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Medicinal Plants used in the Practice of Tibetan

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 18

Medicinal Plants used in the Practice of

Tibetan Medicine
TENZIN CHOEDON AND VIJAY KUMAR*

ABSTRACT
Traditional Tibetan Medicine (TTM) is one of the oldest known medical
systems with nearly 2,000 year old legacy of holistic and naturopathic
approach. It maintains that root cause of all forms of diseases is three poisons,
viz., aversion, ignorance and attachment. TTM aims not only to provide
symptomatic relief but to treat the root cause of disease. Many of the disorders
can be treated through diet restriction as the taste of food or medicines are
considered to possess healing property. Treatment usually involves
integration of diet, lifestyle, golden needle therapy, Moxibustion therapy,
pulse diagnosis and use of herbs. Among the Asian countries Tibet has been
known for its rich resources of medicinal herbs. TTMs are multicomponent
formulations comprising of natural herbs and minerals collected from
mountains and vegetation zones. There are over 250 medicinal formulations
comprising of 3 to 150 herbs per formula. Dosages of the individual
components are very low so as to avoid any adverse effect on the body.
Commonly used plant is Terminalia chebula which is also considered as
King of all medicines since it possesses all the six tastes and can cure
numerous physical disorders. Rhodiola due to its cold nature is used to
treat fevercausing diseases such as tuberculosis. The use of Tibetan medicine
against chronic diseases like cancer has shown a positive move owing to its
improved efficacy and reduced side effects. Tibetan medicines are mostly
seen in the context of Complementary Alternative Medicine and thus, could
be an effective supporting therapy to conventional medical system.
Key words: Herbal medicine; medicinal plant; Moxibustion therapy;
Padma 28; Thapring; Tibetan traditional medicine

Virology Group, International Centre for Genetic Engineering and Biotechnology,

Aruna Asaf Ali Marg, New Delhi110067, India
*Corresponding author:
388 RPMP Vol. 34 Phytoconstituents and Physiological Processes

INTRODUCTION
Traditional Tibetan Medicine (TTM) is one of the oldest known medical
systems with more than 2000 years old legacy of holistic and naturopathic
approach. Traditionally, Tibetan medicine integrates dietary and behavioral
modifications, lifestyle, herbs and accessory therapies to treat the root cause
of disease. The Tibetan medical heritage is based on the book of four tantras
(rgyud bzhi), which remains the fundamental medical text even today
(Fig. 1). This includes the root tantra, explanatory tantra, instructional
tantra and the subsequent tantra. In TTM, any disease is believe to be a
manifestation of the imbalance in four elements (earth, water, fire and air)
and three humors called Wind (rlung), Bile (mkhrispa) and Phlegm (Bad
kan). Tibetan medical treatment usually involves physical therapy, herbal
remedies, adjustment of regular diet, or a combination of two or more
procedures (Lobsang and Dakpa, 2001). Tibetan medicines exist in various
formsfrom decoctions, powders, general pills to precious pills and syrups.
These are prescribed in small dosesreflecting the emphasis of Tibetan
medicine on gentle treatment. The roots of Tibetan Medicine run deep in
Tibetan culture and are the result of thousands of years of development
and integration of the major medical systems of the ancient world. Tibetans
have created a unique holistic system drawing on and blending the medical
traditions of Tibet with those of India, China, Persia, and Greece (much as
western medicine has its roots in the Arabic, Greek, and Persian traditions).

Fig. 1: The Tibetan book of tantras (rgyudbzhi) including root, explanatory,

instructional and subsequent tantras. The book includes 156 chapters and
5900 verses describing a tree with 8 branches: body, pediatrics, gynecology,
disorders caused by evil spirits, wounds inflicted by trauma, toxicology,
rejuvenation and aphrodisiacs.
Medicinal Plants used in the Practice of Tibetan Medicine 389

Principles of TTM
The Tibetan system of medicine recognizes attachment, hatred and delusion
as three mental poisons that constitute the root cause of all human
sufferings. Like Ayurveda, it postulates that all life forms are composed of
five basic cosmic elements viz., earth, water, fire, air and space. Hence,
disease is a manifestation of disequilibrium of these elements. All the
elements are inherent in each cell and tissue that constitutes our body.
The cosmic elements are not static but dynamic forces which are
characterized by their inherent energetic functions than their actual state.
The three principle energiesrlung, Badkan and mkhrispa are directly
linked with the five cosmic elements.

