Asian Medicine 4 (2008) 174–200 www.brill.nl/asme Socio-Economic Dimensions of Tibetan Medicine in the Tibet Autonomous Region, China1 Part One Th eresia Hofer Abstract Th is article investigates some of the socio-economic dimensions of contemporary Tibetan heal- ing practices in the rural areas of the Tibet Autonomous Region (TAR) in China. It sheds light on the workings and the eff ects the commodifi cation of the offi cial Chinese health care system, which started in the late 1990s, have had on Tibetan medicine and how these are related to the concurrent re-introduction of the Co-operative Medical Services (CMS) scheme throughout rural China. Th e contribution to this journal is divided into two parts. Part One predominantly deals with the medical practitioners and the practices within governmental health care in the TAR. Part Two, which will be printed in the next issue of the journal, deals with the private sector of Tibetan medicine. Both parts focus on the situation in the Tsang or Shigatse region of the west- ern and central TAR, hence enabling there to be useful comparisons with medical practices in the capital Lhasa, most of the anthropological literature has focused on so far. Both contribu- tions are based on extensive anthropological fi eldwork in Lhasa and the Tsang region of Tibet. Keywords Tibetan medicine, Sowa Rigpa, Tibet Autonomous Region, health care reforms, Co-operative Medical Services, CMS, rural China 1 Th is article is based on 16 months of ethnographic fi eld research in summer 2001, summer 2003, and from September 2006 to September 2007 in the TAR. I wish to thank the University of Vienna, the Austrian Academy of Sciences, the Wellcome Trust and DDr. Mag. A. M. Hoeger for their generous fi nancial support. I also would like to thank Andrew Beattie, Hildegard Diem- berger, Andre Gingrich, Guntram Hazod and Vivienne Lo for their guidance before and during fi eldwork, Nandini Bhattacharya, Sienna Craig, Anna Lora-Wainwright, Th omas Shor and Geoff rey Samuel for comments on earlier drafts, and Dawn Collins for the many cups of tea and kind words that sustained me throughout my fi eldwork. Tibetan terms, such as names of Tibetan authors and Tibetan titles of books, have been transliterated here according to Wylie 1959. Exceptions are the often-used terms of amchi (doctor, A mchi), Mentsikhang (Medicine and Astrology Institute, sman rtsis khang), rinchen rilbu (precious pill or jewel pill, rin chen ril bu) and Sowa Rigpa (science or knowledge of healing, gso ba rig pa), which are rendered phonetically as are names of places and persons. Chinese terms are transliterated in Pinyin. © Koninklijke Brill NV, Leiden, 2008 DOI: 10.1163/157342108X381250 Downloaded from Brill.com09/25/2021 06:18:52AM via free access T. Hofer / Asian Medicine 4 (2008) 174–200 175 Introduction Tibetan medicine, the inheritor of what in Tibetan has been traditionally referred to as Sowa Rigpa or ‘Science of Healing’, is readily available through governmental and private medical practices in Lhasa, the capital of the Tibet Autonomous Region (TAR) in China. Th e Mentsikhang (established in 1916) is the foremost Lhasa–based institution for the practice of Tibetan medicine and astrology and provides medical care through a fl ourishing and centrally located out-patient department and a large in-patient department in the north of the city. In both locations, Sowa Rigpa practices are often combined with biomedical diagnostic and therapeutic techniques. Th ere is also a part pri- vately and part government owned medical factory, the ‘Tibetan Traditional Medicine Factory of the TAR’, where over 300 diff erent kinds of Tibetan medicines are currently produced and then dispensed through governmental and private institutions in the TAR and on national and global markets.2 In Lhasa there is also the Tibetan Medical College with over 300 students enrolled in undergraduate and graduate courses, who mostly go on to work in govern- ment positions. Additionally, there are several private Tibetan medical practi- tioners who, in some cases, have their own medical production facilities. Tibetan medical drugs and products, for example the famous ‘precious pills’ or rinchen rilbu among other more common medicinal drugs, are now also sold on a large scale as over-the-counter (OTC) drugs through various pharmacies and shops all over town, with buyers often not having had a prior clinical consultation. Th ese medicines may be produced by the TAR medical factory or in one of a growing number of private Tibetan medical factories in the country. Tibetans in the capital Lhasa use Tibetan medicine, which tends to be con- sidered fi nancially and culturally3 a more attractive health care option than Chinese biomedicine, more readily than Tibetans in the rural areas.4 On the contrary, for Tibetans in the rural areas of the TAR it is hard to have access and to be able to aff ord Tibetan medicine, which is unequally reimbursed through a governmental medical insurance scheme. 