Introduction
Tibetan Medicine, Buddhism, and the Visual Arts
Perseverant Nurturing
Bodies in Balance invites readers to explore the complex and
Rigpa's foundational work, the Four Tantras (Gyushi), and
and continuously evolving discipline. Our focus is on visual
Tibetan medicine's most basic principles, such as that of
expressions of Sowa Rigpa (Gsa ba rig pa). Tibetan for
the three nyepa, often translated as the three "humors" of
"science" or "art" of healing. Through discussions of this
wind, bile, and phlegm. Through accounts of her work with
system's aesthetic, intellectual, and experiential dimensions,
contemporary Tibetan medical doctors in India, we learn how
we explore how art, medicine, and Buddhism converge in
a medical consultation unfolds. What does the art of healing
learning and practicing Tibetan medicine. In doing so, we
involve with regard to Tibetan medical diagnosis and therapy?
hope to offer readers a multifacited and beautiful way to
In chapter 2, Geoffrey Samuel's essay delves into Tibetan
access this tradition, drawing out the themes explored in the
medical and Tibetan Buddhist ideas of body and mind. Unlike
associated exhibition at the Rubin Museum of Art in New
in Europe, where a Cartesian model still holds sway over
York and subsequent venues. 1 For those who begin their
medical and philosophical discourse, in which body and mind
journey with this work, and for those already familiar with
are understood to be essentially separate entities, in Tibetan
the subject, this book provides a variety of perspectives from
traditions we find that body, speech, and mind are seen as
which to engage with Tibetan medicine.
three aspects of human existence, not rigidly dichotomized .
Just as Tibetan pharmaceuticals themselves are made of
Samuel demonstrates this through discussion of Tantric
ingredients that have traveled long distances, crossed many
Buddhism and Tibetan imaginative maps and charts of the
borders, and were compounded according to different tradi-
human body's inner and outer cosmologies.
tions, so the contributors to this volume come together from
many different theoretical and geographical backgrounds.
In chapter 3, I offer an introduction to Tibetan pharmacology and medical formulas, which are the most widely
They include scholars in Tibetan and Buddhist studies,
used Tibetan medical treatment, along with dietary and
anthropology, art history, literature, and two practioners
behavioral adjustments and external therapies (FIG. 0.1 ).
and scholars of Tibetan medicine. Their essays represent
One foundational principle is that the five elements that
the culmination of years spent gathering knowledge and
form body and mind are of one and the same essential
experience and collaborating across disciplinary and political
quality as those found in the environment and in disease.
borders. And so, this publication embodies one of Tibetan
Pharmacologists and doctors therefore sought to counteract
medicine's most important attributes- its rich and harmoni-
and balance diseases in the body-mind with those of
ous polyphony. Tibetan medicine's remarkable powers of
opposite elemental qualities in plant, mineral, and animal sub-
adaptation from ancient to current times are more important
stances . I outline how such materia medica are compounded
than ever, as we find ourselves amid rapid ecological and
in one Tibetan monastery pharmacy and in one European
socio-political change.
company, exploring adaptations of Tibetan medicine's empiri-
Part I of the work offers an introduction to the core theo-
Precious Substances
from Jam pal Dorje's
Beautiful Marvelous Eye
Ornament. Mongolia;
19th century. Part II,
folio 6 verso & 7 recto.
Reprinted in Satapitaka
Series (Vol. 82), New Delhi,
International Academy
of Indian Culture, 1971.
Tibetan Buddhist Resource
Center. W30452
In chapter 1, Barbara Gerke introduces readers to Sowa
fascinating world of Tibetan medicine, a highly learned
cal and scientific principles to contemporary requirements.
ries and ideas in Tibetan medicine and related pharmacologi-
Pasang Yontan Arya then describes in chapter 4 the applica-
cal and astrological practice. It addresses the contemporary
tion of a wide range of external therapies in Tibetan medicine
role of Tibetan medicine in health care and the dynamic
and gives us the first preliminary account of the history of
ways in which practitioners and patients have reinterpreted
what is known as Tibetan "spoon" surgery. We learn how
this highly abstract and theoretical corpus around the world .
external applications are in part rooted in texts such as the
It highlights the potential of Tibetan medical ideas and sub-
Four Tantras, cultural exchanges along the Silk Road, and per-
stances as resources for healing, at the same time addressing
sonal experience. Given Arya's scholarly and practical work
frictions that arise when Tibetan medical practitioners, and
as a Tibetan medical doctor in India and more recently in
their ideas and medicines, encounter other cultures and other
Europe, he is able to demonstrate how early knowledge such
medical systems.
