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Knowledge and Context in Tibetan Medicine Edited by William A. McGrath LEIDEN | BOSTON For use by the Author only | © 2019 Koninklijke Brill NV Contents Introduction: Navigating the Ocean of Tibetan Medical Literature vii William A. McGrath A Note on Transcription, Transliteration, and Bibliography xvi List of Figures xvii Contributors xviii Part 1 The Vicissitudes of Meaning in Context 1 A New Sense of (Dark) Humor in Tibet: Brown Phlegm and Black Bile 3 Henk Blezer 2 A Preliminary Study on the Biography of Yutok Yönten Gönpo the Elder: Reflections on the Origins of Tibetan Medicine 59 Yang Ga 3 “Secret Medicine” in the Writings of Sanggyé Gyatso: The Encoded Esoteric Material of Therapeutics 85 Tony Chui 4 Visceral Anatomy as Depicted in Tibetan Medicine Katharina Sabernig 5 The Modern Biomedical Conception of Cancer and Its Many Potential Correlates in the Tibetan Medical Tradition 140 Tawni Tidwell 111 Part 2 Medicine and Religion in Context 6 The Nine-Fold Magical Cord Cycle: Investigating ’Phrul gyi the gu brgu skor, a Wartime Medical Manual 199 Tsering Samdrup For use by the Author only | © 2019 Koninklijke Brill NV vi Contents 7 Knowledge, Imagery, and the Treatment of Communicable Disease in the Vase of the Amṛta of Immortality: A Preliminary Analysis of a Nyingma Medical Corpus 218 Carmen Simioli 8 Tantric Divination and Empirical Diagnosis: A Genealogy of Channel Prasenā Rituals in the Tibetan Medical Tradition 261 William A. McGrath 9 Madness and the Spirits: Examining the Role of Spirits in Mental Illness in the Tibetan Communities of Darjeeling 309 Susannah Deane 10 Material Presentations and Cultural Drug Translations of Contemporary Tibetan Precious Pills 337 Barbara Gerke Index 369 For use by the Author only | © 2019 Koninklijke Brill NV chapter 7 Knowledge, Imagery, and the Treatment of Communicable Disease in the Vase of the Amṛta of Immortality: A Preliminary Analysis of a Nyingma Medical Corpus Carmen Simioli 1 Introduction: The Vase of the Amṛta of Immortality and Its Status in the History of Tibetan Medicine Throughout the centuries, societies have formulated varieties of philosophical, medical, alchemical, and religious responses to outbreaks of pestilence and communicable diseases.1 Tibetan medical sources from the tenth to the late seventeenth century describe complex but uniform epistemological postures concerning the causalities of rimtsé (rims tshad) or “epidemic fevers” and nyenné (gnyan nad) or “infectious diseases,” which subsumes eighteen harsh infective and malignant diseases. In Tibetan medical collections from the tenth century onwards, we find references to these ailments, which were explained as physical disorders, but, as in many other cultural contexts,2 demonology played a significant role in understandings of their pathogenesis. Accordingly, it can be observed that in these sources the empirical approach to the diagnosis of diseases is often interrelated with divination and religious curative methods. When addressing the issue of epidemics and infective diseases, we shall consider to what extent the theories and the practices of Buddhist Tantric medicine came to exert influence on Tibetan medical tradition, and in particular which textual traditions played a prominent role in codifying Tibetan 1 For alchemical responses, see Chiara Crisciani and Michela Pereira, “Black Death and Golden Remedies: Some Remarks on Alchemy and the Plague,” in The Regulation of Evil: Social and Cultural Attitudes to Epidemics in Late Middles Ages, ed. Agostino Paravicini Bagliani and Francesco Santi (Firenze: Sismel-Edizioni del Galluzzo, 1998), 7–40. For religious responses, see Andrew Cunningham, “Epidemics, Pandemics and the Doomsday Scenario,” Historically Speaking 7 (2008): 29–31. 2 Siam Bhayro and Catherine Rider, eds., Demons and Illness from Antiquity to the Early-Modern Period (Brill: Leiden, 2017). © koninklijke brill nv, leiden, 2019 | doi:10.1163/9789004404441_008 For use by the Author only | © 2019 Koninklijke Brill NV Communicable Disease in the Vase of Amṛta 219 epidemiology.3 The medical literature on nyenné and rimné reflects, in a wider sense, the comprehensive nature of Tibetan medical system, which encompasses other complementary disciplines, such as alchemy, iatrochemistry, and magic (las la sbyor ba, lit. the “application of [ritual] activities”). Although, in the course of time, the differentiation between the respective literary genres has generally become clear cut, medical texts on epidemics were closely connected to the alchemical literature of “extracting essences” (bcud len = Skt. rasāyana), treatises of iatrochemistry (dngul chu’i grub pa’i bstan bcos = Skt. rasasiddhiśāstra), and “grimoires” (sngags be’u bum, lit. “collections of mantras and spells”; las sna tshogs be’u bum, lit. “collections of ritual acts”).4 The expectation of finding a valid remedy for mortal disorders, which, as anticipated, were conceived as liminal entities in the midst of corporeal and spiritual reality, prompted pharmacological research on the one hand, and the redaction of ancient ritual literature on the other. Thus, the historical connection between medical and ritual literature can be found in the search for a universal medicine prepared by means of alchemical techniques. What today is known as the Four Tantras (rgyud bzhi), the seminal treatise of the Tibetan medical tradition attributed to Yutok Yönten Gönpo (g.yu thog yon tan mgon po, twelfth century), is the result of a long process of reception, systematization, and canonization of diverse medical theories and practices, which reached its climax during the fourteenth century.5 In this source, among 3 On Tantric medicine see for example Vesna Wallace’s consummate essay on the Kālacakratantra: Vesna A. Wallace, “Medicine and Astrology in the Healing Arts of the Kālacakratantra,” in As Long as Space Endures: Essays on the Kālacakra Tantra in Honor of H. H. The Dalai Lama, ed. Edward A. Arnold (Ithaca, NY: Snow Lion Publications, 2009), 179–91. 4 On the definition of rasāyana in Sanskrit medical and alchemical literature see Dagmar Wujastyk, “Acts of Improvement: On the Use of Tonics and Elixirs in Sanskrit Medical and Alchemical Literature,” History of Science in South Asia 5, no. 2 (2017): 1–36. On Tibetan rasāyana see Barbara Gerke, “Treating Essence with Essence: Re-inventing bcud len as Vitalising Dietary Supplements in Contemporary Tibetan Medicine,” Asian Medicine: Tradition and Modernity 7, no. 1 (2012): 196–224; and Barbara Gerke, “Treating the Aged and Maintaining the Health: Locating bcud len Practices in the Four Medical Tantras,” Journal of International Buddhist Studies 35, nos. 1–2 (2012): 329–62. On rasaśāstra in Tibetan literature, see Carmen Simioli, “Alchemical Gold and the Pursuit of the Alchemical Elixir,” Asian Medicine: Tradition and Modernity 8, no. 1 (2013): 43–77. For a detailed definition of magic as category of knowledge and expertise in the Tibetan context see Bryan J. Cuevas, “‘The Calf’s Nipple’ (Be’u bum) of Ju Mipham (’Ju mi pham): A Handbook of Tibetan Ritual Magic,” in Tibetan Ritual, ed. José Ignacio Cabezón (Oxford: Oxford University Press, 2010), 165–86. 5 Since the cosmopolitan imperial epoch (seventh-eighth centuries CE), the Tibetan medical system started to assimilate and integrate elements from other medical traditions. See Christopher I. Beckwith, “The Introduction of Greek Medicine into Tibet in the Seventh and Eighth Centuries,” Journal of the American Oriental Society 99, no. 2 (1979): 297–313; Dan Martin, “An Early Tibetan History of Indian Medicine,” in Soundings in Tibetan Medicine, ed. For use by the Author only | © 2019 Koninklijke Brill NV 220 Simioli the diverse rasāyana formulations, mercurial compounds clearly epitomize the ideal of the universal panacea. Not unlike the Āyurvedic concept of the rasāyana that “pacifies all disorders” (sarvopaghāta śamanīya), the countermeasure called the “precious reversal suppressant, universal pacifier of all the diseases” (zhi bye kun log gnon rin po che) can dispel any kind of harsh disease, including epidemics, and can even protect from demonic attacks and poisoning.6 Since alchemy and magic represent two categories of operative knowledge that share the same philosophical substratum of “dependent arising” (rten ’brel = Skt. pratītyasamutpāda), they permeate each other. Therefore, along with the alchemical idea of the manipulation of substances to create a perfect medicine, we find the secret potencies of materia medica that pertain to natural magic (the sympathies and the antipathies existing in the whole of nature), as well as ritual practices (invocations, the use of incantations to summon and also exorcisms), and also the conjunct preparation of magic diagram or circles (’khor lo) and sacred images (gzugs brnyen), which typify image magic.7 Mona Schrempf (Leiden: Brill, 2007), 307–25; Dan Martin, “Greek and Islamic Medicines’ Historical Contact with Tibet,” in Islam and Tibet: Interactions along the Musk Routes, ed. Anna Akasoy et al. (Burlington, VT: Ashgate Publishing Company, 2011), 117–44; William A. McGrath, “Vessel Examination in the Medicine of the Moon King,” in Buddhism and Medicine: An Anthology of Premodern Sources, ed. C. Pierce Salguero (New York, NY: Columbia University Press, 2017), 501–13; Anna Akosay and Ronit Yoeli-Ylalim, “Along the Musk Routes: Exchanges between Tibet and the Islam World” in Asian Medicine, Tradition and Modernity 3 (2007): 217–40 ; Ronit Yoeli-Tlalim, “On Urine Analysis and Tibetan Medicine’s Connections with the West,” in Studies of Medical Pluralism in Tibetan History and Society, ed. Sienna Craig et al. (Halle: International Institute for Tibetan and Buddhist Studies GmbH, 2010), 195–211; Ronit Yoeli-Tlalim, “Re-visiting ‘Galen in Tibet,’” Medical History 56, no. 3 (2012): 355–65; Ronit Yoeli-Tlalim, “Central Asian Mélange: Early Tibetan Medicine from Dunhunag,” in Scribes, Texts, and Rituals in Early Tibet and Dunhuang, ed. Brandon Dotson, Kazushi Iwao, and Tsuguhito Takeuchi (Wiesbaden: Reichert-Verlag, 2013), 53–60; and Ronit Yoeli-Tlalim, “Between Medicine and Ritual: Tibetan ‘Medical Ritual from Dunhuang,’” in Tibetan and Himalayan Healing: An Antology for Anthony Aris, ed. Charles Ramble and Ulrike Roesler (Kathmandu: Vajra Publications, 2015), 739–46. For further analysis of this process of unification, standardization, and modes of knowledge transmission in the Tibetan medical system, see William A. McGrath, Buddhism and Medicine in Tibet: Origins, Ethics, and Tradition (Charlottesville, VA: Doctoral Dissertation at the University of Virginia, 2017). 6 This formulation appears in the Ultimate Tantra (phyi’i rgyud) of the Four Tantras. See Bdud rtsi snying po yan lag brgyad pa gsang ba man ngag gi rgyud (Lhasa: Bod ljongs mi rigs dpe skrun khang, 1982), 601/9–12. 7 Image magic with its astrological and philosophical implications, as well as its divinatory, medical and apotropaic uses, have been largely investigated in western studies. For a detailed study on textual amulets see Don C. Skemer, Binding Words: Textual Amulets in the Middle Ages (Philadelphia, PA: University of Pennsylvania Press, 2006). For a theoretical approach to the concept of simulacra in Tibetan Buddhism see Stephan Beyer, The Cult of Tara: Magic For use by the Author only | © 2019 Koninklijke Brill NV Communicable Disease in the Vase of Amṛta 221 These disciplines are part of the instructional corpus of the Tibetan medical tradition, which is an immense body of practical occult lore, grounded in Tantric Buddhist knowledge. These narratives and ritual practices were gathered up over the centuries and condensed in the literature of “accomplishing medicine” (sman sgrub), a genre structured according to the model of Mahāyogatantra that flourished in Tibet between the twelfth and the thirteenth centuries.8 In these scriptures, alchemy and various forms of magic merged with evocation rituals (sgrub thabs) aimed at producing a ritually empowered “amṛta of immortality” (’chi med bdud rtsi). The Great Vase of the Amṛta of Immortality (’chi med bdud rtsi bum chen; hereafter Vase of Amṛta), whose contents will be examined in this study, belongs to this literary genre. I will be using two redactions of the Great Vase: the first is included in the nineteenth century Precious Treasury (rin chen gter mdzod) redacted by Jamgön Kongtrül Lodrö Thayé (’jam mgon kong sprul blo gros mtha’ yas, 1813–1899) and Jamyang Khyentse Wangpo (’jam dbyangs mkhyen brtse’i dbang po, 1820–1892); the second belongs to the Collection of Prominent Medical Works Ascribed to Padmasambhava (slob dpon pad ’byung gi sman yig gces bsdus), which is a volume included in the publication series of ancient medical works redacted by the Arura Medical Institute and Tibetan Medical Research Association in Tsongön (Kokonor, Qinghai).9 The Vase of Amṛta formally conforms to the category of treasure texts (gter ma), the revealed-scripture tradition ascribed to Padmasambhava, and is a medical oriented textual cycle completely devoted to the cure of nyenné and rimtsé. Other titles are, indeed, contained within the corpus of the Vase of Amṛta, each alluding to its contents and structure, such as the Medical Corpus in Eight Branches (gzhung yan lag brgyad pa), the Trilogy of Tantras of the Medical Methods (gso dpyad rgyud don skor gsum pa), or the Three Precious Heaps of Medical Methods and Ritual in Tibet (Dehli: Motilal Banarsiddass, [1973] 2001); for an analysis of an iatromantic image see Ronit Yoeli-Tlalim, “A Tibetan Image of Divination: Some Contextual Remarks,” in Imagining Chinese Medicine, ed. Vivienne Lo and Penelope Barrett (Leiden: Brill 2018), 429, fig. 9. 8 On “accomplishing medicine” see for example: Francis Garrett, “The Alchemy of Accomplishing Medicine (sman sgrub): Situating the Yuthok Heart Essence Ritual Tradition,” Journal of Indian Philosophy 37, no. 3 (2009): 207–30; and Cathy Cantwell, “The Medicinal Accomplishment (sman sgrub) Practice in the Dudjom Meteoric Iron Razor (gnam lcags spu gri) Tradition: Reflections on the Ritual and Meditative Practice at a Monastery in Southern Bhutan,” Journal of the Oxford Centre for Buddhist Studies 8 (2015): 49–95. 