Introduction Tibetan Medicine, Buddhism, and the Visual Arts Perseverant Nurturing Bodies in Balance invites readers to explore the complex and Rigpa's foundational work, the Four Tantras (Gyushi), and and continuously evolving discipline. Our focus is on visual Tibetan medicine's most basic principles, such as that of expressions of Sowa Rigpa (Gsa ba rig pa). Tibetan for the three nyepa, often translated as the three "humors" of "science" or "art" of healing. Through discussions of this wind, bile, and phlegm. Through accounts of her work with system's aesthetic, intellectual, and experiential dimensions, contemporary Tibetan medical doctors in India, we learn how we explore how art, medicine, and Buddhism converge in a medical consultation unfolds. What does the art of healing learning and practicing Tibetan medicine. In doing so, we involve with regard to Tibetan medical diagnosis and therapy? hope to offer readers a multifacited and beautiful way to In chapter 2, Geoffrey Samuel's essay delves into Tibetan access this tradition, drawing out the themes explored in the medical and Tibetan Buddhist ideas of body and mind. Unlike associated exhibition at the Rubin Museum of Art in New in Europe, where a Cartesian model still holds sway over York and subsequent venues. 1 For those who begin their medical and philosophical discourse, in which body and mind journey with this work, and for those already familiar with are understood to be essentially separate entities, in Tibetan the subject, this book provides a variety of perspectives from traditions we find that body, speech, and mind are seen as which to engage with Tibetan medicine. three aspects of human existence, not rigidly dichotomized . Just as Tibetan pharmaceuticals themselves are made of Samuel demonstrates this through discussion of Tantric ingredients that have traveled long distances, crossed many Buddhism and Tibetan imaginative maps and charts of the borders, and were compounded according to different tradi- human body's inner and outer cosmologies. tions, so the contributors to this volume come together from many different theoretical and geographical backgrounds. In chapter 3, I offer an introduction to Tibetan pharmacology and medical formulas, which are the most widely They include scholars in Tibetan and Buddhist studies, used Tibetan medical treatment, along with dietary and anthropology, art history, literature, and two practioners behavioral adjustments and external therapies (FIG. 0.1 ). and scholars of Tibetan medicine. Their essays represent One foundational principle is that the five elements that the culmination of years spent gathering knowledge and form body and mind are of one and the same essential experience and collaborating across disciplinary and political quality as those found in the environment and in disease. borders. And so, this publication embodies one of Tibetan Pharmacologists and doctors therefore sought to counteract medicine's most important attributes- its rich and harmoni- and balance diseases in the body-mind with those of ous polyphony. Tibetan medicine's remarkable powers of opposite elemental qualities in plant, mineral, and animal sub- adaptation from ancient to current times are more important stances . I outline how such materia medica are compounded than ever, as we find ourselves amid rapid ecological and in one Tibetan monastery pharmacy and in one European socio-political change. company, exploring adaptations of Tibetan medicine's empiri- Part I of the work offers an introduction to the core theo- Precious Substances from Jam pal Dorje's Beautiful Marvelous Eye Ornament. Mongolia; 19th century. Part II, folio 6 verso & 7 recto. Reprinted in Satapitaka Series (Vol. 82), New Delhi, International Academy of Indian Culture, 1971. Tibetan Buddhist Resource Center. W30452 In chapter 1, Barbara Gerke introduces readers to Sowa fascinating world of Tibetan medicine, a highly learned cal and scientific principles to contemporary requirements. ries and ideas in Tibetan medicine and related pharmacologi- Pasang Yontan Arya then describes in chapter 4 the applica- cal and astrological practice. It addresses the contemporary tion of a wide range of external therapies in Tibetan medicine role of Tibetan medicine in health care and the dynamic and gives us the first preliminary account of the history of ways in which practitioners and patients have reinterpreted what is known as Tibetan "spoon" surgery. We learn how this highly abstract and theoretical corpus around the world . external applications are in part rooted in texts such as the It highlights the potential of Tibetan medical ideas and sub- Four Tantras, cultural exchanges along the Silk Road, and per- stances as resources for healing, at the same time addressing sonal experience. Given Arya's scholarly and practical work frictions that arise when Tibetan medical practitioners, and as a Tibetan medical doctor in India and more recently in their ideas and medicines, encounter