as that of nineteen moxibustion points on a ninth-century
Authors of the essays in this section explore how clinical,
illustration (see FIG. 4.1) are still known under the very same
dietary, and Buddhist practices come to be learned and
terms and in use today. Chapter 5 by Ron it Yoeli-Tialim is on
practiced in contemporary Tibetan medical contexts. They
basic principles of Tibetan astrology and divination and their
seek to understand how medical ideas grounded in common
role in relation to the practice of Sowa Rigpa. The adjoining
textual frameworks are adapted and practiced across such
vignette by Inger Vasstveit introduces us to the work of
varying geographical, medical, and legal settings as Milan,
astrologists at the Dharamsala Medicine and Astrology
Lhasa, Xining, northern India, New York, and Switzerland.
Institute and to lay exile Tibetans' use of the protective
3
0.1 Tree of Treatment.
Corresponding to Plate 4
of the Tibetan medical
paintings (Lhasa set).
Tibet or Mongolia; 17th
century. Pigments on
cloth; 68.5 x 78.5 em.
Pritzker Collection, Chicago
devices and amulets they produce. Developing this theme
concepts are commonly found in Tibetan medical thought:
of the geographical movement of Tibetan heritage further,
medicines always have at least three ingredients; the three
Sienna Craig considers in chapter 6 the many new realities in
forces of the nyepa pervade the body-mind; and there are
which Tibetan medicine is now practiced around the globe.
three mental poisons (desire, hatred, and delusion) that,
She tells several compelling stories of what happens when
according to the Buddha's teachings, form the root of human
Americans learn to become amchi (Tibetan medical doctors),
suffering. The linearity and segregation that informs much of
Buddhism and Sowa Rigpa meet capitalist market logic, and
European thought is at odds with what we have attempted
knowledgable doctors foster the best possible outcomes for
here: understanding a range of simultaneously existing and
their patients' well-being.
integrated phenomena, to better appreciate the interrelated
Part II examines historical and art historical perspectives
on Tibetan medicine, appraising its development in relation
aspects of the human body and mind in health and illness.
Gyurme Dorje expounds in chapter 7 on the artistic rep-
to Buddhism and the visual arts. Together with medicine,
resentations and the role of the Medicine Buddha in Tibetan
Buddhism and arts and crafts are important fields of
medical practice and Buddhist rituals. Adding to the earlier
knowledge among Tibet's ten Buddhist arts and sciences.
introduction of the structure and the contents of the Four
Their triangular relationship is the main focus here. Three-fold
Tantras in chapter 1, Yang Ga's essay offers a path-breaking
4 BODIES IN BALANCE
investigation into the sources for this early medical text
with Knud Larsen, I provide detailed discussion and
in chapter 8. He traces influences from Indian, Chinese,
architectural plans alongside drawings and photographs.
Greco-Arabie, and indigenous Tibetan and Himalayan
This contribution is offered in hopes of inspiring a possible
medical traditions in early medical works. These were
reconstruction of Chagpori Medical College in its original
brought into a Buddhist framework by its author, Yuthog
location, where it was destroyed in 1959 by the Chinese
Yonten Gonpo, who was a prolific lay scholar of the twelfth
People's Liberation Army. While the original Mentsikhang
century. We can understand this text as an important
building fortunately survived, it is potentially at risk as we
template for the kind of cosmopolitan and complex medical
witness ongoing and dramatic destruction of the historical
system that Sowa Rigpa would continue to be. How Buddhist
houses of old Lhasa. Each house tells its own story- of
and medical scholars then transmitted this and other texts
families, offices, temples, crafts, schools, and, in this case,
and developed the various traditions is discussed by Frances
the education in the art of healing throughout the twentieth
Garrett in chapter 9.
century- collectively connecting contemporary Tibetans
Casting new light on the stunning set of seventy-nine
medical paintings from seventeenth-century Lhasa (FIG. 0.2).
chapter 10 by Janet Gyatso explores some of their intricate
details to understand what they might tell us about the
and national and international scholars to the riches of Tibet's
history.
