Biographies of Tibetan Precious Pills

Tibetan Precious Pills (rin chen ril bu) are arguably the pinnacle of Tibetan pharmacology, with tremendous medical, social, political, economic, and religious impact in Tibetan societies and beyond. They are prescribed, traded, gifted, worn, and taken orally by people worldwide; they are considered the strongest medicines for the most severe diseases, but are also used as rejuvenating tonics, first aid, and protective amulets (e.g. during the SARS epidemic). They are controversial due to their processed lead and mercury-sulphide content, yet many patients are unaware that they contain heavy metals. They are more expensive than other Tibetan pills due to their precious ingredients of gold, silver, sapphires, turquoise, pearls, etc. Importantly, they find niches among (un)controlled supplements and global Complementary and Alternative Medicine (CAM) markets. However, their recipes remain shrouded in secrecy and their origins are poorly understood. What happens to such multi-compound pills when studied from a theoretical perspective based on ideas of biographies of things (Appadurai 1986, Kopytoff 1986)? And what happens if we stretch these biographies of medicines over time and also consider their longitudinal textual history (for example, recipes, some dating to as early as the 12th century CE) as part of their lived contemporary practice (because those recipes are still used today)? This project takes the idea of biographies of things beyond things as commodities, combining textual and ethnographic methods in sketching biographies of three of the eight Precious Pills that drive the Tibetan pharmaceutical industry in India today, translating and analysing their historical recipes, investigating their social, political, and economic significance, and ethnographically researching their contemporary therapeutic use. Expanding theoretical ideas of medical biographies, this inter-disciplinary project of Tibetan Studies and Medical Anthropology will be hosted at the Institute for South Asian, Tibetan and Buddhist Studies at the University of Vienna. Approaching textual recipes as a literary form that has mediated the exchange of medical knowledge (Nappi 2009), translations and analysis of recipes will explore what therapeutic, religious, and political importance Tibetan medical authors assigned to Precious Pills during different historical periods. Ethnographic fieldwork will be carried out in India, where long-term research affiliations have already been established. Central to the fieldwork are discussions with pharmacology specialists and doctors to find out which of the historical recipe texts are used in their pharmaceutical manufacturing units and how these texts are interpreted today. This study is timely, since it will provide a considerable amount of data and new analysis feeding into the Asian medicines toxicity debate. Dissemination of results through open access peer-reviewed publications and a dedicated project website will enable doctors, patients, policy makers, and other stakeholders to make more informed decisions on their use.

This two-year project focused on biographies of contemporary Tibetan precious pills and their social history. Precious pills are unique multi-compound pills that form a special part of Tibetan medicine, also known as Sowa Rigpa (The science of healing). They are considered precious because they include a variety of pre- processed precious and semi- precious stones (pearl, turquoise, coral, rubies, etc.) and metals. Based on an ethnographic analysis of the most common precious pills currently produced in India and on a study of their formulas in Tibetan medical texts dating back to the twelfth century, several key results became apparent. Precious pills comprise heterogeneous Sowa Rigpa formulas (between 25 and 150 ingredients of herbal, animal, metallic, and mineral origins) that emerged from different histories, contexts, and sources and should, at least textually, not be treated as a homogenous group. Only more recently, largely with the onset of the pharmaceuticalization of Tibetan medical products beginning in the 1990s, have they been presented as a cohesive group of medicines. The overall popularity of precious pills draws on a combination of their perceived therapeutic and rejuvenating benefits. To understand the nature of Tibetan formulas and their biographies comprehensively over time, I looked at recipes as a specific genre and analyzed them in terms of their authorship, intertextuality, and naming practices, as well as their product design. Results revealed a certain flexibility to reformulate recipes while manufacturing the pills. The textual and ethnographic analysis showed that their inherent design poses a challenge within the present movement to codify formulas into a standardized pharmacopeia, which in India is currently required for four medical traditions (Ayurveda, Unani, Siddha, and Homeopathy) and might become relevant to Sowa Rigpa in the near future. The ways in which formulas are standardized will be a defining aspect of the future of the Sowa Rigpa industry in Asia. The findings of this project alert to the issues at stake and the nature of the medical knowledge that will be lost if Tibetan formulas, including those of precious pills, are standardized following the ayurvedic model. The contemporary commodification of precious pills in the Peoples Republic of China (PRC), where they drive a multimillion dollar business, is quite different compared to India, where they are deeply linked to expressions of Tibetan national identity. The analysis of a Tibetan-Chinese-English precious pill leaflet shows that in the PRC Sowa Rigpas specific terminology and disease etiologies are largely sidelined while catering to a Chinese speaking patient and consumer clientele, whereas in India we find elements from Buddhism and Tibetan identity integrated in the presentation and packaging of precious pills. Each serves the commodification of precious pills, but in different ways. Results also highlight how the commodification and over- the-counter sales of precious pills, found largely in the PRC but also at certain clinics in India, might easily lead to their misuse. Warnings about possible toxicity and calls to use precious pills only as prescription drugs are mentioned in brochures but rarely implemented. One of the projects main concerns has been to show that the commodification of precious pills with financial gain as the main strategy undercuts the therapeutic purpose of precious pills as potent medicines and tends to lead to their overuse. Uninformed consumers outside the Tibetan cultural context who buy precious pills over the counter or online either as tonics, supplements, or when self medicating, can easily underestimate their effects. The open- access project publications and an exhibition at the Institute for South Asian, Tibet, and Buddhist Studies provide accessible and relevant information.