other cultures and other Europe, he is able to demonstrate how early knowledge such medical systems. as that of nineteen moxibustion points on a ninth-century Authors of the essays in this section explore how clinical, illustration (see FIG. 4.1) are still known under the very same dietary, and Buddhist practices come to be learned and terms and in use today. Chapter 5 by Ron it Yoeli-Tialim is on practiced in contemporary Tibetan medical contexts. They basic principles of Tibetan astrology and divination and their seek to understand how medical ideas grounded in common role in relation to the practice of Sowa Rigpa. The adjoining textual frameworks are adapted and practiced across such vignette by Inger Vasstveit introduces us to the work of varying geographical, medical, and legal settings as Milan, astrologists at the Dharamsala Medicine and Astrology Lhasa, Xining, northern India, New York, and Switzerland. Institute and to lay exile Tibetans' use of the protective 3 0.1 Tree of Treatment. Corresponding to Plate 4 of the Tibetan medical paintings (Lhasa set). Tibet or Mongolia; 17th century. Pigments on cloth; 68.5 x 78.5 em. Pritzker Collection, Chicago devices and amulets they produce. Developing this theme concepts are commonly found in Tibetan medical thought: of the geographical movement of Tibetan heritage further, medicines always have at least three ingredients; the three Sienna Craig considers in chapter 6 the many new realities in forces of the nyepa pervade the body-mind; and there are which Tibetan medicine is now practiced around the globe. three mental poisons (desire, hatred, and delusion) that, She tells several compelling stories of what happens when according to the Buddha's teachings, form the root of human Americans learn to become amchi (Tibetan medical doctors), suffering. The linearity and segregation that informs much of Buddhism and Sowa Rigpa meet capitalist market logic, and European thought is at odds with what we have attempted knowledgable doctors foster the best possible outcomes for here: understanding a range of simultaneously existing and their patients' well-being. integrated phenomena, to better appreciate the interrelated Part II examines historical and art historical perspectives on Tibetan medicine, appraising its development in relation aspects of the human body and mind in health and illness. Gyurme Dorje expounds in chapter 7 on the artistic rep- to Buddhism and the visual arts. Together with medicine, resentations and the role of the Medicine Buddha in Tibetan Buddhism and arts and crafts are important fields of medical practice and Buddhist rituals. Adding to the earlier knowledge among Tibet's ten Buddhist arts and sciences. introduction of the structure and the contents of the Four Their triangular relationship is the main focus here. Three-fold Tantras in chapter 1, Yang Ga's essay offers a path-breaking 4 BODIES IN BALANCE investigation into the sources for this early medical text with Knud Larsen, I provide detailed discussion and in chapter 8. He traces influences from Indian, Chinese, architectural plans alongside drawings and photographs. Greco-Arabie, and indigenous Tibetan and Himalayan This contribution is offered in hopes of inspiring a possible medical traditions in early medical works. These were reconstruction of Chagpori Medical College in its original brought into a Buddhist framework by its author, Yuthog location, where it was destroyed in 1959 by the Chinese Yonten Gonpo, who was a prolific lay scholar of the twelfth People's Liberation Army. While the original Mentsikhang century. We can understand this text as an important building fortunately survived, it is potentially at risk as we template for the kind of cosmopolitan and complex medical witness ongoing and dramatic destruction of the historical system that Sowa Rigpa would continue to be. How Buddhist houses of old Lhasa. Each house tells its own story- of and medical scholars then transmitted this and other texts families, offices, temples, crafts, schools, and, in this case, and developed the various traditions is discussed by Frances the education in the art of healing throughout the twentieth Garrett in chapter 9. century- collectively connecting contemporary Tibetans Casting new light on the stunning set of seventy-nine medical paintings from seventeenth-century Lhasa (FIG. 0.2). chapter 10 by Janet Gyatso explores some of their intricate details to understand what they might tell us about the and national and international scholars to the riches of Tibet's history. The authors of this book all engage with the texts, medicines, practices, ideas, and symbols related to Tibetan relationship of medical and Buddhist ideas and practices medicine and culture on a day-to-day basis. In Bodies in at the time of their creation. Could it be that the medical Balance they have sought to engage and inspire both general authors and illustrators of the set challenged the Buddha's and specialist readers. In addition to