Palliative care in cancer management -Siddha

This is an article presented for World Siddha Day- 2013

Dr.T.Thirunarayanan

Centre for Traditional Medicine & Research

4A, 4^th Cross Street,

Mahalakshmi Nagar, Adambakkam, Chennai- 600088

E-mail: ttn64@sify.com

Disease burden due to epidemics caused by vector borne diseases like dengue, swine flu, malaria are unabated on one hand, with no respite in communicable diseases like tuberculosis, hepatitis, HIV, the incidence of non- communicable diseases like stress, obesity, hypertension, diabetes, Ischemic heart disease and cancer pose a major challenge to the Public health managers of a developing country like India. There is a possibility of reducing the burden of the vector borne diseases by effective mosquito control, improving sanitation, making potable drinking water available to the mass. Early lifestyle modification, better diet control, exercise can reduce the burden of diabetes, obesity and hypertension. The large majority of the cancers except the tobacco caused cancers as of today is not preventable and once afflicted severely affects the quality of life or life threatening. 

The incidence of cancer is given in the Table- 1

Type in Men	Percentage	Type in Women	Percentage
Oral, including lip and Pharynx	22.9%	Cervical	17.1%
Stomach	12.6%	Stomach	14.1%
Lung	11.4%	Breast	10.2%

Source;  Dikshit R et al, Cancer mortality in India: a nationally representative survey. Lancet. 2012 May 12;379 (9828):1807-16.

Leukemia is common among children, Prostrate cancer a very common problem among men in US (25%) is not that prevalent in India. Cancer of the Urinary Bladder constitutes 5% of the cancer cases.

Cancer Drugs according to classical Siddha texts

Classical literature of the codified system of medicines of India namely Siddha and Ayurveda have detailed descriptions of cancer of the different organs of the body, their clinical manifestations, treatment procedures and drug formulations. ‘Puttru’, ‘Kazhalai’ are the terms used in Siddha, and ‘Arbuda’ ‘Gulma’ in Ayurveda for neoplasm. Many texts on Inorganic Pharmaceutics ‘Rasaoushadi’ list various drugs that could be used in neo-growth. A detailed literature search on the drugs indicated in the classical Siddha texts and are currently being manufactured by Siddha drug industry are the following.

‘Agathiyar Kuzhambu’ (Source-Agasthiyar Amutha Kalai Gnanam) A drug containing purified inorganics like mercury, red orpiment, yellow orpiment, dehydrated borax, rock salt, and herbal drugs like  aconite, croton seeds asefoetida, black mustard, ajowan, black cumin and castor oil is indicated as topical application in mammary cancer   

‘Kaantha chendooram’ (Source- Agasthiyar paripooranam 400) A drug containing purified  lode stone, sulphur, lead wort powder processed with eclipta juice, lime juice, milk, egg albumin, madder latex is indicated in Abdominal tumor

‘Poorna chandroodayam’ (Source- Theriyar Karisal 300) A drug containing Gold filling, Mercury, Sulphur processed with red cotton flower juice and banana rhizome juice is indicated in cancerous ulcers.

Mahaavallaathi (Source - Bogar Vaithyam 700 and Vallathi 600) A drug containing all herbal ingredients milk, ghee and honey- china root, emblic and belleric myrobalan, dry ginger, lesser galangal, Indian spikenard, cinnamon bark, picrorrhiza, telichery seeds, shiva’s neem, black musale, nutmeg, c;loves, cinnamon leaves, black pepper, cardamom, ajowan, long pepper, psoralea, coriander seeds, embelia, nigella, leadwort root, celestrus, withania, saffron, korochan, purified marking nut, brown sugar, is indicated in cancer.

