Animal-derived natural products of Sowa Rigpa medicine: Their pharmacopoeial description, current utilization and zoological identification

Author’s Accepted Manuscript Animal-derived natural products used in the Bhutanese Sowa Riga medicine Karma Yeshi, Paolo Morisco, Phurpa Wangchuk

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To appear in: Journal of Ethnopharmacology Received date: 9 April 2017 Revised date: 4 June 2017 Accepted date: 8 June 2017 Cite this article as: Karma Yeshi, Paolo Morisco and Phurpa Wangchuk, Animalderived natural products used in the Bhutanese Sowa Riga medicine, Journal of Ethnopharmacology, http://dx.doi.org/10.1016/j.jep.2017.06.009 This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting galley proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.

Animal-derived natural products used in the Bhutanese Sowa Riga medicine Karma Yeshia, Paolo Moriscob, Phurpa Wangchukc* a

Wangbama Central School, Thimphu District, Bhutan

b

c

Health and Wellbeing North Ward, 34 Gregory Street, Townsville, QLD 4810, Australia

Centre for Biodiscovery and Molecular Development of Therapeutics, Australian Institute

of Tropical Health and Medicine, James Cook University, Cairns Campus, QLD 4870, Australia [email protected] [email protected] [email protected] 

Corresponding author. Phone: +61 07 0416666886

Abstract Ethnopharmacological relevance: Bhutan has two traditional healing systems: a folklore medicine and the Bhutanese Sowa Rigpa medicine (BSM). Three different types of ingredients namely plants, animals (and their derived products) and minerals are used for the preparation of various formulations in combined form. Animals and their derived products are vital ingredients in the preparation of numerous traditional remedies. Unlike medicinal plants, research on medicinal animals has remained largely untouched. Aim of the study: This study is aimed to investigate the animal-derived natural products used in BSM as a zootherapeutic agents, taxonomically identify the medicinal animals, and shed lights on their positive as well as undesired implications. Materials and methods: A five stage process was conducted which consisted of: (1) a survey of specialized ancient ethnomedical texts (Pharmacopoeias and formularies) to list animal products used as 1

ingredients; (2) identify the natural products from animals used as ingredients by consulting Traditional Physicians (Drungtshos) and other experts at Menjong Sorig Pharmaceutical (MSP); (3) collect information about number and types of diseases treated by each animal ingredient; (4) confirm the list of animal ingredients separately as currently used, total medicinal animals described in the traditional text books, and those which are substituted by plants; (5) ethno-pharmacological uses of each animal ingredients were translated with the help of Traditional Physicians, clinical assistants and experts at MSP. The nomenclature of identified animal ingredients was confirmed by crosschecking the descriptions with the series of translated books of vernacular literature, scientific papers on animal ingredients, and the animal databases. Results: The study reported 73 natural products belonging to 29 categories derived from 45 medicinal animals (36 vertebrates and 9 invertebrates) which are used as ingredients in Bhutanese Sowa Rigpa medicine system to prepare various formulations. The identified species comprise 9 taxonomic categories and belong to 30 zoological families. The groups with highest number of species were mammals (n = 26; 19 – wild and 7 – domestic), birds (n = 5), reptiles (n = 3), gastropods (n = 3) and insects (n = 3). Out of 116 formulations currently produced, 87 of them contain one or more extracts and products obtained from 13 medicinal animals to treat more than 124 illnesses. This demonstrates the importance of zootherapy as alternative therapy in Bhutan. Only five (5) animal ingredients namely Bear’s bile (dom-m.khris), male musk deer’s naval musk gland (gla-rtsi), pig’s blood (phag-khrag), red deer’s horn (śa-rwa) and red deer’s immature horn (śa’i-khrag-rwa) were found available in Bhutan, the rest being imported from neighbouring countries like India. There is an increasing demand for animals and their parts in the traditional medicines (TMs) but MSP prefers plant substitutes due to difficulties in obtaining the animal parts.

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Conclusions: In this study, we identified 73 natural products belonging to 29 categories derived from 45 medicinal animals (36 vertebrates and 9 invertebrates) in the Sowa Rigpa medicine. 13 medicinal animals were currently included in formulating 87 essential multi-ingredient prescription medicines in BSM to cure multiple diseases. This demonstrates the importance of zootherapy as alternative therapy in Bhutan. The Bhutanese Sowa Rigpa medicinal fauna is largely based on wild animals (n = 38; 84.4%), including some endangered species. Only 2 of the medicinal animals were substituted by plants. Graphical abstract Traditional pharmacopoeia

Medicinal animal (Pearl)

Formulation (Pills)

Abbreviations BCL, Bhutanese conservation laws; BSM, Bhutanese Sowa Rigpa Medicine; CITES, Convention on International Trade in Endangered Species; CTM, Chinese Traditional Medicine; HPTLC, High Performance Thin Layer Chromatography; IAM, Indian Ayurvedic Medicine; IUCN, The International Union for Conservation of Nature; MoAF, Ministry of Agriculture and Forest; MSP, Menjong Sorig Pharmaceuticals; MTMB, Monograph on Traditional Medicine of Bhutan; NITM, National Institute of Traditional Medicine; NTMH, National Traditional Medicine Hospital; RGoB, Royal Government of Bhutan; TLC, Thin Layer Chromatography; TRAFFIC, Trade Record Analysis of Flora and Fauna In Commerce; TSM, Tibetan Sowa Rigpa Medicine; WHO, World Health Organisation

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Keywords: Bhutanese Sowa Rigpa medicine; medicinal animal; zootherapy; uses of animal parts; health implications

1.

Introduction

Since antiquity, human used parts of animals (both domestic and wild species) for foods, medicines, decoration, ornaments and rituals. Even the most dangerous and repulsive animals form the part of bizarre food and medicinal preparations across the world. The animal product when used for healing ailments or diseases is known as zootherapy (Holennavar, 2015; Alves and Alves, 2011; Alves et al., 2009; Costa-Neto, 1999). Zootherapy materials and techniques are applied in both traditional and modern medical systems for the treatment of various ailments (Lawal & Banjo, 2007; O’Hara-May, 1971). Many animal products form the basis of pharmaceutical products either as therapeutics or as vehicles and play vital role in modern medicine (Betlloch-Mas et al., 2014; Yohannes & Chane, 2014; Soewu, et al., 2012; Lawal & Banjo, 2007; Alves & Rosa, 2005). Out of 252 essential therapeutic agents recognised by the World Health Organisation (WHO), 8.7 % are derived from animals and in USA, 27 out of 150 prescription drugs used in modern medicines are animal origin (World Resource Institute, 2000). For instance, heparin derived from porcine intestines and bovine lung is the oldest and widely used drug today. It is used for treating many disorders including acute coronary syndromes, deep venous thrombosis, pulmonary embolus, cardiopulmonary bypass surgery, atrial fibrillation, extracorporeal membrane oxygenation circuits, and in surgical procedures requiring anticoagulation (Bozoghlanian & Butteri, 2015). Bovine serum albumin or fetal calf serum is used as a nutritional component in growth media for the production of many vaccines including ACT®-HIB vaccine for haemophilus influenza type b (Hib), ADT

