We were drinking tea in Ya'an, a city at the edge of the Sichuan Basin, mainland China. Ya'an is a traditional tea center, with tea growing in great quantities in the city's surrounding agricultural areas. The tea we were drinking, though, was not a local tea. It was Tibetan butter tea.

Our Tibetan friend brought out a kettle of butter tea and poured it into our cups. We drank the tea while chewing on dried yak meat and watching a Tibetan Buddhist ceremony on TV. It was scorching hot outside.

It seemed unusual that we would be drinking Tibetan butter tea, a highland drink, in the Sichuan Basin, where it is very hot in the summer. But after I had a few cups of the tea, which was made from brick tea produced by the Tibet Langsai Tea Factory, the circumstances became appropriate because I knew that the Tibetan people had entered upon a new epoch in their tea-drinking history.

The Tibet Langsai Tea Factory was opened by a Tibetan named Cirendundian. It was the first brick tea factory established by a Tibetan in more than one thousand years.

They drank brick tea but never produced it

As early as the Sung Dynasty (960-1279), the "Tea and Horse Bureau" had been set up in Ya'an to supervise and monopolize the tea trade. Tea was sold in Mongolia and Tibet in exchange for good horses bred in those places. During the Ming Dynasty (1368-1644), authorities even forbade the entry of tea seeds and seedlings into Tibet for fear that the Tibetans might grow and produce tea themselves.

Through this trading system, Tibetan people were able to obtain their daily tea while the government maintained control of the ethnic minorities living in the border areas. The tea and horse commerce did not decline until the reign of Emperor Kanghsi (1661-1722) during the Ching Dynasty (1644-1912) when the Ching government began to shift its attention to exporting tea to other countries.

In the 1950s, the Chinese government finally lifted the monopoly on the tea trade. Tea became an item which ethnic minorities could deal in freely. Last year, some Tibetans stepped out of their highland homeland to establish a brick tea factory in Ya'an, Sichuan Province. The factory caters to Tibetans and other ethnic minorities. What is so significant about the factory is that it broke a long-standing Tibetan tradition--in the past, Tibetan people drank a lot of brick tea but never produced it.

For Tibetans, who had never had any experience in manufacturing brick tea, establishing a tea factory was not an easy undertaking. The only things Cirendundian, who opened the Tibet Langsai Tea Factory, could rely on were a lifetime of tea-drinking experience and his knowledge and expertise as a tea merchant--he had been one for more than ten years. He decided to open a tea factory in Ya'an after five years of on-the-spot investigation and evaluation because Ya'an boasts an abundant supply of raw tea leaves as well as first-rate tea-making techniques.

"I opened my tea factory to make good tea for my fellow countrymen, not to make money," said Cirendundian. Jinyebazha, the brand he established, received a great deal of praise after its appearance because of its high quality and low price. Although it has been only two years since the Tibet Langsai Tea Factory came into being, the brick tea it produces has taken up an important place in the Tibetan brick tea market.

The Tibetan Buddhist ceremony we were watching on TV was very impressive, with myriads of Buddhist followers attending the service. One scene presented Tibetan lamas and their followers drinking tea together. Zhaping, Cirendundian's son-in-law, told us that the Tibet Langsai Tea Factory had donated 5,800 blocks of brick tea (29 metric tons) to the ceremony. The Living Buddha Luorong even praised the brick tea in the ceremony: "Jinyebazha is the best tea that I have had in the past twenty years."

Like most other Tibetans, Cirendundian and his family are devout Buddhists. Because of the success of their factory, they have generously donated tea and money to temples. They talked about their donations with pride, showing that they were happy about being able to do something for their religion and that they were confident about the quality of their tea.

Unable to find good-quality tea

The Tibetans should have formed their tea drinking habit after Princess Wencheng and Princess Chincheng of the Tang Dynasty (618-907) married into Tibet in the seventh and eighth centuries. The two princesses brought a lot of tea with them and even widely promoted tea drinking methods. At that time, in order to disseminate Buddhism, many monks often traveled between the Chinese hinterland and Tibet. They also helped introduce the habit of tea drinking into Tibet. As tea can dissolve fat and aid digestion, it gradually grew popular among the Tibetans, whose main diet consists of meat and dairy products.

