part of my Amdo blog off, part­ly due to the demands of my clin­ic, but also because I want­ed to ful­ly absorb and inte­grate the knowl­edge that I had gained on the moun­tain, digest all my notes and pho­tographs and con­fi­dent­ly iden­ti­fy the plants we had learnt about in terms of their Latin bino­mi­als before embark­ing on writ­ing this part of the blog.  Alas that turned out to be a vast­ly unre­al­is­tic aim. I now realise that those three amaz­ing days of study on the moun­tain have gen­er­at­ed research which will take me well over a year, and quite pos­si­bly a life­time, to com­plete.

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On my return from Amdo I threw myself into the study of these new (to me) med­i­c­i­nal plants.  I was armed with an excel­lent herb study book­let pre­pared by Eric Rosen­bush for all of the Sorig Tour par­tic­i­pants (which must have tak­en hours and hours of work and research to pre­pare), reams of my own field notes and anno­ta­tions, hun­dreds of pho­tographs, every pos­si­ble pub­li­ca­tion on Tibetan Plants and Tibetan Med­i­cine, many writ­ings by the old plant hunters such as Joseph Hook­er and Frank King­don-Ward as well as more mod­ern ref­er­ences such as the excel­lent ‘Guide to the Flow­ers of West­ern Chi­na’ by Grey-Wil­son and Cribbs and the old­er but still very good ‘Flow­ers of the Himalaya’ by Pol­unin and Stain­ton.  I thought naive­ly that it should have been a method­i­cal process of going through the field mate­r­i­al and look­ing every­thing up.

I also had Tibetan Mate­ria Med­ica pub­li­ca­tions to refer to. Since I first stud­ied Tibetan Mate­ria Med­ica in the 1990’s there have been many valu­able works pub­lished in Eng­lish on this sub­ject. I think I prob­a­bly have them all as well as a few in Tibetan too. The most beau­ti­ful and infor­ma­tive of them has to the large two vol­ume work by Dr Dawa which con­tains painstak­ing botan­i­cal illus­tra­tions and good descrip­tions of med­i­c­i­nal qual­i­ties and actions for each of the plants. How­ev­er, dis­ap­point­ing­ly, the uncer­tain­ties of botan­i­cal iden­ti­fi­ca­tion which I first encoun­tered in the 1990’s have per­sist­ed to this day. The Latin names of Tibetan med­i­cines often remain dis­put­ed or unclear. Dif­fer­ent sources show com­plete­ly dif­fer­ent Latin bino­mi­als for appar­ent­ly the same plant and some­times pub­lished sources list three or four pos­si­bil­i­ties for the same illus­tra­tion or pho­to. Dif­fer­ing plants which are used in ther­a­peu­ti­cal­ly sim­i­lar ways may share the same Tibetan name, there being vari­a­tions between dif­fer­ent med­ical lin­eages and regions with­in the area that is cul­tur­al­ly Tibetan. Added to this Tibetan Med­i­cine has long been prac­ticed beyond the bor­ders of its home­land so the use of local plants in neigh­bour­ing coun­tries has been inte­grat­ed into this sophis­ti­cat­ed med­ical sys­tem, mak­ing per­fect sense eco­log­i­cal­ly and sus­tain­ably but adding to the com­plex­i­ties of the botan­i­cal iden­ti­fi­ca­tion issue.

As a side note recent dis­cus­sions have pro­mot­ed the idea that ‘Himalayan Med­i­cine’ is a more apt descrip­tion than ‘Tibetan Med­i­cine’ since its prac­tice extends across all the coun­tries of the region, and now across the world.  I must admit that I find that the removal of ‘Tibetan’ from its name hard to stom­ach. Per­haps I’m led by my heart rather than polit­i­cal expe­di­en­cy.

Any­way with my back­ground in west­ern botany, a deep love of med­i­c­i­nal plants, a rudi­men­ta­ry knowl­edge of Tibetan lan­guage and an under­stand­ing of herbal med­i­cine I thought that I might be able to help shed some light on this botan­i­cal con­fu­sion. My aim is one of cat­a­logu­ing and pre­serv­ing pre­cious knowl­edge and using this as an aid in plant con­ser­va­tion work. It is an aim that I know is in keep­ing with the wish­es of my spir­i­tu­al teacher, Cho­je Akong Tulku Rin­poche. We had in fact dis­cussed this in the ear­ly years of the new mil­len­ni­um dur­ing a spe­cial meet­ing held at Samye Ling in Scot­land.

