Women and Hormones in Tibetan Medical Literature
by
Jennifer Bright
A thesis submitted in conformity with the requirements
for the degree of Doctor of Philosophy
Department for the Study of Religion
University of Toronto
© Copyright by Jennifer Bright 2017
Women and Hormones in Tibetan Medical Literature
Jennifer Bright
Doctor of Philosophy
Department for the Study of Religion
University of Toronto
2017
Abstract
This dissertation examines a contemporary genre of Tibetan medical writings that seek to
integrate Tibetan medical and biomedical notions of “hormones” in the reproductive bodies of
women. The analytical lens of ‘gender’ plays a significant role in this dissertation, specifically
the ways in which medical and Buddhist language and literature surrounding the Tibetan
integration of biomedical notions of hormones deeply implicates modern-day Tibetan national,
ethnic, and religious identities. This dissertation provides overviews and analyses of a selection
of recently published Tibetan medical works that research methods to integrate and articulate
biomedical notions of ‘hormones’ into the Tibetan medical system. These works include booklength commentaries, medical journal articles, book chapters, and home reference books that
focus on women’s health. This dissertation analyzes the relationship between establishing
medical authority with the practice of textual research in present-day Tibetan medical writing in
‘Chinese Tibet,’ and how ‘hormones’ are the central point of intersection and integration between
the Tibetan medical and biomedical systems. Many present-day Tibetan medical authors turn to
Buddhist thought, and specifically the texts and language of Tantra, to explicate and articulate the
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Tibetan understanding of hormones. In their research into the authoritative and classical texts of
their traditions, the majority of the authors discussed within this dissertation argue that it can be
definitively established that the classical Indo-Tibetan medical and Buddhist writers and experts
‘knew’ about the very subtle substances circulating throughout the body that are today known in
biomedicine as “hormones.”
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In Loving Memory of
T. Nicholas Schonhoffer
1982 - 2012
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Acknowledgments
First, I would like to thank my supervisor, Frances Garrett for being a constant source of
encouragement, kindness, and patience throughout my PhD. I could not have produced this
dissertation without your dedication, critical eye, and creative suggestions. I have appreciated
your warmth and hospitality over the years in Toronto and Xining.
Amanda Goodman has been a generous and immensely supportive member of my committee.
You help students think creatively and critically about their work and inspire all of us in doing
so. I thank you for all the time and care you have given to help me get this far.
Pamela Klassen has provided me with much guidance and wisdom over the years. I am greatly
indebted to your constructive feedback and encouragement.
I would also like to thank Gillian Einstein who has been a special mentor since my second year
through the Collaborative Program in Women’s Health. You made the study of hormones
intelligible and intriguing for me, and helped me see this project from a larger, global and crosscultural perspective. I admire your ability to bring out the best in students, to inspire us and
challenge us, and to make us laugh, and puzzle about the world too.
I am indebted to the kindness and generous spirit of the senior scholars of my field, in particular,
Sienna Craig, Geoffrey Samuels, Mona Schrempf, Barbara Gerke, Theresia Hofer, and Pierce
Salguero. My fellow Buddhist studies graduate students, Sean Hillman, Nicolas Field, Sarah
Richardson, Andrew Erlich, and Barbara Hazelton have been fun, engaging, and kind.
I am extremely grateful to my numerous Tibetan colleagues, friends, and interlocutors who have
kindly shared their knowledge and insights with me over the years. In particular I would like to
thank Dr. Tsokyi, Dr. Jia Luo, the late Dr. Pema Dorjee, Chokyi, Gendun and Dawa. I am
indebted to the doctors and medical students at the Qinghai Tibetan Medical Hospital, and the
students and teachers at the Qinghai Nationalities University in Xining, China.
I am grateful for the supportive community of the Department for the Study of Religion at the
University of Toronto. Fereshteh Hashemi, Marilyn Colaço, and Irene Kao have cared for me in
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countless ways over the years. Jennifer Harris was a particularly supportive and caring graduate
director.
I am also grateful to Ken Derry for supporting my professional development and offering sage
and kind advice at all the right moments.
I especially dedicate this work to my parents Barb and John Bright who have always supported
my work, even when it took me far from them. They taught me how to work hard and enjoy life,
and for that I am immensely grateful. My brother, Matt Bright and his better half, Anne Kay have
always supported me, and have known when to take me seriously and when not to take me
seriously at all. Nancy and Jim Bright, and Michelle and Bob Bright have always been
encouraging figures in my life. Sophie and Remy Landau have been generous and loving in-laws
who have helped nurture this thesis to fruition. Daniel Landau, Laura Moebs, and Ariel and
Caroline Landau have also been great sources of friendship and support. My husband, Enoch
Landau, has loved and supported me in this project since we first met. He always made me
believe that this dissertation could be done. My daughter, Mavis, was with me for much of the
final writing and editing of this dissertation (in uterus and outside). I should credit you most of
all for being my muse, and that gentle push to move my dissertation along and out into the world.
