YUNGDRUNG TSEWANG SHOWS me his plant repository, a large room crammed with plastic bags and bowls filled with herbs. Dressed for summer in a blue polo-shirt and black baseball cap, the 39-year-old sniffs a handful of drying leaves, and cheerily tells me they are almost ready to use in medicines. Images of colorful Tibetan deities hang on the walls. Dozens of sprigs of dried plants have been pinned to wooden paneling, their names labelled underneath in Tibetan, Nepali, and English.

Yungdrung is an amchi, a practitioner of Tibetan medicine — a traditional form of healing that has been practiced across the Tibetan plateau for over a thousand years. This room, adjoining his small clinic, is where he dries, cooks, grinds, and mixes the numerous flowers, leaves, roots, seeds, and barks that make up the herbal medicines he gives his patients.

The clinic is located in Dolpo, a remote and mountainous area in the upper part of northwestern Nepal’s Dolpa District. Most of Dolpo is above 3,500 meters in altitude, and almost every settlement here is separated from the next by a pass of over 5,000 meters. The landscape ranges from vertiginous, vegetated slopes to the bare, jagged ridges of the high Himalayas. Culturally and economically, this region shares more with Tibet than the rest of Nepal, and Tibetan medicine is a key, shared element of life here.

Dolpo has few government services providing conventional healthcare. The handful of government health clinics that exist open only in summer and are staffed by healthcare assistants, not qualified doctors. As with many other remote Himalayan regions, the communities here, therefore, rely heavily on Tibetan medicine for most of their healthcare needs. And, as Yungdrung explains, the local population also has strong faith in its healing potential.

“In Dolpo, the locals have very high trust and belief in amchis,” he says, “and many people heavily rely on me for their healthcare.”

High-altitude Himalayan regions such as Dolpo are home to the greatest concentration of medicinal plants, which are crucial to not only Tibetan medicine, but other traditional medical systems, such as Traditional Chinese Medicine and Ayurveda. Similar to other Tibetan doctors, Yungdrung collects many of the plants he needs from the surrounding mountains.

The Himalayas are experiencing the most drastic climate disruption outside of the poles.

A few times a year, he packs a bag of his medicines and hikes for several hours to grazing grounds higher in the mountains. There, he treats yak herders’ smaller ailments, sleeps in their tents, and spends many days scouring for herbs such as the violet petals of Tibetan blue poppy (Meconopsis horridula) or orange, bitter tarbu berries (Hippophae tibetana). He also takes many shorter trips to slopes around the icy, blue lakes near his clinic to collect other ingredients such as the leaves and petals of yellow lugru (Pedicularis hoffmeisteri) and blue, bitter tongzil (Corydalis cashmeriana), setting off in early morning, and returning before nightfall. However, over the last few years he has been encountering unprecedented challenges in sourcing many of these plants and fungi.

Many medicinal plants, herbs, and fungi are becoming scarcer and their habitats shifting upwards, Yungdrung says. Some species, he notes, have simply vanished from their usual habitats. He points to a photograph of a yellow flower tacked to the wall. “This herb, serme (Herpetospermum pedunculosum), a bitter herb, used to grow in nearby areas, but I have never seen it,” he says. “I’ve heard of many herbs that used to grow here but that I haven’t seen. This is a climate problem.”

Yungdrung is right — in part. The Himalayas are experiencing the most drastic climate disruption outside of the poles. The rapid melting of permanent snows and glaciers in recent decades are already altering growing seasons and forcing tree lines in many areas to move upwards. These changes pose a serious threat to several rare and endemic plant species that many local communities in these high-altitude regions rely on for traditional medicine as well as for crucial income through commercial trade in areas with limited livelihoods.

But climate isn’t the only factor impacting these species. Rising incomes, particularly in China and India, and an associated growing interest in alternative medicine have increased demand for many medicinal herbs. This has resulted in severe overharvesting and illicit trade of vital plants. Several species endemic to the region are now endangered. Other Tibetan doctors I have met also identify these challenges, which are not only impacting local ecosystems but are also affecting their practice and treatment of marginalized, mountain populations.

TRADITIONAL TIBETAN MEDICINE, also called Sowa Rigpa, dates back to at least the eighth century CE, and is based on the texts and philosophies of Tibetan Buddhism and Bon — an ancient, pre-Buddhist, Tibetan religion. In Tibetan traditions, physical healing is considered closely related to spiritual development, and religion and medicine are often studied simultaneously.

