Tibetan Medicine Study in Amdo: 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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Tibetan Medicine Study in Amdo: 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.

In the next part of this blog I will describe the herb study in the mountains.  If you want to be notified when it is published, please follow my blog or ‘like’ my page on Facebook.

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Tibetan Medicine Study in Amdo: Part One

Tibet2016 133This 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.

Tibet2016 407The 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.

Tibet2016 363Most 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!

Tibet2016 091As 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.

Tibet2016 239After 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.

In the next part of this blog I will describe my experiences studying clinicals in Malho, firstly at Dr Machik’s Tibetan Medicine clinic and secondly at the Traditional Tibetan Hospital with Dr Nida. Part Three will be about the herb study and the mountain camp.  If you would like to be notified when either of these are published, please follow this blog or check my Facebook Page.

To find out more about Myrobalan Clinic please visit www.myrobalanclinic.com

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A Weekend of Traditional Tibetan Medicine Study in Tallinn

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This time last week I was in Tallinn, Estonia at the 4th International Congress on Sowa Rigpa or Traditional Tibetan Medicine. This conference was very ably organised by the Estonian branch of the International Academy of Traditional Tibetan Medicine, a worldwide academy of Traditional Tibetan Medicine headed up by the bubbly and enthusiastic Dr Nida Chenagstang. I had had the good fortune to meet Dr Nida for the first time last October when he was in London for a week of teaching commitments. It was at this meeting that Dr Nida extended a warm invitation for me to join the upcoming Congress in Estonia.

It was such a joy to spend time with other Tibetan Medicine practitioners and to spend three days immersed in the study of this profoundly spiritual and yet eminently practical system of healing. I love the fact that Tibetan Medicine enables the healing of body, mind and spirit. The development of illness is a complex process which involves ingrained thought patterns, conditioning and emotional blocks just as much as the ingestion of unhealthy foods or a habitually unfavourable lifestyle. To only focus on physical manifestations of illness is to ignore the underlying root cause. Yet western allopathic medicine remains stubbornly uncomfortable about the mind and spirit aspects of healing. But I digress….

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Congress participants were warmly welcomed by Dr Nida Chenagstang.  Dr Nida’s enthusiasm and determination has helped bring the healing knowledge of Tibetan Medicine to students in many countries of the world. Dr Nida has also been responsible for preserving and teaching  knowledge of various external therapies such as:- KuNye Massage, Moxibustion and  YukCho Stick Therapy (this latter is not included in the Gyuzhi and had been preserved only as an oral tradition until Dr Nida’s initiative to teach it more widely).

What did I learn at the Congress? I learnt that there is a wide and dedicated network of Tibetan Medicine practitioners who are actively engaged in research and development projects all over the world. I was especially thrilled to discover that there is an initiative to share knowledge about the growing of Tibetan medicinal herbs in different European countries. I was impressed to learn that there is a now a new college in Nepal called ‘Sorig Khang International Nepal’ which will welcome its first students for a five year degree course in Tibetan Medicine this autumn (this course is open to western students too). I marvelled at the work done by Herbert Schwabl and his team at Padma Inc in order to make Tibetan formulae available in Europe despite complex and restrictive regulations which vary in interpretation within different EU countries, and I was totally enthralled by Eric Rosenbush’s presentation on ‘An Exploration of the Nectar of Immortality within the Science of Healing and its Lore in Indo-Tibetan Spiritual Traditions’. I seriously could have listened to this presentation for a great deal longer than the programme allowed.

On the second day of the congress we were treated to a demonstration of the Lum-Five Nectar Bath Therapy by Dr Dimitri Khokhlov from ATTM Buriatia thanks to the confidence and good humour of a volunteer who agreed to strip off and climb into the steam bath tent and sit there for 40 mins in front of a large audience. Dr Dimitri explained that this very valuable and ancient system of therapy is particularly helpful for patients living in colder parts of the world. I also attended a workshop in the use of heated iron instruments instead of herbal moxibustion cones, called ‘tel me’ in Tibetan. I found the heat from the iron rods to be soothing, penetrating and lasting so I could see how this form of moxibustion would be very good for the treatment of joint problems or injuries. I really liked the fact that this form of therapy does not leave a smoke filled clinic, something which I have found can be a little impractical in my premises where a moxibustion session could in theory be followed by a consultation with a patient suffering from a respiratory disorder. I can already hear the cries of ‘What about smokeless moxa?’ but I find even smokeless ‘moxa’  is a little smokey.

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Dr Anastazja Holecko gave a very interesting presentation on diet. She had drawn on functional medicine to help bring the very ancient advice contained within the Gyuzhi into a format compatible with western diets and lifestyles. My patients will be all too aware that my treatment recommendations always involve dietary and lifestyle advice. It is so important to eat in a manner that suits our personal circumstances and constitution.  I see a great many patients who have unwittingly unbalanced their health due to following a new healthy eating system, promoted on the internet and in the media as being perfect for everyone. In fact in reality we need to adapt our eating to our constitutional nature. For example someone of a nervous or anxious disposition will do much better if they include rich and nutritious, warming foods such as bone broth, oats and sesame seeds rather than following a very light raw food diet.

