Tibetan medicine, also known as Sowa Rigpa, is a profound and valuable traditional medicine system that has a rich history and cultural significance. Developed under the influence of Vajrayana Buddhism and from the accumulated knowledge and experience of the people in the Himalayan region, Sowa Rigpa has evolved into a comprehensive repertoire of healing techniques and knowledge since the eighth century. In 1959, following the Chinese occupation of Tibet, the Dalai Lama fled to India with thousands of Tibetan refugees. With more than 60 years of modernization in Tibetan exile society, Sowa Rigpa has gained popularity and commercial success as a scientific system of healing and was incorporated into the Ministry of AYUSH (Ayurveda, Yoga and Naturopathy, Unani, Siddha, and Homeopathy) in India in 2010. Today, Sowa Rigpa is widely recognized for its unique approach to healing, which focuses on the balance between mind, body, and spirit, and its use of natural remedies. However, despite its importance, Sowa Rigpa has received comparatively less academic attention.
Looking back at the research on Sowa Rigpa, when “Asian medicine” began to receive attention in the 1970s only a few scattered research papers were published on this traditional Tibetan medical system. The hindrance of research can be attributed to several factors. For example, there is a language barrier to overcome. Reading Tibetan medical texts and engaging in conversations with local Tibetans requires a solid foundation in the Tibetan language, which is not as easily accessible as Chinese or other mainstream Asian languages for many foreign scholars and researchers.
Moreover, the geography and environment pose additional challenges. Sowa Rigpa has for centuries been deeply rooted in “The Great Himalayas”, which cover approximately 2,400 km and span the nations of India, China, Bhutan, and Nepal. In these remote areas, Sowa Rigpa plays a central role in local culture, society, politics, and healthcare, and it continues to do so to this day. However, the high altitude and difficult terrain of these regions have made it challenging for anthropologists, sociologists, and historians to conduct studies there. Furthermore, modern geopolitical factors involving India, China, and Pakistan have further complicated access.
In the 1980s, there was a noticeable increase in studies focusing on the theories, classical texts, and institutions of Sowa Rigpa. This surge in interest can be attributed, in part, to the global attention brought by the fourteenth Dalai Lama, who was awarded the Nobel Peace Prize in 1989. However, this increased attention also led to divergent paths of academic research between Chinese Tibet and the Tibetan exile community in India. It wasn’t until 2000 that a group of emerging scholars, primarily medical anthropologists in Europe and the United States, began exploring Sowa Rigpa in exile in India from various perspectives, including politics, economics, and socio-cultural aspects. Their groundbreaking work opened up a new research horizon that continues to thrive today. The majority of the articles included in this book are contributions from these scholars.
Published in 2022, this book provides valuable insights from the far reaches of the Himalayan plateau, shedding light on how people in the region strive to attain and maintain their health and well-being. Although the ethnographic research in this book was conducted around the 2000s, it presents a significant collection of essays that consolidate research on Sowa Rigpa in north India for the first time. The book is edited by two renowned scholars in the field of Sowa Rigpa, Laurent Pordié and Stephan Kloos. Pordié, a sociologist at CNRS-CERMES3 in Paris, has specialized in healthcare systems and the dynamics of medical knowledge and practices. Kloos, the acting director of the Institute for Social Anthropology at the Austrian Academy of Sciences (ÖAW), has conducted extensive research on the social and cultural aspects of Tibetan and Himalayan societies related to Sowa Rigpa.
The book can be broadly categorized into two sections: amchi, who are the practitioners of Sowa Rigpa; and the exploration of Sowa Rigpa itself. The opening chapter delves into the intricacies of a rural Ladakhi society during the specific time period of the turn of the century, shedding light on the significant role and moral values upheld by the amchi. Set within a village characterized by a blend of hierarchical and egalitarian tendencies, complex gender dynamics, and the profound influence of Buddhism, the amchi skillfully maintains social equilibrium by refraining from exploiting his elevated status. This portrayal of a “good doctor” sets the stage for the subsequent chapter, which offers a contrasting narrative of a “bad doctor.” Here, the focus shifts to a Hanu amchi who disregards societal and ethical norms in order to improve the well being of his family and medical practice, upsetting the delicate balance within the community. These two studies emphasize that the amchi’s standing is determined by the recognition they receive from the village community, and that their use of healing as a tool can either enhance or undermine their social standing. Furthermore, a comprehensive analysis of the amchi’s approach to providing medical services and ensuring their survival necessitates a careful examination of the contextual socioeconomic changes at play.
