HEALING AND MEDICINE: HEALING AND MEDICINE IN TIBET

Premodern Tibetan ideas about healing and medicine, like those of other Buddhist societies of Asia, derived from disparate sources. These included local versions of widespread Asian concepts regarding spirit-causation of illness and soulloss, Indian and Chinese-derived ideas about good fortune and astrological influences, the various major medical traditions of Asia (Āyurvedic, Islamic, and Chinese), and Buddhism itself, with its understandings of the suffering implicit in life within the universe of cyclic existence (saṃsāra ) and its body of ritual techniques to relieve that suffering and promote the well-being of its followers. A range of discourses and approaches arose from these various sources and these underlie both popular and elite understandings of illness and healing. This entry covers healing specialists; spirit causation of illness; life-force, soul, well-being, and related concepts; astrology; the Tibetan medical tradition; Buddhist Tantric medicine; Buddhist attitudes toward illness; death and dying; and the effects of modernity.

Healing Specialists

Depending on how a particular illness is understood, Tibetans may approach a traditional Tibetan doctor (a mchi ), a folk shaman, spirit-medium or other folk diviner (lha pa, dpa' bo, mkha' 'gro ma, etc.), or a lama (bla ma ) for assistance. Traditional Tibetan doctors practice a humorally-based medical system closely related to the Indian Āyurvedic medicine. Shamans or spirit-mediums are men or women who act as mediums through which local gods communicate; some also perform folk rituals of healing. Lamas may be monks or lay people but are almost always male. They belong to one of the four main Buddhist traditions or to the Bon tradition, which claims pre-Buddhist origins but is in most respects similar to the Buddhist traditions. All five traditions possess a similar range of divinatory techniques and ritual countermeasures, mostly deriving from the Tantric (Vajrayāna) Buddhism of India. Patients may also try more than one kind of practitioner, and in the contemporary situation both in the People's Republic of China and among Tibetan refugees such medical pluralism is extended to include Western-style biomedicine.

Spirit Causation of Illness

Illness can be caused by spirits, typically local deities who have taken offense at some unintentional action. Thus a class of spirits living in streams or trees (klu, equated by Tibetan scholars to the Indian nāga ) may cause boils, skin diseases, or leprosy if their homes are dirtied or polluted, while another class of spirits (gza', equated with Sanskrit grāha ) cause strokes and partial paralysis if offended. In many such cases, Tibetans will recognize from the nature of the complaint the kind of spirit involved. A lama or spirit-medium may be consulted to discover the nature of the offense and the best approach for remedy. The remedy may include purificatory actions using empowered water and other consecrated substances, avoiding "dirty" foods, and making offerings to the offended spirit.

Life-force, Soul, Well-being, and Related Concepts

A series of folk concepts (dbang thang, rlung rta ) refer to various aspects of health, vitality, well-being, and good fortune. These can be strong or weak, and their loss can threaten illness, misfortune, or death. Probably the most significant of these is bla, and Tibetan ideas regarding the loss of bla parallel those found in many of the neighboring Himalayan and Southeast Asian peoples (e.g., Thai khwan ). As elsewhere, there are ritual techniques to recall the bla and reintegrate it with the body, and both lamas and the idea that the vitality or "soul" (bla ) of the human organism may be lost or scattered. Both lamas and spirit-mediums can perform rituals to recover the lost "soul" in cases where illness is attributed to such sources.

Other personal qualities (tshe or life-span, dbang thang or personal power, etc.) can also be partially or wholly lost. Such loss may be due to spiritual contamination (grib ) resulting from contact with polluting situations such as death or childbirth. It can also be due to the action of witches or sorcerers. Ideas of loss of health or vitality shade into concepts of spirit-attack, since a weakened vitality can leave a person open to such attack. An important function of the lamas, dramatized in particular through major monastic ritual festivals attended by the local lay community, is to defend the community against spirit-attack. They also maintain the strength and vitality of the community through life-empowerment (tshe sgrub ) rituals on these and other occasions. Rituals to maintain or recover good fortune may be performed by lay people or lamas.

