Details of Tibetan Medicine 1: History and Lineages

It was at this time that the Indian Buddhist medical tradi­tion came to Tibet as well. It was introduced from Kashmir by Vairochana, the famous early translator of Buddhist texts, who translated, as well, the Four Medical Tantras (sMan-gyi rgyud-bzhi), which he had stu­died from the Kashmiri physician Chan­dranandana. The word “tantra” means an everlasting stream of continuity. Medicine is called a “tantra” because there is the ever­lasting stream of conti­nuity of the basis, namely the con­tinuity of sub­tlest con­sciousness and subtlest energy; the everlasting stream of the path, namely proper health preserv­ing proper physical, verbal and mental behavior; and the everlasting stream of the result, namely the total good health on all physi­cal, verbal, mental and emotional levels of a fully enlightened Buddha.

The Four Medical Tantras are the Root Tantra (rTsa-rgyud), Explanatory Tantra (bShad-rgyud), Quintessence Tantra (Man-ngag rgyud) and Further Tantra (Phyi-ma’i rgyud). According to tradition, they are traced to the Buddha who, in the form of the Medicine Buddha, Bhaishajyaguru, taught them, at age seven­ty-one, in his palace in the city of Tanadug (lTa-na-sdug). These four tantras deal with eight branch topics:

1. The body, which includes anatomy, physio­logy, embryology and phar­macology
2. Pediatrics
3. Gyneco­logy
4. Diseases from harmful spirits
5. Wounds
6. Pois­oning
7. Geriatrics
8. Fertility and reproduction.

This is slight­ly different from the eight branches of the Ayurvedic system, which omit gynecology and the treatment of wounds, and include instead sur­gery and diseases of the head and neck.

Just as there was held at Samye (bSam-ye) Monastery a debate to decide whether the Indian or Chinese form of Buddhism would be adopted in Tibet, likewise a simi­lar conference was held at the same monastery to determine the system of medi­cine to be used. Just as Indian Buddhism was declared the winner, like­wise it was decided that the Indian Buddhist medical system would form the major framework for Tibetan medicine.

In the early ninth century, the great Tibetan master physi­cian, Yuthog the Elder (g.Yu-thog rnying-ma Yon-tan rgya-mtsho) traveled three times to India and once to China to study with physicians there. Afterwards, he slightly rewrote the Four Medical Tan­tras, including within them material that came from the Hindu Ayurvedic, Chinese, Greek and Bon systems that had been used in an eclectic fashion in Tibet prior to this. This style of taking certain aspects from the teachings of these differ­ent cultures, re­working, combining and making advances on them to derive a unique Tibetan sys­tem occurred with the develop­ment of Tibetan astrology as well. Thus, aspects are found in Tibetan medicine that are reminis­cent of features in the Hin­du, Chinese and ancient Greek systems, but which are defined and used in quite differ­ent ways, as with the example of the eight branch topics just mentioned.

Yuthog the Elder also founded the first Tibetan medical college, Tanadug (lTa-na-sdug), in Kongpo Melong (Kong-po Me-long) and wrote an eighteen-chapter commentary to the Four Tantras. Guru Rinpoche Padma­sambhava, the great Nyingma master, then con­cealed Yuthog the Elder’s compi­lation of the Four Medical Tantras at Samye Monas­tery, where they remained hidden for several centu­ries during which the times were consi­dered uncon­ducive for their prac­tice. Guru Rinpoche also hid as “tre­as­ure texts” (gter-ma, terma) many Buddhist manu­als of this Old Translation Period as well.

The famous New Period translator, Rinchen Zangpo (Rin-chen bzang-po), during the first half of the eleventh century, translated further Buddhist medical texts from Kashmir and founded a medical school at Toling (Tho-ling) Monastery in Western Tibet. This was the monastery that soon afterwards hosted the Indian master Ati­sha, who had been to Indonesia and from whom the Kadam tradi­tion of Buddhism is traced.