Chapter 3 focuses on the remote Changthang plateau in northeastern Ladakh, where there is a notable absence of amchi. This absence can be attributed to unsuccessful attempts to reintroduce Sowa Rigpa amidst socioeconomic changes. The idea that amchi should play a significant social role beyond their medical duties and uphold societal moral values has become unrealistic in modernized Ladakh. Consequently, many amchi face the stigma of being labeled as “bad doctors” (as discussed in the previous chapter) and opt to leave for larger cities, unwilling to remain. As a result, the nomadic population, aware of their health, begins to migrate, triggering a vicious cycle. However, the subsequent chapter presents a successful case of NGO intervention in a health center established in a remote village between Ladakh and Zanskar. The health center operates on a fee system, which is used as a community fund. From a socioeconomic perspective, the authors emphasize that, in this new reciprocal arrangement, amchi and the community support each other while maintaining the ethical code of Sowa Rigpa practices and providing key elements of amchi adaptation of tradition to modernity.
Building upon the examination of the amchi’s role in the previous chapters, the remaining chapters of this volume focus on the healthcare services provided by Sowa Rigpa itself. Chapter 5 analyzes the use of emergency Sowa Rigpa practices during childbirth, including the controversial “butter fish” technique employed in Zangskar. In this ritual, a fish-shaped effigy made of yak butter is created, and the amchi recites specific mantras, infusing the butter with invisible and imperceptible wind from the Buddha Master of Remedies, thus transforming it into blessed butter. The puerperal woman is then required to consume the butter immediately, starting with the head. The author explores the active process of biomedical science in eradicating “superstitious” medical ideologies. In modern hospitals in Ladakh today, these rituals are strictly and completely prohibited.
The next chapter recounts a case where a Zangskari youth was diagnosed with a “wind disorder” or psychotic breakdown by two amchi who prescribed Sowa Rigpa medication. However, another amchi believed the illness to be caused by demonic possession and invited a Tibetan Rinpoche to identify the spirits afflicting the youth and use his supreme ritual healing power, which ultimately cured him. These two cases highlight the coexistence of medicine, herbs, and religious rituals in medical pluralism, where seeking any treatment from local sources is understandable. The final chapter concludes the volume with research conducted in Darjeeling and Sikkim, where there is a high rate of turnover among Tibetan medicine practitioners. Graduates of Tibetan medicine schools are expected to complete a standardized process, but the rotation system has caused disconnection between new doctors and communities. While Sowa Rigpa becomes more institutionalized and standardized, healthcare has become more formalized and less personal.
As mentioned above, the ethnographic studies in this volume were all conducted in the late 1990s and early 2000s. However, the general patterns and cultural elements of healthcare they describe are still present in the Indian Himalayas today. It extensively discusses the traditional ideal of Sowa Rigpa, as well as its professionalization, standardization, commercialization, and globalization in India and other regions. Many of the topics explored in this pioneering anthology are thought-provoking and warrant further investigation and consideration. The issue of retaining rural physicians, for example, which is discussed in Chapter 7, is a long-standing and ongoing global problem that many countries face today. As Pordié and Kloos have stated,
this volume constitutes the first collective effort to study the liminal moment of social crisis and transformation that lies at the root of these processes, without which Sowa Rigpa’s more recent official recognition and entrance into the lucrative market for herbal medicines would be unthinkable and impossible to understand (14).
Another necessary comment concerns the title of the book, Healing at the Periphery, which suggests a core-periphery model. Considering the Himalayan region of North India as the periphery raises questions about who the center is—it could be Dharamsala, the center of the Tibetan Government-in-Exile, India or the West. Dualism can perpetuate misinformation; context and topic specificity are crucial to avoid misleading conclusion. Nomadic Zangskari have inhabited this highland for centuries without perceptions of boundaries in the modern sense. “The Greater Himalayan” region has been a conduit for Tibetan culture throughout the ages, so much so that Ladakh has become known as “Little Tibet” due to its close cultural ties with Tibet. Tibeto-Himalayan cultural diversity is by no means a static tradition processed and maintained by residents locally or in surrounding communities; the multi-cultural and multi-layer identities have never diminished. From this perspective, the Indian Himalayas have always been the center, even though the border is quite blurred.
This volume is a valuable exercise in recording old stories and paving the way for new ones. Its impact is undeniable, as it provides insight into the transformation of the periphery into the center (regardless of whether one is at the center or the periphery). As stated in the postscript, we must gather more insights into this rich field. We should not only explore the reconfiguration of Sowa Rigpa, industrialization, and sociopolitical reconstruction but also learn from the people of the Himalayas with a multilayered vision.