Accompanying the rise in prominence of biomedicine came the larger forces of global development, bringing along urbanization and economic growth as promises to raise standards of living (based on financial income) for the populations of the Tibetan Autonomous Region (TAR).
Urbanization has been the objective of the federal government of China for the TAR, encouraging more and more migration of previously rural Tibetans to increasingly dense cities like Lhasa (Yeh and Henderson 2008). As a result, inequalities between rural and urban resources, cultural tensions between Han Chinese migrants and Tibetans, and the wealth gap between new middle class Tibetans and lower class Tibetans have been sharpened. The subsidized shift of Tibetans from rural to urban translates to a drastic increase in wage dependence and consumption of resources produced elsewhere (likely taken from rural communities), despite the general lack of skills necessary for dignified urban employment, leading to a decline in quality of life with less food insecurity and much less leisure compared to previous subsistence livelihoods (Fischer 2008). Fischer notes that “standard income measures are not well conceived to reflect subsistence or asset-based wealth, nor transitions from more subsistence to more commoditized modes of production and employment”, suggesting an uncaptured wealth in pastoral lifestyles as the reason for the resistance of Tibetans towards earning low but comparatively significant income in cities (Fischer 2008, 41). Beyond decline in wealth, the displacement of Tibetans from their pastoral lands has also led to a decline in cultural traditions, including the practices of Tibetan healing.
There is much effort to preserve and pass on Tibetan traditions of healing through opening up of formal schools in the exile community and within Tibet (di Sarsina et al. 2011). In Xinning on the Plateau, the Qinhai Tibetan Medical School is a leading institution in research, training/placement of students in various Tibetan hospital and clinics throughout the region, and collaboration with biomedical practitioners in treating patients of the adjoined Xinning Tibetan Medical Hospital (di Sarsina et al. 2011). However, similar to Ayurvedic traditions in urban Nepal, it may be that traditional knowledge of sowa rigpa is being eroded as doctors are expected to be educated in formal universities rather than apprenticed under traditional practitioners such as kin, reducing the exposure and experience of the student with important aspects of learning and practicing medicine, such as the field study of medicinal plants and materials (Cameron). One study's finding that there is little difference in knowledge between the younger and older generations suggests that the loss of knowledge is not due to current gaps in knowledge transmission between the young and old generations alive today, but likely due to the social displacement and political turmoil in the last century (Byg et al. 2010).
Based on survey responses from a small sample of men and women, including doctors, from five Tibetan villages on visual recognition and usage of various plants from the official Tibetan pharmacopoeia, it seems that 20 out of 50 people continue to rely on only traditional medicine, followed by 13 relying on a mix of biomedicine and Tibetan medicine, 9 who only use biomedicine, and one who uses a mix of traditional Chinese and Tibetan medicines (Byg et al. 2010). There was much variation in medicinal plant knowledge but overall, showed a much larger pool of knowledge than found by a previous study in a location closer to a main city. Barring differences in methods of surveying, this supports a reasonable assumption that for the general population, traditional Tibetan medicinal plant knowledge and use has declined with increased access and social openness to other forms of healthcare in urban locations like Lhasa. Knowledge also correlated with altitude in terms of the distance between the village and the alpine meadows. Of the 50, 21 people harvested medicinal ingredients for clinical usage, while 29 preferred to buy them in stores due to lack of time and/or training (Byg et al. 2010). Women participated in the harvesting of the most valuable medicines like the caterpillar fungus, but men were associated with outdoor work and engaged directly with wild plants more often than women who are appropriated in the care of the home (Byg et al. 2010). Villagers indicated that they harvested for both personal use and commercial use. Based on the villagers' mentions of illnesses associated with more international and urban needs like high blood pressure, the increased collection of medicines demanded abroad has influenced their range of knowledge to focus on those that are most valuable in the market.
Herbal medicine is now a significant export for the people of the Tibetan Plateau as demand for natural products and alternatives to synthetic pharmaceuticals has grown around the world. At the same time, traditional forms of medicine are still often seen as primitive, crude, and less efficacious by foreigners compared to the biomedicinal pharmaceuticals they are substituting or complementing, requiring much more manual labor and very little processing for safety and standardization. As biomedicinal standards have become necessary to maintain for exports of medicinal products, practices of harvesting and preparing the medicines have become much less about the quality of the plants, but the amount that can be sold on the market as expressed by this quote:
“It is not a problem to make money. The problem is how we make the medicines now, what the ingredients are like, how they are collected. Before, we prepared medicines by first harvesting the ingredients well—taking care with the time we collect, the tastes of the medicines, how much we take when, the nature of our minds when we collected. Then we mixed the ingredients together and ground them by hand. If you read the texts, there are even different descriptions of how your body should feel—where you should be in pain—after making medicines. But now, from Beijing and other parts in China and the world that buy our medicine, they tell us that each ingredient has to be clean, and that you should mix the medicines in big machines. But what do they mean by ‘clean’? It is different than how we have been taught to make medicines”
(Craig 2011, 332).
Tibetan medicine has been directly pressured in “the push toward privatization, capital accumulation, and even market-based approaches to health care that have taken hold in China at an everincreasing pace since its entrance into the World Trade Organization (WTO) in 2001” (Craig 2011, 336). The most commonly known and harvested species for commercial use include: Cordyceps sinensis (caterpillar fungus), Saussurea laniceps (snow lotus), Fritillaria cirrhosa. All three are extremely valuable on the market and now threatened by over-harvesting and other environmental factors.
Even more threatening to the Tibetan medical traditions than the loss of knowledge is the loss of supportive ecosystems in the alpine meadows and forests of the Himalayan Plateau. Climate change has become an urgent issue to address in the conservation of Tibetan livelihoods and culture as a whole.
Seasonal Shifts/Increased Temperatures
Warming of average temperatures in the Himalaya has been estimated at 0.68 degrees Celsius since the middle of the 19th century (Gairola et al. 2010). The impacts of climate warming have been projected and observed to include changes in community composition, dynamics, and range shifts as plants adapt to earlier springs and later autumns. Different plants will react differently as observed in a study that found medicinal plant species have declined 21% while non-medicinal plants have declined 40%; the proposed reasoning is due to the root structure differences as medicinal plants tend to have deep roots and non-medicinal plants tend to have shallow roots more sensitive to harsh environments and lack of surface resources (Klein et al. 2008). Another property of medicinal plants is their possession of higher amounts of secondary plant compounds, the chemicals that have pharmacological effects; these have been found to also be impacted by changing environmental conditions, though different studies had conflicting results on whether these compounds increased or decreased in concentration in the affected plant species (Gairola et al. 2010). However, the overall observed negative impact of warming on medicinal plants has been found by one study to be mitigated and improved by appropriate grazing management due to the historical co-evolution of Tibetan herdsmen and the grassland ecosystems; the complete absence of grazing on fields actually harmed the growth of some plant species, especially in the context of climate warming (Fan et al. 2009, Klein et al. 2008).
Social & Ecological Healing
Conservation of ecosystems that provide important medicinal plants and materials in the traditional Tibetan pharmacopoeia has become an issue of survival not only for the physical well-being of Tibetans without access to biomedicine but for the cultural and spiritual well-being of the Tibetan communities in China and abroad. On the Himalayan Plateau, hotter climates, in addition to denser living conditions, also facilitate the spread of infectious diseases and new illnesses from industrial pollution that may be less amenable to traditional Tibetan medical treatments and more appropriate for an integrative biomedical and traditional approach. Even for non-Tibetans, the concepts behind the Tibetan system of healing, as well as other Eastern traditions, offer a holistic and humane complement to biomedical treatments for many illnesses.