TM

Booster

for tetanus or diphtheria, Boostrix ® for tetanus or Diphtheria or acellular pertussis, IPOL® for polio and Rota Teq® for Rotaviruses; and the embyronated chicken eggs are used for growing influenza viruses to make Flauris® vaccine for influenza and chicken embryo cell 4

for growing measles and mumps viruses-M-M-R® II (The University of Auckland., 2016). Similarly, 9 different anti-venom (Equine derived) and 20 vaccines produced under 28 different product names are animal based out of which 3 are porcine derived, 15 are bovine derived, 4 are derived from eggs (Queensland Government, 2013). Angiotensin (oligopeptide), isolated from the liver, contributes significantly to the well-being and longevity of millions of people and its economic revenue is $1.3 billion a year in sales (Costa-Neto, 1999). Similarly, peptides extracted from the scraped secretions of the frog Phyllomedusa bicolor are now used in the treatment of depression, stroke, seizures and cognitive loss in ailments such as Alzheimer’s disease (Amato, 1992). Today, the proteins, peptides and small molecules from both invertebrates and vertebrates are increasingly studied for their medicinal applications by the researchers and the pharmaceutical companies. In traditional medicines, animals are used in pet therapy and polyingredient formulations. Pet therapy has been applied for treating mental deficiencies and depression (Silveira, 1998). Traditional medicines including Traditional Chinese Medicine (TCM), Indian Ayurvedic Medicine (IAM) and Tibetan Sowa Rigpa Medicine (TSM) use more sophisticated polyingredient formulations. It is claimed that about 13% of the medicines used by TCM are derived from animals (Still, 2003). In IAM, about 15-20% of the formulations contain animal products (Unnikrishnan, 1998). In TSM, which is a hybrid of TCM, IAM and Greco-Roman medicine, the animal products are used in more than 111 formulations (Singh, 2000). In other Asian, African, European and Latin American countries, animal parts are often used as single ingredient treatment regimen. For example, rattle snake (Crotalus durissus Hoge) is used in Brazil to treat asthma (Costa-Neto, 1999). Alves and Alves (2011) reported a comprehensive list of animal based medicines used in Latin America. Since people migrate and trade across the continents and countries, we often see that animal based medicines used by different countries have common ingredients (not necessarily used currently), which include Bear bile, Tiger bone, Rhino 5

horn and Elephant tusk. Growing demand for these animal parts in the past has led to their over-exploitation and near extinction (Soewu et al., 2012; Alves & Rosa, 2005). Ensuring the sustainability of wild fauna resources demands their reduced utilisation in traditional medicinal preparations, food, and as expensive trophies would be a greater challenge. A recent incident at French Zoo, where a white Rhino under the watchful custody of the zookeepers was killed by the poachers for its horn, was a disturbing new development in the rhino poaching crises and more than 1054 Rhinos were poached illegally in Africa in 2016 (TRAFFIC, 2017). In Bhutan, strong forest and national biodiversity conservation laws, and their constitution have succeeded in protecting and enabling the growth of exotic fauna within 72% of the country’s forest cover. Thus, it is considered as one of the ten global biodiversity-hotspots par excellence in the world. In the past, most of the animal species were used for meat, ornament, clothing, decoration and zootherapeutic remedies. Animal parts have been used in many formulations of the scholarly Bhutanese Sowa Rigpa Medicine (BSM) for hundreds of years. The BSM has successfully co-existed with the modern medical system since their integration in 1967 (Yeshi et al, 2017). It has supplemented health care services to about 20-30% of the total daily outpatients visiting 38 district traditional medicine units established under the same umbrella of modern hospitals and Grade I Basic Health Units (Wangchuk et al., 2007). Currently, Menjong Sorig Pharmaceuticals (MSP), under the Ministry of Health produces 116 formularies out of which 88 of them uses natural products obtained from diverse medicinal animals (MTMB, 2015). Use of animal ingredients for Sowa Rigpa medicinal preparations is expected to increase substantially in future as the BSM is increasingly getting popular in the country. With increasing popularity, the demand on quality, safety and efficacy have also risen. The first step in assuring the quality and safety of traditional medicines is to taxonomically identify the ingredients used in BSM.

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In our continuous efforts to scientifically validate the BSM, we have previously reported the taxonomical identification of medicinal plants (Wangchuk et al., 2011, 2016). However, animal parts used in BSM received less attention and remain unexplored. Alves and Rosa (2005) reported that there is a least concern worldwide about therapeutic uses and safety of animals as compared to plants. In this study, we have taxonomically identified medicinal animals, which are either described in the ancient textbooks (not used at present) or that are currently in use in BSM. The information we have presented here would ultimately assist MSP and the Department of Forest in the identification, sustainable utilisation and conservation practices of animal products in Bhutan.

2.

Materials and Methods

2.1 Identification of animal ingredients used in BSM and transcription of their uses A five-stage process was conducted, which consisted of the following: firstly, a survey of specialized ancient ethnomedical texts (Monograph on Traditional Medicine of Bhutan (MTMB), 2015; Dictionary of Tibetan Materia Medica, 1998; ˈkhrungs-d.pe-drimed-shel-gyi-me-long, 1995; Formulary of BSM, 1983) was carried out to list down animal products used as ingredients. This was followed by traditional identification of the medicinal animal products by consulting senior Drung-tshos (Traditional Physicians) and other experts at MSP (n = 8 people). Based on the list of medicinal animals drawn from the literature and after consultation with BSM experts, we conducted taxonomical identification of these medicinal animals. Scientific names of animals cited were updated in accordance with the Integrated Taxonomic Information System’s “Catalogue of Life (Roskov et al., 2017) and the American Museum of Natural History’s “Amphibian Species of the World” (Frost., 2017). Nomenclatures of identified animal ingredients were further crosschecked with the NCBI database (NCBI, 2016). The conservation status of animal species was obtained from the IUCN (2016), and the Convention on International Trade in Endangered Species of Wild Fauna and Flora (CITES WFF, 2016). 7

We have translated the ethno-pharmacological uses of each animal ingredient into English medical terminologies with the help of Drung-tshos, Menpas and other western educated experts at MSP and presented them in Table 1. From the confirmed list, we described the list of animal ingredients as total medicinal animals described in the ancient traditional medical literature, animal ingredients currently used at MSP, and those substituted by plants. We have also described the category of animals, different types of parts used, and total formulations prepared from animal ingredients. To gain a deeper and more understanding of BSM, its status and challenges, semi-structured interviews were conducted with eight people who had a deeper understanding of BSM and who are currently working at MSP. Key areas of interviews with those participants included their views, their experience, and challenges in procurement of ingredients, possible health risks from using imported animal parts, strengths and weaknesses of BSM. Informed consent was sought from the interviewees prior to the conduct of interviews with them. All the information was recorded verbatim and subsequently transcribed.

