TIBETAN HEALTH AND MEDICINE

TIBETAN HEALTH AND MEDICINE

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Health thangka of the human body
Malnutrition is a serious problem. One study showed that half the children in Tibet suffer from it and 60 percent of children are shorter than normal.

People with serious health problems, handicaps and deformities are often ostracized. In some villages blind six-year-old children haven’t learned to walk because no one has taught them. Handicapped people are largely seen as being possessed by demons or paying for sins in past lives.

Tibet is so cold and arid that metal spoons sometimes stick to the lips and germs that cause many diseases can not survive. Lice, however, like to crawl all over the body to get warm.

At high altitude, make sure you drink plenty of water.

Good Websites and Sources: Tibetan Medicine.com tibetanmedicine.com ; Dharma Haven dharma-haven.org ; TibetMed.org tibetmed.org ; Resource Guide on Tibetan Medicine ; Paper on Tibetan Astrology and Medicine berzinarchives.com ; Wikipedia article Wikipedia

Links in this Website: TIBETAN PEOPLE Factsanddetails.com/China ; TIBETAN LIFE Factsanddetails.com/China ; FOOD, DRINK, DRUGS AND CLOTHES IN TIBET Factsanddetails.com/China ; TIBETAN HEALTH AND MEDICINE Factsanddetails.com/China ; TIBETAN FUNERALS AND DEATH Factsanddetails.com/China ; TIBETAN NOMADS Factsanddetails.com/China ; TIBETAN MINORITIES AND TIBETANS ABROAD Factsanddetails.com/China

Good Websites and Sources on Tibet: Central Tibetan Administration (Tibetan government in Exile) www.tibet.com ; Chinese Government Tibet website eng.tibet.cn/ Wikipedia Wikipedia Tibetan Resources phayul.com ; Open Directory dmoz.org/Regional/Asia/China/Tibet/ ; Snow Lion Publications (books on Tibet) snowlionpub.com ; Photos Tibet Photo Gallery Tibet Gallery Terra Nomada Terra Nomada ; Tibetan Cultural Sites: Conservancy for Tibetan Art and Culture tibetanculture.org ; Tibet Trip tibettrip.com ; Tibetan Cultural Region Directory kotan.org ; Tibetan Studies and Tibet Research: Tibetan Resources on The Web (Columbia University C.V. Starr East Asian Library ) columbia.edu ; Tibetan and Himalayan Library thlib.org Digital Himalaya ; digitalhimalaya.com ; Tibetan Studies Maps WWW Virtual Library ciolek.com/WWWVL-TibetanStudies ; Center for Research of Tibet case.edu ; Center for Advanced Tibetan Studies amnyemachen.org ; Tibetan Studies resources blog tibetan-studies-resources.blogspot.com ; News, Electronic Journals ciolek.com/WWWVLPages

High Altitude Health in Tibet

Tibetan nomads that live above 18,000 feet (5500 meter) often suffer discomfort when they descend to Lhasa at 11,550 feet. They have as much as 22 percent more oxygen-carrying hemoglobin in their blood than lowlanders and this extra hemoglobin makes it easier for the oxygen to reach their blood and organs.♠

Studies have shown that different groups deal with high-altitude, low oxygen environments in different ways. Sherpas breathe at a faster rate while Andeans have higher amounts of hemoglobin in their blood and have larger lungs which allow them to take in more air. Cynthia Beall, a scientist studying people living at high altitudes in Tibet, told National Geographic, "At this altitude---5000 meters---all people have very low levels of oxygen saturation but in some they are not so low." She recently discovered that this trait is may be genetic.

Human beings are not very well adapted for high altitudes. Above 18,000 feet, cuts don't heal and women can not bear children. The air is so thin that they can not get enough oxygen into their blood to sustain a fetus growing within their womb. The dry air produces hacking coughs which are strong enough to produce cracked and separated ribs.

