Quality standards and modernization of Tibetan medicine

Tenzin Jigmey 

By Tenzin Jigmey 

The Tibetan Medical System (TMS) is one of the practising systems of complementary and alternative medicine (CAM), also known as Sowa Rigpa (classical Tibetan), which means “science of life”.
Tibetan medicine is practiced in Tibet, India, Ladakh, Nepal, and Bhutan, and now it is becoming more widely available to Western countries. I believe Tibetan medicine is based on a unique synthesis of Indian and Tibetan Buddhism, with some elements of Chinese medicine, and maybe some Arabic medicine. The Tibetan medical systems are holistic and take into account such factors as diet, lifestyle, environment, weather, attitudes, and emotions alongside any symptoms of disease. The theory of energy is highly developed. Tibetan diagnosis is based on taking the pulse, urine analysis (which is exceptionally highly developed and which may run into Persian history), tongue diagnosis, and observations. Treatments in Tibetan medicine, which aim to restore the balance of the humours, include herbal medicine, accessory therapies (massage, moxibustion), dietary aids, behavioural advice, religious rituals, and purification techniques.

After a half-century under the strict guidance of the Dalai Lama and under the control of the Central Tibetan Administration (CTA), the development of traditional Tibetan medicine (Sowa Rigpa) has made great leaps towards modernization, with some achievements. The Institute’s policy of openness presents an opportunity to promote the century-old truths of natural healing through Sowa Rigpa. The current trend of Tibetan herbal medicine modernization is a welcome new wave in this cold modern world of high-speed technology and higher-speed information.

Two ideological branches of Tibetan medicine

As a chemist I believe a development of Tibetan herbal medicine can be traced in the modernization of Tibetan herbal medicine quality control, efficacy/toxicology of Tibetan herbal medicine, and the modernization of the Tibetan herbal pharmaceutical industry — of which two main concepts and ideological branches have evolved:
(1) “Single-entity-mining” type Tibetan herbal medicine products: This idea was never accepted or even thought of in the traditional Tibetan system. In this concept, single active constituents are isolated, characterized chemically, and should be pharmacologically from Tibetan herbal drugs. The concept of isolating the active constituent separates itself from Tibetan herbal medicine philosophy and practice. This idea of a single entity is better accepted by Western society, science, and system of medicine, but it has little or no relation to Tibetan herbal medicine. In the past century, researchers in the West have made efforts to isolate and characterize the “active constituent(s)” in botanicals or other natural resources which have proven to be successful. Examples are artemisinin and taxol. However, the fact is that few single active compounds from natural resources were recognized pharmaceutically in the Tibetan system. The “active component” or “single entity type” model is not suitable for the purposes of Tibetan medical philosophy and will ultimately be insufficient to fully characterize the Tibetan Medical System. Moreover, researchers and manufacturers of Tibetan medicine should consider the many drawbacks, including financial and technological disadvantages and limits, in using the Western system with Tibetan medicine.
(2) “Herbal multi-compounded” type Tibetan herbal products: Historically Tibetan herbal medicine doctrine is basically held in a “herbal multi-compounded” approach which may seem difficult to grasp by Western logic and systems. There is the unfamiliar feature ingrained from the holistic efficacy of multiple actives and unknown active components, and the unique but puzzling philosophy of Tibetan herbal medicine being used in Tibetan herbal medicine clinical practice. I strongly understand that cultural and historical similarity may pose hindrances to Westerners in unscrambling the secrets of Tibetan herbal drugs. I understand the complexity of Tibetan herbal formulation is a big challenge to the research and quality assurance / control of Tibetan herbal products. As the Dalai Lama stated, Tibetan herbal medicines are expected to play a significant role in the future healthcare system. But there is an acute need for conducting timely clinical trials with traditional drugs. More evidence detailing photochemical and pharmacological studies are required for positive exploitation and wider application of these Tibetan herbal medicines.
Although these two branches have differences in research methodologies, I think both sides share the common goal of preventing disease, promoting health, and increasing longevity. Although success in the course of Tibetan medicine modernization relies heavily upon the proper allocation of time, respect, and resources to scientifically understand Tibetan medicine philosophy, such hard work will be futile if inherent cultural awareness is weak, or language barriers exist, or both. For these reasons, Tibetan medicine promotion is a challenging attempt for the Tibetan Medical and Astrological Institute (TMAI) and the exile administration. It is therefore critical, from the very beginning, to concentrate on the clear interpretation of Tibetan medicine philosophy with modern scientific methods and with a language of general acceptance.
So thinking in parallel with the modern attempts, respectable Tibetan medicine practitioners have unendingly and persistently cried out their objection to the evidence-based approach. They insisted that all the evidences were already there from the records in the classical texts. Forcing the Tibetan traditional applications through a rigid modern framework of scrutiny is artificially covering Tibetan medicine with a scientific fashion that does not fit. Thus, the modern proponents are facing an impasse when they rely totally on modern scientific concepts. The Tibetan traditional converts are persisting to push their pilgrims of defence.
Where do we stand so as to achieve the best results of synchronization? There must be a compromise somewhere. Classic Tibetan text evidences can be transformed into a universal language to be fairly evaluated and to be decided whether suitable for further research, using the deductive methodology or an innovative one after intelligent modifications. There is a need for a platform on which a direction can be developed in the attempt to modernize the traditional art and science of Tibetan healing, while remaining free and objective to utilize the decaying wisdom without prejudice. With the growing demand for Tibetan medicine from the global public, and a parallel interest from the service providers, there is an urgent need for the provision of valuable information in this area.

