Tibetan Medicine: All History Is Speculation

"Could you please say something about Tibetan medicine? I have this class I'm taking...[whining deleted]."

O.K., but only if you tell me what this strange pain is that I have in my neck.

In certain, synergistic respects, Tibetan medicine is the world's oldest systematic method of healing to survive, more or less intact, to the present moment. Should you visit a classically trained Tibetan doctor today, you will be diagnosed in a manner demonstrably understood for at least 3,000 years, and you may be treated using medicines that have been known for an even longer period. The diagnostic methods and means of treatment are sophisticated and complete, anticipating modern Western medicine by many centuries. The corpus of clinical experience is incomparably formidable.

We do not know precisely how or when medicine, as a formal discipline, was first practiced in Tibet, so we speculate. Tibet's earliest physician was likely a shaman: what the early Indians called gSan-wa-pa -- secret ones. The oral traditions of Tibetan medicine, as we now understand it, probably began when the shamanic role became institutionalized in ancient medical traditions later associated with the tribal religion of Bön. We cannot be certain, but indigenous myth suggests this may have occurred some 3,800 years ago, well before the time of Buddha, in a kingdom called Zhang-zhung, centered on Manasarowar in far western Tibet.

These ancient traditions are, in my view, traceable back through Macedonia, to Persia, and to Mesopotamia, and may represent later synthesis with an eastward-moving transmission of ancient Greek medicine, as it assimilated traditions in the path of Alexander the Great, in the fourth century bce. Among other means, I arrive at this assumption by comparative study of the mythologies associated with Himalayan medicine, ethnolinguistic study of medical terminology, and by ethnobotanical investigation of the early materia medica. There is also compelling, contextual evidence that the Bön were indeed not indigenous to Tibet, and may be a foreign tribe originating in Persia.[1] Then again, it may be that the Bön are indeed the original Tibetans in the way that Indians are the original Americans.

Beyond these assumptions, we know very little of medicine in Tibet's protohistory. Yet, we do know that a well-developed, indigenous form of medicine existed as early as 127 CE, distinguished from other ancient medicines by its extensive materia medica and use of surgery. One early regional name for Tibet was Men-Jong, or the "Land of Medicines," and there was a Palace of Medicinal Plants in the Yarlung Valley, patronized by local kings. Artifacts of this tradition exist to the present, in the ancient names of some of the Tibetan medicinal botanicals.[2] We also know Tibet's early tribes were renowned for medicaments and mystics. As an example, the Daoist Golden Mother of the West, Hsi Wang Mu, noted in China's Zhou dynasty (r. 1001-952 BCE), was a Tibetan shamaness famous for her longevity prescriptions.[3] Records of a meeting between this woman and King Mu were discovered in 281 CE, and she was regarded by the early Daoists as the author of the legendary Ssu-t'ung-san longevity formula.

According to Western scholarship, the earliest systematic medicine in Tibet realistically dates to circa 350-307 BCE and is known as Upper or Western Tibetan Medicine. Perhaps this date will be revised backward, as new records continue to be unearthed and translated.

The system is established as Bön with substantial Greco-Arabic influence, and first codified in three texts entitled Multicolored Collection of a Hundred Thousand Methods of Curing, White Collection of a Hundred Thousand Medical Cures, and Black Collection of a Hundred Thousand Medical Cures.[4] These, in turn, are claimed by Bön-pos as the origin of the Tibetan rGyud bZhi [Four Treatises], which we will discuss hereafter.

Later Bön texts assert that there are 21,000 curative methods, applied after four methods of diagnosis:

1. Diagnosis through identification of causes.

2. Diagnosis through pulse examination.

3. Diagnosis through urinalysis.

4. Diagnosis through examination of the patient's condition and the identification of signs of death or cure.[5]

This last means of diagnosis, identification of signs, is also discussed in the rGyud bZhi, and is of considerable importance in tracing the earliest influences on Tibetan medicine. As it is, this method is seen in Mesopotamia, in the Akkadian period (c. 2334-2154 BCE), codified in the forty tablets entitled, If A City. The first section of these record signs encountered on the way to the patient's house; the second section discusses symptoms by location on, in, or of the body; the third section investigates the chronology of illness; the fourth section deals with treatments and syndromes, and the fifth section deals with women's maladies.