3.

Data analysis The information collected from the participants was entered into MS excel sheet 2010,

analysed and then the data were represented using bar graph and pie chart. The analysis was grouped into seven categories: total animal ingredients described in the BSM literatures and diseases treated, and currently used animal ingredients and diseases treated, segregation of animal ingredients by their taxonomic category, segregation of animal ingredients by parts used, and segregation by availability of animal ingredients, and number of formularies prepared from individual animal ingredient.

4.

Results and discussion

4.1. Taxonomical identification and the diversity of animal ingredients described in BSM pharmacopoeia 8

The survey of the Bhutanese traditional pharmacopoeia, textbooks and formulary book (MTMB, 2015; ‘khrungs-d.pe-dri-med-shel-gyi-me-long, 1995; Formulary of Traditional Medicine of Bhutan, 1983) revealed that more than 73 natural products belonging to 29 categories derived from 45 medicinal animals were either described or currently used in the BSM (Table 1). Out of 45 animal species, 36 of them belonged to vertebrates and 9 species to invertebrates. The frequent or high use of vertebrates reported in our current study is in line with studies conducted by many authors around the world (Alves, 2009; Alves et al., 2008; Mahawar et al., 2008; Vãzquez et al., 2006; Mahawar et al., 2006; Kakat et al., 2006; El-kamali et al., 2000; Sodeide et al., 1999). The identified species comprise 9 taxonomic categories (Fig.1) and belong to 30 zoological families.

We found that 26 species were mammals (with 19 wild type and 7 domestic animals), 5 species were birds, and other classes including reptiles, gastropods and insects contained 3 species each. Other classes including molluscs, malacostracans and arachnids all contained the lowest number of medicinal animals with 1 species each.

4.2. Diversity of animal parts used in BSM The inventoried medicinal animals can be used whole or in parts. Our analyses found that a diverse range of animal parts including flesh, bone, excretory or secretory products, exudates, horns, blood, bile, fats, fur, tooth, tusk, internal organs, brain, feathers, milk, honey, shell, scale, tail, skull and skin are used in BSM. About 29 categories of products are either described in the BSM or TSM pharmacopoeia or currently used in Bhutan (Table 1 and Fig. 2).

Flesh category ranked highest with 21 citations, followed by blood with 7 citations, bile and bone with 6 citations each. Others include eggs, tadpole, honey, feathers, d.bangril (exudate), gallstone, fur, tooth, tusk, and internal organs like heart and liver. Among the 9

horns, the antlers (red deer horns) are commonly used in BSM. Among the domestic mammals, the flesh of the Yak (Bos grunniens L.), goats (Capra hircus L.), horses (Equus caballus), and cows (Bos taurus L.) are commonly used. Reptiles used as ingredients in BSM include Paralaudakia himalayana Steindachner, Python sp, and Batrachuperus pinchonii David. Insects include Apis cerana Fabricius, Kerria lacca Kerr, and Mylabris phalerata Pallas. Marine organisms and their products used as ingredients in BSM include Pinctada margaritifera L., Rapana bezoar, Manis crassicaudata Gray., Himalayapotamon atkinsonianum Wood-Mason., and Pinctada margaritifera L. The chicken fat of Gallus gallus domesticus (Linnaeus, 1758) is used as ingredients in BSM or folklore remedies against inflammation, burns, and injuries. Interestingly, same part of chicken is used for treating renal calculi, headaches, throat inflammation, nasal congestion, fevers and general swelling in Brazil (Alves et al., 2008).

4.3. Animal ingredients used in the current BSM formulations and their plant substitutes As a result of current formulation trend, health risks, conservation laws and restrictions, and the practitioners’ choice, we found that only 15 natural products from 13 medicinal animals are currently used or have been cited to contain one or more animal parts (Table 2; Fig.3) as ingredients in processing 88 Essential Traditional Medicines at MSP. Seven animals are abundantly available through farming. We found that ghi-vam (gallstone from domestic buffalos or cows) is used in 16 formulations (Fig.3). A total of 1.5 kilograms of ghi-vam is imported every year from India at the rate of Nu 2,550 (US $ 36.74) per gram. In 2015, the MSP spent a total amount of Nu 4,409,222 (US $ 63,533.458) for buying animal ingredients and the majority of this amount was spent for ghi-vam (Nu 3,774,000 (US $ 54,380.40)). Given the fact that the authenticity and quality of imported ghi-vam is subjective, and that it is very expensive, the BSM formulations which use this animal ingredient remains questionable.

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It is important to understand that most of the rare ingredients given in Fig.3, which includes bear bile, musk pod and Rhinos horn are either excluded from use in Bhutan or currently substituted by medicinal plants. However, the names of those rare ingredients are still retained in the current formulations (alongside the plant substitute names) to reflect the original descriptions in the BSM/TSM pharmacopoeia. For example, g.lar-tsi (Musk from Moschus moschiferus) is reflected in almost 31 polyingredient formulations but these formulations have been substituted by the plants, Delphinium brunonianum Royle and Pleurospermum amabile Craib & W.W. Smith since 1960s. Similarly, bear bile from Ursus thibetanus G. [Baron] Cuvier is often substituted by Veronica cephaloides Pennell (Table 2). Except for these two (2) rare animal parts, plant substitute for rest of the animal ingredients are not yet identified.

The plant substitutions were solely based on the ancient texts of BSM/TSM and it is therefore not scientifically proven. No detailed comparative studies have been conducted to find the chemical profiles and clinical efficacy between the identified plant substitutes and animal parts. Using plant substitutes especially for rare animal ingredients could affect the quality of BSM as the ingredients are from two extreme biological sources. Nonetheless, given strong conservation laws and the Buddhist oriented religious sentiments on killing animals, using plant substitutes for these animal parts may be the best alternative. Alternatively, substituting them with the animal parts from farmed animals may have better efficacy than the plants. For example, bear bile could be substituted with the bile from yaks or cows or even pigs. Similarly, since the hoof/toe nails or horns from yaks and cows may contain same levels of keratin, they could be better substitutes for the Rhinos horn. In-situ breeding and farming these rare animals especially musk deer would be another sustainable and profitable option to consider.