A system of research for evidence-based Tibetan medicine

It would be interesting to set up a system of research for evidence-based Tibetan medicine on category, such as:
(a) Set the priority areas: Tibetan Exile government or TMAI policy should choose areas where modern medicine has not yet found perfect solutions. Priority areas are allergy, viral infection, cancer, degenerative diseases, ageing, and preventive measures. These are the areas where research on Tibetan medicine offers great potential for supplementary solutions to unsolved clinical problems.
(b) The efficacy-driven approach: Pharmacocognosy is the field of identifying the active principles from the herbs, and is the most scientific way of developing herbal medicine. However, I believe this is expensive and lengthy. So there is a compromise: The TMAI and CTA have to aim at proving the efficacy of the raw herbal material or raw formula of herbs, before considering further sophisticated analysis. This is much less expensive and less time-consuming compared with the conventional method. Clinical trial research which targets an important clinical problem is important also to find a perfect solution where modern medicine fails to explain. Efficacy is most important to the clinician. Efficacy, once proven, encourages more utilization and invites more commitments on further studies towards further improvement of the drug preparation. Specially the Tibetan herb aconite root (Men-Schen) can produce heart failure due to the presence of cardiotoxic alkaloids, such as aconitine. Other symptoms of aconite poisoning are numbing of mouth and tongue, gastrointestinal problems, muscular weakness, lack of coordination and vertigo. A review published in 1977 from Hong Kong reported 17 cases of aconite poisoning after the administration of traditional medicine contain aconite. They also said toxicity of raw aconite can be decreased substantially by decoction, a process leading to a change in alkaloid composition.
My approach could be like this:

Conclusion and recommendations

Evaluating Tibetan herbal medicine within the theoretical framework of modern medicine can give practical answers to difficult problems. This is a way that endorses modern scientific medicine as the mainstream management tactic of diseases and ailment, while at the same time trying to supplement deficiencies in mainstream treatment. This may be able to gain wide general acceptance. One method of implementing this evaluation could be achieved through the efficacy-driven approach. Evidence for the efficacy and safety of Tibetan herbal medicine must be established by scientifically valid research, the conduct of which is filled with challenges ranging from the pre-clinical determination of the quality of the source material; chemical and biological standardization parameters and methodologies; choice of clinical formulations and good manufacturing practices; to the clinical evaluation of the formulated products.

References

• World Health Organization (WHO) (2001) WPFURC52/7: “A Draft Regional Strategy for Traditional Medicine in Western Pacific”. WHO Regional Committee, 52nd session, Brunei Darussalam, 10-14 September.
• Gottlieb OR, Borin MR, De MB Brito, and de Brito NRS. 2002. “Integration of ethno-botany and phytochemistry: Dream or reality?” Phytochemistry. 60, 145.
• Singh AP. 2007. “A Short Note on Designing Curriculum for Medicinal Phytochemistry”, Ethnobot, Leaflets. 11, 204–205.
• Singh AP. 2008. “Reviving the Dravyaguna Curriculum”, Light on Ayur. 7, 33–34.

NOTE--Tenzin Jigmey, MSc (Industrial Chemistry), MEd, and Certified Quality Controller, is a chemistry lecturer at Warren Community College, NJ, USA, and also a professional call interpreter at Certified Language International, Oregon, USA. He has worked with American standard of testing centers in the US as chemist and research assistant. He worked with the Tibetan Medical and Astrological Institute for two years. 

 

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