Wind, Bile and Phlegm

Amchi Nyima Samphel was a child when he left his home in Nepal to begin studying the Bon tradition in India.  Bon is a religious tradition dating back to at least the 14th century, observed by an estimated 10% of the population of Tibet.  After years of study with monks and ancient texts, Nyima Samphel returned to his community in northern Nepal where he has been working on a small family farm and practicing traditional Tibetan medicine as an amchi, Tibetan for “doctor,” for nearly 30 years.

Amchi Nyima Samphel

Amchi Nyima Samphel has been practicing traditional Tibetan medicine in Nepal for nearly thirty years.

Coming from a long line of healers going back nine generations, Amchi Nyima’s practice is steeped in deep traditional knowledge.  His approach is tied to religious structure and infused with ritual significance, and involves observing the appearance, pulses, and urine of his patients.  He takes a holistic approach with the goal of balancing the three humors of wind, bile and phlegm.  Once a health issue has been identified, Amchi Nyima may provide his patients with traditional medicines he and his family prepare themselves.

However, the generations-old practice is now up against new obstacles.  Climate change, a growing economic demand for medicinal plants, and more patients to treat mean that Amchi Nyima and other traditional healers must find ways to adapt. 

Amchi Nyima recently came to Yale to give a talk titled “Wind, Bile and Phlegm” as part of the Yale Himalaya Initiative. SAGE Magazine’s David Gonzalez sat down with Amchi Nyima to learn more about his practice and the challenges he faces as a traditional healer in the 21st century.  Sumana Serchan, a Yale master’s student from Nepal, translated.

SAGE Magazine: When did you first think about becoming a healer?

Amchi Nyima: I was about 8 or 9 years old when I learned about it.  My father and grandfather told me about the practice I would end up doing.

My father told me, “Your grandfather did not get to study much about this medicine, and neither did I.  So it would be a great opportunity for you to preserve this practice.   For that reason, we would like to send you to India to learn about the Bon tradition.” 

My father learned from a great Tibetan Bon monk who had come to our village.  My grandfather, too.  I’m the first in my family to go to India and learn.

I was sent to a general school in India, not one that specialized in medical practices.  The instructor who knew about medicinal practices was very busy, so I could learn little from him.  I studied there until class five, and after that I stayed for two years.  I cleaned the monastery, looked after the children, and took care of some other things.

While I was there I learned some medicine practices from monks called Rinpoche.  They are reincarnated, like lamas, but within monks we have different hierarchies.  They are considered to be the monks who are reborn and reincarnated again.

From India I returned to my village in 1986 and then remained there for a while.  I learned some skills from my father.  Then in 1994, I went to a place in western Nepal called Dolpa where I learned at an institution that specialized in traditional medicinal practices.

SAGE: Your practice involves a rich depth of knowledge.  How did you study?

AN: The great Tibetan monk who taught me had a big book with a chapter that deals with medicinal practices.  I had that book and learned from that.  At school in India, they told me about the practice and I would go collect herbs and do the practical things.

SAGE: Why did you choose to title your talk at Yale Wind, Bile and Phlegm?

AN: When bile, wind and phlegm are in balance you are considered to be free of disease.  When any of these three get out of balance, then that’s when you get sick.

From the time we are born we carry ignorance.  It’s attached to us.  It’s the same thing I touched upon in my talk.  The text I mentioned earlier discusses three poisons.  When you are ignorant, you are prone to these three poisons: detachment, desire, and disillusion.  These three poisons in turn produce fruits, which result in three elements: wind, bile and phlegm.  When these fruits are balanced then we feel healthy and we are energized.

On top of that there are five elements that are present in all of us: wind, fire, earth, water, and space.  When all these five elements are in balance then we are healthy and energized.  If any of these five are unbalanced, then we are not.

The reason I chose wind, bile and phlegm is because of their importance in the text. Whenever a patient comes to me I first look at whether the wind, bile and phlegm of that patient are balanced or not.  It’s not just about looking at the internal.  I ask about other external conditions that may cause something to be unbalanced.

For example, if my patient is not eating well, and that is because of other reasons—maybe a personal loss, or something in the family—in that case the wind might get unbalanced.  In my practice, I look at those external factors and try to sort out what may lead to the imbalance of any of these elements.

In my practice, whenever I see a patient it’s very important to know how to look at the pulse, at the urine, and then how to ask questions.  These three things are very important.

Amchi Nyima Samphel

In order to identify illness in his patients, Amchi Nyima looks at their pulse and urine, and asks broader questions about their lives.

SAGE: What are some of the connections between your practice and the natural world?

AN: There are a lot of connections. Our belief is that we have a deep connection with the herbs that we use, because there is this idea that the five elements lead to these herbs.  These five elements are within us, too.

I believe that the five elements give birth to the herbs.  For example, if you look at a tree, it needs space or it cannot grow.  The same applies to us if we don’t have space.  We need the five elements the same way the plants need the five elements, and we need to them be in balance with one another to keep us healthy.

SAGE: Are changes in the environment affecting the way you collect herbs?

AN: My major concern is that businesspeople come and exploit the herbs.  They just pick them up without really knowing how to harvest them.  That is a major challenge to the herb population in my area.