Kowsiker kuzhambu  (Source  Kowsika muni nool)

Chebulic myrobalans, black mustard, rock salt, asafoetida, dehydrated borax, purified mercury, purified red orpiment, long pepper, purified yellow orpiment, cumin, picrorrhiza, purified aconite, purified croton seed kernel, carbonized coconut shell, palm jiggery, daemia leaf juice, coconut milk is indicated in cancer with daemia juice

Rasakanthi mezhugu (Source-Pulippani vaidhyam 500)

Purified mercury, purified sulphur, calomel, yellow orpiment, lode stone, blue vitriol, calamine, litharge, dry ginger, ajowan, turmeric, embelia, sweet flag, clove, china root, purified marking nuts, chebulic myrobalan, nigella seeds, wild cumin, beetle killer, yew leaf, raisins, long pepper, lesser galangal, costus, celastrus, fennel, cardamom, nutmeg, black pepper, cumin, psoralea, oak grass, long pepper root, rattan cane root, purified nux vomica, purified nux potatorum, astercantha seeds, sesame seed, horse gram, copra, acalypha fruticosa root, azima root, withania, corallocarpus root, lead wort root, eggs, palm jaggery is indicated for cancers and cancerous ulcers.

Some drugs like Chandamarutha chedooram, Idivallathy Mezhugu, Serankottai Nei, which are used by healers do not have a direct reference for treatment of cancer in the  texts

Treatment seeking pattern

Centre for Traditional Medicine & Research receives cancer patients at different stages. Difficulty in swallowing, abnormal bleeding, loss of appetite, weight loss, low grade fever, fatigue, altered bowel habits and pain are some of the features with which patients present themselves. Most of the patients come to us with diagnosis from cancer hospitals.

Detailed interactions with the patients reveal increasing number of patients seek remedy from practitioners of Traditional medicines for the following reasons.

• 1.      Most cases are diagnosed very late after metastasis has occurred and the general health of the patient does not permit complete surgical removal as the disease has spread to multiple locations. In spite of removal in rest of the cases where the lesion is localized the possibility of microscopic metastasis cannot be ruled out.
• 2.      The serious side effect of chemotherapy like severe vomiting, diarrhea makes the patient does not continue the treatment for its suggested full course.
• 3.      The possibility of chemotherapy and radiotherapy destroying the normal cells apart from the cancer cells due their cytotoxic effects.
• 4.      Target chemotherapy and monoclonal antibodies therapies are not widely available.
• 5.      The absence of specific cancer treatment hospitals even in many district head quarters is yet another hurdle.
• 6.      Without health insurance, the cost of treatment is prohibitive for most people and they are ill affordable to a vast majority.

Above all there is a trust that the traditional medicine, particularly Siddha can cure cancer is very strong among people.

The following are the different categories of patients who seek treatment at CTMR.

• ·   Patients in advanced stage where all other options of chemotherapy, surgery and radiotherapy are not possible,
• ·         Patients not willing to undergo the orthodox method but wants to be treated with Siddha medicine
• ·         Patients who want supportive therapy- supplementation alongside conventional treatment and
• ·       the last set of patients who have undergone treatment including surgery but want to prevent reoccurrence or with late secondaries.

Pallative Care

The basis of treatment at CTMR is palliative care. Since vast majority come at advanced stages the realistic option is palliative care aimed at improving the quality of life of the patient and their immediate family by providing pain relief, psychological support and administration of specific plant based drugs for which enough evidence are available in classical texts and also evaluated by scientific methods both in-vitro and in-vivo.

The first step in the care is proper counseling to the patient and the attendants on the nature of the condition, the likely prognosis and need for following the suggestions on dietary recommendations, lifestyle modification, abstaining from causative substances like tobacco, alcohol and adation of Kayakalpa methods including breathing exercise, meditation etc.

The dietary recommendation is generally rich in fruits and vegetable salads- baked vegetables rather than deep fried once. Significant reduction in intake of meat products, avoidance of oily, fat rich deep fried spicy pungent diet is also suggested. Depending upon the patient’s ability to sallow porridge, fruit juices, soups are suggested.

