Tibetan Medicine and Subjectivity:

An Exploration of Tibetan Corporeality and Chinese State Policy

By Floyd Miller

Submitted to the Department of Anthropology of Amherst College in partial fulllment of the requirements for the degree of Bachelor of Arts with honors.

Primary Advisor: Felicity Aulino Second Reader: Deborah Gewertz Third Reader: Vanessa Fong

December 7, 2012

Table of Contents
Introduction ! ! ! ! ! ! ! 4

Chapter One ! !

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Tibetan Medicine, Buddhism, and the Karmic Body

Chapter Two!

41

Science, Religion, and the Politics of Unhinging

Chapter Three !

! !

55

Tibetan Medicine, State Policy, and the Biomedical Clinic: Legitimacy and Treatment

Conclusion
" "

73

Bibliography !

! !

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Acknowledgments

I would like to thank everyone who offered me personal and professional support in the process of writing this thesis. I would like to thank my advisor, Professor Felicity Aulino, for her help and stepping in near the nal stages while offering her best work. Thank you. Sincerely. I would like to thank my readers, Professors Deborah Gewertz and Professor Vanessa Fong, for taking on this project as additional work of their own. To my friends, Caroline and Khadeejah, who offered me sanity when my thesis was attempting to rob it. For their help acting as a sounding board for my ideas. For inspiring me to write something I hope they would be proud of. I would like to thank Rob, who was there any time, any day, any night -- who knew I could do it when I thought I couldnt -- and who said he was proud of me even when I felt small. Lastly, I would like to thank Sasha. This thesis owes its existence to you, a debt I cannot begin to imagine how to repay. Thank you for your editing, for your ideas, and for watching night turn to day with me as this thesis emerged amidst our time together.

INTRODUCTION
In the contemporary world, classical Tibetan medicine exists only in textbooks

and imaginations. As a consequence of irtation with the national religion and consumption of indigenous products, I initially made the error of attempting to reify my own imagined, exoticized Tibet. With the aim of dispelling, I sought authors that presented Tibetan medical theory rooted in texts that birthed the discipline. Unfortunately, the few English works detailing Tibetan medicines epistemology generally fall into two categories: those that present an atemporal theory and those guided by the heavy hand of biomedicine. This is not to suggest these works were not helpful nor scholarly; on the contrary, many of these pieces are considered fundamental amongst anthropologists studying Tibetan medicine. However, they are also indicative of the plight Tibetan medicine faces today. Tibetan medical theory does not have one epistemology; transnational discourses, fueled by historical diffusion and Western imagination, have generated multiple epistemologies. These bodies of knowledge must be located within time, contextualized, and understood with respect to everyday social realities. The assumption that a single medical theory existed, frozen in time, was a product of my own ignorance. In researching this thesis, I came to realize that my orientalist conceptions of

Tibetan medicine in fact signaled the success of Chinese state policies. China, due to complex historical and geopolitical factors beyond the scope of this thesis, aimed to establish itself economically as an international superpower. Chinas invasion of Tibet,

for reasons detailed below, was largely motivated by perceived political and economic gains. Upon arrival, Mao promised his intentions were to modernize the Tibetan region while maintaining the cultural elements of Tibetan history. Modernization, however, complicated Tibetan notions of subjectivity; subjects were rendered unstable, caught somewhere between a condemned past and an uncertain future.1 Since the early 1950's, China began placing Tibetan Medical institutions under State control. Maoist ideology recognized the possibility of modernitys disorienting effects, implementing policies that simultaneously brought Tibetan Medicine into the modern world (namely through conversation with biomedicine) while maintaining historical facets that gave rise to its initial reverence. Janes suggests that China put biomedicine in conversation with Traditional epistemologies in an effort to modernize Tibetan medicine.2 However, this encounter did not completely eradicate Tibetan medicines pre-modern tenets. Thus, I hesitate to argue Chinas promotion of biomedical policies was completely hegemonic in purpose; in fact, scholars noted biomedicine was often use to conrm the "scientic" nature of Tibetan medicine. However, I disagree with my authors who nd this consolatory. I believe Western anthropologists who understand biomedicine's conrmation of Tibetan medicine as helpful often forget our own entrenchment in its ideologies. Tibetan Medicine was scientic before the arrival of biomedicine: it has a complete, rationalized system of thought with empirical evidence to support it. Therefore, while I acknowledge biomedicine's helpful additions to Tibetan

Modern social theorists speak of a loss or lack that is created through modernization. In speaking to the subjectivitys instability, I am recalling Foucaults (1973) belief that the self is disciplined into lack, conditioned for a constant state of desire. Moreover, modern theory (Giddens 1991; Kracauer 1995,) notes the subject/object dualism that is created in modernity; citizens looking to the past, a time before fragmentation, to offer future ideas of fulfillment.
1 2

Craig Janes "The Transformations of Tibetan Medicine." Medical Anthropology Quarterly 9, no. 1 (1995): 6-39

therapies, I hesitate to suggest that legitimizing Traditional epistemologies via biomedical standards is a "good" thing.3 This thesis will address these issues in the second chapter, exploring Tibetan and biomedical notions of what makes an epistemology scientic. Still, Tibetan scholars, along with the Dalai Lama himself, argue that preserving

ancient beliefs in spite of contradictory, scientic facts is untenable.4 Again, I support this notion, nding biomedicine's therapeutic additions provide remarkable advances in ameliorating indigenous ailments, namely tuberculosis. My concern remains that biomedicine, despite its contributions to Tibetan epistemology, also poses a threat of delegitimization. Moreover, as evidenced in my third chapter, state funding of biomedicine provides it power to trump Tibetan therapies, even those found more effective, because of their "non-scientic" methods. For example, Amchi Trinlay expresses anxiety concerning the impending fragmentation of Tibetan Medicine, a lack only possible when placed alongside biomedicine. However, he reminds us that nding satisfaction in ancient texts without subjecting them to critical analysis will render Tibet obsolete in the modern world.5 However, this belief, too, is underscored by China's Tibetan policy and modernization ideology. Trinlay's ability to recuperate the past and use this information to set a course for the future is constrained by State demands; in order for Tibetan medicine to gain legitimization under the new Communist ideology, it

To avoid confusion through this paper, when speaking about Tibetan Medicine I will often employ terms such as Traditional Medicine, Traditional practitioners, Tibetan epistemologies, Tibetan Physicians etc. Here, when placed alongside medicine, treatment, epistemologies, etc. Traditional/Tibetan are to be read at Traditional Tibetan Medicine in contrast to biomedicine.
3

Vincanne Adams, "The Sacred in the Scientific: Ambiguous Practices of Science in Tibetan Medicine," Cultural Anthropology 6, no. 4 (2001): 542-575; Vincanne Adams, "Tibetan Theorizing of Women's Health." Healing Powers and Modernity: Traditional Medicine, Shamanism, and Science in Asian societies. Ed. Linda Connor Geoffrey Samuel, (Westport, CT: Bergin & Garvey, 2001) 221-223; Janes, Transformations, 1995.
4 5

Adams, Tibetan Theorizing, 2001

must rst problematize its past.6 Failure to do so will not only preclude legitimization but also prove to be a political risk, chancing punishment for exalting a Tibetan medical past that does not conform to socialist doctrine. Whenever speaking about Tibetan medicine's past success, subjects were required

to contextualize epistemological merit within a dark, feudal history. China, for example, claimed Tibetan medicine's rhetoric was historically sexist, rooted in the Buddhist ideology that the PRC aimed to eradicate from the Tibetan cultural milieu. Furthermore, China argued Tibetan medicine's engendered biases, rooted in Tibet's 'primitive' past, contributed to the present disparities of health between the sexes. Thus, contemporary practitioners specializing in women's health must rst speak to these "backward traditions."7 It was impossible, therefore, for physicians to speak about Tibetan medicine without rst demonstrating personal commitment to the PRC's ideologies. More importantly, however, this need to continually contextualize demonstrates modern Tibetans' inability to speak about subjects outside the political realm. This proves especially problematic in light of the current political situation in

Tibet. Tibetan human rights discourse usually focuses on the Tibetan genocide and China's refusal to acknowledge the legitimacy of Tibetan claims to territorial rights. During the Cultural Revolution, China punished anyone who maintained Tibetan folk practices, e.g. jailing Buddhist practitioners. Moreover, the Free Tibet campaign views the inux of Han Chinese into the region as a human rights violation. In fact, they view the displacement of Tibetans in the workforce and Hans refusal to acknowledge the

Craig Janes, "The Health Transition, Global Modernity and the Crisis of Traditional Medicine: the Tibetan Case," Social Science & Medicine 48, no. 12 (1999): 1803-1820.
6 7

Adams, Tibetan Theorizing, 2001

indigenous language as acts of cultural genocide. However, Chinese discourse argues these acts are permissible as they promote the "collective good."8 The PRC argues that giving precedence to individual rights over societal needs promotes anti-socialist sentiments. Additionally, the State argues that individualistic discourse is authored by those who control the means of production, establishing a body of rights aiming only to protect the elite.9 China argues that Tibet's feudal past promoted an individualistic ideology that

only protected the aristocracy, robbing the proletariat of their freedoms. Drawing upon Maoist and Confucian philosophy, the Chinese state argued the invasion of Tibet was meant to liberate the masses from a nation that ignored societal duties.10 However, Goldstein notes that many human rights groups argue China's use of liberation as justication to be a sham. 11 The PRC argues, however, this critique is rooted in the same individualistic discourse that Feudal Tibet employed for subjugation. Further, Chinese collectivist ideology maintains that we must understand freedoms within their own cultural contexts. Thus, those rights that may be appropriate for an American are not necessarily the same for Tibetans.12 Chan notes that Asian societies often do not place the same value on personal autonomy as Westerners do. 13 Therefore, the PRC argues that
Joseph Chan and James T.H. Tang, "The Asian Challenge to Universal Human Rights: A Philosophical Appraisal." Human Rights and International Relations in the Asia-Pacific Region (London and New York: Pinter, 1995), 25-38.
8

Hungdah Chiu, Chinese attitudes toward international law of human rights in the post-Mao era School of Law, University of Maryland (1988)
9 10

Anne Thurston, "The Chinese View of Tibet-Is Dialogue Possible." Cultural Survival Quarterly 12, no. 1 (1988): 70-73.

Melvyn Goldstein., A History of Modern Tibet, Volume 2: The Calm Before the Storm: 1951-1955. Vol. 2. (California: University of California Press: 2007.)
11

Vincanne, Adams. "Suffering the winds of Lhasa: Politicized Bodies, Human Rights, Cultural Difference, and Humanism in Tibet." Medical anthropology quarterly 12, no. 1 (2008): 74-102.
12 13

Chan and Tang, The Asian Challenge

rendering certain actions illicit, such as the incorporation of Buddhism into Tibetan medicine, is not intended to eradicate Tibetan culture, per se, but rather promote policies that maintain the larger, social good. Additionally, the PRC notes that differences in cultural beliefs about subjectivity

do not necessarily entail an unintelligibility. Chinese ideology argues this requires tailoring policies to enculturated ideas of subjectivity. Therefore, China insists those who accuse its policies of giving preference to the Chinese do not take into account that different citizens require different regulations.14 Moreover, China maintains that perceived ethnic discrepancies in its policies only appear dissimilar in aim; though laws may differ regionally, they all intend to protect the larger collective. However, I argue that Tibetan medicine cannot be unhinged from the same Buddhist beliefs that the PRC condemns. Thus, conicts arise when the subjectivity promoted in Tibetan theory contradicts Chinese collectivist ideology (see Chapter 1). Despite the fact that not all of Tibetan citizens are religious, the Vajrayana is still

readily associated with national identity.15 Additionally, the Traditional medical system provides Tibetans a cultural identity as its epistemology is rooted within the national religion.16 Therefore, Tibetan medicine's Vajrayanic physiology promotes the notion of an enculturated body, a corporeality extending beyond the individual. Moreover, Traditional medicine understands idiosyncratic bodily suffering as an expression of a

14

Adams, Suffering the Winds Donald S. Lopez Jr., Prisoners of Shangri-la: Tibetan Buddhism and the West. (Chicago: University of Chicago Press, 1999)

15

Craig Janes. "Tibetan Medicine at the Crossroads: Radical Modernity and the Social Organization of Traditional Medicine in the Tihet Autonomous Region. China." Healing Powers and Modernity: Traditional Medicine, Shamanism, and Science in Asian societies. Ed. Linda Connor Geoffrey Samuel, (Westport, CT: Bergin & Garvey, 2001)
16

larger, cultural distress.17 Again, it is important to note that while not all Tibetans are Buddhist, their engagement with Tibetan medicine places them under the gaze of an epistemology that enculturates their body. Tibetans seeking health care prefer to engage with whichever discipline they believe will best understand their suffering. I suggest that in choosing between biomedicine and Traditional therapies, Tibetans are making a decision that is as much political as it is socio-linguistic. The way they conceive of disease etiology directly speaks to their conceptions of appropriate treatment. Thus, biomedicine's antianxiety medications, e.g. Klonopin, may ameliorate rLung's18 symptoms, but the medicaments inability to speak to and engage with the humoral system prevents treating the source of illness. I argue, therefore, that economic and political policies that limit therapeutic

choices are, in and of themselves, a source of suffering. Again, in order for Tibetans to transcend their suffering, they must engage with medicinal systems whose treatments address their understandings of etiology. This is not to say, however, that biomedicine cannot treat a Tibetan's tuberculosis should the patient understand his/her ailment via Traditional theory. Still, beyond the need for physical curation, I argue that patients also desire that they be heard, that their plights be understood, and that their suffering be acknowledged with regard to their conceptions of the body. Thus, while antibiotics may cure tuberculosis, it cannot assuage the discomfort of incomprehensibility. There is a certain pain involved when one's relationship to his/her body becomes ambiguous. As Tibetans engage with physicians whose conceptions of the body differ from their own,