The first section of If A City is particularly probative, when we encounter such entries as, "If the [doctor] sees either a black dog or a black pig [on the way to the patient's house] that sick man will die. If he sees a white pig, that sick man will live."[6] We contrast this with similar approaches in the rGyud bZhi, or the Bön Lamp Which Makes Clear the Signs of Death and find that the earliest influences on Tibetan medicine are ultimately traceable to Near Eastern origin.[7] This establishes the idea that Tibetan medicine preserves elements of medical belief traditions dating back some 4,000 years.

Another clue comes to us during the reign of King sTag-ri gnyan-gzigs, who was cured of blindness by Bön-pos associated with the ‘A-zha tribe. We recall that the Near East was particularly known for skill in ophthalmology. No doubt, this skill developed quickly. Eye diseases were prevalent owing to vitamin deficiency, and the Code of Hammurabi decrees, "...if [a physician] opened the eye socket of a nobleman and has destroyed the nobleman's eye, they shall cut off his hand."[8]

Then there are the strange little clues that historians like to ponder. Consider gZi beads, which are actually used as an ingredient in some Tibetan medicines. The gZi beads are cylindrical, or football-shaped, etched agates and carnelians of great antiquity.[9] Nobody really knew much about the origin of gZi beads, but because they reached such a cult status, archaeologists and anthropologists began to study them. Today, we have discovered that the etched carnelian gZi are a Mesopotamian trade bead traced back some 5,700 years. It is provocative to contemplate how and why a 5,700-year-old Mesopotamian trade bead enters the Tibetan materia medica.

Early influences aside, the greatest later influence on Tibetan medicine is undoubtedly Indian. During the fifth century ce, two Ayurvedic doctors from India responded to a divine vision of Tara and made their way to Lhasa. These were Bi-byi dGah-byed, and his consort Be-lha dGah-mdzes-ma. The Tibetan king gave his daughter, Yid-kyi Rol-chha, in marriage to Bi-byi dGah-byed and a son was born named Dun-gi Thor-chog-chen. History does not record how Be-lha viewed this marriage, but we do know that trained as a physician by both Bi-byi and Be-lha, Dun-gi founded a medical lineage that would figure prominently thereafter.

Around the first half of the seventh century, Srong-btsan sGam-po, Tibet's first Buddhist king, evinced such a considerable interest in medicine that it redounds to the present day in historical recounting. His father's physician was the seventh generation in Dun-gi's lineage; a doctor named bLo-gros Chhen-po. bLo-gros' descendant, bLo-gros bShes-gnyen, became Srong-btsan sGam-po's physician.

Srong-btsan sGam-po had two wives, one Nepali, and the other Chinese.[10] The Chinese wife is credited with bringing a work on medicine known in Tibetan as Great Investigation of Medicine, (var. Accessory Medicine, var. Great Analytical Treatise on Medicine; quite possibly the Neijing Suwen), which was translated into Tibetan by Hashang Mahadeva and Dharmakosa.[11] The king also invited the doctors Han Wang Hang from China, Bharadhaja from India, and Galenos from Persia to his Court, and encouraged them to translate the chief medical works of their respective countries. These were Large and Small Louse Gravel, and Preparation of New Butter by Bharadhaja,[12] Large and Small Dispersed Chinese Surgery by Han Wang Hang, together with Collection of Main Additions[13] and Cock, Peacock, Parrot Disorder Treatment by Galenos.[14] Following this effort, the doctors produced a joint work in seven chapters entitled Weapon of the Fearless One.[15] The Persian physician, Galenos, remained in Tibet as a Court physician. He married and had three sons, who began their own family lineages.