Then the administration of drugs. The preferred drug of choice in most types of cancer is Mahavallathy Among the different drugs listed in Siddha this drug is free from inorganic and contains powerful anti-oxidants like Amla, long pepper etc, appetite enhancers like black pepper, clove, cinnamon bark etc. cytotoxics like leadwort and marking nut.

As supportive therapy all patients are provided with a blend of turmeric and Indian gooseberry which are known to quench the free radicals. Withania somnifera, apart from being a drug which sensitize cytotoxic drugs is an anabolic and adaptogen helps the patient in overcoming stress and ensure sleep. Dry ginger or Inji legiyam greatly helps in preventing nausea and vomiting in co-adminstered in patients undergoing chemotherapy. The blend of Indian gooseberry and turmeric is also a hypoglycemic drug and reduces supply of glucose to cancer cells and slows down cell multiplication.

In pancreatic carcinoma and secondaries in liver, Phyllanthus amarus extract is also administered. In conditions of spread to lungs manifested with coughing, Thalisathy churanam is included. In anemia associated with blood loss ‘ Karsalai Karpam’ is also prescribed.

Conclusion

Our observations assure us all these patients including the ones with esophageal, pancreatic cancer, ovarian cancer patient have lived over two years without much of clinical symptom and compromising on the quality of life. It is worth considering the Pallative care approach of Siddha in improving the quality of life of cancer patients.

Faulty disbursement of funds pose threat to cultivation of widely used medicinal plants in TN

Cultivation of widely used medicinal plants has slowed down in Tamil Nadu  as the government subsidies earmarked for the medicinal plant cultivation were not properly disbursed among all the herb growers in the rural areas, it is learnt. Due to lack of financial assistance and technical support, the farmers are unable to cultivate many of the medicinal and aromatic plants which are the source for essential raw materials for commonly used Ayurveda and Siddha medicines. This situation forces the market to increase the prices of the available crude drugs day by day. According to sources close to the plant cultivators, the fund coming to the state horticultural department from the national medicine plant board (NMPB) is disbursed among a few number of farmers, and majority of the cultivators who grow the most needed herbs for Ayurveda and Siddha medicines are being deprived of the benefits. The fund is diverted only for one or two varieties of crops which are not widely used for medicines, they alleged. A technical expert and Siddha doctor in Chennai, who regularly trains the growers and provides them valuable information about plant cultivation, said the government subsidies are benefiting only the exporters of herbal extracts and medicinal plants. All the funds supposed to be disbursed among herb cultivators is going to one or two societies or associations of plant cultivators. He said a total of 180 raw drugs are required for manufacturing the commonly used Ayurveda and Siddha medicines. But the farmers of these widely used plants are unable to avail the benefit of the government scheme. This diversion of funds to selected plant growers forces the farmers of other crops to hike the prices of their produce. He said while disbursing the money, the authorities should consider the most important and widely used plants that are required for the manufacture of Ayurveda and Siddha medicines. The money should not be distributed among a few number of farmers, but should be given to all those engage in the plant cultivation and have linkage to Ayurveda and Siddha industry. He alleged that currently the fund is diverted to some extract exporting units only. In Tirupur alone about 9000 acres of land belonging to over 2000 farmers is used for medicinal plant cultivation. The seeds of ‘Glorisa Superba' produced from the area are exported to countries like Italy where the alkaloid extracted from it is used for the preparation of herbal drugs to fight diseases like cancer, said a plant grower from Tirupur. The cultivation of medicinal plants in Tamil Nadu is the key to meeting the raw material needs of the ayush industry in the state and it offers opportunities for exports of extracts and raw herbs, he said. When contacted Dr T Thirunarayanan, secretary of the Centre for Traditional Medicines and Research (CTMR), said, the needs of the ISM industry need to be assessed and funds should be provided to farmers to cultivate the plants in different agro climatic regions. He said some widely used medicinal plants like Andrographis paniculata, Mucuna pruriens, Saraca asoca (Roxb.) Withania somnifera, Piper longum, Oldenlandia umbellata, Desmodium gangeticam,Centella asiatica. Piper nigrum. Pseudarthira viscid, Trichosanthes cucumerina L Gmelia arborea, Vettiveria zizonoides and Steriospermum colais are now rarely available in the market.