It was a great honour to hear about some Tibetan Medicinal formulae passed down through many generations of Dr Wanma Caidan’s family lineage in Amdo. It is awe inspiring to think about how such precious knowledge has been passed orally from father to son and now to daughters too for many centuries. There were also two very interesting presentations on karmamudra and sexual rejuvenation practices, as well as love, attachment and sexuality by Dr Tetsu Nagasawa from Japan and Dr Olev Poolamets from Estonia.

With three very full days packed full of presentations and demonstrations there was a great deal more which I won’t list exhaustively but I will add that I was very happy to hear the highly experienced Tibetan Doctor and teacher, Dr Machik from Amdo, speaking. Dr Machik was special guest of honour at the congress and I believe it was the first time he has travelled outside of China. I’m hoping to be able to travel to Amdo to study with him this summer.

After the formalities of the congress we delegates walked through the beautiful old town of Tallinn to the youth centre where we took part in the ceremony to ritually destroy the intricate Medicine Buddha sand mandala which had been constructed there a few days earlier. Although in the west we may find this destruction an alien concept, within Buddhism it is very helpful to be concious of the fleeting and impermanent nature of life. The destruction of the sand mandala helps to bring this impermanence into the forefront of our minds and helps us to grasp life to the full while we have its blessing.

I could say so much more about this but I am still digesting the experience myself. It was certainly a very intense few days and I found the interchange amongst delegates between the sessions was just as valuable as the formal presentations themselves. I know that attending the congress has refreshed and rejuvenated me after years of hard work focused on my clinic and patients without a change of scenery. I have come away from the congress with new friends, new ideas and a sense of being part of a wider Sowa Rigpa family. Once again though I’m left with a renewed wonder at the sophistication and spiritual depth of this wonderful and ancient system of healing.

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Early Spring at the Allotment

 

This morning was sunny and bright and I was looking forward to spending some time down at my allotment. I  had carved the time out of my crowded diary four weeks ago and I was delighted to see that the weather had been very kind. Perfect in fact, the ground too frozen to dig, but the bright sunshine and hard ground were ideal for cutting back some of last year’s growth without turning the soil into a compacted quagmire.

Part of self sufficient herbalism is being able to cultivate one’s own herbs. Having had the luxury of a half acre field in the past I’m now managing with an allotment. Space is tight for my needs but I still manage to grow and harvest a very wide range of medicines for my clinic.

If you like the idea of self sufficient herbalism and want to keep up with my medicine making, foraging and growing then follow me on Twitter or ‘like’ my Facebook page. To find out more about Myrobalan Clinic please visit www.myrobalanclinic.com

If you are planning to grow your own medicines then you need to be able to recognise medicinal plants at different growth stages and at different times of the year. The following photos show the plants that were visible this morning.

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Agrimonia eupatoria (Agrimony)

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Alchemilla mollis (Lady’s Mantle)

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Melissa officinalis (Lemon Balm)

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Marrubium vulgare (Horehound)

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Chelidonium majus (Greater Celandine)

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Symphytum officinale (Comfrey)

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Nepeta cataria (Catmint)

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Verbascum thapsis (Mullein)

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Cynara scolymus (Artichoke)

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Galega officinalis (Goat’s Rue)

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Primula veris (Cowslip)

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Achillea millefolium (Yarrow)

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Oreganum marjorana (Marjorum)

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Mentha spicata (Spearmint)

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Lactuca virosa (Wild Lettuce)

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Verbena officinalis (Vervein)

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Viola odorata (Sweet Violet)

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Fragaria vesca (Wild Strawberry)

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Solidago virgaurea (Golden Rod)

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Phytolacca americana (Pokeroot)

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Viburnum opulus (Cramp Bark)

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Double Extracted Chaga Tincture

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I was very excited to source some sustainably harvested Scottish Chaga this year. Chaga ((Inonotus obliquus) is known as ‘The Mushroom of Immortality’ in Siberia. It’s a nutritional powerhouse as well as a potent medicine. One of its many beneficial constituents is a compound called super oxide dismutase (often abbreviated to SOD).  but I’d rather use its full title! Super oxide dismutase fights the damage caused by free radicals in the body. Since free radical damage is a huge factor in ageing, Chaga has rightly earned its reputation as a ‘Gift from God’. It’s not just a beauty product though, its free radical neutralising action helps to counteract the ravages of degenerative conditions such as Alzheimer’s and Parkinson’s disease. Chaga also has a long tradition of being used to improve athletic performance, strengthening the immune system and as an anti-inflammatory.  Its known medicinal constituents and long empirical use leads medical herbalists to choose Chaga in supporting patients fighting cancer as well as those suffering from adrenal burn out or overload. There’s a very long list of conditions that Chaga is claimed to cure and a quick internet search will provide you with reams of information. All I can say is that it is a truly fabulous natural medicine and highly suitable to take as a daily tonic.