4.4. Ethno-pharmacological uses and the types of diseases treated by animal ingredients. 11

From the content analysis of the body of literature on BSM, we have identified 73 natural products belonging to 29 categories derived from 45 medicinal animals (see Fig. 2) and translated their ethno-pharmacological uses (see Table 1). We found that more than 124 illnesses and conditions can be treated with these animal parts. The most common illnesses treatable by animal-parts-containing formulations used in BSM include paralysis, oedema, fever, gout, arthritis, piles, sinusitis, rheumatism, phantom tumour, poisonings, diabetes, inflammations, wounds, bronchitis, bile disorders, gallstone, spermatorrhoea, haemorrhage, disorders of liver and spleen, headache, diarrhoea and pharyngitis. It is important to take note that none of these animal ingredients are used as single drugs in BSM. At MSP, these ingredients are pre-processed, weighed in proportionate ratios (often very small amounts) and then mixed with plants and minerals to form complex polyingredient formulations. We observed that, while different parts of an individual animal species are used as raw materials to prepare different remedies for treating various diseases, the use of different medicinal animals to treat same illness is also a common practice. These practices are strategically important with those species having marked seasonality (see Table 1).

4.5. Pre-processing of animal parts or detoxification methods In BSM, we found that the individual animal ingredients are given pre-treatments or preprocessed before they are mixed with other ingredients. The pre-processing - often known as detoxification process - includes removal of toxic content, frying, extraction, incineration (making ashes), filtration and concentration (MTMB, 2015). Whether these detoxification methods are effective in controlling pathogenicity is unknown and calls for urgent scientific validation. At the time of this study, Thin Layer Chromatography (TLC) and High Performance Thin Layer Chromatography (HPTLC) were the only tests protocols available for detecting adulterants in the imported animal parts. There is urgent need to set up the microbiology laboratory techniques at MSP and build capacity to 12

analyse the quality of animal parts to avoid potential risks of toxicity, microbial contamination, allergic reactions and zoonotic diseases.

4.6. Major implications and challenges for zootherapy in Bhutan 4.6.1. Positive implications Zootherapy in Bhutan has been never studied both scientifically as well as empirically and remains largely uncovered. The diversity of animal species used in BSM directly reflects the richness of faunal biodiversity for which Bhutan is well known. The zootherapy presents potential for developing improved primary health care projects. In addition, their rich ethnozoological and ethnomedical information can be used for guiding modern drug discovery projects based on the animals (especially farmed animals) that are not listed in any of the endangered, threatened or protected species of the Bhutanese conservation laws (BCL). Ophiocordyceps sinensis was once enlisted as the endangered species in the BCL (although illegally collected by people across the borders from Bhutan) and was banned from collection. Its legalisation for collection by the farmers in the early 2000s is a perfect income-generating success story for the country. This insect-fungi species have today become a gold mine (fetching as high as USD 30,000-50,000/kg dry weight) to many Bhutanese highlanders. We believe that Himalayan musk deer (Moschus leucogaster) is feasible for farming or rearing commercially and it has huge market potential. Such initiative could not only help conserve the wild endangered species but could also help farmers to generate income and the BSM to re-introduce the production of many formulations that depended largely on musk. This farming project of musk deer could induce a sense of ownership and prevent illegal poaching and trading of animal parts across the borders.

4.6.2. Undesirable health implications and major challenges

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Animal products are highly prone to contamination, enzymatic degradation and microbiological infections and they are often the source of Salmonella infections that can cause acute diarrhoea and endotoxic shock if not pre-treated properly (Alves & Rosa, 2005). In general, there is only limited research conducted to prove the claimed clinical efficacy and undesirable health implications of animal products used in traditional medicines or zootherapy (Alves & Rosa, 2005; Alves et al., 2010). In BSM, the animal products are never used raw or straight from animals. They are pre-processed or detoxified using traditional methods prior to final product formulations. The pre-processing methods are solely based on the ancient traditional pharmacopoeic textbooks, Shel-gong shelphreng (1994) and ‘khrungs d.pe dri-med shel-gyi me-long (1995). Not even a single method has been clinically validated for their safety and efficacy and therefore, the question arises on whether these traditional methods are effective in controlling the transmission of zoonotic infections or microbial pathogens. What is even more challenging is that most of the animal products derived from farmed animals are imported from India, which are quite often prone to adulteration and cross-contamination. Use of low quality or adulterated animal parts could be highly risky and may proliferate unforeseen health complications in consumers. Maintaining the quality of the imported animal ingredients is a very demanding task requiring costly equipment and advanced multi-disciplinary expertise. At MSP, there exist only physiochemical, Thin Layer Chromatography and High Performance Thin Layer Chromatography testing facilities and protocols to assess the quality of animal products. There is urgent need to establish the testing facility at MSP to enable them in determining the microbial and parasitic pathogenicity level of the medicinal products derived from animal ingredients. Following modern hospital protocols on handling the biological samples/ingredients

would

avoid

cross-contamination,

infections

and

parasite

transmissions to the patients in future. Therefore, there is urgent need to train procurement

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personnel (at MSP) on good collection practices and safe handling of the animal ingredients including organs, tissues, bones, blood, secretions and excretions. Other major challenges that prevent BSM from obtaining quality and safe animal ingredients include religious sentiments and cultural belief of some of the Bhutanese. The government’s recent plan to establish abattoir or meat processing units inside the country to improve the meat quality and curtail its import from India has been met with disdain and strong objection from the staunch Bhutanese Buddhists communities (Dema, 2015). The religious sentiments are so strong that even the domestic and the farmed animals are restricted from killing. Such principles, beliefs and regulations do not guarantee sustenance and the quality of zootherapy in Bhutan. Different religious precepts could also influence consumers’ attitude towards zootherapy. For examples, porcine and bovine derived drugs are not accepted by Hindus, Muslim and Sikhs people (Eriksson et al., 2013).