Tibetan Medicine- Siddha Practitioners Interaction

Objective :

 Sow rig pa – The Tibetan Medical System has been officially recogonised by the Govt. of India by including it in the IMCC Act 1970 with due approval of the Indian Parliament in 2010. Since this sy.stem has a lot of commonalities with the Indian Systems of Traditional Medicine      -Ayurveda and Siddha it was decided to understand the commanalities in the area of Basic principles, Drugs & Pharmaceutics, Diagnostic methods and Treatment methods among these systems and also sensitize physicians of the unique speciality procedures of each system.

Organizers

The director of Mee- Tsee-Khang ( Tibetan Medical Astrological Institute) of His Holiness Dalai Lama deputed 16 Tibetan Medical practitioners from TMAI- Dharamsala and its branch clinics (53) functioning across the country to Centre for Traditional Medicine & Research for this interactive meet.

The Local Siddha Partner- CTMR invited 12 Siddha experts (From National Institute of Siddha, Siddha Medical College, Anna Hospital of Indian Medicine,  CCIM E.C member, Siddha Primary health care physician, Varma Physician, Researchers, Private Practitioners and NGO) to interact with the visiting Tibetan practitioners.

Venue and Date

The proceedings took place in the CPR Foundation, Enviornmental Research Centre, Chennai on 8^th and 9^th March, 2013. The delegates also visited Sri Ragavendra Siddha Varma Hospital  the evening of 8^th and National Institute of Siddha on 9^th morning.

First day proceedings

           The proceedings started with traditional invocation in tamil followed by invocation in Tibetian language”Medicine Buddha” . Dr. Nandhitha Krishnan of CPR Foundation welcomed the gathering and explained how the tibetan medicine was able to help cancer patients in chennai and Bangalore This was followed by the inaugural address by Dr. Prof. K. Manickavasakam Director,National Institute of Siddha who appreciated the initiative of dialogoue between two traditional systems of medicines which could further strengthen the systems. The Chief Conservator of Forest and  Director of Sericulture Govt. of Tamilnadu Mr. V. Prabakaran in his keynote address stressed the need of conservation and propagation of medicinal plants, both tropical and high alltitute plants and explained how his department is working towards increasing local production of silk to stop import of chinese silk which could also be done in medicinal plant sector.

The first presentation was by Dr. Thirunarayanan, Secretary, CTMR on the  Basic principles and History of Siddha Medicine where he briefly introduced the system to the Tibetian doctors and also spoke on the scope of collaboration between the two systems. The Basis and History of Tibetian system of medicine was presented by Dr. Sonam Dolkar Oshoe of Documentation & Publication Department Men-Tsee-Khang. The Commonanities where explained by both speakers on the Five Physico cosmic elements. Three humours ( Vata- rlung, Pita- tripa and Kapha- Bad-kan) and the historical exchange between Indian and Tibetan traditional  physicians as early as 7^th Centuary A.D was appreciated by the delegates. The influence of Buddhist thoughts on siddha medicine was clearly spelt out.

 Dr. R.Sudha of Govt. Siddha Medical college Chennai elaborated on understanding disease and diagnostic methods of Siddha while Dr. Migmar Lhamo, Resident Doctor Bylakupee Branch Clinic spoke for Tibetian medicine which was also followed by a question session. The understaning on the Pulse diagnosis and Urine analysis though common for both systems, which does not require any high end laboratory, certain finer details like examining the radial pulse of both hands related to different internal organs of tibetan medicine reminded one of the Chinese pulse diagnosis.

The post lunch session commenced with Vaidya S.Usman Ali’s presentation on Inorganic Pharmaceutics of Siddha. The emphasis on inorganic pharmaceutics in siddha due to non-availability of herbs all round the year, long shelf life of the inorganic drugs, its nano particle size, formulation expertise, requirment of minute dose for short term use and efficacy in addressing nutritional needs (Trace elements) and management of even life threatening conditions.He also explained the intricacies of the detoxifying process of inorganics and mentioned their use only in appropriate condition.The thirty two dosage forms of internal medicine was also touched upon.