bringing together the authority over the science of healing? In the adjoining essays of scholars from distant places, we also present vignette, Katharina Sabernig explores the didactic values of photographs of most objects in the exhibition, hailing from the so-called medical trees found on Plates 2, 3, and 4 of the more than twenty institutional and private lenders in, among same set of medical paintings, which illustrate three chapters other places, Mongolia, India, Nepal, San Francisco, Paris, of the Four Tantras. She explains that in the monastic medical and London, and dating from the ninth to the twenty-first college of Labrang in eastern Tibet, many medical trees have century. Among the medical paintings, drawings, murals, been reproduced as murals, explicating more chapters of the and sculptures, for instance, we show the earliest known Four Tantras using this device. This facilitated medical study Tibetan depiction of the Medicine Buddha on a silk painting, and the memorization of the first two volumes of the Four from 835 CE (FIG. 7.7) . The book furthermore shows images Tantras. of medical instruments, such as those that were used in In chapter 11, we again turn to the delicate details of surgery and medical compounding (pp. 76-83); and we medical illustration- this time marveling at small materia include selected manuscripts, printed texts, and illustrated medica depictions in block-printed Tibetan texts and manu- works as examples of the vast textual corpus of this tradi- scripts. How did this genre develop over time? Could the tion. We include photographs of objects that could not changes that we see in the classification and identification be included in the exhibition or where photographs of the of materia medica be interpreted as yet another example of original object could not be reproduced. The object images how Tibetan medical traditions vividly responded to new are complemented by photographs of twentieth- and twenty- ecological environments and practitioners' encounters first-century Tibetan medical practice taken in the field by with new technologies and novel scientific traditions? How authors and recognized photographers. Taken together, the medical knowledge is adapted in the process of cultural and images and the essays are intended to give readers a sense scientific encounters is also vital to Martin Saxer's discussion of how Tibetan medical practitioners, past and present, con- in chapter 12. Here we follow three generations of Tibetan tinue to apply this ancient and fluid medical tradition, which medical doctors, some also trained in biomedicine, from an offers some of the most diverse and intriguing understand- influential Buryatian family on their journeys westward, from ings of human illness and well-being. the Buryatian steppes via Russia to Western Europe, bringing The three core themes of Bodies in Balance are the with them Tibetan medical ideas, recipe books, and medical practice of the Tibetan art and science of healing, its relation techniques. to Buddhism, and its visual expressions through the arts Bodies in Balance ends with a vignette on the architecture and crafts. These themes can also be seen as three ways of two important Tibetan medical institutes in Lhasa, the of reading the book, or three ways to engage with Tibetan Chagpori Medical College and the Mentsikhang. Together medicine. HOFER : INTRODUCTION 5 6 BODIES IN BALANCE Sowa Rigpa as a Science and a Practical Art conventiona l pharmacies in Switzerland and Austria and Sowa Rigpa can be translated as the "science of healing" or are used by the growing middle classes in China and India. the "art of healing ." In the thirteenth century the famous Tibetan medicines and therapies still remain a crucia l health scholar and religious leader Sakya Pandita codified it as one resource for marginalized communities in Nepal and the of Tibet's ten Buddhist arts and sciences, largely in line with Indian Himalayas and, to some extent, in Tibetan areas of India's longstanding vidyasthana (sciences/scientific fields) China. In the United States and in other affluent countries classification 2 The ten arts and sciences consist of five major with a high prevalence of chronic diseases, patients and and five minor fields, with the former including the Dharma, public health officials take ever greater interest in what or Buddhist teachings (the inner science). epistemology and comp lementary and alternative medicines (CAM) have to logic, grammar, medicine (i.e., Sowa Rigpa), and the arts and offer. Th e holistic approaches to an individual's health and crafts. 