In this mam­moth botan­i­cal under­tak­ing I’ve been lucky enough to enlist the help of Chris Chad­well of the Himalayan Plant Asso­ci­a­tion who I first met while I was study­ing Tibetan Med­i­cine at Samye Ling in the 1990’s. Chris is extreme­ly knowl­edge­able about the flo­ra of the wider Himalayan region and has gen­er­ous­ly helped me with iden­ti­fi­ca­tion advice on the plants that I have so far stud­ied. His knowl­edge and patient expla­na­tions have opened my eyes to the com­plex­i­ty of the task ahead of me.  Ini­tial­ly I was quite daunt­ed but I’m deter­mined to plough on bit by bit, one step at a time. I remem­ber all too well the words of Akong Rin­poche who said: ‘Only the impos­si­ble is worth doing’.

As ever I digress but I want­ed to explain the long gap between the first two parts of this blog and this third and final (for now) part.  I also want­ed to explain why I won’t be focussing on plant iden­ti­fi­ca­tion and plant med­i­c­i­nal prop­er­ties in my blog at this stage. I want to share with you instead the expe­ri­ence of study­ing the herbs on that beau­ti­ful moun­tain far away from the trap­pings of our mod­ern mate­ri­al­is­tic way of life.

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On the day we were due to trav­el to the moun­tain I was filled with excite­ment. We were to trav­el to an unspoilt area which was part of the lands of a monastery and par­tic­u­lar­ly floris­ti­cal­ly rich. We were to camp near to two holy lakes. The shape of these two lakes appar­ent­ly resem­bled the shape of two fish­es. This was par­tic­u­lar­ly apt, I thought, to a Pis­cean like me.

The roads would be too rough for trav­el in a minibus or coach so we piled into sev­er­al taxis togeth­er with pro­vi­sions to last us three days. It was quite a squeeze to fit every­thing in. Water mel­ons, sacks of onions, bread, tea and rice com­pet­ed for space with two large trays of eggs along­side our sleep­ing bags, ruck­sacks and walk­ing boots. Our car had the eggs. Many times dur­ing that jour­ney I won­dered about whether any of them would sur­vive intact but dur­ing our stay we had love­ly boiled eggs for break­fast so my pes­simism was unfound­ed.

The jour­ney was awe inspir­ing. We head­ed out of town towards the vast open space of the Himalayan grass­lands. This was yak herd­ing ter­ri­to­ry.  We hadn’t seen crop cul­ti­va­tion since we were in Rebkong but although we could see the grass­lands from our hotel in Mal­ho we had been ful­ly absorbed in our clin­i­cal stud­ies with patients so had not yet ven­tured out of town.  Now here we were actu­al­ly in the grass­lands. In these vast lands nomadic folk rode hors­es, herd­ed their live­stock and made deli­cious creamy yoghurt as they have done for gen­er­a­tions. Yaks were every­where. The huge views were breath-tak­ing and served to remind us of our remote­ness from the mod­ern ameni­ties that we were so famil­iar with. Yet with­in the vast scale of the land­scape we could see lit­tle set­tle­ments and nomadic tents com­plete with satel­lite dish­es and solar pan­els and men on hors­es that we passed along the high­way checked their mobile phones as they rode.

We stopped for a ‘com­fort break’ on the way and as we stretched our legs the first thing that hit me was the fra­grant smell of the Artemisias mixed with the pun­gent smell of yak dung. It was a smell that was to become very famil­iar over the next three days. I actu­al­ly became filled with fond­ness for it and on my return to the UK I remem­ber sniff­ing my filthy moun­tain jeans nos­tal­gi­cal­ly before load­ing them into the wash­ing machine.

