1Most of the scientific research carried out on medical traditions is ethnopharmacological research. That is to say that it studies local pharmacopoeias in a biological rather than a social perspective, whose final purpose is to determine the pharmacological efficiency of a plant, a part of a plant or plant extract. When reading its definition, it seems that ethnopharmacology is a biocultural science par excellence: it is "the scientific interdisciplinary investigation of the full set of matters of vegetal, animal or mineral origin and the relevant knowledge and practice such as they are implemented by vernacular cultures to modify the condition of living organisms for therapeutical, curative, preventive and diagnostic purposes." (Dos Santos and Fleurentin, 1990).

2However, the "interdisciplinary investigation" in the field often comes down to botany or ethnobotany and the rest of the multi-disciplinarity takes place in laboratories for specifically pharmacological work. We only have to read the specialised journals to see that the huge majority of the publications relate to the analytical results of vegetal extracts or botanical identifications. In fact, all the other disciplines involved in ethnopharmacology (in particular history and anthropology) are seldom applied in practice. Ethnopharmacology gathers very disparate skills and a multidisciplinary approach in teams seems to be the only viable solution. In reality, ethnopharmacology essentially means studying pharmacopoeias and medicinal plants in particular, with scant attention paid to the social or cultural dimension of the use of these plants. The ethnopharmacologist, by the very nature of his judgement, contrasts materialism with mysticism and, as Jean Benoist states, uses anthropology as an "excipient".Pharmacopoeias are the object of research programmes, with for instance the W.H.O. which clearly claims its orientation: "the contribution WHO might make to promoting respect for and maintenance of, indigenous knowledge, traditions and remedies, in particular their pharmacopoeia"1. The term "pharmacopoeia" is understood according to its biological and therapeutic potential, but detached from its socio-cultural environment. It is a kind of "deculturated ethnopharmacology", it is in fact bio-pharmacology. Surveys on Tibetan medicine, which this chapters deals with, fall into similar traps. A representative number of the institutional community formed by the corresponding practitioners and national and international pharmaceutical research aims at giving a scientific character to Tibetan medicine, according to standards foreign to this medical system. The nature of clinical protocols, the mix of nosological categories, the clear distinction between the ritual and the object (the plant), or the interpretation of the state of health represent major impediments to this kind of survey because they may vary from one system to the other and create formidable aporias2. During the International Conference of Tibetan Medicine, which took place in Lhasa, in July 2000, many presentations focused on pharmacological research aimed at determining the efficacy of Tibetan medicine by the use of biomedical paradigms. Biomedicine was systematically regarded as a final standard (CMAM, 2000). This behaviour is supported by both, Tibetan specialists and foreign researchers such as Jürgen Aschoff who clearly states in his book (1996): "There are only marginal attempts to develop Tibetan medicine in a modern scientific direction. Perhaps such a development is undesirable, as any ‘development' in Tibetan medicine over the last few centuries has always meant a mingling with western medical science without any ‘serious' verification of the effectiveness of traditional medicine". This position restricts the approach to biological and pharmacological considerations, and reinforces the orientation of the studies in the respective fields.

3Our intention is to show that medicinal plants and pharmacopoeia in general, beyond their primary therapeutic functions, can shed light on other aspects, when we take a look at their expression in society. They mediate changes in the social world, are an expression of the culture and of the range of the challenges between tradition and modernity. This chapter aims to show the diverse dimensions of ethnopharmacology, by emphasising the biological, social and cultural characteristics of plants. As a symbol of the pharmacopoeia, the plants represent the prism through which we observe the changes stemming from the arrival of modernity in one of the most landlocked places of the Indian sub-continent: Ladakh. That north-western Himalayan area is considered in this research as a systemic set in which each entity forming the social and environmental universe is interlinked and makes up a complex subject to various regional socio-economic changes. The goal is not to integrate the material and the immaterial, but to refuse the dualism of the separation between the biological and the social.

The plants: an expression of culture

4Plants can be certainly studied according to their very biological characteristics, what we call "deculturated ethnopharmacology". Nevertheless, the idea is to present them according to their ethnopharmacology, i.e. according to their pharmacology seen from the angle of considered medical thought. Because, beyond its own theoretical aspects, the study of a vernacular pharmacology reveals the way of thinking of a given culture which put the plants back in their global context.