3 At the time, no fundamental distinction was made disease that characterize Tibetan medicine are of particular between religious and scientific knowledge 4 appea l in the West. It is th is adaptability and openness to Over the following centuries, Sowa Rigpa continued to dialogue and change, without the loss of its own scientific develop within predominantly Buddhist milieus in Tibet, the and empirica l grounds, that constitute Sowa Rigpa's most surround in g Himalayan regions, and Mongolia and Buryatia , significant attributes. enabling a fruitful cross-pol lination of ideas and practices among medical and religious (Buddhist) practitioners . Yet Medicine and Buddhism medical scholars began diverging in significant ways from When we are well we may give little attention to our bodies Buddhist doctrines long ago, as writings and medical and our health. But if one day we are struck by illness or illustrations reveal . This development is explored in chapter 2 injury, we begin to appreciate how much health really means on the body and mind in Tib etan medicine and Tibetan to us, that its va lue exceeds alm ost everything else in this Buddhism, chapter 8 on the human authorship of the Four world. We are thankful for even the slightest step toward Tantras, chapter 9 on the contingent relationship between recovery and being back to "norma l, " and for all the kindness, medical and Buddhist scholars in the twelfth to seventeenth support, and medical ski ll we encounter on the way. century, and chapter 10 on Buddhist practices and idea ls 0.2 Similes of the Human Body. Plate 6 of the Tibetan medical paintings (Ulan Ude set) . Lhasa, central Tibet; early 20th century. Pigments on cloth; 86 x 68 em. National Museum of the Republic of Buryatia, Ulan Ude. Photograph courtesy of Serindia That life comes with sickness and suffering was declared in the Lhasa Tibetan medical painting set from the late sev- by the Buddha as the first noble truth more than 2,500 enteenth century. In Part I we see how such dynamics play years ago in northern India . In his first discourse after his out in recent times . In the process of cu ltural and medical en lightenment he set out the kinds of suffering that we all exchange- which may include, for instance, demands must live through: birth, aging, sickness, death, sorrow, for a simultaneous adherence to religious and empirica l grief, association with what is unpleasant, separation from understandings- creative and new approaches to healing what is pleasant, and not to get what we want- in short, al l develop. The question of how newly combined theories and phenomena associated with the five aggregates of existence. research methods are developed through personal, cu ltural, These refer to the physical aspect of the "body" and four national, and economic exchanges is a field of research that aspects of the "mind ." He then offered the remaining three has spurred significant scho larship in anthropo logy, science, noble truths - the cause of suffering being attachment to and technology studies. 5 the five aggregates and ignorance about their impermanent Sowa Rigpa has never been a purely loca l phenomenon. nature, the cessation of suffering occurring when we let go Nor was it a system stuck in its traditional ways until some of attachment to the aggregates t hrough wisdom and insight, time in the early twentieth century, when it was propelled and the way that leads out of al l suffering: the noble eightfold to adapt to modern concepts that, some say, caused an path. The eightfo ld path is essentially a step-by-step training irreversible loss of its authenticity. On the contrary, Sowa of body, mind, and speech, during which one cultivates an Rigpa encompasses a vast body of knowledge, practice, ethica l way of life, mindfulness, insight, and compassion. and experience that is wel l rooted in its own scientific prin- Its components were intended to offer a practica l remedy ciples, eth ica l requirements, and worldwide connections- to ever-present suffering and delus ion. Despite differences all features we tend to assoc iate w ith modern Western in interpretation, this path is considered the foundation for biomedicine. Buddhist practice around the globe. Today, Tib etan drugs can be ordered via the Internet in Th e context of these early Buddhist teachings and their New York and sent from Tibet directly to friends and family focus on bodily suffering fostered Buddhists' particular members in the diaspora. They are sold over the counter in interest in medicine and healing and ca ll ed for the develop- HOFER: INTRODUCTION 7 ment of compassion toward all suffering sentient beings. his monks and nuns to have enough medical knowledge to The Buddha's teachings and their goal of liberation from tend to themselves and fellow clergy - did not actually allow suffering, or nirvana, became closely associated with notions the practice of medicine on the laity or in return for material of medicine and ultimate healing. Hence we find in the Pali gains. 12 Later commentaries to the earliest versions of the canon, an early record of the Buddha's discourses that these Vinaya mention exceptions, however. 13 That Buddhist monks teachings are referred to as "supreme medicine" and the and nuns did indeed- if in subsequent centuries- care for Buddha himself as "incomparable physician." 