17

Terry Clifford, Tibetan Buddhist Medicine and Psychiatry, The Diamond Healing (Maine: Samuel Weiser Inc, 1984)

rLung: wind humor in the Tibetan Medical system that is related to feelings of desire and anxiety. Explained in more detail in Chapter 1.
18

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they often nd that they are given therapies without understanding their underlying logic. Within Traditional theory, the anxiety produced via physiological and therapeutic dissonance causes an inux in rLung, only adding to their distress. 19 Although these medical engagements demonstrate an incomprehensibility, this

does not suggest that all sufferings escape universal understanding. We must rst reject Chinese relativist ideologies before we can begin to condemn the PRCs Tibetan policies.20 For this thesis to be effective at all, we must create a space of universal understanding where idiosyncratic cultural phenomena do not preclude comprehending these embodiments of suffering. While I may not understand the suffering a Tibetan feels when his/her Traditional descriptions of illness fall on biomedicine's deaf ears, I can, however, empathize with a loss of freedom and integrity. Thus, while I believe in the preservation of Tibetan Medicine for its role as cultural icon, examining its loss within this context alone affords only a recognition of Tibetan suffering, not a commiseration. Arguing against the relativist rhetoric China employs to justify its political regulation of Tibetan medicine rst requires demonstrating that universal notions of suffering exist at all. Theoretically, this is a difcult argument to make, evidenced by the ongoing

debate concerning cultural relativism. Perhaps the best I can do is assert my position, insisting these policies that deprive people of freedom, integrity, and respect indicate the presence of universal sufferings that no human should endure. Moreover, I argue these changes to Tibetan medicine create a lack greater than that generated by loss of cultural

19

Dr. Yeshi Donden, Healing from the Source, (New York: Snow Lion Publications, 2000) Merciless Repression: Human Rights Abuses in Tibet (New York: Human Rights Watch, 1994)

20

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identity alone. Although Chinese policies aim to eradicate the Buddhist logic underlying Tibetan medicine, we must recall that Tibetan medicine is not just a way of seeing the body; it is a way of seeing the self. Moreover, it is a way of seeing the self in relation to others and the larger society. Ultimately, I believe Tibetan medicine's ability to create a space of expression, one that resonates with an enculturated sense of self, society, and nation, remains its most important role. It is here that I nd universal sufferings materialize. Although the PRC's policies did not directly prohibit the practice of Tibetan medicine, they did generate a world in which Traditional therapies existence was under constant threat. Tibetan practitioners, in an effort to thrive alongside biomedicine, focused

extensively on legitimizing their medical epistemology as a scientic system. Subsequently, Tibetan medicine moved away from its own standardizations of science.21 As it shed those things which were not compatible with biomedicine, it also lost its original scientic rationality. Traditional medicine practiced today remains caught in the liminal space created by modernity: claiming legitimacy through a problematized past while looking to the future for the restoration of its original values. However, I do not foresee Tibetan medicines restoration. The system has become a metonym unto itself. Presently, Tibetan epistemology exists as both a diluted version of it's past self and a failed attempt to resemble its biomedical peer. However, I think this is exactly where China wants it. This is not to suggest that I believe the PRC implemented policies with the specic

aim of disrupting corporeal realities, but they don't seem to mind the windfall either. Therefore, this thesis demonstrates Tibetan medicines inability to continue as both a

21

Adams, Sacred in Scientific, 2001

12

traditional and rational system without its Buddhist roots.22 Moreover, I hope it does not appear to argue that all of Tibetan medicines conversations with biomedicine have been detrimental. In fact, many unnecessary deaths have been avoided in utilizing biomedicine, especially in emergency situations. However, I argue it is the deaths we cannot see that deserve lamentation. The death of a Tibetan body infused with Vajrayanic logic. The death of a system completely coherent unto itself, now nothing more than a nostalgic phantom of a remembered past. Yet, what I nd most disheartening is the death of a voice. I believe that Tibetans relationship with their indigenous medicine renders the loss bidirectional. Tibetans have not only lost a way to see themselves but a way to be seen by others. Tibetan medicine created a world in which the suffering body spoke to the aching mind, where the social world breathed life into the corporeal. Therefore, Tibetans relationship with Traditional medicine was not about lling a lack, but restoring the whole, the self, the other, and the soul. Moreover, the bidirectional relationship between Tibetan medicine and its

subjects implies that epistemological changes did not only blind Tibetans to themselves, but to their medicinal system as well. They asked for IV's instead of precious pills. They trusted EKG's over the most sensitive of ngertips. They took refuge in M.D.s rather than the three jewels. In conclusion, Tibetan medicine's evolution, a product of modernization and globalization, makes it difcult to envision a return to coherence. The real work is in uncovering the hegemonic discourse, the non-system system that renders Tibetan medicine invisible to its patients and to itself. In the end, Tibetan medicine's quest for

The first chapter of this thesis details the systematic medical system, demonstrating the strong link between Tibetan Buddhism and Tibetan medical theory.
22

13

legitimacy obfuscated its original rationality; in attempting to be recognized by the Chinese state, Tibetan medicine lost sight of itself and the Tibetans begging to be seen.

14

CHAPTER ONE
Tibetan Medicine, Buddhism, and the Karmic Body Contemporary understanding of the origin of Tibetan medicine remains clouded,

lost somewhere between myth and fact. History places the foundation of Tibetan medicine within the Common Eras seventh century, near the beginning of the Tibetan empire. Examination of the structure of Tibetan Medicine suggests that Indic, Hellenic, and Sinic inuences played a signicant role in its development. Modied Ayurvedic pulse diagnosis and Chinese acupuncture, for example, continue to inform contemporary medical practice. However, these techniques require integration and harmonization with regard to Vajrayanic Buddhist understandings of the world. While the majority of Tibetan practitioners today recognize the import of external medical paradigms, the mythical history of Tibetan medicine constructs a narrative underscored by Vajrayanic logic. To understand current changes in Traditional medical practice, one must rst understand its relation to Tibetan Buddhisms mythological past.

Medicine and Buddhist Mythology 23 The folk beliefs rooted within Tibetan medicine maintain that treatment was initially systematized in response to mans rst physical ailment: indigestion. Tibetan myth details a golden age when man required no food, living in complete Samadhi. Moreover, he possessed magical powers, ultimate beauty, and superior mental facilities (all of which
Because of the limited nature of this knowledge, the section below follows Emil Jacobson, Raoul Birnbaum, and Rechung Rinpoches work, unless otherwise noted. Any discrepancies or information particular to one text will be noted.
23

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negated the necessity of corporeal sustenance). The myth recounts the story of a man who, due to his particular accumulation of Karma from past lives, decided to consume a bitumen. The man, having had no experience with material sustenance, was unable to digest his fare and found himself in great pain. The God Brahma, recalling the medical texts of the great Sha-kya Thubchen Buddha, compassionately offered a solution to the mans discomfort: he instructed the man to drink boiling water. The mans ailment quickly regressed and he was restored to health. Folklore holds, therefore, that indigestion was the rst disease to be cured by Tibetan medicine. Consumption of the bitumen proved to be the Buddhists fall of man. Following

this fall, life expectancy dwindled from eons to years. The Gods assembled to discuss preventative remedies for premature death. Brahma, with divine compassion, recalled his medical knowledge, churning the ocean [to reveal] eight chalices of deathless nectar.24 The presentation of the nectars erupted into a battle between Gods and Titans, resulting with Brahma sustaining a blow to the cheek. Awakening from unconsciousness, he reected upon the Buddha Kasyapas teachings and his cheek began to emanate the sounds of the letters a and tha. Recalling the medical teachings of the Buddha, Brahma then composed the gSodpyad hBum-pa (100,000 slokas on Medicine). Passed down to man through a lineage of Devas 25, this knowledge is believed by Tibetans to be the rst instantiation of medical knowledge in the physical world. Although it was the Buddha Kasyapa who taught Brahma medical knowledge,

occasioning the rst instance of earthly medicine, he is not the source of contemporary

24

Rechung Rinpoche, Tibetan Medicine: Illustrated in illustrated in original texts, (California: Univ of California Press, 1973) 8

General term in Buddhist works that refers to beings who are more powerful than humans, generally invisible and can travel across the planes or reality.
25

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Tibetan medical epistemology. Tibetan Buddhism holds that it was Kasyapas successor, Sakyamuni, who ultimately delivered humans from samsara. It should therefore be noted that medical references in the Buddhist Canon, especially those beginning with the Pali texts, are attributed to Sakyamuni. While he deserves great reverence for his therapeutic knowledge, however, Sakyamuni is not to be understood as the original source of the Tibetan materia medica; he is but a modern messenger for an ancient knowledge. Nevertheless, Tibetan literature maintains that it was Sakyamuni who initiated the necessity for medicine within a Buddhist context, often prescribing specic ways to incorporate it into religious life. The Pali texts, the earliest works of Buddhism, assert medicine as one of the four

necessities of monastic life, alongside food, robes, and lodging. Forms of early medicine included claried butter, fresh butter, mustard, castor with honey, and honey itself; these elements still exist within present pharmacology of Tibetan medicine, suggesting persistence due to efcacy and religious signicance. These dietary prescriptions arise in the Vinaya as well, the text detailing the Buddhas guidelines for monastic life. Herbal remedies were suggested when dietary prescriptions proved insufcient, along with specied procedures concerning the lancing of boils, the oiling of the ears, and various other surgical methods; both herbal and procedural elements exist today, appearing in later Ayurvedic texts as well as classic Tibetan medical literature. Moreover, the Pali texts present healing as analogous to the enlightenment process. 26 The Buddha is referred to as supreme physician, his Dharma as the healing treatment for human suffering, and members of his Order as medical aids. The Buddha

26

Raoul Birnbaum. The healing Buddha. (Boulder, Colo., Shambhala: 1979,) 15

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emphasizes the painful processes of both life and enlightenment, advocating the necessity of a medical regimen aimed at treating body, mind, and spirit. Moreover, these early remedies and metaphors resonate with the important Four Noble Truths of Buddhism.27 These four truths classify the Buddha as the consummate physician in that i) suffering is an intrinsic part of human existence; ii) only Nirvana is free from illness; iii) the Buddha is the supreme healer; iv) the Dharma acts as treatment for human afictions, offering curation through enlightenment. Although modernity generally accepts the Ayurvedic inuence upon contemporary Tibetan medical theory, the early Buddhist Pali texts explicitly detail a triprincipled equilibrate model of illness and health, i.e. the bodily constituents of wind, bile, and phlegm.28 The canon then links these constituents to larger metaphysical categories used in Buddhist methodology to describe the pollution of the mind: namely, the three poisons of ignorance, lust, and aversion (which give rise, respectively, to wind, bile, and phlegm humors.) Although not necessarily incorporated daily into contemporary practice, these categories continue to inform present Tibetan medical theory. They remain an important component of Buddhist literature that prescribes spiritual practice for turning the ve poisons (ignorance, anger, hunger, lust, and jealousy) into the ve wisdoms, each corresponding to a particular facet of awakening. Furthermore, the ve poisons and wisdoms are attributed to the ve elements, i.e. wind, re, water, earth, and space.

Foundational Truths of Buddhism: 1) Existence of suffering 2) Suffering is caused by attachment 3) There is a possible end to suffering. 4) Following the Noble Path one may remove this suffering.
27

Eric Emil Jacobson, Situated Knowledge in Classical Tibetan Medicine: Psychiatric Aspects (PhD Diss., Harvard University, 2000), 56.
28

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Pali texts recount the Sakyamuni Buddhas prescription of spiritual treatment to ameliorate the corruption of the physical body. Examples of such treatment are the recitation of mantras and rumination over the Buddhist notions of emptiness and the ephemerality of existence. In addition to the healing techniques themselves, the Buddha offered accompanying descriptions of practitioners who experienced spiritual enlightenment alongside the success of their corporeal therapies. The ability to perform such physical/spiritual healing, therefore, does not belong only to the Buddha: upon enlightenment, one is said to become a king of Healing and cure all ills. 29 The narration of the Pali texts details the physicians concomitant enlightenment, giving rise to the Medicine Buddhas later prestigious role in Tibetan Buddhist theology (and specically to the relationship between his spiritual reality and his ability to heal humankind). As Buddhism moved into its Mahayanic period, Sakyamunis role as healer led to the rise of movements devoted to reverence for the Medicine Buddha. Birnbaum suggests that early vedic terms, e.g. bisaj/healer and bisaga/medicine, provide the foundation for later healing Bodhisattvas, i.e. Bhaisajyaraja (King of Healing) and Bhaisajyasamudgate (Supreme Healer).30 Moreover, these Bodhisattvas appear in Mahayanic sutras as metaphors for the Dharma, the medicine Sakyamuni made available to humankind. They also appear in the Lotus Sutra; one instance of such appearance details the Bodhisattvas heightened sense of taste, the sense crucial to gathering herbs and formulating pharmacological compounds in Tibetan Medicine. In short, the healing

29

Birnbaum, The Healing Buddha, 13 Jacobson, Situated Knowledge, 59

30

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Bodhisattvas found in the text of the Vinaya serve as the foundation of the Mahayanics healing Buddhas. Examination of the Sutra on the Names of Buddhas provides nine names for discrete incarnations of Healing Buddhas. Moreover, Birnbaum lists Mahayanic texts written during the sixth and seventh century, noting their inclusion of devotion to the Medicine Buddha. These texts prescribe rituals and methods of worship to gain benet from the Medicine Buddha: examples include the repetition of his name, the presentation of offerings to his image, and the recitation of prayers to bestow merit upon the deceased. (One of Tibetan Medicines most revered panaceas, the Myrobalan fruit, is mentioned as an especially meritorious offering.) 31 The Sutra on the Merits of the Fundamental Vows of the Seven Buddhas, written during the eighth century, names Bhaisajaguru and his six Healing Buddha brothers, detailing the individual heavenly realms within which they reside. This sutra also offers ve mantras, known as dharani, to recite over offerings and food, thereby increasing their potentiality for healing properties. Additionally, Buddhist canonical texts associate the Medicine Buddha with azure, the color of his body as well as the color of the gem which possesses its own healing powers. Birnbaum observes that this traditional belief continues to inform contemporary representations, noting that when meditating upon the Medicine Buddha it is essential to envision the body being permeated by an azure blue light. Although these canonical beliefs continue to inform the Vajrayana and Tibetan medicine, it is important to note that they are in fact imports from Chinese and Indian Buddhist texts, the majority having entered the realm of Tibetan Buddhism upon their

31

Ibid., 61

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translation between the eighth and ninth centuries (the time commonly associated with the origins of the Gyu-Shi (The Four Treaties), Tibetan medicines canonical text). Given the concurrence of the Medicine Buddhas ascendancy alongside the initiation of a rationalized Tibetan medicine, the Gyu-Shi is often described as a systematic medical system revealed by the Medicine Buddha himself. More importantly, the use of medical metaphors in early Buddhist texts provide support for an epistemological connection between Tibets materia medica and Buddhist ideology in contemporary medical theory. The development of Tibetan medicine, therefore, is founded upon an integration of religious beliefs, an indiscriminate amalgamation of theological ideas and a rationalized medical system.