4.6.3. Implications of strong conservation by-laws Bhutan is considered one of the leaders in conservation of both flora and fauna. More than 72 % of the land is still under forest cover and it is considered one of the 10 global biodiversity-hotspots par excellence in the world (Wangchuk, 2011). The strong conservation by-laws of the country prevent plants and animals from illegal utilisation and trade. Moreover, experts at MSP express that hunting and killing of wild animals contradict with people’s Buddhist-based belief that all living things must not be killed. Most medicinal animals described or currently used in BSM (n = 38; 84.4 %) are caught wild and many of them are of conservation concern. As many as 27 out of 45 species that we have identified here are either on the IUCN Red List of Threatened Species (IUCN, 2016-3) or CITES List (Convention on International Trade in Endangered Species of Wild Fauna and Flora (CITES, 2016) or Bhutan Forest Laws (MoAF, RGoB, 2016a, 2016b) (Fig.4). 15

Hunting and poaching of wild animals are strictly prohibited by the ‘Rule 64 (1) a-c’ under the ‘Forest and Nature Conservation Rules, 2006’ (MoAF, RGoB, 2016a) and ‘The Forest and Nature Conservation Act of Bhutan, 1995’ (MoAF, RGoB, 2016b). Some wild animals including Manis crassicaudata É Geoffroy (Indian Pangolin), Bubalus bubalis (water buffalo), Ursus thibetanus G. [Baron] Cuvier (Himalayan black bear), Elephas maximus (Asian elephant), Panthera tigris (Tiger), Moschus leucogaster L (Himalayan musk deer), Capricornis thar Hodgson (Himalayan Serow), and Pseudois nayaur Hodgson (Himalayan blue sheep) are listed under schedule I (lists of totally protected wild animals) in ‘The Forest and Nature Conservation Act of Bhutan, 1995’ (MoAF, RGoB, 2016b). These strong conservation by-laws and religious sentiments of some people in turn has forced MSP (government owned pharmaceutical factory) to import many farmed animal ingredients from India at exorbitant prices. For example, 1.5 kg of ghi-vam from farmed Bubalus bubalis (also obtained from cows) was imported from India at Nu 38,250,00 (US $ 55,115.274) (Nu 2,550 (US $ 36.74)/g) in 2016. As a result, the quality and sustainability of zootherapeutic practices in Bhutan remains uncertain.

5.

Conclusions and future direction

Animal derived natural products are important ingredients in both modern and traditional medicines. In Bhutan, the BSM is supported by the country’s rich biodiversity of fauna and flora. Analysing the bodies of literature on BSM, we found 73 natural products belonging to 29 different families were derived from 45 different species of animals (36 vertebrates and 9 invertebrates). Out of 45 species, 13 of them are used for formulating as many as 87 current polyingredient products for treating more than 124 illnesses. The BSM require many animal species including endangered ones, whereby continued exploitation could drive them to extinction. Although, rare animal ingredients such as Rhinos horn, bear bile and musk pod are still listed in the current BSM formulary book (to reflect the 16

original formulation), they have been banned from using BSM since 1960s. They are either substituted with plants or not put in the processed products. Both the law enforcement agencies and MSP believes that the use of rare, endangered and protected species must be strictly prohibited. However, it would be also worthwhile to explore the possibility of raising some of the rare animals (that have medical benefits) especially musk deer in open space fenced rangelands, and sustainably utilising them strictly for treating patients. According to the IUCN Guidelines (Glowka et al.1994), the exploitation of a given species is likely to be sustainable if: 

It does not reduce the future use potential of the target population or impair its long-term viability;



It is compatible with maintenance of the long-term viability of supporting and dependent ecosystems; and



It does not reduce the future use potential or impair the long-term viability of other species.

Currently, animal parts are obtained mostly from farmed animals consumed for their meats, which are imported from India. Since the products imported from India have been implicated with cross-contamination, it would be good to source them from within the country. Establishing the meat processing in the country and buying the required animal parts from the same supplier that is being certified by Bhutan Agriculture and Food Regulatory Authority (BAFRA) would very much reduce cross-contamination, microbial poisoning and parasite transmission to patients. There is also need to develop the capacity of MSP to analyse the animal ingredients for the presence of microbial and parasitic infections, and other adulterations. Training on modern hospital-based approach for collecting and handling the biological samples/animal ingredients is essential for MSP personnel. Even the traditional methods of pre-processing and detoxification methods must be subjected to scientific studies to find out if they are effective in preventing or controlling the transmission of animal related infections to the people through 17

consumption of BSM products. Since plants are often used as substitute for these rare ingredients, it would be interesting to conduct chemical profiling and biological activity screening in the two extreme sources (plant and animal sources) and find out the relevance of substitution. The animal ingredients that we have taxonomically identified here contain enormous ethnomedical information that could help in modern drug discovery projects or could be potentially used in modern medicines. Ethnobiological information has always played a vital role in modern drug discovery programs. An analysis by Fabricant and Farnsworth (2001) on the origin of the drugs developed between 1981 and 2001 showed that 80 % of 122 plant-derived drugs were discovered as a result of chemical studies directed at isolating the biologically active substances from the plants used in traditional medicines. Animals have been also methodically tested by pharmaceutical companies as sources of drugs to the modern medical science (Launet 1993). For examples, the angiotensinconverting enzyme (ACE) inhibitors like captopril, enalapril, and lisinopril, which were developed from a component of snake venom (Bothrops jararaca), are in the top twenty bestselling medicines in the world (Costa-Neto, 2005). Thus, there is huge potential for the medicinal animals used in BSM to navigate future drug discovery as well as deliver income to the poor farmers through commercialisation of farmed medicinal animals, which ultimately has positive bearing to the country’s Gross National Happiness (Wangchuk and Tobgay, 2015). However, while venturing into pharmaceutical or agribusiness business exploration, care must be taken to address the following areas: 

If a pharmaceutical company or an agribusiness firm develops a product based on traditional resources or wisdom, the traditional owner of the ethnomedical knowledge or countries that provide the raw genetic materials must be rewarded with a fair share of profits. This requires signing appropriate material transfer and intellectual property rights agreements.

18



It is critical that the medicinal applications of the animal products is compatible with an environmental conservation by-laws/program wherein the use of natural resources occurs in such a way that human needs and protection of biodiversity are both guaranteed. It is important to maintain biodiversity to provide future chemo-diversity and provide drugs for target diseases that will emerge in the coming years.

Conflict of interest The authors declare that we have no conflicts of interest in this study.

Author contributions KY collected the data, taxonomically identified the animal species, translated the traditional uses of animal parts used in BSM, analysed data and wrote the manuscript. PM helped with the identification of animal parts and writing manuscript. PW designed and supervised the study, taxonomically identified the animal species, analysed the data and wrote the manuscript.

Acknowledgement We acknowledge Menjong Sorig Pharmaceuticals (MSP) for their administrative support. We are particularly grateful to Mr. Samten (Pharmacognosist), Mr. Singye Wangchuk (Procurement officer), Drung-tsho Dorji Nidup, Drung-tsho Dophu, Drungtsho Yeshi Dorji (retired) and sMenpa Jigme Dorji, who all works at the National Institute of Traditional Medicine (NITM), National Traditional Medicine Hospital (NTMH), MSP and Ministry of Health, for their valued participation in the interview and discussions of this study. We highly appreciated Drung-tsho Dorji Nidup, Drungtsho Yeshi Dorji and 19

sMenpa Jigme Dorji for helping us to identify and transliterate ethnopharmacological uses of individual animal ingredients.