The authors of this book all engage with the texts,
medicines, practices, ideas, and symbols related to Tibetan
relationship of medical and Buddhist ideas and practices
medicine and culture on a day-to-day basis. In Bodies in
at the time of their creation. Could it be that the medical
Balance they have sought to engage and inspire both general
authors and illustrators of the set challenged the Buddha's
and specialist readers. In addition to bringing together the
authority over the science of healing? In the adjoining
essays of scholars from distant places, we also present
vignette, Katharina Sabernig explores the didactic values of
photographs of most objects in the exhibition, hailing from
the so-called medical trees found on Plates 2, 3, and 4 of the
more than twenty institutional and private lenders in, among
same set of medical paintings, which illustrate three chapters
other places, Mongolia, India, Nepal, San Francisco, Paris,
of the Four Tantras. She explains that in the monastic medical
and London, and dating from the ninth to the twenty-first
college of Labrang in eastern Tibet, many medical trees have
century. Among the medical paintings, drawings, murals,
been reproduced as murals, explicating more chapters of the
and sculptures, for instance, we show the earliest known
Four Tantras using this device. This facilitated medical study
Tibetan depiction of the Medicine Buddha on a silk painting,
and the memorization of the first two volumes of the Four
from 835 CE (FIG. 7.7) . The book furthermore shows images
Tantras.
of medical instruments, such as those that were used in
In chapter 11, we again turn to the delicate details of
surgery and medical compounding (pp. 76-83); and we
medical illustration- this time marveling at small materia
include selected manuscripts, printed texts, and illustrated
medica depictions in block-printed Tibetan texts and manu-
works as examples of the vast textual corpus of this tradi-
scripts. How did this genre develop over time? Could the
tion. We include photographs of objects that could not
changes that we see in the classification and identification
be included in the exhibition or where photographs of the
of materia medica be interpreted as yet another example of
original object could not be reproduced. The object images
how Tibetan medical traditions vividly responded to new
are complemented by photographs of twentieth- and twenty-
ecological environments and practitioners' encounters
first-century Tibetan medical practice taken in the field by
with new technologies and novel scientific traditions? How
authors and recognized photographers. Taken together, the
medical knowledge is adapted in the process of cultural and
images and the essays are intended to give readers a sense
scientific encounters is also vital to Martin Saxer's discussion
of how Tibetan medical practitioners, past and present, con-
in chapter 12. Here we follow three generations of Tibetan
tinue to apply this ancient and fluid medical tradition, which
medical doctors, some also trained in biomedicine, from an
offers some of the most diverse and intriguing understand-
influential Buryatian family on their journeys westward, from
ings of human illness and well-being.
the Buryatian steppes via Russia to Western Europe, bringing
The three core themes of Bodies in Balance are the
with them Tibetan medical ideas, recipe books, and medical
practice of the Tibetan art and science of healing, its relation
techniques.
to Buddhism, and its visual expressions through the arts
Bodies in Balance ends with a vignette on the architecture
and crafts. These themes can also be seen as three ways
of two important Tibetan medical institutes in Lhasa, the
of reading the book, or three ways to engage with Tibetan
Chagpori Medical College and the Mentsikhang. Together
medicine.
HOFER : INTRODUCTION 5
6 BODIES IN BALANCE
Sowa Rigpa as a Science and a Practical Art
conventiona l pharmacies in Switzerland and Austria and
Sowa Rigpa can be translated as the "science of healing" or
are used by the growing middle classes in China and India.
the "art of healing ." In the thirteenth century the famous
Tibetan medicines and therapies still remain a crucia l health
scholar and religious leader Sakya Pandita codified it as one
resource for marginalized communities in Nepal and the
of Tibet's ten Buddhist arts and sciences, largely in line with
Indian Himalayas and, to some extent, in Tibetan areas of
India's longstanding vidyasthana (sciences/scientific fields)
China. In the United States and in other affluent countries
classification 2 The ten arts and sciences consist of five major
with a high prevalence of chronic diseases, patients and
and five minor fields, with the former including the Dharma,
public health officials take ever greater interest in what
or Buddhist teachings (the inner science). epistemology and
comp lementary and alternative medicines (CAM) have to
logic, grammar, medicine (i.e., Sowa Rigpa), and the arts and
offer. Th e holistic approaches to an individual's health and
crafts. 3 At the time, no fundamental distinction was made
disease that characterize Tibetan medicine are of particular
between religious and scientific knowledge 4
appea l in the West. It is th is adaptability and openness to
Over the following centuries, Sowa Rigpa continued to
dialogue and change, without the loss of its own scientific
develop within predominantly Buddhist milieus in Tibet, the
and empirica l grounds, that constitute Sowa Rigpa's most
surround in g Himalayan regions, and Mongolia and Buryatia ,
significant attributes.