Three Basic Principles of Energy

Wind (rlung) Bile (mkhrispa) Phlegm (badkan)

Wind (rLung) is the manifestation of air element, attachment is related

to rLung. Wind balances deals with our thoughts, the circulation of blood,
and the nervous system. It is one of the main causes of most ailments.
Stress, insufficient sleep or food, extreme dieting, donating too much blood
also lead to wind related problems.
Bile (mkhrispa) involves a properly functioning liver, a healthy
metabolism, and the ability to discriminate intellectually. Aggression is
associated with mkhrispa. Excessive sun bathing, exercises and sports
are conducive to bile upsets.
Phlegm (badkan) is concerned with joint health, general mental sanity,
and proper digestion and ignorance. Heavy meals, relaxing after meals,
swimming during spring and winter favor disturbance in phlegm.

Methods of Disease Diagnosis

Tibetan approach is a more spiritual and natural approach to medicine
than western medicine.The diagnosis of the disease is carried mainly through
visual, touch (pulse) and interrogation (Fig. 2)
Visual: Visual examination involves study of the five sensory organs, stool
and urine. A general visual diagnosis includes complexion of the skin, texture
of the blood which is present in sputum, urine and stool.
Touch: Palpitation involves examination of the body organs, energy
meridians, and pulse of the patients by feeling them with the touch. Most
significantly, the pulse and urine analysis form the most distinctive and
important part of diagnosis.
390 RPMP Vol. 34 Phytoconstituents and Physiological Processes

Diagnosis

Visual Touch Interrogation

(pulse diagnosis)

Fig. 2: The three methods of disease diagnosis visual, touch and interrogation.
A, Urine examination in a specialized container with the help of a stirrer;
B, Pulse diagnosis using index, middle and ring fingers; C. Recording the
patients dietary history.

Interrogation: Interrogation forms the most useful method in diagnosis.

The three main purposes are to find the causative factor, the site of illness
and the signs and symptoms. Wide ranges of questions are asked to the
patients for clinical assessment and correct diagnosis of diseases.

Treatment in Tibetan Medical System

As shown below, there are three different approaches for treating disease:

Types of Treatment

Dietary approach Behavioral approach External approach

Tastes: Sweet Routine Herbal medicine
Sour Seasonal Oil therapy
Astringent Behavioral Moxibustion therapy
Bitter Golden needle therapy
Hot
Salty

Dietary approach: According to the Tibetan medical system, there is no

substance on this earth which does not possess medicinal property. But it
is imperative to know its taste and potency, ways and means to collect it
Medicinal Plants used in the Practice of Tibetan Medicine 391

and know how to process the raw materials for obtaining optimal therapeutic
value. There are six principals of tastes sweet, bitter, astringent, sour,
hot and salty. All of the six tastes are present in the food we ingest, Earth
as a basis, water to moisten, fire to ripen, air to cause movement and space
to provide room for growth. Although all five elements are present,
predominance of the two of the five elements determines the taste. Earth
and water generate sweet, fire and earth result in sour, water and fire
produce salty, water and air form bitter, fire and air generate hot and
earth and air produce astringent taste. All the tastes have differing
influences on the body.
Behavioral approach: Physical, emotional as well as mental behavior
patterns that are practiced in an inadequate, excessive or distorted manner
can create the conditions for manifestations resulting in so called disease
or illness. The behavioral approach focuses on routine, seasonal and
incidental behaviors. Every negative action results in negative consequences.
Routine behavior generally deals with the proper usage of body, mind and
speech. Every individual has a unique distribution of the bodily energies
and elements. Energy transformation takes place in the body with respect
to changes in the environment and must try to harmonize ones behavior
with the changes. The urges of human beings must be allowed to take their
course naturally. The incidental behavior, therefore, prescribes to avoid
obstructing the impulse of hunger, thirst, vomiting, sneezing, evacuation
of mucus, saliva, stool, gas, urine and semen as these would cause humoral
imbalances. If these fluids are suppressed or expelled forcefully, a variety
of disorders could rise with the immediate disruption of rlung energy.
External approach: When the diet and routine behavior are unable to
relieve the disease conditions then herbal medicines are prescribed. This
includes oil therapy, Moxibustion therapy and Tibetan medicines.

Oil Therapy
Many diseases of nerves and muscles, as well as pain and insomnia (related
to rLung), are treated with gentle massage using various medicinal oils.
Tibetan therapeutic massage is one of the external therapies found in four
tantras (rgyudbzhi) for treatment of wind (rlung) imbalances and stress
related disorders. Medicinal bath and natural spring baths are used to treat
an assortment of skin disorders as well as chronic arthritis, gout and cold
types of rheumatism, and rigid and stiffness of the extremities. The Sorig
therapeutic massage oil (Juk Nuum Agar Dhethar) includes Helianthus
annus, Sesamum indicum, Zingiber officinale, Tinospora cordifola, Rubus
sp., Bombax ceiba, Ammomum subulatum, Myristica fragrans, Carum carvi,
Curcuma longa, Adatoda vasica nees, Sweria chirata, Elletaria
cardamomum, Carthamus tinctorius and Syzygium aromaticum.
392 RPMP Vol. 34 Phytoconstituents and Physiological Processes