5In the case of Tibetan medicine, pharmacology is based on Buddhist philosophical foundations underlying the medical practice. It gives us information on the representation of the universe, expresses the interdependence between the elements, the relationships between man and nature and the similarity of constitution between microcosm and macrocosm. Indeed, the Tibetan pharmacology is closely linked to the five cosmo-physical elements (sa, chu, me, rlung and nam-mkha). They are the fundamental components of the human body and the universe and are sometimes misunderstood when they are translated by earth, water, fire, air and space (ether) with their literal meanings. Actually, each substance is a set of all the elements, one of them being predominant. For the human being, that predominance produces some physical and emotional characteristics. The similarity to the universe is proof of the reciprocal effects between man and environment. The pharmacology of ingested substances, medicines or food, is a function of three categories of agents: the six basic tastes (acid, sweet, salty, bitter, astringent, spicy), the three post-digestive tastes (sweet, acid, bitter) and the eight potentialities of drugs (heavy, light, unctuous, pungent, cold, warm, blunted, incisive)3. These different tastes and intrinsic powers are the result of a particular combination of the five cosmo-physical elements4 and act accordingly on the physiological system.

6The human physiology is based on a humoral theory, similar to that of the ayurveda, which underlies all the organic and mental activities. The three humours (nyes-pa: rlung, mkhris-pa and bad-kan), respectively translated by wind, bile and phlegm are divided into five distinct categories characterised by peculiar properties. They are regarded as the physiological functional units of the five cosmo- physical elements5: rlung (wind) giving rlung, me (fire) giving mkhris-pa (bile) and the association of sa with chu giving bad-kan (phlegm). Illness is interpreted as a dynamic imbalance of the three humours (i.e. an initial imbalance of the five elements), which are physiological entities as well as formidable pathogenic agents (Meyer, 1988). Thus the drugs and food administered aim at re-establishing the energetic balance and each of them has properties in line with the increase or decrease of the five elements and the three humours6. 12

7Aetiology is presented according to two types of causes: immediate causes and fundamental causes (root or primary causes)7. The immediate causes are the three humours and their modifications according to patterns of accumulation, erection and sedation. The erection phase corresponds to the pathological phase, after accumulation, by favourable factors related to behaviour, dietetics, seasonal changes, repercussions of past actions, wrong treatment, poisons and evil spirits (Meyer, 1988). The fundamental causes are the three mental poisons (attachment, hatred and mental obscuration), which, according to Buddhist perceptions, are the fruits of Ignorance (ma-rig-pa), in the sense that the individual has a wrong perception of phenomenal reality8. Attachment gives rise to wind, hatred to bile and mental obscuration to phlegm. Nevertheless, illness can be treated by eliminating the immediate causes, instead of eliminating the mental poisons (Cantwell, 1995). Ultimate cure of the three poisons, and therefore of illness, corresponds to Enlightenment and is regarded as reachable through Buddhist religious practice9. Tsering Phuntsog, Ladakhi practitioner of Tibetan medicine, points out that "the only solution to stop any illness is to beat Ignorance, to reach Enlightenment. For this, one has to understand that nothing has existence in itself, that everything is empty and impermanent, this can be done through constantly practicing the Buddha's Teachings10. Medicines cannot eradicate the three mental poisons, they especially have an influence on the effects resulting from immediate causes. But amchi [practioners of Tibetan medicine] should advise their patients to help them realise the very nature of disease. When a patient comes to see me with a high rlung, I try to tell him about desire and attachment, to make him aware". Tibetan pharmacology underlines the role of religion within medicine and medicine appears as a medium for Buddhist doctrines. Tibetan medicine is justified through a pharmacological scientific reasoning, inasmuch as the observed phenomena are interpreted according to links binding them and giving them coherence (Meyer, 1988), the theory of interdependence and the conception of non spiritually realised life as suffering, which is a fundamental conception of the Buddhist thought. The analytical line of thought going from the plant as an object of study ends up giving us information on the close relationship linking Tibetan medicine and Buddhism11. It is a clear example of how an ethnopharmacological survey can bring certain aspects of culture to light.

8The plant is surrounded with other elements indicating the religious framework. According to Tibetan memory, the very origin of Tibetan medicine and of some plants is based on divine conceptions. Tibetan medicine has sacred origins which date back to the teachings of Sangye Menla, the "Medicine Buddha". This deity is considered as a therapeutic emanation of Shakyamuni, the historical Buddha, who used to practice in the large Indian empire of Ashoka before transmitting medical science, including pharmacopoeia and Buddhist spiritual teachings to Tibet in the 7^th century AD. The teachings of the Tibetan art of healing are written in a fundamental book, Rgyud-bzhi, also called the Four Medical Tantra, in which religious references are explicit12. The texts also shows that some medicinal plants have a celestial origin, such as the various myrobolans, (a-ru-ra, Terminalia chebula Retz., skyu-ru-ra, Embellica officinalis Gaertn. and ba-ru-ra, Terminalia belerica Roxb.) or saffron (gur-gum, Crocus sativus L.)13. According to Clark (1995), some flowers and some kind of calcite or mineral exudates, in addition to their reviving properties, enable those meditating and yogi to live with little food and indulge in their practice with improved mental states. The divine leaves a print in the components of the pharmacopoeia, because any material thing has supposed potential healing properties, as stated by the Buddha, or according to the stories by his personal physician Jivaka. As revealed by Buddhist mythology, the historical Buddha asked his disciples to search nature for something without any medical property. None of them managed to do it, and this produced empirical evidence of the "world as medicine" (Clark, 1995).