We left Ya'an and flew to Tibet. In less than two hours' time, an airplane took us from Chengdu, Sichuan, which is located at an altitude of 800 meters [2,625 ft], to Lhasa, Tibet, 3,650 meters [11,975 ft] above sea level. Although it saved us a lot of time to travel by air, the drastic change in altitude caused us to develop high altitude syndrome and made us very uncomfortable.

We strolled along a street in Lhasa. It was a traditional, busy street bustling with devout Buddhists, peddlers hawking daily commodities, long-skirted Tibetan women, snot-nosed children begging for money, and tourists busily taking pictures.

There were also many tea shops on the street. Xueyu Butter Tea Shop, owned by Cirendundian, had been selling tea there for more than ten years. The shop used to sell tea purchased from tea factories in Ya'an. In recent years, however, economic reforms implemented in China had resulted in an overabundance of tea factories. As competition grew fiercer, many tea factories stooped to lower levels, sacrificing the quality of their tea in order to cut costs and increase profit.

"The tea factories paid no heed to hygiene," said Cirendundian. "Sometimes we even found rags and cigarette butts in the tea. That greatly affected the business of my tea shop." After complaining about this to the tea factories from which he purchased tea, he still did not see any improvements. Disappointed at the poor quality of the tea and unable to obtain good tea from other sources, he decided to open a tea factory of his own.

Cirendundian's wife served us steaming hot butter tea. I blew away the thin layer of oil floating on the surface of the tea and had a sip. It is hard to describe the taste; I can only say it was a little bit salty.

The butter tea Tibetans drink is made from brick tea, a fully fermented black tea made from old tea leaves and stems. The preparation of brick tea involves four major steps: withering, rolling, fermenting, and drying. Fermenting is the key to making good tea. During fermentation, the color of tea leaves changes from green to copperish-green and the leaves emit a peculiar aroma. At present, in addition to the two major teas--Jinjian and Kang Brick Tea--the Tibet Langsai Tea Factory also produces a kind of low-fluorine brick tea. The factory is also trying to revive an ancient tea recipe, hoping that it will be accepted on the tea market.

The multiple roles of the highland drink

After a few days in Lhasa, we gradually grew used to the low-pressure, low-oxygen atmosphere, so we began to proceed toward northern Tibet, which lies at an even higher altitude. As our car headed north along the Qinghai-Tibet Road, we saw prayer flags waving in the wind. Tibetans believe the prayers on the flags will be blown heavenward to their deities and bring blessings to the ones who hang them.

On the way, children and women peddled mushrooms to the vehicles that sped past. We pulled over to the side of the road and stepped out of our car to buy some mushrooms. Some local herdsmen invited us to their tents, and we happily accepted their invitation.

The black tents the local herdsmen lived in provided them shelter from hot sun and cold wind. In the middle of the tent was a burner, on top of which perched a terra-cotta teapot. We seated ourselves on a woolen blanket, waiting to be served butter tea. A Tibetan woman poured boiling hot brick tea into a cylindrical churn about one meter [3 ft] high. Then she added butter and a dash of salt and churned the ingredients with a wooden stick until they were well blended.

The butter tea made in this traditional way was delicious. The freshness of the butter made it tasty. According to Tibetans, three things are essential to make good butter tea: good tea, good water, and good butter.

Tibetans obtain their butter, an important part of their diet, from cow or sheep milk. Containing ninety percent fat, butter is rich in calories and enables the inhabitants of the Qinghai-Tibet Plateau to cope with the cold weather and harsh living conditions on the highland. Today, not all Tibetans make their own butter; they also purchase ready-made butter imported from China.

Tibetans make their tea by boiling tea leaves in water. They have used this method since the Tang Dynasty, when tea was first introduced into Tibet. Since electricity is unavailable in the expansive pastures of Tibet, local herdsmen still burn cow dung to cook their tea. Electric butter-tea machines are not popular in the pasturing areas.

Aside from butter, Tibetans also put vegetable oil, milk, or bone soup into their tea. Or they drink simple tea in which nothing is added.

In Tibet's urban areas, sweet milk tea enjoys great popularity. Sweet milk tea--made from black tea, sugar, and milk--was introduced by merchants from India and Nepal. In Lhasa and Rikaze, you can see teahouses everywhere. In the past, only the nobility, merchants, and rich people frequented teahouses. But teahouses have now become a sort of popular resort for all Tibetans.

