Issuing from an original synthesis including and particularizing certain aspects of the Buddhist doctrines, Tibetan medicine has spread in similar cultural contexts as is case in Ladakh, north-western Indian Himalayas. This medical is independent of religion but borrows from it elements to serve its medical and social Collectiev and individual interests. The medicine is never an isolatable speculation it is medicine of a socio-historical political and cultural context the Ladakhiness of Tibetan medicine is thus to be observed on many levels and particularly in the expression of the religion by its practitioners.

What place then does religion today assume in the lives of the Ladakhi practitioners of Tibetan Medicine (amchi)? And how does medicine as a social institution negotiate its relationship to religion? The author addresses these questions by singing out two vantages of observation: institutionalization and the voluntary sector after having defined the ideal religious frame putatively surrounding medicine according to the amchi's representations. The argument is based on the link between the desire for scientificity that characterizes Tibetan medicine institutions and the political use of religion by healers associations as an assertion of identity in a region marked by inter-religious tensions. Focusing on the group formed by the urban amchi elite this approach enables of an understanding of the social convergence of element commonly considered to be disparate. That is science in is role as medical legitimation is a central component in the political rendition of medicine and in this context does not really appear as antinomic to religion on which the collective political identity fundamentally depends. This discreet coalescence sheds light on central aspects of the contemporary construction of Tibetan medicine in Ladakh.

Laurent Pordie is anthropologist and ethnopharmacologist. Head of the program the social construction of healing in India: Comparative anthropology of medicines at the Department of social science French Institute of Pondicherry he is also research fellow at the Laboratory of Human Ecology and Anthropology University of Aix Marseille France and is Director of Research at Nomad RSI an international organization specialized in research action on tradition health system. His present works concern the social and Political dynamics of Tibetan medicine the anthropology of intellectual property rights and the social dimension of plants in the Himalayas.

The medicine of the amchi (am chi) is the most used health care resource in rural Ladakh an Indian region in the north-western Himalayas. This medical system originated in Tibet (gso ba rig pa, the science of healing) and according the tenth century C.E. The exact period is not known but it seems to correspond to the introduction of the Mahayana form of Buddhism (Sanskrit: the great vehicle). This medical practice belongs to the scholastic medicines and is based on the fundamental Tibetan medical works the basic text of which is the Rgyud-bzhi. Tibetan medicine is found in the Tibeto-Mongolian communities distributed from west to east along the Himalayan chain as well as in Mongolia and certain areas of central Asia. This medical practice developed in China as far as Hung Kong and Beijing and has been transmitted with a certain success to the West and to a less extent Japan. It is also found in places of the Tibetan diaspora.

Tibetan medicine must be presented in its plurality for all of the geographical locations and their histories along with contemporary health policies and their various social issues the original medicine. The medical practices and techniques are not necessarily identical and correspond to complex schemata involving the global level such as ideologies relating to modernity and the international market for natural medicines as well as the local level (Modality of instruction institutionalization political conjunctures integration with biomedicine etc). The economic political cultural and social issues of both the practitioners and their institutions respond to varied contexts and over the course extent medically. Without presenting in detail the reason forming and transforming Tibetan medicine we understand that to some extent there are in fact Tibetan Medicines. The generic term Tibetan medicine tends to give the impression of homogeneousness to what in fact remains anthropologically speaking profoundly heterogeneous. In Ladakh the terminology this point. They speak of amchi medicine as appellation, which I retain in this text. This designation reveals in particular the local determination to consolidate a position within the Tibetan medicines and in the identity issues of the Ladakhi amchi community conformed as they are by the community of Tibetan amchi exiled in Indian and by local interests aimed at their legitimation through amchi medicine and gives it a singular character among the Tibetan medicines. These local specificities are to be observed on many levels and particularly in the expression of the religion by the amchi.

Contemporary studies on the Tibet Autonomous Region in China show that the religious practices traditionally surrounding medicine are diminishing, or indeed disappearing (cf, Janes 1995, 1999b: Adams 1999, 2001). The main reason mentioned by these authors are the Cultural Revolution and the Consequent oppression of religion by the Chinese government as well as the biomedicalization of Tibetan medicine which is one of the pragmatic aspects of socialist ideology. One observes with Janes the emergence of a narrow Tibetan practice of the amchi is affected neither by religious herbalism, which is possibly taking the place of a more complete Tibetan medicine (1995). The social and political mutations in China and their ambivalent nature have not surprisingly influenced medicine both in its organizational structure and its daily practice.

This paper explores certain characteristics of the Ladakhi amchi have with religion in order to provide elements for comparison with the operative logics animating the Tibetan-medicine-of-Tibet. In Ladakh the oppression for by a biomedicalization imposed by the state. There are however inter religious tensions in this region between Buddhist and Muslim communities (particularly Kashmiri) and there is a certain biomedical development on the level of health and the emergence of a biomedical ideology (Pordie 2000), although and integration/confrontation of medicines is not formally planned. The question therefore is to know what place religion assumes in the life of the amchi. The first part of the paper presents the discourse of the role of Buddhism in their medical practice and considers their religious practice when its is directly applied to medicine. The amchi representations thus serve as markers to construct the religious frame putatively surrounding medicine. This approach then leads us to consider the contemporary urban combinations of religion and medication singling out two vantages of observation institutionalization and the voluntary sector (in the case of a non-governmental organization). This in turn makes it possible to provide to provide certain analytical keys to the understanding of more extensive regional phenomena concerning the expression of religion in Ladakh. Briefly, this chapter answers the following questions what role does the institutionalization of Tibetan medicine which tends to become universal (scientific)? How do practitioners associations mobilize religion to non-medical ends? And what are the issues and modalities in the religious expression today.

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