6 the laity and others is evidenced in archaeological findings from India and Sri Lanka, as well as in the social history and MEDICINE AND THE EARLY BUDDHIST SANGHA In the practice of Tibetan medicine today. 14 Buddhist Pali canon we also find several chapters that discuss medicine. These are mostly found in the monastic TRANSMISSION OF INDIAN BUDDHISM AND MEDICINE rules part of the work, referred to as Vinaya, which is one TO TIBET From the eighth century onward, together with of three parts, or the so-called three baskets, of the Pali the Mahayana form of Buddhism, many elements of South canon 7 In the Nissiggiya section of the work, which deals Asian civilization were carried across the Himalayas to the with confession of offences to monastic rules, we find that Tibetan Plateau . With texts in their bags and equipped with after having been consulted by a group of sick monks, the experiential knowledge and techniques, Indian scholars, or Buddha is said to have allowed the otherwise possession less pandits, arrived in Tibet. At the same time Tibetans went monks and nuns to carry with them for up to seven days five to Nepal and India to study Buddhism and associated medicines (bhesajjani): clarified butter (ghee). fresh butter, medical ideas and techniques. We know for certain that in oil, honey, and molasses or sugar8 In the same section of the the eleventh century the first concerted efforts were made Vinaya, but regarding rules on permissible foods and their to translate the Indian text Heart of Medicine by Vagbata, offences, we find seven additional groups of materia medica theA$tarigahrdavasamhita, into Tibetan, although it is items that the Buddha specifically allowed sick monks and likely that Indian medical knowledge spread in Tibet long nuns to take before sunrise and after midday, that is, apart before this time through Sanskrit materials and through oral from their ordinary mealtime, which is the only time they transmission. This work exerted great influence on practicing were allowed to consume solid foods B These materia medica physicians in Tibet, who complemented it with indigenous include five types of animal fats, medicinal roots (including knowledge, especially with locally available materia medica. turmeric and ginger), extracts from four kinds of trees (for instance, neem and Indian beech), leaves of five plants In addition, some Tibetan physicians had access to the knowledge of practitioners of diverse medical traditions (for example, the tulsi plant), seven different kinds of fruits from other neighboring regions- such as China, Central (including those of the three myrobalan trees), at least two Asia, and Persia- who had come to Tibet over the preceding kinds of resins, and five kinds of medicinal salts (including centuries through royal intermarriages, trade, and other kinds ocean, rock, and black salt) W Many of these items are still of exchanges and donations. Although legends throughout used medicinally in Ayurveda, the classical Indian system of Tibetan medical histories refer to several regional medical medicine, and in Tibetan Sowa Rigpa. conferences in Tibet, the medical texts that might have been Based on a study of the earliest Buddhist texts in the Pali employed and discussed at those conferences are now language and a comparison of its medicine-related chapters lost, and only later editions of some of them are available for with classical Indian medical works, especially Susruta's and historical scrutiny. Caraka's Sanskrit works, Kenneth G. Zysk first suggested in his landmark Asceticism and Healing in Ancient India that Among the earliest medical records in the Tibetan language is an illustration and description of nineteen the heterodox wandering ascetics of the Buddha's time and moxibustion points on the body, moxibustion being a widely subsequent centuries in all probability exerted great influence practiced ancient technique of burning herbs (usually of the on the development of medical knowledge, which we subse- mugwort family) on certain points on the body surface. This quently find in the early texts of Ayurveda n Zysk argued that and one divination scroll, as well as a fine large silk painting the wandering life of early Buddhist monks and their status of from Dun huang in western China are shown in chapters 4, 5, not being bound by the prohibitive ritual purity requirements and 7 of the current publication (FIGS. 4.1, 5.9, and 7. 7). The of contemporary Hindu cultures ensured the wide-ranging cave where these and other records were stored was sealed dissemination of many of their medical ideas and practices. for a millennium, until the early twentieth century, when the This occurred even though the Buddha - while encouraging materials were discovered. They constitute original evidence 8 BODIES IN BALANCE 0.3 Wheel of Existence. Tibet; early 20th century. Pigments on cloth; 80.3 x 57.7 em. Rubin Museum of Art. C2004.21.1 (HAR 65356) HOFER: INTRODUCTION 9 of some aspects of a cosmopolitan medical tradition on the wind), tripa (khris pa, bile), and beken (bad kan, phlegm) as borders of Tibet, which when compared to Chinese materials well as causes for their imbalances. Throughout this book we in the find, exhibit partial influences from medieval Chinese refer to the nvepa with their transliterated Tibetan terms, as medical pluralism. 