The texts of Yuthog the Elder were recovered in 1038 by Drapa Ngonshe (Gra-pa mNgon-shes) and eventually were transmitted to Yuthog the Young­er (g.Yu-thog gsar-ma Yon-tan mgon-po) in the twelfth century. This great physician re-edi­ted the Four Medical Tantras in their pre­sent form of 156 chap­ters, written in the style of questions and answers between two sages. This, with its commentaries, forms the basis of all Tibetan medicine.

The number 156 is significant since it is the number of side channels that come from the six chakras according to the Kalachakra system. Together with the six chakras, 162 is the traditional number of verses in the seminal Kalachakra text, A Concert of Names of Manjushri (’Jam-dpal mtshan-brjod, Skt. Mañjuśrīnāmasaṃgīti), minus the five verses of the epilogue. This text had already been translated into Tibetan during the time of Emperor Tri Songdetsen. The Kalachakra teachings were introduced to Tibet in 1027. It’s difficult to ascertain, however, the influence of the Kalachakra teachings on Tibetan medicine at this early stage.

Yuthog the Younger also compo­sed Heart Essence Teachings of Yuthog (g.Yu-thog snying-thig), a set of Nyingma ritu­als used for the conse­cration of Tibetan medi­cines even today.

In the early fourteenth century, the Third Karmapa, Rang­jung Dorje (Rang-byung rdo-rje), wrote commentaries to the Abridged Glorious Kalachakra Tantra, Stainless Light (dPal dus-kyi ’khor-lo’i bsdus-don dri-ma med-pa’i ’od). From his commentary on the first chapter, An Adornment to Clarify the Manner of “The Abridged Kalachakra Tantra, Stainless Light” (dPal dus-kyi ’khor-lo’i bsdus-don dri-ma med-pa’i ’od-kyi tshul gsal-bar byed-pa’i rgyan) is derived the Tsurpu (mTshur-phu) tradition of Tibetan astrology. From his work on the second chap­ter, The Meaning of the Profound “Internal (Kalachakra” Chapter of “Stainless Light”) that Gathers Together the Essence of Oceans of Anuttarayoga Tantras (rNal-’byor bla-na med-pa’i rgyud-sde rgya-mtsho’i snying-po bsdus-pa zab-mo nang-gi don) are derived various aspects that were ela­borated upon and incorporated into the Tibetan medical system. Thus, from this point onwards, certain anatomical and terminolo­gical features dealing with the body’s subtle energy channels are adapted from the Kalachakra system. Also derived from the Kalachakra system are the formulas for the compilation of vari­ous medicines from precious gem substances and particularly for com­pounding detoxified mercury. Further­, the Kalachakra Buddha-figure, together with its inter­woven ten-syllable symbol, became asso­ciated from this time with both Tibetan medicine and astro­logy.

In the fifteenth century there developed two medical linea­ges, the Chang (Byang-lugs) and the Zur (Zur-lugs), founded by Changpa Namgyal Drag­zang (Byang-pa rNam-rgyal grags-bzang) and Zurkar Nyamnyi Dorje (Zur-mkhar mNyam-nyid rdo-rje) respectively. The former wrote commentaries to and put special emphasis on the first two of the Four Medical Tantras, while the latter wrote commentaries to all four. They differ slightly in their descr­iptions of some as­pects of the subtle energy system, on the preparation and ingredients of certain medicines, on the use of enemas, on the detoxification process for mercury and on certain moxa­bustion points.

The Fifth Dalai Lama (rGyal-ba lnga-pa chen-po Ngag-dbang blo-bzang rgya-mtsho) was a great patron of Tibetan medicine during the second half of the seventeenth century. His prime minister, Desi Sanggye Gya­tso (sDe-srid Sangs-rgyas rgya-mtsho), who also ruled as regent after the Dalai Lama’s death, wrote texts on both medicine and astrology, called respectively Blue Aquamarine (Baidurya sngon-po) and White Aquamarine (Baidurya dkar-po). He combined the Chang and Zur traditions and founded the Chag­pori (lCags-po-ri) Medical College for monks at Lhasa.

