TIBETAN HERBAL MEDICINE

Un excelent intro asupra medicinii tibetane, pe care il recomad in lectura integrala.

TIBETAN HERBAL MEDICINE

With examples of treating lung diseases using rhodiola and hippophae

by Subhuti Dharmananda, Ph.D., Director, Institute for Traditional Medicine, Portland, Oregon

Tibetan medicine has a rich heritage and is currently practiced not only in Tibet, but also in the adjacent Chinese provinces of Qinghai, Gansu, Sichuan, and Yunnan, and in the neighboring kingdoms of Bhutan, Nepal, Ladakh, and Sikkim, where communities of Tibetan people have long been established. Many non-Tibetans also seek out treatment by this traditional system because of its good reputation. As a result of the flood of refugees from the Chinese military occupation of Tibet, Tibetan medicine extended to India, and, from there, to many countries of the world (especially in Europe and North America) under the guidance of a small number of refugee physicians. One of the most famous of the refugee doctors is Dr. Yeshe Donden, who was the personal physician of the Dalai Lama in exile from 1961-1969. Dr. Donden has spent much time in the U.S., where he has diagnosed and treated patients, given teachings to doctors and laypersons, written books and articles, and answered numerous questions about the Tibetan system of health care. Tibetan medicine has also been popularized by a lineage of the Badmajev family that originated in Russia, near Mongolia; members of the family traveled West during the 20th century. Tibetan herbal formulas they brought with them have been available as pharmaceutical products in Europe since 1980.

Tibetan medicine originated with the local folk tradition (known as Bon) that dates back to about 300 B.C. and was formally recorded by Xiepu Chixi, the physician to the Tibetan King Niechi Zanpu, in 126 B.C. Aspects of both the traditional Chinese and Indian (Ayurvedic) medical systems were added later; Ayurveda has had the most profound influence on Tibetan medicine. The medicine of India was introduced to Tibet as early as 254 A.D., with the visit of two Indian physicians. During the following century several physicians from India reinforced the teachings.

The greatest influence from India came about when Buddhism was adopted in Tibet as the state religion. This occurred as Tibet was unified under King Songzan Ganbu (618-652 A.D.). Buddhism had great implications for the practice of the Indian approach to medicine that evolved separately in Tibet. The Ayurvedic principles, especially the concept of tridosha, or three faults (in Buddhism, the three poisons) provided the basis for analyzing physical disorders and designing treatments, while Buddhism provided a strong spiritual component.

The legend of how Tibetan medicine was introduced to Tibet is relayed in the story The Life of the Great Physician Yuthog Yonten Gonpo [pinyin: Yutuo Yuandan Gongbu] which has been translated and presented in the book Tibetan Medicine by Rechung Rinpoche (1). The following is the command by Tara (the Buddhist god of compassion, which is identified in the Chinese tradition as the goddess Guan Yin) to two famous physicians of India who are said to have become immortals (now living in the sandalwood jungles of India):

It has been prophesied by the Buddha about the country of Tibet; and all the Buddhas have discoursed on Tibet, and Avalokitesvara [also called Chenrezi; a champion of Buddhism: a boddhisatva] was made the special protector of Tibet. Avalokitesvara is the chief protector and I am helping him. When you go to Tibet, you will teach the people medicine, in the way the Buddha comes with his teaching. There is no doubt of success. Go quickly, and I shall look after you with my merciful eyes. And you will have the blessing of Avalokitesvara and great results. By the strength of your former prayers, the teaching of medicine will be kept up by the lineage of your families. Be of good cheer and go to Tibet!

The lineage spoken of here involved the birth in Tibet of Yuthog Yonten Gonpo (708-833 A.D.), who studied medicine since an early age and was exposed to Buddhism during his teen years. Yuthog made three trips to India and studied with the great masters of Buddhist and Ayurvedic medicine there, and he eventually wrote 30 classic medical works integrating the local, Indian and Chinese medical traditions (2, 3). The involvement of Chinese medicine came about in 641 A.D. when a Tang Dynasty princess, Wen Cheng, was married to the Tibetan leader Songzan Ganbu (who was also married to a Nepalese princess that introduced him to Buddhism). Wen Cheng brought with her many Chinese books, including the medical books, as well as herbal formulas and medical instruments. Seventy years later, during Yuthog's life, another Chinese princess, Jin Cheng, brought additional medical books, as well as several Chinese physicians, to Tibet.