According to the precepts of Sowa Rigpa, the health of one’s body, mind, and spirit are dependent on the balance of three nyepa, or humors, which are derived from levels of the five natural elements — earth, water, fire, air, and space — in the body. Imbalances in the nyepa cause disease. Diagnoses are made through examination of the pulse, urine, and body, and treatments focus around natural medicines — made predominantly from herbs and plants — and therapies such as massage and bloodletting. Himalayan biodiversity is therefore crucial to the work of a Tibetan doctor and the health of the remote populations living in the region. In fact, many people here prefer Tibetan treatments to modern medicine. “My body isn’t used to Western medicines,” Sonam Bhutti, a patient I meet at an amchi’s home in the Dolpo village of Ringmo, tells me. “They relieve pain quickly, but I feel very sick afterwards,” she says, clutching her sprained wrist. The amchi gently prods her wrist, asking about the pain, and then rolls small balls of medicine from a brown, sticky paste for her to take. “It takes many days to visit the hospital,” Bhutti adds. “I don’t have that time during the growing season.”

There are no paved roads into or out of Dolpo, only rough trekking trails. It takes two days of walking through the conifer-clad gorge of Phoksundo to get from Dolpo to the local administrative center of Dunai, where Dolpa district’s only hospital is located.

At Yungdrung’s small consulting room — lined with plastic jars full of beige, cream, and white powders, and small, brown pill balls, each marked with a label written in Tibetan — he describes what it takes to be an amchi.

“I studied for ten years in university to be an amchi: It takes a long time; you must be very committed. Even now I am still learning in the field every day,” he says.

Yungdrung was born in a village a few days walk north of his clinic. Like most, he left Dolpo as a child and was schooled in India and the school of Tibetan medicine at Triten Norbutse, a Bon monastery in Kathmandu. He practiced for several years in other areas of Nepal before returning to Dolpo. Every Dolpo village has at least one amchi‚ he explains. Throughout their years of training and experience, amchis build their knowledge of the hundreds of plants, herbs, fungi, and lichen endemic to the Himalayas.

In earlier times, aspiring amchis would have apprenticed with a senior village amchi, learning on the job. Today, they pursue Tibetan medicine degrees at institutes in Kathmandu, Nepal’s capital city; Lumbini, a city in southern Nepal; or northern India, where their time is split between theory in the classroom and practice in rural field-sites.

The training is extensive and takes many years, and collecting herbs and making their own medicines is a key part of it. First, the students learn to identify and harvest the plants, he says. There are four different harvesting seasons, each suitable for picking different parts of plants. Then they learn how to wash and dry the herbs and prepare the medicines. “Some ingredients must be burned in the fire, some fried, some boiled,” he tells me.

Most amchis forage the ingredients from the surrounding mountains, sometimes exchanging materials with amchis from different areas of Dolpo. What cannot be found locally, such as saffron and sandalwood, they buy from Kathmandu, some 400 miles away.

In another part of Dolpo, I meet Tashi Tsewang, a 58-year-old amchi who lives in the village of Bhijier, a mixed Buddhist and Bon settlement a day’s walk from the Tibetan border. When I arrive at his home, Tashi is writing with black ink on the inside of a half-made, wooden prayer drum. I watch as he slowly traces his finger over the Tibetan letters. Later, as we drink tea, he talks about how unregulated harvesting is creating further problems to his supply of medicinal herbs.

Commercial over-harvesting is drastically reducing the prevalence of certain species.

“In a deep corner outside Bhijier there used to be some kutki, a local herb. But we never sold this herb — we only used what we needed,” Tashi tells me. Kutki (Picrorhiza kurroa), a perennial herb that grows mainly on open, rocky, grassy slopes, is used by amchis to treat fever, coughing, and liver problems.

Widely known for its many pharmacological properties, including anticancer, antimicrobial, antioxidant, antiallergic, and anti-asthmatic benefits, it is used in other Asian traditional medicinal systems, such as Ayurveda, Yunani, and Chinese medicine, as well. It is one of the oldest medicinal plants traded from the Himalayas and one of the major income-generating, non-timber forest products of Nepal.

Tashi says that two years ago, many people from outside Dolpo came and collected most of the kutki near his village. “Now there are only a few kutkis left around here,” he says.

Yungdrung agrees, describing how pharmaceutical companies need huge amounts of particular herbs, such as kutki, and that this high demand encourages intensive collection wherever they are available. (Kutki has been listed as a threatened species under the Convention on International Trade in Endangered Species since 1997.)