Legitimacy of the Gyu-Shi

Tibetan medicines authoritative text, the Gyu-Shi, details anatomical and physiological conceptions of the body. The Gyu-Shi, as both text and epistemology, owes its continued existence to a history of integration and meticulous preservation. Before the publication of the Gyu-Shi, Srongtsan Gampo and Trisong Detsan32 assembled scholars from neighboring empires (specically India, China, Persia, and Nepal) to present theories of the body and to discuss therapeutic remedies. After these debates, both Gampo and Destan invited, respectively, Persian and Chinese doctors to remain in the Tibetan Court. Both relationships gave rise to a plurality of lineages maintained through kin-based transmission. Although this initiated momentum for a developing Tibetan
The first two of three Dharma kings, rulers of Tibet who promoted Buddhism and are seen responsible for its existence in the region today.
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Medical system, it did not provide legitimacy for the Classical Tibetan theory detailed in the Gyu-Shi. Jacobson and Karmey discuss the modern debate regarding the original, authorial source of Tibetan medical theory. Karmey remarks that the multiplicity of Yuthog Yonten Gonpos treaties has led to problems between the two opposing camps of authorship: while one camp is comprised of those who see Gonpos works as a revelation of the Medicine Buddha, the other consists of those who understand the Gyu-Shi to be a composite work of Gonposs early, and now lost, texts. 33 Jacobson ascertains the importance of this debate, stating that it informs the degree to which Tibetan medical texts can be considered part of the Buddhist Canon.34 For example, those arguing that the Gyu-Shi is the ultimate disclosure of the Medicine Buddha insist that the text warrants inclusion in the Kangyur, a denitive piece within the Buddhist Canon. Although the Kangyurs past and present authorities denied the Gyu-Shis inclusion, Jacobson notes that eight medical works, both root texts and commentaries, are included in the canons commentarial division, the Tangyur.35 Based on this precedent, one cannot argue for the exclusion of medical works from the Canon. However, opposing arguments that assert Gonpo as the Gyu-Shis author insist that, regardless of the aforementioned medical precedent, it is the mortality of the author that precludes the texts canonical incorporation. Tibetans throughout the ages have continued to defend the Vajyranic connection with medical thought. They argue that the Gyu-Shi would attain greater
33

Samten Karmay, Vairocana and the Rgyud-bzhi, Tibetan Medicine 12, (1989): 19--31 Jacobson, Situated Knowledge, 66 Ibid., 66-67

34

35

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cultural legitimacy if linked to Tibetan Buddhism rather than an individual author. The Nyingmapa (Ancient Ones), one of Tibetan Buddhisms oldest orders, argues that Guru Rinpoche36 initiated the relationship between Buddhism and medicine. He sent Vairocana, his disciple, to India, charged with a collection of esoteric Buddhist works to be translated into Tibetan. Of the translations presented to Guru Rinpoche, Indias Four Treatises proved most signicant for Tibetan medicine. Guru Rinpoche subsequently delivered them to Gonpos successor, Yuthog the Elder, who preserved their wisdom through concealment; these terma37, known as dharma treasure transmissions, provided the Nyingmapa not only original medical knowledge, but also unadulterated works on both religion and yoga. These terma are said to have detailed precious pills, medicine made potent through laic blessing, suggesting that Buddhism afforded medicine both legitimacy and therapeutic power. It is argued that the concomitance of religious and medical doctrines in Yuthog the Elders terma justies the classication of the Gyu-Shi as a Vajrayanic text. Tibetans who argue for a legitimate connection between Buddhism and medicine claim that there are additional hidden terma whose contents would further support Tibetan medicines religious foundation. Prophecy holds that these particular terma, believed to be concealed within the earth, sky, and leaves of plants, will be revealed upon future necessitation. Although these terma have been transcribed by man, their religious/yogic content suggests ethereal authorship, man acting as conduit for the Medicine Buddhas knowledge.While lamas recognize oral transmissions propensity for

36

Also known as Padmasambhava. Believed to have brought Buddhism to Tibet in the 8th century C.E. Esoteric religious text hidden until needed in the future upon which it will reveal itself.

37

23

adulteration, they argue that the limited guardianship of these terma allays verbal transferences diluting effect. The small lineage of Guru Rinpoche, therefore, affords his transmission of Buddhist medical thought greater legitimacy, as the purity of the message informs its level of divinity.

Gyu-Shi and the Body Although Tibetan medical scholars continue to debate the authorship of the Gyu-Shi and its relation to the Buddhist Canon, most would not deny that the information is ultimately a revelation of the Sakyamuni Buddha. Beyond the physical description of the body, the text also details the engagement of anatomical/physiological theory with Buddhist ideology. This section will therefore present Classical Tibetan humoral theory and will detail the relationship between esh and mind. More specically, this section will explain the spiritual mechanisms that give rise to the materialization of the body. The Gyu-Shi is divided into four treatises: the Root Treatise (rTsa-rgyud), providing concise descriptions; the Commentary Treatise (bShad-rgyud), giving longer, more detailed accounts; the Information Treatise (Man-nag rgyud), offering explanations for practical methods; and the Last Treatise (Phyi-rgyud), concluding the three previous treatises and presenting an overarching account that makes practice easier for students. This section will specically deal with the Second Book, the Commentary Treatise. The second book of the Gyu-Shi provides anatomical and physiological descriptions of the body and its relationship to disease, methods of diagnosis, and the need to understand patient diet, environment, and spiritual conduct when dispensing treatments.

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Study of the body in the Gyu-Shi begins with an image of the Illustrated Trees of Medicine38, a visual aid that describes a tree with three roots, from which grow nine trunks on which there are forty-two branches; these have 224 leaves, and there are two owers and three fruits. The rst of the three roots presents the denition of the body.39 From here, the roots divide into two trunks: one healthy (balanced state) and the other diseased (unbalanced.) Rather than present the parts traditionally, detailing their interrelationships while simultaneously explaining their meanings, I will briey explain how each individual part offers a lucid understanding of the body. The rst branch of the healthy trunk represents the humoral system in Tibetan medicine; its three leaves are symbolic of wind, bile, and phlegm. Medical theory holds that the balance of these humors maintains a healthy body, restoring it quickly from disease. All three humors break down even further into their ve types. rLung act as the current that moves energies through the body. The ve types of rLung are: life sustaining, ascending, pervasive, re-accompanying, or downwards voiding wind. The names of the ve bile types readily reveal their function: digestive, color/complexion regulating, determining, sight, and complexion-clearing bile. The ve phlegm types detail experiences manifested through the body: supportive, decomposing, experiencing (e.g. experiencing taste), satisfying, and connective phlegm. These humoral components are common to all humankind, sustaining the body and enabling proper function when in balance.

38

Donden, Healing from the Source, 33 Ibid., 32

39

25

The seven leaves stemming from the second branch of the health trunk represent the physical constituents of the body: nutritional essence, blood, esh, fat, bone, marrow, and regenerative uid. The digestive process is responsible for the material of these elements as well as the maintenance of their proper function, indicating the important role that diet plays in sustaining bodily health. Digested food is separated into its rened and unrened parts, nutritional essence being comprised of the rened material. The unrened material continues towards the liver for blood production, which then gives way to esh, fat, bone, marrow, and lastly, regenerative uid. Moreover, the bodys purication of sustenance is not an immediate process; as rened and unrened material moves through the body it continues to be broken down by digestion. After the digestive process is complete, the excretion process beings, represented by the three leaves of the healthy trunks third branch: feces, urine, and perspiration. In short, a body is in good health when the humors are balanced and the production of bodily constituents is maintained. The unhealthy, represented by the body roots second trunk, contains nine branches. The rst branchs three leaves stand for the causes of disease: desire, hatred, and ignorance, which produce wind, bile, and phlegm disorders, respectively. The underlying Buddhist logic, e.g. the correlative relationship between origin of ailments and Buddhisms three poisons, further determines that disease arises from desire; when the desire for happiness becomes insatiable, disease manifests itself through the resultant suffering. Dr. Yeshi Donden explains that we make great efforts to achieve happiness but that we generally create the opposite of what we seek -- bringing on ourselves more

26

pain40 Moreover, theoretical holdings of Classical Tibetan Medicine assert that the three poisons that generate humoral disruption are expressions of karma, manifestations of the effects one accumulates through the conduct of past lives. Still, we should not consider karmic-based humor disruptions as nal condemnation; Dr. Donden suggests that resistance to the afictive emotions of desire, hatred, and ignorance will prevent and/or lessen the effects of disease. Therefore, although karma may affect the bodys initial humoral disposition, humans, through control over mental attitude, can counter these negative effects. rLung disorders arise through insatiable desire, provoking us towards endless need and eternal want. This corporeal agitation irritates the wind humor, causing increased prevalence of rLung in the bodily system, leading to anxiety, depression, etc. Donden explains that, upon encountering a rLung imbalanced patient, Tibetan physicians will rst point to the faulty logic that gives rise to desire, hoping to convey the individuals inability to control such desire ; they also aim, however, to provide a path of acceptance that will calm the desiring self, reduce rLung, and remove the cause of physical ailment. The four leaves of the second branch are representational of the conditions that affect humoral dispositions. The rst leaf, time, details the effect of the seasons upon wind, bile, and phlegm levels. Again, diet plays an important role in humoral maintenance and must therefore adapt accordingly to seasonal change; both individual disposition and seasonal effects upon the three humors are taken into consideration when prescribing appropriate dietary regime. Even medicine must be adjusted accordingly throughout the seasons to accommodate the environmental effect on internal states. The

40

Ibid., 37

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second leaf notes the effect of spirits upon the body, the spiritual often giving rise to spontaneous humoral agitation (also problematizing diagnosis of these invisible forces). The third leaf refers to poor diet, e.g. eating the wrong foods with respect to ones particular body type or eating foods that will exaggerate the effects of environmental inuence on humoral states. The last leaf denotes improper behavior, e.g. inappropriate attire to combat the elements that exacerbates the humors. The third and fourth branches refer to entrances and locations of disease, respectively. For example, the six leaves of the entrance branch detail the possible doorways through which disease may enter the body, e.g. skin, esh, bone. The three leaves on the location branch refer simply to afictions of the upper, middle, and lower parts of the body, respectively attributed to phlegm, bile, and wind. The fth, pathway branch contains 15 leaves, detailing the ve courses disease takes with respect to each humor, e.g. bile disorders moving through the gall bladder or phlegm disorders moving through the stomach and urinary bladder. The sixth branch represents the time at which different afictions arise based on humoral cause and pathway of disease. Age, locality/environment, and seasonal factors all affect predispositions to disease but also assist the physician when determining what humoral disruption is revealed by the presented illness. The seventh branch refers to fatal effects, detailing a progression of bodily responses to medicine and their ability to indicate prognosis and available treatment methods. The twelve leaves of the eighth branch refer to the side effects of improper diagnosis and treatments of disease. Though the humors are described as giving rise to certain ailments, physicians often nd that the symptomatic expression of a disease may not directly reect the suspected humoral cause.

28

For example, if a Tibetan doctor failed to treat a phlegm disorder effectively the disease may appear to be rooted in a rLung disturbance. However, a properly trained physician will be able to recognize that the expressions of wind disruption are actually rooted in an untreated phlegm disorder. The side effects, therefore, detail the positive consequences of effective treatment as well as the humoral disruption that ensues from ineffectual medicine. The last branch categorizes disorders as hot or cold, commonly referred to as the condensation of disease. For example, blood and bile disorders are related to heat while wind ailments are believed to be cool in nature. Moreover, lymph ailments possess attributes of both, necessitating that the physician be extremely adept in diagnostic and interpretive procedure.