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Fig. 1. Number of animal species described as remedies in BSM textbook and their taxonomic category Fig. 2. Different parts of medicinal animals described as ingredients in BSM. Fig.3: Animal parts used or cited as ingredients in the current formulations. Ursus thibetanus is substituted by plant parts - Delphinium brunonianum and Pleurospermum amabile. Moschus moschiferus is substituted by Veronica cephaloides. Rhinoceros unicornis is no longer used in formulations. Fig. 4. Status rating of animal species by national and international by-laws. CITE Convention on International Trade in Endangered species of Wild Fauna and Flora. BFLs - Bhutan Forest Laws (Forest and Nature Conservation Rules, 2006; Forest and Nature Conservation Act of Bhutan, 1995). IUCN Red List - International Union for Conservation of Nature Red list of Threatened Species.

Table 1 Total animal ingredients described in the Sowa Rigpa (g.so-ba-rig-pa) literature and used by folklore medicines and their individual ethno-pharmacological uses Ethnopharmacological uses (Dictionary of Tibetan Sowa Materia Medica, Rigpa Zoological Commo Part 1998; Shel-gong- Stat Family (local name n name used shel-phreng, us ) 1994; name Formulary of Traditional Medicine of Bhutan, 1983) Stegodontid Fossilia ossis Dragon ‘brug Bone and Prevents wound NA ae Mastodi rus fang bone from rotting, heals injuries, inflammatory fever, and heals bone fracture and 25

Ethnopharmacological uses (Dictionary of Tibetan Materia Medica, 1998; Shel-gong- Stat shel-phreng, us 1994; Formulary of Traditional Medicine of Bhutan, 1983) dog bite.

Sowa Rigpa (local ) name

Part used

ña phyis

Bone and shell

Treatment of brain injury & neurological disorders; antipoison

Treatment of V wounds & injuries, heals diarrhoea; removes & heals degenerated tissues of internal wounds

Zoological name

Commo n name

Pteriidae

Pinctada margaritifera L., Pteria margaritifera L. (synonym)

Black-lip pearl shell, Oyster

Ursidae

Ursus thibetanus G.[Baron] Cuvier Selenarctos thibetanus G. Cuvier. (synonym)

Himalaya dom n Black mkhri Bear, s Asian Black Bear

Exudate and bile

Moschidae

Moschus moschiferus L.

Siberian Musk Deer

gla rtsi

Bovidae

Bubalus bubalis L.

Water buffalo

ba's ghi

Musk Cures poisoning pod/gland from mixed , blood substances & other related poisons, snake bite; removes parasites residing inside & outside the body; cures fever due to afflictions from evil spirits & phlegm, heals wind-disorders, boost immune systems, accepting pregnant women, all diseases can be cured. Gallstone Improves heart strength;

Family

NA

V

NA

26

Family

Zoological name

Commo n name

Sowa Rigpa (local ) name

Part used

vam Accipitridae

Aegypius monachus L.

Cinereou s Vulture, Black Vulture

bya rgod thal ba

Flesh, bone, and bile

Moschidae

Moschus chrysogaster Hodgson, M. sifanicus Büchner. (synonym)

Alpine Musk Deer, Himalaya n Musk Deer

gla ba, gla ba’i mjug rus

Flesh and tail bone

Buthidae

Mesobuthus martensii Karsch

Chinese Scorpion

Flesh

Kerriidae

Kerria lacca Kerr.

Common lac insect

sdig pa nag po rgya skyeg s

Exudate (lac/scale )

Ethnopharmacological uses (Dictionary of Tibetan Materia Medica, 1998; Shel-gongshel-phreng, 1994; Formulary of Traditional Medicine of Bhutan, 1983) treatment of stroke & epilepsy Gives warmth & disintegrate goitre, cure afflictions from evil spirits (flesh); bone removes urinary obstructions; bile heals wounds & lungs disorders, cease lhen & lcags dreg; suppress tumour & dries away pus in tumour. Cures post digestion effects & power arising from taking medicines, gives physical strength, clears bile & wind-disorders. Beneficial for lymphatic vessel diseases, ease great pain of diseases, headache & wounds in the chest. Cures nywa-log, kidney disorders, removes urinary obstructions. Cures lungs fever, kidney fever &

Stat us

NT

E

NA

NA

27

Sowa Rigpa (local ) name

Zoological name

Commo n name

Bovidae

Capricornis thar Hodgson, C. sumatraensis Hodgson (synonym)

Himalaya rgya n Serow

Flesh, fats and horn

Rhinoceroti dae

Rhinoceros unicornis L.

b.se ru

Horn

Dries pus & blood in chest, lungs & lymph

V

Potamidae

Himalayapota mon atkinsonianum Wood-Mason.

Indian onehorned rhinocero s Freshwat er crab

Flesh

Cures kidney diseases, removes urinary obstructions

NA

Cervidae

Cervus elaphus L.

Elk, Wapiti, Red deer

sdig srin (ka ka ru), sdig srin dkar po śa rwa

Horn

Cervidae

Cervus elaphus L.

Elk, Wapiti, Red deer

śa rwa’i thal ba

Powder of dried horn

Bufonidae

Bufo gargarizans Cantor.

Asiatic toad, Zhousha n toad

sbal nag

Flesh, liver, bile, eggs and tadpole

Heals chest pain, LC destroy dropsy, pus in lungs & under thin tissues. Cures phlegm disorders, supress great pain of diseases; destroy dropsy. Flesh cures throat LC swelling, heals enlargement or swellings of tongue; Liver & bile cures poisons from mixed

Family

Part used

Ethnopharmacological uses (Dictionary of Tibetan Materia Medica, 1998; Shel-gong- Stat shel-phreng, us 1994; Formulary of Traditional Medicine of Bhutan, 1983) inflammatory fever Cures NT menstruation problems like irregular periods; heals wounds & injuries

28

Sowa Rigpa (local ) name

Zoological name

Commo n name

Viviparidae

Cipangopaludi na chinensis Gray.

Chinese mystery snail, Freshwat er snail

‘bu skyog s

Shell

Canidae

Vulpes vulpes L.

Red fox

va yi glo ba

Flesh

Suidae

Sus scrofa L.

Wild boar

phag khrag

Blood

Suidae

Sus scrofa L.

Wild boar

ga bur Black nag camphor po

Equidae

Equus(Equus) caballus L. Equus Equus caballus L. (synonym)

Horse

rta śa

Flesh

Cures fever due to winddisorders, revitalize physical vigour

Canidae

Canis lupus L.