In contrast, amchis harvest very small amounts and understand how to conserve the plants, Yungdrung says. “If I need the whole plant for a medicine, I will take only from one place and leave other areas of the plant alone. If the plant is very rare, I will also plant new seeds while picking,” he explains. “I make sure the plants can replenish, and new ones will grow in the future.”

Commercial over-harvesting is drastically reducing the prevalence of certain species, particularly those harvested from the root, he says. Already, he is not able to produce some medicines he would normally use. “In a few years it will be very difficult,” he says.

While there is scant data available on the amounts of most medicinal herbs harvested in Nepal, there’s some research on a few specific varieties, particularly highly endangered herbs. One study, on the Indian spikenard (Nardostachys jatamansi) — a critically endangered alpine perennial used to treat generalized anxiety disorder and depression — found nationwide trade to have increased threefold between 1997 to 2014.

Nepal has been exporting medicinal herbs for over a thousand years (there are records of plants from Nepal being traded across the borders to Tibet as far back as 600 AD), and revenues currently make up about 5 percent of Nepal’s GDP ($2.5 billion of $41 billion). The main consumers, India and China, have a long history of medicinal plant use. Recently, the volume and value of this trade has expanded due to changing consumer preferences and rising incomes in both countries. In the decade ending in 2016, per capita incomes rose by 4.3 and 11.4 times respectively in India and China. Since the Covid-19 pandemic, demand for natural medicines has only grown further.

Research has found that at least 300 of the more than 2,300 species of medicinal and aromatic herbs found in Nepal are actively traded. Many medicinal herb hotspots lie within protected areas, such as Shey Phoksundo National Park, which covers much of Dolpo, and 39 percent of these traded species fall into one or more international conservation categories. Such an endangered status usually leads to a ban or quota being implemented on collection by the Nepali government.

However, low institutional capacity combined with the remote, challenging terrain of collection sites, makes implementation of rules difficult, explains Suresh Ghimire, a professor of botany at Tribhuvan University in Kathmandu. “The government officials in different [regulatory] bodies do not have the expertise to identify the plant,” he tells me. So protected plants are still traded often, sometimes camouflaged among other products.

And now climate change has become a significant added stressor, altering how and where the plants amchis collect can be found, Yungdrung asserts. It is also impacting other trees and crops that people in the region rely on, he adds, citing the example of apples, which he remembers as growing only in the Dunai area — a lower-altitude region of Dolpo. Now apples are found in areas of Dolpo at altitudes almost 2,000 meters higher than Dunai. “I see the same happening with all plants,” he says.

IN KATHMANDU THAT winter, I meet Suresh Ghimire in a chilly, university lecture-room filled with wooden, metal-framed benches, and posters of Nepali fauna taped to the peeling walls. We move to the balcony and the warmth of the winter sun, and Ghimire dusts off two wooden stools. Dressed in a checked, flannel shirt and black puffer jacket, he looks out over the university’s untended garden and talks softly of the effect climate change is having on medicinal herbs.

Ghimire was part of a team that studied how climate change is impacting Himalayan alpine vegetation, especially rare, endemic, and useful species. The study identified altitude — a proxy for temperature — and precipitation as the two factors that have the most significant impact in determining Himalayan alpine vegetation. While the relationship is complex, the study shows that, overall, medicinal herbs grow, bud, and flower better in areas of cold temperatures and higher rainfall.

Regions from 2,000 to 5,000 meters in altitude are particularly important habitats for medicinal plants, Ghimire says. “The medicinal plants are medicinal precisely because of the stress that they receive from the environment. When the environment is harsh — like in the northern parts of Nepal — the plant must produce more chemicals to defend itself.”

The warming climate has already resulted in Himalayan species shifting upwards in altitude, he says, a trend that will continue into the future, as temperatures go on increasing. Himalayan regions are expected to warm at twice the rate of the world average, which would exacerbate the problem.

As temperatures continue to increase, it is possible some species may run out of suitable habitats, being left with nowhere to go. A scarcity of soil at altitudes above 5,000 meters creates an upper boundary for growth. When there is nowhere left to migrate to, plants will either have to compete and adapt, or die, Ghimire tells me.

The Kathmandu-based Global Institute for Interdisciplinary Studies (GIIS) led a recent study examining possible changes in the habitats for 29 species of medicinal herbs across Nepal. Its modeling predicted future climate changes may reduce the areas climatically suitable for two-thirds of the studied species, and that 40 percent of hotspots with suitable climatic circumstances for a maximum number of species would disappear in the future.

Climate change has become a significant added stressor, altering how and where the plants amchis collect can be found.

