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Introduction: Stroke is characterized by high incidence, recurrence rate, and mortality. Patients with acute ischemic stroke (AIS) who are ineligible for acute revascularization therapy require more effective medication treatments. A previous clinical study showed that Ruyi Zhenbao tablets and Baimai ointments might be effective against AIS; however, high-quality clinical evidence supporting their application in AIS is lacking. To explore the efficacy of the two classic Tibetan medicines in the treatment of AIS, a randomized clinical trial will be conducted in patients with AIS who are not eligible for thrombolytic treatment. Methods: A prospective, randomized, multiple-center, double-blinded, placebo-controlled, and parallel-group trial will be conducted. We shall randomize 480 eligible participants to either the intervention or the control group. The distribution ratio of each group will be 1:1:1:1, including 120 patients each in the dual-medication group, the Baimai ointment group, the Ruyi Zhenbao tablet group, and the placebo group. Participants will be treated with medication for 8 weeks, and they will receive three follow-up visits: at 4 weeks (D29), 8 weeks (D56), and 90 days (D90) after commencing treatment. The primary outcome will be D90 change in the simplified Fugl-Meyer score from baseline to posttreatment. The secondary outcomes are as follows: D29 change of simplified Fugl-Meyer score from baseline to posttreatment; proportion of participants whose D29 NIHSS scores decreased by four or more points from baseline D90 proportion of subjects with mRS score of 0–2 (inclusive); D90 proportion of subjects with Barthel index score ≥95; D90 incidence of cardiovascular and cerebrovascular events. Safety endpoint includes mortality within 90 days; proportion of subjects with adverse events/serious adverse events within 90 days. Conclusion: This research protocol lays a solid groundwork for its practical execution. This study is poised to serve as a reference for other Tibetan medicine researchers, contributing to the reduction of stroke-related expenditures globally and, in turn, benefiting a broader population of stroke patients.

Objective. To explore evidence for the traditional Tibetan medicine, Zhi Byed 11 (ZB11), for use as a uterotonic. Methods. The eleven ingredients in ZB11 were chemically analyzed by mass spectroscopy. A review was conducted of Western allopathic literature for scientific studies on ZB11's individual components. Literature from Tibetan and other traditional paradigms were reviewed. Results. Potential mechanisms of action for ZB11 as a uterotonic include laxative effects, a dose-dependant increase in smooth muscle tissue peristalsis that may also affect the uterus smooth muscle, and chemical components that are prostaglandin precursors and/or increase prostaglandin synthesis. A recent RCT demonstrated comparable efficacy to misoprostol in reducing severe postpartum hemorrhage (PPH) (>1000 mL) and greater effect than placebo. Historical and anecdotal evidence for ZB11 and its ingredients for childbirth provide further support. Discussion. ZB11 and its ingredients are candidates for potentially effective uterotonics, especially in low-resource settings. Further research is warranted to understand the mechanisms of action and synergy between ingredients.

Introduction Hypertension is a leading cause of cardiovascular disease, which is the cause of one-third of global deaths and is a primary and rising contributor to the global disease burden. The objective of this systematic review was to determine the prevalence and awareness of hypertension among the inhabitants of Tibet and its association with altitude, using the data from published observational studies. Methods We conducted electronic searches in Medline, Embase, ISI Web of Science and Global Health. No gender or language restrictions were imposed. We assessed the methodological characteristics of included studies using the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) criteria. Two reviewers independently determined the eligibility of studies, assessed the methodology of included studies and extracted the data. We used meta-regression to estimate the degree of change in hypertension prevalence with increasing altitude. Results We identified 22 eligible articles of which eight cross-sectional studies with a total of 16 913 participants were included. The prevalence of hypertension ranged between 23% and 56%. A scatter plot of altitude against overall prevalence revealed a statistically significant correlation (r=0.68; p=0.04). Meta-regression analysis revealed a 2% increase in the prevalence of hypertension with every 100 m increase in altitude (p=0.06). The locations and socioeconomic status of subjects affected the awareness and subsequent treatment and control of hypertension. Conclusions The results from cross-sectional studies suggest that there is a significant correlation between altitude and the prevalence of hypertension among inhabitants of Tibet. The socioeconomic status of the inhabitants can influence awareness and management of hypertension. Very little research into hypertension has been conducted in other prefectures of Tibet where the altitude is much higher. Further research examining the impact of altitude on blood pressure is warranted. [ABSTRACT FROM AUTHOR]

This article emerges from a workshop titled "Producing Efficacious Medicine: Quality, Potency, Lineage, and Critically Endangered Knowledge," held in Kathmandu, Nepal, in December 2011. An experiment in collaborative event ethnography (CEE), this workshop brought together Tibetan medicine practitioners (amchi) from India, Nepal, and Tibetan regions of the People's Republic of China, with anthropologists who have been working with amchi for decades. This workshop focused on practitioners who still compound and prescribe their own medicines, in an era when such practitioners are declining in number due to rapid commoditization of Tibetan medicines, shifts toward standardized mass production, institution-based education, and the implementation of pharmaceutical governance regimes derived from biomedicine. The workshop aimed to encourage knowledge exchange between diverse practitioners and generate new, collective, and more nuanced anthropological knowledge about Sowa Rigpa epistemology, history, theory, and practice. Our method of choice was collaborative event ethnography formulated as a workshop in the most literal sense of the word: a space where artisanal forms of praxis were honored and where material things-medicines-were collectively made. This article discusses how this CEE experience departs at the level of scope, structure, and implications from other collaborative, event-based ethnographic practice described in the anthropological literature. [ABSTRACT FROM AUTHOR]

Several letters to the editor are presented in response to the article on the research on collaborative event ethnography (CEE).

Classical Tibetan medicine is closely related to Buddhist philosophy. This article describes how die study and meaning of sexual differentiation in Tibetan medicine is deeply rooted in Buddhist texts and philosophy. The article pays particular attention to die Buddhist theory of mutual dependence of birth and death and on the medical ways of explaining the determining of sex. While Tibetan medicine approaches sexual differentiation by examining its various determinant factors, thus aiming to improve understanding of the human body and diseases, which manifest differently in men and women, in Buddhist philosophy sexual differentiation is perceived as a fundamental, natural phenomenon of human life that forms a key in Tantric practices to comprehend the nature of mind and thence attaining the highest state of mind. The article consists of a translation of die first chapter of a Tibetan medical book on obstetrics, including a newly written introduction to the Buddhist interpretive frame employed in the chapter. [ABSTRACT FROM AUTHOR]