enabling a fruitful cross-pol lination of ideas and practices
among medical and religious (Buddhist) practitioners . Yet
Medicine and Buddhism
medical scholars began diverging in significant ways from
When we are well we may give little attention to our bodies
Buddhist doctrines long ago, as writings and medical
and our health. But if one day we are struck by illness or
illustrations reveal . This development is explored in chapter 2
injury, we begin to appreciate how much health really means
on the body and mind in Tib etan medicine and Tibetan
to us, that its va lue exceeds alm ost everything else in this
Buddhism, chapter 8 on the human authorship of the Four
world. We are thankful for even the slightest step toward
Tantras, chapter 9 on the contingent relationship between
recovery and being back to "norma l, " and for all the kindness,
medical and Buddhist scholars in the twelfth to seventeenth
support, and medical ski ll we encounter on the way.
century, and chapter 10 on Buddhist practices and idea ls
0.2 Similes of the
Human Body. Plate 6
of the Tibetan medical
paintings (Ulan Ude set) .
Lhasa, central Tibet;
early 20th century.
Pigments on cloth;
86 x 68 em. National
Museum of the Republic
of Buryatia, Ulan Ude.
Photograph courtesy
of Serindia
That life comes with sickness and suffering was declared
in the Lhasa Tibetan medical painting set from the late sev-
by the Buddha as the first noble truth more than 2,500
enteenth century. In Part I we see how such dynamics play
years ago in northern India . In his first discourse after his
out in recent times . In the process of cu ltural and medical
en lightenment he set out the kinds of suffering that we all
exchange- which may include, for instance, demands
must live through: birth, aging, sickness, death, sorrow,
for a simultaneous adherence to religious and empirica l
grief, association with what is unpleasant, separation from
understandings- creative and new approaches to healing
what is pleasant, and not to get what we want- in short, al l
develop. The question of how newly combined theories and
phenomena associated with the five aggregates of existence.
research methods are developed through personal, cu ltural,
These refer to the physical aspect of the "body" and four
national, and economic exchanges is a field of research that
aspects of the "mind ." He then offered the remaining three
has spurred significant scho larship in anthropo logy, science,
noble truths - the cause of suffering being attachment to
and technology studies. 5
the five aggregates and ignorance about their impermanent
Sowa Rigpa has never been a purely loca l phenomenon.
nature, the cessation of suffering occurring when we let go
Nor was it a system stuck in its traditional ways until some
of attachment to the aggregates t hrough wisdom and insight,
time in the early twentieth century, when it was propelled
and the way that leads out of al l suffering: the noble eightfold
to adapt to modern concepts that, some say, caused an
path. The eightfo ld path is essentially a step-by-step training
irreversible loss of its authenticity. On the contrary, Sowa
of body, mind, and speech, during which one cultivates an
Rigpa encompasses a vast body of knowledge, practice,
ethica l way of life, mindfulness, insight, and compassion.
and experience that is wel l rooted in its own scientific prin-
Its components were intended to offer a practica l remedy
ciples, eth ica l requirements, and worldwide connections-
to ever-present suffering and delus ion. Despite differences
all features we tend to assoc iate w ith modern Western
in interpretation, this path is considered the foundation for
biomedicine.
Buddhist practice around the globe.
Today, Tib etan drugs can be ordered via the Internet in
Th e context of these early Buddhist teachings and their
New York and sent from Tibet directly to friends and family
focus on bodily suffering fostered Buddhists' particular
members in the diaspora. They are sold over the counter in
interest in medicine and healing and ca ll ed for the develop-
HOFER: INTRODUCTION 7
ment of compassion toward all suffering sentient beings.