Diagnosis

A physicians diagnosis of disease usually begins with an interrogation, aimed at discovering the particular aspects of their patients daily life, e.g. diet, lifestyle, social networks, etc. Though the physician will employ tongue, pulse, and urine techniques to discover the root cause of disease, it is crucial that he also understand the patients lifestyle when establishing their humoral disposition. For example, the predisposition for bile agitation is an effect of the patients frequent sun exposure, whereas an overabundance of phlegm may result from a leisurely afternoon spent lying in the grass. Moreover, physical examination of the patients body informs the physicians understanding of humoral states. Yawning, dull senses, and aching joints suggest a wind imbalance, while poor appetite, indigestion, and cold extremities suggest a phlegm disorder. Lastly, a physician

29

will attempt to discover lifestyle factors that provide temporary amelioration to humoral disruptions, aiming to rule out cases where disease is present but temporarily masked by diet and lifestyle. For example, a patient may have a wind disorder that causes internal damage but the patients consumption of oily/nourishing foods and listening to gentle music may lessen symptoms to the point where the disease isnt noticeable but remains active. Moreover, the physician may utilize these factors for exploratory reasons, e.g. if the patient benets from taking bone broth, this may conrm a rLung disorder, and a positive result from taking a decoction of gig ta (chiretta) would indicate a bile disorder. Tibetan medicine prides itself on the use of pulse diagnosis and the degree of accuracy that the technique provides. Though believed an import of Ayurvedic pulse diagnosis, Tibetan medical theory has modied pulse work to create diagnostic categories for geo-specic ailments. Pulse diagnosis is an extremely subtle art, the mastery of which takes a lifetime. Pulse theory holds that blood moves through vessels via rLung, but that the pulse can offer information about all three humors. Over time, with practice and observation, physicians can come to discriminate the three humors in the pulse, identifying location and movement as instantiations of the humoral system. As discussed before, seasonal and temporal effects must be considered when taking the pulse; a patients bile, for example, will read differently based on time of day. Pulse diagnosis also requires that the physician be adept in procedural techniques, e.g. applying proper pressure, nger placement, etc., as the diagnosis is only as effective as its practitioner. Before pulse diagnosis begins, the physician must rst interview the patient to determine any factors that might distort his readings. The Gyu-Shi also dictates that the activities of the physicians themselves may preclude the accuracy of their pulse diagnosis,

30

e.g.physicians are to refrain from sex, alcohol, and strenuous activity directly prior to pulse reading. The physician is able to read different organs throughout the body as his patients pulse moves over each of his ngertips. Moreover, different pulses indicate humoral composition of the organs throughout the body. In addition to pulse diagnosis, Tibetan medicine details urinalysis techniques to diagnose humoral imbalances. As with pulse diagnosis, proper urinalysis readings require the patients to abstain from certain food, drink, and activities that could skew the results. The physician should collect urine in a clear container, one that allows for easy examination of sediment that accumulates at the bottom (the character of the sediment providing information about blood and bile in the body). The Gyu-Shi explains that healthy urine should be light yellow, possess a moderate amount of sediment, and a moderate lm on top. Likewise, the three humoral components reect themselves in urine differently; wind as watery with large bubbles, bile as reddish yellow and strong smelling, and phlegm as whitish with many little bubbles that stay on the surface after stirring. Urine analysis also provides information concerning demonic disruptions and spiritual deviations from the noble path of Buddhism. The Gyu-Shi provides a grid against which physicians can judge the accumulation of sediment and further, the patients relation to evil spirits and impending death. In summary, Gyatzo, in his Essentials of Tibetan Medicine, 41 concludes that the doctors must bear the following ten points in mind before beginning any therapy: 1) state of the patients seven bodily constituents and three excretions; 2) patients home climate; 3) season when disease manifests; 4) patients constitutional type; 5) patients age; 6)
41

Thinley Gyatzo, Essentials of Tibetan Traditional Medicine, (California: North Atlantic Books, 2010)

31

humor at the origin of the disorder; 7) location of the illness; 8) state of the patients digestive heat; 9) patients energy level and its uctuations; 10) patients willingness to change lifestyle and diet. Only when these factors are consistent with each other may therapy be applied effectively. The amount of attention paid to socio-environmental elements in addressing humoral disruptions suggests that disease was not simply a physical ailment, but was indicative of larger social ills; the bodys health reected the world around it.

Treatment of Disease Given the aforementioned descriptions of the body, humoral composition, and diagnostic techniques, Tibetan medical theory aims to create an effective regimen of treatment and to restore balance to the body. Treatment ultimately aims to understand the relationship between humoral disposition and socio-environmental factors. The humors are known to accumulate or arise depending on the season; the Gyu-Shi explains that treatment is most successful when the humor is still conned to its natural location and during the season it accumulates rather than in the season when it arises.42 Treatment of the humors during the accumulation phase allows a pacication of the imbalance without disrupting the other humors. Administration of such treatment is dependent upon the type of humoral-disorder and the time of day when the humor is most active, and must be given before, during, or after meals to be most effective. However, if patients do not take the medicine as instructed they run the risk of causing further disruption.
42

Ibid., 113

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Indigestion is the most commonly presented ailment in Tibet, paralleling this same ailments mythical role in Tibetan medicine. Digestive heat, in fact, is considered crucial in all medical treatment as its diminishment allows impure nutrients, normally released through the three excretions, to penetrate the seven bodily constituents, causing malabsorption. Physicians will often recommend cleansing treatments, such as the Three Fruit Decoction, Decoction of Seven Precious Ingredients, or se bru dwangs ma gnas jog (Pomegranate Sanctuary), to reinvigorate the digestive wind before prescribing treatments, ensuring maximum efcacy. However, this cleansing requires a delicate balance between invigoration of digestive re and maintenance of humoral balance. If this treatment is used arbitrarily or before the disease has presented itself the patient runs the risk of aggravating the disease. Likewise, the pacication of a single disrupted humor necessitates the preservation of balance throughout the other humors. Such preservation, however, is not often achieved; disease tends to arise from a combination of humoral disruptions due to lifestyle and poor disposition from birth. In some cases the patient presents a superimposed disease, where new ailments compound upon pre-existing illness, usually entering the body at the natural site of humoral disruption, i.e. a weakened digestive-re will present an easy target for illness to strike. Physicians must carefully determine, therefore, whether to treat illness according to its original entryway or to the symptoms presented by the new ailment. If the disease arises from an imbalance of humors, the physician usually prescribes a ru ra (chebulic myrobalan) and brag zhun (mineral pitch) to bring the states into balance. Additionally, specic organs and humoral disorders may require that specically tailored ingredients be added to the original panacea. Alongside herbal treatments, physicians will also provide

33

dietary regulations based on the humoral effect they have on the body, e.g. warm and nutritious foods to treat combined wind and phlegm disorders. As previously mentioned, however, doctors will employ exploratory treatments if the diagnosis does not provide clear results. A doctor might administer a decoction of rgyam tshwa (rock salt). sman sag (ginger), and a ru ra (chebuilic myrobalan), if a phlegm disorder is suspected and if conrmative diagnosis if the condition approves. Still, treatment often proves difcult and curation elusive when the humoral system presents disease as a complex set of ideas, each part requiring an adept understanding of its interconnection before able to be untangled. The Gyu-Shi notes that physicians often fail to treat disease because it has either not completely manifested (rendering the treatment erroneous) or because the physician himself fails to understand the subtle cause of the disease, treating the wrong humoral imbalance. Other examples of failure include treating a blood disorder without rst cleansing via the Three Fruits decoction or treating hidden fever without rst treating the cold symptoms with warm therapies. For the most serious of disorders, physicians must use the corresponding four waters or four res, their application dependent upon the nature of the disorder, i.e. hot or cold. For example, a serious hot disorder will be treated with cold medicine (camphor), cold therapy (bloodletting), cold diet (light eating), and cold lifestyle (cold places). All four must be applied at once as the synergistic effect is necessary to successfully combat the disease. Still, most diseases are mild in nature and are treated step-by-step, beginning with lifestyle. Physicians will then suggest a change in diet, followed by hot or cold medicines, and nally, if all else fails, external therapies. Physicians will, in non-fatal cases, suggest lifestyle and diet changes before offering medicinal therapies. Herbal decoctions are

34

intended to have rapid effects, but affect the humors quickly as well. Therefore, medicinal compounds and external therapies are reserved for more serious cases as they necessitate effective treatment but also heighten the propensity of misguided therapies (the latter endangering humoral imbalance). The pharmacological component of Tibetan medicine is its most remarkable part, providing a materia medica that can ameliorate almost any illness. These compounds are often discovered through sensory experience, i.e. through taste and smell. Dr. Lokesh Chandras work, the Illustrated Tibetan Mongolian Materia Medica of Ayurveda, details over 700 medicinal substances made from plants, animals, and herbs divided up into the following sections; 1) Gems and Metals (a. precious substances which cant be melted; b. precious substances which can be melted); 2) Substances derived from rocks and minerals (a. meltable; b. not meltable); 3) Medicinal earths (natural; manufactured; salts); 4) Exudates and secretions; 5) Medicinal substances obtained from trees (fruits and nuts; blossoms; leaves, twigs, stalks, roots, saps); 6) Medicinal substances obtained from boiled extracts of various parts of plants; 7) Medicinal plants, herbs and grasses (roots; owers; fruits; leaves; leaves-stalks-owers-fruits together; entire plant; cultivated plants, i.e. bearded; leguminous and roots); and 8) Medicines obtained from sentient creatures (birds; herbivores; wild animals; magical birds; domestic animals; those living in holes and burrows; those thriving in moisture.) 43 When examining these materials, physicians employ the Gyu-Shis six tastes and eight potencies to discover the elemental constitution of components, i.e. earth, water, re, air, and space. The most highly regarded component, a fruit known as Myrobalan, is

43

Jampa Dorjee An Illustrated Tibeto-Mongolian Materia Medica of Ayurveda, Ed. by Lokesh Chandra, Satapitaka Series 82

35

comprised of all ve elements and esteemed for its ability to ameliorate almost any humoral disruption: Myrobalan is good for fevers and colds. The root is good for bone diseases, the trunk for esh, the branch for nerve disorders and sinew, the bark for skin, the leaf for diseases of the hollow organs, the ower for sense organs, and the fruit for heart and the solid organs. Myrobalan has all the six tastes and all the eight powers of Tibetan medicine. Its perfume drives away all 404 diseases.44 When employing materials whose elements are not as well balanced, physicians must consider geographic origination, seasonal inuence, and the way that the six tastes and eight potencies change through time. (The six tastes are sweet, salty, bitter, sour, astringent, hot. The eight potencies are four pairs of opposites: heavy and light; unctuous and rough; hot and cold; dull and sharp). When physicians encounter diseases that arise from harmful spirits, poor karma, and lost merit, traditional treatment methods no longer sufce. Spirits enter the body invisibly, causing both physical and mental illness. Believed to be disgruntled, disembodied consciousness that employs negative forces to gain entry into human bodies, the spirits are commonly referred to as devas, yakshas, bhutas, nagas, parthivas and ksamapatis. Each negative entity manifests differently, devas causing ego dissociation and nagas leading to tumor development. The Gyu-Shi prescribes pulse and urine diagnosis for determining spiritual harm, but often these spirits require a physician who has mastered the more subtle manifestations of spirit inhabitation. Dr. Donden notes that these entities may be removed through proprietary rituals, but efcacy depends rst and foremost on proper identication.

44

Susan C. Maresco, Practicing the Art of Tibetan Buddhist Healing, Mandala Magazine, May 2000.

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Predominance of these spiritual inuences and the need to treat them immediately and effectively is so critical that two chapters of the Gyu-Shis third tantra are devoted completely to identifying diseases caused by spirits; another three are focused completely on the spirits ability to affect mental states. Dr. Donden explains there are 360 entities that may possess the individual, altering mind and personality. Often one may never discover what past karmic force or non-virtuous action is causal of spiritual afiction, but through prayer, meditation, curation by lamas one may attempt to eradicate the spirit completely. Although Tibetan medicine presents a rational, systematic formulation of the body, alongside diagnostic techniques aimed at understanding bodily constituents, it cannot be separated from its underlying Buddhist logic.

Karma and Subjectivity Tibetan medical theory illustrates a body whose instantiation is a product of social

relations. The humoral system, giving rise to the material body, is in constant communication with the outside world. Every action is informed by one's humoral predispositions, and in turn, the consequences of these actions affect the humors as well. In demonstrating the holistic body, scholars and Tibetan physicians alike often employ rLung to illustrate the humors social nature, as socio-environmental factors generally have the greatest affect on this specic humor. Previously, this chapter explained the state of one's rLung is informed by both one's karmic predisposition and desirous mental states. 45 Thus, symptoms that indicate a rLung disruption are as much personal as they
In fact, the mere possession of a physical body entails an inevitable attraction to the material world. Moreover, though not entirely the same, Tibetan epistemology resonates with ideas about lacking in modernity. Tibetan medicine argues it is mere existence, not any modern encounter, that generates a feeling of lack. Karma, too, puts us in constant conversation with the past and future, trying to place ourselves in the present.
45

37

are social in cause. Moreover, disruptions of rLung, because these winds guide all bodily movement, indicate a holistic corporeal dysfunction. The Gyu-Shi explains that bringing rLung back into balance requires tending to

both body and mind. As desire gives rise to rLung, Buddhist logic in Tibetan Medicine explains the only true cure for these afictions of desire is through engagement with Vajrayanic practice. Taking refuge in the Three Jewels 46 and constantly working towards personal enlightenment were the only lasting ways to manage rLung. Thus, Tibetan medical treatments, though aimed at bringing the bodily humors into equilibrium, were not intended to be the rst line of defense; Tibetan therapies only meant to provide bodily relief so that one could, again, engage in religious practice, taking over the unruly reins of mind. In researching rLung disorders, I found every scholarly article on Tibetan medicine

that presented examples of rLung disruptions described them as responses to the turmoil Tibet presently faces. In responding to these social ills, the body became sufferings palette, a canvas for an innite number of possible representations. Some informants was very clear in identifying China's continued presence in Tibet as the cause of their humoral disruptions. They claimed Chinese state policies generated discontent amongst Tibetans, subsequently agitating rLung. Thus, Tibetans' frustration with Chinese policy was revealed somatically, their bodily ailments resulting from the stirred internal winds. Chinese biomedical theory failed to account for these rLung disruptions, often identifying them as anxiety disorders, as they did not conform to a biochemical model of diagnosis.