People weigh more at sea level than they do in higher levels. Not by much, but at measurable levels. Weight is a measurement of gravitation pull, in the this case between the earth and a person. The farther away you are from the bulk of the mass of one object the less gravitational pull. By one estimate a person who weights 150 pounds at seas level would weigh 149.92 at 10,000 feet.

Tibetans have unusually low blood hemoglobin levels, which allows them to thrive at high altitudes. When low-landers visit Tibet the low levels of oxygen in the bodies can cause altitude sickness. Jichuan Xing of the University of Utah Medical School said, “Presumably Tibetans have developed a regulation mechanism to control hemoglobin concentration to prevent these negative effects.”

Adaption of Tibetans to High Altitudes

In a May 2010 paper published in Science a team headed by Jichuan Xing of the University of Utah Medical School found two genes---EGLN1 and PPARA in chromosomes 1 and 22 respectively---that appear to help Tibetans live comfortable at high altitudes. In a study the genes of 31 unrelated Tibetans were compared to the genes of 90 Chinese and Japanese. EGLN1 and PPARA turned up repeatedly in the Tibetans but not in the Chinese and Japanese. Xing wrote, “Their exact roles in high-latitude adaption is unclear. Both EGLN1 and PPARA...may cause a decrease of the hemoglobin concentration.”

Ann Gibbons wrote on sciencemag.org: “Researchers have long wondered how Tibetans live and work at altitudes above 4000 meters, where the limited supply of oxygen makes many people sick. Other high-altitude people, such as Andean highlanders, have adapted to such thin air by adding more oxygen-carrying hemoglobin to their blood. But Tibetans have adapted by having less hemoglobin in their blood; scientists think this trait helps them avoid serious problems, such as clots and strokes caused when the blood thickens with more hemoglobin-laden red blood cells. [Source:Ann Gibbons, sciencemag.org, July 2, 2014 <|>]

“Researchers discovered in 2010 that Tibetans have several genes that help them use smaller amounts of oxygen efficiently, allowing them to deliver enough of it to their limbs while exercising at high altitude. Most notable is a version of a gene called EPAS1, which regulates the body’s production of hemoglobin. They were surprised, however, by how rapidly the variant of EPAS1 spread—initially, they thought it spread in 3000 years through 40 percent of high-altitude Tibetans, which is the fastest genetic sweep ever observed in humans—and they wondered where it came from.” <|>

Tibetans Inherited High-Altitude Gene from Ancient Human

In 2014, research was published that appeared to indicate that Tibetans inherited a gene that makes it easier to live at high altitudes from an ancient human group. Ann Gibbons wrote on sciencemag.org: “A “superathlete” gene that helps Tibetans breathe easy at high altitudes was inherited from people known as Denisovans, who went extinct soon after they mated with the ancestors of Europeans and Asians about 40,000 years ago. This is the first time a version of a gene acquired from interbreeding with another type of human has been shown to help modern humans adapt to their environment. [Source:Ann Gibbons, sciencemag.org, July 2, 2014 <|>]

“Now, an international team of researchers has sequenced the EPAS1 gene in 40 Tibetans and 40 Han Chinese. Both were once part of the same population that split into two groups sometime between 2750 to 5500 years ago. Population geneticist Rasmus Nielsen of the University of California, Berkeley, his postdoc Emilia Huerta-Sanchez, and their colleagues analyzed the DNA and found that the Tibetans and only two of the 40 Han Chinese had a distinctive segment of the EPAS1 gene in which five letters of the genetic code were identical. When they searched the most diverse catalog of genomes from people around the world in the 1000 Genomes Project, they could not find a single other living person who had the same code. Then, the team compared the gene variant with DNA sequences from archaic humans, including Neandertals and a Denisovan, whose genome was sequenced from the DNA in a girl’s finger bone from Denisova Cave in the Altai Mountains of Siberia. The Denisovan and Tibetan segments matched closely. <|>