The second thing is I’ve noticed that some herbs require a lot of water, and that over the years there has been less rainfall.  The herbs that need a lot of water are not able to grow.  Also because of snowmelt, it’s becoming difficult to find the herbs that I need to find.

SAGE: How do you make up for the herbs you can’t find?

AN: One way to get it is from the market, but when there’s a scarcity it’s also difficult to get herbs from the market.  We believe if you don’t find herbs in one place, then you can find them in another place.  If it’s not here, it’s somewhere.  It just becomes expensive.

But if I cannot find it in my area, then I cannot make the medicine.

There are some herbs that are considered absolutely central—the king of plants.  They have to be present in the mixture.  Other plants you don’t necessarily need in the mixture.  If the plants that are considered king and queen are not there, I cannot make the medicine.

SAGE: Are the king and queen herbs being affected? 

AN: The reduction in the population of the main plants depends on many factors.  One thing is how you harvest.  If you harvest in a way that does not allow the seed to drop down, then you are basically reducing the population of that species.  When you let seeds fall on the soil, you will have more of the plant.

On the other hand, the main species are getting scarce in the western part of Nepal.  I’m not sure whether it’s because the businesspeople are more prevalent in that area or if it’s because of climate.  It’s hard to say.

I’ve been seeing less of the plant in some areas, but in other areas I’m finding more.  In my village the rainfall is becoming scarce, so I’m finding less of the plant than I used to find.  It’s not like before.  Now we’re getting less rainfall and less snowfall.

SAGE: Who are these businesspeople?  Are they from Nepal?

AN: I’m not sure who these businesspeople are.  About half of them contract villagers, and then ask the villagers to bring certain plants to them.  So then the villagers go and collect plants, and not all the villagers know how to harvest.  In some cases, when they could just harvest the leaves they take out the whole plant.  The harvest also depends on the seasons, and the villagers and businesspeople are not aware of that.

They come, collect, and then they go.  Sometimes they harvest when the seeds haven’t fallen yet, which reduces the population.

SAGE: You collect herbs, prepare medicines, and meet with patients.  How do you balance all that?

AN: The summer is a time to go and collect flowers.   The winter is a time to go and collect roots.  And the fall is a time to go and collect seeds.  In spring I go and collect bark from the trees.

We follow a religious calendar for the preparation of medicine.  Looking at this calendar, we have to find the optimal day to prepare medicines when I’m also not busy with patients.

When I go and collect different plant parts for medicines I clean them there in the field.  If I cannot clean them in the field, then I bring them to my house and leave them outside in the open and then I cleanse them.

Then I dry them.  There are two methods of drying.  When I dry the roots for herbal medicine, it depends.  Maybe it’s used for treating something cooler, and for that reason they need to be stored in shaded areas.  Roots that are used to treat something hot need to be dried in the sun.

Sometimes patients come to me, and sometimes I go to the patient’s house.  Usually the patients will call for me and I go to their house.  It could be the daytime or the nighttime.  I might have to leave my family and go.

Now it’s changing.  If I have to go travel to the patient’s house it might be an hour walk or more.  It takes a long time going back and forth.  Nowadays people come to my place.

In the city it has changed more.  They can go to the Tibetan doctor.  In my village I still go and visit patients in their houses.

SAGE: What are some of the most important differences between Western medical practice and your medical practice?

AN: One difference is obviously the facilities.  There are more medical facilities in the U.S. than we have.  There are different departments: for eyes, for nose, for lungs.  There’s a separate department for everything.  I have to look at everything, there is no separation.

The same thing goes with the medicine treatment here in the U.S.  Pharmaceutical companies make medicine, and I make medicines myself.  They use many different medical devices just to check on the patient.  In my case, I check on patients myself.

SAGE: I’m curious about your other work as a farmer.  What do you farm?

AN: In springtime we grow wheat, barley, and potatoes.  In the summertime we grow two different types of buckwheat.  We also grow vegetables, different kinds of greens, beans, corn, and garlic.  Also apple trees.  In the wintertime we grow a different kind of barley.  We only sometimes sell produce; most of it is for us.

SAGE: In your talk you mentioned your two young sons.  What are your hopes for your sons in the future?

AN: Right now they are very small: one is seven, one is twelve.  I hope they will become Tibetan doctors.  They’ve both expressed the desire to be Amchi.  When I’m drying the medicine, they come and observe.  I hope they ask me, “How do you do that?”

Edited by Timothy Brown.

David Gonzalez

David Gonzalez is an Editor and Webmaster at SAGE Magazine and a Master of Environmental Science (MESc) candidate at the Yale School of Forestry & Environmental Studies. His studies focus on global health and the environment, with a regional interest in Latin America.

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One Comment

  1. Hector Gonzalez Sr. says:

    Just read your article with Amchi Nyima. I Interesting and pleasing to see your doing a great job. Keep up the great work. Te Amo Abuelito Hector

    Interesting to read about what you do at school. I am so proud of you and who know one day we might see you in National Geographic. I love you and keep up the good work. Grama Rosie

    Enjoyed the article. I like the part about the three poisons. Looking forward to the next article.
    Tia LIsa

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