Sonam Phuntsho¹

¹Faculty of Traditional Medicine, Khesar Gyalpo University of Medical Sciences of Bhutan, Thimphu, Bhutan.

Corresponding author: Sonam Phuntsho, Faculty of Traditional Medicine, Khesar Gyalpo University of Medical Sciences of Bhutan, Thimphu.

Email: phuntshosonam705@gmail.com

DOI: https://doi.org/10.47811/bsj.0019060102

Owing to the holistic approach of Sowa Rigpa, its therapeutic modalities can be used to supplement allopathic medicine in the prevention, treatment, and management of several non-communicable diseases. The Royal Government of Bhutan provides equal provision to both modern and traditional medicine as mandated in the Constitution of the Kingdom of Bhutan. The two medical systems must identify core areas to foster collaborative efforts in catering effective medical services to the general public. This encompasses a number of dimensions that include musculoskeletal pain management, mental disorders, palliative care of various ailments, and fevers caused by malaria. The synergistic efforts of both modern and traditional medicine in the management of these conditions will not only be effective but also reduce the burden on the overall health economy of the country. The key substratum for generating evidence and innovative ideas in Sowa Rigpa prominently lies in enhancing the culture of scientific research that emphasizes on discovering knowledge. There are several feasible and actionable areas for research in Sowa Rigpa, including investigation of medicinal plants, documentation of widely treated diseases, and conducting clinical trials for formulated products and therapies. The development of new fields like Sowa Rigpa-based pharmacognosy that targets on conducting in-vitro and in-vivo studies to evaluate the physical, chemical, and biological properties of Sowa Rigpa remedies are some suitable approaches to transform Sowa Rigpa into an evidence-based medical system.

Anti-malarial alkaloids; Hot herbal compression; rLung humor; Musculoskeletal pain; Non-specific low back pain; Sowa Rigpa

As globalization continue to permeate rapidly, Sowa Rigpa, an integral part of traditional medicine is gradually paving its way towards a more dynamic medical system. Although, Sowa Rigpa has embedded roots dating back to more than 2500 years, the core principles are still being practiced with an enhanced approach relative to the modern context. Unlike other medical systems, Sowa Rigpa encompasses multiple energy dimensions and subtle channels of the body to define the state of health and adopts a holistic path to treat and manage ailments [1]. However, despite its effectiveness, this concept of energies and subtle channels are mostly not rationalizable in the modern scientific spectrum. Sowa Rigpa, being a perfect blend of science and Buddhist philosophy, grapples to prove its effectiveness that revolves around the phenomenon of five cosmo-physical elements and emotional spheres like attachment, hatred, and ignorance [2]. Nevertheless, there is a wide range of topics and areas in the field of Sowa Rigpa that can be validated scientifically, thus assisting in the advancement of knowledge.

Owing to the holistic approach of Sowa Rigpa, its treatment modalities can be used to supplement allopathic medicine in the prevention, treatment, and management of several non-communicable diseases. The Royal Government of Bhutan provides equal provision to both modern and traditional medicine as mandated in the Constitution and the National Health Policy [3], but there are efforts required to establish integration between the two systems in areas of patient care. The two medical systems must identify core areas to foster collaborative efforts in catering medical services to the general public. There are only a few platforms for dialogues focused on discourses related to generating new ideas and integrating Sorig medicine with modern medicine practice.

The Faculty of Traditional Medicine under Khesar Gyalpo University of Medical Sciences of Bhutan hosted its 1st National Sorig Conference (NSC) themed (Figure 1) "Unraveling the Wisdom of Sowa Rigpa for Holistic Healthcare” on 17 - 18 May, 2024.The NSC witnessed insightful exchange of diverse ideas, perspectives, and knowledge among faculty members, academia, experts, and researchers nationwide in the field of Traditional Medicine. This article provides an analysis of the dialogues and discussions undertaken during the conference.

The core substratum for generating evidence and innovative ideas in Sowa Rigpa lies in enhancing the culture of scientific research that emphasizes on discovering knowledge. During the conference, one of the thematic speakers highlighted the significance of identifying key study areas and developing strategies to execute scientific research. One such area discussed during the dialogue was to focus on research approaches that investigate pharmacological constituents of materia medica in Sowa Rigpa and in line with that, the forum also placed importance on documenting and archiving the treatment outcomes through clinical trials of the formulated products.Globally, 249 million people contracted malaria in 85 countries, claiming approximately 608,000 lives in 2022 [4] and in Bhutan, 24 malarial cases were recorded in 2023 [5]. Although the incidence of malaria in Bhutan is relatively low, it can have a significant effect on public health if it is not managed properly.A study conducted by one of the researchers found that Upel Ngonpo ཨུཊྤལ་སྔོན་པོ། (Meconopsis simplicifolia D. Don) had a new anti-malarial alkaloid known as simplicifolianine [6] which showed most potent anti-plasmodial activities against Plasmodium falciparum strains, TM4/8.2 (chloroquine antifolate sensitive strain) and K1CB1 (multi resistant strain) with IC50 values of 0.78μg/ml and 1.29μg/ml, respectively[6]. This finding is a piece of scientific evidence that closely aligns with the benefits of Upel Ngonpo stated in the classical text of Sowa Rigpa which asserts that it can pacify any fever related to liver infections [7].Similarly, another study observed that Ray Koen རེ་སྐོན། (Corydalis dubia) constituted an alkaloid named scoulerine [8] that showed the best anti-plasmodial activity against Plasmodium falciparum strains (TM4/8.2 and K1CB1) with IC50 values of 5.4 μM and 3.1μM respectively [8]. Such findings will not only substantiate the materia medica but also establish Sowa Rigpa as an evidence-based medical system. Due to the wide range of potential therapies in the materia medica and compendium of pharmaceuticals, Sowa Rigpa stands out to be the centre for investigating pharmacological constituents, medicine compounding, and other treatment approaches through proper scientific research [9].