9The religious and cultural framework also surrounds the amchi's everyday acts. The divine can reinforce his/her medical practice, as in plants collection. It is a ritualised act that has a symbolic meaning and reveals religion. It enables the intrinsic power of the plant to be increased when it takes place on holy days14 and goes with reciting mantra15, mantra are aimed at reinforcing the plant's effects thanks to Sangye Menla's divine help or at using this cosmic guide to find them16. These actes de paroles (performative sentences) are not only aimed at representing the immaterial, they are themselves matter. They have an effect because supernatural forces are constrained to be present. Of course, the collection also depends on biological requirements (flowering, budding, root collection times, etc...), which, from experience, helps gather the plants, or parts of the plants, at their best physiological state according to the use that has to be made of them. This conception was often regarded as tirelessly repeated actions that finally went down in tradition (Levy Strauss, 1962). The use of plants in drug preparations is also a particular form of religious expression. The amchi recites mantra while grinding the plants to powder and making his preparations. Once prepared, he imagines the plants transformed into nectar and gifted with an additional power. Then, treatments become religious offerings. The amchi puts a part of it on his/her altar or offers it as a symbol to Sangye Menla and ingests another part of it so that he/she can benefit too from the blessings of the plants turned into a medicine17. The practitioner uses the plant to create an object (the medicines), which, in turn, exerts its divine influence on the creator of the object. Tsering Tondup, Ladakhi amchi from Lingshed, gives us information on another functional side of the ritual set: "the ceremony increases the treatment powers, it purifies negative or impure things. If one or two plants [in a treatment] are missing, the ceremony makes it possible to have the same effect". Those comments confirm the role of religion in therapeutics. The ceremony can improve the therapeutic power of the medical preparation but is also a substitute for missing plants and brings its very therapeutic dimension to light.

10In these two examples, the plants reveal the force of the ritual aspect as an adjuvant to the physical remedy. The plant is actually the meeting point of the various efforts made to get the Power, which is forced to come into action through codified and culturally meaningful acts. The plant is regarded as a symbol of the medico-religious act. Then, it becomes possible to consider the plant, beyond its biological dimension, as the main medium of the symbolic efficiency of the provided treatment and as the physical representation of immaterial cultural representations. The relationship between the practitioner and the plants assure his/her contact to the divine and, to some extent, makes it appear closer. The amchi's meeting with the Medicine Buddha through those ritual and religious techniques suggests, affirms and confirms that a brilliant description of reality is present in many Mahayana texts (Birnbaum, 1979), among which, some of the medical texts. The plant catalyses the practitioner's acts, group cohesion is re-ensured and the community heritage is passed down. The plant becomes a relation acting through an indirect dialogue. The materia medica carries the cultural identity and becomes part of a social project.

Plants and modernisation in Ladakh

11Plants are both, threatened by a modernising society and maintain potentially the majority of the population in good health. The plants appear as public health challenge in the rural and with little access to biomedicine areas of Ladakh. But, the changing social world has consequences on the biological world. The plants act as a philtre to us and reveal the changes in the Ladakhi community. The environmental deterioration, in other words the social causality of a biological deterioration, the rise of biomedicine (new healing techniques, competition with plants), the apparition of new pathologies (socio-cultural epidemiology) or the development of tourism and infrastructures related to it are parameters that enable us to consider the plant as a meeting point for the biological and the social settings. But, before going one step further, we have to know the context of our analysis: contemporary Ladakh.

12Due to its nodal location, Ladakh has always been in contact with various cultures and merchants from the salt route traders or thanks to the trading with neighbouring Tibet. It is described by some 18th century authors as a large caravanserai inhabited by traders from numerous lands and disparate cultures (Dollfus, 1989). China's invasion in Tibet in 1959 put an end to commercial cultural and educational relationships between the two regions, which had the same religious allegiance (ibid.). But the most radical change and the most drastic disruption happened with the emergence of modern industrial society. The two predominant causes of social changes in Ladakh are tourism18 and Indian military troops (which arrived in 1948 and in 1962, i.e. after the Indo-Pakistani and the Sino-lndian conflicts). They represent the main driving forces of local economy and favour the cultural diffusion process. The third side of this triangle of causality is the regional developments resulting from the various development policies implemented in the North Western part of the Himalayan area, and is closely linked the two other factors. Building roads and therefore developing means of transport modified the relationship with space.