Yuthog is viewed as the father of Tibetan medicine. He became a royal court physician and established the first Tibetan medical school at Congpo Menlong; he also became a monk at the Samye Monastery. A great medical conference was held at Samye during this time, bringing together Indian, Chinese, Persian, and Greek medical experts. Yuthog received the forerunner of the Four Medical Tantras (Sibuyidian; in Tibetan: rGyud-bzhi, ca. 770 A.D.) that serve as the basis of Tibetan medical practice. The original version is thought to have been written in Sanskrit around the 4th Century A.D. and then translated into Tibetan and given to the royal court (4). Yuthog's work in reorganizing and clarifying these books, as well as adding supplemental material (including that from other traditions described at the Samye conference) made him the true author of the Tibetan traditional text. Because of the vast contributions he made, he is considered a reincarnation of the Medicine Buddha, venerated as "the second Medicine Buddha."

The Four Medical Tantras were revised (1573 A.D.) by the "younger Yuthog" who was a 14th generation descendent of the original Yuthog, now referred to as the "elder Yuthog." Additional revisions were made during the 17th century to bring forth the current version. The first two medical tantras (called the "root tantra" and the "explanatory tantra") have been translated and annotated by Dr. Yeshi Donden (5) and translated again in expanded form by Dr. Barry Clark (6). These first two tantras make only brief mention of herbal medicine, and focus instead on behavior, diet, diagnostics, disease categories, and other aspects of traditional medicine. The third tantra ("instructions") details the cause and treatment of each major category of disease, and the fourth tantra ("concluding text") is devoted to the details of diagnosis, herbs, moxibustion, and other techniques. One major obstacle to translating the section on herbs is that the identification of the original materials in this 1,200 year old text is quite difficult.

The general methods of diagnosis and therapeutics used by Tibetan doctors follow the Indian tridosha system; that is, being based on three humors (see Table 1).

Table 1: The system of three humors adopted into Tibetan medicine from India.

English	Tibetan	Pinyin	Indian	Basic Concept
wind	rLung	long	vayu	movement, breath, cold
bile	mKrhispa	chiba	pitta	metabolism, digestion, fire
phlegm	Badkan	peigen	kapha	restraint, lubrication, moistness

The imbalances in an individual are revealed by a combination of reported symptoms, pulse diagnosis, tongue diagnosis, and urine analysis. The overall physical appearance of the person and information about their daily habits, and consideration of seasonal influences also contribute to the analysis. The Tibetan pulse diagnosis appears to be derived from the Chinese system, and is taken at the same artery of each wrist, but the method of feeling the pulse and the interpretations differ. Tongue diagnosis is simplified compared to the Chinese system (long disorders are characterized by red and dry tongue; chiba disorders by a yellowish tongue coating; and peigen disorders by a greyish and sticky coating with a smooth and moist texture). Urine analysis is unique to the Tibetan system and may have been introduced from Persia. Physicians inspect the color, amount of vapor, sediment, smell, and characteristics of the foam generated upon stirring, relying on the first urine excreted in the morning.

Traditional Tibetan formulas are described mainly in terms of the diseases and symptoms that they treat, rather than their properties and influences on the humors. For example, in this article, several formulas that treat lung diseases are presented and their description mainly involves characteristic symptoms (cough, coloration of sputum, fever, involvement of the throat). In order to select among various possible remedies, it is important to know if the lung disease is hot or cold in nature, and to know the disturbances of the three humors that form the background to the disease in an individual patient. The humors may either be insufficient and require supplementation (invigoration) or they may be excessive and require pacification. In an attempt to correlate Tibetan and Chinese concepts, it has been suggested (3) that long corresponds roughly to concepts of qi and wind, chiba corresponds to fire or gallbladder, and peigen corresponds to moisture, the earth element, and phlegm.

The modern Materia Medica of Tibet is derived from the book Jingzhu Bencao (The Pearl Herbs), published in 1835 by Dumar Danzhenpengcuo (7). This text has been compared to the famous Chinese herbal Bencao Gangmu. Its format includes two sections, one being in the style of the Buddhist sutra with praise of the medicines, and the other being a detailed classification of each substance, giving the material's origin, environmental conditions where it is found, quality, parts used, and properties. The text included 2,294 materials, of which 1,006 are of plant origin, 448 of animal origin, and 840 minerals. The heavier reliance on minerals and animals than on plants-compared to other traditional medical traditions-can readily be understood for a country at such high altitude that is very rocky and supports only small areas of plant growth over much of the terrain.

About one-third of the medicinal materials used in Tibetan formulas are unique to the Tibetan region (including the Himalayan area in bordering countries), while the other two-thirds of the materials are obtained from India and China. The Tibetan population that had access to the medicines was relatively small until this century, so the total amount of pills produced were correspondingly small. Bringing herbs from India and China to Tibet has always been difficult and has limited the production of herbal formulas. Today, it is relatively easy to get Chinese herbs into Tibet, and China cultivates most of the herbs indigenous to India that might be needed.