Moxibustion Therapy
Herb cones of mugwort (Artemesia) are burned directly in the skin of certain
reflex points or indirectly through a golden needle (Fig. 3). Energy is supplied
to these specially selected reflex points. In addition, many practitioners
use golden needle to stimulate the energy channels of the body. This external
therapy is mainly used in the anterior fontanel area of the head. Moreover
low blood pressure, dizziness, dullness of sensory organs, imbalances related
to wind (rlung) and phlegm (badkan) are treated through this therapy.
Moxibustion can be performed on all the points known to acupuncture and
can be used for most cold diseases. The list of indications for them mostly
includes rlung and Bad kan imbalances. It helps to increase blood circulation,
tonify energy as well as boost the immune system

Fig. 3: Disease treatment by external approach. A, Moxibustion therapy involves

the burning of mugwort a small, spongy herb to facilitate healing. It
assists in dispelling cold and damp from the body and useful in a wide
range of conditions, including aches and pains, colds and flu, and even
poor digestion. B, The golden needle therapy is a type of acupuncture which
is used for treating high fever, headaches, colds and vomiting.

Tibetan Medicines
Tibetan medicines are taken in various forms, such as decoctions, powders,
pills, precious pills and syrups, and are prescribed in small doses. TTM
always constitute several ingredients, which mostly vary from 3 to 20.
Medicines having combinations of sweet, sour, salty and hot taste will help
eliminate problems related to rlung. These with combinations of bitter,
sweet and astringent taste will help eliminate problems related to mKhris
pa. Medicines, while combination of hot, sour and salty taste help eliminate
problems related to BadKan. (Dunkenberger T, 2000)
Most medicinal preparations are combinations of eight potencies which
are heavy, oily, classified into the 17 properties which can counteract the
Medicinal Plants used in the Practice of Tibetan Medicine 393

20 subtle natures of rlung, mKhrispa and BadKan. For example heavy

power of Agaru nagpo (Aqularia agallocha Roxb), the oily power of bone
marrow and butter, cure wind (rlung) disorders. Tikta (Swertia chirayita),
cool power and Chugang (Kaolin) blunt power cure bile (mkhrispa) diseases.
Similarly lightness like Letre (Tinospora sinensis), rough quality like ginger
and hot power like Phowa rilbu (Piper nigrum) and sharpness like Pipiling
(Piper longum), etc. cure Phlegm (Bad kan) disorders. TTMs are closely
allied to the Indian system Ayurveda. Herbs are important ingredients of
the Tibetan medicine. Great emphasis is laid on the part used and methods
of its identification, collection, preservation and extraction. Minerals and
gems are other important constituents of the medicine which forms 57%
of medicinal substances. The main constituents of the Tibetan medicines
that support the cleansing of the body are the decoctiosn of the combination
of Terminalia chebula (Aru ra), Terminalia belerica (Baru ra) and Indian
gooseberry or Phyllantus emblica (Kyuru ra) which is also known Aru
BaruKyuru, just as Triphala churna in Ayurveda (Figure 4). In fact the
teacher of Tibetan medicine or Medicinal Buddha (Sangye Menlha) is an
enlightened being with unbiased compassion as depicted in Figure 5. He
protects living beings from any form of sickness and helps them to eradicate
the three mental poisons which are the source of all sickness. He holds a
blooming Myrobalan (aru ra) plant in his left hand that depicts healing
touch. Myrobalan is the only plant in Tibetan pharmacopoeia that can aid
in healing all three mental poisons related diseases (www.dharma
haven.org). Tibetan medicines are mainly composed of a single herb or
hundreds of them like Pangyen 15 have fifteen different herbs mainly used
for treating cough and cold related problems. Multitarget drug design
combined with a networkdependent approach is a promising concept in
Tibetan medicine to combat multifactorial diseases like cancer. The control
of a complex disease system should involve simultaneous disruption of
multiple targets located in distant cellular networks (Keith et al., 2005).
Butea monosperma has antimicrobial property and purifies the blood. in
combination with Embelia ribes, Butea helps in relieving skin problems
like vitiligo, psoriasis, fungal infections and others. (www.mentsee
khang.org) Nutmeg 20 (Zati) constituting Myristica fragrans, Aquilaria
agollacha, Melia composita, Coriandrum sativum, Allium sativum, Ferula
jaeschkeana, Terminalia chebula, Terminalia belerica, Santalum album,
Pterocarpus santalinus, Bambusa textilis, Carthamus tinctorius, Eugenia
caryophyllata, Elettaria cardamomum, Amomum subulatum, Shorea
robusta, Acacia catechu, Geranium and Emblica officinalis help in subsiding
rlung disorders and promote mental well being. Nutmeg 20 promotes sleep,
increases concentration, lessens anger, irritability, tension and soothes
nerves and curbs tinnitus. Herbal ingredients are carefully balanced in
time tested combinations and concentrations. The most important
therapeutic role of Tibetan medicine is to restore the balance of the three
poisons (nyepas) to ensure that the seven constituents of the body namely
394 RPMP Vol. 34 Phytoconstituents and Physiological Processes

essential nutriment, blood, fat, muscle tissues, bone, marrow and

regenerative fluid remain in a healthy state. (Tsarong, 1986)

