TIBETAN MEDICINE, A « SCIENCE OF HEALING» CLOSELY RELATED TO BUDDHISM, by Fernand Meyer, Senior Research Fellow at EPHE, Chair of 'Sciences and civilization of the Tibetan world' ; Inalco ; UPR 299

TIBETAN MEDICINE
A « SCIENCE OF HEALING» CLOSELY RELATED TO BUDDHISM

Among Asian traditional medicines based on a written corpus, Tibetan medicine was the latest  to attain noticeable recognition outside its cultural area. Research on Tibetan "science of healing" (gso-ba rig-pa) in fact developed only from the middle of the 20th century, especially with the influx of refugees towards the South, escaping from the army of the young Chinese People’s Republic, which had taken control of the Tibetan plateau. At the same time, teachings imparted throughout the world by religious leaders of the Diaspora, Tibetan defense groups’ activism, promotion of alternative medicines, development of tourism in regions of Tibetan culture, and a certain craze for media coverage have publicized among the general public the existence and possibly the resources of this medicine to different extents. Finally, since a few decades, Tibetan medicine has undergone an increasing institutionalization in many regions of its traditional geographic area, where it is now confronted everywhere with local avatars of the globalized biomedicine. NGOs implicated it in primary health or even environmental protection programs at the local level, and in some cases it was integrated into national health systems in different forms.

While we restrict our subject here to the scholarly system of Tibetan medicine, one should however emphasize that a majority of native health practices depended – and still depends in many remote areas – on ways that are not strictly medical: popular therapeutic practices, formal acts aiming to accumulate merits (donation to the poor or religious institutions, freeing an animal destined to be slaughtered, patronage of the recitation of religious texts for example), visits to  sacred places and pilgrimages, blessings of great religious figures, wearing protective charms, resorting to divinatory and astrological calculations, rituals of exorcism, longevity or recovery, diagnostic or cure done by a medium possessed by a god.

The development of Tibet’s scholarly medical system was intimately linked to its culture, and therefore to Buddhism that has strongly influenced all its aspects. Buddhism in fact shows close affinities to medicine at several levels. As a doctrine and path to salvation, recovery from illnesses has quite naturally imposed itself as a metaphor for the ultimate liberation from being enslaved to the endless cycle of re-births. Besides, and more fundamentally, the problem of suffering has always remained at the heart of its Soteriology. Finally, this affinity of Buddhism to medicine was further strengthened, in the beginning of our era, with the doctrinal development of Mahayana and its new idea of Bodhisattva, "Being dedicated to Enlightenment", for which healing of the battered bodies is both the opportunity for cultivating the perfections of compassion and generosity, and a skilful means of converting the beings. Medical science itself was from then on open to being part of the syllabus for Buddhist studies, especially in the monasteries. Around the same time, the Buddhist pantheon developed with figures having therapeutic connotation. Among these, the Buddha, Master of Medicine, (Bhaisajyaguru) was worshipped with great devotion in Central Asia, then in the Far-East, and later in Tibet.

Classical Tibetan historiography places the origins of the medical tradition in the 7th century, when Tibet, at the time unified for the first time to the extent of being an empire, came in contact with ancient neighboring civilizations: India, China, Central Asia and the Iranian world. Having acquired a style of writing borrowed from India, it could gradually assimilate a great many texts (especially Buddhist), including medical books. The variety of influences, particularly Indian and Chinese, probably even Greco-Arab, which according to the Tibetan historiographers would have marked the origins of their medicine, is corroborated by ancient Tibetan documents and by traces of these influences that can be found in the medical treatises that are still used today. Through the centuries, some of these influences were abandoned, while others were integrated, with the heritage of native therapies, into a coherent whole of knowledge and specialized practices. The treatise called The Fourfold Tantra (rGyud-bzhi) became the corpus of reference for all the Tibetan practitioners, in a vast medical literature that is still little known.

Medical teaching, texts as well as oral instructions and practical techniques, was imparted for centuries, often together with religious teachings, not in specific institutions, but from master to disciple, often in a monastic setting, or from father to son along family lineages. Traditionally, this teaching was not sanctioned by formal degrees, and the medical practice did not require any recognition, by any civil or religious authority, which would have required a standard level of theoretical knowledge or technical expertise. Moreover, the Tibetan practitioners have never constituted a well-defined socio-professional group, and many had other main functions, particularly religious. It’s only at the end of the 17th century that the first monastic establishment especially devoted to medical teaching was founded, on the Iron Hill (Lcags-po-ri) near Lhasa. Later it served as a model for establishing some other similar establishments in Eastern Tibet, at Beijing and in Mongolia. Finally, Tibetan medical science gained a renewed impetus when the Tibetan Astro-Medical Institute (sMan-rtsis-khang) was founded by the Thirteenth Dalaï Lama in 1916, with a lesser clerical orientation, in the very heart of Lhasa. Nevertheless, parallel to these centers of institutionalized medical teachings, sanctioned by examinations, medical tradition continued to be imparted, like in the past, outside all official control, by individual practitioners, in family lineages or not, at inevitably very varied levels of knowledge and practices. Some women had thus access to medical teaching, generally with their father. 