Although Tibetan herbal medicine includes the use of decoctions and powders, for the most part, Tibetan doctors utilize pills that are usually made from a large number of herbs (typically 8-25 ingredients). Pills have the advantage of being easy to use and they can be prepared in advance at a medical facility where all the ingredients are gathered together. Due to the vast distances, rough terrain, and limited development of Tibet, it was not possible to have the broad range of ingredients available to individual doctors who might compound formulas for decoction, as was often done in China. Instead, a relatively small variety of pills prepared at central facilities would be carried by the doctors to their patients. For many doctors, a collection of about two dozen principal formulas would have to suffice. In Lhasa, where there was a centralized population, the doctors have had access to about 200 kinds of pills.

The traditional Tibetan pills were often large and hard and time consuming to prepare. Dr. Lobsang Dolma Khangkar (8) explained that each herb had to first be processed meticulously and then had to be mixed and preserved properly:

If we are using cardamom, we have to use only the inside, because the outside has no value and then we have to peel each one. There is no machine that can do this, it has to be done by hand. After treating each of the ingredients like this, we will mix maybe three, thirteen, or twenty-five ingredients to make one pill. The first step is to mix all of these ingredients together. If this is not done properly, then each of these ingredients will maintain their own potency without combining with the rest. So, first they have to be completely mixed and this takes a long time of grinding and mixing. After that, it has to be left at rest for a whole day. After the rest, the person who is preparing the medicines has to clean his hands and then begin again with mixing and grinding that medicine. After this, we make the pills. The pills can be made with machines....Then the pills are put into a very long bag made of cotton cloth. Two men hold the cloth from each side and move it back and forth so that the pills roll from one side to the other. This is done for a whole day. This last procedure is what is responsible for making Tibetan medicine pills so hard. This procedure takes out all the air that is still in the pills. If air remains in the pill, then it is prone to bacteria getting in, and for the pills to go bad.

In order to make Tibetan medicines available to more people, modern factories have worked out new methods of blending, grinding, and making the pills, as well as producing other forms of the finished materials to make them easier to consume. There are regulations on the production of pills made in Tibet, with 97 different formulas formally recognized; of these 25 are covered under State medical insurance.

Many of the formulations that are still in use were established many centuries ago. The principles of herbal combining to yield a traditional formula are not clearly defined in the Tibetan system. There are complex methods of analyzing the qualities of medicinal materials: 6 tastes, 8 properties, and 17 effects (see Table 2), but the precise organizational principles for compounding numerous ingredients into the formulas is lost to history.

Table 2: Classification of herbal properties in Tibetan medicine (4).

Grouping	Characteristics
Six tastes	sweet (e.g., bamboo, grapes, saffron; pacifies long and chiba; increases peigen); sour (e.g., pomegranate, hippophae, crataegus; pacifies long and peigen; increases chiba); salty (e.g., salt and several minerals; pacifies long and peigen; increases chihba); bitter (e.g., gentiana, aconite, berberis; pacifies chiba, increases long and peigen); acrid (e.g., piper, ginger, garlic; pacifieslong and peigen, increases chiba); and astringent (e.g., sandalwood, terminalia, aquilegia; pacifies peigen, increases long and peigen)
Eight properties	heavy, smooth (these two treat combat long); cool, soft (these two combat chiba); light,rough, acrid, and sharp (these four combat peigen). To increase long, rough and cool medicines are used; to increase chiba, warm, sharp, and smooth medicines are used; to increasepeigen, heavy, smooth, cool, and soft medicines are used.
Seventeen effects	cold, hot, warm, cool, thick, thin, moist, rough, light, heavy, steady, motive, blunt, sharp,tender, dry, and soft. Disease is treated by the opposing effect; a hot disease by a cold effect, stagnant diseases by a motive effect, an accumulation by a sharp effect, a moist condition by a dry effect, etc. Long disorders tend to be dry, light, cool, mobile, subtle, and hard; chiba disorders tend to be oily, sharp, malodorous, purging, hot, flowing, and light; peigen disorders tend to be cold, heavy, blunt, smooth, oily, stable, and sticky.

In general, Tibetan remedies emphasize the use of spicy (acrid), aromatic, and warming herbs. The climate has a substantial influence on these choices: the high altitude of Tibet means that cold and windy conditions prevail. The warm, spicy, aromatic herbs help to compensate for this condition. Ayurvedic medicine relies heavily on spicy herbs for stimulating the digestive system functions, which is understood to be the key to health. Thus, among the commonly used Tibetan herbs are those derived mainly from the Ayurvedic system, such as the peppers, cumins, cardamom, clove, ginger, and other hot spices, complemented by the local aromatics such as saussurea and musk. Also, the Tibetan system emphasizes astringent herbs, possibly representing an attempt to conserve body fluids and alleviate any inflammation of the mucous membranes. The "king" herb of Tibetan medicine is the chebulic myrobalan (Terminalia chebula), which is an astringent herb, but is said to possess all the tastes (different parts of the fruit have different tastes), properties, and effects. Despite this emphasis on herbs with properties that are generally needed for the Tibetan climate, cooling and bitter herbs are often required to treat the disease manifestation, as inflammatory processes finally result if the pathogenic influences are not conquered or expelled.