Astrology

Tibetan astrology derives from both Indian (dkar rtsis ) and Chinese (nag rtsis ) sources. The Chinese system, also known as 'byung rtsis or elemental astrology, is based on the daily variation of five personal quantities in astrologically determined cycles, which are correlated with the five elements (iron, wood, water, fire, air) and the Chinese twelve-animal cycle. The five quantities are bla (life-force), srog (vitality), dbang thang (strength or personal power), rlung rta (good fortune), and lus (bodily force); 'byung rtsis can be regarded as a systematized version of folk ideas regarding soulloss, and good and bad fortune. Printed almanacs, which trace the variation of these quantities and predict good and bad days for various activities, are popularly available.

The Tibetan Medical Tradition (A MCHI Medicine)

The principal textual basis for the Tibetan medical tradition is the Rgyud bzhi (Four medical Tantras), which was probably compiled in the eleventh century by the famous physician G'yu thog Yon tan Mgon po [Yut'ok Yönten Gonpo] (1112–1203). While the framework of this text is a dialogue between emanations of the medicine buddha Bhaiṣajyaguru, large parts of the content are adapted from the Tibetan translation of a well-known Āyurvedic text, the Aṣṭāṅgahṛdayasaṃhitā of Vāgbhata. Other sections indicate borrowings from Chinese and perhaps also Islamic medicine, as well as indigenous Tibetan developments. An alternative textual tradition associated with the Tibetan Bon religion varies only in details.

A series of commentaries were composed to the Rgyud bzhi, of which the best-known is the Vaiḍūrya sngon po (Blue beryl) by Sangs rgyas Rgya mtsho (Sanggye Gyats'o; 1653–1705), sde srid or regent to the fifth Dalai Lama. A substantial literature of other medical works has also been written by Tibetan doctors and scholars.

Sde srid Sangs rgyas Rgya mtsho was also responsible for the foundation in 1696 of the main Tibetan medical college, named Lcags po ri (Chakpori) after the hill in Lhasa where it was situated. A second college, the Sman-rtsis-khang, was founded in Lhasa by the thirteenth Dalai Lama in the early twentieth century, and the Rgyud bzhi system is now taught in more or less modernized versions by training institutions in Chinese-controlled Tibet and among the refugees, as well as in Europe and the United States. There are also many local versions of the Tibetan medical tradition, often passed down hereditarily, also for the most part derived from the Rgyud bzhi. Doctors may be lay people or monks. In the past, they were almost all men, but there have been some notable women doctors in recent years, and the profession is becoming increasingly open to women.

The Rgyud bzhi texts have been widely studied in the West, often in conjunction with the works of Sde srid Sangs rgyas Rgya mtsho, and many Western presentations of Tibetan medicine are little more than paraphrases of these texts. This material, however, does not necessarily relate closely to current medical practice. While memorizing all or part of the Rgyud bzhi remains central to the training process, other texts are also studied, and doctors undoubtedly acquire much of their knowledge and clinical expertise through subsequent apprenticeship with a practicing doctor.

The Tibetan medical tradition today employs the three Āyurvedic doṣa or "humors" (nyes pa ) as basic theoretical and diagnostic categories. The three nyes pa are rlung (wind; Skt., vāta ), mkhris pa (bile; Skt., pitta ), and bad kan (phlegm; Skt., kapha ). Thus illness can be understood in terms of one or more of these nyes pa, which are residues of the ongoing processes of bodily existence, being present in excessive or inappropriate quantity. The Rgyud bzhi' s opening sections link the nyes pa to the three poisons of samsaric existence (ignorance, desire, and hatred), thus providing a Buddhist foundation to Tibetan medical theory. The importance of the nyes pa can nevertheless be exaggerated. In practice, much of Tibetan medicine operates in terms of the identification of one or another named illness category, each corresponding to a specific mode of treatment, rather than on restoring the system as whole to a state of balance. Diagnosis employs examination of pulse and urine, as well as observation. Pills (ril bu ), made of complex compounds of substances of herbal, mineral, and animal origins, are used for healing. Use is also made of diet, and of techniques of cupping and moxibustion.