The Three Jewels in Buddhism are the Buddha, the Dharma (his teachings), and the Sangha (members of the Buddhist community.)
46

38

Adams work, however, found that informants were reluctant to identify their

rLung with external causes, explaining imbalances through their own actions and mental states. Adams notes that this may, in fact, contradict Tibetans actual sentiments.47 Most Tibetans, notably physicians, dared not suggest Tibetan medical ndings indicated a negative relationship between bodily states and Chinese policies. Doing so would prove an extremely risky move, as it was a punishable offense to suggest 1) that the PRC's Tibetan Policy was nefarious or 2) Buddhism had a legitimate place within Tibetan medicine. Moreover, because Chinese ideology delegitimizes Buddhism's role in Tibetan medicine, it also distances socio-karmic conceptions of suffering from medical practice. Karmic logic portrays the body as a product of social relations resulting from ethical choices made in daily engagements. Moreover, karmic beliefs explain the body as a reication of these deeds, one's humoral composition a product of karmic histories. Lastly, karma's ability to corporeate the social world indicates that the body simultaneously reies both individual and collectivist sentiments. Moreover, karmic ideas in Buddhist ideology explain how one should practice compassion and respect indiscriminately. All people are believed karmic kin; over the eons we have come into contact with every living beings past self. Karma from these interactions continues to inform the present. Moreover,the karma created through such interactions subsequently affects humoral states. However, it is often in moments of trauma that these karmic, collectivist notions of self and subjectivity become most lucid.48

47

Adams, Tibetan Theorizing, 2001

Jean Comaroff, Medicine, Symbol and ideology, In The Problem of Medical Knowledge: Examining the Social Construction of Medicine, ed. P Wright, A Treacher, (Edinburgh: Edinburgh Univ. Press, 1982)
48

39

Here, the body reveals the meeting between sociocultural, economic, and political facets of everyday life. It is when disease threatens the corporeal that Tibetan bodies render the social somatic. The following chapters will explore present day changes in both conceptions of the body and pharmacological practices, and will focus specically upon how such changes relate to Chinese state policies that aim to remove spiritual and non-Biomedical components from Tibetan medicine. I will use the aforementioned material to explore the relationship between culture, medicine, and conceptions of disease and how they give voice to Tibetans narratives of suffering.

40

CHAPTER TWO
Science, Religion, and the Politics of Unhinging

The previous chapter serves to establish basic Tibetan medical theory, including

conceptions of the body, diagnostic techniques, and methods for therapy. Moreover, the rst chapter also aims to establish the connection between Buddhist thought and Tibetan history, illuminating their interaction in Tibetan medicine. In this second chapter, I aim to show the changing conception of science in Tibetan medicine resulting from Chinese socialist reforms, new social realities, and praxis regulations specically the unhinging of Buddhist thought from Tibetan medical therapeutics. Moreover, the introduction of Western Science, as conceived through the Chinese regulations and resulting indigenous understandings, encourages Tibetans to believe that "science" itself produces a universal understanding of the world. However, further examination of social understandings of scientic realities show this is not the case. The Tibetan effort to understand their medical epistemology within the connes of a biomedical model produces conict, which in turn reveals ambiguous meanings of what makes Tibetan medicine "scientic." Therefore, this chapter will examine how ambiguous understandings of anatomy, physiology, and treatment practices disclose the tension between maintaining traditional Tibetan medical theory and new attempts to underscore it with scientic logic.

41

 Religion, Science, and Questions of Compatibility One contemporary tension is illustrated by the idea of the three channels (rtsa gsum) within the Tibetan body. Tibetan medicine holds that there exists one channel that runs through the center of the body with two accompanying channels on the left and right side of the body. These three channels, (the w-ma, to-ma and rkyan-ma) are found in Buddhist tantra texts, associating them with subtle winds that carry energies through the body and inuence psychological and physical states. Moreover, these three winds are directly tied to the three poisons anger, greed, and ignorance which then give rise to the three humors rLung, mkhris pa, and badkan as detailed in the previous chapter. Again, these three humors themselves are believed instantiations of resulting consequences from one's present actions and karmic inuences, which then in turn materialize as the physical body. Present debates, due to the inuence of biomedical ideas in contemporary Tibet, argue that these three channels may not exist at all. However, physicians trained before the Chinese introduction of new regulations

regarding medical practice continue to argue for the scientic basis of these channels. Vincanne Adams, a scholar in contemporary Tibetan medicine, details the work of Dr. Tsultrim Gyaltzen and his work on the three channels and embryology. 49 Dr. Gyaltzen argues that upon conception, a consciousness from a past life intermingles with the newly conceived embryo at the moment of fertilization. Furthermore, the egg and sperm are believed to contain energies of their own, resulting from their own particular elemental constituents. These are, respectively, the red and white elements. These red and white
49

Adams, Sacred in Scientific, 2001

42

elements themselves are comprised of the ve elements necessary for life, detailed in the previous chapter, which combine with the wandering consciousness full of the three poisons to begin the development of a human. During this fusion of spiritual and physical, the three channels begin to form. Because these three channels are also believed physical representations of one's karmic past, they also give rise to and govern the humoral disposition of the developing fetus. Thus, the body itself is an incarnation of one's karmic past.50 Again, these karmic faults do not necessarily determine one's bodily experience.

Herein enters the purpose of Tibetan medicine. To provide an example: given that one's karmic history causes high levels of rLung, the resulting possibility of life-long anxiety can be ameliorated through Tibetan therapeutics aimed at balancing this humor. Understood tantrically, the center channel also provides the means for Buddhist enlightenment, i.e. escaping rebirth in the physical world and dispelling karma, through a regulation of breaths. These breaths of the center channel, when properly regulated, have the power to move through the other two channels and can simultaneously balance humors and reduce the number of breaths, thereby lowering metabolism and increasing life-span. 51 Adams points out that the physician uses this knowledge to make diagnosis and prescribe treatments, whereas the tantric practitioner aims to improve their meditation practice under the idea that through regulating the body, one can regulate the mind that in turn brings one closer to enlightenment.52

50

Rinpoche, Tibetan medicine, 1973 Clifford, Tibetan Buddhist Medicine, 1984 Ibid.

51

52

43

Again, we must remember that traditional Tibetan medical theory holds as the

ultimate medicine the Buddha himself, otherwise known as the "King of Medicines." Examination of Dr. Gyaltzen's work reinforces this idea, where he writes: "It is common knowledgethe three poisonscause [illness]. The Buddha cures all illness."53 Therefore, traditional Tibetan medicine holds that control over these three channels through mental regulation allows for control over the body. Moreover, these channels also explain the relationship between the body, environment, seasons, astrological events, and other external natural phenomena. While Dr. Gyaltzen's work focuses specically on embryology and its relationship to the three channels, this work serves to unearth the tension between science as understood in traditional Tibetan theory and biomedical epistemology. Further illuminating that tension, scholarly ethnographic work in Tibet revealed

that there were many problems in attempting to translate the "scientic" parts of the GyuShi, given that understandings of science differed between traditional physicians and those trained in the newly regulated education facilities.54 Physicians trained before the introduction of biomedical knowledge in medical schools understand science more broadly than those trained more recently.55 Rig-pa, the term the Gyu-Shi provides to the "science of Tibetan medicine," encompasses all of the text's knowledge, including humoral systems, that underly Buddhist logic, astrology, pharmacological empowerments

53

Adams, Sacred in Scientific, 2001

Vincanne Adams and Fei-Fei Li "Integration of Erasure? Modernizing medicine at Lhasa's Mentsikhang." In Tibetan medicine in the contemporary world: global politics of medical knowledge and practice. Ed. Laurent Pordi. (London: Routledge, 2008), 105-131; Janes, Transformations, 1995; Barbara Gerke, Mona Schrempf, Sienna R. Craig, and Vincanne Adams. "Correlating Biomedical and Tibetan Medical Terms in Amchi Medical Practice." In Medicine between science and religion: explorations on Tibetan grounds. (New York: Berghahn Books, 2011), 127-152.
54 55

Adams and Li, Integration or Erasure, 2008

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from lamas, etc. However, when Adams interviewed Tibetan physicians and asked the relationship of rig-pa to "Western Science", she found many of the physicians began to address these more esoteric parts of their medical theory as art, using the English word. Still, there were some who continued referring to Tibetan medicine as tshan-rig (scientic), and that the knowledge of biomedicine was scientic as well in just a different way.

What Science Can See Yet, because of the introduction of Chinese policy regulating Tibetan Medicine

and the inuence of the Western desire for Tibetan therapeutics, physicians nd themselves needing to translate the 'science' of Tibetan medicine into a biomedical, 'scientic' understanding. Practitioners must think through Tibetan medicine in a new way that divides those aspects deemed religious from those believed scientic. Because of these circumstances, we encounter a changing linguistic understanding of the term science as well. Again, tshan rig, (science), previously encompassed all features of Tibetan medicine, both religious and secular. However, the new need to provide a biomedical understanding of Tibetan medicine has initiated a changed in the term 'science,' with physicians now employing the term phyila gi rig (outside science) to refer to traditional medicine. Subsequently, physicians have displaced the term tshan rig from it's all encompassing nature to now only signify those ideas in Tibetan medicine that appear compatible with biomedical understandings of the body and therapeutic treatments. This is not to say, however, that Tibetan physicians regard their traditional

medicinal system as unscientic. The repercussions of attempting a one-to-one translation often leaves both traditional practitioners and those outside the system to
45

regard one science as more rational than the other. Practitioners trained in the newly formed curriculums often doubt the existence of the above listed channels due to their invisible nature. Though they believe that within the traditional system itself the knowledge is scientic, it still remains devalued when it comes into contact with biomedical understandings.56 Thomas Kuhn's work on scientic revolution comes to mind here, as we consider that the newly trained physicians insist that they are attempting to elevate Tibetan medicine beyond its status as "normal science." 57 Thus, because modern-trained physicians see biomedical inuences as a revolutionary science, one that can help Tibetan medicine progress, they place a value judgement on the knowledge within Tibetan medicine. Although they are willing to afford it a place as a 'normal science,' they believe the revolutionary principles of biomedicine are something to be sought out and promoted. However, these desires must be considered in the light of the political regulations and economic benets of conforming Tibetan medicine to biomedical standardization. Again, recall the Chinese state's desire to remove religion from the science of

Tibetan medicine. Traditional physicians claim that western medicine leaves no room for religious ideas: they are simply antithetical to biomedicine. This is the source of the great tension between biomedicine and traditional medicine, as traditionalists argue the religious background remains imbued through all the tests of the gSowa Rigpa, the source of medical knowledge that predates the 12th century Gyu-Shi.58 This secret knowledge,

56

Adams, Sacred in Scientific, 2001 Thomas S. Kuhn The structure of scientific revolutions. Vol. 2. (Chicago: University of Chicago press, 1996)

57

Jan Barmark "Tibetan Buddhist Medicine from the Perspective of the Anthropology of Knowledge." Tibetan Medicine 13 (1991): 3-37
58

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handed down through oral transmissions, contains sacred understandings of medicine and the knowledge itself is believed holy. Moreover, remembering Kuhn, biomedicine is unable to include Buddhist understandings of the world because its epistemology does not include concepts that would reveal a Buddhist anatomical, physiological body. Thus, because biomedicine has no apparatus to "see" the three channels, they are deemed nonexistent. Yet, we must consider that the Gyu-Shi does provide the means to see these channels while it does not provide the means to see microorganisms. The point being, while Tibetan medicine did not articulate ways to see common biomedical facts, e.g. germ theory, it does not presently deny their existence. However, biomedicine in Tibet refuses to accept anything outside of its own epistemological sight as false, superstitious, and harmful to the progression of health sciences. This view is evident in those trained at the main medical college in Lhasa, the

Men-Shee-Khang. While they do not completely deny the three channels exist, they do equate their place in the body with biomedical anatomical understandings, namely the central nerve system, arterial blood ow, and venous blood ow.59 The uma, roma, and kyang ma (Tibetan terminology for the three channels) are deemed religious concerns and, therefore, unscientic. Thus, because they lack scientic value they are not important to medical science. Moreover, these colleges, because of overarching policy and globalization of pharmaceuticals, want to eradicate all ideas of the superstitious, including the inuence of karma, the relation of the three poisons to the humors, and the idea that regulating the body can bring the mind to enlightenment. The argument for this understanding, as Adams notes, is often one based on the history of medical texts. Those
Craig Janes "Imagined lives, suffering, and the work of culture: The embodied discourses of conflict in modern Tibet." Medical Anthropology Quarterly 13, no. 4 (1999): 391-412
59

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who push for eradication of religion from Tibetan medical theory argue the religious aspects of the Gyu-Shi were added with Zhurkha Lodri Gyalbo's under Tibet's theocratic state in the 17th century.60 Thus, these fundamentalists believe that Tibetan medicine has become less "scientic" over time and if physicians understand the medicinal system as it was written originally they will see larger compatibility between traditional Tibetan and biomedical views. This conversation must be considered in light of the values instilled since the

Cultural Revolution, i.e. regarding those ideas deemed religious as backward and harmful to the progress of society. As Chinese state policy began to set the standard for medical knowledge, incorporating guidelines found in biomedicine, Tibetan medicine was scoured of any irrational religious backgrounds, leaving behind what was deemed scientic. This policy promotes problems larger than the maintenance of Buddhism in medicine. Those ideas regarded as superstitious became dangerous, both politically and socially, and using them, especially at the highly visible medical level, has often entailed penalties in the form of nes, imprisonment, or, more often, corporal punishment. 61 Therefore, as these physicians become trained in educational systems that celebrate the scientic and despise the religious, the search to equate biomedicine with Tibetan medicine is not simply driven by economic benet or scientic progress but also by fear. This is not to say that many of these new physicians themselves do not regard

some parts of Tibetan medicine as unscientic, rather, it entails that we must ask: what drove the change outside of policy? How did people come to practice a form of Tibetan
Adams and Li, Integration or Erasure, 2008; Vincanne Adams "Equity of the ineffable: cultural and political constraints on ethnomedicine as a health problem in contemporary Tibet." Public Health, Ethics, and Equity (2004)
60

Craig Janes. "Buddhism, science, and market: the globalization of Tibetan medicine." Anthropology & Medicine 9, no. 3 (2002): 267-289.
61

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medicine that rejects the Buddhist logic that formed its foundation? It is often the case that modern professors came to the college already understanding biomedicine as the correct way to legitimize Tibetan medicine? However, there are many voices that were stied for those who continued to believe the religious necessary for Tibetan medicine's existence. Fear of political repercussions either drove them away from teaching at such a visible level, or forced them to stay and disseminate an epistemology they did not believe.62 The irony here is, again, the physicians and professors who support the

Traditional medicine see these religious parts as the science that gives Tibetan medicine its credibility. Thus, returning to the example of embryology and the three channels, their invisibility often renders them unscientic when viewed under biomedical eyes. However, Dr. Gyaltzen regards the union of red and white elements with the consciousness (rnam shes) necessary for a scientic understanding of the inner wind channel (rLung tsa.) Other Tibetan physicians, scholars, and patients who understand the body through a Tibetan medical lens maintain that even these elements invisible to microscopes and MRI's are just as necessary to approach Tibetan medicine scientically.63 These theoretical schematics of the body require both physical and spiritual understandings to effectively treat illness. For example, the three poisons, underscored with Buddhist rationality, give rise to the three humors, whose balancing requires knowledge of the rational treatment system detailed in the Gyu-Shi.