13But, the geographical space is also a relation space, and those changes have meant increasing social relations. Bringing people nearer to each other led to multiplying the relationships between them. Those relationships became more and more diverse and intense and contributed to what Guy Rocher calls "general stimulation" (1968). Today there are roads between Ladakh and the Himachal Pradesh state and Srinagar in Kashmir. The end of almost total inaccessibility made it possible to get new commodities and diverse materials, as well as new technologies and to set up the market economy, which weakened the subsistence society and the traditional exchange systems. Money, though existing before, gained in value. The population, concerned with new desires, felt it necessary to seek new ways to get rupees, symbol of success and, beyond that, of social integration. Developing biomedical structures and an education system from the model of a technological-based and economic-based society rather than an ecological-based society had an impact on the emerging modern society. Then Ladakh's local powers switched from traditional frameworks to modernity in every aspect of society, especially as far as dominant traditional medicine is concerned. The consequences of this include the realignment of social values, which are interlinked in the complex muddle of the different factors of modernisation and a strong impact on the environment, which leads to change in local medical practices.

The plants: between biological and social challenges

14The plant as a social item is an inversion of perspective because our point of view on society stems from a fundamentally biological object. The biological stakes carried by the plant are potentially a matter of public health, especially in the remote areas of Ladakh. However, most of the reasons involved in changes in supply modalities of plants, drug preparation, paying traditional doctors or prescriptions given to the patients, are social reasons; and their repercussions have a potential influence on the therapeutic sphere. Observing the world through the plant widens our ethnopharmaco- logical spectrum and thus reveals pharmacopoeias as a certain form of social expression.

The supply of plant resources

15Road building has altered supply modalities. More specifically, a road between Leh and Manali in Himachal Pradesh facilitates the importation of Tibetan medicinal herbs, which are not endemic in Ladakh. It is also easier for amchi to reach the Rothang pass, which is well-known for having a rich flora, in a two-day bus drive instead of a three-week walk. They can find plants that are unavailable in Ladakh. But this quest for plants also has bad consequences, since all rural practitioners, who are also farmers or shepherds, are away from home for some fifteen days at a time and cannot assist the family with the agricultural commitments. Rural amchi gather their plants from the surrounding mountains and may exchange them with those collected by other village practitioners. However, as degradation increases through general environmental mismanagement, plant populations decline. Roads also have negative repercussions on Ladakh's plants since accessibility has improved, bringing motorised vehicles and a great number of visitors. Growing pollution and tourism exert real pressures on the natural environment. To carry bags and food tourists have horses or mules, the number of which may reach several dozen for a single group. An increasing number of tourists are causing environmental disturbance, especially amongst the nomadic pastoralists. For example, by occupying non-permanent settlements, identified by the buildings used by nomads for over-nighting their animals, the tourists' hired mules and horses graze on fodder grown for nomads' livestock. The sheer number of tourist groups trekking in these areas results in hundreds of hired animals grazing in places that are supposed to be occupied later by the nomad's animals (their transhu- mance is according to the availability of pasture). Amchi Motup, from Kharnak, states that: "trouble with tourists is that their animals eat our animals'grass. (...). Last year [1997] we had to buy fodder in order to survive the winter. We always buy some, but now we buy more and more fodder. We went and saw the D.C. [Development Council] to report this problem and they told us to ask tourists coming to our camps for more money. We already charge twenty rupees a tent, but twenty rupees is not enough to feed a single animal, and we own hundreds of animals (...). Now I must go even farther to find my [medicinal] plants." In addition, "professional collectors" (retailers, large-scale Tibetan institutions...) exacerbate the situation yet further. According to Thinley, the Men-Tsee- Khang of Dharamsala (Tibetan Medical and Astro. Institute, TMAI), one of the world's largest manufacturers of Tibetan medicine, is being accused by environmentalists of over-exploitation of Himalayan natural resources following a recent 25 % increase in output (Thinley, 1997). Tenzin Cheudrak, the Dalai Lama's private amchi, acknowledges this: "when I arrived in India, Tibetan doctors had less than eighty substances at their disposal from which to make their traditional remedies. I got down to seeking raw material, most of it coming from Tibet or Ladakh" (quoted by Tager, 1999) . Nevertheless, it is important not to under-estimate the collection of the Ladakhi amchi and its consequences on the availability of plants. As stated by a representative of the Forest Department, amchi may be one of the major causes for the extinction of some medicinal plants. They generally collect the plants without leaving enough to allow their reproduction. The entire plant is taken even when only a part is useful. The roots are taken out, often needlessly, prohibiting the plant to grow again. Other practitioners collect more plants than they really need for their medical practice. They take benefit of the market economy and the increasing demand in medicinal plants to serve their own financial interests and needs.