Fig. 4: Forms of Tibetan medicines. The constituent of Tibetan medicines are mixed
and pulverized into pill or precious pill (rinchen rilbu) forms.

Fig. 5: The three precious jewels of Tibetan medicine. Also known as Arubaru
kyuru, it includes the myrobalan fruits or Terminalia chebula (aru ra),
Terminalia belerica (baru ra) and Phyllantus emblica (kyuru ra) that are
wellknown to support the cleansing of toxins form the human body.

Precious pills are different form of medicines (Fig. 6) which have the
capacity to heal diseases intractable to other agents. These pills have
extraordinary therapeutic effects based on special ingredients involving
complex pharmacological processing methods and also involve spiritual
power and concentration of the physician who prepares the medicine. For
Medicinal Plants used in the Practice of Tibetan Medicine 395

example the great precious cold compound black pills (Rinchen drangjor
rilnag chenmo) are recommended for all chronic diseases like chronic fever,
contagious fever, gastrointestinal cramps, allergies, arthritis, blood
diseases, and nerve problems. These have been proven effective for Bad
kan sMugpo, a chronic and complicate hepatic gastrointestinal disease,
characterised by a simultaneous involvement of rLung, mKhrispa and bad
kan. These are prescribed against all types of food, metal and chemical
poisoning, as well as illness caused by environmental pollution. And also
help to provide strength for major organ systems and bone structures. A
healthy person can take them as a general tonic. The pills contain more
than a hundred ingredients including gold, silver, copper, iron, sapphire
emerald, turquoise and ruby in their detoxified form. A large number of
herbal ingredients such as Sativus (L), silicious concretion of bamboo,
Myristica fragrans (Houtt), Phytolacca esculenta (Van Houtt),
Seneciodianthus (Franch), Delphinium brunonianum (Royle), Oxtropis sp.,
Frittelaria delavayi (Franch), Berberis aristata (D.C.), Myricaia bracteata
(Royle) and Terminalia chebula (Retz) are all used in the pill.
(www.jcrow.com/precioushistory.html)

Fig. 6: Medicine Buddha (Sangye Menlha) with radiant azure blue body. His left
hand is in the meditation mudra while his right hand outstretched in the
gesture of giving and holds the great medicinethe blooming myrobalan
plant (aru ra).

Properties of Some Commonly Used Medicinal Plants in TTM

Terminalia chebula (Family Combretaceae) (Arura in Tibetan): it can
cure blindness and is believed to inhibit the growth of malignant tumors.
The dried fruit has been shown to block imbalanced production of iNOS.
This inhibition of inducible nitric oxide synthesis might contribute to the
anti imflammatory activities of Padma 28. (Moeslinger et al., 2000)
396 RPMP Vol. 34 Phytoconstituents and Physiological Processes

Juniperus macropoda Boiss (Family Cupressaceae) (Shugpa in

Tibetan): it grows at the altitude of 3700m. Juniper twigs and needles are
very important for fumigation. Burning of juniper produces aromatic smoke
which is believed to clean the atmosphere and ward off diseases. Juniper
needle is an important ingredient in traditional Tibetan incense. It has
been used medically for kidney diseases.
Myristica fragrans (Family Myristicaceae) (Zati in Tibetan): it promotes
heat and balances rlung. It is used against all types of rlung, poor appetite,
loss of heat in the stomach and liver and retains mental stability.
Carum carvi (Family Apiaceae) (Gohnyod in Tibetan): helps to combat
nerves and muscle constriction. It promotes heat, strengthens vision, blocks
rlung opening and is used against loss of appetite.
Swertia petiolata (Family Gentianaceae) (Chuck theek kar poh in
Tibetan): possess antiinflammatory effect. It is used against scleritis,
inflammation of live and high blood pressure from mkhrispa, inflammation
of stomach and kidneys from excessive hot diet and lifestyle.
Taraxacum spp. Agg. (Family Asteraceae) (khurmang in Tibetan): grows
at an altitude of 4020m in wet humus ground, flat base camp. Roots are
specially used for medicine. It is known for its usage in stomach ulcers. The
whole plant is regarded as an excellent liver tonic.
Emblica officinalis (Family Euphorbiaceae) (Kyu ru ra in Tibetan):
well known to balance the three rlung, mkhrispa and badkan. It is medically
used as a diuretic and antiinflammatory substance, and in the treatment
of polyuria and hair loss.
Lancea tibetica (Family Scrophulariaceae) (Pah yah tza wah in Tibetan):
has cooling nature and heals pulmonary disorders, dries up blood and pus,
joins broken nerves. It is used against pus in the lungs, coughs and
coagulates the blood mixed with pus. The fruit is used for heart disorders
and retention of menses while the leaves are used for healing the wounds.
(Tsarong, 1994)
Rubus sp. (Family Rosaceae) (Khen drah kah rhee in Tibetan): is known
to balance the three processes of rlung, mkhrispa and badkan. It acts as
antitussive, antiinflammatory, antitoxin and febrifuge. It can combat
pulmonary disorders such as fever aggravated due to wind (rlung) and
phlegm (badkan) disorders due to cold etc.

