Covid-19 from Tibetan Medical and Cultural Perspectives: A Report from Lhasa

From the Series: Responding to an Unfolding Pandemic: Asian Medicines and Covid-19

What Is a “Virus” in Tibetan?

Biomedicine defines viruses as submicroscopic infectious agents that replicate in a living cell, just like the genes of the host organism (DNA or RNA). Although a virus is not itself a life-form, it can incorporate another organism’s genetic material, through which it produces identical viral forms that are transmitted throughout the body. In biomedicine, a virus and its pathophysiology are understood through an examination of its biological structure and capacities as well as its clinical manifestation. This knowledge is then used to develop differential diagnostic criteria and treatment strategies for viral-borne diseases. However, even with a clear understanding of what a “virus” is, and even with deep knowledge about zoonotic disease pathways (see Lynteris, this series), challenges exist in providing a comprehensive explanation of causation for emergent novel viruses, such as the SARS-CoV-2 that causes Covid-19.

How does Tibetan medical theory define and understand this term virus? How does this relate to understandings within Sowa Rigpa of disease causation? In Tibetan, a virus is described with the Tibetan gloss né duk (nad duk), a contemporary neologism directly translating the biomedical concept of a virus as expressed by the Chinese term bìng dú. Né means disease, and duk can be glossed as “poison” or “toxin.” Despite né duk not being a classical Tibetan medical term, and one that has been created also with reference to Chinese biomedical vocabulary, each chosen part of this term also relates to Tibetan medical theory.

The concept of duk refers to a substance or compound with varying levels of capacity to harm the body. Such a concept is not limited merely to visible conditions (i.e., conventional toxic substances or compounds), but to subtle aspects of the substance or compound, depending on whether or not it is imbued with the quality to harm our body. There are also different categories of duk. In the Oral Instructions Tantra of the Four Tantras (Yutok Yönten Gönpo 1993), the foundational text of Sowa Rigpa theory and practice, three major categories of duk are described: jar duk (sbyar dug; compounded poisons), gyur duk (gyur dug; transformed poisons), and ngö duk (dngos dug; natural poisonous substances). With respect to né duk, the understanding of this term can be from different angles. At the level of material substance, a né duk can be understood as jar duk. It can also be understood through the broad classification of rim (rims), which itself is often translated as “infectious disease” as well as “epidemic” or “plague” (see McGrath, this series). This latter designation is given from the perspective of pathology—the way the disease develops, its process of generation. The concept of né duk also can be classified as part of dön (gdon nad), conditions that originate from external causes, which have a harmful or threatening effect to the life-force, sok (srog). In the twenty-second chapter of the Oral Instructions Tantra of the Four Tantras for example, it is stated: “No rim results without the inciting influences of the seasons and dön” (Yutok Yönten Gönpo 1993, 179). Both seasonal and dön influences are aspects of human–environment interactions.

The cause of the transmission of viruses, particularly those of the form of newly emergent epidemics such as Covid-19, are attributed to a loss of harmony between society and the environment (see Arya and van der Valk, this series). The Four Tantras continues to instruct:

The causation of the rim is attributed to excessive human desire, abuse of natural resources, destroying the harmonious connection between humans and the universe, the loss of peace and wellness in people’s minds, and causing imbalance among the natural world, which results in all kinds of pollution floating as clouds, leading to contagion (rim). (Yutok Yönten Gönpo 1993, 243)

Yet even with this clarity about causation, these communally shared and complicated new phenomena are difficult to independently measure, understand, or identify.

How Is Covid-19 Transmission Understood in Sowa Rigpa?

With this basic translational gloss of the relationship between the biomedical categories of virus and infectious disease within a Tibetan medical framework, I now offer some comments on how the transmission of Covid-19 is being understood in Tibetan medical terms, from the perspective of institutions and individual practitioners in Tibet. Again, according to the Four Tantras, the diagnosis of epidemic diseases, rim, are made based on specific criteria such as the pathological dynamics of the illness, and further referring to the sub-classifications of rim. As Sowa Rigpa understands this phenomenon, the pathological dynamics of Covid-19, specifically its transmission route, is mainly saliva droplets in the air and touching. In this sense, our understanding is similar to biomedical frameworks. Where we differ, however, is in the further connection of these material substances—droplets and air—to the foundational dynamics of lung (air/wind) and béken (phlegm).1 Additionally, when considering the described symptoms of Covid-19, we relate it to the specific type of rim that arises from “disturbed fevers,” themselves syndromes that emerge from imbalance of the three foundational dynamics.2 These infectious fevers can be more severe than other types.

What of Treatment Protocols for Prevention and Management of Covid-19 in Tibetan Medicine?

With regard to prevention and treatment, a profound philosophy and theory about rim in Tibetan medicine is contributing to a wide ranges of the therapeutic forms, including the use of incense, which are used to prevent transmission by purifying the air, and potent substances that are worn as amulets (see Gerke, Tidwell, this series).3 Other approaches to prevention include the recitation of the mantras that aim to consolidate the individual’s own defense system. Since the start of the epidemic, medicine factories across Tibetan areas in China have put effort into producing large numbers of pill amulets to satisfy demand. In addition to these methods of prevention, specific ingestible medicines and external treatments are being used on presumed Covid-19 patients, based on precise diagnoses; while practitioners do not claim that this is “curing” Covid-19, these seem to be helpful clinical management strategies with promising results (see Tidwell, this series).

In terms of the prevalence of Covid-19 in the Tibet Autonomous Region, there have been only two official cases reported,4 both of which were traced to public transportation; however, no additional community transmission has been identified. Some from within the Tibetan medical community think that one of the reasons for these low numbers may be the use of preventative technologies such as amulets as well as environmental conditions that are fairly unique to Tibet: the strong ultraviolet rays of the sun on the Tibetan plateau and the different quality of air in high-altitude environments, both of which may aid in limiting or destroying the virus. These assumptions were also made during the SARS epidemic in 2002–2003. However, while the use of Tibetan formulas, including incense and amulets, were popular among general Tibetan and Chinese populations during that epidemic (Craig and Adams 2008), in this moment, there is more direct engagement and support for the use of Sowa Rigpa from both state and private institutions (see Tidwell, this series).


1. These three foundational dynamics or nyépa sum (nyes pa gsum), are wind, bile, and phlegm or lung, tripa, and béken (rlung, mkhris pa, bad kan), respectively.

2. These “disturbed fevers” (’khrugs thsad) are one of the four types of fever. The status of the fever results from disorder of the nyépa sum. Heat rises through blood circulation, harming the body; tsarim (tsha rims) is a combination of infectious disease and disordered fever.

3. Wearing pills around the neck in the form of amulets has the potency to prevent the epidemic diseases through smell and spiritual power. One example is Nakpo Gujor, the Nine-Compound Black Pill .

4. One officially confirmed case traveling from Wuhan, and another potential case confirmed after her return to Wuhan.


Craig, Sienna, and Vincanne Adams. 2008. “Global Pharma in the Land of Snows: Tibetan Medicines and Identity Politics across Nations. Asian Medicine: Tradition and Modernity 4, no. 1: 1–28.

Yutok Yönten Gönpo (G.yu thog Yyon tan mgon po). 1993. Dud rtsi snying po yan lag brgyad pa gsang ba man ngag gi rgyud. Lhasa: Tibet People’s Publishing House.