9 (1) ’Chi med bdud rtsi bum pa, in Rin chen gter mdzod (Paro: Stod lung mtsur phu’i par khang, 1980), vol. 46 (ngo, ha), 1.1–124.1 (hereafter ’Chi med bdud rtsi bum pa [1]); and (2) ’Chi med bdud rtsi bum pa, in Slob dpon pad ’byung gi sman yig gces btus (Beijing: Mi rigs dpe skrung khang, 2006), 1–193 (hereafter ’Chi med bdud rtsi bum pa [2]). For use by the Author only | © 2019 Koninklijke Brill NV 222 Simioli (gso dpyad rin chen spungs bag gsum pa).10 Another significative appellation is the Scroll of Quintessential [Teachings] (yang thig gces shog dril), which alludes to the Nyingma doxographical category of pith instructions. Despite being redacted in these rather late collections, the rediscovery of the Vase of Amṛta is specifically attributed to Dorbum Chökyi Drakpa (rdor ’bum chos kyi grags pa), a mysterious yogin from Ngari (mnga’ ris). We find scattered references to Dorbum within the Vase of Amṛta, regarding his physical appearance and his tantric implements: he was a yogin of small stature (bong thung) and had a particular spot on his forehead, which caused him to be also known as the “one endowed with the peacock brilliant mark” (’od kor rma bya’i mdongs can); and he owned a fanged skull (ga li [=ka li] rkan so can).11 The Vase of Amṛta provides us with the approximate date of its rediscovery that took place “in the year of the sharp-minded hare” (blo gsal yos bu lo la ’don). A detailed description of this event is to be found in Dorbum’s hagiography: according to this work, the yellow scroll of the Vase of Amṛta emerged directly from the hearth of Hayagrīva, the “resplendent subjugator of arrogant beings” (zil dregs zil gnon) at the temple of Jang Tradüntsé (byang pra dun rtse).12 The chapter on the calcite (cong zhi) theriac in the modern redaction of the Vase of Amṛta, which should correspond to the final section and the colophon of nineteenth-century version of the Vase of Amṛta, reveals that this manuscript is a scribal work. The copyist (yi ge pa), who calls himself as Sönam Rinchen (bsod nams rin chen), provides us with a few temporal and geographical data. After restating the role of Dorbum as treasure-finder (gter ston), the copyist starts narrating the account of a so-called “sky-holder” (gnam ’chang), who connected the transmission of the manuscript to the “noble clan of those [wearing] shining thunderbolt-proof [armor?] in the lineage of Minyak” (mi nyag rigs la thog thub mdongs kyi rus). The copy was written “during the waxing period of the moon in the fourth Mongolian month of the [male] earth-dog year (sa khyi hor zla bzhi pa’i yar ngo la), when 2496 years had passed after the Nirvāṇa of the Buddha, in the sacred land with the horned Khyung mountain 10 11 12 ’Chi med bdud rtsi bum pa (1), 6v/5–7r/6; and ’Chi med bdud rtsi bum pa (2), 9/6–24. The first title refers to the exposition of the issue of epidemics in eight points (primary and secondary causative factors; time and place of the outbreak; diagnosis; ritual protections and therapeutic countermeasures); the other refer to its major subdivisions in the three main tantras devoted to the general exposition of the contents, diagnosis, therapeutics, and apotropaic rituals. ’Chi med bdud rtsi bum pa (1), 115v/6; ’Chi med bdud rtsi bum pa (2), 55/6–8. ’Jam mgon kong sprul blo sgros mtha’ yas, Gter ston brgya rtsa’i rnam thar (Lhasa: Bod ljongs mi dmangs dpe skrun khang, 2007), vol. 1, 137/ 9–17. For use by the Author only | © 2019 Koninklijke Brill NV Communicable Disease in the Vase of Amṛta 223 as its center.”13 Although I have not been able to date this copy of the manuscript based on the provided chronological data, these elements allow us to state that this copy was first redacted no earlier than the thirteenth century.14 Despite the paucity of historical data provided by these manuscripts, however, the Vase of Amṛta has an intriguing lineage history that connects it both to the Nyingma treasure tradition and to the Tibetan medical tradition. In the Current of the River Ganges: Enumeration of the Received Teachings on the Vast and Profound Sacred Dharma (Gang ga’i chu rgyun; hereafter Current of the River Ganges), the Fifth Dalai Lama Ngawang Lozang Gyatso (ngag dbang blo bzang rgya mtsho, 1617–1682) clearly identified the Vase of Amṛta as a “northern treasure” (byang gter) and connected it to important religious and medical figures, such as the “treasure finder” (gter ston) Trashi Topgyel (bkra shis stobs rgyal, 1550–1603) and the physicians of the famous Drangti (brang ti) and Zur families, even connecting the Vase of Amṛta back as far as the twelfthcentury Yutok. Although a definitive historical study of the medical lineage of the Vase of Amṛta is beyond the scope of the present chapter, we will consider the inter-textual lineage of the Vase of Amṛta in the thirteenth and fourteenth centuries, as well as its transmission in the influential medical collections of the seventeenth century. The intertextual lineage links the Vase of Amṛta to the iatrochemistry of mercury procedures (dngul chu btso bkru) that originated in Orgyenpa Rinchen Pel’s (o rgyan pa rin chen dpal, 1229/30–1309) alchemical system and that were transmitted through important collections, such as the Drangti’s Great Measure of Gold (gser bre chen mo) and Lhatsün Rinchen Gyatso’s (lha btsun rin chen rgya mtsho, fourteenth century) Collection of Drongtsé (’brong rtse be’u bum). Moreover, the Vase of Amṛta probably served as source for the fourteenth-century redaction of the chapter on precious stones remedies of the Ultimate Tantra of the Four Tantras.15 Fragments of the Vase of Amṛta are 13 14 15 Compare ’Chi med bdud rtsi bum pa (2), 101/1–112/9; with the final section and the colophon of ’Chi med bdud rtsi bum pa (1), 118r/–123r/6. The manuscript of the ’Chi med bdud rtsi bum pa (2) might have been written after the Mongolian final conquest of Tangut reign in 1226 and the consequent settlement of Tanguts in the eastern territorial areas of Tibetan plateau. Certainly, it was composed later than the introduction of the “Mongolian month” (hor zla) to the Tibetan calendar in the thirteenth century by the Drogön Chögyel Pakpa Lodrö Gyeltsen (’gro mgon chos rgyal ’phags pa blo gros rgyal mtshan, 1235–1280), who was the preceptor of Kublai Khan. See Dpal ldan rgyal mtshan, Brang ti lha rje’i rim brgyud kyi man ngag gser bre chen mo (Lhasa: Bod ljongs mi dmangs dpe skrun khang, 2005),144–78; Lha btsun Rin chen rgya mtsho, ’Brong rtse be’u bum dkar po (Beijing: Mi rigs dpe skrun khang, 2005), 278/20– 283/24. See also Carmen Simioli, “The ‘Brilliant Moon Theriac’ (Zla zil dar ya kan): A Preliminary Study of Mercury Processing according to the Vase of Amrita of Immortality For use by the Author only | © 2019 Koninklijke Brill NV 224 Simioli included in other sections of the Great Measure of Gold and consist of short recipes and spells for curing specific rim and nyen diseases, such as the rim disease of the gall bladder and the bile duct (mkhris rims), or the rim disease affecting the gastrointestinal tract (rgyu gzer). The treasure text is referred to as the Innermost Essence of the Vase of Amṛta (bdud rtsi bum pa yang snying) and Guru Padmasambhava’s “oral pith instruction source” (man ngag = Skt. upadeśa) transmitted through the Drangti medical system.16 With this information in mind, it might be possible to assume that at least sections of the Vase of Amṛta circulated widely and were preserved in the indirect medical textual tradition from the thirteenth century onward. At the turn of the seventeenth century, the speculative models, which guided the interpretation and classification of epidemic fevers and infective diseases in Tibet, were well-established conceptions rooted in the study of the Four Tantras, as well as in the study of formative magical and alchemical scriptures. Sanggyé Gyatso (sangs rgyas rgya mtsho, 1653–1705), regent (sde srid) of the Fifth Dalai Lama and leading academic theorist of medicine, composed several commentarial works on the Four Tantras, including a subsidiary collection entitled the Camphor That Dispels the Torments of Fevers, the Sword That Cuts off the Lasso of Untimely Death: Supplements to the Excellent Tantra of Oral Instructions (man ngag yon tan rgyud gyi lhan thabs zug rngu’i tsha gdung sel ba’i kat pu ra dus min ’chi zhags gcod pa’i ral gri; hereafter Supplements to the Instructional Tantra). The contents and structure of its chapters devoted to nyenrim reflect the clear authorial intent of systematizing all of the notions on these diseases distilled from authoritative medical and religious sources in a coherent and legitimate body of knowledge. Sanggyé Gyatso also supplemented the instructions of the Four Tantras with a plethora of recipes, spells to consecrate medicines, and protective rituals derived from tantric sources, presenting them as an expansion of something inherent in the medical classic.17 In the twenty-sixth chapter on “contagious fever” and “Nepalese disease” (bal nad), and in thirtieth chapter on the “nyen disease afflicting the brain” (klad gzer), Sanggyé Gyatso states his indebtedness to several tantras of the “early translation” (snga ’gyur) and of the “late translation” (phyi ’gyur) schools. He tried to produce a perfect “synthesis of the pith instructions drawn from 16 17 (’Chi med bdud rtsi bum pa) and Its Influence on Tibetan Pharmacological Literature,” Revenue d’Etudes Tibétaines 37 (2016): 391–419. Brang ti lha rje’i brgyud kyi man ngag gser bre chen mo, 203/3–204/13; 236/13–237/8; 252/17–253/6. On the secret recipes of the Supplements, see Tony Chui, “‘Secret Medicine’ in the Writings of Sanggyé Gyatso: The Encoded Esoteric Material of Therapeutics,” in the present volume. For use by the Author only | © 2019 Koninklijke Brill NV Communicable Disease in the Vase of Amṛta 225 the ‘treasure texts’ ascribed to Padmasambhava.”18 The contents of the Supplements to the Instructional Tantra reflect not only the place of magic in Sanggyé Gyatso’s medical thought, but it can also offer a perspective on the status of specific ritual magic texts in the history of Tibetan medicine. Plumbing the intricate web of literary references in the Supplements to the Instructional Tantra, we find that Sanggyé Gyatso quoted passages from a treasure text entitled the Great Guru’s Vase of Amṛta (gu ru chen po’i bdud rtsi bum pa),19 which can be identified as the Vase of Amṛta on the basis of intertextual analysis. As we can infer from the Current of the River Ganges, upon which Sanggyé Gyatso relied to describe the contents of the Vase of Amṛta in his medical historiography, the Vase of Amṛta in question seems to coincide with the textus receptus preserved in the nineteenth-century Precious Treasury collection.20 The influential role of this scripture in the Supplements to the Instructional Tantra was certainly due to the Fifth Dalai Lama’s lineage of transmission. In the seventeenth century, the Vase of Amṛta became one of the most authoritative sources concerning the treatment of epidemics and poisoning. Deumar Tendzin Püntsok (de’u dmar bstan’ dzin phun thsogs, b. 1672), important theorist and physician, frequently cites the Vase of Amṛta in his chapter devoted to the treatment of the “black disease, union of the three” (nag po gsum sgril). Like the Drangti physicians, Deumar calls it the Innermost Essence of the Vase of Amṛta and classifies it as an oral instruction.21 The lineage of transmission of the Vase of Amṛta can be traced up to nineteenth century. The Precious Treasury collection not only preserves the textus receptus of the Vase of Amṛta but includes a series of related instructional texts, such as the Essential Daily Practices of the Vase of Amṛta (bdud rtsi bum pa’i rgyun khyer snying dril), the transmission and guiding explanations of the Vase of Amṛta authored by the luminary Jamgön Kongtrül, who worked alongside with the treasure finder Jamyang Khyentsé Wangpo for the preservation of the 18 19 20 21 Sangs rgyas rgya mtsho, Man ngag gi yon tan rgyud gi lhan thabs (Xining: Mtsho mi rigs dpe skrung khang, 1991), 175/11–176/3. Sangs rgyas rgya mtsho, Man ngag gi yon tan rgyud gi lhan thabs, 184/8. I have compared the catalogue of contents provided in the Gang ga’i chu rgyun and the contents of ’Chi med bdud rtsi bum pa (1) and ’Chi med bdud rtsi bum pa (2). For references see the previous note and Ngag dbang blo bzang rgya mtsho, Zab pa dang rgya che ba’i dam chos kyi yig gang ga’i chu rgyun, in Gsung ’bum (Gangthok: Sikkim Research Institute of Tibetology, 1991–95), vol. 1 (gsan yig ka), 340/1–345/9. See also Gavin Kilty, trans., Mirror of Beryl: A Historical Introduction to Tibetan Medicine (Boston, MA: Wisdom Publications, 2009), 177–85. De’u dmar btan’dzin phun tshogs, Gso rig gces btus rin chen phreng ba (Xining: Mtsho sgnon mi rigs dpe skrun khang, 1993), 205/14–218/3. For use by the Author only | © 2019 Koninklijke Brill NV 226 Simioli treasure text tradition.22 This work has been included in a modern extended edition of the Yutok Heart Essence (g.yu thog snying thig), an anthology of ritual practices related to different medical lineages.23 This brief conspectus provides us with some noteworthy elements. The medical lineage of the Vase of Amṛta can be traced back to the fourteenth century, when it was considered an authoritative recipe book and spell book whose excerpts circulated through important medical collections and were part of the secret oral transmissions connected to medical lineages. Its influential role was mainly related to the codification of mercurial procedures. Its importance increased in the seventeenth century due to Nyingma lineage of the Fifth Dalai Lama. Its history is intertwined with the renaissance of the treasure-tradition within the non-sectarian (rigs med) movement of the nineteenth century. The presence of Jamgön Kongtrül’s text in the modern redaction of the Yutok Heart Essence shows that the ritual practice based on the Vase of Amṛta is effectively part of a set of accomplishing medicine rituals connected to the medical tradition still being practiced today. Drawing on the contents of the Vase of Amṛta, it is possible to determine other relevant elements that can allow us to better situate the Vase of Amṛta in the broader contexts of medical and alchemical literatures. Specific passages will illustrate how in the Vase of Amṛta, the alchemical quest for the long-life elixir and the search for the ultimate remedy against pestilences and poisons came to be conflated. The core part of this paper will be devoted to the analysis of the whole spectrum of diagnostic methods and rituals described in the Vase of Amṛta: its contents stretch from medical rubrics to divinatory prognosis (kha dmar). The work also deals with the preparation and consecration of “medical compounds” (sbyor ba) known as theriac (dar ya kan), the preparation of magical “unguents” (phyug sman), and “protective amulets” (srung ’khor), or ritualized therapies. Before discussing the contents of the Vase of Amṛta, it is necessary to first briefly introduce the concept of nyenné and rimné 22 23 Jamgön Kongtrül, Bdud rtsi bum pa’i rgyun khyer snying dril, in Rin chen gter mdzod (Paro: Stod lung mtsur phu’i par khang, 1980), vol. 47 (ci, ha–a), 1r/1–3r/1. The Index of Treasure Texts Dealing with the Protection [From Epidemics] (Srung ba’i kha byang) by Jamyang Khyentsé Wangpo, includes the Vase of Amṛta, among other important magic-medical sources. See Slob dpon pad ’byung gi sman yig gces btus, 367–89. G.yu thog snying thig (Beijing: Mi rigs dpe skrun khang, 2007), 11–13. This has been edited by the Arura Institute and Medical Research Association in Tsongön. Based on the Lhasa Chakpori (lcags po ri) redaction of the collection authored by Karma Jigmé Sengé (karma ’jigs med seng ge, nineteenth century), this anthology has been expanded with the addition of writings composed by authors from different historical periods. For use by the Author only | © 2019 Koninklijke Brill NV Communicable Disease in the Vase of Amṛta 227 as expressed in ancient authoritative and canonical sources from the tenth to the seventeenth century. 