“The team also compared the full EPAS1 gene between populations around the world and confirmed that the Tibetans’ inherited the entire gene from Denisovans in the past 40,000 years or so—or from an even earlier ancestor that carried that DNA and passed it on to both Denisovans and modern humans. But they ruled out the second scenario—that the gene was inherited from the last ancestor that modern humans shared with Denisovans more than 400,000 years ago because such a large gene, or segment of DNA, would have accumulated mutations and broken up over that much time—and the Tibetans’ and Denisovans’ versions of the gene wouldn’t match as closely as they do today. <|>

“But just how did the Tibetans inherit this gene from people who lived 40,000 years before them in Siberia and other parts of Asia? Using computer modeling, Nielsen and his team found the only plausible explanation was that the ancestors of Tibetans and Han Chinese got the gene by mating with Denisovans. The genome of this enigmatic people has revealed that they were more closely related to Neandertals than to modern humans and they once ranged across Asia, so they may have lived near the ancestors of Tibetans and Han Chinese. Other recent studies have shown that although Melanesians in Papua New Guinea have the highest levels of Denisovan DNA today (about 5 percent of their genome), some Han Chinese and mainland Asians retain a low level of Denisovan ancestry (about 0.2 percent to 2 percent), suggesting that much of their Denisovan ancestry has been wiped out or lost over time as their small populations were absorbed by much larger groups of modern humans.

Although most Han Chinese and other groups lost the Denisovans’ version of the EPAS1 gene because it wasn’t particularly beneficial, Tibetans who settled on the high-altitude Tibetan plateau retained it because it helped them adapt to life there, the team reports online today in Nature. The gene variant was favored by natural selection, so it spread rapidly to many Tibetans. A few Han Chinese—perhaps 1 percent to 2 percent—still carry the Denisovan version of the EPAS1 gene today because the interbreeding took place when the ancestors of Tibetans and Chinese were still part of one group some 40,000 years ago. But the gene was later lost in most Chinese, or the Han Chinese may have acquired it more recently from interbreeding with Tibetans, Nielsen says.

Either way, what is most interesting, Nielsen says, is that the results show that mating with other groups was an important source of beneficial genes in human evolution. “Modern humans didn’t wait for new mutations to adapt to a new environment,” he says. “They could pick up adaptive traits by interbreeding.” The discovery is the second case in which modern humans have acquired a trait from archaic humans, notes paleogeneticist Svante Pääbo of the Max Planck Institute for Evolutionary Anthropology in Leipzig, Germany, whose team discovered the Denisovan people. Earlier this year, another team showed that Mayans, in particular, have inherited a gene variant from Neandertals that increases the risk for diabetes.

Oxygen at High Altitudes

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High altitude plains
At sea level there is adequate oxygen and high enough pressure to push the oxygen into the body. Breathing is easy; the blood carries oxygen at full capacity; the heart beat rate can range from 64 while resting to 170 while exercising. At 9000 feet (3000 meters) the level of oxygen is 75 percent what it is at sea level. Respiration speeds up and deepens and the body senses less oxygen in the blood; the brain swells slightly, producing headaches and nausea; the kidneys increase production of a hormone that triggers increased production of more red blood cells; and the heart beat rate ranges from 70 while resting to 155 while exercising.

The amount of oxygen available to the human body is determined by atmospheric pressure. At higher latitudes there is less pressure so less oxygen is available. The air is one third thinner at 16,000 feet than at sea level and two thirds above 25,000 feet. Above 25,000 feet is regarded as the "death zone" by mountain climbers.

Acclimatization is essential for outsiders. A person brought directly to the "death zone" from sea level would pass out within three minutes and die in 10 minutes from lack of oxygen. Climbers acclimatize by training at gradually higher elevations. Studies show that some people are born with an ability to adjust to high altitudes while others have genes that make them more likely to have breathing problems at high altitudes. Many people, even Sir Edmund Hillary, have found they have increasingly more difficulty adapting to high altitude as they age.

Many climbers get sick. The combination of the high latitude, poor food, bad water. stomach parasites and a new environment give people a Montezuma’s revenge-like nausea and diarrhea that is sometimes referred to in the Everest area as the Khumba Krud. It is not unusual for climbers to get dysentery.