15 the common English translation "humor" does not convey In the twelfth century, such heterogeneous knowledge the full range of meanings, as further explained in chapter 1. was more explicitly brought into the fold of Tibetan This chapter goes on to discuss how the three nvepa are in Buddhism, forming the basis for much of what we now turn influenced by environment, food, behavior, social factors, commonly refer to as Tibetan medicine. The Tibeta n and medicin es . In practice these nvepa, as well as more medical classic Gvushi (Rgyud bzhi), or Four Tantras, plays specific manifestations of diseases, are assessed visually a pivotal role in recording much of these early traditions. through examination of a patient's physique, complexion, Composed by Yuthog Yonten Gonpo- Yuthogpa, as he was urine, tongue, and- crucially- via touch, when a physician known- and based on the study of the multiple medical feels a patient's pulse on the radial arteries of both w rists . The traditions and texts of his time, it also incorporated his earlier nyepa also interact with the seven bodily constituents, called writings and experience (discussed in chapter 8). However, luzung dun, and with the body's waste products. When these the work is framed as the teaching of the Medicine Buddha , three apects of the body and mind work well, the results are who has been throughout the ages an important saintly shown as the flowers and fruits of a tree, symbolizing health, figure to followers of Mahayana Buddhism (chapter 7). prosperity, and longevity (FIG. 0.4). Its framing as an esoteric teaching- one given by an Underlying Tibetan medicine's understanding of health emanation of the historical Buddha in India, transmitted to and illness is the concept that all phenomena in the uni- Tibet, but concealed and only later discovered in a Tibetan verse- body, environment, and medicinal substances- are monastery- has contributed to the English translation of its made up of the five elements of water, fire, earth, air, and Tibetan title to be Four Tantras, in line with the denomination space. Again this is something we find in Buddhist (and of other esoteric Buddhist texts as tantras. To translate the Hindu) philosophy. In medical texts, certain constellations of title of this work as Four Treatises or Four Texts would also elements in the body were described as the nyepa and further be appropriate, but given the common use of the title Four specified in relation to particular diseases, symptoms, and Tantras in the w ider literature, we use this English rendering treatments. Hence Tibetan medicine has both a nyepa-related in the present volume and refer to its four volumes as Root as well as a disease-specific approach to treatment. To Tantra, Explanatory Tantra, Instructional Tantra, and Last Tantra. The Medicine Buddha is seen by many Tibetan doctors balance the nvepa in the body, to support the function of certain body parts and organs, and to counteract diseases, and is framed in the texts themselves as the divine source of remedies with opposite qualities are prescribed, as discussed much medical knowledge. Doctors, patients, and Buddhist in chapter 3, along with suggested behavioral and dietary practitioners relate to the Medicine Buddha as a resource changes, and in some cases use of external therapies, as for healing through prayer, visualization, and ritual. For these discussed in chapter 4. Patients routinely combine these reasons the Medicine Buddha, or Sangye Menlha (Tib. Sangs approaches with ritual healing , astrological consultations, rgyas sman lha, Skt. Bhaisajyaguru) has been axiomatic to and Buddhist practices- such as prayers, pilgrimage, and the practice of Tibetan medicine in lay and Buddhist medical meditation. Patients also worship, respect, and appease contexts. the gods and spirits of the land, mountains, lakes, and other SHARED FOUNDATIONS OF MEDICINE AND BUDDHISM connected with well-being and sickness in the community. 