2 The Etiology of Nyenné and Rimné According to Canonical Medical Sources: Physical Causation, Morbific Airs, and Demonic Poisons This preliminary investigation intends to probe the coexistence of different explanatory models and the considerable uniformity of the medical discourse on nyenné and rimné from the twelfth to seventeenth century. Its core focuses on the analysis of sections from the Instructional Tantra (man ngag rgyud) of the Four Tantras, which has been compared with the Sons’ Benefit (bu don ma), an ancillary treatise ascribed to Yutok Yönten Gönpo. We will also briefly refer to a medical source predating the Four Tantras, known as the Moon King (zla ba’i rgyal po). This analysis of the Instructional Tantra, will be complemented, when considered necessary, with references to exegetical writings such the Blue Beryl (baidurya sngon po) and the Supplements to the Instructional Tantra authored by Sanggyé Gyatso. The Tibetan etiology of nyenné and rimné ultimately developed in the context of ancient Āyurvedic concepts. The selected sources provide a threefolded epidemic causality: diseases are determined by natural factors, supernatural factors, and are related to a moral causality. The taxonomy of nyenné and rimné proposed by both the Sons’ Benefit and the Instructional Tantra notably corresponds with the etiological models provided by the Tibetan translation of the Compendium of the Essence of the Eight Branches (yan lag brgyad pa’i snying po bsdus pa = Skt. aṣṭāṅgahṛdayasaṃhitā; hereafter, Essence of the Eight Branches),24 the well-known classic of Āyurveda authored by Vāgbhaṭa (pha khol). According to these scriptures, the “three disturbing elements” (nyes pa gsum) and blood (khrag) are the dominant physiological models for interpreting nyenrim. Rimné are classified in four categories corresponding to each of the cited “disturbing elements” as well as their “combination” (’dus pa).25 These 24 25 Yan lag brgyad pa’i snying po bsdus pa, in Sbyor ba brgya ba dang yan lag brgyad pa’i snying po bsdus pa sogs (Beijing: Mi rigs dpe skrun khang, 2005), 309/12–316/11. There are six classes of rim diseases forming three couples of diseases, each associated with one of the “three disturbing factors”: a) Epidemics fevers associated with “wind” (rlung rims), i.e. febrile states associated with insomnia called yerbu (yer bu), are characterized by intensive shivering, called darbu (’dar bu), which manifests in the prodromal phase of the disease; b) epidemic fever associated with “bile” (mkhris rims), i.e. lepgen (leb rgan), are characterized by yellow watery eyes and mucus, the disease of atrocious pain For use by the Author only | © 2019 Koninklijke Brill NV 228 Simioli three elements are potential pathogenic factors influenced by wrong behaviors, in particular excessive exhausting actions (drag shul), an imbalanced dietetic regimen (kha zas ma snyoms), and unusual changes in the climate that happen when the “seasons display inappropriate features” (dus bzhi’i ’byung ba dman lhag log; lit. the “elements of the four seasons are less or more than appropriate, or the opposite”).26 The fourth class of rim diseases is conceived as a clear manifestation of demonic assaults. The term used to identify the diseasecarrier demon is dön (gdon), which refers to an evil uncanny force sent by nonhuman beings and therefore referred to as negative influence of malevolent “elemental beings” (’byung po). In order to gain a clear picture of how nyenné and rimné are interpreted in the Instructional Tantra, we will now turn to the concept of contagion. In the Instructional Tantra, the term rim, which literally means “gradual,” is glossed as follows: (a) it refers to a disease that enters the body thorough the nose and subsequently affects the other “entrances” (’jug sgo), i.e. it manifests by penetrating the skin, then gradually affects the flesh, the channels, the bones, and the organs; (b) it describes the contagious nature of the disease, which can spread through impure solid substances (dri dngos) or “air” (rlung) and “smoke” (du ba) emanating from the “disease breeding ground” (nad yod sa), and by infecting one after another, finally reaching “epidemic proportions” (yams su rims kyis ’gos pa).27 Among the causes for such contagions, “impurity” (dri ma) is primary. The term refers to physical defilements, deriving from the contact with impure substances (human and animal), the pungent odors of infected bodies (nad dri), and the effluvia that infest insalubrious places. This concept is further developed within the context of the subgroup of nyen diseases. According to the Instructional Tantra, unpleasant smells descend from the sky as pestilential vapors that are disseminated by irate goddesses, become morbific stains that enter the body, and affect the organism. The Sons’ Benefit refers to the celestial miasmas of diverse colors exhaled by mother goddesses (ma mo) 26 27 of the brain (glad zer); c) epidemics associated with “phlegm” (bad kan rims), i.e. diseases characterised by aphasia and mental torpor (rmongs bu), are diseases characterized by a state of dullness and muteness (lkugs pa). Bu don ma (Beijing: Mi rigs dpe skrung khang, 2009), 84/1–86/10. For a further analysis of the Bu don ma, see Henk Blezer, “A New Sense of (Dark) Humor in Tibet: Brown Phlegm and Black Bile,” in the present volume. Bdud rtsi snying po yan lag brgyad pa gsang ba man ngag gi rgyud, 641/13–14. Bdud rtsi snying po yan lag brgyad pa gsang ba man ngag gi rgyud, 243/11–12. See also Sangs rgyas rgya mtsho, Gso ba rig pa’i bstan bcos sman bla’i dgongs rgyan rgyud bzhi’i gsal byed baidur sngon po’i mallika (Lhasa: Bod ljongs mi dmangs dpe skrun khang, 1982), 642/1–4. For use by the Author only | © 2019 Koninklijke Brill NV Communicable Disease in the Vase of Amṛta 229 as disturbances that provoke specific rim diseases.28 The morbific stains are invisible entities called parpata, categorized as sinbu (srin bu), which are described at length in Sanggyé Gyatso’s Blue Beryl and Supplements to the Instructional Tantra. Nevertheless, “impurity” also refers to moral faults that occur due to social and religious transgressions, as well as the desecration of nature and the dwellings of supernatural beings, which determine demonic influences.29 The Moon King identifies “impurity” (mi gtsang), “malice” (’khon), and the “bad smell of burning impure animal substances” (gzhog pa) as the “immediate causes” for the onset of gaklhok (gag lhog), a specific class of contagious disease characterized by swelling throat and ulcers. According to this text, the “disturbances” (’khrugs) of “planetary gods” (gza’), “lunar mansions” (rgyu skar), “ferocious goddesses” (ma mo), and “local deities” (sa bdag) are causative factors of poxes (’brum bu).30 This idea is reiterated in the eighty-first chapter of the Blue Beryl: the demonic assaults of nyen spirits (gnyan gdon) are provoked by (1) the destruction or (2) the profanation of deities’ dwellings. Here “impurity” refers to polluting substances (grib can)—human odor, garbage, leftovers, and so forth—thrown into spirits’ abodes. Fireplaces are also considered impure when the burning stoves (thab) leak various substances such as water (water extinguishes fire and leaves wet ash), blood, butter, or milk. Other impure substances include “burning animal parts,” such as skin, fur, and bones, which produce “foul smoke” (dud ba ngan). Impurity can also be more abstract, referring to the “performance of wanton actions” (’jol nyog spyod pa), such as slaughtering animals, Buddhist monks or Bönpos who have no time to properly perform the “preliminary practices, sādhana meditation, and ritual activities” (snyen sgrub las gsum), or contaminating spirit dwellings with impure substances used for “black curses” (mthu gtad). 28 29 30 The female spirits called ma mo are ichnographically represented as wrathful sorceresses with emaciated and pendant breasts, bringing sacks full of diseases. In some cases, the ma mo are hybrid figures with animal heads. See René de Nebesky-Wojkowitz, Oracles and Demons of Tibet: The Cult and Iconography of the Tibetan Protective Deities (Delhi: Book Faith India, 1993), 269–72. Bu don ma, 84/3–4. See Giuseppe Tucci, Le Religioni del Tibet (Roma: Edizioni Mediterranee, 1996), 217. Sman dpad zla ba’i rgyal po (Leh: Tashigang, 1989), 69r/3–6. This disease is a classified as a hybrid nyenrim disease; its onset is characterized by the eruption of pustules and bulla caused by excessive impure blood and “yellow fluids” (chu ser, lit. “yellow water”) beneath the skin; the process of suppuration starts from the feet and spreads overall the body. There are two categories of poxes: 1) “white poxes” (’brum dkar) caused by the combination of phlegm, wind, and cold disorder (bad rlung grang ba shas che); and 2) “black poxes” determined by bile and blood (mkhris khrag shas che). See Byams pa ’phrin las et al., Bod lugs gso rig tshig mdzod chen mo (Beijing: Mi rigs dpe skrun khang, 2006), 599. For use by the Author only | © 2019 Koninklijke Brill NV 230 Simioli The idea of contagion is related to a multidimensional perception of “impurity,” which involves magical-religious conceptions and also has moral connotations. This aspect reflects, again, a correspondence with ideas developed in Vāgbhaṭa’s work, and it is also comparable to the similar category of “errors of judgment” found in the Compendium of Caraka (carakasaṃhitā):31 the individual predisposition to be affected by contagious fevers is rooted in negative mental attitudes and emotions, such as harboring hate, ager, fear, longing, and suffering, which are conceived as immediate causes of rim fevers.32 When moral degeneration and decadence penetrate every social level, contagious fevers reach epidemic proportion. This point is particularly stressed in the Instructional Tantra and even more radically, as we will see, in the prophetic Vase of Amṛta, which starts with the narration of the fall of human society as the cause of pestilence and demonic forces. Another fundamentally remarkable correspondence between the Instructional Tantra and the Vase of Amṛta concerns the idea of poison in relation to demonic influences. While Vāgbhata’s Essence of the Eight Branches clearly distinguishes the scents of plants (sman dri), poisons (dug), and demonic attacks (gdon gzhugs) as three different causes of rim diseases, the Instructional Tantra describes “poisonous influences of malevolent spirits” (’byung bo’i gdug) as a possible cause of contagion. This interpretation is restated in later exegetical sources, such as the Blue Beryl and the Supplements to the Instructional Tantra.33 3 Etiology and Taxonomy of Nyen and Rim according to the Vase of Amṛta The etiological models described in the Vase of Amṛta are consistent with those already examined. Both the natural and the demonic aspects of nyenrim are considered concomitant, but in the context of this prophetic literature, the moral and the supernatural causes of the disease are emphasized. According to the Vase of Amṛta, human arrogance and misbehaviors outrage 31 32 33 See Dominik Wujastyk, The Roots of Āyurveda: Selections from Sanskrit Medical Writings (London: Penguin Books, 2001), 79–91. Yan lag brgyad pa’i snying po bsdus pa 312/23–313/4; Bdud rtsi snying po yan lag brgyad pa gsang ba man ngag gi rgyud, 243/9–10; and Gso ba rig pa’i bstan bcos sman bla’i dgongs rgyan rgyud bzhi’i gsal byed baidurya sngon po’i mallika, 641/14–19. See also Sangs rgyas rgya mtsho, Man ngag gi yon tan rgyud gi lhan thabs, 97/6–7. See the previous note. See also Olaf Czaja, “The Four Tantras and the Global Market: Changing Epistemologies of Drä (’bras) versus Cancer,” in Medicine Between Science and Religion, ed. V. Adams et al. (New York, NY: Berghahn Books, 2011), 286. For use by the Author only | © 2019 Koninklijke Brill NV Communicable Disease in the Vase of Amṛta 231 the demons and gods of the eight classes (sde brgyad), and in turn the ferocious mamo exhale noxious (dug can) breath (kha rlangs), which forms clouds in order to disseminate deadly diseases. The final five hundred years of our cosmic eon are called a “dark age” (snyigs dus) of moral and spiritual degeneration, characterized by the dissolution of the social order and by the downfall of religious vows, wars, famine, and the diffusion of pestilence. The nature of the disease is vividly described using an imaginative and codified language, as can be inferred from this passage of the Vase of Amṛta, entitled Treatment for the All-Encompassing Oblivion: The Amṛta of Riving the Dead (cog ’gyel bcos thabs bdud rtsi shi sos): […] During the five hundred eons of degeneration, atrocious and horrific diseases [will appear]. They will be called the “poisonous allencompassing oblivion,” or the untimely death that befalls unexpectedly, baring its teeth with a sardonic grin. Trying to dispel them will be like facing a raging fire. They will be the death that comes under the conditions conducive to epidemic infections, and they will be difficult to cure. The mere sound of them will strike terror […].34 The nyen disease described in the Vase of Amṛta comes under the category of the “black poisonous all-encompassing oblivion” (ha la cog ’gyel nag po),35 a complex concept that simultaneously defines both the virulent and the deadly aspects of the pathology. Its symptoms are compared to those of a