Every morning, after paying a visit to a temple, citizens will go to teahouses for a cup of tea or a bowl of noodles. When they have some business to talk over with friends, they are also accustomed to going to the teahouses to sit and chat. It seems that the teahouses in Tibet play a similar role to that of the coffee shops in Taiwan.

In addition to being the most important drink for Tibetans, tea also plays a variety of other roles in Tibetan society. It is regarded as an excellent wedding present. During Tibetan New Year, brick tea is offered on family altars; lama temples have even incorporated tea drinking into their religious services, making it an important part of their Buddhist ritual.

A disease rarely heard of in Taiwan

Tea is considered to have many health benefits. That was what Professor Cao Jin from Xiangya Medical College of Zhangsha University thought before he entered Tibet to carry out his research.

The Third Elementary School in Naqu, northern Tibet, is located on the Qiangtang Plateau at an altitude of 4,500 meters [14,764 ft]. Due to an urban development project, the green grassland on which the school stands is now full of excavated bumps and hollows. Today was going to be a busy day at the world's highest orphanage school, as Cao was coming to examine the schoolchildren's teeth.

The students all looked short for their age. They stood in lines, full of excitement, smiling innocent, radiant smiles. Cao coaxed the student at the front of a line to show him his teeth. The child's dark skin set off his bright white teeth.

"What's your name? How old are you?"

"My name is Yuchen. I'm eight years old."

"First grade." Cao classified the teeth according to the condition they were in, and his assistant took notes.

"Next!"

"What's your name? How old are you?"

The child shyly told Cao his name and age.

"Second grade. Look, their teeth are all in the same condition," Cao said, sounding helpless. "Next!" He proceeded to check the next student's teeth, still muttering to himself.

"Tooth decay. Don't eat too many sweets. You may go play now." Cao's face broke into a smile when he saw the decayed teeth.

His attitude puzzled me. Why did he keep frowning when he saw those sparkling white teeth and break into smiles when he found decayed ones? I began to look more closely at those sparkling white teeth. Then I noticed that the teeth were either covered with dents or brown spots and stripes. This was a disease called dental fluorosis, which we rarely hear of in Taiwan.

I suddenly realized why Cirendundian, his son-in-law Zhaping, and most other Tibetans had shining white teeth. It was because they were all afflicted with dental fluorosis, which had caused the enamel of their teeth to become incompletely calcified.

Bai Xue-xin, who works for the Sichuan Regional Disease Prevention Center, once published a report on the relationship between fluorosis and brick tea drinking. The subjects he studied were Tibetans who resided in Kangqu, Sichuan Province. "Does tea drinking lead to poisoning?" Cao Jin, who was devoted to studying the health benefits of tea, was doubtful.

A health problem among the Tibetans

With his doubts in mind, Cao decided to go to Tibet, Qinghai, and Gansu to conduct an investigation. In 1995, funded by Chou Yu, a teahouse owner in Taiwan, Cao finally made the trip.

After five years of surveys, Cao found that above fifty percent of the Tibetan, Mongolian, Yuku, and Hasake teenagers and children he studied were afflicted with dental fluorosis. As many as fifty-six percent of the Tibetans, who lived at the highest altitudes and consumed the largest amount of brick tea, were found to have the disease.

Fluorosis is a disease resulting from excessive consumption of fluoride. Food or drinking water that contains too much fluoride or coal pollution can all cause the disease. In the areas where Cao performed his surveys, however, none of these problems existed. But it was found that brick tea, the main beverage of the people in these areas, contained a prodigious amount of fluoride, tens or hundreds of times the amounts contained in other kinds of tea. Moreover, because local people love to drink strong tea, they make it by boiling it for a long time, which easily dissolves the fluoride contained in the tea bricks. Thus, this tea is without doubt the cause of the fluorosis discovered in the area.

How serious is the problem of brick tea fluorosis? How vast is the area affected by it? So far, no comprehensive survey has been conducted to answer these questions. Although the Chinese government has begun to notice the problem, it is difficult to take any precautionary measures against it before the incidence and symptoms of the disease have been ascertained.

To help solve the problem, Cao is now carrying out a more complete investigation in Tibet, hoping to gather more accurate and reliable statistics for the Health Bureau. After examining the teeth of the schoolchildren in the Third Elementary School, he found that as many as ninety percent of them were victims of dental fluorosis. The ratio was shockingly high. It meant that nine in ten of these children had accumulated enough fluoride in their bodies to induce the occurrence of pathological changes.