16Social factors usually have a faster impact on the environment than nature itself. Urban development, demographic growth and tourism, rather than pollution factors or natural disasters, are the main reasons for environmental deterioration. In some built-up, cultivated or livestock-grazed areas, fewer plants now survive. From this position, we can draw a pattern revealing the passage from nature's appropriation by man to nature's exploitation by man. The relationship of man and nature changes with modernity (Eder, 1996), and recent environmental pressures can restrict the availability of wild plants. Today, amchi are aware of the decline or even extinction of certain medicinal plants from their own local areas and villages19. In 1998, Amchi Tashi Boulou from Hanu Gongma summed up the situation by saying: "It is tougher to gather plants today, because I am an old man, and walking in mountains is more tiring". I put the discussion back in an environmental context. "Actually it is easier to find them, because nowadays there are some plant shops in Leh", he comments. I write it down and ask him other question trying to be as clear as possible: "No, actually it is more difficult to find them in the field because I am almost 60 and my knowledge of them is always improving as I get older. I know more plants and therefore it is more difficult to find all of them. Sometimes I have to go to Manali" [a two and a half-day bus drive from his village], he says. I ask him again about that and he answers: "There are fewer plants here today because there are more people, cultivation and animals". This amchi provides an overview of the demographic, economic, and environmental issues, as well as of the fact that the remaining practitioners are getting older. These are as many parameters linked to modernisation, arising in a survey initially dedicated to medicinal plants.

17Environmental changes also affect the amchi through the rising cost of raw materials, resulting from their increasing rarity. Species of Aconitum provide a good example, since many have become rare in the wild. This plant only grows in some regions of Ladakh, which, according to Tsering Phuntsog, the person responsible for the department of amchi medicine, are kept secret and non-disclosed. However, he says that he sees less and less of this plant in the mountains and that he is surprised to notice that the prices of some Aconitum species have increased in New Delhi20. Our hypothesis is that the rise of prices goes together with plant rarefaction in Ladakh and in other Himalayan regions. The relation of cause and effect probably is not as linear as that, but we can suggest that a link between those two factors exists. Moreover, a rise in price in New Delhi is immediately followed by a rise in price in Leh. Now, all the amchi buy their plants, in addition to the gathering, in medicinal plant shops and price rising represents a hindrance to their activity. The availability and cost of medicinal plants may have direct impacts on the local economy as well as public health.

18The cash economy has had an enormous effect upon the economy of Tibetan medicine. Today there are medicinal plants shops in Leh where the amchi, without exception, come to buy their products. The stores opened in the early 90's and have enjoyed considerable success. While amchi living in rural areas continue to collect some of their own plants in the wild, amchi of urban areas only buy their plants in shops of the main city. In these stores, amchi may find parts of plants, animal medicinal matter, medicinal stones and ready-made pills. The stores have both positive and negative consequences on local medical practice. They force the amchi to pay for the raw materials they need, whereas few of them have the total cost of their treatments paid back (only some practitioners of the urban areas are paid). These shops offer fixed prices, and their recent rise plunged the practitioners into turmoil because a lot of them had got used to easily buying their products. The amchi who stock up in this way for winter often wait until the last moment and may end up stuck by the snow and then forced to spend the long winter months without any medication. An incident of this kind took place in October 1998 due to the effects of abnormal weather (early snowfalls), which led to a government intervention to provide a village with medicines. However, the medical shops also sell plants that are not available in Ladakh, and so make the medical practice easier by providing all the existing ingredients of the pharmacopoeia. Tibetan medicine is indeed a conglomerate of various medical systems and, although some endemic plants have been replaced by non-indigenous plants (Meyer, 1986), there are some plants that come from outside Ladakh and outside the Himalayas21. They may come from some sub-tropical Indian regions or from China, such as some Menispermaceae. These stores appear as an expression of the free market and tend to replace the local traditional exchange system. So medicinal plant supply meets new modalities, concomitant with the changes in the Ladakhi society and refers to the plant as a health stake, but also as a part of the new economic market.

19Because of the new displays offered in the stores (products in parts or powdered products) identifying the plants may be a further difficulty, especially for the younger amchi. But practitioners have developed an art in recognising their products thanks to organoleptic characters, and the real problem, according to them, is the substitution of plants in medicinal preparations. This is generally done for financial reasons, the retailer will substitute cheaper plants for expensive plants leading, at best, to ineffective remedies and, at worst, to harmful ones. Some plants may be substituted with close relatives or look-alike species. But, if this reasoning can be acceptable as far as plant chemistry is concerned, even if it can be hazardous (between two Aconitum, one is toxic and the other one is not), in the Tibetan traditional system, each plant has its own pharmacological characteristics (taste, post-digestive taste, potentiality) which also depend on where and how it grew, and nothing guarantees that two plants of the same gender have the same properties.