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We wait­ed by a stream for the oth­er cars to catch up and lis­tened to sky­larks and run­ning water. It was heart-open­ing­ly remote, beau­ti­ful and oth­er world­ly. The road had been steadi­ly get­ting nar­row­er and we hadn’t seen anoth­er vehi­cle for over an hour. After cross­ing the stream, we soon reached the end of the road. We were now bump­ing along a rut­ted grassy track but I hard­ly spared a thought for the eggs. I saw we were near­ing a small hill topped by a round chort­en made of wood­en poles and sticks. Prayer flags flut­tered in the wind and some­how empha­sised the inten­si­ty of the blue of the sky.  Dr Machig got out of his car and opened a rusty met­al gate which blocked our way. We were now in the monastery lands.

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We passed the chort­en hill and round­ing a bend in the track saw anoth­er match­ing chort­en in the dis­tance. The Yel­low Riv­er wound its way across the plain to our right, and beyond that we could see end­less peaks stretch­ing away into the dis­tance. Some were snow capped even though it was August. I checked my altime­ter and we were at 3800m.

Our tents (one for the girls and one for the boys) were set up in a flat area of mead­ow quite near to the sec­ond chort­en. There was smoke com­ing from the chim­ney in the cook­ing tent. A local nomad fam­i­ly had put the tents up and pre­pared a deli­cious meal for us on our arrival. We unloaded our stuff and helped car­ry the pro­vi­sions into the cook­ing tent before sit­ting down to our meal. Our hosts poured us milk tea from a large ket­tle, the tea leaves being strained out by a bunch of twig­gy stems shoved into the spout. Appar­ent­ly this was a shrub known local­ly as ‘Nomads’ Chop­sticks’.  The tea tast­ed smoky from the yak dung fire that it had been pre­pared on, but it was refresh­ing and wel­come after such a long jour­ney.

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We ate and were briefed on the eti­quette of our camp. We were camp­ing near to two sacred lakes which were in the shape of two fish­es. We were lucky to have per­mis­sion to camp here as it was usu­al­ly out of bounds. We had to respect the sanc­ti­ty of the lakes, refrain from hunt­ing or oth­er dis­re­spect­ful actions such as pee­ing or drop­ping lit­ter by the lakes.  We were not to go into or touch the water. We were wel­come to cir­cum­am­bu­late the lakes as long as we did so qui­et­ly and kept to these guide­lines. It was a delight to see that the spir­i­tu­al impor­tance of the lakes was being safe­guard­ed in this way.

We were instruct­ed to head towards the Yel­low Riv­er in order to answer our calls of nature. Some­what apt I thought. A group of us girls head­ed off to find a suit­able spot, climb­ing through an appar­ent­ly dilap­i­dat­ed wire fence but which turned out to be well main­tained by the local farm­ers. The wires remained under a good degree of ten­sion and it was actu­al­ly quite tricky to climb through. There was one spot marked by a rock where the pas­sage through the fence was slight­ly eas­i­er.  I tried to make a men­tal note of where this was but there were few land marks. After a bit of hys­ter­i­cal laugh­ter we all man­aged to squeeze through the fence and found our­selves in an area of com­plete­ly flat land between our camp and the Yel­low Riv­er maybe half a mile ahead. There were no bush­es, rocks or oth­er cov­er. The smell of Artemisias and dung hung in the air. Yaks graz­ing near­by made sweet lit­tle grunts as they talked to each oth­er.  Even­tu­al­ly we found a slight dip in the topog­ra­phy which pre­served our mod­esty from the waist down. Mar­mots were every­where and they seemed curi­ous about this inva­sion of laugh­ing west­ern women. One or two of them emerged from their bur­rows and sat up, appar­ent­ly watch­ing us as we peed.  It was a new expe­ri­ence but some­how lib­er­at­ing. Bear Grylls would be proud of us I thought.

Back at the camp we pre­pared for our first herb study trek. The sun burned fierce­ly. We were remind­ed that with­out a hat we would be burnt to a fraz­zle with­in min­utes. We applied sun­screen, lip sun­block and donned our hats.  It was strange to think that lat­er on after sun down the tem­per­a­ture would prob­a­bly drop below freez­ing.

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We climbed a stony track and head­ed towards the lake. It was hot work but luck­i­ly we had all become accus­tomed to the high alti­tude by now so man­aged to walk steadi­ly up the incline with­out too much trou­ble. We even­tu­al­ly found our­selves at a van­tage point above the lakes and start­ed walk­ing down towards them through long grass filled with beau­ti­ful wild flow­ers. Drs Machig, Wako and Nida point­ed out plants along the way explain­ing what their names were in Tibetan and briefly describ­ing their prop­er­ties.