Tibetan medicines are today prescribed by several thousand Tibetan doctors that have been trained in recent decades in Tibet, Qinghai, Gansu, and Sichuan. Ten cities in China have set-up Tibetan medical facilities (teaching and clinical units), including a large one in Lhasa and an even larger one in Beijing. There are also 57 hospitals of Tibetan medicine throughout China and 30 Tibetan medicine factories. The refugee community in Dharamsala has a medical college and there are several small manufacturers of Tibetan herb products throughout India and Nepal.

Tibetan medicine, like other traditional medical systems, is highly complex, and represents a comprehensive effort at dealing with health and disease. Some modern pharmacologists, herb enthusiasts, and product developers have focused on certain herbs that can be used in a general way, thus making them accessible to the world population without having to transmit the medical system itself. Two such herbs are rhodiola and hippophae.

RHODIOLA

Rhodiola is mainly found on rocky slopes at 3,500-5,000 meters (11,000-16,000 feet). The Chinese name hongjingtian refers to the red flowers of the stonecrop-the common name given in the West (hong = red, jingtian = view of heaven or heavenly view, probably referring to its growth on high altitude stone faces). This herb is in the family Crassulaceae, which yields a small number of genera of medicinal plants, mainly rhodiola and sedum. The root of the plant is used in the current medicinal applications. The outer peel of the root has a light golden color, so that the herb is sometimes referred to as golden root; the inside of the root is pink. There are several species of rhodiola collected, with the main ones being Rhodiola rosea and Rhodiola kirilowii; others are being investigated, including R. eoccinca, R. crentinii, R. krifida, and R. atropurpurea.

Tibetan rhodiola has become so popular in recent years that, according to a survey by the Tibet Institute of Biology, 10,000 tons of it are collected annually and six factories make products that have rhodiola as a key ingredient (or sole ingredient). Rather than relying on its traditional applications, rhodiola is presented as a health product of general benefit, described as an adaptogen.

The concept of an adaptogen has been attributed to the Russian pharmacologist N.V. Lazarev from his work during the period 1958-1959. Basically, he defined an adaptogen as a substance that has no toxicity or side effects at normal dosages and that non-specifically increases the resistance to disease and to physical and chemical stresses. Put another way, use of an adaptogenic herb will safely assist the body in maintaining its homeostatic balance and recovering from the effects of adverse weather, emotions, and disease influences. The leading advocates of developing natural resources as adaptogens were the Russian researchers I.I. Brekhman and I.V. Dardymov. They reviewed the status of research into adaptogenic agents in the seminal article "New substances of plant origin which increase non-specific resistance," published in 1969 (9).

The leading adaptogens identified at that time were eleutherococcus (Eleutherococcus senticosus), ginseng (Panax ginseng), rhaponticum (Rhaponticum carthamoides), and rhodiola (Rhodiola rosea). The Russians went on to develop eleutherococcus (usually simplified to eleuthero) as a major health product, used locally and exported to Western countries. The Chinese developed their own resources of this herb (which grows in abundance in northeast China), eventually becoming the world's main supplier. Ginseng had long been used in the Orient and revered as a health tonic; the Koreans developed the world market for this herb, promoting research into its pharmacology and clinical effects and cultivating huge quantities of the roots. China and the U.S. (providing an American species, P. quinquefolium) eventually became major suppliers as well. Rhaponticum is still being investigated in China and Russia; it is mainly studied in relation to antioxidant activity, but is also reputed to improve circulation and mental acuity. Rhodiola has been researched in Russia and China and has become a common health food product which has been promoted in the West in recent years. The development of rhodiola as an adaptogen represents one aspect of Chinese efforts to promote Tibetan medicine (as one of the Chinese indigenous medical systems).

As an adaptogen, rhodiola is considered to be like ginseng (renshen) and eleuthero (ciwujia) in terms of effects and applications; adaptogens from numerous different plant species have the same basic actions (25). Modern promoters of rhodiola have dubbed the herb "Tibetan ginseng." Though some herbalists object to this off hand use of the term ginseng (similarly, ashwaganda is called Indian ginseng, eleuthero is called Siberian ginseng or eleuthero ginseng), it may well represent the current intended use of the herb for consumers who are already familiar with ginseng as a general health tonic. One of the adaptogenic applications of rhodiola that has received considerable research attention recently is for aiding adaptation to high altitudes, thus, as a preventive and treatment for mountain sickness (23, 24, 25).