In the middle part of the eighth century, during the reign of King Khris-srong-lde-btsan, medicine earned renewed interest. In the tradition of Srong-btsan sGam-po, Khris-srong-lde-btsan also organized an international medical congress, inviting doctors from India (Shanti Garbha), China (Hva-shan Bala Shibata), Kashmir (Guhya Vajra), Persia (Hala Shanti), Nepal (Dharmashila), West Tibet (Seng-mdo ‘Od-chhen), Dolpo (Khyol-ma Ru-tsi), Mongolia, Sinkiang, and Afghanistan. The prominent Court physician of the era was a Chinese doctor named mTha'-bzhi sTong-gsum Gang-ba, who specialized in pediatrics. On his way to Tibet, Gang-ba composed a work especially for the king and thereafter cured the king's afflictions. He, too, remained in Tibet, married, and founded a medical lineage. His work, The Light which Makes Clear the Way of the Methods of White Cure is reportedly still in the literature, now held in Beijing.[16]

Incidentally, Communist Chinese propagandists point to the presence of Chinese physicians as evidence that Tibetan medicine originates in Chinese medicine. They conveniently ignore their own history, and the presence of physicians from other cultures.

To attribute Tibetan medicine to Chinese origin is an absurd ascription. According to the Tibetan historical accounts, the main Chinese contributions were in the field of astrology and pediatrics. The other contributions are stated as follows: "in Nepal they specialized in the mechanical arts, in Kashmir in chemistry, in Mongolia in bloodletting, in Garlog in cauterization, in Taxila in the treatment of poisoning, in Khrom in the examination of the urine, in Zahor in cupping with a horn, in Kesar in healing by means of mantras, in Shanshung in curing by purging, in Uddiyana by vomiting, and in Tibet by the four remedies. The Bon-po system lays the greatest stress on curing by means of heating, balneology, and the use of ointments."[17]

During Khris-srong-lde-btsan's reign an emanation of the Buddha named Padmasambhava came to Tibet. In his manifest form of healing power and activity, named Urgyan Menla, Padmasambhava established the divine medical tradition, composing such works as the Nectar Essence.[18]

According to Buddhist accounts, Padmasambhava also directed his disciple, Vairocana, to visit India and collect the extant medical literature. This resulted in the translation of the Amrta Hrdaya Astanga Guhyopadesa Tantra into Tibetan, which was then presented to the king and a celebrated Tibetan physician, gYu-thog Yon-tan mGon-po. Authorship of this text is invested, variously, in Buddha, his contemporary, the physician Kumara Jivaka (both fl. sixth century bce), Nagarjuna (fl. first century ce), Nagarjuna's spiritual heir Ashvaghosha, and finally the latter's Kashmirian heir Chandranandana, who gave it to Guru Padmasambhava's disciple. In later Tibetan medical histories, gYu-thog is also credited as a probable author. The full Tibetan title translates as Secret Quintessential Instructions on the Eight-Branched Ambrosia Essence Tantra.[19]

Believing the time unsuited to promulgation of this work, Padmasambhava directed that it be hidden in a pillar of Tibet's first Buddhist monastery, Samye, where it would remain for the next two hundred years.

In 1038, following establishment of a Kalachakra Tantra lineage in Tibet, the text was removed by Gra-pa mngon-shes and the tradition it engendered thereafter flourished. Redacted in the twelfth century, this work, familiarly known in Tibetan as the rGyud bZhi, or Four Treatises, is the foundational text of the Tibetan medicine we know today, and is still studied in its twelfth century form.

As we have seen above, there are alternative statements of origin for the rGyud bZhi, and this hermeneutic controversy has been hotly debated among Tibetan physicians for the past six centuries. One of the more persuasive arguments against Indian origin is contained in bKra-shis dpal-bzang's circa fifteenth century work gSo-ba rig-pai' rtsod-spong, in which he lists sixteen major points that definitively establish the work as original to Tibet, probably originating with the Bön.[20]

Yet, other evidence arises in the Astanga Hrdayam attributed to Vagbata, for which the English edition's translator notes, "A Sanskrit medical text ‘rGuyud bzi' [sic] corresponding very closely to Astanga hrdaya has been translated in Tibetan language during 728-786 ad."[21] He then looks backward to the records of the Chinese traveler Itsing, who wrote 671-695 ce, "lately a person collected all the eight branches of medicine hitherto separate and made them into one bundle." The Astanga Hrdayam was translated into Arabic c. 773-808, and cited in a Persian medical treatise dating to 849-850 ce.