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There was so much infor­ma­tion being giv­en It was vir­tu­al­ly impos­si­ble to record it all, let alone take good pho­tographs of each plant. We were encour­aged to pick sam­ples and I put them into my note book hop­ing to be able to sort out the infor­ma­tion lat­er.  Com­pared to my herb walks in Som­er­set this was high speed learn­ing, but it was excit­ing that there were so many amaz­ing species to see.

We made our way around the first lake and start­ed to climb a steep incline on its far side. Under­foot it was loose scree and quite dif­fi­cult going. We had to cling onto the branch­es of shrubs to steady our­selves. My fre­quent stops to exam­ine plants and write notes meant that I found myself one of the strag­glers but I didn’t mind as I was in good com­pa­ny with Dr Wako. We con­versed in sign lan­guage, bro­ken Tibetan and his Eng­lish (which was far bet­ter than my Tibetan). He explained about many of the plants that we encoun­tered, giv­ing me the Tibetan names and indi­cat­ing their actions on the body through mim­ing and sim­ple expla­na­tions which my very rusty knowl­edge of med­ical terms in Lhasa dialect seemed to cope with.

Even­tu­al­ly we reached the top and col­lapsed down onto the grass to admire the view and gulp water from our bot­tles. We could see the Yel­low Riv­er wind­ing away across the plain, one bank, the near­est one to our camp, boul­der strewn but acces­si­ble. On the far bank sheer cliffs came right down to the water’s edge. Beyond the riv­er were lay­er after lay­er of high moun­tains con­tin­u­ing as far as the eye could see. The only habi­ta­tions vis­i­ble were our own tents and far beyond them the encamp­ment of the nomad fam­i­ly who had pre­pared our camp and our first meal. It felt as though we were in the remotest and the most beau­ti­ful place on earth.

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Dr Wako found a large wild rhubarb plant and set about cut­ting pieces of fleshy stem for us to chew. He peeled the out­er skin and passed chunks around. It tast­ed astrin­gent but refresh­ing.

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We sat cross legged at the top of the high ground above the lakes and Dr Nida led us in a med­i­ta­tion. There in the vast land­scape under the blue sky my ear­li­er wor­ries about not record­ing all the plant infor­ma­tion seemed triv­ial.  I knew that by being there with these amaz­ing doc­tors and my Sorig Tour fam­i­ly a con­nec­tion was being made and a seed was being plant­ed. Unknown caus­es and con­di­tions had led me to be in that place at that time but every­thing that was tak­ing place was per­fect and planned and right.

When we arrived back at our camp hot and exhaust­ed we were greet­ed by plen­ty of milk tea strained through Nomads’ Chop­sticks twigs and a hearty meal pre­pared by Tse­tan our chief guide, ably assist­ed by Gyamt­so, Yang­mo Tashi and Paljor. They had done a very good job and we all ate very well. Bear Grylls prob­a­bly wouldn’t have been impressed but I didn’t care. I had had the most amaz­ing day, I had climbed to the high­est alti­tude of my life, admired a breath-tak­ing view and met plants that I’d been read­ing about and study­ing for over 20 years.

The sun set and some brave souls opt­ed to sleep out­side under the stars. I set­tled down in the girls’ tent lis­ten­ing to the oth­ers telling ghost sto­ries as I drift­ed off to sleep.

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The next morn­ing was freez­ing cold and the grass out­side our tents was cov­ered with a heavy dew. Every­thing was shroud­ed in mist and it was quite oth­er world­ly. I had slept well, my extra warm sleep­ing bag and meri­no ther­mals had done their job.  I got up ear­ly, sit­ting in my sleep­ing bag to do my morn­ing Med­i­cine Bud­dha prac­tice.  Lat­er once every­one was awake we ate break­fast of tea with tsam­pa and hard boiled eggs, their mirac­u­lous­ly undam­aged shells stained with cin­na­mon bark. The eggs were pre­pared the night before and left soak­ing over night with a cin­na­mon stick as is appar­ent­ly the cus­tom here.