16 manifestations in the environment who are seen as intimately In Tibetan medical theory the ultimate causes of all illnesses are considered to be the three mental poisons (dugsum) Medicine and the Visual Arts of desire, hatred, and delusion. They are also described as In addition to exploring the relationship between Sowa the root of all suffering in the Buddha's teachings. Dugsum Rigpa and Buddhism, this publication takes a close look at are depicted at the core of the Wheel of Life, a common how medicine and Buddhism interacted with the arts and Tibetan iconographic depiction of the six realms of samsaric crafts, or zo rigpa (bzo rig pa). This interaction is addressed existence, where they are illustrated in the form of a snake, a throughout the book, with particular emphasis in Part II. cock, and a pig (FIG. 0.3). Although virtually never mentioned Arts and crafts have always held a place of high impor- in a medical consultation, doctors understand these mental tance in Tibetan society, for both the learned and the illiterate. poisons as distant causes of the three nvepa of lung (rlung, Thangkas representing the Medicine Buddha and medicine's 10 BODIES IN BALANCE human propagators, such as Yuthogpa, were widespread as opportunities for expression by Tibetan artists. Although their sponsorship and creation were thought to accumulate clearly influenced by Tibetan Buddhist art forms and merit and alleviate suffering. Instruments and objects used by iconography, in several important ways artists engaging in physicians to make and store medicines as well as for apply- the medical arts could surpass the established themes of rep- ing treatment were beautifully and pragmatically crafted. The resenting Buddhist deities and the holy life. Tibetan medical wooden block prints of medical texts and the wonderful illus- paintings offer glimpses into ordinary peoples' lives, showing trations of materia medica manuscripts to identify medical them in health and sickness, receiving medical treatment, ingredients are further examples of how medicine depends making love, giving birth, and dying. The Tibetan medical on the arts and crafts. The most vivid interaction between physicians and artists paintings, together with illustrated materia medica handbooks (in chapter 11), also serve to illuminate the environment of occurred in late seventeenth-century Lhasa, when a set of Tibet - its minerals, plants, and animals. Finally, we also get seventy-nine splendid medical paintings was created under to see depictions of the male body's interior channels, organs, the auspices of Desi Sangye Gyatso, then Regent to the Fifth and bones. Throughout, symbols and aspects of Buddhism, Dalai Lama n The set illustrates Sangye Gyatso's Blue Beryl though not central to the paintings, can be seen. commentary on the Four Tantras . These works constitute an artistic and medical legacy that remains to this day visually Toward the Futures of Sowa Rigpa stunning and unparalleled in scope. The paintings have been Bodies in Balance speaks of the past and the present of copied over and over again, a few times as a whole set, and Tibetan medicine, its convergence with Buddhism and the more often as a smaller set of selected paintings mainly for visual arts. And what about the future of this rich medical instructional purposes. One copy of the entire set has been tradition? Can its vitality and diversity, its adaptability and its published with English annotations, accompanied by transla- efficacy be maintained for the decades and centuries to come? tions from the Blue Beryf.1B Apart from serving directly to relieve suffering and cure diseases, Sowa Rigpa also provided new subject matter and Tibetan medical practitioners in Asia find themselves in the midst of rapid socio-economic change, their traditions globalized and thoroughly commercialized. The environment 0.4 Detail from Fig.1.3. Tree of Body in Health and Illness. HOFER : INTRODUCTION 11 on which they depend for raw materials is undergoing medicines has declined and our medicinal herbs are being irreversible alteration intimately linked to global, regional, depleted due to the massive increase in demand arising from and local influences. the development [of the Tibetan medicine industry], where One of the most significant changes that has occurred over the last decade has been the development of a large- short-term profit is reaped at the expense of the future. If we don't take better care now, there will be great problems scale industry for the production of Tibetan medicines. ahead ... When I was small we had a little bit of even some Previously there had been a relatively limited number of very rare species, but at this current rate of 'development' medical institutions, hospitals, clinics, and colleges that we'll be out of ingredients in twenty years. Our Tibetan Sowa produced medicine for patients in their own establishments. Rigpa is like a precious jewel. It needs protection for the Patients' needs were largely met by private doctors who future. If we don't pay attention now, future generations will made their own remedies, working in small towns, in mon- accuse us! " 20 asteries, and among agricultural and pastoral communities. Twenty years in Sowa Rigpa's recorded history of almost There was not any sizeable for-profit production of Tibetan a millennium is a very short time to lose the most significant medicines, and clinical practice, teaching, and medical therapeutic component of this healing tradition. The protec- production were intentionally kept in close quarters. While the small institutional and private producers still tion of Tibetan medical plants has to be made a high priority. This could be achieved through