Traditional Medicine in the Modern World: Key Challenges and Constraints
Historically, amchi (traditional physicians) began their medical training at an early age. Knowledge and skills were passed down from teacher to student, often from father to son or daughter. Such lineages of amchi families exist throughout the Tibetan and Himalayan cultural world. After learning to read and write classical Tibetan and studying relevant religious texts, students apprenticed under elder amchi, studying the Gyu Zhi—the Four Root Tantras of Tibetan medicine.
Young amchi also learned how to identify and harvest medicinal plants, prepare medicines, remove toxic properties from certain ingredients, diagnose illnesses through pulse and urine analysis, and prescribe treatments. Some received training in moxibustion, cauterization, and other healing methods, while others studied astrology, historically considered an essential component of Tibetan medical diagnosis and treatment.
Amchi have long been repositories of knowledge about the use, trade, history, and status of medicinal plants. These ranged from lowland species, acquired through barter and trade and crucial to their pharmacology, to high-altitude species found in their home regions and used locally.
Within a single generation, the circumstances under which Nepali amchi treat patients, make medicines, and transmit knowledge have changed dramatically. Amchi are now increasingly engaged in dialogue not only with fellow practitioners across the Himalaya and Tibetan Plateau but also with representatives of NGOs, international organizations, and the Nepali government.
Institutionalized forms of Sowa Rigpa (the science of healing) have existed in the centers of Tibetan and Himalayan civilization since the 17th century. In Nepal, however, most amchi until very recently learned through a master-apprenticeship system rooted in pharmacology, clinical practice, and medico-religious techniques, all shaped by their ecological and cultural setting. Traditionally, Nepali amchi were taught medicine by their fathers or elder male relatives, blurring the boundaries between healer and householder, herdsman and trader. As Buddhists living in peripheral regions, amchi and their communities were physically and ideologically marginalized by Nepal, which until recently was the world’s only Hindu nation-state.
Interconnectedness, Nature, and the Science of Healing
In the Dolpo region, high-altitude medicinal plants grow around snow-covered mountains, watersheds, forests, and mineral-rich soils. Overgrazing and overharvesting are now major environmental concerns. These plants, highly valued for both medicine and livelihoods, are often collected for economic benefit. However, conservation of seeds and rare species is crucial for the future.
A Tibetan saying goes: “When the gem is in our hand, we do not realize its precious value.” Our environment is such a jewel. A healthy environment sustains healthy communities, while degradation brings drought, disease, and natural disasters.
In Sowa Rigpa, the human body is understood as a combination of the five elements—earth, water, fire, air, and space. Healing plants and substances are also formed from these five elements. Illness arises when the elements fall out of balance, and medicines restore harmony. Thus, body, plants, and environment are deeply interconnected.
Health awareness campaigns are needed to prevent both physical and psychological disorders. Negative forces arise not only from imbalances in body, speech, and mind—attachments, anger, and ignorance—but also from outer environmental changes and disturbances caused by local deities and naga serpent spirits. Monasteries, shrines, stupas, and water sources must be kept clean, as pollution, mining, or destruction of sacred landscapes invite negative influences and chronic illness.
Dharma texts note that when snow and rain do not fall in their proper seasons, farmers face poor harvests, animals suffer, and entire ecosystems decline. Climate change is therefore also a pressing challenge for Himalayan medicine. If rare plants such as the bzang po drug (the six superlative ingredients) become scarce, effective medicines cannot be compounded. Conservation of biodiversity is thus essential for both health and survival. As Acharya Nagarjuna once said: “Tree, stone, garden, mountain—if tested and recognized properly, each can be used as nectar with medicinal value.”
Overcoming Negativities and Restoring Balance
In the high Himalayas, households protect themselves by raising prayer flags representing the five elements on mountain passes, rooftops, sacred forests, bridges, and gates. Families also use protective amulets made of precious minerals. If a family member falls ill, visitors may be suspected of carrying negative energies. In Sowa Rigpa, such afflictions are called don, with five main categories described, including disorders caused by spirits, local gods, nagas, and karmic conditions.
Mental illness is treated through recitation of mantras, rites, and offerings, such as burning roasted barley flour mixed with butter and medicinal substances. Incense and ritual fires are also used to dispel harmful influences. These practices, still alive today, reflect the belief that suffering may arise from hungry ghosts, local deities, or karmic debts.
Treatment of mental illness is not limited to lamas and spiritual practitioners. Amchi also play vital roles, though in some cases they refer patients to specialists in astro-science. Mental disturbances—stress, anxiety, and depression—are increasingly common in the modern world, linked with diseases such as hypertension, heart disease, diabetes, and premature aging.
Medical texts teach: “Medicine cures physical factors, while spiritual healing brings inner peace and mental health.” Sowa Rigpa contributes greatly to mental health management through Buddhist and Bon principles, emphasizing peace of mind. Since body and mind are inseparable, amchi treat both physical and emotional aspects of illness. Compassion, love, joy, and equanimity are central to healing. This holistic approach reflects the principle: “Healthy Mind, Healthy Body.”
Integration of Astro-Science
Astro-science (Men-Tsee) is another unique feature of Sowa Rigpa. A basic knowledge of astrology and astronomy is required to become a qualified doctor. Timing of herb collection, medicine formulation, diagnosis, and therapeutic processes are all linked to astrological calculations. This integration highlights the unity of environment, body, and cosmos in traditional Tibetan medicine.