8th to 17th century, early 20th to 21st century

Tibetan Medicine

Tawni Tidwell (University of Wisconsin-Madison) and Katharina Sabernig (University of Applied Arts Vienna)

Introduction

Tibetan medical culture historically extended from the northernmost regions of the Indian subcontinent across the Tibetan Plateau and Central Asia to encompassing both Mongolia and Siberia, as well as Bhutan, Nepal and parts of mainland China regions. The initial transmission of Buddhism to Tibet catalyzed extant indigenous medical practices with a bewildering plethora of scholastic development integrating both medical and Buddhist philosophical thought transmitted from India. Emperor Songtsen Gampo (Srong btsan sgam po, c. 650 CE) invited physicians from India, China, and Persia to his court, including a doctor named Galenos, reputedly associated with the school of medicine of historical physician Galenos of Pergamon (c. 129-216 CE). The next centuries marked lively transfer of medical knowledge from neighboring geographic regions. The first original Tibetan medical texts emerged by early second millennium, followed by vibrant commentarial traditions and major schools of interpretation. The authoritative Four Tantras (Rgyud bzhi) treatise, compiled by now recognized founder of the medical tradition Yutok Yönten Gönpo (G.yu thog yon tan mgon po, 1126-1202) in the 12th century, provides the foundational theory and practice. Its most famous commentary Blue Beryl explicates descriptive nuance. Under the Fifth Dalai Lama (1617-1682) and his Regent Sangyé Gyatso (Sangs rgyas rgya mtsho, 1653-1705), the late seventeenth century became the Golden Age of Tibetan medicine. The first major monastic medical college Chakpori (Lcags po ri, lit. Iron Hill) was established near the Potala Palace and 79 Tibetan medical paintings—known as medical thangkas— were commissioned, colorfully illustrating Blue Beryl medical content, thus providing a visual standard to accompany the scholastic standard. A couple paintings (e.g., Fig. 8) also illustrate key points distinct from Blue Beryl as explicated in Medical Arts of the Lunar King (Sman dpyad zla ba’i rgyal po), known in Sanskrit as Somarāja, thought to have been a Chinese medical treatise translated into Tibetan in 8th century CE during the imperial period by Emperor Trisong Detsen, the Chinese monk Hashang Mahāyāna, and the great Tibetan translator Vairocana. Some argue that the text has Tibet origins from circa 11th century since it integrates classical Chinese medical content (e.g., dyadic pulse theory) alongside Indian Āyurvedic content (e.g., three doṣā descriptions, numerous Sanskrit words) and Tibetan indigenous knowledge (e.g., endemic plants). These influences demonstrate the syncretic origins of the Tibetan medical tradition. Continuing its position as one of the five great knowledge fields in India, medicine in Tibet played a prominent role in monasterial education thereafter, propagated most prominently through numerous monastic medical colleges and family-based medical houses across the Tibetan Plateau, Mongolia, and Buryatia. After a long period of consolidation, the early twentieth century brought a focus on public health and modernization. Yet the Cultural Revolution abruptly ended such developments until the 1980s when revival and partial reinvention was allowed with biomedical partnerships in research and clinical care, yet still censoring Buddhist-related content. Today revitalization efforts in Tibetan medicine seek to restore insights from Buddhist contemplative practice, regenerate traditional lineage practices, and continue research exchanges with conventional biomedicine.

Tibetan medical representations of the guts

These Tibetan medical paintings can be understood as an extension of a broader iconographic painting tradition known as thangka originating in Indic Hindu and Buddhist cultures as a support for visualizing the ideal form in contemplative and yogic practice for soteriologically transformative aims. Similarly, these anatomical thangkas illustrate ideal medically functional forms vis-à-vis prescribed anatomical metrics (Figs. 1, 2) and metaphor-based descriptions (Fig. 3). Quotidian details of facial expressions, householder and monastic contexts, and environmental and social ecologies (Figs. 3, 4, 6, 8) represent naturalistic content physicians should understand to help patients cultivate health. The dual aims of the physician to support patient mundane wellbeing and salvific mind-body transformation are illustrated (e.g., coarse-subtle channel structures (Figs. 4, 5); tri-color fingernails symbolizing three kāya bodies of Buddhahood (Fig. 6)). Smaller medical drawings had been made in texts much earlier in Tibetan history to illustrate medicinal plants, critical treatment points, and anatomical details. However, Desi Sangyé Gyatso’s 17th century 79-painting commission formalized a new tradition of thangka. As visualized by the series, the most critically relevant structures for health and healing from the Tibetan medical perspective are the guts, channels, and their related interplay. The three gastrointestinal chambers and functional phases most critical to digestion—stomach, intestines, and colon—as well as the most relevant associations to liver and gallbladder are illustrated (Figs. 1, 2, 4, 5, 6). Cupped hands (Fig. 3) illustrate a measuring technique for proper amounts of fluids, including urine and faeces, normally produced by the body as described to be in proportion to an individual’s anatomy. Paintings detailing major and minor vasculature (Figs. 4, 5) and treatment points (Fig. 7, 8) provide important visual supports to key paradigms for the gut, namely that all chronic disease results from impairment to the gut’s qualitative function of accessing nutrition and removing waste product. Disruption to normal metabolic processes, particularly when waste product enters the nutritional stream, known as dangma mazhuwa, can develp into innumerable chronic conditions. Invariably such conditions involve poor synchronization of liver function and poor blood quality, at times therapeutically resolved through venesection of key points (Fig. 7). Impaired gut function can also give rise to cancers and other neoplasms, edema disorders, ascites, arthritis types, and chronic inflammatory conditions like asthma, psoriasis, atopic dermatitis, and various gastrointestinal conditions. Moxabustion, or burning herbs on designated points (Fig. 7, 8), is administered for a number of gut conditions, particularly those that are cold-natured. The gut interconnects with every part of the body through a rich channel network (Fig. 4, 5)— blood, neural, lymphatic and interstitial. This vast integrated complex facilitates the body’s development, maintenance, and healing activities, as well as subtle associations with mind (esp. Fig. 4). With the later spread of Buddhism towards the north, various medical schools were established in Mongolia and Buryatia, copies of the set were reproduced, and regional forms of visual interpretations emerged. In early twentieth century, shortly before the Stalinist purges began, a new school of artistic interpretation developed, particularly in Buryatia, based on integrating the Tibetan medical traditional approach with biomedical concepts. During the last two decades, a number of modern anatomical atlases have been published in Tibetan and Chinese-Tibetan. Contemporary renditions (Fig. 9, 10) represented by knitwork result from an interdisciplinary art project merging historical terms and neologisms with different modes of anatomical presentation by coauthor Katharina Sabernig.