Janet Gyatso (2015) Being Human in a Buddhist World: An Intellectual History of Medicine in Early Modern Tibet, New York: Columbia University Press, 519 pp.

One of the topics discussed in this brand new book is the coexistence of Buddhist tantric and Tibetan medical knowledge. Janet Gyatso explains that for Tibetan Buddhists, access to the internal anatomy of the body was perhaps never a problem. The practice of dismembering corpses to feed them to vultures, for instance, is an old one, and the analysis of corpses from a medical perspective was already well established in India. Tibetans, too, are known to have dissected corpses in order to learn from first hand experience. Gyatso (p. 193) reports the case of Darmo Menrampa Losang Chödrag, who was very active in the field of medicine. He studied Tibetan texts, wrote medical treatises, taught at one of the medical schools, and he was allowed to perform an operation on the fifth Dalai Lama. In 1670 he gathered his students together and dissected in a park in Lhasa the corpses of four male, female, old, and young Tibetans. He found 365 bones in the body, 5 more than the accepted number in medical literature.

In this particular case, and also when it came to the problem of diverging descriptions of the inner channels of the human body in medical and tantric literature, Darmo Menrampa didn’t react like the Hindu reformer Dayananda Sarasvati (1824-83), who tore up his manual of hathayoga after dissecting a corpse and failing to find the cakras (Gyatso, p. 205). Instead, Darmo Menrampa made efforts to reconcile the tantric system and the four kinds of channels in medical literature (p. 272).

As Janet Gyatso describes in her book, we find in the Tibetan literature attempts to explain the actual nature of the channels in various ways. There are for instance those who try to identify aspects of tantric anatomy with “actual” anatomy. Others, however, recognise tantric anatomy as a unique system outside of, or apart from, “actual” anatomy. Among those who discussed the nature of tantric anatomy, some were assuming a fine or subtle kind of materiality, while others, such as some medical theorists, rather assumed a conventional material existence of the tantric channels.

In short, there are two basic approaches. One is to posit a tantric anatomy that is of an essentially different order than ordinary anatomy; the other is an attempt to reconcile the two systems in some way. The first strategy that posits tantric anatomy as an essentially different order allows to uphold various views about the tantric body (i.e. the vajra body) that in such an approach does not need to be reconciled with the anatomy of the ordinary body (tha mal kyi lus). Things that are of different orders do not necessarily need to be in total agreement. The second strategy that tries to reconcile the two systems proves to be difficult to accomplish, as it has to explain many inconsistencies between the systems.

The situation is further complicated, explains Gyatso (p. 208 f.), by the fact that there also exists a “medical body” (gso ba’i lus), i.e. the body that is to be healed by medical practise. All three bodies — the tantric, the ordinary, and the medical one — certainly have some overlap. A medical practitioner, for instance, would make a bad impression if he would try to bleed a vein as described in medical literature, when his instruments can’t hit on an actual blood vessel of the body. But there are also differences, as pointed out by those who warn that the identification of the tantric central channel with an actual material channel of the ordinary body could lead to insanity if yogic practise is attempted based on such an ordinary channel.

Among those exegetes who juxtapose the Buddhist tantric materials with the medical, we find the strategy to assume that medical literature only explains the overt channels, while tantric literature is able to provide a more detailed picture. Such a view of the superiority of the tantric system was expressed by Kyempa Tsewang (sKyem-pa Tshe-dbang, see Gyatso, p. 213 ff.), who preceded the commentator of the Single Intention, the Drikungpa Rigdzin Chökyi Dragpa (1595-1659) by perhaps a bit more than a century. Rigdzin Chökyi Dragpa was, as is well known, himself a tantric yogi and author of treatises in the medical tradition of the Drikungpas. He might have had in mind writers like Kyempa Tsewang when he commented on a vajra statement of Jigten Sumgön that juxtaposes tantric and medical analysis in a surprising and somewhat more nuanced way.

In general, the vajra statements found in the Single Intention are already in the earliest versions of the text contrasted with views held by others that need to be corrected, or sometimes even refuted. In the case of the present topic, the general view is explained to be that the Buddha taught the cause of the body, the basis of its abiding, and the conditions of its final disintegration in the most profound manner in the Mantra Vajrayana, since the nature of the body’s qualities and defects arises through the dependent origination of winds and channels. Thus it is assumed that the way how things really are in the body, and the functions of winds and channels, are profound only as taught in the Mantra Vajrayana.