Despite the differences in the concept, diagnostic approach, and treatment modalities between modern and traditional medicine, the motive and objective of both the medical systems remain resilient to treat and heal the patient. It is high time to ascertain core areas to complement each other and converge the collective efforts of both medical systems to deliver enhanced health services to the general public. Primarily, improving the cross-referral of patients between the two medical systems can consolidate the effectiveness of integration.

The rising burden of mental disorders and emerging issues of antimicrobial resistance due to the overuse of antibiotics pose a greater threat to the global community [10]. Due to Sowa Rigpa’s wide range of materia medica and formulations, it can provide alternative remedies in curbing the problem of antimicrobial resistance and external therapies like warm oil compression (Numtsuk), gold needle (Serkhap), and Sorig yoga can help in managing and treating mental disorders. Cross referral of patients with such conditions between the two medical systems has high scope of enhancing patient care.

Musculoskeletal conditions like low back pain constitute 7.4% (570 million cases) of the global years lost to disability [11] and in Bhutan 92,434 cases of musculoskeletal disorders were registered in 2022 [5], indicating a rising concern among the health professionals. Patients with chronic musculoskeletal pain like non-specific low back pain can be managed with the application of hot herbal compression (Chingdug),which is found to be equally effective in alleviating non-specific low back pain in comparison to diclofenac gel [12]. The hot herbal compression on non-specific low back pain saw a reduction in functional disability score 57.17±14.87 at baseline to 39.93±11.89 at week 2 based on the Oswestry Low Back Pain Disability Index [12]. Thus, the therapies mentioned in the classical text of Sowa Rigpa can be a feasible treatment in the management of musculoskeletal conditions.

Concurrently, palliative care, which is considered to be an ethical responsibility of the health system and a key component of the universal health coverage [13] is one of the principal areas in which Sowa Rigpa can contribute and supplement its services. The concept of Sowa Rigpa that encircles holistic approach of both psychological and physical well-being can provide external therapies such as relaxing massage, spa, herbal bath, herbal compressions, and acupuncture to benefit the patient[14].Currently, palliative care services are customized according to patient requirement, where patients undergoing cancer treatment and post-cancer treatment are provided with relaxation massage, trigger release, cupping, moxa, hot and cold compression, and acupuncture[15]. These therapies primarily help in suppressing aggravated rLung humor, one of the pathogens in Sowa Rigpa that causes common palliative symptoms like anxiety, low appetite, insomnia, fatigue, constipation, pain, and depression. Similarly, Sorig Yoga and meditation are some of the treatment approaches that can calm the minds of the patients. Although Sowa Rigpa is integrated with modern palliative care for managing cancer patients, it still has a wider scope in other terminal diseases requiring palliative care [16].

The NSC deliberated on improving the current academic system of Sowa Rigpa by supplementing the main classical text with other complementary texts. To further enhance the research culture in the Sowa Rigpa field, the forum discussed a phase-wise advancement approach starting from critical reviews of prominent areas, observational studies and more advanced studies like clinical trials. The forum outlined the significance of generating evidences from theoretical context derived from ancient Sorig references through a robust scientific approach. It also considered collaboration with international researchers as a means to enhance the mileage of Sowa Rigpa in the global spectrum, which will in turn aid the researchers to publish in international journals. Dynamic leadership was seen to play a pivotal role in navigating the course of Traditional Medicine towards greater. The plan to come up with a road map documentation to further enrich the current system of Traditional Medicine was also discussed for both present and future development. The integration of various agencies involved in the conservation of flora and fauna with traditional medicine was also seen imperative to collaboratively leverage the management and sustainability of medicinal herbs in the country.

As the name suggests, Sowa Rigpa looks upon the overall wellbeing of the patient and empowers the body to heal from within the core. Sowa Rigpa in Bhutan can be a potential research hub for harnessing new knowledge covering various disciplines for many scholars, albeit in its infancy stage. Relevant fields like studying the pharmacological constituents of medicinal herbs, randomized control trials on formulated drugs and commercial products, observational studies on various external therapies, and documenting and archiving the treatment outcomes can generate scientific evidence and new ideas validating the effectiveness of Sowa Rigpa. The evidences generated will further forge and strengthen the collaboration between modern medicine and traditional medicine, ultimately resulting in an enhanced health system benefiting the general public. The synergistic efforts of both modern and traditional medicine in the management of various ailments will not only be effective but also reduce the burden on the overall health of the country.

Declarations

Not applicable

Consent for publication

Not applicable

Competing interests

SP is a member of the editorial board of this journal. SP was blinded from the peer review process of this article.

There was no funding for this article.

All public sources of data have been cited in this article.

Conceptualization, investigation, resources, writing – original draft, writing – review and editing: SP

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