Information about traditional uses of rhodiola remains somewhat limited; it was used for treatment of dysentery, back pain, lung inflammation with expectoration of bloody mucus, painful and irregular menstruation, leukorrhea, and traumatic injuries (25). Based on the indications for use, rhodiola appears to be cooling and detoxifying, and vitalizes blood circulation.

By including the related genus Sedum in the discussion, one can get a better understanding of the herb since the two are nearly interchangeable. Some of the Chinese and Tibetan species of Sedum go by the name jingtian that is used for rhodiola:Sedum erythrostictum, is the main species known by this name. Sedum was described (10) during the Song Dynasty as "being sweet in taste, cold and slightly toxic in nature, the plant crawls on stones of the southern side of a mountain and it is tender and lustrous...." Sedum erythrostictum was described in the Bencao Gangmu of the Ming Dynasty (11) as having the reputation of protecting from fire. It was grown in pots on house tops to protect the house (i.e., protecting thatched roofs), and the herb would be used to treat people burned by fire or scalded by hot water, or who suffered from the burning sensation of insect bites. It is used topically much the way we currently use Aloe vera, which has a similar mucilaginous quality to the leaves. Some Chinese species of Sedum are administered as hemostatics; this especially applies to Sedum aizoon, which is known as tushanqi, being named the same as the famous hemostatic notoginseng (sanqi; tu means local variety). The traditional Tibetan use of both sedum and rhodiola is for lung diseases, specifically, lung heat (generally meaning a lung infection). In fact, the two herbs are combined in a simple decoction with licorice and lacca (zicaorong) for treating lung heat (12).

In recent years, sedum extracts have been shown to protect the liver from damage due to chemicals and the herb has been used in treatment of viral hepatitis. The most commonly used species for this purpose in China is Sedum sarmentosum(chuipencao). The whole plant is applied in cases of damp-heat and to counteract toxic-heat (13). A tablet made from this herb, containing 8 mg of the glycoside component was used to treat chronic hepatitis at a dosage of 9 tablets per day (72 mg of glycoside). Its main effect was to lower transaminase levels within two weeks (23). In addition to tablets, rhodiola is produced in the form of a wine, oral liquid (that includes other Chinese herbs), capsule, and tea bag.

Much of the research on rhodiola has been carried out in Lhasa. The Tibet Institute of High Altitude Biology has done research with rhodiola and confirmed that it is of benefit as an adaptogen, including use against mountain sickness. A capsule with rhodiola and hippophae (plus lycium fruit) is produced by one factory and is promoted as a treatment for altitude sickness. In Chengdu, the West China University of Medical Sciences undertook a review of the research on this herb, which was published in 1988, evaluating 90 reports on the botany, chemistry, pharmacology, toxicology, and clinical effects. They reported that hongjingtian was obtained from the root and rhizome of several species of Rhodiola, with studies conducted on the constituents of 20 of China's 70 species. The active constituents include numerous flavonoids (such as quercetin, rutin, and kaempferol), condensed flavonoids (polyphenols, mainly gallic acid and epigallocatechin), cyanoglycosides (which have histamine-inhibiting activity), and salidroside, which is deemed one of the main active constituents of interest by virtually all authorities. In concentrated extracts of rhodiola, salidroside makes up about 1-2% of the content. Salidroside is comprised of tyrosol linked to glucose; tyrosol is one of the major flavors and aroma ingredients of the olive which confers notable antioxidant activity to olive oil. Rhodiola also contains sterols, notably daucosterol and sitosterol.

According to mouse experiments conducted in China, rhodiola extract has a central stimulant action and increases the tolerance to anoxia, fatigue, microwave irradiation, poisoning by strychnine, tetanin, and other toxins; it regulates brain functions, leukocyte count, blood glucose, and promotes protein hydrolysis; and it enhances the functions of the thyroid gland, adrenals, and ovaries. According to the reports from recent clinical research efforts conducted mainly in Russia, rhodiola may prove helpful in treating depression and its use may result in improvements in mental performance and alleviation of fatigue. All reports suggest that the toxicity of rhodiola is very low and that there are no significant side effects (24). As can be seen, the modern research (both laboratory and clinical) is aimed at the potential of rhodiola as an adaptogen rather than its traditional function as a treatment for lung diseases.

