The History of Tibetan Medicine

TEXT BY THUBTEN PHUNTSOG

Caterpillars enjoying better sales today. Photo by Le Jinxiong

1. Origins
The search for the means to maintain health is as ancient as the civilization of man. There is a Tibetan saying that: ‘the first ailment was indigestion; and boiled water, the first medicine.” There are many such expressions through which we can deduce the knowledge of ancient times.  For example, the application of melted butter to cauterize a wound, or the drinking of boiled water to cure indigestion, tell us something of traditional household treatments. Such experiential knowledge, gathered and passed on for many generations, gradually was collected and became a written tradition.
 
Among the extant manuscripts, the oldest treatise of Tibetan medicine is a Bon text called gSo rig “bum bzhi. This treatise is a transcription of the teachings on medicine given by Shenrab Miwo, the master of the Bon, edited by his son Chebu Trishe, the first holder of the knowledge contained in the treatise. The sequence of the transmission of the gSo rig “bum bzhi is described in the colophon as follows:

Concerning the sequence of the lineage of the Nine Scriptures, Ambrosia of the Medicine,1 the enlightened sovereign of the Doctrine transmitted it to Chebu Trishe. He taught it to Mutsa Trahe, who transmitted it to Sertog Chejam, who in turn transmitted it to Tongyu Thuchen, who explained it to Gyimtsha Machung, who transmitted it to seven Buddhist monks. When [The Ambrosia of the Medicine] was adapted to a Buddhist format, the treatise was about to be thrown into the fire, but seven followers of the Bon rescued it and hid it in the secret cave of Jema Yungdrung, situated in the upper region of Western Tibet. Later, when the times were appropriate, Butso Sipe Gyelpo, a Bonpo priest of Western Tibet, rediscovered the treasure and explained it’s meaning to Phelchen, a sage of the Meu region. Drungmu Nyiwer, the venerable monk of Kham Yukar, lamp of the teaching, transmitted it to [others]. May all circumstances be conducive!

This information concerning the 'bum bzhi reveals the existence and the origin of a truly ancient medical tradition. Shenrab Miwo lived twenty centuries before Christ.  In The Light of Tise2, An History of Tibet and of Shang Shung, the scholar Namkhai Norbu states:

Shenrab Miwo, the Master of the Bon, was born the year of the wood mouse, 1917 years before Christ and lived till the age of eighty two.

From that time until the Buddhist King Trisong Detsen founded the school of Tibetan medicine, for a period stretching over more then 2,600 years, Tibetan doctors practiced medicine on the basis of this treatise, the bum bzhi.

During the reign of the Tibetan King3 Nyatri Tsenpo, born in  417 BC., there were twelve lores known as ‘the Bon of the Twelve Lores”.  Among them is the lore known as ‘therapeutic methods, the Altruistic lore of healing” constitutes the medical knowledge. From that time until the advent of Trisong Detsen4, every Tibetan king invited a master-doctor from the kingdom of Shang Shung (sku gshen, bla smen pa in the current language).

An anecdote from the end of the sixth century gives an example of the  sophistication of the medical knowledge of this period.  It is said that Tagri Nyenzig5,  the  31st king  of Tibet was blind from birth. He called a doctor from the region Asha, now known as Ngapa (an autonomous prefecture of Tibet) who successfully operated him and cured him from the blindness (cfr. Pawo Tsulag Trengwa, A History of Tibet, Feast for the Sages ).

2. Translation of Foreign Medical Treatises
In the 629 AD, during the 33rd king  of  Tibet , Songtsen Gampo became the sovereign of  Tibet. He established political relations with some neighboring countries, and in the course of time he invited numerous doctors from India, China and Persia. Several treatises from these countries were translated into Tibetan, thereby stimulating the composition of other texts. Kongtrul Lodro Taye states in his Encyclopedia  Indo-Tibetica:

 At the time of Songtsen, the treatises of three major traditions,
 And during the period of Agtshom7 those of the tradition that  
       accompanied the Chinese princess,
 And many others,  written by Chinese monks and by Bi ji 8were
            translated.
 The Somaraza 9 is the outcome of the exchange of knowledge among
 many experts.