Under the Thirteenth Dalai Lama (rGyal-ba Thub-bstan rgya-mtsho), during the early part of the twentieth century, the present system of four levels of medical degrees was instituted, as well as a standard medical examination system. This was parallel to the re­structuring he initiated in the monastic education system for the Geshe degree in Buddhist philosophy. His personal physician, Khyenrab Norbu (mKhyen-rab nor-bu), founded in Lhasa the Mentsi­kang (sMan-rtsis khang), the Tibetan Government Medi­cal and Astro In­stitute, primarily for monks and Tibe­tan military men from all over the country. Some special lay students were admitted as well.

Lady doctors were traditionally trained only privately, out­side the col­leges, and most often within family lineages. In the southeast­ern Tibetan province of Kham, medicine was studied only privately from individual teach­ers. In the north­eastern Tibetan province of Amdo, there was a tradition of “menpa da­tsangs” (sMan-pa Grva-tshang) – monastic medical colleges – the most famous being at Lab­rang Tashi­kyil (Bla-brang bKra-shis ’khyil).

Many great Tibetan figures have been masters not only of Buddhist meditation sys­tems, but also of medicine. The most well-known example was Milarepa’s disci­ple, Gampopa (sGam-po-pa).

There is a tradition in Tibetan monasteries for people to try to master all fields of knowledge and become like what was known in Europe as “Renaissance men.” This would naturally include the subject of medicine. Examples of such masters in the nineteenth century, who were noted for their medical skills among their other accomplishments, were the three great spiritual leaders of the “rimey” (ris-med) non-sectarian movement in the south­eastern Tibetan province of Kham, namely Jamyang Khyentse Wangpo (’Jam-dbyangs mkhyen-brtse’i dbang-po), Ju Mipam (’Ju Mi-pham) and Jamgon Kongtrul Lodro Taye (’Jam-mgon Kong-sprul Blo-gros mtha’-yas). A more recent example in the twentieth century was the late Junior Tutor of His Holiness the Dalai Lama, Trijang Rinpo­che (Khri-byang Blo-bzang ye-shes bstan-’dzin rgya-mtsho).

In 1959, the Chagpori Medical College in Lhasa was destroy­ed by the Commu­nist Chi­nese. The activities of the Tibetan Government Medical and Astro Insti­tute were drastically cur­tailed in that year, and totally stopped during the Cultu­ral Revolution in the late 1960’s. After the death of Mao Tse-tung in 1977, it was re-opened in Lhasa under Chinese control, with women students also admit­ted. It has been renamed the Medical and Astro Institute of the Tibetan Auto­nomous Region, with the Chinese claiming that Tibetan medicine is merely a subdivision and variant of Chinese medicine, which is not the case. Of all the aspects of Tibetan culture, Tibetan medicine is the only one that the Com­munist Chinese have allowed to continue intact. This is because of its great effectiveness in having cured many Chinese officials.

The Tibetan Government Medical and Astro Institute has been continued in the Tibetan refugee community around His Holiness the Dalai Lama in Dharam­sala, India. It was restarted in 1962 and, at present, has a seven-year pro­gram for training doc­tors, open to both men and women. It also has, in connec­tion with it, an astro­logy school with a five-year course, as well as a hospi­tal, an out-patient clinic, a factory for making medicines, a small medical library and a medical museum. At present (1990), it has thirty-four branch cli­nics around India and Nepal.

The Tibetan Government Medical and Astro Institute has a modest research program as well, for instance concerning the diseases of the future predicted in the ancient Tibetan medical texts. In the eighth century, Topon Chokyi Dragpa (Chos-kyi grags-pa) explained eighteen malignant disor­ders of the future, such as cancer, meningitis, diphtheria and pneumonia, and wrote in detail about their signs of development, symptoms, prevention and treatment. Guru Rinpoche Padmasambhava predict­ed other diseases, and further ones are men­tioned in the Kala­chakra Tantra.