Buddhist Tantric Medicine and Divination

Tantric (Vajrayāna) Buddhism in Tibet, while centered on the achievement of buddhahood, includes a wide variety of ritual techniques to bring about this-worldly results. In some of these, lamas mediate the powers of Tantric healing or long-life deities (such as Bhaiṣajyaguru, Amitāyus, and White Tārā), conferring healing power on lay followers directly or through empowered substances, often pills (ril bu ) similar to those used in a mchi medicine. Life-empowerment rituals of this kind were regularly performed by most major Tibetan monasteries, forming part of annual community festivals. Consecrated substances, empowered water, and the like are still widely used in cases of illness. They may also be used prophylactically in situations of perceived risk (for example, the selling of sweaters by Tibetan refugees on dirty, polluted Indian streets). Situations of grib (pollution, spiritual contamination) may arise from a variety of causes and will often be countered through the use of empowered substances.

Other Vajrayāna techniques derive from the alchemical traditions of eighth- to twelfth-century India, which were closely linked with Tantric Buddhism. In these, complex medical compounds are prepared and further empowered through Tantric ritual. These "precious pills" (rin chen ril bu ) are expensive, highly valued, and frequently used by lay people either on the recommendation of a lama or a mchi or on their own initiative. Ideally, they are taken under ritually-prescribed conditions and accompanied by prayers and mantra recitation.

Lamas also have an important role as diviners, again using techniques derived in part from Vajrayāna sources. Divinations (mo ) are frequently sought in cases of illness in order to ascertain the most appropriate mode of treatment. Other health choices (e.g., the most suitable location for childbirth) may also be made by recourse to divination. In addition, some lay people have a reputation as diviners, and spirit-mediums can also be asked for divination.

Buddhist Attitudes toward Illness

Beyond all this, we can ask about the effects of Buddhist teachings on popular attitudes toward illness and health. Suffering and the transitoriness of life are central themes for Buddhism in Tibet as elsewhere. As in other Buddhist countries, however, most Buddhists in Tibet regard the attainment of Buddhist enlightenment as beyond their reach, at least in their present lives, so lay Buddhist religious practice is focused mainly on future lives and on the performance of morally positive actions that will lead to a good rebirth in the future.

Lay Tibetans are also interested in this-worldly success and prosperity, and this is largely the domain of the various regional and local deities (Yul lha, Sa bdag, Klu, etc). Much lay ritual, such as the widely practiced bsangs, fire-offerings of fragrant wood, herbs, milk, butter, yogurt, etc., are directed towards these local gods. Vajrayāna Buddhist ritual techniques give the lamas control over the local gods and spirits, providing the basis of the Buddhist role in village affairs. However, the Buddhist stress on the illusory nature of apparent reality and the inevitability of suffering within saṃsāra undoubtedly serves to relativize Tibetans' attractions to this-worldly matters. As David Lichter and Lawrence Epstein (1983) have noted, most Tibetans look for worldly success but maintain a "slightly ironic detachment" from a happiness that is at best impermanent.

Death and dying are particularly associated with Buddhism, and a consideration of healing should perhaps also encompass how terminal illness is dealt with. The Bar do thos grol (Tibetan Book of the Dead) texts have become well known in the West, and provide a liturgy based on guiding the consciousness of the dead person through the after-death states. Equally or more significant are the 'pho ba practices, which are aimed at achieving rebirth in a buddha realm (usually that of Amitābha) at the time of death. These techniques, which have received little study from Western scholars, are often taught nowadays to lay people, and offer dying people a way of dealing positively with the final moments of life.

The Effects of Modernity

The various discourses and modes of healing discussed above were never separate, hermetically sealed modes of explanation. They overlapped and intersected in a variety of ways and continue to do so today. Thus grib, spirit attack, and soul loss are not always separable categories, and a particular illness may be dealt with by a combination of a mchi medicine, Tantric purificatory rituals, and spirit-medium consultations. In Chinese-controlled Tibet, in traditionally Tibetan areas of Indian and Nepal, and among Tibetan refugees, traditional Tibetan approaches to healing continue to be used situationally, often in combination with ideas from Western medicine (usually known among Tibetans in South Asia as rgya gar sman, literally "Indian medicine").

See Also

Āyurveda; Tibetan Religions, overview article.

Bibliography

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Tibetan & Himalayan Digital Library. TDHL Medicine Collections. Available from: http://iris.lib.virginia.edu/tibet/collections/medicine/index.html. These pages provide extensive textual, visual, and bibliographical resources relating to Tibetan medicine.

Geoffrey Samuel (2005)