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We set off for more herb study and then trekked to the near­by monastery where we were giv­en an impromp­tu Med­i­cine Bud­dha empow­er­ment by the incum­bent lama. As we walked back towards our camp in the late after­noon the sky looked threat­en­ing. The first drops of rain start­ed to fall as we entered camp.  Some of the girls dis­ap­peared off to the mar­mot encamp­ment and came back absolute­ly drenched 10 min­utes lat­er. The heav­ens had opened and rain was com­ing down in a relent­less tor­rent. We shel­tered under­cov­er but it soon became clear that water was run­ning off the hill behind us and find­ing its path to low­er ground through our tent, soak­ing every­thing in its path. We rushed about mov­ing stuff off the floor and away from the worst of the leaks. We cov­ered things with dry sacks, plas­tic bags and pieces of tar­pau­lin. We lift­ed some of our pos­ses­sions up secured them to the cross sup­ports of the tent. There was no way we were going to be able to keep every­thing dry so it was a ques­tion of dam­age lim­i­ta­tion. I grabbed my Tibetan prayer text and put it inside my clothes next to my skin and hud­dled in my sleep­ing bag. The rain showed no sign of let­ting up and con­tin­ued to lash down while we sat for­lorn­ly in the tents hop­ing that they wouldn’t blow away.  When the thun­der and light­en­ing start­ed I tried not to think about the fact that we were basi­cal­ly sit­ting in a pool of water at 3800m.  Say mantras I said to myself. Talk­ing to any­one else was in any case impos­si­ble due to the deaf­en­ing roar of the wind, rain and thun­der. The storm raged all night – a total of 12 hours from when the rain start­ed. It final­ly went qui­et at 5.00am. I ven­tured out qui­et­ly so as not to wake the oth­ers and was greet­ed by a beau­ti­ful dou­ble rain­bow.

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Tse­tan and the oth­er guides were already up and they shout­ed to every­one to come and look. Soon we were all out­side admir­ing the spec­ta­cle. The dis­com­forts (and frankly, ter­ror) of the pre­vi­ous night was now for­got­ten.  We set about try­ing to dry every­thing out – our clothes, sleep­ing bags, note­books, ruck­sacks, hats and shoes. My note­book stuffed with all my plant sam­ples was drenched so I put it by the stove and grad­u­al­ly turned the pages to try and dry it out. Bear Grylls may not have been impressed but I felt like Frank King­don-Ward on one of his plant hunt­ing expe­di­tions bat­tling to save his pre­cious sam­ples.

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As the sun came up it got hot very quick­ly and with every­thing dry­ing we ate break­fast and start­ed to pack up the camp. We took a last oppor­tu­ni­ty to go down to the lakes and drink in the scenery. This land­scape which was so serene on our first day had now revealed anoth­er aspect.

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With the taxis packed we thanked the nomad fam­i­ly, posed for self­ies and waved our good­byes. As we head­ed off to the next part of the tour I looked back at our tem­po­rary moun­tain home and reflect­ed on the expe­ri­ence. I’d encoun­tered plants that I nev­er thought I would see grow­ing in their nat­ur­al habi­tat. I’d learnt valu­able first hand herbal infor­ma­tion from Tibetan Med­i­cine mas­ters who are devot­ed to their tra­di­tion. I’d done my spir­i­tu­al prac­tice beside a sacred lake and med­i­tat­ed on the banks of the Yel­low Riv­er. I’d camped for two nights on a moun­tain­side at 3800m – quite sig­nif­i­cant for some­one who usu­al­ly avoids camp­ing at all costs; and I’d shared all of this with an amaz­ing bunch of like­mind­ed peo­ple.

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The moun­tains had pro­vid­ed us with a per­fect les­son in humil­i­ty and the won­der of nature. Our first night had been benign and gen­tle while the sec­ond night had been wrath­ful and dra­mat­ic. We’d felt safe and com­fort­able in the tents on our first night but on the sec­ond night it had been hard not to feel flim­sy and irrel­e­vant dur­ing the height of the storm.  No won­der this has long been con­sid­ered a land of gods and demons.

We may have only been on there for two nights and three days but I knew that my time on the moun­tain had changed me for­ev­er.

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