Contemporary Practice in Tibetan Medicine

The use of therapeutic plants and flora in the treatment of diseases are
common to all civilizations and cultures. In the west, lately patients have
developed a great sense of fascination for Traditional medicine from the
Medicinal Plants used in the Practice of Tibetan Medicine 397

east. TTMs in the west are seen under the context of CAM despite some
concern for lack of scientific validations.

Scientific Touch to Tibetan Medicine

According to modern western medical research, no medicine is qualified
until scientifically proven. Padma 28 is one such formulation that has been
extensively researched according to western standards. Padma 28 was
developed from the traditional Tibetan formula, Gabur 25. The Swiss
company Padma AG, founded by Karl Lutz, started manufacturing Padma
28 in Europe in 1970 and Karl Lutz also initiated scientific research
programmes in this field. Padma 28 is a multicomponent herbal mixture
formulated according to ancient Tibetan medical text and was assessed for
its beneficial effect in human skin culture (Aslam et al., 2005). It is a mixture
of a variety of different herbs (403 mg of active ingredient) as given in
Table 1.

Table 1: Herbal and non-herbal constituents of Padma 28

Herbal constituents of Padma 28

Aegle marmelos(Bengal Quince) fruit (20 mg)
Pimentadioica(Allspice) fruit (25 mg)
Aquilegia vulgaris(Columbine) aerial part (15mg)
Calendula officinalis(Marigold) flower (5 mg)
Elettaria cardamomum (Cardamom) fruit (30 mg)
Syzygium aromaticum(Clove) flower bud (12 mg)
Saussurea lappa(Saussuria) root (40 mg)
Hedychium spicatum(Hedychium) rhizome (10 mg)
Lactuca sativa(Lettuce) leaf (6 mg)
Cetraria islandica(Iceland moss) thallus (40 mg)
Glycyrrhiza glabra(Licorice) root (15 mg)
Azadirachta indica(Margosa) fruit (35 mg)
Terminalia chebula(Myrobalan) fruit (30 mg)
Plantago lanceolata(Ribwort) aerial part (15 mg)
Polygonum aviculare(Knot-grass) aerial part (15 mg)
Potentilla aurea(Golden Cinquefoil) aerial part (15 mg)
Pterocarpus santalinus(Red Sandalwood) wood (30 mg)
Sida cordifolia(Heart-leaved Sida) aerial part (10 mg)
Valeriana officinalis(Valerian) root (10 mg)
Aconitum napellus(Monkshood) tuber (1 mg)
Also present are 2 non-herbal components:
Dextrocamphora(natural camphor) (4 mg)
Calcii sulphas pulv.(Gipsum; 20 mg)

Recent scientific studies show that Padma 28 inhibits collagen degrading

enzyme matrix metalloproteinase1 and induces type I procollagen synthesis
398 RPMP Vol. 34 Phytoconstituents and Physiological Processes