“Although the climate change impact is a very slow, gradual impact, once you cross the threshold — boom, gone, the habitat is completely unsuitable for certain species, completely wiping out certain species,” says Uttam Babu Shrestha, director of GIIS and lead author of the study that Ghimire also participated in.

“These are hypothetical scenarios. Every species on Earth will [either] evolve or become extinct — this is what we call the natural extinction rate,” Shrestha says. “But with climate change, the extinction rate of some species will be thousands of times greater than the natural or baseline extinction rate.”

The threat that climate disruption poses to medicinal plants, not only in the Himalayas, but across the world, is a growing concern among researchers. In 2019, a group of scientists issued a report, “Scientists’ Warning on Climate Change and Medicinal Plants,” pointing out that 70 to 95 percent of citizens of most developing countries rely on these plants for their primary healthcare needs and that they are “increasingly utilized by large numbers of people residing in wealthier countries,” as well.

Indeed, awareness of the contribution of traditional medicine to conventional medical treatments is growing. According to World Health Organization (WHO) 40 percent of pharmaceutical products today derive from natural products and traditional knowledge. Examples include aspirin, derived from willow bark, and the childhood cancer drugs vinblastine and vincristine, which are sourced from Madagascar periwinkle. Tu Youyou, a Chinese chemist, was awarded the 2015 Nobel Prize in Physiology or Medicine for developing the antimalarial drug artemisinin. In 1971, she identified the chemical component responsible for the anti-malarial properties of sweet wormwood — a natural ingredient that had been used in Chinese traditional medicine for thousands of years.

Shrestha points out that global regulation and governance around the development of new pharmaceutical drugs are very strict, with the majority now being produced from bacteria grown in controlled, laboratory settings. “But, at some point in the future, we might need some biomolecules for new diseases, or new problems. From that point of view, we need to conserve,” he says.

THE FOLLOWING AUTUMN, I meet Yungdrung again at his clinic in Dolpo. The sky is dark, following many days of incessant rain, and we walk to a nearby lodge for a glass of local liquor by the wood-burning fire.

Our conversation turns to the future, and what should be done to preserve the medicinal herbs of the Himalayas. Historically, informal local rules encouraged careful use of these communal natural resources, Yungdrung tells me. Harvesting by an amchi would only take place after the performance of a ritual to the menlha, the medicine deity, and Tibetan medicine texts, studied by all amchis, describe guidelines for sustainable collection.

“Amchis always keep environmental conservation in their minds,” Yungdrung says. “Our method of harvesting actually helps replenish the herbs. A little picking is useful for the environment, but picking in huge amounts is detrimental.”

Ghimire’s research affirms that amchis harvest selectively, at many different levels. First, the time of collection is closely considered, depending on the part of the plant needed. Then sites are selected based on knowledge of the current distribution of plants, and within these, larger plants, or stronger or mature portions, will be chosen. Finally, only small amounts will be taken.

Yungdrung says that the more endangered herbs must be actively cultivated. “If they are completely lost then it will be very difficult in the future,” he says. (The 2019 scientists’ warning also recommends actions including “conservation and local cultivation of valued plants, sustainability training for harvesters and certification of commercial material, [and] preservation of traditional knowledge,” in addition to efforts to mitigate climate change.)

Most amchis I meet describe cultivating a limited number of herbs, with varied success. Tsewang Gyurme Gurung, an amchi in nearby Mustang, says this is very difficult in practice, especially when it comes to plants found at higher altitudes than human habitation. “Bringing herbs from high elevations to lower elevations, they won’t die, but they will survive with a lot of pain and struggle,” he tells me.

Both Ghimire and Shrestha assert that the management of these herbs should be given to the local people, with the harvesting organized and carried out by locals, not outsiders. “The local communities have been collecting these plants for hundreds of years. They are custodians as well as beneficiaries,” Shrestha says.

It is clear any management plan should incorporate Indigenous knowledge, as well as the latest scientific data, into local monitoring systems. But a dearth of information around the current populations and sustainable harvesting levels of different species that would inform a management plan is a significant problem.

Government authorities must look at medicinal plants not only as a source of revenue but in terms of conservation, focusing more heavily on data collection, Shrestha says. “Their conservation must be given much greater attention. Otherwise, the herbs will not be there to collect in the future.”

Back in Dolpo, Yungdrung tells me he is treating 100 patients every month. “These Tibetan medicines are very important to the local people,” he says. “But if we don’t look after our environment, it will be very hard in the future.”

Travel and research for this story was funded by Royal Geographical Society’s Neville Shulman Challenge Award.