In the year 841 AD, the king Langdarma was murdered and Tibet fell into disunity. As a result of various insurrections ancient documents, and evidence of culture were lost. During this period, few people were able to pursue study of the culture; the medical tradition was adversely effected and its development came to a halt.

During the second propagation (in 10th and 11th Centuries) of Buddhism, the translator  Rinchen Zangpo (958-1055 AD) traveled to India to deepen his knowledge. On his return, he retranslated into Tibetan The Essence of the Eight Branches 10 and other treatises that had already been translated by Yig  Rinchen of the Nyewo clan and others. Concerning these translations, in his Encyclopedia Indo-Tibetica, Kongtrul states:

"Before and later, during the second propagation, the translations
were numerous; Rinchen Zangpo propagated The Eight Branches
and transmitted them to the four doctors of Phureng; They passed the
transmission to Shang Shig, Dargon, Yuthok, and others, then the
knowledgeable Tibetan doctors began spread the teachings that reached far and wide."

3. The First School of Medicine in Tibet
The first school in Tibet was a school of medicine.  In  755, Trisong Detsen was crowned  38th king of Tibet. Besides the Buddhist doctrine, he attached great importance to the preservation and development of the various sciences. Due to his concern, the ancient texts on Tibetan culture were adapted to a Buddhist format by Vairocana, Yuthok Yonten Gonpo and other scholars. In this way the culture and Buddhism developed and propagated in the country. These events are clearly illustrated in the biography of Guru Rinpoche, The Treasure Rediscovered in the  Crystal Rocks.

Tibetan medicine capsules.Photo by Gao Guorong

It is in the year 762 AD, under the auspices of the same king that the first school of Tibetan medicine was founded in Menlung in the region of Kongpo12.  In the first year, three hundred students attended the school. The entire course of studies lasted for ten years, at the end of which the new doctors received  a title according to the degree attained. The highest title was that of “Bumrampa”13 corresponding to the  Doctorate degree; followed by the title of  “Rabjampa” corresponding to the  Master’s degree; and that of “Kachupa” corresponding to a Bachelor’s degree. The lowest title was that of  “Durapa”. These titles are still in use today. Among the students of the first course, fifty obtained the title of “Bumrampa”, fifty that of  “Rabjampa”, and a hundred that of “Kachupa”. At that time the ethical basis and the norms of behavior for the medical profession, were laid down that, besides the actions to be done for the benefit of the patient, the practice of benevolence and compassion should also be upheld.

In the next course of studies, about one thousand students coming from every region of Tibet and also from India, China and Persia participated. The events related to this school are clearly illustrated in the important Biography of Yuthok Yonten Gonpo.

From the Colophon of the contents of the old Bon manuscripts “Kaju”, by Nyima  Tenzin, it is clear that the textbook used in that school was the “bum bzhi,  the ancient Bon text on medicine reformatted to the newly emerging Buddhist needs by Vairocana and other scholars, and its title was changed to The Four Medical Treatises (or Tantras).

4.  New Influences on the Tibetan Medical Tradition
In the 12th Century AD, the second Yuthok Yonten Gonpo (1126-1202) examined the different transmissions of The Four Medical Treatises comparing them with foreign medical texts.  He went about revising and expanding The Four Treatises extensively.  He wrote several supplements to them, and initiated  a  renewed  interest in Tibetan medicine. 

Later, in the 13th Century AD, the tantric adept Ugyenpa (1230-1309) traveled to India and in the country of Oddiyana15. There he studied various methods for the preparation of medical substances. He tells us that in the country of Oddyiana he received numerous instructions from “woman of knowledge”. When he returned to Tibet, Ugyenpa continued his research on medicinal substances, studying their tastes, potencies and other properties.  He developed a technique  (known asngul chu btso bkru) to detoxify mercury. The detoxification of mercury is a complex chemical procedure that uses, among other things, the ashes of  eight metals and eight minerals.  Ugyenpa’s discovery led to detoxified mercury being used as a crucial substrate for the addition of many precious gem recipes into the Tibetan pharmacopoeia.

New medicinal substances were again added to the Tibetan pharmacopoeia  at the beginning of the 14th Century, Rangjung Dorje (rang byung rdo rje), the third Karmapa (1284-1339), undertook research on medicinal substances and identified about 830, among them herbs, minerals (such as the ten precious minerals), and animal substances. He described their taste (including the post-digestive taste), their potencies and their various properties.  He compiled the result of his research in a treatise called The Ocean of Names of Medicines. 