potent “poison” (ha la). Its fatal nature is expressed by the term chokgyel (cog ’gyel), which portrays the image of a multitude of falling corpses claimed by the disease, which “steals their life-supporting breath” (lus srog dbugs ’jags par byed pa).36 The dramatic description is ultimately accomplished with the demonic embodiment of the disease, which is represented by a ferocious sardonic mask. Nyen refers to a particular class of liminal beings dwelling in natural abodes, but at the same time it also identifies a particular class of diseases, heralds of divine ire, pathologies that are characterized by the presence of a noxious 34 35 36 ’Chi med bdud rtsi bum pa (1), 71v/1–3. ’Chi med bdud rtsi bum pa (1), 73/7. The Great Dictionary of Tibetan Medicine describes this nyen disease, which mainly affects the brain and the heart, as follows: dug can srin bus bskyes pa’i gnyan nad stobs chen snying dang klad pa la phog nad yod do kun ’gyel te srog ’dor byas pa’i don (Byams pa ’phrin las et al., Bod lugs gso rig tshig mdzod chen mo, 998). For use by the Author only | © 2019 Koninklijke Brill NV 232 Simioli parasite in the organism (dug can srin), which is related to the increasing impure yellow serum (chu ser) and blood.37 The term nyen, which already connotes the malignant nature of the diseases, is often correlated to specific adjectives, such as “wild” (rgod pa), thereby revealing the interpretation of the disease as an aggressive force, similar to a wild animal that can feed on human flesh. This is the initial phase of the disease, which corresponds to the demon’s bite (gdon gyi so bas bzung ba).38 The description of the disease called lhokpa (lhog pa), which subsumes different kinds of ulcers and swelling sores, is a paradigmatic representation of the fiery essence of nyenné. Lhokpa is described as follows: [Among] the signs of the disease [by which one can diagnose lhokpa] there is the [taxonomic] category of the four elements. The lhokpa disease associated with the wind element [is characterized by] pale and soft [pustules], the swelling is temporary and pulsating, and it is similar to a belly full of yogurt. The lhokpa associated with the fire element is bloody and painful, it manifests as a strong fever that flares up quickly and is permeated with a heat, which possess the quality of a flaming immeasurable mansion. The lhokpa disease associated with the water element is a swelling disease, soft and wet, and characterized by cool vesicles, which, to using a metaphor, [are cold] as a blue glacial turquoise lake. The lhokpa disease associated with the earth element is firm and solid; the swelling is firm and black in color and spreads over the head. It is similar to an iron pan turned upside down with the opening [on the ground]. Besides, there are the two categories of wild and wildest. The wild one spreads as quickly as a running elephant, the pain is strong, and it rides on the channels. The wildest is characterized by a large swelling [similar to] a volcano and it spreads radiating towards the edge [of the wounds]. It is also called the thorny plant with nine heads.39 Here wild (rgod) and wildest (yang rgod) represent two distinct categories of this disease, or two different degrees of the same disease. This taxonomy and the related terminology are also kept in later works on nyenné, such as Supplements to the Instructional Tantra.40 The preservation of this metaphorical 37 38 39 40 ’Chi med bdud rtsi bum pa (2) 40/ 17–18. See also the Guru’s Lesser Vase (gu ru bdud rtsi bum chung), which also was rediscovered by Dorbum. Slob dpon gso rig gces btus, 193/10–11: […] ming ni srin bu par pa ta zhes bya ba yin//. ’Chi med bdud rtsi bum pa (2), 10/15. ’Chi med bdud rtsi bum pa (2), 123/19–124/11. Sangs rgyas rgya mtsho, Man ngag gi yon tan rgyud gi lhan thabs, 208/13–209/8. For use by the Author only | © 2019 Koninklijke Brill NV Communicable Disease in the Vase of Amṛta 233 language is indicative of a certain level of coherence of the intellectual representation of these ulcers in pre-modern Tibetan medicine.41 Interestingly, this same description is found in the Son’s Benefit, where this description is said to drawn upon an oral pith instruction text (man ngag).42 According to the Vase of Amṛta, the natures of all the diseases are identical, but what differs is the specific organ or part of the body that is affected. The five macro-categories of nyenné are distinguished as follows: when the disease manifests externally (phyi ru byung ba), it becomes the aforementioned lhokpa (lhog pa), which has also three subcategories of “doe disease” (yu mo),43 the “lhok disease affecting internal [organs]” (khong lhog), and the “lhok disease affecting the calf” (byin lhog). When lhokpa affects the throat (gre bar byung ba), it is gakpa (gag pa); when it affects the viscera (don la babs pa), it is zertung; when it affects the hollow organs (snod par babs ba), it is “the pain afflicting the gastrointestinal tract” (rgyu zer) and “pain afflicting the upper part of the body” (stod zer).44 Along with these five, the texts enumerate the following rimné and nyenrim diseases: “epidemic influenza” (chams rims); “white and black poxes” (’brum dkar dang nag), and other similar diseases called bekgé (beg ge), “yellow-eye disease” (mig zer), or even the “disease affecting the brain” (klad zer); “plague” (byis rims, lit. “an epidemic [spread] by rats”); “dysentery” (dmar bshal); “twisted esphagus” (mid ’chus); and “sardonic grin” (’dzum ltag dgye), which aligns with the category of tetanus.45 41 42 43 44 45 In the history of ancient Eurasian medical systems, there are analogous cases. For example, the Hippocratic Corpus describes the nature of ulcers as “wild” or even “ferocious,” using a vocabulary inherited from Greek tragedies. Indeed, as the Hippocratic doctors transformed the metaphorical language of tragedy into technical language, medical scholars drew upon the imaginative and religious representation of disease provided in visionary works such as the ’Chi med bdud rtsi bum pa. For a further reading on the Hippocratic concept of epidemics see Jacques Jouanna and Neil Allias, trans., “Disease as Aggression in Hippocratic Corpus and Greek Tragedy: Wild and Devouring Diseases,” in Greek Medicine from Hippocrates to Galen, ed. Philips van der Eijk (Leiden: Brill, 2012), 81–96. Bu don ma, 121/1–122/2. “Doe disease” (yu mo) is a swelling disease characterized by spotted pustules similar to small pox. ’Chi med bdud rtsi bum pa (1), 111v/4–112v/1. ’Chi med bdud rtsi bum pa (1), 63v7/1–69v/4. The disease causes spasms that affect the facial muscles resulting in the appearance of a sardonic grin; it causes spasms of the back muscles and the consequent arching of the neck bones and spine. See ’Chi med bdud rtsi bum pa (1), 93r/5–93v/4. For use by the Author only | © 2019 Koninklijke Brill NV 234 Simioli 3.1 Diagnosis and Divinatory Prognosis of Nyenrim According to the Vase of Amṛta The following section will be devoted to the examination of the diagnostic techniques described in the Vase of Amṛta: we will observe how the hermeneutics of pathology are based on a detailed differential description of the diseases, which starts from the general symptomatology and proceeds to the specific symptoms, and lead to the localization and the identification of the noxious demons. The passages reveal a methodical accuracy that is a distinctive feature of a medical mentality: the spectrum of the symptoms, which in itinere becomes more and more specific, serves as frame of reference to isolate the significative morbific features, reconstruct the taxonomy of the pathology (see the above description of ulcers), and consequently apply the right cure.46 The description provides us with a sophisticated depiction of the internal body, which is the result of overlapping models of physiology that originated in tantric and medical matrices. The analyzed sections unfold an internal landscape of intricate paths (lam) connecting functional organs to hollow organs and sense organs (section 3.2), and hint to the visionary system of subtle light channels called “lamps” (sgron ma) of the Nyingma Great Perfection (rdzog chen) tradition (sections 3.2 and 3.3). The discussion will illustrate the inextricable twofold nature of the diagnostic process described in the Vase of Amṛta, at the same time divinatory and based on empirical observation. The main diagnostic sections of the Vase of Amṛta are: (a) the root diagnostic tantra, entitled Union of the Sun and Moon (rtags pa nyi zla kha sbyor), otherwise called the Mañjuśrī Heart Essence: Union of the Sun and Moon (’jam pa’i dbyangs kyi thugs kyi bcud nyi zla kha sbyor);47 (b) its commentary entitled the Exegetical Tantra Mañjuśrī Heart Essence: Union of the Sun and Moon, otherwise called the Exegetical Tantra: The Sun Illuminating the Diagnostic Signs (brtags pa nyi ma’i snang gsal bshad rgyud);48 (c) the Innermost Pillar of the Vital Force (yang gsang srog gyi ka chen);49 and (d) the Great Treasure of Vital Strength (srog gter chen gyi gyad).50 Both the Mañjuśrī Heart Essence texts begin with the invocation of Mañjuśrī, the primordial Buddha Vagiśvara, and 46 47 48 49 50 On empiricism in Tibetan medicine see Janet Gyatso’s groundbreaking work: Janet Gyatso, Being Human in a Buddhist World: An Intellectual History of Medicine in Early Modern Tibet (New York, NY: Columbia University Press, 2015). ’Chi med bdud rtsi bum pa (1), 7v/1–9v/1; ’Chi med bdud rtsi bum pa (2), 10–12. ’Chi med bdud rtsi bum pa (1), 9v/1–12v/5; ’Chi med bdud rtsi bum pa (2), 10–19. ’Chi med bdud rtsi bum pa (1), 44v/4–45v/6; ’Chi med bdud rtsi bum pa (2), 47–52. ’Chi med bdud rtsi bum pa (1), 35v/4–38r/1. In the ’Chi med bdud rtsi bum pa (2), 40–44; the title is the Medical Compounds of the Great Treasure of the Vital Strength (srog gter chen gyi sbyor ba). For use by the Author only | © 2019 Koninklijke Brill NV Communicable Disease in the Vase of Amṛta 235 his Bodhisattva youthful form, Kumāra. Being the embodiment of transcendent wisdom, he discerns the different aspects of these fatal diseases and can guide the practitioner during the diagnosis, thus the signs will appear clear to him as the “vision of the rising sun light” (rtags nyin shar dang ’dra). The diagnostic procedure is conceived as a process of divine inspiration (rtogs pa dang ldan pa dang zhing lha’i nga rgyal dang ldan).51 As we can infer from an analysis of the corpus, however, the diagnostic instructions in the root and exegetical tantras are also based on the detailed empirical observation of general and specific symptoms (spyi dang byed brag gi brtags) that manifest in connection with the three aspects of the diseases, which are “wind” (rlung), fever (tshad), and nyen. This is the reason why the disease is called the “black one, union of the three” (nag po sum sgril). Although, as we shall see, the progression of the disease is associated with the three humors, the connection of the demoniac disease with deviant winds is particularly stressed and points to an ancient medical conception, developed in different medical contexts. The Carakasaṃhitā describes the normal and abnormal function of wind with its divine creative and destructive powers, in nature and humanity.52 The perverted wind-demonic force (guiqi 鬼气) also characterizes epidemics and the class of xie 邪 diseases in traditional Chinese medicine.53 In order to diagnose the disease, the physician observes changes in the patient’s physical appearance and the physiopathology of pain through “channel examination” (rtsa brtags) and “uroscopy” (chu brtags). According to this system, every disease is associated with the “three disturbing factors,” as well as with “cold” (grang) or “heat” (tsha) manifestations of the febrile states and with the “categories of the five elements” (’byung ba lnga’i rigs). The prodromal phase of the disease, which is called the “gray unripened state of the disease” (skya rims ma smin), is related to “wind” and fever. In this phase, the demonic attack is detectable through the interpretation of “turbid dreams” (rmi lam nyag nyog). The following excerpt describes the “wind” aspect of the disease: In the case of “wind,” the pain is acute at dawn and in the evening (tho rangs dang dgong shin tu rlang); ocular bulbs are painful and the person may faint (mig ril na ’gyel snyoms byed); buzzing in the ears (rna ’ur) and despair (snying mi dga’) arise, as well as febrile states characterized by 51 52 53 ’Chi med bdud rtsi bum pa (2), 18/4–5. Priyavrat Sharma, Carakasaṃhitā: Text with English Translation (Varanasi: Chaukhambha Orientalia, 2014), 81–84. Vivienne Lo and Sylvia Schroer, “Deviant Airs in Traditional Chinese Medicine,” in Asia Medicine in Globalisation (Philadelphia, PA: University of Pennsylvania Press, 2005), 45–66. For use by the Author only | © 2019 Koninklijke Brill NV 236 Simioli intensive shivering (’dar bu). The symptoms are similar to those of “cold diseases that belong to the category of the element water” (grang ba’i nad ltar g.yo ’byung chu’i rigs); the pain is so strong that the bones of the lower part of the body seem to boil (ro smad kyi rus pa khol). The “pulse is empty and submerged” (rtsa stong bying) or “scarcely perceptible” (nyams chung); feces and urine are retained and fever moves through the circulatory system (rtsa chu dal ba rtsa kha tsha ba ’ong).54 The state of fever places these diseases under the “category of the fire element” (’byung me’i rigs), which are characterized by intense “shivering and straight body hair” (phrum ser khyer), “dry nose and mouth” (kha sna skams), and a “quick pulse” (rtsa mkhyogs). The intermediate and increasing state of the disease (’bar rgyas rtags) is the visible sign of nyen. During this phase the disease manifests the symptoms of “phlegm” (bad kan), “bile” (mkhris pa), or combined disorders (’dus pa). The first category is characterized by a “black tongue” (lce nag), “deterioration of the sense faculties” (dbang po nyams), a submerged and “profound pulse” (gting rtsa), or a “subtle pulse” (phra rtsa) and an “accelerated pulse” (myur rtsa). The latter category is associated with the “element space” (’byung nam mkha’i rigs) and shows all the symptoms together (kun ’dus pa). The disease process culminates in irreversible injuries of functional organs (don la ’babs). It should also be said that this diagnostic section finds correspondences in the general description of symptoms provided in the Sons’ Benefit and the Four Tantras.55 3.2 Pathogenic Demonic Pulses in the Vase of Amṛta The “pulses of obstructive beings” (bgegs rtsa) are