20Plant shortages lead to other consequences for some amchi. If an amchi can no longer obtain the plants he requires, he may be reluctant to treat patients. This can result in a social backlash where amchi may be accused of laziness. "I have not enough plants to treat my patients, that is the reason why I avoid visiting them. But they think that I am an idler, that I do not want to treat them", Sonam Dorje, Lingshed, 1998. This remark illustrates a paradoxical scenario where a conflict arises between an obligation to treat and practical issues of supply. By being unable to assume his medical duty, the amchi may fall into disrepute and unintentionally contribute to the undermining of his own practice. There are several kinds of supply problems in Ladakh covering social, environmental and economic aspects.

Drug preparation and delivery

21The Tibetan materia medica lists 2294 substances, divided into eight categories: the precious medicines, medicinal grounds, medicinal stones, medicinal essences, thang medicine, drugs taken from trees, drugs taken from living beings and the simples (Meyer, 1988). They are administered through different galenic forms: concentrated or non-concentrated decoctions, powders, pills, pastes, medicinal butter, medicinal ashes, medicinal wine, stones and vegetable compounds. In addition to natural substances, the practitioner may resort to external techniques such as bleeding, moxibustion, medicinal baths in hot springs, massage, external applications, golden needle and as a last resort, small surgery.

22Rural practitioners make relatively few pills. The evocated reasons for this are the lack of time or adequate equipment. Amchi are mainly involved in agricultural work, for which they often have access only to an insufficient domestic workforce because of children going to school and relatives emigrating to urban areas22. Some amchi complain of not having the necessary equipment. In this case, they refer to more modern equipment that can be found in Leh or Dharamsala. The introduction of modern processing techniques causes changes in the preparation of plants and especially in its output efficiency. The practitioners of Leh make many more pills in less time and with less difficulty. The following comments show the gap between rural and urban areas. "I grind my plants to powder with two stones. It is tiring and the result in not as good as when it is made by machines. I know they can be found in Leh, I have seen some already. I need one, because some day I will not be able to make drugs anymore", Amchi Motup, Kharnak. This amchi specifies that he does not know any of his rural counterparts who own such a machine. He only saw them in Leh, the District capital. His remark expresses well the consuming spiral that is slowly taking place. Technology is not necessary for hundreds-year-old preparation modes, and the real issue rather arises in technical terms. Some amchi, like some of their fellow Ladakhis, want new and easy things for fear of "not being able to do without it". Therefore, the rural amchi mostly deliver powders or dry plant formulations. But, the observance of these treatments is not easy because posologies are constraining and the treatment duration, as well as a symptomatic healing, takes, according to Ladakhis, generally much more time compared to biomedicine. So patients find in biomedicine more comfort and a packaging that respects the new standards (plastic packaging, cleanness, delivery made by educated practitioners...). The imported medical model has lead to a desire of "prompt healing" and offers a new and modernising medical image, which undermines traditional medicine practices. The tendency to rapidity and to modernity, caused by the beginnings of a change of time perception, leads to negligence of the initial steps of the treatment23 (alimentary and behavioural recommendations) but also leads to neglecting questioning the patients24. The particular institution of the biomedical ideology forces the amchi to give the patient a physical treatment and, therefore, to go against the progressiveness rules displayed in the medical texts. The prescribed treatment is directly plant-based, and thus, plants get a new temporal position in therapeutics.

23The galenic formulation in the form of pills enables the medicines to be better stored. Now, in an extremely cold and arid place like Ladakh, storing dry plants does not present real problems. In any case, it is not the main reason for making pills from home. The older amchi say that they used to make their pills, but that now, they buy them in Leh in case of an urgent need. They reveal once again the role of the medicinal shops. Some practitioners claim that pill making takes too much time and that they can treat with exactly the same medicinal compounds in powder form without the patient giving much importance to it or the efficiency of the treatment being altered. But this last assertion does not fit to the medical texts because pills should be used at specific moments of a pathological development. The efficiency of the treatment, according to Tibetan medical theory, should be affected. Moreover, it seems that patients appreciate pill deliveries. The proof of this counter-example is that when the amchi are provided with such medicines, whether homemade or exogenously prepared, patients ask for them first and in any case, therapists deliver them first. One might say that pills are a galenic form closer to the various biomedical conditionings and that they are easier to use than powders. However, the gap is clear between the theory, the discourse of the amchi and the actual practice. The study of a delivery register of a Tibetan medicine rural centre has revealed that pills, provided by an NGO after the practitioners themselves had assessed their needs, had been distributed in only fifteen days, whereas the stock was supposed to last for six months. However, at the end of the aforementioned period, a lot of dry plants were left to the amchi. These results indicate preferences in the kind of medicines to be delivered and may reveal patients' expectations. Moreover, the pharmaceutical support of the governmental department for amchi medicine only includes products prepared in pill form. But, the government also carries an image of progress and modernity and represents the rise of new powers in the fields of traditional therapies. So, products in the form of pills embody a higher standing compared with the other forms of therapy. This is reinforced by the fact that most of the delivered treatments in amchi clinics in Leh, which tend to look like biomedical clinics, are delivered in the form of pills. The governmental, or even non-governmental amchi who deliver this kind of product ensures his/her status within the community because s/he is in harmony with the modern frameworks and meets the new forms of a changing society. Plants, with their numerous physical forms and formulations, play on symbols within the representations of the social world.