his monks and nuns to have enough medical knowledge to
The Buddha's teachings and their goal of liberation from
tend to themselves and fellow clergy - did not actually allow
suffering, or nirvana, became closely associated with notions
the practice of medicine on the laity or in return for material
of medicine and ultimate healing. Hence we find in the Pali
gains. 12 Later commentaries to the earliest versions of the
canon, an early record of the Buddha's discourses that these
Vinaya mention exceptions, however. 13 That Buddhist monks
teachings are referred to as "supreme medicine" and the
and nuns did indeed- if in subsequent centuries- care for
Buddha himself as "incomparable physician." 6
the laity and others is evidenced in archaeological findings
from India and Sri Lanka, as well as in the social history and
MEDICINE AND THE EARLY BUDDHIST SANGHA In the
practice of Tibetan medicine today. 14
Buddhist Pali canon we also find several chapters that
discuss medicine. These are mostly found in the monastic
TRANSMISSION OF INDIAN BUDDHISM AND MEDICINE
rules part of the work, referred to as Vinaya, which is one
TO TIBET From the eighth century onward, together with
of three parts, or the so-called three baskets, of the Pali
the Mahayana form of Buddhism, many elements of South
canon 7 In the Nissiggiya section of the work, which deals
Asian civilization were carried across the Himalayas to the
with confession of offences to monastic rules, we find that
Tibetan Plateau . With texts in their bags and equipped with
after having been consulted by a group of sick monks, the
experiential knowledge and techniques, Indian scholars, or
Buddha is said to have allowed the otherwise possession less
pandits, arrived in Tibet. At the same time Tibetans went
monks and nuns to carry with them for up to seven days five
to Nepal and India to study Buddhism and associated
medicines (bhesajjani): clarified butter (ghee). fresh butter,
medical ideas and techniques. We know for certain that in
oil, honey, and molasses or sugar8 In the same section of the
the eleventh century the first concerted efforts were made
Vinaya, but regarding rules on permissible foods and their
to translate the Indian text Heart of Medicine by Vagbata,
offences, we find seven additional groups of materia medica
theA$tarigahrdavasamhita, into Tibetan, although it is
items that the Buddha specifically allowed sick monks and
likely that Indian medical knowledge spread in Tibet long
nuns to take before sunrise and after midday, that is, apart
before this time through Sanskrit materials and through oral
from their ordinary mealtime, which is the only time they
transmission. This work exerted great influence on practicing
were allowed to consume solid foods B These materia medica
physicians in Tibet, who complemented it with indigenous
include five types of animal fats, medicinal roots (including
knowledge, especially with locally available materia medica.
turmeric and ginger), extracts from four kinds of trees (for
instance, neem and Indian beech), leaves of five plants
In addition, some Tibetan physicians had access to the
knowledge of practitioners of diverse medical traditions
(for example, the tulsi plant), seven different kinds of fruits
from other neighboring regions- such as China, Central
(including those of the three myrobalan trees), at least two
Asia, and Persia- who had come to Tibet over the preceding
kinds of resins, and five kinds of medicinal salts (including
centuries through royal intermarriages, trade, and other kinds
ocean, rock, and black salt) W Many of these items are still
of exchanges and donations. Although legends throughout
used medicinally in Ayurveda, the classical Indian system of
Tibetan medical histories refer to several regional medical
medicine, and in Tibetan Sowa Rigpa.
conferences in Tibet, the medical texts that might have been
Based on a study of the earliest Buddhist texts in the Pali
employed and discussed at those conferences are now
language and a comparison of its medicine-related chapters
lost, and only later editions of some of them are available for
with classical Indian medical works, especially Susruta's and
historical scrutiny.
Caraka's Sanskrit works, Kenneth G. Zysk first suggested
in his landmark Asceticism and Healing in Ancient India that
Among the earliest medical records in the Tibetan
language is an illustration and description of nineteen
the heterodox wandering ascetics of the Buddha's time and
moxibustion points on the body, moxibustion being a widely
subsequent centuries in all probability exerted great influence
practiced ancient technique of burning herbs (usually of the
on the development of medical knowledge, which we subse-
mugwort family) on certain points on the body surface. This
quently find in the early texts of Ayurveda n Zysk argued that
and one divination scroll, as well as a fine large silk painting
the wandering life of early Buddhist monks and their status of
from Dun huang in western China are shown in chapters 4, 5,
not being bound by the prohibitive ritual purity requirements
and 7 of the current publication (FIGS. 4.1, 5.9, and 7. 7). The
of contemporary Hindu cultures ensured the wide-ranging
cave where these and other records were stored was sealed
dissemination of many of their medical ideas and practices.
for a millennium, until the early twentieth century, when the
This occurred even though the Buddha - while encouraging
materials were discovered. They constitute original evidence
8 BODIES IN BALANCE
0.3 Wheel of Existence.
Tibet; early 20th
century. Pigments on
cloth; 80.3 x 57.7 em.