My dissertation was made possible through the generous funding from the following sources: the
SSHRC, Ph.D. Award, the University of Toronto Less Commonly Taught Languages Travel
Grant, the University of Toronto, School of Graduate Studies Travel Grant, University of
Toronto, the Julia Ching Travel Grant for Study in China, and the University of Toronto Doctoral
Completion Grant.
And my dog Chester. You’re a pretty smart dog, gracing the acknowledgments of two Ph.D.
dissertations. You have been a constant companion and friend, you took me for walks when I
needed them, and you have always been happy to see me. What else could a human want in a
friend?
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Table of Contents
Acknowledgments ...........................................................................................................................v
Table of Contents ...........................................................................................................................vii
List of Conventions ........................................................................................................................ix
General Introduction ........................................................................................................................1
0.1 The Relation between Medicine and Buddhism in Recent Tibetan History: Issues of
Translation and Integration .................................................................................................6
0.2 “Chinese Tibet” and the Politics of Tibetan Identity ..........................................................14
0.3 Current Trends in Western Studies of Tibetan Medicine ................................................21
0.4 Medical Authority in a Biomedical World ..........................................................................28
0.5 An Intellectual History of “Hormones” in Western Biomedical Thought ..........................34
1.Contemporary Tibetan Medical Literature on Women: The Primary Sources in Context ..........46
1.1 General Description of Primary Sources ............................................................................46
1.2 Medical Practice and Publishing in Qinghai Province ......................................................50
1.3 The Past Becomes Present: Establishing the Authority of Tibetan Medical and Buddhist
Literature ............................................................................................................................53
1.4 Contemporary Interpretations of Women and their Disorders according to the Four
Treatises ............................................................................................................................67
1.5 The Tantric Body in Tibetan Buddhism ............................................................................73
2.“Hormones” in Present-Day Book-Length Commentaries ........................................................81
2.1 Menstruation: A Fundamental Condition of Womanhood ..................................................83
2.2 Establishing the Reproductive Fluids in the Authoritative Literature .................................86
2.3 Problems in Tibetan Embryology: Strategies of Ignoring the Modern Evidence ...............91
2.3 The Body’s Constituents: A Tibetan Medical and Buddhist Framework for Life ...............95
2.4 The Body’s System of Channels: The Movers ..................................................................102
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2.5 The Relationship between the Vajra Body of Winds, Channels, and Drops and the Medical
Body of Hormones and Reproductive Fluids ................................................................ 118
2.6 Women’s Reproductive Bodies in Mingji Cuomu ...........................................................130
2.7 Establishing the Relations Among the Seeds, the Drops, and Hormones in Tibetan Medical
and Buddhist Literature....................................................................................................135
2.8 The Function of the Ovary in Relation to the Reproductive Seed ....................................145
2.9 Final Remarks on Thupten Püntsok’s and Mingji Cuomu’s Works .................................159
3.Brain Marrow and Reproductive Fluids: A Case for Interpreting Hormones in Authoritative
Medical Literature .................................................................................................................163
3.1 Lhamokyi on Menstruation ...............................................................................................163
3.2 Digestion, Menstruation and “Supreme Quintessences” .................................................170
3.3 The Relation between the Brain and Reproductive Fluid ...............................................181
3.4 Brain, Marrow and Reproductive Fluid in Gönpokyap ....................................................194
3.6 Concluding Remarks on Lhamokyi’s and Gönpokyap’s Works ......................................208
4.Hormones in Home Reference Works for Women .................................................................. 211
4.1 Hormones in Wangyal .......................................................................................................213
4.2 Hormones in Palzang Gyatso ............................................................................................219
4.3 Conclusions on Home Reference Works ..........................................................................222
5.Conclusions ...............................................................................................................................229
Bibliography—Tibetan Sources ...................................................................................................236
Bibliography—Western Sources ..................................................................................................239
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List of Conventions
1. Tibetan Transliteration
In this dissertation the spelling of Tibetan words follows the Wylie transliteration system outlined
on the Tibetan and Himalayan Library website (www.thlib.org). The names of Tibetan persons
are rendered phonetically according to the THL Simplified Phonetic Transcription of Standard
Tibetan by David Germano and Nicolas Tournade (2003) also found on the Tibetan Himalayan
Dictionary Website. With the exception of proper names of persons and places, which remain
phoneticized (unless they appear in the Wylie transcription of a translated passage, or as part of a
Tibetan bibliographic reference), the Wylie transliteration system is employed in footnotes.