which provides a basis for development of the herbal preparation as a skin

repair agent. Padma 28 has been shown to act as an atherosclerosis agent
in advanced peripheral arterial occlusive disease, (Exner et al., 2006).
Tibetan medicine is known to offer cure for chronic diseases. Multiple
sclerosis is a chronic often progressive demyelization disease that is
characterized by gait disturbances, visual and coordination impairment,
sensory complaints and genitourinary dysfunction. According to Tibetan
medicine, multiple sclerosis is rlungmkhrispa disorder in women and
badkanmkhrispa disorder in men. Excess of rlung mkhrispa causes
exacerbation, inflammation and demyelination in both genders. Padma 28
has been known for its regeneration property in multiple sclerosis patients
(KorwinPiotrowska et al., 1992). It showed improvement in 44% of the
multiple sclerosis patients with diminition of the cerebellum symptoms,
disappearances of disorder of sphincters and improvement in abnormal
vision as against untreated patients. Prolonged application of the herbal
preparation caused no undesirable symptoms. Further Padma 28 improved
walking distance in patients with stable, intermittent claudication of long
duration (Drabaek et al., 1993). Padma 28, a multifactorial herbal formula
can be used in treatment of cancer (Jenny et al., 2005) though biochemical
studies are extensively required to bridge the gap. As a rich source of
antioxidant polyphenols, Padma 28 preparation seems to be a promising
candidate for treatment of degenerative disease like Parkinsons disease
(PD) and Alzheimers disease (AD). Protective effect of Padma 28 was found
on the neurotoxicity of PC12 cells induced by neurotoxins like amyloid
beta (A), glutamate, 1methyl4phenyl1, 2, 3, 6tetrahydropyridine
which are known to be involved in PD and AD. A decrease in the oxidative
capacity of PC12 cells treated with Padma 28 was observed with the decrease
in cell viability induced by toxins due to oxidative stress. Thus Padma 28
seems to be a promising candidate for treatment of CNS disease (Ginsburg
et al., 2011).
Padma hepaten is another formula derived from traditional Tibetan
medicine produced by Padma Inc. In Tibetan it is called three fruits and is
composed of Chebulic myrobalan (Terminalia chebula Retz.), amla fruit
(Phyllanthus emblica L.) and belleric myrobalan (Terminalia bellerica Roxb.)
in the ratio 2:1:1. A similar formula with equiproportionate mixture of the
three fruits is known as Triphala in Ayurvedic medicine. Hepatic fibrosis
was significantly ameliorated by Padma hepaten administration. Serum
ALT levels in nave wild type were 17.314.4U/l which raised significantly
to 7033.4 following fibrosis induction by carbon tetrachloride. The serum
ALT levels dropped significantly to 32.316.6 by oral and 195.8U/l by
intra peritoneal routes of Padma administration. The expression of alpha
smooth muscle actin also significantly decreased confirming the role of
Padma hepaten as an anti fibrotic agent. (Ginsburg et al., 2009)
Medicinal Plants used in the Practice of Tibetan Medicine 399

Padma Basic is based on a traditional cooling formula, used to combat

symptoms of heat, and support healthy responses to inflammation. Padma
Basic is a unique formulation consisting of over fifteen rare and powerful
herbs that act to promote healthy cardiovascular, circulatory and immune
health as shown in Table 2. A combination of tannins, flavonoids,
polyphenols, and essential oils, these cooling components function
throughout the body to support balanced immune function, combat free
radicals, and support both the cardiovascular and circulatory systems.
(www.choosecra.com/store/supplements/padmabasic.html).

Table 2: Herbal constituents of Padma basic

Iceland moss
Costus root
Neem fruit (Azadirachta indica)
Cardamom fruit
Red saunders heart wood (Pterocarpus santalinus)
Chebulic myrobalan fruit (Terminalia chebula)
allspice fruit
Bael tree fruit (Aagle marmelos)
Columbine aerial part (Aquilegia vulgaris)
English plantain aerial part
Licorice root
knotweed aerial part (Polygonum aviculare)
Golden cinquefoil aerial part (Potentilla aurea)
Clove flower
Kaempferia galanga rhizome
Heartleaf side aerial part
Valerian root, lettuce leaf (Lactuca sativa)
Calendula flower
Natural camphor (Cinnamomum camphora)

Diabetes is one of the most common diseases among the Tibetan

community. The Tibetan Medical Astro Institute (TMAI), Dharamsala in
collaboration with All India Institute of Medical Sciences (AIIMS), New
Delhi has conducted at a large scale to study the efficacy of Tibetan medicines
(Kyuru6, Aru18, Yungwa 4 and Sugmel 19) on diabetic patients (Namdul
et al., 2001). Ancient text has shown successful management of diabetes.
The phytoconstituents of the drugs Aru 18 are given in Table 3. A total of
200 newly diagnosed or untreated type 2 diabetic patients aged between
3065 yrs with a fasting venous plasma glucose value between 140 and 250
mg/dL and post prandial plasma glucose (PPG) value of > 200 mg/dL were
recruited for the study. The treatment and control groups were comparable
with regards to age, gender, blood pressure, body weight, body mass index,
serum creatinine and urine albuminuria. Patients in the control group were
400 RPMP Vol. 34 Phytoconstituents and Physiological Processes

treated only with dietary and life style modification where as in treated
group, patients were treated with two of the four Tibetan medicines
mentioned above based on personality, pulse and urine characteristics.
Fasting blood glucose level decreased by 12.2 30.5% at 12 wks and 23.4
20% at 24 wks in treatment group as compared to 7.4 30% at 12 wks and
6.4 27.7% in the control group. The PPG measurement was significantly
lower in the treatment group at 12 and 24 weeks (decrease of 18.0 31.2
and 23.4 27.1%) compared with the control group (decrease of 5.5 32.9
and 10 41.2%). Namdul et al., 2001 reported a significant improvement
in glycemic control with the use of Tibetan medicine in patients with a
recent onset of type 2 diabetes compared with patients treated only with
diet and lifestyle changes. The preliminary trials have shown positive effect
of TTM in the management of diabetes.