Fernand Meyer "Theory and practice of Tibetan medicine." Oriental Medicine: An Illustrated Guide to the Asian Arts of Healing (1995): 109-143.
62 63

Adams, Sacred in Scientific, 2001

49

Scholars who support the traditional medicine system acknowledge that rLung

disorders are religious because they are tied to ideas of the rnam shes (soul).64 However, Tibetan theory holds this immaterial soul has an effect on the physical, effects we can see regardless of whether one employs traditional or biomedical understandings. The issue for scholars goes beyond debating what is viable for biomedicine to inspect and deem scientic; the true crux of the problem lies in discovering those underlying principles that determine where biomedicine even focuses its gaze. Moreover, Tibetans who support the traditional medical epistemology argue that distinguishing the religious from the scientic was never necessary in order to produce the effects of Tibetan medicine seen in the region today.65 Doing so today, in fact, undermines the logic that afforded Tibetan medicine its efcacy and prestige to begin with. The Politics of Science The aforementioned conicts between science, religion, medicine, and the state

also stem from the common knowledge of Tibetan medicine roots in religious institutions. From the 17th century to 1916, Tibetan medicine was often taught in a Buddhist context, specically with the aim of how one could use it to further his/her religious practice.66 Taught almost completely in monasteries during that period, Tibetan medicine was regarded as absolutely Buddhist in nature. Moreover, Tibet has a history of infusing

Thubten Jigme. Norbu, "The Development of the Human Embryo According to Tibetan Medicine: The Treatise Written for Alexander Csoma de Koros by Sangs-rgyas Phun-tshogs." Silver on Lapis: Tibetan Literary Culture and History, Christopher I. Beckwith, ed (1987): 57-61.
64

Joseph J. Loizzo and Leslie J. Blackhall. "Traditional alternatives as complementary sciences: The case of Indo-Tibetan medicine." The Journal of Alternative and Complementary Medicine 4, no. 3 (1998): 311-319.
65 66

Janes, Crossroads, 2001

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Buddhism into both education and governance, using Buddhist laws and morals to guide what is taught and what actions were condemnable through law. Goldstein's seminal work, A History of Modern Tibet: Vol. 2, argues that the move away from pre-modern Tibet, guided by theocratic principles, did not come into modernity until the 20th century when the government advocated for nationwide social reforms.67 She notes that although the Cultural Revolution criminalized the inclusion of religious principles in forms of governance, this distinction was not entirely new. In the 1920's, Tibet initiated a campaign to separate the monastic from the larger government, attempting to demarcate the delineation between Buddhism and the Tibetan culture itself. Still, the aforementioned debate on the scientic qualities of Tibetan medicine,

she notes, were not in effect until the 1960's when China began the campaign to promote science in the Tibetan region, necessitating the removal of superstitious/religious qualities. As this delineation permeated the Tibetan culture, Adams explains that it was "no longer possible for Tibetan practices to be "religious" in the same way they were before.68 It was this turn, she argues, that created the critical self-consciousness concerning Tibetan medicine and whether it possessed a scientic basis. The impetus for a biomedical approach lay in China's desire to create public health programs that met somewhere between traditional Tibetan medicine and the use of Western health technologies. In this push, China enforced education underscored by Marxist principles of society, specically the need to simultaneously promote a religion-free, scientically based

67

Goldstein, A History of Modern Tibet, 1999 Adams, Sacred in Scientific, 2001

68

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medicinal system, while making sure the consequences of such did not favor the elite class.69 Furthermore, The Cultural Revolution provided new terminology for Tibetan

doctors to employ, a new language of medicine that also required a reworking of priorities, notably ridding the medical epistemology of medicine to ensure all members of society, religious and secular, could enjoy therapeutic benet. Janes also notes this model resembled the Chinese push for Barefoot Doctors, resulting in training physicians with an extremely simplied version of Tibetan medicine, e.g. such-and-such symptoms provide this diagnosis and thus require this or that standard treatment.70 Therefore, individual humoral dispositions were disregarded in this push for pharmaceutical standardization. Moreover, it is important to note here that while these three humors have their basis in religious understandings, it was the need to establish a scally conservative pharmacological system that drove most physicians disregard not the religious factors themselves. Rofel's 71 work explores the relationship between benevolent state and loyal subject

in her work on China, but for all intents and purposes her work speaks to Tibet. The state provides public health care to subjects so long as they unquestioningly support the Communist state, often resulting in a need to rework medical texts so they too support the communist ideology 72. Thus, in the 1960's when China aimed to equate science with
69

This effect is not limited to Tibet, either. See Farquhar (1987) for portrayals of similar educational pushes in China itself. Janes, Transformations, 1995 Rofel, Lisa. Other modernities: Gendered yearnings in China after socialism. University of California Press, 1999.

70

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I find it important here to note the need for not only human subjects but also inanimate objects to change themselves to fit national ideologies. Though this thesis does not have enough time to explore this idea fully, it remains an interesting point that objects, too, became subjects whose ideas must be changed to support the communist state, offering the question of whether hegemony can only apply to the Tibetan people and not those object that support Tibetan Medicine themselves?
72

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modernization, rendering supports of Tibetan medical ideals un-modern, they were making a political statement as well. To reject scientic notions of Tibetan medicine was to reject the public health initiative, thus interfering with state practice a punishable offense. In Adams' earlier work on Tibet 73, she notes the transformation of these same

medical practices as China encountered the global, free-market economy. China, in order to be globally and economically viable, shifted the rhetoric (of modernization and making Tibet scientic) away from support for the socialist state. The PRC initiated changes in practice that were not so much about adherence to political ideology as they were to empower Chinese subsidiaries and prepare them for capitalistic competition. Thus, China recognized that Tibetan medicine would not remain viable on the larger global market unless they began to push for scientic standardization that provided international validity. 74 However, the biomedical standards China established in Tibet were often a remote mimicry with more lenient guidelines than those found in the modern Western world. Still, although the contradictory religious policies of Chinese state created spaces

for including spiritual aspects, Tibetan medicine still requires a delicate balance between adherence to original texts and allegiance to the state. As seen above, ideas of science and viable sites of biomedical study in Tibetan medicine are inuenced by Tibetan conceptions of the scientic, the political danger of retaining religious aspects, and socialist policy handed down from the Chinese state. Even today, educators of Tibetan
Vincanne Adams. "Karaoke as modern Lhasa, Tibet: Western encounters with cultural politics." Cultural Anthropology 11, no. 4 (1996): 510-546; Adams, Equity of the ineffable, 2004
73

Sienna Craig, and Vincanne Adams. "Global Pharma in the Land of Snows: Tibetan Medicines, SARS, and Identity Politics Across Nations." Asian Medicine 4, no. 1 (2008): 1-28.
74

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medicine, especially lama-scholars, are held in high regard so long as their religious teachings of medical science do not appear politically charged, suggesting support of a separatist movement for Tibet's independence.75 The proceeding chapter in this thesis aims to show the present negotiations Tibetans make in nding a space for Tibetan medicine in the political, religious, and scientic realm. Therefore, while Tibetans reformulate religious aspects of the medicinal system because of State regulations, they also nd deeming Tibetan medicine scientic places it outside the normal realm of the politically dangerous. The challenge now becomes moving Tibetan medicine into a realm outside the normal scope of political condemnation while retaining those features that made it a signicant body of study initially.

75

Solomon M. Karmel "Ethnic tension and the struggle for order: China's policies in Tibet." Pacific Affairs (1995): 485-508.

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CHAPTER THREE
Tibetan Medicine, State Policy, and the Biomedical Clinic: Legitimacy and Treatment

The co-practice of Traditional Tibetan physicians and biomedical doctors has

proven problematic for both patient and practitioner. Tibetan and biomedical doctors spend time debating what to classify the disorder as. This naming process is not only important for medical records, but also for deciding what course of treatment to employ: names for humoral disruptions require traditional Tibetan treatment, while biomedical classication signal use of biomedical therapies. As detailed in the rst chapter, these changes in practice are due to a conuence of factors. The restructuring of the education system, the changes in nancial policy for public health, the creation of biomedical institutions by the Chinese state, and the political condemnation of Buddhist incorporation into Tibetan practice have all inuenced recent integration practices. Thus, this chapter aims to understand how these policies have enabled changes in both practice amongst biomedical/Tibetan physicians and physicians/patients. In doing so, this serves to illuminate the resulting reformulation of corporeality, enabling the following chapters exploration of the relationship between conceptions of the body and suffering.

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Diagnosis, Naming, and Terminology The most immediate problem that these encounters present are issues of

terminology. As the Chinese reforms concerning Tibetan medicines education introduced biomedical knowledge into medical texts, a new wave of biomedically trained doctors entered the work force alongside traditionally educated physicians. 76 The encounter often presented difculties in diagnosis as both schools understood the process of naming to be not just an issue of classication, but about a way to see the body. Newly trained physicians, educated with a modernized Gyu-Shi that substituted biomedical terms for their Tibetan equivalents, often argued the humoral theory had lower value in formulating a prognosis and treatment plan.77 Moreover, the method of diagnosis, e.g. pulse vs. an EEG, informed not only which diagnostic term the physicians used but also the perceived legitimacy and justication for using the diagnostic methods associated vocabulary. Adams and Lis work in Lhasas Mentsikhang described medical wards where

pulse and urine diagnosis were employed along with blood pressure cuffs and ultrasound machines.78 Moreover, while the Tibetan physicians found themselves unable to understand results from biomedical diagnostic procedures, many biomedical doctors, often equally unable to understand Tibetan medical ndings, simply ignored pulse and urinalysis because of their perceived irrelevance. Traditional and biomedical physicians, when viewing charts, often skipped over misunderstood ndings, believing them
76

Adams and Li, Integration or Erasure. 2008

Geoffrey Sameuel. "Tibetan medicine in contemporary India: theory and practice." Healing Powers and Modernity: Traditional Medicine, Shamanism, and Science in Asian Studies. Westport, Connecticut and London: Bergin & Garvey (2001): 247-68.
77 78

Adams and Li, Integration or Erasure. 2008

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superuous and unnecessary to create an effective treatment plan.79 Still, it is important to note that this was not always the case. Digestive and liver disorders, for example, required both schools physicians to utilize the biomedical diagnostic methods, i.e. endoscopy and hepatitis blood tests, when diagnosing their patient. 80 Furthermore, recently trained physicians versed in biomedical epistemology

argued that their diagnostic technologies were often easier to use than Tibetan procedures. 81 Referring to Chapter 1, pulse and urine analysis often required years of training, not only to understand the concepts but also to train the body in ways of feeling and seeing that biomedicine does not afford. Thus, reading the output of an EKG, for example, requires much shorter periods of training and does not necessitate conditioning the body to understand the information. Tibetan physicians argued the ease in learning biomedical diagnostic practices resulted in their counterparts disregard for pulse and urine analysis. Tibetans believed biomedical physicians belittled their techniques not because they were ineffectual but because they were unwilling to devote the time necessary to employ them effectively. Because of their efciency, biomedical diagnostic technologies were often over

employed. Subsequently, physicians became increasingly dependent on these techniques and believed they could not diagnosis patients without them.82 Tibetan physicians, beyond chastising their counterparts for the simplicity of their techniques, believed use of

Craig Janes, and Casey Hilliard. "Inventing Tradition: Tibetan Medicine in the Post Socialist Contexts of China and Mongolia." Tibetan Medicine in the Contemporary World: Global Politics of Medical Knowledge and Practice. New York: Routledge (2008).
79 80

Adams, Tibetan Theorizing, 2002 Adams, Sacred in Scientific, 2001 Adams, Sacred in Scientific, 2001

81

82

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biomedical diagnosis alone failed to illuminate the complete picture of disease. Biomedical physicians countered these arguments, stating their technologies offered an objective view of disease, helping them afrm diagnosis with greater condence given the smaller chance of error.83 Moreover, biomedical physicians argued some diseases eluded pulse diagnosis, their testing methods able to reveal these invisible ailments.84 While Tibetan physicians admitted that biomedical testings offered diagnostic ease and accuracy, they believed these techniques failed to individualize the patient, drawing on the Gyu-Shis diagnostic instruction that requires knowledge of each patients individual humoral disposition. Thus, these arguments often encourage skepticism amongst both camps concerning their counterparts diagnostic techniques, resulting in a plurality of testing to ensure universal condence.85 Thus, in medical settings where both Tibetan and biomedical physicians

concomitantly treated patients, deciding on diagnostic techniques not only spoke to naming the disease but how the body was understood anatomically and physiologically. Pordie, Adams, Li, and Janes all note the best case scenario entailed those ailments that had one-to-one correspondences between Tibetan and biomedical understandings.86 This linguistic equivalence does not suggest both groups understood the relationship between body and ailment similarly; however, this mutually understood substitution signaled, at the very least, a shared understanding of what troubled the patient. Moreover, diseases
83