Rubin Museum of Art.
C2004.21.1 (HAR 65356)
HOFER: INTRODUCTION 9
of some aspects of a cosmopolitan medical tradition on the
wind), tripa (khris pa, bile), and beken (bad kan, phlegm) as
borders of Tibet, which when compared to Chinese materials
well as causes for their imbalances. Throughout this book we
in the find, exhibit partial influences from medieval Chinese
refer to the nvepa with their transliterated Tibetan terms, as
medical pluralism. 15
the common English translation "humor" does not convey
In the twelfth century, such heterogeneous knowledge
the full range of meanings, as further explained in chapter 1.
was more explicitly brought into the fold of Tibetan
This chapter goes on to discuss how the three nvepa are in
Buddhism, forming the basis for much of what we now
turn influenced by environment, food, behavior, social factors,
commonly refer to as Tibetan medicine. The Tibeta n
and medicin es . In practice these nvepa, as well as more
medical classic Gvushi (Rgyud bzhi), or Four Tantras, plays
specific manifestations of diseases, are assessed visually
a pivotal role in recording much of these early traditions.
through examination of a patient's physique, complexion,
Composed by Yuthog Yonten Gonpo- Yuthogpa, as he was
urine, tongue, and- crucially- via touch, when a physician
known- and based on the study of the multiple medical
feels a patient's pulse on the radial arteries of both w rists . The
traditions and texts of his time, it also incorporated his earlier
nyepa also interact with the seven bodily constituents, called
writings and experience (discussed in chapter 8). However,
luzung dun, and with the body's waste products. When these
the work is framed as the teaching of the Medicine Buddha ,
three apects of the body and mind work well, the results are
who has been throughout the ages an important saintly
shown as the flowers and fruits of a tree, symbolizing health,
figure to followers of Mahayana Buddhism (chapter 7).
prosperity, and longevity (FIG. 0.4).
Its framing as an esoteric teaching- one given by an
Underlying Tibetan medicine's understanding of health
emanation of the historical Buddha in India, transmitted to
and illness is the concept that all phenomena in the uni-
Tibet, but concealed and only later discovered in a Tibetan
verse- body, environment, and medicinal substances- are
monastery- has contributed to the English translation of its
made up of the five elements of water, fire, earth, air, and
Tibetan title to be Four Tantras, in line with the denomination
space. Again this is something we find in Buddhist (and
of other esoteric Buddhist texts as tantras. To translate the
Hindu) philosophy. In medical texts, certain constellations of
title of this work as Four Treatises or Four Texts would also
elements in the body were described as the nyepa and further
be appropriate, but given the common use of the title Four
specified in relation to particular diseases, symptoms, and
Tantras in the w ider literature, we use this English rendering
treatments. Hence Tibetan medicine has both a nyepa-related
in the present volume and refer to its four volumes as Root
as well as a disease-specific approach to treatment. To
Tantra, Explanatory Tantra, Instructional Tantra, and Last Tantra.
The Medicine Buddha is seen by many Tibetan doctors
balance the nvepa in the body, to support the function of
certain body parts and organs, and to counteract diseases,
and is framed in the texts themselves as the divine source of
remedies with opposite qualities are prescribed, as discussed
much medical knowledge. Doctors, patients, and Buddhist
in chapter 3, along with suggested behavioral and dietary
practitioners relate to the Medicine Buddha as a resource
changes, and in some cases use of external therapies, as
for healing through prayer, visualization, and ritual. For these
discussed in chapter 4. Patients routinely combine these
reasons the Medicine Buddha, or Sangye Menlha (Tib. Sangs
approaches with ritual healing , astrological consultations,
rgyas sman lha, Skt. Bhaisajyaguru) has been axiomatic to
and Buddhist practices- such as prayers, pilgrimage, and
the practice of Tibetan medicine in lay and Buddhist medical
meditation. Patients also worship, respect, and appease
contexts.