Table 3: Herbal constituents of Aru 18

Terminalia chebula (Family: Combretaceae)

Juniperus communis (Family: Cupressaceae)
Curcuma longa (Family: Zingiberaceae)
Elettara cardamomum (Family: Zingiberaceae)
Syzygium cumini (Family: Myrtaceae)
Rubia cordifolia (Family: Rubiaceae)
Adhatora vasica (Family: Acanthaceae)
Tribulus terrestris (Family: Zygophyllaceae)
Crocus sativus (Family: Iridaceae)
Laccifer lacca (Family: Lacciferidae)
Emblica officinalis(Family: Phyllanthaceae)
Berberis lycium (Family: Berberidacea)
Saxifraga sp (Family: Saxifragaceae)
Canavalia gladiata (Family: Fabaceae)

In TTM, complex herbal and mineral pharmacopias are utilized. Use of

metals is an integral part of Tibetan medicine and detoxified mercury
(Tsothel in Tibetan) is commonly used (Sollen et al., 2006). There have
been numerous speculations of the use of detoxified mercury in medicine.
Mercury in TTM undergoes a lengthy process of detoxification to produce
detoxified mercury which is a substance traditionally considered safe for
use by patients while possessing important therapeutics properties
(Choedrak et al., 2000). Sollen has shown that daily intake of mercury in
the form of Tsothel (10 g/kg/day) was nondetectable in blood by atomic
absorption spectrometry. Prolonged ingestion of detoxified mercury
containing medicine is associated with its absence in blood levels but
relatively higher urinary levels (89 g/L) than the normal reference levels
(<20 g/L). These results are of particular interest in view of growing
popularity of Tibetan medicine in the west.
Medicinal Plants used in the Practice of Tibetan Medicine 401

Cancer has been a leading cause of death worldwide. Various Tibetan

medications have shown positive effect depending on various stages of
cancer. In fact many cancer patients have been totally recovered from this
dreadful disease. In our laboratory, we have studied Thapring in detail for
its anticancer and hepatoprotective properties (Choedon et al., 2011)
Thapring is a multi compound herbal preparation with ingredients shown
in Table 4 to support treatment of hepatocellular carcinoma (HCC) (Dawa,
2003). We have shown the cytotoxicity of this herbal formulation on liver
cancer cells. Interestingly under the experimental conditions used normal
cells were spared whereas hepatoma cells undergo apoptosis. The oral
administration of Thapring to transgenic mice model of hepatocellular
carcinoma (HCC), led to a significant reduction (p < 0.001) of the serum
ALT indicating ameliorative effect of Thapring against HCC. The serum
VEGF level also decreased significantly. Like ALT, serum ALP and AST
level were also reduced in Thapring treated mice as shown in Figure 7.
Further, the Thapring treated mice maintained body weight unlike increase
in the untreated mice ultimately leading to death. Deregulation of cell cycle
progression in cancer cells by anticancer agents is an effective strategy to
halt the tumor growth (Malumbres and Carnero, 2003). Thapring showed
a significant growth arrest at G1 phase (P < 0.01) suggesting its growth

Fig. 7: Therapeutic efficacy of Thapring (Tib) in different age groups of X15myc

oncomice. (A) Change in the body weight, (B) lowering of serum AST, and
(C) serum ALP enzymatic activities (E.A.) in the control and treated
animals.
402 RPMP Vol. 34 Phytoconstituents and Physiological Processes

inhibition property and induced apoptotic cell death which is a good feature
of anticancer agents. Further Thapring treated hepatoma cells showed
disruptions of mitochondrial membrane potential increased release of
cytochrome c. Thus, Thapring appears to be a good and reliable candidate
for therapy in cancer (Choedon et al., 2011).