Janes, Health Transition, 1999 Adams, Tibetan Theorizing, 2002

84

Although physicians had both sets of information available, it was almost universal fact they would utilize almost one set exclusively.
85

Adams and Li, Integration or Erasure, 2008; Janes, Transformations, 1995;, Laurent Pordie. "Tibetan medicine today: neotraditionalism as an analytical lens and a political tool." Tibetan Medicine in the Contemporary World. Global Politics of Medical Knowledge and Practice (2008): 3-32.
86

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agreed to be treatable with either Tibetan or biomedical therapies herald shared assumptions about illness between physicians, avoiding situations where disagreement precluded treating the patient in a timely manner. Adams, in her work on Tibetan hospitals, illustrates the process of co-naming

diseases, observing an easy mapping of one set of names for disorders onto others. 87 She followed physician teams that examined womens reproductive systems, namely nine types of growths that occur. Seven of the growths named biomedically, e.g. cervical cancer, polyps, molar pregnancy, etc., had equivalent Tibetan terms. Further, biomedical physicians presented photographs from Chinese textbooks, asking Tibetans to name the disease without rst knowing the biomedical diagnosis. The Tibetan physicians, again, were able to name the equivalent term, established empirically through co-practice. However, the Tibetans were careful to note these terms owed their etymology to the GyuShi, not revelations made in practice itself. However, biomedical institutions often avoided these co-naming situations, not

through intentional evasion but because biomedicine encouraged specialization, separating physicians according to eld. Some wards were deemed better suited for Tibetan or biomedical treatment simply on type, e.g. tuberculous as biomedical ward, digestive disorders as Tibetan.88 Moreover, patients in mixed wards were often assigned one doctor; medical training backgrounds played no importance when allocating physicians. While Tibetan physicians generally used only Tibetan terminology when constructing patient charts, the biomedical doctors often utilized different language

87

Adams, Tibetan Theorizing, 2001 Adams and Li, Integration or Erasure, 2008

88

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systems based on classication: Chinese for strictly biomedical ailments and Tibetan when a biomedical/Tibetan equivalent existed. Thus, Tibetan was used whenever possible, even for ailments originating in biomedical epistemology that were only recently assigned Tibetan equivalents.89 Categorical Dissonance: Illness and Treatment Physicians also found comfort in having two categories of medicine come to the

same diagnostic conclusion. For example, employing both Tibetan and biomedical technologies in tumor detection, e.g. pulse analysis and MRIs, further legitimized the original diagnosis. This process provided an additional legitimizing effect for Tibetan physicians, who felt that biomedical conrmation of their techniques veried the scientic nature of Tibetan medical theory.90 Borrowing terminology resulted in shared ideas about disease etiology and treatment, leading both groups of physicians to assume they were looking at the same biological thing. Moreover, sharing of terminology resulted in "expansion" of Tibetan medicine; both groups of physicians believed biomedical knowledge offered a more complete picture of disease etiology.91 Knowledge generally moved from biomedicine to Tibetan medicine, (rarely was it the other way around) based on the presumption that knowledge from biomedicine was "improving" Tibetan medicine. Biomedical physicians argued they were not attempting to write over Tibetan

89

Adams, Tibetan Theorizing, 2001 Ibid. Ibid.

90

91

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epistemology, but simply offer objective, empirically based techniques for diagnosis and treatment that would elevate, not destroy, Tibetan medical theory.92 However, this matching process was often convoluted, especially in those instances

where matching disease to symptoms was difcult. Within the Tibetan model, for example, a set of symptoms could signal a wide array of possible causalities.93 Furthermore, some diseases in the biomedical tradition, like HIV, are not described in Tibetan traditional theory, leaving Tibetan physicians to locate humoral disruptions that came closest in describing the presented symptoms.94 While the previous paragraphs aim to demonstrate successes in co-naming, naming discrepancies amongst Tibetan and biomedical physicians illuminate the core differences in medical epistemology, subsequently problematizing treatment methods. Patients with diabetes, for example, presented similar symptoms to biomedical

doctors, were assigned the same category of disease, and placed on similar regiments of treatment. However, patients who worked with Tibetan physicians, often disgruntled by biomedicine's failure to properly treat their disease, encountered multiple categories of disease, all of which were reduced to the singular term termed "diabetes" in the biomedical traditions.95 Thus, Tibetan physicians might offer two "diabetic" patients very different treatment therapies based on the symptoms presented and their relation to the patients humoral composition.Tibetan physicians also noted biomedical physicians failed

92

Janes, Health Transition, 1999 Donden, Healing From The Source Ibid. Adams. Tibetan Theorizing, 2001

93

94

95

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to take into account social, environmental, and behavior factors that inuence disease, as detailed in the Gyu-Shi.96 The diseases Tibetan physicians categorized as disruption in rLung often proved

most problematic; because rLung lacked correspondence to biomedicines empirical data, biomedical physicians argued this religious disorder did not belong in the hospital. 97 China, in reforming education policy, namely prohibiting superstitious components, initiated a new generation of doctors who denied religious explanations not out of fear for political repercussion, but because they truly believed these explanations scientically irrelevant. These newly trained doctors were not just educated on state policy; they were being indoctrinated into Chinas national ideology. Recalling Kuhn, these policies that established prejudices against opposing systems

of medicine blinded physicians from seeing relevant information in a patients chart. Biomedical physicians often ignored Tibetan ndings, information that could have been utilized to ensure the greatest absorption of pharmaceuticals.98 However, cases where Tibetan doctors did not see relevant biomedical information often entailed consequences of greater severity. Tuberculosis, for example, was often handled symptomatically in Tibetan medicine, failing to address the infection that gave rise to the disease. Thus, though the patient found symptoms ameliorated, biomedical doctors were often frustrated when these patients became terminally ill because their Tibetan physicians failed to see the infectious cause.99 This further supported the widely held opinion amongst patients
96

Rinpoche, Tibetan Medicine Adams and Li, Integration or Erasure, 2008 Adams, Tibetan Theorizing, 2001 Janes, Health Transition, 1999

97

98

99

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that Tibetan medicine was useful in maintaining the body, but biomedicine was more successful in treating acute infections and diseases. I believe these situations where disagreements in diagnosis preclude effective,

timely treatment remain the greatest dangers to integration. All physicians, regardless of training, identied biomedicine as the most effective treatment course for acute, emergency ailments. Tibetan physicians agreed biomedicine eradicated symptoms more rapidly, however, they argued this treatment was supercial.100 Tibetan doctors, in their ignorance/disregard for biomedical ndings, diligently treated what they believed the source of disease with Tibetan therapies. It was often only when symptoms made physicians immediately aware of acute infections that they would prescribe both Tibetan and biomedical treatments, knowing the latter worked more effectively in this context.101 However, I believe the possible danger of ignoring biomedical treatments actually stems from assumptions generated through technological imperatives. It is only in knowing effective, biomedical treatments are available that makes their under-utilization so repugnant. Moreover, biomedical physicians placed value judgements on Tibetan

pharmaceuticals, arguing Tibetan medicines were of lower quality and weaker in relation to biomedicines therapies. 102 Here the arguments shifts from a question of judgement towards an ethical dilemma; now, treatment was an issue of morality, rendering it immoral to give precedence towards medicines known a priori to be weaker. Considering this argument fails to take into account competing ideas of curation, its logic is awed.
100

Adams, Sacred in Scientific, 2002 Adams, Tibetan Theorizing, 2001 Janes, Crossroads, 2001

101

102

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Examination of the Gyu-Shi reveals Tibetan medical epistemology aims to cure the root cause of disease and alleviate its symptoms, not serve as acute treatment or reverse malignancies (see chapter 1). If using biomedical logic to evaluate the efcacy of Tibetan medicine, then yes, Tibetan treatments fail to provide curation. However, standards of curative success detailed in Tibetan medical theory provide an alternative interpretation: Tibetan medicaments were nothing less than successful in producing their intended effects. Furthermore, Chinese state policies provided authority to biomedical doctors who

believed Tibetan medicines ineffective. Biomedical physicians, backed by Chinese ideology, gained hegemonic power over public representations of Tibetan medicine. This power allowed them to assume control over treatment methods, 103 resulting in overuse of IV antibiotics to preemptively cure most ailments 104. In turn, the large presence of antibiotic uids gave rise to Tibetan patients equating prevalence with efcacy. Biomedicines control over therapeutic technologies limited patients interaction with Tibetan treatment methods.105 Thus, I nd as Tibetan treatments faded into the background, their disappearance was mistaken for ineffectiveness. Despite biomedicines ideological power, many Tibetans cited hostile relationships

with biomedical doctors as encouragement to seek Traditional physicians. Patients noted biomedical doctors often chastised their inability to pay medical bills, ignorance of biomedical principles, etc.106 However, what drove patients to Tibetan physicians was not
103

Aside from policy that promote biomedicine, there were very little policies regulating standardization of practice. Used extensively by those whose work or personal insurance would pay for it.

104

Alex McKay. "Biomedicine in Tibet at the Edge of Modernity." Medicine Between Science and Religion: Explorations On Tibetan Grounds (2011): 33-56
105 106

Adams, and Li, Integration or Erasure, 2008

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just a personal preference for amicable relationships. The Gyu-Shi details Buddhist/ physician associations in describing the relationship between medical interactions and humoral dispositions. Religious medical theory holds the three Buddhist poisons generate humoral imbalances, materialized as physiological disturbances. The patient, in coming to the physician, arrives in an psychologically vulnerable state. Thus, the Gyu-Shi commanded physicians treat their patients with consideration; aggressive interactions would agitate patients humors, possibly causing further harm. Moreover, the Gyu-Shi notes pharmaceutical efcacy relied as much on it's compounds as it did the patient's state of mind. The simplest medicine, if provided by a caring physician, had better chance at treating the disorder than the any therapy offered by a hostile doctor.107 Traditional education reinforces this idea, training physicians to imagine

themselves as a Buddha lled with compassion. This is not to suggest Tibetan doctors believe only their medicinal system produces compassionate doctors. However, as Adams' piece details, traditional Tibetan physicians do not incorporate Buddhist principles into practice solely to ensure amicable interaction; practicing these principles gives rise to a still mind, necessary to provide the highest levels of care. Tibetan physicians note that although the attention devoted towards patient and practitioner's mental states is religious in origin, their somatization are empirically discoverable facts.108 They argue the documented efcacy of element-focused treatments (namely in regulating emotional and mental states) provides evidence for declaring Tibetan medical practices scientic (tshan rig.) Moreover, Traditional physicians express beliefs that present biomedical

107

Clifford, Tibetan Buddhist Medicine, 1984 Adams, Tibetan Theorizing, 2001

108

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misunderstandings of their medical science (Bod pa'i sman ne tshan rig) will wane over time, citing the lack of equivalent vocabularies precludes this process.109

The Financial Pressures of Tibetan Medicine Although biomedical arguments aimed at delegitimizing Tibetan medicine have

problematized Traditional therapies viability, it is important to consider Chinese economic policy, specically regulations concerning state medical subsidies and pharmaceutical production. When Mao proclaimed Tibet part of the Chinese state, he promised to provide Tibetans a socialist health care system that would make Tibetan medicine available to all, regardless of socioeconomic status: this move was as economically driven as it was politically strategic.110 Maos early Tibetan policy sought to gain Tibetan trust, believing a successful merger of Tibet and China required subjects willingly accept state ideology. Thus, in training public health physicians with rudimentary forms of Tibetan medicine, Maos aim was two fold: create a health-care system with low-over head costs and one that would culturally resonate with Tibetan citizens.111 Mao hoped Tibetans would see Chinas consideration of their cultural beliefs as a sign of respect, encouraging subjects to view Chinese policies as attempts to better the region, not destroy its people.
One such example, detailed in Terry Clifford's (1984) work on Tibetan psychiatry, concerns demons and their effect on the humors. Contemporary Traditional practitioners no longer view these demons as religious entities, they are but culturally understood metaphors for psychological distresses. Moreover, ailments understood today, such as epilepsy, strokes, etc., were not fully understood 1000 years ago when the Gyu-Shi was written, explaining their association with nefarious spirits who remained unseen. Tibetan physicians argue their system remains scientific, regardless of whether one claims religious or biological causation, as the original texts contained a systematic approach to diagnosis and treatment. Clifford explains biomedicine aided Traditional practitioners in understanding these bio-psychological disturbances more completely, but the Gyu-Shi treatment protocol remains the most important guide.
109 110

Janes, Transformations, 1995 Ibid.