the abnormal pulses of functional organs and reveal the class and the nature of demonic forces. Every functional organ is associated with a sense organ and one of the five elements, which are considered “mounts of the obstructive forces” (bgegs ’byung ba bzhi nam kha’ dang lnga rta la zhon). These pulses show clear similarities with descriptions provided in the Ultimate Tantra (phyi’i rgyud) of the Four Tantras and with the medical literature predating it, such as the Lamp of Sunrays (nyi zer sgron ma) attributed to Nāgārjuna. Every organ corresponds to a specific class of elemental beings. According to the Vase of Amṛta, “king spirits” (rgyal po) are related to the heart; “demons of madness” (smyo ’dres) are related to the lungs; “serpent spirits” (klu), “earth lord spirits” (sa bdag), and “haunting 54 55 ’Chi med bdud rtsi bum pa (2), 14/1–8. Bu don ma, 84–99; Bdud rtsi snying po yan lag brgyad pa gsang ba man ngag gi rgyud, 243 et passim. For use by the Author only | © 2019 Koninklijke Brill NV Communicable Disease in the Vase of Amṛta 237 ghosts” (bstan) are related to the liver; “mother goddesses” (ma mo) and serpent spirits are related to the kidneys; and “cannibal demons” (sa srin) are related to the intestines.56 These obstructive forces are localized through: (a) their entrances (’jug sgo); (b) their “wandering pathways” (’grims pa’i srang); (c) “regions and residences” (yul gnas); and (d) “fortresses” (rdzong).57 A geographic imaginary is involved in the construction of the environment for the description of the pulses. (a) The demon of the regal caste (rgyal rigs) mounts the fire element and enters the body from the life-force cakra (srog ’khor) aperture of Brahmā at the top of the head. The demon of the servile class (dmangs rigs) mounts the water element and enters the body from the door of the “karmic wind of formative actions” (’du byed las kyi rlung) or from “nerves and tendons of the heel of the foot” (rkang mthil chu rgyus sgo). The demon of the aristocratic class (rje rigs) mounts the wind element and enters the body from “right subtle channel” (ro ma’i sgo). The Brahmin demon (bram ze) mounts the earth element and enters the body from the “door of the left subtle channel” (rkyang ma sgo nas ’jug). The outcaste demon (gdol ba can) is a “friend of the space element” (nam mkhar ’grog) and enters the body from the central “all-vibrating channel” (kun ’dar ma). (b) The king demon wanders from the triangular path of the heart to the tongue. The aristocratic demon wanders from the “snowy mountain path of the lungs” (gangs ri glo ba’i lam) to the nose (dri ’dzin lam); the Brahmin wanders from the “quartz-mountain path of liver” (mchong ri mchin lam) to the eyes (gzugs’ dzin lam); the servant wanders from the “kidney path of nyen” (mkhal ma gnyan lam) to the ears (sgra ’dzin lam); and the outcaste wanders from the “spleen path” (mtsher lam) to the lips. (c) The king demon’s domain is the “triangular region of the heart” (zur gsum snying gi yul), and its residence is the intestines (rgyu ma nag du gnas); the aristocratic demon’s domain is the snowy mountain of the lungs while its “residence is the colon” (long gi nang gnas); the Brahmin’s region is the quartz mount of the liver; its residence is the gallbladder (mkhris pa’i nang gnas); the servant’s region is the cold region of the kidneys, while its residence is the 56 57 ’Chi med bdud rtsi bum pa (1), 43v/2. See also Bdud rtsi snying po yan lag brgyad pa gsang ba man ngag gi rgyud, 565/15–566/4; Rtsa yig cha nyi zer sgron ma (Beijing: Mi rigs dpe skrun khang, 2008), 368/8–21. For a further inquiry into the concept of demonic diseases in Tibetan medicine see Susannah Deane, “Madness and the Spirits: Examining the Role of Spirits in Mental Illness in the Tibetan Communities of Darjeeling,” in the present volume. ’Chi med bdud rtsi bum pa (1), 42r74–43r/5; ’Chi med bdud rtsi bum pa (2), 48/7–49/17. For use by the Author only | © 2019 Koninklijke Brill NV 238 Simioli urinary bladder (lgang pa). The outcaste’s region is the secret spleen and its residence is the stomach (pho ba’i nang du gnas). (d) The king demon lives in the heart-fortress, the “mind-lake of memory” (tsi ta dran pa’i mtsho); the aristocratic demon lives the kidney-fortress, the “tent-like-lake of the breath” (gur khyim dbugs gi mtsho); the Brahmin lives in the liver-fortress, the “quartz-mountain and lake of blood” (mchong ri khrag gi mtsho); the servant lives in the kidneys-fortress, the “lake of urine and cold disease” (grang ba chu’i mtsho); and the outcaste lives in the spleen-fortress, the “lake of fever and composite disorders” (tsha ba ’dus pa’i mtsho). 3.3 The Signs and Pulses of Death The “final signs of death” (tha ma ’chi rtags) are detected through the observation of “dissolving sense-faculties” (dbang thim) and can be predicted by examining the channels (’phar rtsa sgo nas brtags) and by interpreting premonitory secret signs. In this section, we will analyze the first two methodologies, while the third will be considered in the next section. In particular, we will observe that, according to the text, each external sign of a limited or absent sense faculty corresponds to an internal sign concerning an injured or collapsed functional organ, which ultimately reveals the dissolution of the related elemental constituent (don lnga’i khams nyams). The dying process is essentially the “dissolution of the five elements” (’byung ba thim) and takes place when the elements fade one into another, in reverse order to that of the birth process.58 The Vase of Amṛta does not refer to the visions experienced during this dissolution, which are usually found in other tantric texts. The breathing process indicates radical changes of the directions of subtle winds, which start from the nostrils (sna rlung g.yas g.yon ’gyu chad log). When the earth element dissolves into the water element, the spleen is injured and the sensation of intense heaviness prevails. The process continues with the water fading into fire, which corresponds to dysfunctions of the kidneys, indicated by the dissolution of the sense-faculty of hearing. Subsequently, the element fire fades into the wind causing deficiency of body heat. This is a sign that the disease has reached the liver and therefore leads to the dissolution of the faculty of sight. Then consciousness dissolves into the wind elements and “breath is reversed” (dbugs ldog); it connotes injury to the lungs and the dissolution of the faculties of smell. When the heart is injured, the faculty of taste is hindered. 58 The second chapter of the Explanatory Tantra (bshad rgyud) of the Four Tantras is devoted to the description of the birth process or “formation of the body.” See Bdud rtsi snying po yang lag brgyad pa’i gsang ba man ngag gi rgyud, 16/7–20/7. For use by the Author only | © 2019 Koninklijke Brill NV Communicable Disease in the Vase of Amṛta 239 Death pulses also show clear similarities with the description provided in the Ultimate Tantra and the Lamp of Sunrays. Among these pulses there are: (a) those regarding the signs that a “disease of the water class that manifests in the case of a disease belonging to the class of the fire element” (chu rtags me la byung), which means that the fevers and the pulses typical of a febrile state show characteristics that are usually associated with cold diseases; and (b) the process opposite to the previous one that occurs when the “signs of the diseases usually associated with the class of the fire element manifest in case of a disease characterized by the element water” (me rtgas chu la byung).59 This irregular manifestation is considered to be a result of the deceiving action of these demonic diseases. In another section of the text is said that, when hot and cold diseases present anomalous signs (tsha grang ma snyoms), the physician should be able to discern the real cause of the diseases through his or her penetrative knowledge, similar to an arrow of awareness (rig pa’i mda’), or like the blacksmith’s instrument, which can “dismember the illusory body” (sgyu lus dum bur btub) created by the demons.60 In this passage it is affirmed that, to cure the nyen disease, it is indispensable to rely on the scriptures, to know the nature of the disease (ngo ’dzin) and then accordingly apply the right cure (knowing the potencies of the medical substances; apply moxibustion or bloodletting; dietary and behavioral prescriptions). When these criteria and measures are insufficient, however, the physician will not fail due to the inspiration of the invoked divinity. What follows is a description of the death pulses expressed through similes of the exegetical tantra, the Union of the Sun and Moon, which again includes some correspondences with the above mentioned Four Tantras and Lamp of Sunrays. When the pulse resembles a frog jumping in the water, one is about to die.61 When the pulse resembles a falling drop or a bird that pecks grain from the ground, one is about to die.62 59 60 61 62 ’Chi med bdud rtsi bum pa (2), 17/10. ’Chi med bdud rtsi bum pa (2), 8/1–4 and 21/1–4. See similar definition of the demonic pulse in the Gso ba rig pa’i bstan bcos sman bla’i dgongs rgyan rgyud bzhi’i gsal byed baidur ya sngon po’i mallika, 1537/10: […] rtsa mi snyoms pa. This corresponds to the death pulse of a combination of phlegm and bile. This corresponds respectively to the death pulse of phlegm and the union of phlegm and wind. For use by the Author only | © 2019 Koninklijke Brill NV 240 Simioli When the pulse resembles a great banner blowing in the wind, one is about to die.63 When the pulse resembles to dropping saliva of a bull, one is about to die.64 As we can see here in the Vase of Amṛta we find only seven of the eleven pulses of death described in the Ultimate Tantra, excluding those regarding the weak pulse of a strong person, the pulse of long debilitated person, and the deviations in the bile pulse.65 3.4 Premonitory Signs of Death Two groups of extraordinary premonitory signs are provided by the Pillar of the Vital Force (srog gyi ka chen) and by the Treasure of the Vital Force (srog gter chen gyi gyad). All the signs are obscure metaphors correlated to exact interpretative keys. The Treasure of the Vital Force compares these signs to the hermetic images appearing in a mirror (brtags pa ’phrul kyi me long), therefore creating a parallel between this divinatory prognosis and prasenā divination.66 What follows is the translation of the signs described in the Pillar of Vital Force: If on the top of the mountain of the magical wheel the turquoise mist disappears, one is about to die. If the vapor emanated from the head dissolves, one is about to die. If the signs of pristine cognition disappear in the lamp-radiance of the ocean, one is about to die. If the iris, queen of the eye, appears soulless, one is about to die.67 If the pillar of the Sky and Earth is destroyed in the space, one is about to die. If the two forearms in the space appear like being cut off in the middle, one is about to die. 63 64 65 66 67 This corresponds to the death pulse of wind. This corresponds to the death pulse of combined humors. ’Chi med bdud rtsi bum pa (2), 17/15–20. See also Rtsa yig cha nyi zer sgron ma, 371/8–372/1. Rgyud bzhi, 565/4–6. ’Chi med bdud rtsi bum pa (2), 43/11–12. On prasenā divination see William A. McGrath, “Tantric Divination and Empirical Diagnosis: A Genealogy of Channel Prasenā Rituals in the Tibetan Medical Tradition,” in the present volume. ’Chi med bdud rtsi bum pa (2), 51/9–10: […] rgya mtsho mdangs kyi sgron ma la ye shes rang rtags yal na ’chi. The iris (mig gi rgyal mo) is the residence of the subtle channel where inner wisdom manifests on the outside through vivid eye light. For use by the Author only | © 2019 Koninklijke Brill NV Communicable Disease in the Vase of Amṛta 241 If the sound of the ḍākinī ceases within the inner recess of the forest, one is about to die. If there are no sounds in the ears, one is about to die.68 If one of the five guards that stay together, stands up one is about to die. If the artery of the ring finger pulsates, one is about to die.69 If the sun rises on the wheel of magical manifestations, one is about to die. If the body heat of the legs vanishes, one is about to die.70 If from the maṇḍala of water and great bliss, the moon goes down, one is about to die. If semen is emitted, one is about to die.71 The sign of the pulsating ring finger similarly occurs in the Ultimate Tantra as a sign of the demonic forces, or nyen: the “life-force channel” (bla rtsa), which is connected to the concept of life essence (srog) and life span (tshe), can be detected thought the pulse of the ring finger.72 The Exegetical Tantra (bshad rgyud), the second treatise of the Four Tantras, includes the premonitory signs of death regarding optical illusions appearing in the space, the examination of unusual shapes of the body shadow, as well as the analysis of iris luminosity.73 These series of metaphors remind one of the cryptic images described in the Union of the Sun and Moon (nyi zla kha sbyor) of the Seminal Essence (snying thig) scriptures of the Great Perfection (rdzogs chen), part of the Collected Instructions (man ngag sde).74 The following quotations are two examples of 68 69 70 71 72 73 74 ’Chi med bdud rtsi bum pa (2), 51/12–13: nag ’dabs gsang ba’i brag phug tu/ mkha’ ’gro’i rang sgra chag na ’chi/ rna ba’i sgra chag na ’chi//. ’Chi med bdud rtsi bum pa (2), 51/13–14: sdud byed so ba mi lnga nad so ba mi gcig lang na ’chi/ srin lag gi rtsa ba ’phar na//. ’Chi med bdud rtsi bum pa (2), 51/14–15: sprul ba ’khor lo’i grong khyer nas nyi ma gyen la ’dzeg na ’chi / rkang pa’i drod yal na ’chi//. ’Chi med bdud rtsi bum pa (2), 51/15–16: bde chen chu’i dkyil ’khor nas zla ba thur du babs na ’chi/ sa bon ’dzag na ’chi//. Baidurya sngon po, 1559/1–4. Bdud rtsi snying po yan lag brgyad pa’i gsang ba man ngag gi rgyud, 32/11; 33/1–5;37/7–16. According to Ronald Davidson (Tibetan Renaissance: Tantric Buddhism in the Rebirth of Tibetan Culture [New York, NY: Columbia University Press, 2005], 228–29), the Collected Instructions (man ngag sde) most probably were compiled around the eleventh and the twelfth centuries. See also the Instructions on the Six Lamps from the Aural Transmission from Zhang zhung of the Great Perfection (rdzogs pa chen po zhang zhung snyan rgyud las sgron ma drug gig dams pa): its sixth and last chapter is very similar to the Nyi zla kha sbyor section on the signs of death but contains further explanations. Zhang zhung snyan rgyud zhang zhung snyan rgyud las sgron me drug gi