HIPPOPHAE

Hippophae (Chinese: shaji, literally: sand thorn, the English common name is sea buckthorn) is a member of the Elaeagnaceae family, a family that has very few medicinal herbs, mainly Hippophae, Eleaegnus, and Elaeocarpus. There is one dominant species of Hippophae used in China and Russia: H. rhamnoides. Hippophae is usually found at an altitude of 1,200-2,000 meters (4,000-6,500 feet) in cold climates, though it can grow at both higher and lower altitudes, in sandy soil. It has recently been planted in temperate zones worldwide to prevent soil erosion and to serve as a source of food and medicine (15). Hippophae has been developed into a major resource for China, with numerous organizations devoted to the project, including the following three that have sponsored a journal, Hippophae, that has been published (in Chinese) since 1988:

• China Research and Training Centre on Sea Buckthorn
• Sea Buckthorn Office of the Yellow River Water Commission
• Shaanxi Sea Buckthorn Development Office

The fruit is the main part used as food and medicine. It is one of the richest sources of vitamin C, with about 6 mg/gram in the fruit and about 5 mg per ml of fruit juice (16), so the juice has been made into a health beverage on that basis. Medicinally, the flavonoids of the fruit and the oil of the seed are deemed the main active constituents. The flavonoid are present in the range of 1-10 mg/gram of fresh fruit. Injected into laboratory animals (17) at a dose in the range of 2-5 mg/kg, they improve non-specific immunity (one of the actions of an adaptogen). In addition, the flavonoids promote bone marrow production of red blood cells, and reduce allergy reactions (26). Both the vitamin C and flavonoids are thought to help protect against carcinogenesis when ingesting food contaminated with carcinogens (18). In a double-blind clinical trial (19) 128 patients with ischemic heart disease were given total flavonoids of hippophae at 10 mg each time, three times daily, for 6 weeks. The patients had a decrease in cholesterol level and improved cardiac function; also they had less angina than those receiving the control drug isosorbide dinitrate. No harmful effect of hippophae flavonoids was noted in renal functions or hepatic functions.

Hippophae seed oil is rich in vitamin E and essential fatty acids, including several that inhibit inflammation. One ingredient, palmitoleic acid, is a component of skin that is considered very valuable in treating burns and healing wounds. The oil is used alone or in various preparations topically applied for a wide range of skin ailments, including burns, scalds, ulcerations, infections, and as an aid in promoting regeneration of tissues and protectant in sunblocks (hippophae oil itself has UV-blocking activity). The seed oil and the bark of the plant have been found to possess anti-tumor effects in preliminary laboratory studies (15). For internal use, the oil is put into soft gelatin capsules, which are used for treating gastric and duodenal ulcers, liver inflammation, and skin disorders, such as atopic dermatitis. Both the seed oil and flavonoids have been used in laboratory animal studies aimed at revealing adaptogenic properties, such as protection against harmful effects of radiation, cold, fatigue from excessive activity demands, and oxygen deficits (26).

In the Indian Materia Medica, hippophae is mentioned briefly, the fruit being used for lung diseases (20). In Thousand Formulas and Thousand Herbs of Traditional Chinese Medicine (21), hippophae fruit is described as sour, astringent, and warm in nature, and used to eliminate phlegm, stop cough, improve digestion and remove accumulations, and to move blood and remove blood stasis. Examples of uses are:

cough with profuse sputum;

abdominal pain due to accumulation of food and indigestion;

amenorrhea due to blood stasis; and

swelling and stagnation in trauma.

These functions and applications are similar to those described in Tibetan medicine, where hippophae is used for lung-heat disorders and stomach-intestine disorders with bleeding. However, the emphasis of modern research and product development is on its nutritional and general health benefits rather than the traditional medical applications. Some simple formulas with more specific applications have been developed recently; for example, there is a liquid preparation of hippophae, carthamus, and licorice intended for use in treatment coronary heart disease and sequelae of heart attack and stroke, based on improving blood circulation.

TRADITIONAL TIBETAN FORMULAS WITH RHODIOLA AND HIPPOPHAE

T.J. Tsarong outlined 175 important Tibetan formulas in his Handbook of Traditional Tibetan Drugs (22). In the next two tables, formulas with rhodiola and/or hippophae are mentioned; other herbs commonly included in these formulas are: sandalwood, saussurea, carthamus, bamboo, terminalia, licorice; geranium, emblica, gentiana, inula, and grapes (see also Tables 5 & 6). Of these, all are used in Chinese medicine except emblica and grapes, both used extensively in Indian medicine. Tsarong included 12 formulas that utilize rhodiola, all of which are used for lung disorders (see Tables 3 & 4).

Table 3: Traditional Tibetan formulas with rhodiola. The number of herbs in the formula is indicated in the formula name or added in parenthesis after the formula name.