111

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Moreover, China promised Tibetans the PRC simply wanted to help rebuild the

region, providing it an infrastructure that indigenous subjects would later take over when complete. Tibetans learned, however, this was not the case. Mao saw Tibet as an unblemished region, a large area of land perfectly suited for Chinese business expansion. Moreover, the Tibetan land possessed valuable minerals that China could protably mine.112 Furthermore, Mao envisioned a modern, globalized China that still retained its unique history. Over the years, the push towards modernization resulted in policies that prohibited inclusion of superstitious beliefs in Tibetan medicine. More importantly, economic reforms in the public health sector rendered Tibetan medicine nancially impractical. Changes in State policy directed government funding away from Tibetan

medicine and towards biomedical facilities, institutions China believe produced the modern forms of knowledge needed to make the State a global competitor.113 Part of these reforms entailed price designation for different treatment methods, encouraging facilities to promote the most protable treatment, i.e. biomedicine. Such changes proved especially problematic for poor, rural Tibetans. As detailed in the previous section, contemporary Tibetans often seek biomedical treatments rst given their perceived superior efcacy. However, Tibetan medicines, namely herbal compounds, were far less expensive to manufacture than corresponding biomedical treatments. Thus, impoverished Tibetans often sought out Tibetan physicians despite their desire for biomedical treatment.114 Even more, most of the poor Tibetans in these biomedical hospitals lacked
112

Goldstein, A Modern History of Tibet, 1999 Adams and Li, Integration or Erasure, 2008 Janes, Health Transition, 1999

113

114

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government insurance, frequently beseeching the facility for institutionally subsidized care. (These requests were usually denied, resulting in inadequate therapies.) As biomedical treatments grew more protable, the Chinese state increasingly

recommended facilities to focus on biomedical care. Institutions began implementing policies that pushed biomedical treatments onto physicians, regardless of ones training background.115 Unfortunately, this made Tibetan medicines survival progressively more difcult. Traditional therapies, already struggling to gain legitimacy in biomedically run hospitals, were often the facilitys rst budget cut. Even Tibetan therapies whose curative effects were found extremely effective were sidestepped in order to cut costs. This led to a decline in Tibetan therapeutic offerings, leaving those who specically sought out Tibetan medicines empty handed and frustrated.116 Tibetan medicines continued existence relied on Traditional physicians ability to

market therapies as both cost-effective and equally legitimate as biomedical cures. Tibetan staff engaged in a commercialization of their products, moving away from individually tailored prescriptions towards standardized, pre-determined compounds that resembled biomedical treatments.117 Traditional Tibetan medicines resistance to clinical testing complicated Tibetan physicians attempts at mimicking biomedical legitimacy. Traditional physicians, often out of frustration, chose to engage biomedical

practices. Subsequently, Tibetan doctors facing such nancial pressures were often compelled to reformulate their techniques in ways that complied with biomedical logic.
115

Adams, Tibetan Theorizing, 2001

Mona Schrempf. "Between Mantra and Syringe: Healing and Health-Seeking Behaviour in Contemporary Amdo." Medicine Between Science and Religion: Explorations On Tibetan Grounds 10 (2011): 157.
116

Sienna Craig,. "From empowerments to power calculations: Notes on efficacy, value, and method." Medicine Between Science and Religion: Explorations on Tibetan Grounds (2010): 215-244.
117

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However, while Tibetan remedies proved unprotable within the region, trans-national encounters with Tibetan medicine encouraged new international markets.118 Tibetan medicine's global marketability heavily inuenced China's push to

biomedically legitimize traditional therapies. The state's recognition of Chinese and Western desire for Tibetan pharmaceuticals, rooted in exoticized beliefs about traditional medicine119, initiated structural changes in pharmaceutical production and their standardization. Yet, global markets only remained viable so long as Tibetan therapeutics gained international legitimacy. Doing so required subjecting the traditional system's treatments to clinical trials underscored by biomedical standards. However, traditional theory, namely its idiosyncratic treatment plans, evaded biomedical trial procedures. 120 Therefore, China's policies, ridding traditional theory of religion and promoting biomedicine's ability to "elevate" its epistemology, ultimately sought an evolution in Tibetan medicine; this new imagined system entailed greater methods of standardization, thus enabling entrance into clinical trials. However, producing standardized pharmaceuticals entailed problems larger than

garnering global legitimacy. Tibetan physicians who wished to produce pharmaceuticals for global markets sought out production factories that had developed alongside Tibetan medical hospitals. No longer owned by their former institutions, the Chinese state seized these factories and implemented regulations regarding quality of material, biomedical

118

Ibid. Lopez, Prisoners of Shangri-la, 1999

119

Vincanne Adams, Suellen Miller, Sienna Craig, and Michael Varner. "The challenge of crosscultural clinical trials research: case report from the Tibetan autonomous region, People's Republic of China." Medical Anthropology Quarterly 19, no. 3 (2008): 267-289.
120

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legitimacy, etc.121 Moreover, these factories often hired Chinese businessmen to market Tibetan medicaments. These men were often ignorant of Tibetan medical theory, focuses on securing contracts between physician and factory. However, the competition generate through these practices gave rise to a never

before seen phenomenon; matters of intellectual property and knowledge production. Amongst Traditional Tibetan physicians, their discipline encouraged sharing of information, from diagnostic suggestions to effective pharmaceutical compounds, in order to improve the medicinal system as a whole. Yet, as nancial pressures encouraged Tibetan physicians to sell their compounds globally, this sharing of knowledge came to a halt. Tibetan doctors began patenting their specic formulations for common illness, each trying to patent their preparation before the other.122 In turn, this increased intra-Tibetan prices for Tibetan medicine; whereas before any physician could provide common prescriptions, Tibetans must now locate each formulas specic distributor. Pordie, Adams, and Li note that in almost every case Tibetans could not afford their own indigenous medicines; patented formulations were a luxury for the wealthy Chinese and their Western counterparts. However, dissonance within Chinese policy concerning Tibetan medicine

complicated this process. On the one hand, Maoist and post-Maoist Chinese thought aimed to preserve traditional aspects of Chinese history. Upon China's ofcial subjugation of the Tibetan Autonomous Region to Chinese policy, Tibetan medicine was specically selected as an artifact of Chinese history. The Chinese State declared

121

Adams and Li, Integration or Erasure, 2008

Laurent. Pordi "Hijacking intellectual property rights. Identities and social power in the Indian Himalayas." Tibetan Medicine in the Contemporary World. Global Politics of Medical Knowledge and Practice (2008): 132-159.
122

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Traditional Tibetan medicine was a derivation of Traditional Chinese Medicine, arguing their similarities indicated the need for preservation.123 Additionally, Tibetan medicines mythical history fueled Western imaginations,

increasing their desire for magical, precious pills. The international desire for these medicine that complicated Chinese views on the growing pharmaceutical market. The Gyu-Shi explains these medicines are ritually blessed, their components laid out in a mandala shape and then meditated upon by senior lamas. After spiritual leaders recite countless mantras over the medicines, the components are then compressed into pills while the physician meditates on images of the Medicine Buddha. 124 Thus, outsiders were willing to pay large amounts of money to secure these highly potent medicines. However, lamas were often unwilling to produce them, fearful of State punishment for reintroducing religion into Tibetan medicine.125 Therefore, China found itself at a crossroads: either continue banning all

superstitious aspects of Tibetan medicine in efforts to modernize it or allow Buddhism back into pharmaceutical manufacturing process for increased protability. Moreover, recent events in Tibet have made China nervous to permit practices strongly tied to Tibetan cultural identity. Since 2008, Tibetan uprisings have become increasingly violent, often resulting in China blocking travel in and out of the region. Moreover, Buddhist ideas are tied to the Dalai Lama, believed an incarnation of the important Vajrayanic Bodhisattva, Chenzrig, strictly outlawing images and worship of him . The Chinese State

123

Janes, Transformations, 1995 Clifford, Tibetan Buddhist Medicine, 1984 Janes, Crossroads, 2001

124

125

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identies him as a separatist, arguing he is responsible for the bloodshed and recent selfimmolations in Tibet. Thus, while Tibetan medical hospitals possess greater control over what ideas can

and cannot enter their halls, the pharmaceutical market and its global context prove much more difcult to regulate. Biomedical disregard for Tibetan therapies, particularly those Buddhist in origin: 1) conforms to Chinese policy and 2) provides greater protability to institutions within Tibet. However, precious pills force the state into a situation where it must choose which competing ideology to support, revealing the States priority in the matter. In this case, China chose to make room for Buddhist ideology, placing import on economic success. However, we must be careful not to interpret this as leniency for Tibetan

Buddhism. Theoretically, China believes preventing another cultural uprising more important than economic success. Moreover, they recognize creating these spaces where Buddhism may permeate back into the culture remains politically dangerous. Why, then, did they choose economic success? Simple: its less difcult to violently suppress Tibetans than it is to encounter another equally lucrative and easily seizable market.

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CONCLUSION
Tibetan medicine's ontology remains in a constant state of ux. Ambiguity

pervades the eld of practice; debates about diagnostic ambiguities are presented as intellectual conversations. However, whatever resulting changes in practice, whomever won the debate, it would all be incidental: mere actors for a charade of discourse. This debate was was over before it started; only biomedicine could win. State policies effectively make practicing Traditional Tibetan medicine near impossible. Discussing standards of the scientic did not matter. Chinese funding of biomedical programs, supporting Western ideas of pharmaceutical standardization: these made very clear what the scientic discipline was. It was the one that got the money. It was the one that provided China with international prestige. Biomedicine teased Tibetan Medicine into believing it stood a chance at all. Tibetan physicians, rushing to patent their idiosyncratic pharmaceuticals, failed to see or simply ignored the oxymoron in this line. Tibetan medicine's pharmacopeia was a testament to its reverence for a plurality

of prescriptions. Moreover, these were but masterpieces doctors could build upon by accounting for the inuence of environment, climate, and social realities on both disease etiology and treatments efcacies. Each patient was a different narrative of health: a pulse that felt thin, rolling over the rst nger gentler than the third. These abstract descriptions are, too, nothing but guidelines at which to start medicine. It was only through years of empirical training that one could feel these subtle beats. Training often resembled meditation. One is present with their thoughts, watching their breath, and learning how

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to feel so that they may see. Ostension provided countless examples of what a thin pulse should look like. Moreover, teaching provides examples of these abstract labels so that the physician may group experiences of feeling into categories of knowledge. Feeling the pulse of another acknowledges not only their subjectivity, but very much your own. You must silent your body rst; keeping the ngertips quiet and their sensations arrested, one may feel the science only made possible through touching another. So, yes, I believe Tibetan medicine cannot exist without it idiosyncrasies, often

providing names for diseases when other disciplines were simply inconclusive. Therefore, I offer a denition of 'pharmaceuticals' guided by Tibetan medicine's importance of personal subjectivity within the eld. The term pharmaceuticals, as used in China, signaled both standardization and objectication of the patient. The patient was viewed objectively, treatments tailored towards his/her disease category rather than individual reality. Biomedicine, however, knows this is not the case. Patients present the same symptoms and thus, garner the same diagnosis and treatment. However, what happens when only one returns cured? What went wrong? According to Tibetan Medical theory, this is precisely the problem with standardized pharmaceuticals. It's not that the biomedical doctor should've assigned a difference treatment. It's beyond that. It's beyond diagnosis, too. Hell, it didn't even matter if he got the symptoms right. He failed because these patients were no longer subjects with individual needs but objects, things that required no creativity in repair. I had hoped Tibetan Medicine would avoid avoid this fate. I've dedicated this

thesis to condemning China's Tibetan policies, to restoring the title science back to Tibetan medicine, and to revealing the political implications of relationships between

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science and government. Things like, how the State policy slowly edged out Tibetan medicine when placed alongside biomedicine, or how it made Tibetan pharmaceuticals too expensive for the its own indigenous grandchildren, or how you answered the question, "Where do I go when I hurt?" knowing some remembered names for your present pains were titles that are now forbidden. I had hoped that in light of this, in knowing all of these atrocities, it would be impossible not to feel something was lost and that this was China's fault. I had hoped Tibetan medicine would've rebelled, someone openly discussing Buddhist meditation as treatment when State Health ofcials were in town. I had hoped that Tibetan Medicine would win it all.

But it didn't. I sometimes forget that Tibetan doctors are not just physicians but individuals as

well (at times playing patient themself.) They need to eat and a place to sleep. They need a job they can keep. So they sell a patent of priceless knowledge for amounts that made even the gods lament their loss; a loss of money / a loss of art. Tibetan patients entered hospitals and could not help but notice the I.V. bags, the EKG's, the rows and rows of remedies stacked inside the pharmacies. Tibetan medicine did not easily t into this business model, it's ghost now hanging around the halls. You would read about in a patient's chart, and even hear it in their pleas, but you never saw it on the wall lled with 'real' degrees. Patients chose the Western medication because their friends told them it worked quickly. They chose it because their insurance paid for it it. They chose it because it's all they could nd.

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However, I said they didn't win it all, not that they lost completely. Tibetan

medicine proved to be an interesting case study in competing political ideologies. For example, why did China continue to employ lama-physicians, those who maintained Tibetan Medicine was rooted in Buddhism? Why did they allow lamas to begin reciting mantras over pills again, changing mantas while the people who watched outside could not pray in their own homes? Why did China afford Tibetan physicians an open space of transgression, hospitals where Buddhist principles slipped in at times without incurring immediate punishment. One thing is for sure; China wasn't doing it as a favor. I argue that the Chinese government deliberately supported modern, biomedical

policies that inadvertently resulted in Tibetans forming new understandings of their body. I believe the removal of Buddhism from Traditional theory was larger than just promoting modernization. I believe the discrepancies in state funding of biomedicine over Tibetan medicine are bigger than problems of scientic legitimization. The Tibetan body is ultimately a social one. Moreover, karmic principles found within the Gyu-Shi depict a body that at once houses both self and other. Therefore, removing these principles from Tibetan practices robs it its power to serve as a plot for suffering. (Though this project lacks the literature necessary to argue this point, I nd it a compelling project for future research.) Furthermore, what I nd most disconcerting is biomedicine's collapsing of the

mind and body into one unit. Interviews with the Tibetan laity concerning their protests against the Chinese state demonstrate their willingness to sacrice their body for the greater good. Believing their consciousness does not end with the body, they nd even death cannot annihilate the Tibetan cause. Moreover, I believe the recent self-

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immolations in Tibet demonstrate the intersection between karma, society, and body. In the rest of the world, we often nd those who employ suicide as a means of protest use their death to inict harm on both themselves and other. Tibetan self-immolations, however, aim only to injure the self. I believe this is partly due to their conception of reincarnation, namely that their suicide is only the death of a body, not of consciousness. Contrast this with suicide bombers who, I believe, aim for such devastating effects because they believe this life their only chance at making a difference. Still, what I nd most interesting is how karmic beliefs directed political suicide

inwardly. I believe it is because Tibetans understand the self as instantiation of the other, they use their death to create awareness, not cause harm. In fact, using suicide to injure another would reject the very same principles they aim to protect. Therefore, selfimmolating in response to Tibet's current political situation is a call for attention. Attention to the fact that they would rather sacrice their life than continue living under Chinese rule. Attention to their continuing commitment to Buddhism. And attention to their belief that despite the torture and no matter the body count, China can never fully eradicate the Tibetan nation.

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