What we should glean from the above, rather abbreviated account, is that Tibetan medicine is rightly understood as a synthesis of ancient medical traditions. These influences arise in Mesopotamia, as a seminal issue; Greece and Persia, no doubt in large result of Alexander the Great's eastern expansion circa 336-323 BCE; China, through a period of cultural contact and intermarriage, circa 350 bce-700 CE, and India, circa 500 CE and continuously thereafter, through religious contact. This synthesis involved taking the essential, useful elements of each tradition and blending them together with indigenous approaches into an integrated whole. If we had to summarize the process, we could assert the general proposition that early Tibetan medicine is, more likely than not, an amalgam of Greek, Chinese, and Indian medical traditions, with indigenous elements from the shamanic tradition. Current scholarship explains that the Chinese influence is the smallest part-Tibetan scholars persuasively argue that Tibet influenced China, not the other way around-and Indian influence is the largest part. In fact, there were fifty-seven different medical systems available to the Tibetans, and it is likely they made use of all of them.

There is also a divine origin, which we must not ignore. Buddhas exist in Buddha Fields, or pure realms beyond the illusion of subject and object, and manifest in our own and other world-systems to benefit all beings.

Although all Buddhas have the same nature, each has a particular power. The Vaidurya Buddha --the Healing or Medicine Buddha-- exists in a Buddha Field known as lTa-na-sDug, or "Beautiful to Behold." From here, he imparts knowledge of healing to benefit suffering sentient beings, and he embodies the essence of healing. That is his particular power.

As a Buddhist, I believe that the knowledge of healing codified in the Tibetan tradition is a direct gift from the Medicine Buddha. I also believe that the Medicine Buddha did not confine the dissemination of this knowledge to one place, one time, one tradition, or one people. Rather, this knowledge is continuously imparted in ways uniquely suited to each period, place, and circumstance.

Proceeding from this foundation, we should note as well that contemporary Tibetan Buddhist medicine is also fundamentally connected to the outer, inner, and secret presentations of the Kalachakra Tantra.

As a doctrinal issue, circa the tenth century, after many condensations and commentaries, Kalachakra was reintroduced into India, where a variety of lineages evolved. In 1028 CE, some of these reached Tibet, and eventually two of these flourished.

Through the passage of centuries, the Indian lineages dissolved, whereas the Tibetan lineages remained intact. Thus, if in this century, you receive an initiation into the Kalachakra Tantra from His Holiness Dalai Lama XIV, as it is indeed still possible to do, you are entering an unbroken lineage reaching back directly to Shakyamuni Buddha.[22]

The transmission of the Kalachakra Tantra to Tibet was fortuitous, as it occurred proximate to a time when such traditions were destroyed by Muslim barbarism in India. Under Tibetan guidance, the Kalachakra transmissions were reintegrated with the earlier Ayurvedic transmissions, circa 1038 ce.[23] Thus did divine medicine come to survive and prosper in Tibet, until the mid-twentieth century and the military occupation of Tibet by Communist China. There are now only a few monasteries left in Tibet where the Kalachakra is practiced, chiefly in eastern Tibet, in the Chinese provinces of Qinghai and Sichuan, but one questions the circumstances in which the practitioners find themselves.

We are now at the stage when the Kalachakra Tantra transmissions are propitiously guarded in the West. This is likewise fortuitous; as the Kalachakra tradition informs us, an apocalyptic struggle will occur approximately 360 years from now, wherein the teachings will lead to decisive victory over tyranny.[24] Since the teachings and the tradition they spawned have proved irrefutably accurate for each of the past 2,500 years, an intelligent person would take this prediction very seriously.

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[1] In spite of centuries of investigation, and accounts of the Bön themselves, we still do not know who they really were, or are, and for this the blame lays squarely on the Tibetan monarchy. "Bön" is at once a people, a belief system, and the elements of a belief system. I hesitate to say this, but I sometimes think the fate that befell Buddhist Tibet at the hands of Communist China is in karmic consequence of the fate that befell the Bön at the hands of Buddhist Tibet. I have always yearned to examine Bön in its original state, devoid of Buddhist influence, but unfortunately, this is impossible.

[2] As an example: the Tibetan name for tinospora sinensis is sle-tres, said to originate in the ancient Bön language, thus indicating use of this herb may date back to c. 800 BCE.