the gods and spirits of the land, mountains, lakes, and other
SHARED FOUNDATIONS OF MEDICINE AND BUDDHISM
connected with well-being and sickness in the community. 16
manifestations in the environment who are seen as intimately
In Tibetan medical theory the ultimate causes of all illnesses
are considered to be the three mental poisons (dugsum)
Medicine and the Visual Arts
of desire, hatred, and delusion. They are also described as
In addition to exploring the relationship between Sowa
the root of all suffering in the Buddha's teachings. Dugsum
Rigpa and Buddhism, this publication takes a close look at
are depicted at the core of the Wheel of Life, a common
how medicine and Buddhism interacted with the arts and
Tibetan iconographic depiction of the six realms of samsaric
crafts, or zo rigpa (bzo rig pa). This interaction is addressed
existence, where they are illustrated in the form of a snake, a
throughout the book, with particular emphasis in Part II.
cock, and a pig (FIG. 0.3). Although virtually never mentioned
Arts and crafts have always held a place of high impor-
in a medical consultation, doctors understand these mental
tance in Tibetan society, for both the learned and the illiterate.
poisons as distant causes of the three nvepa of lung (rlung,
Thangkas representing the Medicine Buddha and medicine's
10 BODIES IN BALANCE
human propagators, such as Yuthogpa, were widespread as
opportunities for expression by Tibetan artists. Although
their sponsorship and creation were thought to accumulate
clearly influenced by Tibetan Buddhist art forms and
merit and alleviate suffering. Instruments and objects used by
iconography, in several important ways artists engaging in
physicians to make and store medicines as well as for apply-
the medical arts could surpass the established themes of rep-
ing treatment were beautifully and pragmatically crafted. The
resenting Buddhist deities and the holy life. Tibetan medical
wooden block prints of medical texts and the wonderful illus-
paintings offer glimpses into ordinary peoples' lives, showing
trations of materia medica manuscripts to identify medical
them in health and sickness, receiving medical treatment,
ingredients are further examples of how medicine depends
making love, giving birth, and dying. The Tibetan medical
on the arts and crafts.
The most vivid interaction between physicians and artists
paintings, together with illustrated materia medica handbooks
(in chapter 11), also serve to illuminate the environment of
occurred in late seventeenth-century Lhasa, when a set of
Tibet - its minerals, plants, and animals. Finally, we also get
seventy-nine splendid medical paintings was created under
to see depictions of the male body's interior channels, organs,
the auspices of Desi Sangye Gyatso, then Regent to the Fifth
and bones. Throughout, symbols and aspects of Buddhism,
Dalai Lama n The set illustrates Sangye Gyatso's Blue Beryl
though not central to the paintings, can be seen.
commentary on the Four Tantras . These works constitute an
artistic and medical legacy that remains to this day visually
Toward the Futures of Sowa Rigpa
stunning and unparalleled in scope. The paintings have been
Bodies in Balance speaks of the past and the present of
copied over and over again, a few times as a whole set, and
Tibetan medicine, its convergence with Buddhism and the
more often as a smaller set of selected paintings mainly for
visual arts. And what about the future of this rich medical
instructional purposes. One copy of the entire set has been
tradition? Can its vitality and diversity, its adaptability and its
published with English annotations, accompanied by transla-
efficacy be maintained for the decades and centuries to come?
tions from the Blue Beryf.1B
Apart from serving directly to relieve suffering and cure
diseases, Sowa Rigpa also provided new subject matter and
Tibetan medical practitioners in Asia find themselves in
the midst of rapid socio-economic change, their traditions
globalized and thoroughly commercialized. The environment
0.4 Detail from Fig.1.3.
Tree of Body in Health and
Illness.
HOFER : INTRODUCTION 11
on which they depend for raw materials is undergoing
medicines has declined and our medicinal herbs are being
irreversible alteration intimately linked to global, regional,
depleted due to the massive increase in demand arising from
and local influences.
the development [of the Tibetan medicine industry], where
One of the most significant changes that has occurred
over the last decade has been the development of a large-
short-term profit is reaped at the expense of the future. If
we don't take better care now, there will be great problems
scale industry for the production of Tibetan medicines.
ahead ... When I was small we had a little bit of even some
Previously there had been a relatively limited number of
very rare species, but at this current rate of 'development'
medical institutions, hospitals, clinics, and colleges that
we'll be out of ingredients in twenty years. Our Tibetan Sowa
produced medicine for patients in their own establishments.
Rigpa is like a precious jewel. It needs protection for the
Patients' needs were largely met by private doctors who
future. If we don't pay attention now, future generations will
made their own remedies, working in small towns, in mon-
accuse us! " 20
asteries, and among agricultural and pastoral communities.