Chaga can be taken as a powder, a decoction or a tincture, but the best way to extract the full array of medicinal constituents is as a double extracted tincture. Let me show you how I used this process to create a very high quality Chaga extract in my clinic.

The first challenge is to source good quality sustainably foraged Chaga. A responsible forager will not strip the birch trees but take a little from a range of trees so that there is a thriving source for future years.  Dried Chaga comes in woody slightly ‘rubbery’ chunks with a gorgeous autumnual brown hue. The outside edge of each chunk is dark and fissured, almost as though it has been burnt.

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The second challenge is to cut the chunks into smaller pieces so that there’s a large surface area to volume ratio which will result in a more efficient extraction process. Cutting Chaga is not an easy process. I tried a junior hacksaw and a rubber mallet before settling on a plain old sharp knife. I found that pressing the point of the knife into a chunk and then twisting allows the fungus to cleave naturally and makes the job slightly easier.

After you have cut the Chaga into chunks put it into a Kilner jar and add a high strength alcohol mix. I used 60% alcohol. Using a lower strength alcohol (for example vodka) will mean that you must be careful about the amount of water you add later in the second stage of the process.

Put the jar away in a dark place for at least three weeks, agitating it every so often to ensure proper extraction. Once the tincture has macerated it can be strained and pressed.

The resulting high alcohol tincture is bottled temporarily and set aside. The quantity of this tincture is recorded so that the volume of the aqueous decoction can be calculated. The Chaga used to make the tincture is reserved and then used for the second stage of the process.

A quantity of water (I use spring water) which is twice the volume of the tincture is put into a pan with the Chaga. You can use a knife to measure the depth. You are going to need to simmer this gently for several hours until  the volume is reduced by 50%.  At this stage it is a thick dark nutritious (and delicious) liquid. The decoction is strained and pressed again.

The final stage is that the cooled decoction is mixed with the alcoholic tincture so that there are equal quantities of each. If you use a lower strength alcohol in the tincture making part you will need to combine it with less than its own volume of decoction. This is because if the overall alcohol content of the finished article is less than 25% the double extracted tincture may not keep properly. I wouldn’t want to have any risk of spoilage so my final alcohol content is a decent 43%.

Once the double extracted tincture has been made all you have to do is to bottle and label it. I recommend taking 10 – 20 drops as a daily tonic. If you have a particular health challenge you and your herbal practitioner may decide on a higher dose.

Most of the Chaga extract that I have made will be used in my clinic dispensary but at the time of writing I have a small amount available for sale. Do send me an email if you want to know about availability and cost.

If you like the idea of self sufficient herbalism and want to keep up with my medicine making, foraging and growing then follow me on Twitter or ‘like’ my Facebook page. To find out more about Myrobalan Clinic please visit www.myrobalanclinic.com

 

 

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Homemade Thick Non Dairy Yoghurt

yog1 Yesterday I made my first trial batch of delicious creamy thick coconut yoghurt. Ever since going dairy free nearly 10 years ago I have missed proper thick creamy yoghurt – the type that you can use in Naan breads or in savoury sauces, creamy but not too sweet. I’ll definitely be making a bigger batch next time!

I was guided and inspired by Tasty – Yummies’ excellent post on the subject which is here: http://bit.ly/1yDMEc1 .They do point out that everyone needs to experiment a little and find out what works in their own kitchen. So here is my experience.

yog2You will need:

  • 1 tbsp Agar flakes
  • 0.5 cups cold water
  • 400g thick canned coconut milk
  • 0.5 tsp honey
  • 1 sachet Bio Yoghurt culture
  • a yoghurt maker – mine is a Severin

Add the Agar flakes to the cold water and heat gently without stirring until it simmers. Simmer for 3 minutes whisking occasionally to make sure the flakes are thoroughly dissolved. Add a can of coconut milk and heat gently until it reaches blood heat then stir in the culture and 0.5 tsp honey to ‘feed’ it. (When I used to make yoghurt with sheep’s milk I always pasteurised it first by heating to boiling point and then allowing it to cool to blood heat. In this case I decided to see what happened if I didn’t heat the coconut milk any more than necessary). Mix the culture and the honey thoroughly into the warm milk and pour into the yoghurt pots. I left mine for about 8 hours before refrigerating. When I removed them from the yoghurt maker it looked as though they weren’t going to set but they did set on cooling. Yay!

Next time I’d probably double up the quantities but keep the same amount of dried culture. I’d also like to see how things turn out if I use a spoonful of a previous batch to inoculate the new batch. Obviously if you are using your own culture then you need to be meticulous about sterilising everything throughout the process in order to keep the culture untainted.

So if you are vegan or need to avoid dairy for health reasons and have missed ‘proper’ thick homemade yoghurt then give this recipe a try!

To find out more about Myrobalan Clinic please visit www.myrobalanclinic.com

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