Common Wolf, Gray wolf, Timber Wolf,

spyan lce

Flesh

Gives warmth, LC cures indigestion, heals swelling, clear obstructions & promote physical strength.

Family

Part used

Ethnopharmacological uses (Dictionary of Tibetan Materia Medica, 1998; Shel-gongshel-phreng, 1994; Formulary of Traditional Medicine of Bhutan, 1983) substances/associ ated poisons, eggs cures diarrhoea; flu related diseases. Tadpole suppresses plague, cancer. Destroy parasites, dry dropsy in the chest or in the pericardium, clear urinary obstructions. clear pus in lungs, eliminate excessive expectoration Cures poisoning, chronic phlegm & prevent their spread Flu, treatment of gallstone

Stat us

LC

LC

LC

NA

29

Family

Zoological name

Commo n name

Sowa Rigpa (local ) name

Part used

Ethnopharmacological uses (Dictionary of Tibetan Materia Medica, 1998; Shel-gong- Stat shel-phreng, us 1994; Formulary of Traditional Medicine of Bhutan, 1983)

Wolf

Colubridae

Ptyas Big-eyed dhumnades rat snake Cantor. Coluber dhumnades Cantor. Zaocys dhumnades Cope. (synonyms)

sbrul gyi śa

Flesh

Equidae

Equus (Asinus) Donkey, asinus L. domestic ass, Burro Batrachuperus Western pinchonii Chinese David. mountain salamand er

boṅ thor khrag

Blood/tail Dries pus in the blood limb joints

NA

da byid smug po, gang sbal

Flesh

V

Himalaya rtsang -Agame, pa Himalaya nAgama, Agamid lizard

Flesh

Hynobiidae

Agamidae

Paralaudakia himalayana Steindachner, Agama himalayana Steindachner. (synonym)

Cures indigestions, poison from mixed substances

Revitalize physical vigour, develops sexual instinct, promote semen production, cures fever due to kidney disorders. Flesh cures mkhal grang, promote sexual instinct; brain cures head injuries; bile heals post digestive effects or power arising from taking medicines, help in healing wounds & growth of new flesh under

NA

NA

30

Sowa Rigpa (local ) name

Zoological name

Commo n name

Bovidae

Pantholops hodgsonii Abel.

Tibetan antelope, Chiru

gtsod

Passeridae

Passer montanus L.

Eurasian tree sparrow, common sparrow

mchil pa

Columbidae

Columba rupestris Pallas.

Hill pigeon

phug ron

Family

Part used

Ethnopharmacological uses (Dictionary of Tibetan Materia Medica, 1998; Shel-gong- Stat shel-phreng, us 1994; Formulary of Traditional Medicine of Bhutan, 1983) curing wounds.

Flesh, Flesh cures NT blood and bilious fever & horn beneficial for rlung ldan; blood & horn cures fever due to intestinal disorders, diseases of womb & breast etc, phlegm disorders, goitre & suppress gzerrigs. Flesh Lightens body & LC becomes energetic, promote sexual instinct; cures liver diseases & fever due to wind-disorders Flesh, Flesh lightens LC skull, body & gives brain, physical strength, excreta promote semen and production. Skull feathers & brain promotes sexual instinct, swifter desires; excreta heal swellings & dries away pus. Feathers cures lungs related disorders 31

Sowa Rigpa (local ) name

Zoological name

Commo n name

Accipitridae

Haliaeetus leucoryphus Pallas.

Pallas’s laṅ fish eagle thaṅ rtse

Leporidae

Lepus oiostolus Hodgson.

Woolly hare

ri boṅ sniṅ

Heart

Bovidae

Bos mutus Przewalski. Bos grunniens mutus Przewalski (synonym)

Wild yak

‘broṅ khrag

Heart blood (preferen ce) or its other blood

Cypraeidae

Monetaria moneta L. Cypraea moneta L. (synonym)

Money cowrie

Canidae

Canis lupus familiaris L. Canis familiaris Linn. (Synonym)

Dog

‘gron Bone bu chun ba (’gron thal) khyi Flesh lce

Family

Part used

Flesh

Ethnopharmacological uses (Dictionary of Tibetan Materia Medica, 1998; Shel-gongshel-phreng, 1994; Formulary of Traditional Medicine of Bhutan, 1983) Revitalize physical vigour, suppress ‘byung gdon. Cures evil afflictions, psychotic episodes & fits, depression & other heart related disorders. Relieve pain due to diseases. Beneficial for wind disorders in the heart & heart pain.

Destroys benign tumour, Stops bleeding from injuries, dries away piercing pus & lymph Heals wounds & injuries

Stat us

V

LC

V

NA

NA

32

Family

Zoological name

Commo n name

Bovidae

Ovis aries L.

Sheep, mouflon

Corvidae

Pica pica L.

Blackbilled magpie

Muricidae

Rapana bezoar L. Buccinum bezoar L. (synonym)

Murex snails, rock snails

Ethnopharmacological uses (Dictionary of Tibetan Sowa Materia Medica, Rigpa Part 1998; Shel-gong(local used shel-phreng, ) 1994; name Formulary of Traditional Medicine of Bhutan, 1983) lug Flesh, Cures fever due rman bone, bile to phlegm rdog and brain disorders, pa zhi improves physical strength (flesh). Bone cures winddisorders, fever, diseases of womb, breast etc. also heals prolonged headache due to wind disorders. Bile cures post digestive effects & power arising from taking medicines; heals stitched wounds & prevents wounds from growing bigger. Brain cures phlegm & wind related disorders, dizziness. skya Flesh Ease away post ga’i digestive effects śa & power arising from taking medicines; disintegrate goitre. duṅ Bone Cures acute bsregs tumour, thal concretion under the skin, swellings; dry & remove pus &

Stat us

NA

LC

NA

33

Sowa Rigpa (local ) name

Zoological name

Commo n name

Bovidae

Capra hircus L.

Domestic ra goat khrag

Blood

Meloidae

Mylabris phalerata Pall.

Beetle, Chinese blister beetle

byan pa dmar khra

Flesh

Cricetidae

Arvicola amphibius L.

chu je

Flesh

staggi-om

Milk

Family

Felidae

Eurasian Water Vole Panthera tigris Tiger L.

Manidae

Manis pentadactyla L.

Apidae

Apis cerana Fabricius.

Chinese Pangolin

chu srin sder mo (na gi) Eastern sbran honeybee g-rtsi

Part used

Ethnopharmacological uses (Dictionary of Tibetan Materia Medica, 1998; Shel-gong- Stat shel-phreng, us 1994; Formulary of Traditional Medicine of Bhutan, 1983) lymph.