gdams pa. In Zhang zhung snyang rgyud kyi gsung pod (Lun grub steng: Sde dge par khang, [n.d.]), 10a/5–11a/6. For use by the Author only | © 2019 Koninklijke Brill NV 242 Simioli the paradigmatic correspondence: “When the pillar of the Sky and Earth is destroyed, one is about to die” (gnam sa gnyis kyi ka gdun de/ bar snang chag na ’chi); “If the sound of the ḍākinī ceases within the inner recess of the forest, one is about to die” (nag ’dabs gsang ba’i brag phug tu/ mkha’ ’gro’i rang sgra chag na ’chi).75 Therefore, we might assume that some diagnostic methods and divinatory techniques exposed in the Vase of Amṛta have connections with, and could derive from, the notions developed in the context of the early Seminal Essence literature. At this stage of the research, the exact history of transmission of these diagnostic techniques cannot be established with certainty. However, the congruences among the various texts point to different literary traditions and narrative nuclei as possible sources for the development of demonic pulses on one hand, and for the prediction of signs of death on the other. The first represents a syncretistic literary tradition based on development of pulse taking, which shows clear similarities with Chinese sphygmology, and had integrated elements of the ancient Indian Buddhist demonology, magical healing, and exorcistic methods emblematically represented by specific categories of tantras, such as the Garuḍatantras (see section 4). In this tantric literature the ailments of the human body are attributed to divine factors, and magico-religious means are utilized in the cure. In the Tibetan medical context, the syncretic elaboration of pulse-taking and demonology (bhūtavidyā) is well represented by the scriptures ascribed to Nāgārjuna, such as the Moon King and the Lamp of Sunrays. This second literary tradition has developed from a hermeneutic sensibility that originated in the tantric investigation of ontological and soteriological themes. In this literature the examination of the nature of the mind and death and dying processes are associated with yogic and contemplative techniques for experiencing them. The cited Seminal Literature sources are paradigmatic examples of these concepts. 75 ’Chi med bdud rtsi bum pa (1), 44v/3–49v/1. The first verse is explained as an optical illusion that arises when staring at the forearms fixed in a particular position. For an analysis on the corresponding verses in the Union of the Sun and Moon, see Giacomella Orofino, Sacred Tibetan Teachings on Death and Liberation (Bridport, Dorset: Prims-Unity Press, 1990), 33, 93. See also Nyi zla kha sbyor chen mo gsang ba’i rgyud, in Rnying ma rgyud bcu bdun (Dpal yul rdzong: A ’dzom chos sgar par khang, 2000), 28r/1–6; and Zhang Zhung snyan rgyud las sgron ma drug gi gdams pa (Lun grub steng: Sde dge par khang, [n.d.]), 10a/5–11a/6. For use by the Author only | © 2019 Koninklijke Brill NV Communicable Disease in the Vase of Amṛta 243 3.5 Knowing the Body and Defining the Nature of the Diagnostic Process: Overlapping Models of Physiology The Vase of Amṛta provides us with a complex image of the body that integrates elements of different medical systems with demonology and tantric physiology. In the following, this imagery will be used as a guiding thread for reexamining the previous sections. In light of these therapeutic systems, we will also consider the diagnostic processes as a joining of divination and observation. As seen, the architecture of the body is organized according to spatial and temporal patterns. The perspectives are pushed inwards, moving from material embodiment (skin, muscle, bones, organs, and arteries) to the luminescent innermost essence of being (subtle channels, winds, and awareness). Accordingly, it can be observed that the first step of the diagnostic process is the perception of the body through visual observation (patient’s physical appearance and mental status), pulse taking, and urine analysis. Therefore, the signs (rtags) are interpreted in order to formulate a series of inferences and establish a prognosis. This process is complemented by speculative models: the medical approach to the diseases is underpinned by the theoretical apparatus of Buddhist cosmology, physiology, and knowledge of the nature of mind and its structures. The disease process is not only outlined according to Āyurvedic humoral physiopathology, but it also mirrors the dissolution of the elements (earth, fire, water, wind, and space), which regulates the state of constant metamorphosis of the entire universe. The internal body is depicted as a microcosm, a reflection of the tantric knowledge of subtle channels. It evolves around an axial construction, the vital pilaster (srog gi ka chen) formed by three right, left, and central channels (ro ma, skyang ma, and kun ’dar ma). The first two are connected on a more physical level to breath and blood, while the third is connected to emptiness, thus its materiality is considered very subtle. The channel of “karmic wind of formative actions” (’du byed las kyi rlung) is associated to the triad: this corresponds to the channel of “karmic wind” (las kyi rlung), related to the arising of discursive thoughts and karmic propensity, which is in several Great Perfection sources and is described as abiding in the lungs or located between lungs and heart.76 This channel might correspond to the “life channels” (tshe’i rtsa) of vital breath, also described in Tibetan medical literature, such as the Exegetical Tantra.77 According to Vase of Amṛta, consciousness and conceptual thoughts 76 77 Daniel Scheidegger, “The First Four Themes of Klong chen pa’s Tshig don bcu cig pa,” Revue d’Etudes Tibétaines 16, no. 2 (2009): 67–68. Janet Gyatso, Being Human in a Buddhist World: An Intellectual History of Medicine in Early Modern Tibet (New York: New York University Press, 2015), 202. For use by the Author only | © 2019 Koninklijke Brill NV 244 Simioli arise due to the karmic wind, whereas the mind itself is located at the center of the heart: the word citta (tsit ta) defines both the mind and the heart, which is considered its palace, and is connected to memory (dran pa). The text is consistent with the conception of mind luminosity developed in the Seminal Literature of the Great Perfection. It shows similarities with the conception of luminous channels or “lamps” (sgron ma), and in particular the Vase of Amṛta refers to the capacity of “pristine awareness” (ye shes) to show its luminosity (mdangs) through the eyes, elements that also indicate the presence of a channel connecting heart to the eyes.78 Cognition (shes pa) is associated to another channel called the “vital channel” (srog rtsa). Its affliction causes alteration of the mental status (shes ’khrul), as well as bloody eyes and pain radiating all over the torso. This channel seems to be connected both to the nervous system and the cardio-vascular system, as well as to the life-force (bla rtsa) channel since it can be detected at the ring finger channel (srin lag).79 Indeed, according to the Vase of Amṛta, cognition is also related to different organs: it relates to the heart, whose role seems to be associated with the clarity of thoughts, therefore, when the heart is affected by nyen, thought loses its clarity (dran pa mi gsal shes pa ’tshub, lit. “unclear memory and turbid/ confused cognition”). Cognition is also related to the liver and spleen, which, when damaged, determine different levels of “heavy cognition” (shes lci; shes pa shin tu lci).80 In the first case, the problem occurs because liver cannot purify the blood, causing a disease that aligns to jaundice (mkhris nad, lit. “disease of the gallbladder”; mig ser, lit. “yellowish eyes”); consequently this disorder affects the brain (klad gzer), causing a loss of brain functions and bloody eyes.81 An injured spleen affects the formation of concepts and mental focus (dmigs thams cad g.yo bar byed).82 We can assume that, even though the text does not refer to the “vital channel” as “black or white vital channels” (srog dkar nag), a distinction applied in the medical literature, it describes the vital channel in terms of the functions associated to these two categories of channels. The text provides us with the description of the location of the “vital channel” in the physical body. Its upper extremity coincides with the cakra on the top of the head (srog ’khor spyi gtugs). There also are scattered references within the chapters explaining the secret points of moxibustion (me btsa’ gsang dmigs): the secret point of the vital channel is located at the sixth vertebral digit, which 78 79 80 81 82 For further inquiry on “lamps” and their categories see Daniel Scheidegger, “Lamps in the Leaping Over,” Revue d’Etudes Tibétaines 8, no. 10 (2005): 40 et passim. ’Chi med bdud rtsi bum pa (2), 63/13–18. ’Chi med bdud rtsi bum pa (2), 15/14–16/1. ’Chi med bdud rtsi bum pa (2), 15/21–24; 177/4–5. ’Chi med bdud rtsi bum pa (2), 12/ 17–18. For use by the Author only | © 2019 Koninklijke Brill NV Communicable Disease in the Vase of Amṛta 245 is not far from the “equidistant point between the black and white” (dkar nag mtshams), and the so-called “secret point of the heart” located at the intersection of the horizontal line between the nipples and the vertical distance between the throat cavity and the breast bones.83 Therefore, we can assume that the “vital channel” extends from the head crown downward, passing through the throat and heart, and connecting to the brain and the eyes. This microcosm conforms to precise heuristic schemata of correspondences and contrapositions: geographical elements, citadels and paths establish a web of connections among functional organs (heart, liver, kidneys, spleen, and lungs) and hollow organs (intestine, colon, gallbladder, urinary bladder, and stomach). This system of correspondences between the two groups of organs derives from Chinese influence.84 The contraposition of mountains and lakes denotes the nature of organs in terms of solidity and softness, and in particular the watery aspect indicates the function, or the faculty associated to each vital organ. The description involves anatomical details, such as those regarding the intrathoracic triangular region with the heart at its center covered by the tentshaped lungs, an image that recalls the medical representation of the body reproduced in the famous seventeenth-century medical paintings. The landscape of the body is inhabited by wandering spirits that move through the channel-paths, which connect the functional organs to the sense organs. Therefore, by observing the sense faculties and detecting the deviating pulses, it is possible to understand which demonic classes have afflicted the patient. The notion of five demonic fortresses is similar to the description of spirit castles (mkhar) inhabited by pathogenic demons in the Diagnostic Signs and Cures of the Eighteen Kuṣṭha Diseases Based on the Tantra of Peaceful and Irate Manifestations (mdze rigs bco brgyad kyi rtags rdo rje bde khros kyi dgongs pa las byung ba), ascribed to Nāgārjuna.85 According to this work, a certain group of symptoms reveal the demonic fortress, and consequently the right cure is administered. In the Vase of Amṛta the internal landscape might be considered to be a demonological chart, envisioned in order to individuate the hiding spirits. It illustrates specific body areas or points that are to be manipulated through different categories of moxibustion, such as “burning 83 84 85 ’Chi med bdud rtsi bum pa (2), 125/16. The Vase of Amṛta does not include a clear formulation of the “triple burner” (sam se’u), the sixth hollow organ of Chinese medicine, which was assimilated in Tibetan medicine through works like the Moon King. See William A. McGrath, “Vessel Examination in the Medicine of the Moon King,” in Buddhism and Medicine: An Anthology of Premodern Sources, ed. C. Pierce Salguero (New York, NY: Columbia University Press, 2017), 501–13. Klu sgrub, Mdze rigs bco brgyad kyi rtags rdo rje bde khros kyi dgongs pa las byung ba, in Slob dpon klu sgrub kyi sman yig (Beijing: Mi rigs dpe skrun khang, 2008), 140–42. For use by the Author only | © 2019 Koninklijke Brill NV 246 Simioli moxibustion” (me bsreg) or “warming moxibustion” (sdigs me), and bloodletting (gtar), which are prescribed as external therapies in the case of ulcers, swelling diseases, poxes, and diseases afflicting the internal organs of the upper and lower parts of the body (stod gzer and rgyu gzer). In this context, the therapies are ritualized and reconfigured as methods to tear away the demonic nyen from the body. The healer is also instructed to observe the body in search of the wandering nyen spirits. This should take place within the “vital channel” from the crown of the head to the “red eye-channel” (mig dmar) below the navel at the groin area, at the armpit point (dpung dzum), at the “ratna point of the wind channel” (rtsa rlung rat na), and at the heart secret point. Then, applying the “moxa to close the channel” (rtsa’i ’bros ’phrang bsdoms), the practitioner should block the demonic flow by burning a circumscribed area at the its perimeter and then in the middle, where the nyen abides.86 Other two emblematic descriptions regard the “warming interdependent moxibustion” (sdigs rten ’brel gyi me) and the “mirror moxibustion” (me long btugs me). The first consists of burning the secret points of the first vertebral digit at the nape of the neck, the sixth vertebral digit and at the secret point of heart, while reciting mantras to tear away the serpent spirits from the body. The latter starts with an examination of the pulse and an analysis of a patient’s feces (’khru mdog) to individuate the injured hollow organ. Afterwards the mirror-moxibustion should be performed using a mirror as an implement: it has to be applied directly on the skin and where it reflects a specific form or, we might say when the practitioner scries a significant vision, that point or area should be burned or pierced, since this would be considered the demonic residence.87 A lengthy description of these two kinds of moxibustions is also provided by Deumar: when performing the first kind of moxibustion, the practitioner should visualize himself/herself as red fiery goddess and recite the mantra of interdependence. In the second case, the evoked divinity dissolves in a consecrated mirror (pra thim), which is then used for moxibustion.88 In the Vase of Amṛta, the body is a system intelligible on multiple levels. The evidence and visions of its nature and alterations change