[3] Hsia, Veith and Geertsma, The Essentials of Medicine in Ancient China and Japan: Yasuyori Tamba's Ishimpo. Part Two. (Leiden: E.J. Brill, 1986), p. 6-7, identify her as the matriarchal chieftain of what they call the Tso-Ngong-Bo tribe, which they translate as Blue Sea. Because we do not know what transliteration scheme they employ, we cannot dissect this. gTso-snon-po could mean Blue Lady. gSo-snon-po could mean Blue Physician. mTsho-snon-po is Blue Lake, or Lake Kokonor. gSto is the name of a tribe, so in theory this could be Sto-snon-po. We regret we cannot trace this tribe with precision. This could be the gTso, one of the ‘bangs-rus-drug group, or the 6 clans of royal lineage. This could also be the sTong, hailing from the area the Sui Chinese knew as the Land of Women, or what the Han Chinese generally called a Ti Ch'iang tribe. In any case, the area is around the upper Nyag-chu River, well to the east of Zhang-zhung. See: Ancient Tibet: Research Materials from the Yeshe De Project (Berkeley: Dharma Publishing, 1986).

[4] dPyad ‘bum khra bo, sMan ‘bum dkar po, and sMan ‘bum nag po.

[5] Enrico dell Angelo, "Notes on the History of Tibetan Medicine," Tibetan Medicine 8 (1994), p. 4-5. Cf. Namkhai Norbu, Drung, Deu and Bon (Dharamsala: Library of Tibetan Works & Archives, 1995).

[6] Nancy Gordon, "Mesopotamian Medicine," op. cit. p. 17.

[7] ‘Chi-rtags gSal-ba'i sGron-ma.

[8] A. Leo Oppenheim, Ancient Mesopotamia: Portrait of a Dead Civilization (Chicago: University of Chicago Press, 1977), p. 293 explains that this refers to scarification, not surgery, and was a common practice in Alexandrian medicine.

[9] One authority describes them as onyx. See: Sarat Chandra Das, A Tibetan English Dictionary With Sanskrit Synonyms (Calcutta: Bengal Secretariat Book Depot, 1902). Chalcedony is also seen.

[10] We wonder, on some experience in such matters, if household relations between China and Nepal account for the King's frequent call for doctors.

[11] sMan-dpyad Chen-mo.

[12] Bu-shag-ma Bu-che-chung and sByor-wa Ma-sar.

[13] Ga-ched Thor-bu Che-chung and Go-gnon Dud-pa.

[14] De-pho Ma-ja Ne-tso sum gi Ched-shog, all cited as such in Lobsang Rabgay, "The Origin and Growth of Medicine in Tibet," Tibetan Medicine, 3 (1994), pp. 18-19.

[15] Mi ‘Jigs-pa'i Mtson-pa.

[16] gSo ba dkar po lam gyi sgron ma.

[17] Rechung Rinpoche, Tibetan Medicine, illustrated in Original Texts. (Berkeley: University of California Press, 1973), pp. 202, quoting the biography of gYu-thog. "Balneology" is the use of medicinal baths.

[18] bDud-rtsi'i snying-po.

[19] bDud-rtsi snin-po yan-lag brgyad-pa gsan-ba man-nag gi rgyud.

[20] Samten G. Karmay, "Vairocana and the rGyud-bzhi," Tibetan Medicine 12 (1989), pp. 19-31.

[21] K.R. Srikantha Murty, trans. Astanga Hrdayam. (Varanasi: Krishnadas Academy, 2003), vol. 1, p. xvi.

[22] He has given the initiation more than twenty times, including twice in Tibet.

[23] This is when the revision of the rGyud bZhi by gYu-tog was removed from its hiding place in a pillar on the roof at Samye Monastery by Grva-pa mngon-shes, but note other accounts give the date of this event as 883. See: Pasang Yonten, "A History of the Tibetan Medical System," Tibetan Medicine 12 (1989) p. 41, n 29, remembering that mNgon-shes' birthdate is usually given as 1012, giving rise to a considerable discrepancy.

[24] Is it difficult to believe such things? Witness the behavior of Nazi Germany, Communist China, and the Fundamentalist Muslim world.