Anti-poison; NA heals skin diseases & eczema Heals paralyse, NA removes worms in the blood nadis of the brain (arising from ‘khugs pa), removes urinary obstructions. Treatment of LC meat poisoning

Boost immune E system & gives fair complexion. Cures wind & bile related disorders Scale Cures sinew CE fever, prevents expression of poison, joins opened veins & arteries. Honey Sweet in taste, NA collected warm in power & from bees cure diseases of the stomach & spleen. It is tonic & dissolves the cancerous tumours of a phlegm disease called mid ‘chus. 34

Sowa Rigpa (local ) name

Family

Zoological name

Commo n name

Part used

Bovidae

Bos taurus L.

bamar

Butter

Suidae

Sus scrofa domesticus Erxleben.

Domestic cow, Aurochs Domestic pig

phagkhrag

Blood

Manidae

Manis crassicaudata Gray.

Indian Pangolin

na'kyi

Scale

Pythonidae

Python bivittatus Kuhl. P. molurus bivittatus Mertens. (synonym)

Indian Rock Python, Tiger Python, Burmese python

sbrulchenmkhri s-pa

Bile

Pythonidae

Python bivittatus Kuhl. P. molurus bivittatus Mertens. (synonym)

Indian Rock Python, Tiger Python, Burmese python

sbrul- Fats chenmtshil

Ethnopharmacological uses (Dictionary of Tibetan Materia Medica, 1998; Shel-gong- Stat shel-phreng, us 1994; Formulary of Traditional Medicine of Bhutan, 1983) It is also useful for cataracts & cure phlegm & lymph fluid disorders when used as a vehicle for their medicines. Heals wounds & NA injuries Cures NA poisonings, chronic phlegm & prevent them from spreading Heals bone E inflammation; anti-poison, heals torn veins and arteries Bile of a python V is beneficial for all types of bile disorders; kills & removes intestinal worms; viral infections; heals cuts and wounds; prevents wounds from spreading Indicated for broad spectrum medications, improves eyesight, heals stitched wounds & prevent them from spreading. 35

Ethnopharmacological uses (Dictionary of Tibetan Sowa Materia Medica, Rigpa Zoological Commo Part 1998; Shel-gong- Stat Family (local name n name used shel-phreng, us ) 1994; name Formulary of Traditional Medicine of Bhutan, 1983) All medicines derived from snakes need to be detoxified. Elephantida Elephas Asian gaTooth Prevents nose E e maximus L. elephant, dza(ivory) bleeding when Asiatic dan exposed to elephant smoke from burnt teeth Elephantida Elephas Asian Tusk Protect from or e maximus L. elephant, dispel 360 gdon Asiatic diseases elephant (inflicted by lha klu, gza’ btsan etc), infectious diseases, plague epidemic and poisons applied or made by mixture. Elephantida Elephas Asian Tail fur Ease or heals e maximus L. elephant, toothache when Asiatic fumigate with tail elephant fur Note: All identified animal species were cross-checked with ‘The IUCN Red List of Threatened Species for their conservation status. NE: Not entered in IUCN catalogue; NA: Not Assessed; LC: Least Concerned; NT: Nearly Threatened; V: Vulnerable; E: Endangered; CE: Critically Endangered. Same species of medicinal animal with more than one Sowa Rigpa names are not assigned separate conservation status. Table 2 Animal ingredients which are currently used in the BSM and their substitution by plants

Zoological name

Common name

Sowa Rigpa (local) name

Part used Uses

Substituted by plants and remarks

36

Sowa Rigpa Part used (local) name sbrang- Honey rtsi collected from bees

Zoological name

Common name

Apis cerana Fabricius.

Eastern honeybee

Bos taurus L.

Domestic cow, Aurochs Water buffalo

ba-mar

Butter

ba's ghi vam

Gallstone

Chinese mystery snail, Freshwater snail

‘bu skyogs

Bubalus bubalis L.

Cipangopaludina chinensis Gray.

Kerria lacca Kerr. Common lac insect

rgya skyegs

Moschus moschiferus L.

gla-rtsi (sbrul dug)

Siberian musk deer

Uses

Substituted by plants and remarks

Sweet in taste, Not required warm in power & cure diseases of the stomach & spleen. It is tonic & dissolves the cancerous tumours of a phlegm disease called mid ‘chus. It is also useful for cataracts & cure phlegm & lymph fluid disorders when used as a vehicle for their medicines. Heals wounds No required & injuries

Improves heart strength; treatment of stroke & epilepsy Shell Destroy parasites, dry dropsy in the chest or in the pericardium, clear urinary obstructions. Exudate Cures lungs (lac/scale) fever, kidney fever & inflammatory fever Naval Cures gland poisoning from mixed substances & other related poisons, snake bite; removes

Imported from India

Not required

Not required

Substituted by Delphinium brunonianum Royle, and Pleurospermum amabile Craib & W.W. Smith 37

Zoological name

Pinctada margaritifera L.,

Common name

Sowa Rigpa (local) name

Part used Uses

Black-lip pearl shell, Oyster

ña phyis

Bone and shell

Himalayapotamon Freshwater atkinsonianum crab Wood-Mason.

sdigsrin

Flesh

Ptyas dhumnades Cantor.

Big-eyed rat snake

sbrulsha

Flesh

Rapana bezoar L.

Murex snails, rock snails

duṅ bsregs thal

Shell

Rhinoceros unicornis L.

Greater b.se-ru one-horned Rhinoceros, Great Indian

Horn

Substituted by plants and remarks

parasites residing inside & outside of body; cures fever due to afflictions from evil spirits & phlegm, heals winddisorders, boost immune systems, accepting pregnant women, all diseases can be cured. Treatment of Not required brain injury & neurological disorders; antipoison Clears urinary Imported from obstructions India

Breakdown of unwanted blood clots & improves circulation; cures constipation; improves eyesight Cures acute tumour, concretion under the skin, swellings; dry & remove pus & lymph. Heals chest pain, dries away pus in lungs & under thin tissues

Not used in the formulation

Not required

Not used in the formulations.

38

Zoological name

Common name

Sowa Rigpa (local) name

Part used Uses

Substituted by plants and remarks

Rhinoceros Sus scrofa L.

Wild boar

phag khrag

Blood, black camphor

Ursus thibetanus G.Cuvier.

Himalayan black bear, Asiatic black bear

dommkhris

Bile

Cures poisoning, chronic phlegm & prevent their spread; flu and treatment of gallstone Heals opened veins, heals wounds, injuries & cures diarrhoea;

Not required

Substituted by Veronica cephaloides Pennell

Fig.1

39

Fig.2

Fig.3

Fig.4

40