2 Th is factory in their publicity advertises their uninterrupted existence of over 300 years. It claims to date back to the medical production section at Chagpori Medical College, established in 1696 by Desi Sangye Gyatso in Lhasa, despite this institute being totally destroyed by Chinese armed forces during the 1959 Tibetan uprising against communist Chinese occupation of Tibet. 3 Janes 1999. 4 Th e practices and ideas referred to here as Chinese biomedicine are what Tibetans call ‘out- sider medicine’ (Tib.: phyi lugs sman), ‘Chinese medicine’ (Tib.: rgya sman, Chin.: zhong yi) and ‘communist medicine’ (Tib.: tang sman). I am aware that the use of the term ‘biomedicine’ in this context is problematic, since its practices are not uniform across nations and, in fact, often bear little resemblance in diff erent places. See Berg and Mol 1998. Downloaded from Brill.com09/25/2021 06:18:52AM via free access 176 T. Hofer / Asian Medicine 4 (2008) 174–200 Th is disparity in use and availability of Sowa Rigpa between the urban and the rural areas was of concern to some of the Tibetans I worked with during my stays in the TAR, and sparked off my interest to research further the ques- tion: ‘Who uses and has access to what kinds of Tibetan medical health care in the contemporary TAR?’ Th is question is part of my ongoing research, in which I consider a variety of historical, political, socio-economic and cultural forces that infl uence twentieth-century and current Tibetan medical practice in its incessant encounters with Chinese biomedicine and government poli- cies. I have narrowed my focus in this article to some of the socio-economic dimensions and pressures that infl uence contemporary Tibetan healing prac- tices in the rural areas, which have, so far, not been dealt with in its own right in the literature on Tibetan medicine.5 Anthropological research on contemporary Sowa Rigpa practices in TAR to date has largely focused on Government institutions for Tibetan medicine in Lhasa. For these, scholars describe and analyse the increasing secularisation and commercialisation of Sowa Rigpa,6 as well as shifts towards a ‘scientifi ca- tion’ of Tibetan medical ideas, practices, theory and training.7 We also have one in-depth account of the radical changes taking place in the manufacturing of Tibetan pharmaceuticals following the introduction of Good Manufactur- ing Practice (GMP) in 2003 and increasing pressures for Tibetan medicine to perform in clinical trials.8 Although the changes described and analysed in the above literature infl u- ence Tibetan medical practice outside the capital and in Government institu- tions also, in particular because of sharp increases in costs of medicines, I aim to shed light on the workings and eff ects of the commodifi cation of the offi cial Chinese health care system and the impact of the re-introduction of the Co- operative Medical Services (CMS) on Sowa Rigpa practices in the rural areas in the late 1990s. In Part One, I will predominantly deal with governmental health care in the TAR and in Part Two, which will be printed in the next issue of Asian Medicine: Tradition and Modernity, I consider the private sector of Tibetan medicine, in both cases with focus on the Tsang or Shigatse region of western and central TAR. Before turning to the medical fi eld of this peripheral region, a brief vignette on Tibetan medicines in the capital Lhasa will illustrate some of the larger dynamics at play in the contemporary TAR. It shows a diff erent and far wealth- ier economy into which much Tibetan medical practice is increasingly drawn. 5 Only Craig in Schrempf (ed.) 2007, Schrempf (ed.) 2007 and TIN 2004 touch on some aspects of this. 6 Adams 1998, 2001, 2007, Adams and Li 2007. 7 Adams 2002, Adams et al. 2005 and Craig in Schrempf (ed.) 2007. 8 Craig 2006. Downloaded from Brill.com09/25/2021 06:18:52AM via free access T. Hofer / Asian Medicine 4 (2008) 174–200 177 Rinchen Rilbu for the Rich? During my residence in Lhasa in the 12 months from September 2006 to September 2007, working on contemporary and twentieth-century transforma- tions of Tibetan medicine, most of my regular visits to the main branch of the China Post Offi ce on Beijing Lu passed a Chinese or a Tibetan customer packing up colourful boxes of rinchen rilbu to be sent home or abroad. In Lhasa’s spe- cialised Tibetan medical pharmacies, rinchen rilbu boxes sit on the front shelves and catch the viewers eye (Figure 1). Several companies advertise on large post- ers and on television: Mutig 70, Rinchen Drangjor and Rinchen Mangjor are the names one usually sees written in Tibetan, Chinese, and roman characters.9 Chi- nese and biomedical pharmacies-cum-souvenir shops also stock these pills, espe- cially around the tourist area of Lhasa between the Jhokhang (Lhasa’s main temple) and the Potala.