5. The Schools of Jang and Zur
In the 15th Century, two schools of medicine emerged:  Jang and Zur. These two lineages still exist today. They take their name from two important doctors in the commentarial lineage and in the transmission of The Four Medical Treatises. The two schools do not present substantial differences. Differences in the climatic conditions of the regions where the two doctors originated made the identification, classification and use of plants vary.  Certain points of the body where moxibustion and bloodletting are performed also differ. 

The school of Jang originated with Jangpa Namgyel Trakzang (1395-1475).  He was born in a family of local administrators in Jangpa Depa, a village in the area of Ngamring in Western Tibet. The main recipient and disseminator of the teaching and of the lineage of the new treatises written by Jangpa Namgyel, was Mi”i Nyima, his son, followed by Lhatsun Trashi Pelzang, Sonam Yeshe Gyaltsen and others.

The most important figure of this ancient school was Desi Sangye Gyatso (1653-1705). In Lhasa, on Chagpori hill, he built the school of medicine known as Dropen Rigje Ling, where students were given free education, lodging and food. Sangye Gyatso invited expert doctors from various regions of Tibet. With their collaboration and on the base of The Words of the Elder (composed by Zurkawa Lodro Gyelpo), he compiled The Blu Beryl, a new commentary on The Four Medical Treatises. Thanks to his work the teaching of the Jang school spread and flourished.

The school of Zur originated with Zurkar Nyamnyi Dorje known also as Awo Choje (1439-1475). Nyamnyi Dorje was born in Zurkar in Southern Tibet. He wrote comments on different parts of the Four Treatises on Medicine and texts on various aspects of Tibetan medicine. Among the disseminators of the teaching of Zurkawa Nyamnyi Dorje we find the “four students who gained proficiency”, the “eight student that were made potent”, the ‘sixteen intelligent ones”, the ‘twenty famous ones” and so forth.  Of particular relevance was the work of Zurkawa Lodro Gyelpo (1509-1585), nephew of the founder of the school that authored The Words of the Elder, a commentary on the Four Treatises  and other texts such as the Refutation of the Arguments Vindicating  that the Four  Medical Treatises Belong to the Buddhist Canon.

However, the figures that have contributed in major ways to the spread of this school were Deumar Tenzin Phuntso (1672-?) and Situ Choji Jingne 1700-1774. This last, in the year 1754, founded a school called “Ngarig Lobling” (The Island for the Study of the Five Sciences)16. The School produced a number of doctors of great value that favored the spread of the Zur School.  Due to their scholarship and dedication there has been a continuous transmission of the school's teaching up to the present time.     

Deumar Tenzin Phuntso undertook detailed researches on various types of medicinal substances existent in Tibet, in India, in China, in the region of Jang (at the border between Tibet and China) and in other places. The result of his research is contained in two treatises that he wrote in the year 1727, entitled The Sphere of Crystal and The Crystal Necklace. In these texts, 2,294 medicinal substances are identified on the basis of their taste (including their post-digestive taste), potencies and properties. Still today, these texts form the basis of the pharmacopoeia used by Tibetan doctors from every region of Tibet.

 6. The Medical Profession in Ancient Tibet
In ancient Tibet, the doctors were mainly monks. The laboratory where they prepared  medicines and the clinic where they checked the patients were usually part of a monastic complex. In fact, the Tibetan monasteries were not only places of worship where the spiritual traditions flourished, but actual universities  where the different disciplines were studied and  medicine was practiced. In every part of Tibet there was a monastery, large or small, to which sick people could seek treatment.  The population itself collected the substances used for the preparation of medicines:  by either nomads in the colder regions, or those in the lower valleys.

In ancient time, in Tibet, it was a common custom for the doctor to give out the medicines regardless of the financial situation of the patient. If the patient was a rich man, the custom required that he offer, as a reward, gold, silver, horses and other domestic animals; if the patient was from the middle class, he offered what he could afford. However if the patient was very poor, the doctor would not ask nor accept any remuneration. It is said that it never happened that even the poorest, sick person would die because he or she was unable to buy the medicines he or she needed.