Twenty years in Sowa Rigpa's recorded history of almost
There was not any sizeable for-profit production of Tibetan
a millennium is a very short time to lose the most significant
medicines, and clinical practice, teaching, and medical
therapeutic component of this healing tradition. The protec-
production were intentionally kept in close quarters.
While the small institutional and private producers still
tion of Tibetan medical plants has to be made a high priority.
This could be achieved through installation of so-called
exist- albeit in dwindling numbers -the vast majority of
Important Plant Areas (I PAs) where regions with a high diver-
Tibetan medicines, at least in Tibetan areas of China, are
sity of plant life are protected for future generations, together
now produced by something close to one hundred primarily
with a serious shift toward cultivation of as many species as
private Tibetan medicine factories. In India the majority of
possible 21 Access to plant and mineral resources needs to be
Tibetan pharmaceuticals are produced at the Dharamsala
newly and fairly organized so that those who have been the
Men-Tsee-Khang Pharmaceutical Factory, which caters to
stewards of related medical traditions will be prioritized over
its more than forty branch clinics as well as for-profit sales-
short-term business and/or external political interests.
with a small number of private amchi also making medicines
themselves. The overall production output as well as profits
What about the future of the books, artifacts, and
manuscripts related to Tibetan medicine? While a majority
of the Tibetan medicine industry in China alone has vastly
of the items shown in the exhibition and this publication are
increased since the mid-1990s, 19 when Tibetan medicine
currently held in institutional and private collections outside
was announced by the Chinese government as one of Tibet's
of Tibet, we are aware of the number of surviving collections
three "pillar industries," alongside tourism and mining.
within Tibetan communities and institutions. Much of this
This development has far reaching environmental, social,
and medical implications. The amount of raw materials
heritage could be preserved only at great personal risk when
the destruction of early Communist and socialist reforms
needed to keep up production at current levels, most of
swept across Tibet, Mongolia, and Buryatia. Again, only a
which has to be harvested from the wild, is far beyond what
fraction of what has survived has been catalogued, many
has been picked and gathered over the previous decades.
items are in dire need of conservation, recording, and
Among other things, this has resulted in an increasing
publication, which is hindered at a time when opportunities
number of endangered and already extinct species and in
for international research collaboration with institutions and
limiting local communities' and their medical practitioners'
individuals in Tibetan areas of China are rare. While every
access to medical substances that were once in ready supply.
effort has been made to include collections and objects from
Together with new requirements to meet production stan-
Tibet in the exhibition and publication, regrettably this was
dards, the increasing demand for raw materials and resultant
not possible to the extent hoped for. Nevertheless, it is my
reduction of certain species has led to rising costs of Tibetan
sincere wish that such an opportunity will arise in the near
medicines in general and for rural communities especially.
future. With new online databases, there is also potential that
Tibetan and Himalayan peoples' access to good quality
a greater number of Tibetan medical books and manuscripts
Tibetan medicines and to well-qualified and experienced
held in private and institutional collections worldwide will
doctors is at stake, as is the long-term health of the environ-
be included in the study of Tibetan medicine's past and as a
ments on which much Tibetan medical treatment depends.
basis for future application.
These are all serious real-world concerns, which a senior
And what of the knowledgeable people, those women
doctor from Lhasa, Professor Wangdu, spoke about at a
and men able to transmit Tibetan medical knowledge and
recent Tibetan medicine workshop: "Today, the quality of
hands-on practice to future generations? While Tibetan
12 BODIES IN BALANCE
medicine is now translated across borders - there are trans-
smaller." It is essential to give students the opportunity to
lations of the Four Tantras in Russian, English, and Chinese,
learn from experienced practitioners and henceforth work in
and Tibetan medicine is growing new roots in Europe and the
environments where they can offer well-rounded, affordable,
United States- its future will also depend on solid education
and effective care.
and practical experience of the young generation in the
The processes that have just been discussed are neither
heartland of this tradition. Professor Wangdu, quoted above,
unilinear, nor are their outcomes easily predictable. Rather,
is clear on this matter: "We need to study Sowa Rigpa very
the trajectories of the ongoing development of Tibetan
deeply and from those who have many years of experience.
medicine and its various turning points could be understood
Unfortunately, every year, the number of knowledgeable and
as additional voices and harmonies in the polyphony of
experienced doctors [still living] is becoming smaller and
Tibetan medicine.
HOFER: INTRODUCTION 13