In Tibetan medicine, the pressure of three fingers on both wrists of a patient can reveal the health status of twelve internal organs. A doctor, pressing the index finger of the left hand on a woman's radial artery, can determine whether the heart and small intestine are in balance and therefore healthy.

Pulse diagnosis is one of the methods used in Tibetan medicine, alongside visual examination of the tongue, urine analysis, and an in-depth consultation with the patient. In this system of care — whose foundational texts are traced back to the eighth century — the most widely used remedies are based on herbs and minerals. They are produced in Mcleod Ganj, in Himachal Pradesh, in northern India, the current residence of the fifteenth Dalai Lama Tenzin Gyatso and the seat of the Tibetan government in exile since 1959.

We entered the museum and pharmacy laboratory of the Men-Tsee-Khang, the institute of Tibetan medicine and astrology, to learn more about this medical tradition and understand how it has not only managed to adapt to the profound changes the Tibetan people have undergone, but also to spread, despite an exile now nearly seventy years old.

The exile that introduced Tibetan culture to the world

In October 1950, the Chinese People's Liberation Army entered Tibet by crossing the Jinsha River. After years of abuses and failed political negotiations, in March 1959 the Tibetan people rose up against the invasion with the meagre means at their disposal.

The uprising was brutally suppressed by the Chinese army, causing the deaths of 87,000 Tibetans within a few months.

Following the Dalai Lama's flight to India, thousands of Tibetans followed him, choosing to undertake the same gruelling and dangerous journey on foot across the Himalayan mountain range.

The Indian government of Jawaharlal Nehru allowed the young Tenzin Gyatso and the first community of refugees to settle in Mcleod Ganj, a corner of the world far from everything, where there were not even roads.

As Jetsun Pema, the Dalai Lama's sister, recounts in her biography "Amala" written by Piero Verni, it was the Tibetan refugees themselves who built the roads of the region, in labour camps organised by the Indian government. It was the only means of earning a living, the only source of minimal income — one that also kept busy the women who carried stones, dug, or cooked on the worksites.

Fifty per cent of our health is in our own hands, because it depends on our behaviour and our diet.

Jetsun Pema

With the spread of Tibetan Buddhism across the world, this once-remote area on the slopes of the Dhauladhar mountain range has attracted people from every corner of the globe. Today, the roads leading there remain the same — narrow and poorly maintained — but shops, restaurants and guest houses have multiplied, and the small central square, once used solely as a turning point for the few buses that passed through, is now a blaze of neon signs, loud music and shops.

What has remained intact, however, is the determination of Tibetans to preserve every aspect of their culture, and traditional medicine is one of its most fundamental expressions.

We seek out and cultivate our raw materials in unspoilt places, as Tibet was before the Chinese invasion.

Medicinal herbs are gathered at high altitude in the Himalayan regions

To reach the Men Tsee Khang, you need to make your way to the lower part of town. Today, the institute of Tibetan medicine and astrology, founded in 1961 — just two years after the Tibetans' arrival in India — employs around 250 members of staff.

"We produce almost 180 types of remedies, which are distributed across 59 centres throughout India. We do not have permission to export abroad, but many people — including Westerners — come here to have a treatment prescribed." The speaker is Dr Dorjee Tsering, of the pharmacy department. "Each individual remedy can contain between 25 and one hundred types of herbs and plants, which are gathered predominantly at high altitude in the Himalayan regions, such as Ladakh. We seek out and cultivate our raw materials in unspoilt places, as Tibet was before the Chinese invasion."

The foundations of Tibetan medicine

Its Tibetan name is Sowa Rigpa, meaning "the science of healing", and it is founded on four texts — the tantras — known as rGyud bzhi, from which various commentaries have been derived. A copy of the Gyud bzhi is kept in the Men Tsee Khang museum, where we meet Dr Kalsang Youdon, a young woman with a soft voice and graceful manner.

"Fifty per cent of our health is in our own hands, because it depends on our behaviour and diet," she explains. "If a patient is unwilling to change their habits, taking the remedies can help, but it won't be enough on its own."

Dr Youdon trained at the Men-Tsee-Khang, which admits around fifteen students each year following an entrance examination. "The course lasts six years, plus an additional eight months of supplementary classes. Training includes an intensive internship period during which students work alongside more experienced doctors. Academic study, meanwhile, is based on memorising the texts and their commentaries."