Not only are ailments dangerous in their own right they can also mean that climber are at less than their best and more likely to fall or have some other mishap.

Lack of Oxygen

Heavy breathing and dry air at high elevations causes the body to lose fluids at an alarming rate. Sometimes water content in the blood drops from a normal level of 50 percent to 15 percent and the number of red blood cells increases, causing the blood to circulate more slowly, increasing the risk of frostbite. Climbers carry stoves to melt snow, the only means of getting liquids. About ten pots of snow equals one pot of water.

The lack of oxygen prevents people from eating and sleeping and makes even simple chores like melting snow, putting on clothing, putting food into ones mouth exceedingly difficult. Each pace above 27,000 feet requires about half a minute. One step...six breaths...another step...six more deep breaths is how the climbers ascend during the final the assault of Everest.

The lack of oxygen in the brain can cause confusion, bad judgement and even self-mutilation. Climbers recall having imaginary conversations, distortions of time and space and hallucinations. Peter Habler, one of the first two men to reach the summit of Mt. Everest without oxygen, said, "In this lonely environment, which is so hostile to life, the imagination conjures up all manner of strange desires or horrifying apparitions.”

Strong climbers often have enormous lungs and the ability to function at high levels of aerobic activity for long periods of time. To compensate for the lack of oxygen climbers breathe 50 times a minute compared to 12 times at sea level. Most climbers breath oxygen from 13 pound oxygen canisters carried up to the camps by Sherpas to elevations as high as 27,000 feet. Four liters of oxygen is considered the best rate, but most climbers inhale two liters to make it last longer.

High Altitude Health Problems

At 18,000 feet (6,000 meters) there are no permanent settlements because no one can adjust to living at that elevation year round. The oxygen level is only 50 percent of what it is at sea level. The lungs expel so much carbon dioxide that the blood’s Ph balance is affected. Kidneys discharge more water to correct for the high levels of acidification in the blood, causing dehydration. The heart rate varies between 85 resting and 140 exercising.

In A.D. 100 a Chinese official visiting the Tibetan plateau referred to the region as the "Headache Mountains." Tourists who visit the Tibetan plateau today often suffer from altitude-related ailments. Altitude sickness, frostbite and heart palpitations are very common in Tibet. Oxygen depravation caused by thin air at high altitudes also causes brain function to decrease, the blood to thicken, the intestines to shut down, and the heart rate to become erratic.

Frostbite and Hypothermia

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Everest
Frostbite is a condition in which the body parts freeze, turn black and die. It usually occurs on the extremities of the body first: the finger tips, toes and nose. Frostbitten body parts often have to be amputated to prevent gangrene from developing and spreading to the rest of the body, causing severe infection and quite possibly death.

Frostbite is particularly dangerous near summits of high mountains where winds can kick up to 90 mph and temperatures can drop many degrees below zero. Since the mid 1980s the development of efficient cold-resistance boots and Gortex gloves have greatly reduced the occurances of frostbite.

Many mountaineers die of hypothermia---loss of body heat. In severe cases victims become so disoriented they take of their clothes and fight anyone who tries to help them. Climbers need to drink a lot. Even under normal conditions they exhale more than gallon of moisture a day.

Brain and Eyes and High Altitude

The brain is sensitive to any kind of change, and high altitude conditions puts special stresses on it. The brain accounts for only 2 percent of the body’s weight but uses 15 percent of the body’s oxygen. Low amounts of oxygen can: 1) cause a dysfunction in the frontal lobe, resulting in impaired reasoning and memory; 2) produce plasma leakage from the corpus callosum, creating internal pressure; 3) create pressure on the cerebellum, resulting in staggering and loss of balance; and 4) put stress on the brain stem, resulting in coma and death, [Source: National Geographic, May 2003]

Temporary blindness can occur when the brain’s visual cortex doesn’t get enough oxygen. It is also not unusual for blood vessels in the eyes to break. Such breakages aren’t painful but they can blur vision and take six months to heal. Climbers wear dark glasses in part because ultraviolet radiation, which increases at 4 percent per thousand meters, can also cause damage to the eyes.