Tibetan science of healing, as it is presented in its reference treatise, The Fourfold Tantra supposed to have been taught by the Buddha Master of Medicine, has nothing of an empiric medicine. On the contrary it was consciously developed as a sophisticated system of which all the parts, whether they come under empirical experience or theoretical speculation, are integrated into a coherent whole subjected to epistemological rules and formal logic, based on a limited number of natural laws.

For Tibetan medicine, like for the Indian ayurvedhic medicine, from which it has borrowed the basic theoretical essentials concerning physiology, pathology and therapy, the living body is made up of an organic substrate on which three humoral fluids, pneuma, bile and phlegm ensure the different vital functions. These humours, blood and other organic fluids flow through the body in channels forming a network.  While the humours endow the body with life and health as long as they remain in harmony, the state of the illness is nothing but the pathological symptoms of these very humours in an imbalanced state, under the influence of food, lifestyle, seasons etc.
Medical diagnosis is conceived as the outcome of a process of logical inference during which the doctor should ideally compare clinical signs obtained by questioning, palpation of pulses and visual examination, especially of the tongue and urine. In fact, diagnostic examination is often limited to taking the pulses, according to a technique that was, obviously, borrowed from China.

The treatment requires four types of therapies supposed to get more and more drastic in the following order: healthy lifestyle, dietetics, remedies and external therapeutic procedures. Generally it involves setting excessive humours against qualities that are opposite to them and if the need arises to discharge them from the body. Among the tangible qualities attributed to food items and drugs, their flavors and their hot or cold nature are particularly taken into account. The remedies combine the elements of a very rich materia medica, in varied preparations (mainly powders, decoctions or pills) where products of plant origin predominate to a great extent. The external therapeutic procedures include moxibustion with relatively frequent use, possibly fomentations and medicinal baths, unction, bleeding and small surgery.

Since three decades, Tibetan medicine has experienced major transformations in all the settings where it was traditionally practiced, as much in the Tibetan regions of China, as in the Himalayan regions or in the diaspora. In China, it was a victim of major upheavals that followed the Dalaï Lama’s escape into exile, in 1959, then of extreme political violence of the Cultural Revolution. With the period of relative liberalization that started around 1980, Tibetan medicine however appeared as one of the cultural heritage elements to have best survived, in spite of everything. It owes this no doubt to several factors: traditional medicine having recognition in China itself, its availability at a low cost locally, its pragmatic orientation with a rational side set to be encouraged at the expense of its religious aspects, and its aptitude, easily controllable, to serve as an emblematic image of a Chinese politics wanting to be anxious in promoting both the well-being and cultural heritage of the Tibetans. Tibetan medicine has thus been integrated into the health system of the Tibetan regions of China at the expense of an evolution that has borrowed some traits from biomedical model:  institutional education sanctioned by degrees, - and therefore, evolution towards a relative standardization of knowledge and practices -, secularization, professionalization, more exclusive focus on the somatic nature of illnesses to the detriment of their psycho-affective or social aspects, more impersonal consultation of patients in a formal context of a small clinic, a dispensary or hospital, re-evaluation of some notions or practices with reference to modern science, practitioners giving up on preparing medicines to make way for pharmaceutical companies with more and more commercial goals, recourse to certain diagnostic or therapeutic biomedical techniques. Some of these tendencies also mark, in varying degrees, the evolution of Tibetan medicine outside Chinese borders under the influence of so-called development programs, local process for government integration, or even at the behest of the exile community. Finally, Tibetan medicine, which is also being subjected to identity issues, is present today on the globalized market of alternative medicines. The concerned practitioners have found a way of adjusting themselves to this by shifts in their statements and practices and which is are in turn echoed in their native settings.

Bibliography
F. Meyer, Tibetan medicine. gSo-Ba Rig-Pa, Paris: CNRS Editions, 2007 (re-edition)
Y. Parfionovitch, F. Meyer, G. Dorje, Tibetan Medical  Paintings, London:  Serindia Publications, 1992 (2 vols)
L. Pordié (éd.), Tibetan Medicine in the Contemporary World. Global Politics of Medical Knowledge and Practice, London and New York,  Routledge,  2008

Fernand  Meyer
Is Senior Research Fellow at Ecole Pratique des Hautes Etudes, Historical and Philological Sciences Section, Chair of "Sciences and civilization of the Tibetan world ". Professor at INALCO.
 Member, UPR 299 du CNRS, "Milieux, sociétés et cultures en Himalaya".
Contact :  fmeyer@ vjf.cnrs.fr