The last chapter of the Four Medical Tantras predicts that, in the future, changes in diet and life­style, and the use of chemicals, will provide the contributory condi­tions for new diseases to arise. Air, food and the earth will become polluted. This will foster the growth of micro-organ­isms that will cause the defense system of the body to weaken and such sick­nesses as aller­gies, asthm­a, cancer and AIDS to arise. Sicknesses will come even from the sunrays, which implies from other types of radiation as well. These new pol­lution-induced diseases can often be preve­nted by proper diet, behavior and lifestyle. They can also be treated by various medicines. Such medicines have been prepared by this Tibetan Medical and Astro Institute according to the guidelines given in these texts and are being tested in India and various coun­tries around the world.

The Tibetan medical system spread from Tibet to Mongolia, both so-called “Outer” and “Inner” Mongolia, and from there northwards to the Buryat Mongol and Tuvinian Turkic regions of Eastern Siberia. It also spread di­rect­ly from Tibet to the Oirat Mongol regions of East Turkistan, which are in present-day Xinjiang province of China, and to their relatives in Kalmykia, around the northern part of the Caspian Sea, as well as to north­ern China and Manchuria. It is found as well throughout the Buddhist Himalayan regions from Ladakh eastwards through Lahul, Spiti, Kinnaur, Nepal, Sikkim, Bhutan and Arunachal.

The first translations of medical texts from Tibetan into Mongo­lian were started during the time of Khubilai Khan, in the mid-thirteenth century. It was at that time that the first translations were made into Mongo­lian of Tibetan Buddhist texts as well. The Four Medical Tantras were trans­lated in the fourteenth century. Once Tibetan Bud­dhism had become tho­rough­ly esta­blish­ed and widespread throug­hout the Mongol re­gions at the end of the fif­teenth cen­tury with the visit of the Third Dalai Lama, the basic medical texts were re­transla­ted in the early sixteenth century, toget­her with Desi Sanggye Gya­tso’s medical works.

The first Tibetan medical school in Mongolia, the Dakhan Emchi Aimak, was founded by the Tibetan physician Dakhan Emchi Losang Norbu in 1712. The most famous monastic medical col­lege, the Sorig Shanpan Ling, was started in Urga, present-day Ulaan Baatar, in 1760. Eventually, most of the monasteries in Mongolia, as well as in Buryatia, Kalmykia and Tuva had medical colleges as one of their divisions, where monk doctors were train­ed. This was in keeping with the tradition of the Amdo province of northeas­tern Tibet. In fact, Mongo­lian doc­tors became so famous that even in Tibet the modern colloquial term for a doctor is the Mongolian borrow-word “emchi.”

The most outstanding Mongol physician was the eighteenth century Mongour master, Sumpa Khenpo Yeshe Paljor (Sum-pa mKhan-po Ye-shes dPal-’byor), known in Mongolian as Ishbaljor. The Mon­gours are a Mongolian people living in the northeastern Tibetan province of Amdo and in adjacent Gansu. He com­posed five medical texts, including one that describes the local medicinal plants that grow in the Mongol regions and which can be used in the pharmacopoeia as substi­tutes for those found only in Tibet.

In the nineteenth century, the Mongolian physician Jambal­dorj wrote in Tibetan a four-volume text with fur­ther elabora­tion on native Mongo­lian medi­cinal plants, with all the ingre­dients and preparation procedures for the various medicines, given in the Tibe­tan, Mongolian, Manchu and Chinese lan­guages. Mon­go­lia at that time was part of the Manchu Chinese Empire.

