"Healing Elements is a beautiful ethnography of the practices, products and epistemology of Tibetan Medicine. Through her rich and gifted storytelling of experiences spanning a decade, Craig weaves together a mosaic of the medical and therapeutic engagements of the troubled whole that is Tibetan Medicine today. Healing Elements shows us how this conversation itself constitutes a path toward healing." - Vincanne Adams, Professor of Medical Anthropology at the University of California, San Francisco.

Sienna Craig is an Assistant Professor of Anthropology at Dartmouth College. She is the author of Horses Like Lightning: A Story of Passage Through the Himalaya and coeditor of Medicine Between Science and Religion: Explorations on Tibetan Grounds.

Healing Elements

Efficacy and the Social Ecologies of Tibetan Medicine

By Sienna R. Craig

UNIVERSITY OF CALIFORNIA PRESS

Copyright © 2012 The Regents of the University of California
All rights reserved.
ISBN: 978-0-520-27324-5

Contents

List of Illustrations, ix,
Preface, xi,
Acknowledgments, xiii,
Notes on the Use of Non-English Terms, xvii,
List of Acronyms, xix,
Introduction, 1,
1. Portrait of a Himalayan Healer, 27,
2. The Pulse of an Institution, 48,
3. Lineage and Legitimacy, 78,
4. Therapeutic Encounters, 112,
5. Good Manufacturing Practices, 146,
6. Cultivating the Wilds, 183,
7. The Biography of a Medicine, 215,
Conclusion, 253,
Glossary, 263,
Notes, 275,
Bibliography, 285,
Index, 309,

CHAPTER 1

Portrait of a Himalayan Healer

We have weathered so many journeys, and so many forms of love. Would it have been the same, we ask one another, had we stayed still, in the mill with the water running under us. There is no way of knowing.

—Alastair Reid, Whereabouts: Notes on Being a Foreigner

READING SIGNS

It is early September 2008. The high-altitude air is tinged with autumn. I walk through the alleys of Lo Monthang, the largest settlement in northern Mustang District, Nepal. This is the time before animals have been let out to graze, before children have gone off to the new local day care, to school, or to help gather dung and tend animals. I pass whitewashed homes decorated with protective door hangings above the threshold: colored yarn webs holding sheep skulls, repelling nefarious spirits and gossip. I hear the muffled sounds of cymbals, bells, and the resonant drone of Tibetan Buddhist monks calling forth another day.

As I make my way through Lo Monthang, I am conscious of borders. This is Nepal's northern edge, where the Indian subcontinent is subducted under the Tibetan Plateau. Mustang lies in the Himalayan rain shadow; it is mostly high-altitude desert, abutting the Tibet Autonomous Region, China. Jomsom, the district's headquarters, is linked to Pokhara, the nearest city, by flights from a small airport and by trails. No all-season motor road connects the district to any urban center, although this reality is changing swiftly. Seasonal unpaved roads have been constructed over the past decade and are passable with tractors, jeeps, and motorcycles. Mustang is encompassed by the Annapurna Conservation Area, Nepal's largest protected area. The district is home to approximately 14,000 individuals (2001 Nepal census), whose households and property are partitioned into sixteen village development committees. Upper Mustang, at the center of which sits Lo Monthang, is home to Tibetan speakers, tsampa eaters, and practitioners of Buddhism and Bön, indigenous religious practices of the Tibetan plateau (Snellgrove 1981; Samuel 1993). These moral cosmologies lend structure and meaning to life here, along with what Charles Ramble (2008) calls a "civil religion," which prescribes social norms and governs natural resource use, further defining the region's cultural and natural landscape.

Mustang's Kali Gandaki River and settlements situated along its banks have been a locus of trans-Himalayan trade for centuries, including the exchange of lowland grains for Tibetan salt. The people of Mustang have relied on agriculture, animal husbandry, and trade to wrest survival and even prosperity from the area for centuries. Mustang was incorporated into the nation-state of Nepal in the eighteenth century, though the area has maintained cultural, economic, and political alliances with Tibet (Ramble 2008). The most significant and enduring of these connections is the lineage of kings, descendants of western Tibetan nobility who, since the fourteenth century, have wielded influence over the region, particularly in upper Mustang, or what is known as the Kingdom of Lo (Dhungel 2002). Jigme Palbar Bista, the twenty-fifth in the lineage of Lo kings (T. gyalpo, N. raja), still lives in a looming whitewashed palace at the heart of Lo Monthang. His wife, the queen (T. gyalmo, N. rani), hails from Shigatse, the second largest city in the TAR. Tibetan Resistance forces occupied Mustang from 1960 to 1974, as they waged guerrilla war against the Chinese People's Liberation Army (Knauss 1998; McGranahan 2010). A permanent Tibetan refugee settlement has existed in southern Mustang since the 1970s.

Due in part to this sensitive political history, foreign access to upper Mustang was prohibited until 1991. Travel to the region is now allowed on a restricted basis, requiring a permit that costs $50 per person, per day. In contrast, villages in lower Mustang are part of the Annapurna trekking circuit and have been a mainstay of Nepal tourism since the late 1970s. Lower Mustang is also more accessible to roads and regional markets. These distinctions have real-world effects with respect to economic opportunities and the provision of government services, including health care. Many from the region spend the winters engaged in small business in northern India, Pokhara, or Kathmandu. During Nepal's decade-long (1996–2006) conflict between Maoist forces and the state's army and armed police, Mustang remained the only district in the country that did not see active combat. Yet this conflict—along with the chance to earn social and economic capital by working abroad—has propelled many people to leave Mustang (Craig 2002, 2004, 2011b).

On this crisp September morning, I round the corner past Thubchen, a fifteenth-century monastery that has been restored recently (Lo Bue 2011). I walk past a row of reliquaries (T. chöten, Skt. stupa) and stop before the wood-and–corrugated metal door leading to a school. A window, rimmed in black and red paint, rests above the door. Between window and door hangs a trilingual signboard. There is an arc of English—"Lo-Kunphen Traditional Herbal Medicine Clinic and School"—under which is written an approximation of the same, first in Tibetan and then in Nepali. The Tibetan reads Lo Kunphen Mentsikhang Lobdra. The Nepali reads Lo Kunphen Aamchi Aaushadhyalaya Skul. My friends and colleagues, Gyatso and Tenzin Bista, run this small institution.

Many elements of meaning are lost and gained across the two-dimensionality of this sign. As mentioned in the Introduction, the term mentsikhang means "house of medicine and astrology." In its generic sense, this is a place where Sowa Rigpa is practiced. It is also the name given to major state institutions of Tibetan medicine in China and India. It becomes, simply,"clinic" in English. In Nepali aamchi aaushadhyalaya skul is an amalgam of language and history. The first term is a Nepali approximation of amchi, itself a Mongolian word long ago loaned to Tibetan, which means "healer" or "doctor." Aaushadhylaya connotes a medical establishment. It is formal, Sanskritized, the type of word most people from Mustang—though citizens of Nepal—would have trouble using in common speech. The word might conjure memories of failed School Leaving Certificate (SLC) examinations, and it would probably feel more foreign than the English word clinic. Finally, skul is a Devanagari approximation of the English term school.

I have passed this sign many times. This morning it stops me short. I realize that, in Nepali, there is nothing Tibetan about this place. In Tibetan, centuries...