Altitude Sickness

left Acute Mountain Sickness (AMS, altitude sickness) causes fluid to form in the brain and lungs and kills by causing the brain to swell and hemorrhage inside the skull. Many people die of it every year, and there is no rhyme or reason to who it strikes (sometimes fat smokers are unaffected while athletes get sick).

Describing altitude sickness, one mountain climber told the Washington Post, “You feel terrible, your head is pounding, your body failing, you can’t think, you can’t move. I was fit, but I couldn’t lift my head on my shoulders.”

The effects of the low oxygen on body tissues are noticeable above 3,500 meet (11,480 feet) and marked above 5,000 meters (16,400 feet)." Symptoms include headaches, nausea, vomiting, lightheadedness, lassitude, breathlessness, anorexia, fatigue, insomnia, swelling of hands, feet, or face, and decreased urine output.

People with severe AMS have difficulty breathing with minimal activity, feel extremely tired, and have a dry cough. When the disease becomes more advanced the victims have bubbly breathing, cough up fluid or blood, feel confused and become bluish in color.

Above 12,000 feet a swelling of the brain called HACE (high altitude cerebral edema) may occur. The first symptom of this disease is a severe headache, hallucinations, stumbling walk, drowsiness and faulty judgement (which can make self-diagnosis difficult). Brain damage and death can occur quickly. As is true with AMS, the best treatment for a cerebral edema is to descend quickly.

AMS generally affects people who ascend too quickly at elevations above 8000 feet. Those who fly from sea level to a higher elevation should be especially careful. The general rule of thumb is to "climb high and sleep low" and ascend no more than 1000 to 1,500 feet a day and take every third day off. If you ascend more than that rest a day or two. Even if you are super fit that is no guarantee you won't have problems.

The only cure for AMS is to descend to a lower elevation. If you experience any of the aforementioned AMS symptoms, descend immediately, the more you don't want to the more imperative it is that reach you lower elevations, even if it is rainy night.

To prevent altitude sickness eat and drink a lot. Diamox tablets are often prescribed as a preventative measure. They generally only treat the symptoms of mild AMS put do nothing to prevent the condition. Many local people chew on raw garlic.

Edemas

Edemas, the accumulation of excess fluid in the body, are big dangers, especially when they occur in the brain (cerebral edemas) and the lungs (pulmonary edemas). A physician who has reached the summit of Mt. Everest four times told National Geographic, “I can honestly say I’ve never gone to Everest without seeing someone suffer from cerebral edema.”

A cerebral edama occurs when plasma leaks through the capillary walls, increasing pressure in the skull. Why the brain capillaries leak is still somewhat of mystery (possible reasons include new capillary growth in low-oxygen conditions, separation of junctions between cells, inflamation of the vessels). The amount and kind of damage caused often depends on how much and where leakage occurs.

A pulmonary edema occurs when blood vessels are squeezed inside the lungs. The constrictions and high pressure cause the fragile lung capillaries to leak fluids which inhibits the ability of the lungs to collect oxygen and this causes the victim to drown in his own secretions.

In the past it was thought that edemas were caused by swollen cells rather than leakage and by inflamation or heart failure not constriction. Studies shows the body produces nitric oxide, a chemical that dilates the blood, to reduce constricting of the blood vessels. Some studies suggest that people who do not produce adequate amount of nitric oxide are more susceptible to pulmonary endemas.

Health Care in Tibet

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Health thangka
Tibetans have their own form of traditional medicine. A Tibetan physician named Yuthok Yonten Gonpo, compiled the Four Medical Classics of Tibetan Medicine, which include 70 colored wall charts made to assist diagnosis and the selection of drugs.

Traditional doctors are called "amchi." Many of them are monks who received their training at monasteries. Yoji Kamata, a Japanese scholar who has studied Tibetan medicine told the Daily Yomiuri, "They don’t receive payment for helping others and they adhere to very high codes of conduct that follow Buddhist traditions.