In contrast to such a general view, Kyobpa Jigten Sumgön teaches that (5.13) “medicine teaches some ways how things are and some functions more profoundly.” This vajra statement is actually ascribed by the early commentator Rinchen Jangchub (fl. mid 13th c.) to “Je Drogön” (i.e. Phagmodrupa, 1110-1170), who, “having seen one [copy of Vagbhata’s] Ashtangahrdaya[samhita] said ‘this is very profound’ and expressed his joy.” The Ashtanga was, as Janet Gyatso (p. 107) states, influential in Tibet and the last great Indian medical work translated (by Rinchen Zangpo). Phagmodrupa might have known it through his studies in Sakya, where the medical academy specialised in the system of this work (Gyatso p. 112). According to Rigdzin Chökyi Dragpa, this treatise states that first, during the body formation (lus chags pa’i dus), the four types of diseases occur respectively in dependence on whichever mental affliction predominates. By differentiating each type of disease further, each of them turns into a hundred diseases. Each of these particular diseases must be treated through different individual remedies.

With regard to medical treatments, Rigdzin Chökyi Dragpa states that he himself has seen how such diseases are treated by doctors who understand how the ultimate nature of channels, winds and vital essences of that body really are (and we can safely assume that he himself has also been both a tantric yogi and a medical expert). Therefore, he concludes, “I think that [medical knowledge] is very profound!” As an example for the profoundness of medical treatises, he quotes the following lines of the Ashtanga:

Since the sickness of completely all the desires and so forth
is intertwined with the [mental] continuum, it pervades the constituents of the body.

In addition to these remarks, Rigdzin Chökyi Dragpa recalls an earlier incident where a great practitioner with profound insights perceived in the back of one man a creature that had the size of a sinew (chu rgyus). He reported this to a doctor, who then removed the sickness by applying moxibustion to the upper, middle and lower part of the body of the creature hidden in the back of the man, thereby proving the great profoundness of medical treatments.

Furthermore, Rigdzin Chökyi Dragpa continues, a doctor ascertains how the rough and subtle channels of the body, the primary and secondary winds that move in them, etc., and the vital essences that are emitted and not emitted, are, and he identifies by questioning, looking, and touching, the diseases that develop from wind, bile, phlegm, combinations of these, and from heat, and cold. (This refers to the seven groups of diseases arising from wind, bile, and phlegm, as well as from combinations of two or three of them.)

Rigdzin Chökyi Dragpa moreover points out that a doctor bestows life (‘tsho ba’i srog ster ba) by getting to the heart of the matter through four things, namely medical treatment, investigation (of outer appearance), dietetics, and conduct regulations (sman dpyad zas bcos bzhis) that are fitting to the disease.^{♦ 1} Finally, he argues that these medical practises (lag len) have the benefit of others in mind, and that they have been well elucidated and explained by saintly authors and commentators who have well comprehended the vital points of the Sugata’s instructions, yet the same depth and clarity cannot be found in the presentations of the tantras of Buddha Vajradhara.

This latter point, namely that the same clarity of presentation cannot be found in the tantras, is actually interesting in the context of the immediately preceding vajra statement in the Single Intention, which says: (5.12) “He maintained that some [aspects of] the natural state were hidden by Vajradhara.” Another early commentator of the Single Intention, Dorje Sherab, explains that the tantras were intentionally “brought into disorder (dkrugs),” so that, as Rigdzin Chökyi Dragpa states, people are prevented from attempting to enter the mandala and trainings without the proper guidance by an authentic master who is endowed with authentic lineage, pith instructions, and reading transmissions.

In the light of these words we might understand vajra statement 5.13, “medicine teaches some ways how things are and some functions more profoundly” to mean that the medical literature teaches the profound aspects of channels etc. not only more clearly, but also more openly than the tantras.

In sum, if we dare to make a conclusion based only on these bits of information that we find in the Single Intention and its commentaries, the Drikungpas do not seem to have chosen the approach of viewing the medical channels as essentially different from the tantric channels. As far as these brief statements of the eminent medical and yogic expert of the Drikungpas, Rigdzin Chökyi Dragpa, allow us to make a judgement, they rather seem to take the channels of both systems — the medical and the tantric — to be basically identical, and in cases of doubt, the descriptions in medical literature may be preferred, since they are — with regard to anatomical details — more profound ( / clear / openly taught) than the descriptions in the tantras.

The medical system of the Drikungpas, and in fact Tibetan medicine as such, certainly needs much more and much deeper exploration, especially its many important and interesting relations to the tantric tradition, and vice versa. I am sure that Jane Gyatso’s book, which offers much more than the single topic I have discussed here, will prove to be an essential step forward.²

Notes
^{1. [I understand “sman dpyad zas bcos bzhi” to be (1) medical treatment (sbyor ba sman), (2) investigation (of outer appearance, cha byad dpyad), (3) dietetics (‘tsho ba zas), and (4) conduct regulations (bya ba spyod lam bcas).]↩}