"The museum displays eighty thangka, the traditional paintings on cloth that illustrate the content of the four tantras, precisely to aid understanding," adds Khelsang Choedon, the museum's curator, who welcomes us with an open smile and the quiet authority of someone who knows the institution extremely well, having worked there for over 25 years. "Seventy-nine of them relate to the 156 chapters of the foundational text, including thangka dedicated to embryology and the various stages of foetal development and childbirth. One thangka illustrates the external therapeutic instruments, such as cupping vessels, the small hammer and the golden needle."

Seen through the display case, the golden needle looks rather intimidating — nothing like the fine needles used in modern acupuncture.

Khelsang Choedon apparently notices our quizzical look and comments with a smile: "Personally, I've been treating my migraines for years with the golden needle technique, which involves heating the needle and inserting it into the crown of the head. It's remarkably effective."

Health corresponds to a state of balance among the five elements — of which we and the entire universe are composed — and the three humours, that is, the three types of energy that flow within the body.

Wind, bile and phlegm: the three humours of Tibetan medicine

The museum also displays some of the remedies produced within the institute. The most common are pills ranging in colour from brown to reddish, in two sizes depending on the prescribed dosage.

"According to Tibetan medicine," Dr Kalsang Youdon continues, "health corresponds to a state of balance among the five elements — of which we and the entire universe are composed — and the three humours, that is, the three types of energy that flow within the body. The five elements are earth, air, water, fire and space. The three humours are wind, rLung; bile, mKhris-pa; and phlegm, Bad-kan. When, due to poor habits or external influences — such as weather conditions — this balance is disrupted, one humour prevails over the others and causes illness. The physician's responsibility is therefore to investigate the nature of the ailment and explore its underlying causes. The aim is to restore a state of balance."

The precious pills and the process for eliminating the toxicity of minerals

Wrapped individually in coloured cloth are the precious pills, rinchen rilbu in Tibetan. There are eight types, prescribed, for example, to treat inflammation, the effects of poisoning and neurological conditions.

Their production is anything but straightforward, as Dr Dorjee Tsering explains: "In addition to herbs, the precious pills also contain minerals such as gold, iron, coral, turquoise and even mercury. The process for eliminating the toxicity of the minerals is extremely complex. It is a highly delicate phase that we carry out with the utmost rigour. Each mineral undergoes a long and specific procedure, which may involve various types of heating — such as prolonged boiling, immersion in particular solutions, and in some cases the minerals are also fried. These pills are produced at specific times of year, and production is currently paused. Tibetan medicine is also closely connected to astral energies," adds Dorjee Tsering. "We therefore plan the production of the various medicines according to the guidance of the astrology department. Each day, following mathematical and astrological calculations, we are told which formulations are advisable to produce and which are not recommended."

All medicines that leave the Men-Tsee-Khang have received the power of blessings. This aspect promotes and enhances their efficacy for patients.

The blessing of Tibetan medicines

In Buddhist thought, all things are interdependent, just as the body, the mind and the subtle and gross energies that flow through it are all interconnected.

In this vision, the therapeutic principles of herbs and minerals are enhanced by blessing rituals and prayers. "Every five years, a ceremony is held to bless the medicines," Dorjee Tsering explains. "Afterwards, a small portion of the blessed remedies is used to produce new ones. In this way, all the medicines that leave the Men-Tsee-Khang have received the power of the blessings. This aspect promotes and improves their effectiveness on patients."

The effects of exile and climate change on traditional medicine

"The texts describe around 3,000 herbs and plants, many of which have long since disappeared and are now known only by name," Dorjee Tsering continues. "At the Men-Tsee-Khang we use around 200 of them. We have cultivations in Ladakh, but being now far from Tibetan soil, several herbs have become difficult to source. To make up for this, we have been forced to replace them with others that have similar effects."

Water pollution is also a problem, and standard practice requires that everything collected at high altitude be washed with water from the same location.

Ancient Tibetan medicine survives in India, despite exile

Well-being — di Estella Beltramelli

At the institute of Tibetan medicine and astrology in northern India, Tibetan refugees still produce their natural remedies