Modern systems of health care were introduced by the Chinese in the 1950s. Health and health education improved greatly in the 1980s. Recent reforms have encouraged monks to teach hygiene and refer sick infants to clinics using Western medicine.

Even when good, modern medical care is available people don’t always take advantage of it. A Swiss doctor working in Bhutan in the 1970s told National Geographic, "Only when they can no longer stand the pain do they come to me. Then it is often too late. I must say to them, 'Go home. It is not good to come to me only when they are ready to die.'"

Disease in Tibet

Even though Tibet is so cold and arid that many disease-causing agents can not survive, incidents of influenza, tuberculosis, and parasitic infections are high.

The rate of respiratory disease is high. The smoke from yak-dung fires can be quite nasty and sting the eyes. Photographer Peter Menzel wrote: "The combination of smoke and flies was the worst I have seen anywhere. All the kids had diarrhea and runny noses, and most had some kind of skin infection." The family of 14 he stayed with included a father with a club foot, a hunchback son and dwarf-like daughter.

One study found that 67 percent of children in some Himilayan areas suffered from rickets, a disease caused by a Vitamin D deficiency.

Kashen-Beck Disease in Tibet

In Tibet there high incidents of Kashen-Beck disease, or Big Bone disease, an ailment that largely disappeared from rest of the world. By some estimates 9 percent of the population suffers from the disease Sufferers have stunted growth, elbows with huge knots and hands, writs and arms that are bent at strange angles. In the worst cases the long bones stop growing during childhood and sufferers look like dwarfs.

Kashen-Beck disease is linked with poverty, poor diet, lack of minerals and bad water. It has also been linked with a fungus that grows in the soil in some places. The Chinese government is helping to resettle people that live in villages where the incident of the disease is very high and the soil is contaminated with the fungus. Fungicides have been brought in to treat fields. Mineral supplements, iodine and selenium have been given to children

Cataracts in Tibet

Tibetans also suffer from unusually high incidents of eye disease. The high levels of ultraviolet rays found at high elevation takes its toll. After a lifetime of exposure to these rays many people develop cataracts (dense, foggy masses in the lenses) and go blind. Around 30,000 people in Tibet are blind as a result of cataracts. An additional 1,500 to 2,000 lose their sight every year because of them.

Dri, Sanduk Ruit---a Sherpa from Nepal---came to Tibet in the late 1990s at the invitation of the Tibet Development Fund and has spent a great amount of time and energy performing operations to remove cataracts and training local doctors how to do the surgery.

Cataracts in Tibet have traditionally been treated with a 2,000-year-old procedure known as couching, in which the clouded part of the lens is removed but nothing is inserted to replace it, Although some sight may be restored vision is usually extremely blurry. The procedure used by Dr Ruit---replacing the clouded lens with a plastic lens---is simple and effective. The operation takes less than 30 minute, does not take great skill to perform and is relatively painless for the patients, who usually recover their sight within a couple days after the surgery.

Image Sources: Purdue University except Everest by Luca Galuzzi

Text Sources: 1) Encyclopedia of World Cultures: Russia and Eurasia/ China , edited by Paul Friedrich and Norma Diamond (C.K.Hall & Company, 1994); 2) Liu Jun, Museum of Nationalities, Central University for Nationalities, Science of China, China virtual museums, Computer Network Information Center of Chinese Academy of Sciences, kepu.net.cn ~; 3) Ethnic China ethnic-china.com \*\; 4) Chinatravel.com chinatravel.com \=/; 5) China.org, the Chinese government news site china.org *|* New York Times, Washington Post, Los Angeles Times, Times of London, Lonely Planet Guides, Library of Congress, Chinese government, Compton’s Encyclopedia, The Guardian, National Geographic, Smithsonian magazine, The New Yorker, Time, Newsweek, Reuters, AP, AFP, Wall Street Journal, The Atlantic Monthly, The Economist, Foreign Policy, Wikipedia, BBC, CNN, and various books, websites and other publications.

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© 2008 Jeffrey Hays

Last updated July 2015

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