according to the methodology of diagnosis. The signs are structured according to physician’s experiential understanding of the body and its functions; moreover, the 86 87 88 ’Chi med bdud rtsi bum pa (2), 125/13–18. ’Chi med bdud rtsi bum pa (2), 140/21–24: […] mdun rgyab du me long btsugs pa de la gzugs kyi rtags me long la snang ba de la btsod kyi me btsas bsreg. De’u dmar bstan ’dzin phun tshogs, Lag len gces rigs sdus pa sman kun bcud du sgrub pa’i las gyi cho ga kun gsal snang mdzod ces bya ba bzhugs in Dri med shel gong dang dri med shel phreng dang lag len gces bsdus (S. W. Tashigang: Leh, 1970), 565/6–566/9. For use by the Author only | © 2019 Koninklijke Brill NV Communicable Disease in the Vase of Amṛta 247 interpretation is substantiated by acquired knowledge based on the textual tradition (zhung bzhin, lit. “according to the scriptures”) and divine inspiration. In respect to the latter aspect, it should be said that in different passages the text affirms that the interpretation of signs and the medical practice is guided by Mañjuśrī or by a wrathful divine manifestation (see the next section). In this sense the terminology “arrow of awareness” used to penetrate the illusion created by demons and understanding the nature of the disease, assumes the value of contemplative “state of awareness” (rig pa), which allows the physician to discern the three causes of the disease (nyen, fever, and wind) and individuate the injured/afflicted organ. This divine arrow represents the trace of the ancient divination and exorcistic ritual of sucking away (’jib rgyab) the disease, which is alleged to be of Bön origin. This practice is carried out by setting up a special divination-arrow (mda ’dar) to pierce the demon residence found by a mirror and a bowl to collect the puss from the infected blood and serum.89 In the Vase of Amṛta, the Reversal Suppressant [Ritual] of Sucking [the Infection] with the Adamantine Sow’s Tongue (log gnon phag mo’i ljags ’jibs) clearly refers to this practice: the healer is the manifestation of the Black Sow Goddess who devours the nyen with her meteoric lips, a lancet (gtsag bu) is used to cut the pustules of ulcers is envisioned as the “fangs of a wild boar” (phag rgog mche bar bsgom), and the purulent serum sucked away from the scars becomes nectar.90 The use of mirror as a scrying implement associated with the practice of moxibustion and the ritualized therapies to exorcise pathogenic demons not only substantiates the divinatory aspect of the diagnosis, but also shows how different methodologies have been adapted and assimilated in the Tibetan medical tradition. 4 Magical Protection and Invulnerability: How to Realize the Vajra Armor and Manipulate the Secret Potencies of Materia Magica In the Vase of Amṛta, ritual magic (evocation rituals), image magic (preparation of textual amulets), natural magic (uses and consecration of materia magica), and alchemy merge into complex apotropaic rituals for averting diseasecarrier demons. The Long [Ritual] Vajra Armor of Meteoric Metal (nam lcags rdo rje’i khrab ring) and the Armor that Protects the Vital Force (srog gi srung gi 89 90 de Nebesky-Wojkowitz, Oracles and Demons of Tibet, 365–66. ’Chi med bdud rtsi bum pa (1), 110r/1; ’Chi med bdud rtsi bum pa (2), 152/11. For use by the Author only | © 2019 Koninklijke Brill NV 248 Simioli go cha)91 describe the powerful practice of “vajra armor” (rdo rje’i khrab, otherwise called go cha or go khrab), which allows for the achievement of magical invulnerability, of an unspoiled divine and immortal body. Not different from the kavaca rituals found in diverse Hindu traditions,92 “vajra armor” includes a certain set of practices: the recitation of magical formulas, the summoning of a divinity to enter the practitioner’s body, and the transformation into a divine being. It also involves the preparation of protective textual amulets (srung ’khor, lit. “protective wheel”), magical unguents (phyug sman), pills (ril bu), and powders (phur ma). The preliminary purification process consists of lengthy recitations of sūtras (mdo sde), “dietary prescriptions” (mi ’phrod za, lit. “unwholesome food”), and sexual abstinence. The central practice includes two phases: (1) “internal protection” (nang gi srung), which involves incantations, amulets and empowerments of medical substances; and (2) “secret protection” (gsang srung), or the meditative practice centered on the wrathful blue Khyung (garuḍa). Given the venomous nature attributed to nyenné and rimné diseases, the Vase of Amṛta represents the conflation of a long-life nectar and an alexipharmic antidote. Different sets of substances called the “nine heroes” (dpa’ bo rnam dgu),93 which belong to different categories of materia medica, are the fulcrum of arcane alchemical procedures aimed at transforming substances into an antidote for poisons and other diseases. The definition of the “nine heroes” indicates their intrinsic therapeutic potencies and occult virtues (nus mthu),94 91 92 93 94 ’Chi med bdud rtsi bum pa (1), 12v/1–16v3; ’Chi med bdud rtsi bum pa (2), 24–29; and ’Chi med bdud rtsi bum pa (1), 104r/1–117v/6; respectively. For a further inquiry see Karel R. Van Kooij, “Protective Covering (Kavaca),” in Selected Studies on Ritual in the Indian Religions, ed. Ria Kloppenborg (Leiden: Brill, 1983), 118–29; and Bühnemann, “Maṇḍala, Yantras and Cakra.” The lists of substances provided in the ’Chi med bdud rtsi bum pa present some variations. According to ’Chi med bdud rtsi bum pa (2), 24/16–18; the nine substances are gla ba, gu gul, gi wang, shin kun, shu dag, sman chen, a ru ra, ldong ros, and sgog skya. According to ’Chi med bdud rtsi bum pa (2), 65/8–10; there are ten substances, i.e. gul nag, bong nga nag po, spru nag, gla ba, shing kun, shu dag, mu zi, stag sha, ldong ros, and sa tshur. According to ’Chi med bdud rtsi bum pa (2), 70/12–1; (a) the substances used for preparing the protective unguent are: gla ba, gu gul, shing kun, shu dag, rma chen, ldong ros, gi wang, tharnu, and sgog skya; and (b) the substances used for the medicinal powders are: sha chen, spru nag, stag sha, gla ba, mu zi, bong nga, yung ba, and ru rta. Mthu means power and in general is used to indicate black curse. In this context, it refers to the magical protective and reversal or exorcistic power (bzlog pa) of substances and amulets. ’Chi med bdud rtsi bum pa (1), 14v/6–15r/1; ’Chi med bdud rtsi bum pa (2), 27/2–9: […] thams chad ’tshogs pa’i zu gu la sogs pa nus mthu yis// nad kyi bkal ba byung gyur rang la ’gos pa mi srid do//[…] ’chi bdag bdud las bzlog par ’gyur […]. For use by the Author only | © 2019 Koninklijke Brill NV Communicable Disease in the Vase of Amṛta 249 which are mainly apotropaic virtues. In this group there are substances of animal origin such, as musk95 and bezoar stones,96 which are considered excellent antidotes for poisoning. There are also plant exudate such as the guggul gum resin,97 whose medical and ritual uses are well documented since ancient Vedic times. There are substances of mineral origin such as sulfur and realgar, two important ingredients of mercurial medicine.98 The text enumerates the myrobalan fruit,99 famous for its rejuvenating potencies, along with plants used for curing different kinds of communicable and malignant diseases, 95 96 97 98 99 Gla ba. It is categorized as “essence medicines” (rtsi sman). Most probably it corresponds to the male musk deer, responsible for the production of musk (gla rtsi can), which is used in Tibetan medicine. It can be identified with the Siberian Moschus moschiferus Linnaleus, see for example Dga’ ba rdo rje, ’Khrungs dpe dri med shel gyi me long (Beijing: Mi rigs dpe skrun khang, 1995), 102; however, there are other possible identifications. See Olaf Czaja, “The Substitution of Materia Medica in Tibetan Medicine: An Inquiry into Traditional Tibetan Treatises,” East Asian Science, Technology and Medicine 46 (2017): 174–75. According to Jampa Trinlé et al. (Byams pa ’phrin las et al., Bod lugs gso rig tshig mdzod chen mo, 116–17) gla rtsi can cure “poisoning” (dug nad), “kidney diseases” (mkhal nad), nyen fevers, and infective “sin diseases” (srin nad). For detailed references on ancient medical uses of musk in Tibetan and Arabic medicine see Akosay and Yoeli-Tlalim, “Along the Musk Routes,” 217–40. Gi wang. See for example Dga’ ba rdo rje, ’Khrungs dpe dri med shel gyi me long, 99; and Byams pa ’phrin las et al., Bod lugs gso rig tshig mdzod chen mo, 127–28. Both sources describe giwang as a powerful remedy to cure poisoning, rim diseases, different kinds of fever such as the fevers in infants (byis pa’i tshad), febrile states connected to several organs and in particular those affecting the liver and the bile duct (mchin mkhris gtsor rgyur don snod kyi tshad sel), and episodes of hysteria followed by collapse and shivering (smyo ’bog brgyal dang ’dar ba). Gu gul also belongs to the category of “essence medicines”; according to Gawa Dorjé (Dga’ ba rdo rje, ’Khrungs dpe dri med shel gyi me long, 120) it is identifiable as Commiphora mukul and is particularly efficacious in annihilating different kinds of obstructive spirits and planetary hindrances (bgegs skrod, ’dre klu, bdud dug gsod; gza’ gsod); according to Jampa Trinlé (Byams pa ’phrin las et al., Bod lugs gso rig tshig mdzod chen mo, 98–99) this substance is particularly efficacious in curing “leprosy” (mdze nad) and other categories of nyenrim diseases. Mu zi and ldong ros. See for example Dga’ ba rdo rje,’Khrungs dpe dri med shel gyi me long, 72–73; 67–68. A ru ra is commonly identified with the chebulic myrobalan fruit. See for example Dga’ ba rdo rje, ’Khrungs dpe dri med shel gyi me long, 167–69. It is considered a very potent rasāyana substance. It cures different kinds of fever and eye diseases, and “dispels evil forces” (gdon sel ba). For use by the Author only | © 2019 Koninklijke Brill NV 250 Simioli epidemics, and poison-induced fevers, such as ferula,100 costus,101 turmeric,102 locoweed,103 the purgative root of tharnu (thar nu),104 Notopterygium,105 and the poisonous black aconite.106 100 101 102 103 104 105 106 There are several identifications of shing kun plant, the majority belong to the Ferula species. For a detailed discussion see Czaja, “The Substitution of Materia Medica in Tibetan Medicine,” 195–96. According to Gawa Dorjé (Dga’ ba rdo rje, ’Khrungs dpe dri med shel gyi me long, 299–300) and Jampa Trinlé et al. (Byams pa ’phrin las et al., Bod lugs gso rig tshig mdzod chen mo, 912–13) there are two variants of the shu dag plant both from the aquatic Araceae species: the white one (shu dag dkar po) is identifiable with Acorus gramineus Soland; the black one (shu dag nag po) is identifiable with Acorus calamus. Most probably, the author of the ’Chi med bdud rtsi bum pa, refers to the latter because this variant, according to the mentioned sources, “can overcome diseases characterized by ‘impure serum’ (chu ser), bad wounds and ‘putrefactions’ such as the gaklhok disease” (gag lhog rma ngan rul ba rnams gcod la chu ser skam) and can also “bring out nyen fever” (gnyan tshad gyen du ’dren par byed pa). Ru rta is commonly identified with plants of the Asteraceae family commonly known as Costus. For a detailed discussion see Czaja, “The Substitution of Materia Medica in Tibetan Medicine,” 194–95. For further references on the therapeutic potential of Saussurrea Lappa, see Kulsoom Zahara et al., “A Review of Therapeutic Potential of Saussurea lappa: An Endangered Plant from Himalaya,” Asian Pacific Journal of Tropical Medicine 7, no. 1 (2014): 60–69. Yung ba, according to Gawa Dorjé, is identifiable with Curcuma longa, a perennial plant of the Zingiberaceae family, particularly effective against envenomation and nyen diseases. See Dga’ ba rdo rje, ’Khrungs dpe dri med shel gyi me long, 192. Stag sha is usually identified as a locoweed species. See Czaja, “The Substitution of Materia Medica in Tibetan Medicine,” 197–98. According to Jampa Trinlé (Byams pa ’phrin las et al., Bod lugs gso rig tshig mdzod chen mo, 321–22) there are two variants of stag sha, both can cure nyen fevers, poison-induced fevers (dug tshad), different nyen diseases and “swelling diseases” (skrangs po’i rigs), such as lhog pa, and chronic diseases (’bras nad) that most closely aligns with the biomedical category of cancer. On this topic see Twani Tidwell, “The Modern Biomedical Conception of Cancer and Its Many Potential Correlates in the Tibetan Medical Tradition,” in the present volume. Thar nu is a purgative root, which can cure lhog pa and nyen fevers. See Byams pa ’phrin las et al., Bod lugs gso rig tshig mdzod chen mo, 336. Spru nag. Gawa Dorjé (Dga’ ba rdo rje, ’Khrungs dpe dri med shel gyi me long, 240) identifies it with the Notopterygium forbesii Boiss. This plant can cure nyen and rim diseases, “toothache” (so na ba), can stop “hemorrhages” (khrag shor ba), leprosy, urological, and gastrointestinal disorders, can cure diseases connected to the yama type of sinbu (ya srin), a kind of animalcule or parasite, which according to Tibetan medical texts can affect eyes and ears, thus the yama disease most closely aligns to sinusitis. Bong nga nag po is usually identified as a “black variant of aconite” belonging to the Aconitum species of Ranunculaceae family. See for example Dga’ ba rdo rje, ’Khrungs dpe dri med shel gyi me long, 244–45. In the rasaśāstra literature, this poisonous plant is enumerated among the “five major poisons” (dug chen lnga) used to process mercurial compounds. See Simioli, “Alchemical Gold and the Pursuit of the Alchemical Elixir,” 62. Both Gawa Dorjé (Dga’ ba rdo rje, ’Khrungs dpe dri med shel gyi me long, 245) and Jampa Trinlé (Byams pa ’phrin las et al., Bod lugs gso rig tshig mdzod chen mo, 661) agree in identifying For use by the Author only | © 2019 Koninklijke Brill NV Communicable Disease in the Vase of Amṛta 251 The nine heroes should also be understood in term of their other appellation, “reversal suppressants” (log gnon). In the Scroll of Reversal Suppressant Antidotes (log gnon gnyen po’i shog dril), all the substances are defined as the “heroes that defeat Yama, the Lord of Death” (’chi bdag ’joms pa’i dpa bo).107 According to the Vase of Amṛta these virtues can be exploited to empower a series of medical compounds, such as the five types of theriac (dar yak an).108 Theriac combines a plethora of ingredients, many even potentially venomous, such as aconite, toxic animal substances, such as frog meats, or different kinds of minerals, including mercury, which are substantially detoxified (’dul