Formula	Main Uses in Tibetan Tradition
Blue Garuda Bird (9)	acute inflammation of the lungs and throat, as well as fever and dysentery
Bamboo 9	coughing, infections, fever and diarrhea (this formula is usually used for pediatric cases)
Pulmonary Medicine of Death Healing Nectar (15)	acute and chronic cough and sputum streaked with pus (formula includes hippophae)
Eliminator of Lung Inflammation (13)	inflammation of the lungs, cough, chest congestion
Eliminator of All Lung Imbalances (11)	chronic cough with expectoration of phlegm, and fever
Blood Gentian Pill (18)	antipyretic and expectorant for inflammation of the lungs and cough
Gentiana 15	cough, shortness of breath, hoarseness, blood in sputum
Sandalwood 8	inflammation of the lungs, blood and pus in the sputum
Sandalwood 9 (add cinnamon to above)	inflammation of the lungs, pus in the sputum, fever
Yuthog's Bamboo 25	pain and inflammation of the lungs, blood in the sputum, inflammation of the respiratory tract (formula includes hippophae)
Copper Calcine 25	all types of lung inflammation; difficulty breathing, coughing

A representative rhodiola formula is the Eliminator of Lung Inflammation. Its ingredients, in addition to rhodiola, are bamboo, carthamus, clove, white and red sandalwoods, geranium, terminalia, aconite, myrrh, musk, saussurea, and cinnabar (vermilion). Though this is considered a valuable remedy by the Tibetans, it is not a suitable preparation for use in the West, as it contains raw aconite (a toxic substance, though used in small amounts), musk (obtained from the musk deer, an endangered species), saussurea (collected from wild sources; it is an endangered species), and cinnabar (contains mercury). The main characteristic of the formula is that it is very fragrant, mainly due to the clove, saussurea, sandalwood, geranium, myrrh, and musk; it has a bitter, acrid, astringent taste (sandalwood, saussurea, and terminalia are the main astringents); and the overall action is cooling. When interpreting its effects and uses, it must be understood that the classification of the herbs are often different in the Tibetan system compared to the Chinese system. As examples, both carthamus and sandalwood are deemed warming in the Chinese system but cooling in the Tibetan system; sandalwood is used to regulate qi in the Chinese system, but is applied as an astringent in the Tibetan system; carthamus is used in the Chinese system to vitalize blood circulation, but it is used to stop bleeding and nourish blood in the Tibetan system. In this formulation, phlegm-fire (chiba; bile) is controlled by ingredients such as white sandalwood, carthamus, and bamboo, while phlegm-damp (peigen) is controlled by aconite and penetrated by the fragrant herbs. This formula is suited to treating lung diseases in which there is considerable difficulty breathing due to sticky phlegm.

Two of the formulas in Table 3 include hippophae; there are also 6 formulas with hippophae that do not include rhodiola (see Table 4). Most of these are also used for lung diseases and phlegm accumulation problems, but hippophae is also included in formulas for treating blood-heat disorders (these usually manifest as bleeding disorders).

Table 4: Traditional Tibetan formulas with hippophae (see Table 3 for two additional formulas).

Formula	Main Uses in Tibetan Tradition
Blue Poppy 8	to control excess blood from the liver into the stomach lining (hematemesis)
Balancing Comforter (17)	for all types of phlegm accumulation with lack of stomach heat (symptoms of anorexia, indigestion, stomach tumors), discomfort of stomach and liver, hematamesis, lymphatic disorders, skin disorders (including itching)
Reed of Comfort (17)	for phlegm accumulation, pain along with emesis of sour and watery vomitus, inflammation of the stomach, indigestion, hematemesis, irregular menstruation, painful menstruation
White Nectar Pill (5)	to promote digestion (increases stomach fire), disintegrates stomach tumors and mucus, removes phlegm accumulations, acts like a nectar for colic and cold parasites
Amla 25	removes bad blood, reduces blood pressure, treats dryness of throat and mouth, and redness of eyes
Hippophae 5	for chronic inflammation of the lungs, with discharge of pus and blood; it suppresses coughing and treats hidden fever

A representative formula with hippophae is Hippophae 5; which also contains licorice, grape, emblica, and saussurea. This is a formula compatible with Western requirements in terms of safety of the herbal materials, though the main Tibetan source for saussurea, S. lappa, is on the endangered species list (cultivated sources and a related herb used as a common substitute,Vladimiria souliei, can resolve this problem). Hippophae 5 has the characteristic of being sweet (mainly due to licorice and grape) and sour (mainly due to the hippophae and emblica) with only modest fragrance (mainly contributed by saussurea) and a cooling quality (not compensated by spicy warm herbs). Sweet herbs are considered useful for controlling chiba (phlegm-fire), while peigen (phlegm) is controlled both by sour herbs and those that are coarse (hippophae). This formula is given for lung disorders with accompanying fever, and with free flowing mucus. Comparing the two formulas-Eliminator of Lung Inflammation and Hippophae 5-the former is more suited for lung disorders dominated by stuffiness and the latter is more suited for lung problems associated with fever and infection (which can lead to discharge of copious mucus including pus and blood), while both are good for the most general category of lung inflammation.