Although, as in all lineages of Tibetan medicine, diseases are classified according to the three humors of wind, bile and phlegm, in the Mongolian tradition there is more emphasis on the discus­sion of the heat functions of the bodily organs and the classification of sick­nesses into hot and cold disorders. This is due to the slight influence found in the Mongolian tradition from Chinese medi­cine and its classification of diseases as yin and yang. Ne­vertheless, Tibetan medicine in the Four Medical Tantras does speak in terms of hot and cold disor­ders. This is not at all alien to the Tibetan system, but just a shift in emphasis.

It should be repeated, then, that Mongolian medicine is not a separ­ate system from the Tibe­tan one. It is firmly anchored in the Four Medical Tantras, although it has some of its own distinctive aspects, developments and adaptations. For in­stance, the Mongolian tradition has its own unique form of massage practiced in conjunction with the trad­itional Tibetan system. When nowadays Chinese acupuncture is practiced in Tibetan medical clinics in Mongo­lia and Buryatia, and certain herbal medicines from the Chinese system are used, this is an expedient, recent addition made mostly in the 1950’s due to loss of contact with the Tibetan tradition of acupu­ncture and Tibetan sources of medicinal plants. It does not indicate that Mongolian medicine is based on or a variety of the Chinese system. 

Tibetan medicine first came to the Trans-Baikal Siberian Mongol region of Buryatia at the end of the seventeenth cen­tury. There were two main tradi­tions, the Kho­rinsk and Selen­ga. The Khorinsk tradition came from the monastic medi­cal college of Labrang Tashikyil in the northeast­ern Tibetan pro­vince of Amdo. It followed only Tibetan texts, and its main centers were Sholotu Datsan at Atsagat, and Egetuiski, Aginski and Tsugulski Datsans. The Selenga tradi­tion came from Mongo­lia, followed both Mongolian and Tibetan texts and, like the Mongolian tradition, had a slight influence from Chinese medi­cine. Its main centers were Gusino-ozorski, Tsongulski, Sanaga and Yan­garzhinski Da­tsans.

The Caspian Mongol region of Kalmykia, the Siberian Buddhist Turkic area of Tuva, and Inner Mongolia, now incor­porated into the People’s Republic of China, also had monas­tic colleges for Tibetan medicine in their Bud­dhist mona­ster­ies. In Kalmykia, one of the main such colleges was at Em­chin Khurul, with many branches at the other monasteries.

In Tuva, the main monastic medi­cal college was at Chadanski Khure. There was a well-developed local tradition of shamanis­tic herbal medicine in Tuva as well. This system was not mixed, how­ever, with the Tibetan Buddhist one in the monas­teries, but co-existed out­side.

Tibetan medicine flourished in Imperial Russia in the nineteenth and early twentieth century. Pyotr Badmaev, for instance, a Buryat doctor from Aginski Datsan, was the per­sonal physician of the last Czar of Russia, Nikolai II, as well as of Rasputin. For this reason, Badmaev was official­ly out of favor until 1985. Czar Nikolai II was the czar who had the Leningrad Datsan, a Tibetan Buddhist monastery, built in St Petersburg.  

These medical colleges in Buryatia, Kalmykia, Tuva, and Mongolia were des­troyed, along with the Buddhist monasteries in general, during the Stalin era of the late 1930’s. In Inner Mongolia there was also great decline, especially during the Cultural Revolution in the late 1960’s.

In the early eighteenth century, a Tibetan monastic medical college was foun­ded as part of the Yonghegong monastery in Beijing. The Tibetan medical tradition was also found among the Oirat Mongols of East Turkistan, but more research must be done about all of this.

At present (1990) there is an Institute of Traditional Mongolian Medicine in Ulaan Baatar, Mongolia, which mostly continues the tradition of Mongolian massage and is just recently working to revive the rest of the system. There are lineages of private traditional doctors, however, mostly continued at Gandan Thek­choling Monastery in Ulaan Baatar. The government has just recently given permission for the re-establishment of the Sorig Shanpan Ling Medical Monaste­ry, which will train not only monks, but also laymen and women.