 Tibetian medicine pharmaceutics was presented in tibetian by Jamyang Tashi, Head of Pharmaceutical Department of Men-Tsee-Khang and was translated by Dr. Sonam Dolkar Oshoe for the audience. He explained the ten dosage morms – Decoction, concentrate, powder, pills, medicinal paste, medicinal butter,medicinal ash, medicinal wines, gem medicines and herbal compounds. In all 176 drugs are prepared under GMP conditions in his department at TMAI, Dharamsala and distributed to all 53 branch clinics in the country and abroad. He also mentioned that medicines are not being prepared for the purpose of commerce and there is no deviation from the textual reference both in terms of ingredients or process. But however Modern equipments for particle size reduction, cleaning, blending, pill making are used as well as utilities for clean manufacture. Quality parameters for raw material and processing are follwed as per the text Rgyud-bzhi ( Four tantras)

The Topic on Plant medicine resource was also presented by Vaidya S.Usman Ali for Siddha and by Dr. Tsetan Mingyur, Materia Medica Department, Men-Tsee-Khang, Dharamsala for Tibetian medicine. The drug raw materials are classified as gem, stone, soil, tree, musciliginous, shrubs, herbs and animal products. Most plants are common like Chebulic myrobalan, belleric myrobalan, Indian gooseberry, Pushkaramool, kutki etc, There are some exclusive high alltitute plants that are unique to Tibetan medicine. The issue of  non availabity of certain species like musk were also discussed. The issue of ban on mercurial drugs from 2013 Jan and its implication on both systems and ayurveda as well was discussed.

 The entire interactive programme was co-ordinated by Dr. T. Thirunarayanan.

The participants then went on a field visit to Sri Ragavendra Siddha Varma Hospital were a private siddha hospital specializing in varma and other external therapies are being carried out in North Chennai, the tibetan practitioners said it motivated them to take up the accessory therapies of their system with more seriousness in their branch clincs  and the day closed with dinner hosted by CTMR.

Second day proceedings

The morning session started with a visit to NIS and Dr.A.Rajendrakumar presented a overview of the functioning of NIS, its clinical services, academic branches, research, capacity building activities. The visiting practitioners were surprised with huge turn out of patients in the NIS hospital (around 2300 p[er day). They expressed the apprehension that individual patients have to wait for their turn both to see physicians as well as to collect their medicines. The proposal for expansion of hospital services was explained to them by the Director, NIS. They were also taken around the campus to study its flora, particularly medicinal plants used in siddha system.

The post lunch session started with presentation on Role Of Diet by Dr. R. Padmapriya of Centre for Traditional Medicine & Research and by Dr. Sonam Dolkar Oshoe for Siddha and Tibetian medicine respectively. The similarities between the two system of medicines reflected beautifully in these presentations. In fact the incompatabile foods mentioned in both systems were too similar.Dr Bhooma of Ambattur briefed with clarity on Cleansing Therapy while Dr. T. Thirunarayanan introduced External Therapies of Siddha Medicine and Dr. Siddique Ali demonstrated it for frozen shoulder which hogged the attention of all participants. Specialtiy treatment for Tibetian medicine was presented.

Dr. B.Muthukumar Executive committee member of Central Council For Indian Medicine rendered his reflection of the interactive meet. He mentioned gSowa-rigpa and Siddha medicine should also be compared in the areas of reproductive and child care and this was a good platform to debate and many similarities were discussed and there is a good scope for collaborative efforts. Dr. Dorjee Rapten Neshar CMO of the Bangalore unit of Mee- Tsee- Khang made the concluding remarks and expressed his desire for continued interaction between the two systems.