Practitioners' remuneration modalities

24The Ladakhi society has been able, in the course of its history, to find the necessary solutions to allow an optimal practice of Tibetan medicine. When Ladakh was a kingdom, amchi were granted lands as payment and one of the highest social statuses. Later on, villages were provided with a "field of medicines" in which the inhabitants used to work alternately and thus enabled the amchi to spend most of his/her time gathering raw materials, making drugs and visiting patients. Amchi, in some regions only, were exempt from community tasks (going to the main city, common work, transporting natural fuel) for the same purpose. The payment of the amchi was therefore based on the close cohesion of the community. The pharmacopoeia, through medical practice, was then funnelling the flow of exchanges. Nowadays, plants and formulations deriving from it are delivered according to a traditional remuneration system corresponding to the "don et contre-don" pattern as defined by Marcel Mauss. The practitioner administers the treatments against some work done by the healed patients in his fields or against some commodities. The market economy has changed the nature of these exchanges and amchi paying for medicines in Rupees is becoming widespread, as patients working in the amchi's fields dwindles. Modernisation in Ladakh makes people stay with their families, leads to a growing individualism and a marked loosening of social links. Repercussions logically concern the community support given to the amchi.

25Today, the amchi of the villages have to buy some of their plants, go to Leh, if not to Manali, for their plant supply, and therefore are forced to have money to make their drugs. Rural practitioners currently are in a dead end situation, as they distribute medicines almost for free25 whilst having to pay for essential raw materials. They claim that they cannot ask for money explicitly without being called a niggard or accused of breaking tradition, but they must, or should, give help to any patient to keep their medical commitments. Because, if the "don et contre-don" system is "in reality done and returned" (Mauss, 1950), it is, in theory, a voluntary and deliberate act and cannot be asked for without leaving the exchange system and therefore, the traditional framework. However, some practitioners such as Tsultim Gyatso do not give up the idea of integrating their practice into the new social model. "The fault does not lie with the village inhabitants but rather with the amchi who do not want to ask for money. The village residents know that today the means of transaction is money and if they want to, and understand the final use of it, they can pay. So, amchi have to inform them (...). Amchi do not know how to use their mind to use money in return. Even if they have money, they use it for other purposes.(...). Amchi think more about money than about the [medical] system, whereas they should use money through and for the system". This practitioner from Leh lies within a resolutely modern practice, he owns two private clinics, travels around Europe and negotiates with foreign sponsors. This pitfall shows the two main tendencies, and the respective tensions stemming from them. The issue highlighted by the changes of practitioners' remuneration modalities is a fundamental challenge for the medical practice.

26Further to this, there are - if they are properly operating - government health centres, which deliver medicines for free and favour the depreciation of the image conveyed by traditional medicine. Free drug delivery completely deletes the "contre-don" and thus contributes to destabilising the traditional social organisation and to confirming, through biomedical hegemony, the possibility to get treatments without a counter-part, which favours the process driving rural amchi to money difficulties. From Chief Amchi Tsering Phuntsog's point of view, delivering drugs for free clashes in a certain way with the care given to the treatment by the patient. The "contre-don" seems, in popular representations, to be a guarantee for the value of what is given: "If people get drugs for free, they do not take care of them. If they pay, or give something in exchange, they become conscious of the value of drugs and take them in a better way. They think that free things have no value". Value is the real price of the object, more than the object itself, and if you suppress this price, the object - in this case the drug - is regarded as less important, even if for village residents, not to pay is logically more attractive.

27As an answer to this, by choice or by default, amchi have found some solutions, such as starting profitable activities (setting up supply shops for hikers, working as pony-men for trekking agencies etc) or opening private clinics, working with fixed prices in urban areas. Others have been integrated into government programmes or associations of a social nature and yet others have been forced to give up their activity.