In Buryatia, there are also some lineages of pri­vate tradi­tional doctors at Ivolginski Datsan near Ulan Ude and at Agin­ski and Tsugulski Datsans in Chita District, but they are limited in their supply of medicines and very few of them can do pulse diagnosis. There is also much scientific study of Tibetan medicine at the Buryat Institute of Social Studies of the Siberian Branch of the Academy of Sciences of the USSR in Ulan Ude. But the tradition is com­pletely lost in Kalmykia and Tuva.

In Inner Mongolia, the system is more intact and is found at the Medical College of Inner Mongolia in Hohhot and the Scientific Research Center of Mongolian Medicine in Tongliao. The Chinese try to divide the Mongolian and Tibetan sys­tems of medicine and claim they are distinct entities which, as has been seen, is not the case.

This article and the subsequent ones that follow in this section of the Study Buddhism website derive from a series of lectures I delivered in the Soviet Union many years ago. In March 1990, as part of a teaching and research tour of the Soviet Union and Mongolia, I delivered a series of lectures in Moscow at the Library of Medicine of the Ministry of Health of the U.S.S.R. The lectures were organized and co-sponsored by the Center for Traditional Medicine of the Department of Medical Information (Soyuzmedinform) of the Ministry of Health of the U.S.S.R., under the directorship of Dr. Natalia Lukyanova, and the Central Spiritual Board of Buddhists of the U.S.S.R., under the guidance of its Moscow representative, Tom Rabdanov. The lectures were given in English and translated orally into Russian by Andrey Terentyev. Together with revisions and expansions I later made, they were prepared for publication in Russian, under the title Tibetan Buddhism and Culture in Modern Perspective: A Series of Lectures in the Soviet Union, by Slava Komarovskiy, Elena Shilingovskaya and Andrey Terentyev. They will be published by Soyuzmedinform of the Ministry of Health of the U.S.S.R. The present work is a further expansion and reorganization based on that text.

I wish to express my appreciation and gratitude to His Holiness the Dalai Lama and Lodi Gyari Rinpoche for their encouragement in this project. I also wish to acknowledge all the help and information I have received during the course of researching this material from Dr. Natalya Lukyanova, Tom Rabdanov, and Andrey Terentyev in Moscow; the late Most Ven. Bandido Khambo Lama J.J. Erdyneev, Ven. Cho Dorji, Ven. Sherab Jamtso, Ven. Bazarsada, Prof. Regbi Pubayev, Dr. Elbert Bazaron and Dr. Viktor Poopyshev in Buryatia; Ven. Gombo Badmaevich Tsybikov and Ven. Jinba Jamtso Tsybenov in Chita; Ven. Tuwang Dorji, Dr. Petr Bitkeev, Dr. Juli Oglaev, Alevtina Ulanova, and Elsa Bakaeva in Kalmykia; Ven. Lama Shinbayol, Dr. Uriy Aranchyn, Dr. Kaadyr-ool Bicheldei, Mongush Kenin-Lobsan, and Damdin Kuular in Tuva; Most Ven. Gaadan Gambajov, Ven. Choji Jamtso, Ven. Divasambuu, Ven. Dambajov, Ven. Dr. Mugh Tembrel, Ven. Dr. Natsogdorj, Ven. Nasambogh, Dr. Lubsantseran, Wangchindorj, and L. Terbish in Mongolia; and Ven. Yeshe Lodro Rinpoche, Gyatsho Tshering, Dr. Tenzin Choedrak, Dr. Namgyal Qusar, the late Prof. Lodro Gyatso, Prof. Jampa Gyeltsan Dagthon, Tenzin Choegyal and Aleksandar Kocharov in Dharamsala, India. I also wish to thank Ven. Thubten Chodron for her suggestions in simplifying the style and language of the text. Any inadvertent mistakes or confusion left in this work are solely my own responsibility.