Dr.T.Thirunarayanan, Secretary, CTMR said as both systems have many commanalities that collaborations in areas of drug research, treatment is possible and expressed his desire that Siddha system should emulate the TM in expanding it services to all over the country and subsequently to humankind all over the world. He appreciated that with 300 registered practitioners 53 branch clinics of Mee- Tsee- Khang is functioning all over, then it is time for Siddha too to spread.

Language barrier (Texts of Siddha and training being only in Tamil) is the impediment and it should be overcome. The Dept of AYUSH should come out with Special schemes for Siddha to open centres atleast in all major cities of India with Sizable Tamil population.

Dr.V.Tamilalagan and Dr.R.Sangeetha documented the whole proceedings. Vd.R.B.Ramamurthy, traditional siddha physician also provided his insight.

Time to Act - Mainstream Siddha Medicine

Time to act - Mainstream Traditional Medicine

The initiative of the Govt. of Tamil Nadu particularly the Chief minister has started paying results in containing the 'Panic' caused by the outbreak of the dengue epidemic in Tamil Nadu. Initially there was a resistance from Public health personnel to admit the outbreak, subsequently efforts were taken to get the actual data on the outbreak from both Govt. Hospitals and Pvt. Health providers. The approach to the management of the outbreak was first to identify the actual number of dengue from all fever patients with ELISA in major hospitals and subsequently in major secondary level centres and disease surveillance by making it mandatory for Pvt. clinics and hospitals to inform public health dept. Awareness about controlling mosquito breeding was also made.  The treatment approach was to provide simple Anti-pyretics and wherever necessary platelet transfusion. Along side outbreaks of water borne diseases like Jaundice and Typhoid  also occurred making it difficult for the public health authorities. 

Practitioners of Traditional Siddha  Medicine started using the conventional 'Nilavembu kudineer' which showed promise of controlling fever and different siddha vaidyars suggested different herbs including Adathoda, Manjista, Pidangunaari to improve platelet counts. Social media was full with posts on Papaya leaves. Individual Siddha doctors and Groups conducted Camps to distribute Nilavembu kudineer. That is the point when CM intervened and issued not just a Govt. Order instructing all hospitals to co-administer Nilavembu kudineer and Juice of Papaya and Malai Vembu but released publicity material in both print and visual media. This became a Game changer. More and more people consumed these herbal medicines from Govt. Hospitals, Pvt. Clinics and even as 'Over the counter product'. Studies where initiated at the King Institute, Chennai which reconfirmed many earlier studies on the anti-viral properties of the herbs which Siddha physicians were insisting on. The epidemic is now slowing down but not completely stopped as i write this note ( 22nd Dec 2012).

Now is time for the key interventions needed to mainstream traditional medicine whole heartily and provide a decent budget for the native system of medicine, which time and again stand scrutiny not just in labs but in Clinical set ups.

1. Inspite of the assurance in Tamilnadu Health Policy note of the Present CM (2004) that every PHC will have a siddha doctor, it has not been done so far- Mainly as no new Siddha Wings were sanctioned between 2006-2011. Therefore about 40% of the rural population to do not  have access to Siddha Medicine even within the state. Another 30% have only a limited access as in about 450 PHC Siddha wing operate with contract physicians on a very low salary for 3 days a week. The Chief minister should take personal interest to convert in the first step the part time centres into Full fledged Siddha Wings. With building infrastructure already in place under NRHM  only additional post of Siddha Medical officers and paramedics need to be created and of course supply of quality medicines. The budget would be an additional Rs60 crore /annum (15 lakhs/Centre) Which is not impossible for a State like Tamil Nadu. Subsequently Rest of the PHCs could have Siddha wings in a phased manner.This will greatly reduce the health expense burden of the  people of Tamil Nadu and as Traditional medicine focus on Prevention and Promotive health - Productivity of the state will go up with a healthy population.

