Tibetan Medicine Study in Amdo: Part Two – Clinicals

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.

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.

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.

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.

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.

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.

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.

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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