Table 4: Herbal constituents of Thapring

Terminalia chebula (Rety) (Family: Combretaceae)

Saussurea lappa (C.B. Clarke) (Family: Asteraceae)
Acorus calamus (L) (Family: Araceae)
Aconitum ferox (Wall. ex Ser) (Family: Ranunculaceae)
Oxytropis microphylla (Pall) (Family: Fabaceae)
Commiphora mukul (Hook) (Family: Burseraceae)
Acacia catechu(L.F.Willd) (Family: Fabaceae)
Delphinium brunonianum (Royale) (Family: Ranunculaceae)

Breast cancer is one of the most prevalent cancers in both developing

and developed part of the world. Hundreds of women are faced with
metastatic breast cancer every day. Dr. Debasish Tripathy, an Oncologist
from University of California, San Francisco along with Tibetan physician
Dr. Yeshi Dhondhen carried out validation of Tibetan system of medicine
for oncology in breast cancer patients. The clinical study was carried out to
determine the safety of diagnosis and treatment regimen by Tibetan
medicine in patients with metastatic breast cancer without symptoms or
with minimal symptoms due to cancer. And also, to determine the efficacy
of Tibetan medicine as measured by time to disease progression, tumor
response, and quality of life in this population of patients. Eleven patients
agreed to participate in the study, and all met the inclusion criteria required
for the study. Dr. Yeshi Dhonden prescribed an herbal regimen with a nod
from FDA, USA for investigational new drug permit for each patient, and
the examination was repeated every 3 to 4 months with changes in the
formula as needed. Tumor measurements by physical examination and
appropriate scans were performed at baseline and every 3 months along
with monthly examinations and safety assessments. Of the 11 patients
enrolled in the study, data for 9 patients were evaluated for response to
therapy. One patient completed the study without disease progression, three
patients were stable for 612 months, four patients were stable for less
than 6 months, and one patient had a partial response to therapy using
standard WHO response criteria. The patients participating in the trial
did not experience any Grade III or IV toxicities attributable to the Tibetan
herbal formula utilized. It can be noted, therefore, that the therapy used in
this trial is both safe and feasible. Further studies of safety, feasibility and
efficacy of TTMs are needed to evaluate a broader range of Tibetan herbal
formulae(Randal, 1999).
Medicinal Plants used in the Practice of Tibetan Medicine 403

Dr. Yangkyi from Lhasa Menzikhang, Tibet carried out Phala treatment,
a powder directly applied to the eye for a broad spectrum of external diseases.
The medication comes in red and white form and is used against six
disorders Pterygium, Leukoma (corneal scar, ulcer, nodular keratopathy,
granular dystrophy), inflammatory disease of the nasal limbus, seasonal
allergic conjunctivitis, interstitial keratitis and discifirm stromal keratitis.
The basic ingredients of the red form of Phala are cotus root, camphor oil,
cinnabar, dried fruit of Terminalia chebula and borate. (Yangkyi et al.,
2011)
The Tibetan medicine Pokar 10 is often given for treatment of joint
inflammation/ pain and skin diseases. TMAI in collaboration with tissue
culture laboratory of Portland community college, Portland, Oregan, USA
carried out investigation of Pokar in two stressed fibroblast cell lines for 5
days where positive chemotactic response was observed. Similarly TMAI
carried out clinical studies on 50 Hepatitis B patients following WHO
selection criteria. LFT levels in treated patients were reduced significantly
showing the hepatoprotective efficacy of Pokar 10. (www.tibmedcouncil.org)
The preparation of every Tibetan medicine follows the seven important
procedures (Dunkenberger, 2000) that the plants must be grown in their
own natural habitat, the plants should be collected at the right time.
Detoxification procedure is must to eliminate all the toxins followed by
sorting and drying. For maximum potency, medicines should contain plants
which were picked in the same year, the older the plant the less potency
and following pharmacological formula to make the plants easier to ingest
and assimilate. Finally, compounding of ingredients for proper usage
according to the pharmacological texts.

CONCLUSIONS
In view of Tibetan medicine gaining popularity and more patients following
Tibetan medicine of treatment, the authentication of the TTMs scientifically
has become a need of the hour. According to H.H. The Dalai Lama we move
forward to understand and research ancient formulae, it is his belief and
clinical experience that we need to respect and preserve their origin and
traditional indications. In view of Tibetan medicines benefit, TMAI has
come out with many herbal products under brand Sorig which has medicinal
value and has been known for its health benefit. In western medicine,
chemotherapeutic agents are used in different combinations for treatment
which are associated with side effects where as TTM or naturopathic
treatment often cures chronic diseases and often relieves the symptoms
considerably with minimum side effects. In TTM, detoxified mercury is an
important constituent which has created panic in the west hence clinical
research has taken off. However no specific evidence of toxicity has been
detected and its side effects reported. Studying TTMs in depth will create
404 RPMP Vol. 34 Phytoconstituents and Physiological Processes

an integrative model for the treatment of chronic diseases. Thus, Tibetan

medicine has a great potential to help the sick if the medicine is scientifically
proven for the patients benefit. It is the objective of Tibetan medicine that
the balance of the energies be maintained to experience a healthy state of
being.

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