2. CM has been kind enough to sanction even a budget for starting an ISM university as early as Feb 2012 but unfortunately  even the spade work has not started. A competent Siddha expert with rich experience in establishing Institutes, Research council and worked closely in framing regulations with adequate expertise in Finance Planning and budgeting and ability to team up with the central govt and get the 'Acts & Rules' in place and mobilize central resources may be appointed immediately as Special officer. He need not have to be an academician as once the University is in place an Academician may be Posted as Vice- Chancellor.

3. All Siddha wings and hospitals which have external therapy facilities under the Centrally Sponsored Schemes need Para medical personnel and the first batch of therapists trained by the two Govt. Siddha Medical Colleges  are already available and they may be posted immediately.

4. It is the right time to fill all vacancies of higher faculties in Siddha Medical Colleges so that hospital, teaching and research activities happen in full swing with some additional infrastructure. 

Ban on industrial use of mercury to affect Traditional Medicine.

The 2nd International Conference on Tibetan Medicine concluded recently in the exile Tibetan headquarters of Dharamshala after three days (27th – 29th October 2012) of in depth discussions and presentations on various aspects of the ancient Tibetan medical system. The conference, jointly organised by the Central Council of Tibetan Medicine, Men-Tsee-Khang, Chakpori Medical Institute, Darjeeling and Department of Sowa Rigpa of the Central University of Tibetan Studies, Varanasi, was held at the Sarah College for Higher Tibetan Studies. More than 300 doctors, representing different medical systems from all over the world, including India, US, Israel, Russia, Mongolia, Spain, Latvia, Italy, China, and Japan among others took part in the conference. According to the organisers, the objective of the conference is to “preserve and promote the Tibetan medical system, to enhance the interaction among Tibetan medical doctors, and to get acquainted with the number of researches which have gone on to prove the authenticity and effectiveness of Tibetan medicine.”The first international conference on Tibetan medicine was held over a thousand years ago at Samye, central Tibet in the year 728 A.D. by Trisong Deutsen, the 37th King of Tibet.

Sowa Rigpa, the Tibetan science of healing is a unique medical system dating back more than 2500 years. With the Buddhist philosophy as its backbone, this system of medicine is influenced by the religion, culture, and environment of Tibet. The commonalities in the basic principles of Tibetian medicine and Siddha medicine was highlighted. Some of the major topics discussed during the conference included, History and Basic Principles of Tibetan Medicine, Research Methodology, Medicinal Herbs and Plants, Pregnancy and Child Care, Ethics of Physician, and State of Tibetan Medicine around the world. In the plenary Sessions were dedicated for deliberations on the salient features of different traditional medical systems including Siddha, Ayurveda, Mongolian and Traditional Chinese Medicine. Dr. D.Natasagdorj, Head of the Training Centre of  Mangolian Traditional medicine, Dr.Hsu, Sheng- Feng of Director of  Graduate Institute of Acupuncture Chinese, Taiwan, Dr. Balendu Prakasah, Ayurvedic physician from Dehuradoon, Dr.Dorji Wangchuk Director, National Institute of Traditional Medicine, Bhutan, Dr Sarah Sallon, Director, Natural Medicine Research Centre, Jerusalem, Israel and Dr.T.Thirunarayanan, Siddha Physician  of Centre for Traditional Medicine and Research, Chennai delivered lectures in the Plenary session.

H.H.Dalailama in his address to the delegates stressed the need for working together with Indian Medicine researchers to further enrich Tibetian medicine since, the Dept. of AYUSH has included Sowrigpa in the Indian Medical council Act in 2010. He also stressed  Compassion to fellow human beings as the main virtue of Tibetian medicine and adivised all medical personnel to follow it in letter and spirit.

Concerns were also expressed about the use of mercury in traditional medicines and the proposed ban on mercury for industrial use by UN, which will take out many of the traditional medicines. Research studies which clearly confirms the safety of detoxified mercurial salts used  in Traditional medicines and efforts should be taken by all stake holders to ensure the ban on element mercury should not affect the use of mercury ores used by Traditional medicines, including Siddha, Ayurveda, Sowrigpa, Manba Datsan and Chinese Medicine.