Hierarchy of Resort in Medical Pluralism: Chronic Dyspepsia Across Western Biomedicine, Traditional Chinese Medicine, and Sowa Rigpa

Chronic Dyspepsia (a group of symptoms such as postprandial fullness, bloating, early satiety) is perceived differently by different medical systems. This paper explores the functioning of medical pluralism between Western biomedicine, Traditional Chinese Medicine (TCM) and Sowa Rigpa and what their coexistence reveals about unequal medical authority. It makes use of Kleinman's explanatory models and the hierarchy of resort, comparing and contrasting the role of the two systems in explaining, diagnosing and treating the symptoms, and analyzing a personal case: the author's own path from a biomedical clinic to a TCM practitioner, and finally to a private Tibetan practitioner. The comparison shows that the three systems interpret the same symptoms in different models. The pathway was a hierarchy of resorts, each step being triggered by a treatment or explanation that did not get to the bottom of the illness. But the order and access were also determined by institutional Legitimacy: biomedicine came first and excluded infection, while access to Sowa Rigpa was through personal connection. The paper argues that pluralism is better understood as a structured landscape rather than as a menu of equal options.