ba, lit. “subjugated”) through complex alchemical processes. These compounds are otherwise known as the “five nectars” (bdud rtsi lnga) and are hence associated with a category of consecrated substances that play a key role in the tantric context of “accomplishing medicine” literature and rituals.109 To be effective, the group of hero-substances undergoes a consecration ceremony of accomplishing medicine (rab gnas sman grub), which starts with an evocation ritual (spyang dren pa) aiming at transforming the substances in ambrosia. Both the celebrant and the medicine become recipients of divine 107 108 109 sman chen with a variant of bong nga nag po: according to Gawa Dorjé, it corresponds to the Aconitum kongboense Lauener, which is otherwise called btsan dug sman chen. Rma chen is not identified, most probably it is a corrupted transcription of sman chen. ’Chi med bdud rtsi bum pa (1), 96v/6–97v/1. See Simioli, “Brilliant Moon Theriac.” Their formulations are not unique to the Vase of Amṛta. See for example the Medical Compound of the Nine Black Substances to Overcome Every Disease and Evil Force (nag po dgu sbyor ba nad gdon kun ’joms) preserved in the Bye bya ring srel. See Zur mkhar ba mnyams nyid rdo rje, Man ngag bye ba ring bsrel pod chung rab ’byams gsal ba’i sgron me (Lanzhou: Kan su’u mi rigs dpe skrun khang, 1993), 727/6–728/16. The five key substances of the theriac compounds in the ’Chi med bdud rtsi bum pa are: mercury (dngul chu), as the key element of the “brilliant moon-theriac” (zla zil dar ya kan) [’Chi med bdud rtsi bum pa (1), 88r/2–93r/5; ’Chi med bdud rtsi bum pa (2), 87–92]; calcite (cong zhi), which is the key substance of the “fat-theriac” (tshil bu dar ka yan) [’Chi med bdud rtsi bum pa (1), 118r/5–123r/6; ’Chi med bdud rtsi bum pa (2), 101/2–112/9]; locoweed (stag sha) that acts as the key substance of the “meat-theriac” (sha dar ya kan) [’Chi med bdud rtsi bum pa (1), 86r/46–88r/2; ’Chi med bdud rtsi bum pa (2), 82/8–86]; myrobalan or Therminalia chebula (a ru ra), which is the main ingredient of the “bone-theriac” (rus pa dar yak an) [’Chi med bdud rtsi bum pa’ (1), 81v/6–84r/6; ’Chi med bdud rtsi bum pa (2), 79–82/7]; Chrysosplenium carnosum H. (gsha’ g.ya’; lha mo g.ya’, g.ya’ kyi ma), a key ingredient of blood-theriac (khag dar yak an) [’Chi med bdud rtsi bum pa (1), 50v/1–56r/6; ’Chi med bdud rtsi bum pa (2), 93–101/1]. On Chrysosplenium carnosum see Dga’ ba rdo rje, ’Khrungs dpe dri med shel gyi me long, 283. On consecrated nectars see Garrett, “The Alchemy of Accomplishing Medicine,” 300–26. For use by the Author only | © 2019 Koninklijke Brill NV 252 Simioli beings; in particular, each of the nine heroes is associated with a specific Buddha’s manifestation.110 In order to achieve invulnerability, the nine substances must be eaten with food and used to prepare a magical unguent. The text instructs one to intake, or literally to “thrust into the body” (nang zug gu gzud),111 these substances in order to protect the organs. The medicinal powder, once amalgamated with animal fat or butter, becomes an unguent used to anoint the eight important points of the body (gnas brgyad), precluding them from demonic forces. Inserted in the amulets, the powders cast out demons. The Vase of Amṛta conforms to the model of the “Khyung texts” of the Mahāyogatantra literature, which can be compared with other tantric medical literatures centered on the cult of the Garuḍa and connected to the knowledge of poisons and their herbal and ritual healing methods.112 It prescribes the practitioner to visualize himself as a powerful bird-of-prey deity, the transcendent emanation (sprul ba’i ye shes) of the wrathful “Great Noble Lord of the Secrets” or Guhyapati (gsang bdag rje bstun chen po) Vajrapāṇi, who is unified with Hayagrīva, the “resplendent subjugator” of evil beings. The Khyung should be envisioned while churning the primordial ocean with his “blazing meteoric beak and claws” (gnam lcags ’bar ba’i mchu sder) and devouring the serpent spirits that cause nyenné and rimné. The visualization is animated by theomorphic figures which represent the wheel of life: eagles and ravens, wild boars, and poisonous and medicinal snakes (dug sbrul dang sman sbrul).113 While absorbed in this non-dual state of profound and indissoluble communion with the real divine nature,114 the officiant is able to draw down the virtues of divine intelligences. One is then instructed to impart them upon, or better yet, infuse them into the images and diagrams inscribed with magical formulas by reciting the incantations and empowering the medical powders 110 111 112 113 114 ’Chi med bdud rtsi bum pa (1), 40r/5–6; 41v/2–3: […] sman so so rang rang gi// lha bskyed de de’i steng du ye shes sems pa spyan drengs la// mchos stod bskur bsol bar gdab bar bya; […] sman lha a ru ra gu ru yab yum sman chen gla ba// thugs rje chen po shu dag// manju shri gi wang//gsang bdag gu gul// rta mgrin shin kun//bdud rtsi khyil ba mu zi// sgrol ma chig skyes//. See ’Chi med bdud rtsi bum pa (2), 24/16–20; ’Chi med bdud rtsi bum pa (1), 91v/3; provides a different spelling: […] phru gu ’jug//. Gregory Hillis, “The Khyung Texts in the Rnying ma’i Rgyud ’Bum,” in The Many Canons of Tibetan Buddhism, ed. H. Eimer and D. Germano (Leiden: Brill, 2002), 313–32. For references on Garuḍa medicine, see Michael Slouber, Early Tantric Medicine: Snakebite, Mantras, and Healing in the Garuda Tantras (Oxford: Oxford University Press, 2017). ’Chi ned bdud rtsi bum pa (2), 71/9–22. ’Chi med bdud rtsi bum pa (1), 12v/6; ’Chi med bdud rtsi bum pa (2), 25/5: […] mi rtogs stong ba’i ngang nyis las// lha’i nga rgyal ma brel ba//. For use by the Author only | © 2019 Koninklijke Brill NV Communicable Disease in the Vase of Amṛta 253 and pills. The texts recommend preparing the amulets at auspicious times to attune them astrologically to the planets and constellations,115 and to use specific writing supports (black sheets of paper, fabric, or bark), material such as inks made of gold, cinnabar, or black Chinese ink mixed with precious substances, and envelopes made from five-colored silk, all of which need to be consecrated. Textual amulets are illustrated with powerful iconic elements: the three figures of Vajrapāṇi, the Khyung, and the black wild boar (phag nag), which accomplish the function of devourer of evil nyen and snake-demons,116 are decorated with their specific mantras in order to bestow them with magical efficacy. The “Khyung remedy” (gnyen po khyung) or “condensed protective diagram” (sgril ba’i srung ’khor), represents the sophisticated union of the diverse divine figures and their mantras. This textual amulet is a maṇḍala diagram, which replicates the primordial universe within six concentric circles (mu khyu) drawn at the center of the Khyung’s body. As with every magical wheel, this diagram is characterized by a specific orientation determined by sacred geometrical and geographical elements and also by the orientation of the Khyung’s head. The Khyung’s shoulders should be marked with the mother and father cakras representing the two lineages and smeared respectively with bezoar and saffron (representing the male and female sexual fluids); and his head can be oriented towards one of the two wheels overpowering the specific lineage or look at front in order to potentiate the practitioner. All of the circular patterns should contain a mantra and, each part of the Khyung body should be marked with mantras and smeared with empowered fragrant medical substances.117 During the consecration ritual the lunar and solar cakras written on the palms of the sacred Khyung should be joined and the Essence of Interdependence Mantra (rten ’brel snying po) should be written on the back of the paper sheet. These final actions embody the nonduality of reality through its symbols (union of the solar and lunar cakras) and mantra, which condenses the ontological ground of the magical act. The mantras and the magical formula will be not analyzed here; however, it should be said that its general meaning refers 115 116 117 ’Chi med bdud rtsi bum pa (2), 68/8: […] zla stod rgyal dang rta chen brgyad//. ’Chi med bdud rtsi bum pa (2), 73/ 6–7: […] dus tshod gza’ skar gyi gnad rang gi bla gza’ bla skar bla nyi ma dang po ’o. This interpretation of the boar is substantiated by other sections of the ’Chi med bdud rtsi bum pa, such as the cited Reversal Suppressant [Ritual] of Sucking [the Infection] with the Adamantine Sow’s Tongue (log gnon phag mo’i ljags ’jibs). ’Chi med bdud rtsi bum pa (1), 110r/1; ’Chi med bdud rtsi bum pa (2), 152/11. ’Chi med bdud rtsi bum pa (1), 117r/3–117v/6; ’Chi med bdud rtsi bum pa (2), 64/21. For use by the Author only | © 2019 Koninklijke Brill NV 254 Simioli to the annihilation of any evil forces, adjuring the demons by the name of the afflictions they cause (rims thams cad la svāhā), and bestowing a powerful protection on the “holder” (’chang ba po = Skt. dhara, the one who mastered the magical formula) from all kinds of poisons emerged from the prime kālakūṭa poison (ha la ha la).118 Finally, the textual amulets should be rolled up and wrapped in colored silk, ready to be bound to the body of the patient (worn around the neck or arm, or tied in the hair). The amulets are considered to be also effective against any kind of sorcery or negative astral influence, misfortune, or natural calamity. They also protect children from ghosts’ assaults (chung sri), and they can even bestow fortitude (dpa’ la ’dzangs) and fecundity (gshin la ’dzangs).119 The magical diagrams and unguents can also be used to protect residences by applying them on the door lintels (sgo ltag), and they are used during extensive ritual to protect the entire land from the outbreak of pestilences or to stop their spreading.120 These magico-alchemical sections allow us to restate some considerations about the composite structure and the contents of the Vase of Amṛta. This corpus is rooted in the religious discerning of epidemics and communicable diseases. Indeed, due to the apocalyptical and prophetical frame of this literature, the diffusion of the diseases reflects the eruption of evil and corruption in the human world: communicable diseases originate in invisible entities, which are conceptualized as demonic. Therefore, apotropaic rituals are the ultimate methods to tear away the disease from the body. The threefold subdivision of the Vase of Amṛta, claimed by the various titles attributed to it (see the introduction), mirrors a specific conception of medical knowledge as a tripartite system (diagnosis, therapeutics, and rituals), and operative forms of knowledge, such as alchemy and the art of amulets, are considered essential. 5 Conclusion The contents of the Vase of Amṛta reveal an intricate web of connections, with diverse historical and literary traditions. The wide array of topics associated with epidemiology, such as channel examination and the techniques for divinatory prognosis insert the Vase of Amṛta in the context of Seminal Essence literature, alongside magical and apotropaic procedures that relate it to the broader literature of Mahāyogatantra. As we have seen there are several 118 119 120 ’Chi med bdud rtsi bum pa (2), 25/21–26/19. ’Chi med bdud rtsi bum pa (2), 69/16–70/5. ’Chi med bdud rtsi bum pa (1), 15r/1–15v/1; and ’Chi med bdud rtsi bum pa (2), 27/9–28/1. For use by the Author only | © 2019 Koninklijke Brill NV Communicable Disease in the Vase of Amṛta 255 important correspondences between the contents of important medical sources such as the Ultimate Tantra and other sources, including the Vase of Amṛta. In particular the connections regard the body physiology, the taxonomy, and the etiological models of nyen and rim diseases. The title of the Quintessential Scripture (yang thig gces) defines not only to the esoteric nature of this corpus but also refers to the interrelation of different theoretical models deriving from Āyurveda, tantric alchemy, and demonology within this source. In the history of Tibetan medical thought, the Vase of Amṛta represents a refined attempt to codify and systematize medical theories and practices in a coherent and comprehensive body of knowledge. The structure of the Vase of Amṛta reflects a clear authorial intent of keeping the secrecy of teachings, a methodology akin to the principle of “dispersed knowledge” we find in other alchemical traditions.121 The language is often metaphorical and the information is scattered here and there, disseminated in main sections and ancillary explanatory scrolls and chapters, which clarify the main ritual and alchemical sections. The explanatory sections are called “strengths” (gyad), which might refer both to the mastering of magic-alchemical arts and to the effective application of this power to the opus. Another term for referring to these sections is “keys” (lde’u mig), which disclose the real and deep meanings of the scriptures.122 This terminology, which has ancient origins, in this context means “commentarial” or “interpretative” and could refer to the hermetical tradition based on the precious contribution of the transmitters of the text.123 According to Deumar’s analysis of this corpus, these keys are the “filial texts” (bu yig) included in the Vase of Amṛta, which proceed from the main “maternal texts” (ma yig), and are a medium (them ltar, lit. “door threshold” or even “ladder”) for ascending to a deeper understanding of medical knowledge.124 Despite its mysterious origin, the history of the transmission of the Vase of Amṛta appears to be connected to important medical collections. In the fourteenth century, physicians culled fragments or entire sections from the rituals and the pharmacopeia of the Vase of Amṛta, which was considered an 121 122 123 124 See for example, Lawrence Principe, The Aspiring Adept: Robert Boyle and His Alchemical Quest Including Boyle’s “Lost” Dialogue on the Transmutation of Metal (Princeton, NJ: Princeton University Press, 2000), 143 and passim. The complete series of “keys” and “strength” can be found in ’Chi med bdud rtsi bum pa (2), 33–34; 38–39; 53–55; 55–58; 58–61; 79–112; and 135–42. These sections are also complemented by two groups of minor scrolls: ’Chi med bdud rtsi bum pa (2), 149–53; 154–59; and 163–93. See Michael Walter’s comparison of Tibetan alchemical tradition and Gnosticism in Michael Walter, The Role of Alchemy and Medicine in Indo-Tibetan Tantrism (Bloomington, IN: Doctoral Dissertation at Indiana University, 1980), 13–27. De’u dmar bstan’dzin phun tshogs, Gso rig gces btus, 94/19–95/12. 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