installation of so-called exist- albeit in dwindling numbers -the vast majority of Important Plant Areas (I PAs) where regions with a high diver- Tibetan medicines, at least in Tibetan areas of China, are sity of plant life are protected for future generations, together now produced by something close to one hundred primarily with a serious shift toward cultivation of as many species as private Tibetan medicine factories. In India the majority of possible 21 Access to plant and mineral resources needs to be Tibetan pharmaceuticals are produced at the Dharamsala newly and fairly organized so that those who have been the Men-Tsee-Khang Pharmaceutical Factory, which caters to stewards of related medical traditions will be prioritized over its more than forty branch clinics as well as for-profit sales- short-term business and/or external political interests. with a small number of private amchi also making medicines themselves. The overall production output as well as profits What about the future of the books, artifacts, and manuscripts related to Tibetan medicine? While a majority of the Tibetan medicine industry in China alone has vastly of the items shown in the exhibition and this publication are increased since the mid-1990s, 19 when Tibetan medicine currently held in institutional and private collections outside was announced by the Chinese government as one of Tibet's of Tibet, we are aware of the number of surviving collections three "pillar industries," alongside tourism and mining. within Tibetan communities and institutions. Much of this This development has far reaching environmental, social, and medical implications. The amount of raw materials heritage could be preserved only at great personal risk when the destruction of early Communist and socialist reforms needed to keep up production at current levels, most of swept across Tibet, Mongolia, and Buryatia. Again, only a which has to be harvested from the wild, is far beyond what fraction of what has survived has been catalogued, many has been picked and gathered over the previous decades. items are in dire need of conservation, recording, and Among other things, this has resulted in an increasing publication, which is hindered at a time when opportunities number of endangered and already extinct species and in for international research collaboration with institutions and limiting local communities' and their medical practitioners' individuals in Tibetan areas of China are rare. While every access to medical substances that were once in ready supply. effort has been made to include collections and objects from Together with new requirements to meet production stan- Tibet in the exhibition and publication, regrettably this was dards, the increasing demand for raw materials and resultant not possible to the extent hoped for. Nevertheless, it is my reduction of certain species has led to rising costs of Tibetan sincere wish that such an opportunity will arise in the near medicines in general and for rural communities especially. future. With new online databases, there is also potential that Tibetan and Himalayan peoples' access to good quality a greater number of Tibetan medical books and manuscripts Tibetan medicines and to well-qualified and experienced held in private and institutional collections worldwide will doctors is at stake, as is the long-term health of the environ- be included in the study of Tibetan medicine's past and as a ments on which much Tibetan medical treatment depends. basis for future application. These are all serious real-world concerns, which a senior And what of the knowledgeable people, those women doctor from Lhasa, Professor Wangdu, spoke about at a and men able to transmit Tibetan medical knowledge and recent Tibetan medicine workshop: "Today, the quality of hands-on practice to future generations? While Tibetan 12 BODIES IN BALANCE medicine is now translated across borders - there are trans- smaller." It is essential to give students the opportunity to lations of the Four Tantras in Russian, English, and Chinese, learn from experienced practitioners and henceforth work in and Tibetan medicine is growing new roots in Europe and the environments where they can offer well-rounded, affordable, United States- its future will also depend on solid education and effective care. and practical experience of the young generation in the The processes that have just been discussed are neither heartland of this tradition. Professor Wangdu, quoted above, unilinear, nor are their outcomes easily predictable. Rather, is clear on this matter: "We need to study Sowa Rigpa very the trajectories of the ongoing development of Tibetan deeply and from those who have many years of experience. medicine and its various turning points could be understood Unfortunately, every year, the number of knowledgeable and as additional voices and harmonies in the polyphony of experienced doctors [still living] is becoming smaller and Tibetan medicine. HOFER: INTRODUCTION 13