A comprehensive history of Sowa Rigpa in the twentieth century is yet to be written. Rather than taking on this greater task my aim here is to identify the forces that shaped the industrialisation of Tibetan medicine. Whereas the actual creation of the industry started only in the 1990s, earlier events in the history of Sowa Rigpa under communist rule set the basic conditions for its development. In the first part of this chapter these basic conditions are discussed. I argue that the history of Sowa Rigpa in the People’s Republic of China has to be understood in relation to