TIBETAN HERBS COMMONLY COMBINED WITH RHODIOLA AND HIPPOPHAE

In traditional Tibetan formulas, rhodiola and hippophae are combined in complex formulas, as depicted above, for treatment of lung diseases. Table 5 presents these two key herbs along with several of the other herbs commonly included in the formulas. Table 6 presents information about the inclusion of these herbs in the same formulas that are listed in Table 3 and Table 4. Other herbs, that are in some of these formulas but mentioned less frequently, include geranium, emblica, gentiana, inula, and grapes.

Table 5: Tibetan herbs commonly used in formulas for treating lung diseases. The Tibetan name is presented according to the transliteration system used in the Quintessence Tantras of Tibetan Medicine (6), and the Indian name is presented according to Indian Materia Medica (20).

Herb (common name); (botanical name)	Tibetan name; Part used	Sanskrit name; Bengal name	Chinese name; Category
Bamboo resin Bambusa sp. or Phyllostachys sp.	chu-gang resin	vansa bans	tianzhuhuang resolve phlegm
Carthamus* Carthamus tinctorius	gur-kum flower	kamalottera; kusumba kajireh	honghua vitalize blood
Hippophae Hippophae rhamnoides	star-bu fruit	dhurchuk (Hindi) dhurchuk	shaji resolve phlegm
Licorice Glycyrrhiza glabra or G. uralensis	shing-mngar root	madhuka, yashti-madhu yashto-madhu	gancao tonify qi
Rhodiola Rhodiola sp.	sro-lo whole plant	Not included	hongjingtian tonify qi
Sandalwood (red) Pterocarpus santalinus	tsan-dan dmar-po heart wood	rakta chandana pit-sal	hongtanxiang regulate qi
Sandalwood (white) Santalum alba	tsan-dan dkar-po heart wood	chandanam; srigandha sada-chandan	tanxiang regulate qi
Saussurea Saussurea lappa	ru-rta root	puskara, kushta kashmirjagada pachak	guangmuxiang regulate qi
Terminalia Terminalia chebula	a-ru-ra fruit	haritaki, abhaya, pathya, etc. hirda	hezi astringent

*common substitute for saffron, the originally-specified ingredient

Table 6: The inclusion of common Tibetan herbs in the formulas with rhodiola and/or hippophae.

Formula	Rhodiola	Hippophae	Sandalwood	Saussurea	Carthamus	Bamboo	Terminalia	Licorice
Blue Garuda Bird	•						•
Bamboo 9	•		•		•	•
Pulmonary Medicine of Death Healing Nectar	•	•	•	•	•	•		•
Eliminator of Lung Inflammation	•		•	•	•	•	•
Eliminator of All Lung Imbalances	•		•				•
Blood Gentiana Pill	•		•	•		•	•	•
Gentiana 15	•			•		•	•	•
Sandalwood 8 & 9	•		•		•	•		•
Yuthog's Bamboo 25	•	•	•	•	•	•	•	•
Copper Calcine 25	•		•		•	•		•
Blue Poppy 8		•			•	•		•
Balancing Comforter		•	•		•	•
Reed of Comfort		•		•	•	•	•
White Nectar Pill		•
Amla 25		•	•	•	•		•
Hippophae 5		•		•				•

SUMMARY

Tibetan medicine is a derivative of the Indian and Chinese medical systems, with a dominant Buddhist influence, especially that carried over as a translation and revision of the Four Medical Tantras during the 8th Century A.D. Tibetan herbal medicine represents a complex system that involves a large number of medicinal substances, about a third of which are high altitude plants (especially those that grow in dry sandy or rocky areas). The classical Tibetan Materia Medica was developed in the 19th Century, and remains the primary source of pre-scientific herb information. Rhodiola and hippophae are examples of herbs frequently included in traditional Tibetan formulas, especially for treatment of lung diseases. They have been developed into health products apart from the Tibetan tradition, with rhodiola promoted as an adaptogenic agent, and hippophae as a nutritious beverage, a treatment for circulatory disorders, and as a skin protectant and healer.

Tibetan medicine has been promoted and further developed in recent years both by China and by Tibetan refugee physicians. The main Tibetan texts are being translated into other languages (mainly Chinese and English) and scholars are investigating archeological sites and lost texts. The Tibetan medical system is experiencing a revival as the growing world population seeks solutions for difficult medical problems for which the modern system lacks adequate remedies. However, there are not enough trained physicians to support the demand. It is likely that more of the individual Tibetan herbs will be taken from this tradition and developed as health products as further research is undertaken. These general health products may stimulate interest in the preservation and further development of this unique medical tradition.