Hunchbacked figures on the highland

It is hard for us to understand why brick tea cannot be replaced by other kinds of tea. The staple Tibetan diet consists of yak meat, mutton, dairy products, and tsampa [roasted barley flour], which are usually washed down with butter tea. Tibetans often begin their meals by drinking a few cups of butter tea. Then they have tsampa with more tea. After that, they gulp down more tea.

In the urban areas of Tibet, owing to more frequent contacts with the outside world, the diet of the local people is continuously diversifying. But in remote pastoral areas where communications with the outside world are inconvenient, the food remains largely the same, with tea occupying an important role. The more brick tea that is consumed, the higher the chance of developing fluorosis. Naqu, for instance, was listed by Cao as an area seriously affected by fluorosis.

Our car took us away from the ugly city streets into the pastoral areas of northern Tibet. The Qiangtang Plateau, a place we had longed to visit, unfolded before us--lush green grassland, winding rivers, smoke curling upwards from tent chimneys, herdsmen in brightly colored clothes, yaks leisurely walking, sheep softly bleating. As soon as we got out of our car, the doctors who came with us called out at the top of their lungs for the herdsmen who lived in the neighborhood to congregate.

Cao started to examine a local woman, 61-year-old Yangzong. "Stretch out your arms, like this." "Put your right hand behind your head and touch your left ear, like this." "Stoop down, like this." Cao demonstrated the actions and asked Yangzong to imitate him. Yet the old woman, like most other aged Tibetans, was unable to do as asked. She could not straighten her arms, her knees could not work properly, and she had difficulty crouching down. Cao diagnosed Yangzong as suffering from skeletal fluorosis, a crippling bone disease.

"Skeletal fluorosis can cause people to lose their ability to work and even the ability to take care of their daily needs," Cao said. As fluoride accumulates in the body over a long period of time, the bones begin to be affected. Skeletal fluorosis occurs mainly in adults. Early symptoms include sporadic pain and stiffness and numbness of joints. Gradually the bones harden and calcify. In the end, even the nervous system, urinary system, and kidneys are affected.

I looked at the slowly-moving, hunchbacked figures on the grassland. When I learned why they were so deformed, my heart grew heavy.

"It's hard to change customs and habits passed down from the ancestors." Cao knew very well that brick tea was irreplaceable in Tibet. The only way to solve the fluorosis problem was to reduce the quantity of fluoride contained in the tea. Some tea factories have already noticed this problem and have begun to think of ways to manufacture low-fluoride brick tea. The Tibet Langsai Tea Factory is one of them. The most urgent matter now is to find the safe amount of fluoride and to invent and develop techniques to lower the content of fluoride in brick tea.

Fortunately, Cao has discovered a way to reduce fluoride. He is carrying out a three-year research plan to prevent and control fluorosis in Naqu. He is also training local researchers to investigate the fluorosis problem in the area and to find out the safe amount of fluoride to use. During the three years in which the plan is implemented, low-fluoride brick tea will be provided for free to residents of Naqu. The Tzu Chi Foundation is financing the production of the low-fluoride brick tea and the fluoride-measuring instruments.

Recipients of the low-fluoride brick tea include schoolchildren in the Third Elementary School and more than twenty herdsmen's families in Naqu, totaling five hundred people. When we distributed blocks of low-fluoride brick tea to these people, they were so delighted that we felt like Santa Claus giving away presents.

A turning point

To complete his three-year research plan, Cao needs not only tons of brick tea, but also money, patience, and persistence. It won't be easy to keep tabs on the Tibetans, who drink a lot of tea every day. I asked Cao what made him take on this task, a great challenge for any person's willpower. He said that he deemed it his responsibility as a medical researcher to undertake the job. "A medical research project that aims to help people improve their health is more important than one that aims to prolong life." He vows he will do his utmost to find a way to solve the fluorosis problem.

One thousand years after tea was introduced into Tibet, Tibetans began to make their own brick tea. They opened their own tea factory and produced the tea they wanted. Not only that, they have paid attention to the health problems caused by tea drinking. The Tibet Langsai Tea Factory, for example, has been determined to manufacture good tea for the Tibetan people. Professor Cao Jin has also been working hard to ensure that Tibetans can drink tea in health. This is a turning point in the history of tea in Tibet. I hope all Tibetans can live safe and healthy on the land their ancestors chose for them and happily drink butter tea with their fellow people.