28Studying the income modes gives us much information. It sheds light on the new economic system, on the changes in social organisation and individualism, on the amchi's opinions and on the role of institutional structures, whether governmental or not, involved in the development of amchi medicine. The pharmacopoeia then becomes a micro-economic stake, the target of development projects and reveals the destabilisation of the social organisation.

Plants: between tradition and modernity

29This chapter concludes with this paragraph which gives a new point of view on pharmacopoeia considering it as a particular interface between tradition and modernity. Our general idea, beyond casting particular light on culture and on the changing world, is to understand the interplay between traditional and modern spheres through an apparently simple thing - pharmacopoeia. Tibetan pharmacopoeia can seem very modern: based on an ecological ideology, it is a symbol of a "return to the roots", a political weapon, it has economic potential, and medicine that is regarded as "natural" in the west, it has therapy closely connected with the elements and it is considered as a Buddhist one.

30The pharmacopoeia appears as having economic potential thanks to the hope it brings in therapeutic terms. Furthermore, it arouses the interest of international pharmaceutical research, symbolically expresses knowledge and tradition stemming from a centuries-old medical science and is opposed to the modern technological world. The Tibetan pharmacopoeia meets with the free market economy, yet it is this meeting that is mainly responsible for the break in the social organisation and the traditional remuneration modes of the amchi. It lies within contradictory veins, between development or promotion and deterioration or decline. But if the means are limited for the development of amchi medicine in Ladakh, it is because it does not seem to be a good export product. The situation is far different in the Men-Tsee-Khang of Dharamsala, which is the main institutional medical structure for the exiled Tibetans, for whom medicine appears as an excellent consensual representation of the Tibetan culture26. What is taken for popular or folk culture may actually be considered as a reconstruction strategy designed by an elite close to the political leaders. The case of Ladakh is very different, but the current situation may lead us to think that the Ladakhi authorities may see the economic potential for Tibetan medicine. Indeed, it is well known that the Sino-Tibetan conflict sparks off fund rising and general interest as far as Tibetan culture, or Tibetan Buddhism is concerned.

31The pharmacopoeia can be seen as a part of the cultural identity of the Ladakhis who claim a proprietarial interest in them, setting up strict local controls and resisting any foreign applicants for botanical research. Beyond juridical protection, ethnic identity is expressed through the plants. Sympathising with traditional forms of medicine, or with their pharmacopoeias, is also a modern identity pattern. Returning to native values is one of the modern world's orientations and developing traditional forms of medicine, or defending them politically, lies nowadays within a contemporary field. Traditional pharmacopoeia represents forms of medicines that are experiencing a certain renewed fame. These then become, finally, modern forms of medicine.

32Pharmacopoeias are a symbol of the environment and through their ethnic dimension, in the case of the defence of flora, stimulate local awareness about the natural environment, its value and wealth (as well as socio-cultural environment). The plants are central to conservation policies and embody a new symbol of modernity, the subject of environmental conservation, but preserving tradition (Tibetan medicine). In this respect, we understand why the plants, in their diverse aspects, can be seen as valuable political tools, able to catalyse traditional and modernist networks: plants as culture and plants as a challenge in the new conservation policies.

33The environmentalist movement, through the plants, leads to a new stage in the political institutionalisation regarded as a construction factor of the modern society. Nature becomes the field for a social integration by naturalising the logic of interaction between individuals. Environmentalism, to the benefit of medical traditions, can adopt an ecological line and turn its political movement into a cultural lobby in a society strongly dependent on the environment. Plants are able to crystallise networks, by representing the nodal point of their intentions. They throw light on the meeting between a therapeutic Nature and Nature as a social fact, and therefore force the transition from plant to man, from botany to anthropology.

34This double bipartition, "social-biological" and "tradition-modernity", enables us to see the plants representing a turning point in the contemporary evolution of the Ladakhi society. This chapter, focused on some significant examples, shows the pharmacopoeia as a pertinent window through which to understand social and cultural settings in a given community. A survey on plants, which escapes from simply biological perspectives and naturalistic explanations, does not have to be restricted to symbolic efficiency or psychobiology. It expresses the interactions between man, as an individual or in society, with nature and the changes undergone by both of them in the process. The pharmacopoeia appears as a first-rate biocultural element and reveals the dialectic interplay between man in society, nature and culture from both material and conceptual points of view. It is an expression of society, which takes care of and tries to heal, by proceeding from a multifarious dynamic deeply rooted in the social world. The plant conveys culture and depends on social life, and confirms that a global understanding, as ethnopharma- cology is defined, must take into account the work taking place in laboratories as well as the social aspect of the plants.