2. Chinese Transliteration
This dissertation renders Chinese characters in Wade-Giles, unless the Chinese character is given
in the original source.
3. Tibetan Capitalization
This dissertation capitalizes the first letter only for Tibetan text titles, and names of persons and
places.
4. Spelling
This dissertation uses Canadian spelling.
5. Foreign Terminology in Parentheses
Some English terms are followed by their equivalent in Tibetan, and in some instances, in
Chinese and Sanskrit, which is marked with Ch. and Skt. respectively. In the case that both
Tibetan and Sanskrit and/or Chinese terms are given, the Tibetan and Chinese and/or Sanskrit
words are separated by a semicolon.
6. Italicization of Foreign Terminology
Non-English words are italicized, unless they are commonly known and used in the English
language, such as karma and Tantra.
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General Introduction
One of her first remarks when I met the resident gynaecology specialist at the Qinghai
Tibetan Medical Hospital (QTMH) in Xining, China was that her medical practice was a
“mixture” (‘dres pa) of Tibetan and “world medicine” (‘dzam gling gso rig). Showing me her
crossed fingers, she gave the impression of believing that these were equal systems in their own
rights, each methodology supporting the other, and integrated together, achieved an optimum
benefit for the patient. The idea of ‘mixing’ or ‘integrating’ two medical systems, while
seemingly simple in her hand gesture, is enormously complex. It involves not only the medical or
scientific problems of translation, but also the social, political, religious and moral factors. In a
similar way to daily clinical practice, contemporary Tibetan medical writers (who are themselves
doctors and researchers) must also consider the social, religious, and political implications of
integrating biomedical ideas with ‘traditional’ Tibetan medical ones. This thesis focuses on the
social and scientific complexity of ‘mixing’ in the present-day Chinese Tibetan medical tradition
through an investigation of medical works that integrate biomedical notions of “hormones” with
authoritative Tibetan medical thought.
The central argument herein is that research on hormones—and the mixing of Tibetan and
biomedical knowledge—in contemporary Tibetan medical works is based upon the strategic
positioning and use of authoritative Buddhist and medical texts that articulate not only a Tibetan
Buddhist nationalist identity, but also one that is carefully scripted so as not to disrupt China’s
official narrative of Tibet’s “liberation” and a ‘Chinese Tibet.’ It can be observed that the presentday Tibetan medical writers script their works by referencing their authoritative sources, which
are masterpieces of the Tibetan intellectual world, and engaging these as the primary sources of
their tradition. By such means these authors establish Tibetan medicine, knowledge and culture
as unique, distinct, and universally valuable. As Mingji Cuomu1 writes, Tibetan medicine is “a
priceless and amazing gem among the treasury of world medicine, which is equally famous in
1
Mingji Cuomu is a contemporary author whose work I examine in the second chapter of this thesis.
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the ten directions for emanating radiant happiness and benefit.”2 Given the current climate of
‘glocalization’—the economic, political and social situation wherein the so-called notions of
‘global’ and ‘local,’ ‘unique’ and ‘universal,’ ‘tradition’ and ‘modernity’ are made to operate
together to solidify ethnic and national identities3 —it is not surprising that Mingji Cuomu frames
Tibetan medicine in the way that she does. To call an exalted person, text, celestial palace and so
on a “gem” or “jewel” (nor bu) has historically been common in Tibetan Buddhist and medical
culture, and therefore Mingji Cuomu’s choice of calling Tibetan medicine a jewel—a common
assertion in contemporary medical works—communicates salient cultural meanings. Mingji
Cuomu also places Tibetan medicine on an even footing among the world’s systems of medicine,
implying in part that despite the worldwide dominance of biomedicine, other national medical
systems are of equal worth and value, much like the national cultures that embed them. In
important ways, from her choice of authoritative sources to the terms and phrases she employs to
name and integrate biomedical and Tibetan notions of hormones in relation to menstruation, she,
like her colleagues, participates in and speaks to the wider discourse of Tibet’s national, cultural
and religious identity.
The medical works I engage with as my primary sources are published from inside
‘Chinese Tibet,’ that is, the Tibetan regions that beginning in 1951 were incorporated into the
People’s Republic of China (PRC). Although not exclusively, I focus on a selection of medical
works published or written by authors from the eastern or ‘marginal’ regions of Chinese Tibet,
the former Amdo and Khams provinces, and in particular the capital of Qinghai province, Xining
where Qinghai Tibetan Medical Hospital—the central medical institution of eastern Tibet of
which more will be said in the following chapter—and its affiliated colleges, research institutes,
publishing houses and pharmaceutical industry is centrally located. Other primary sources are
published either in Lhasa, the capital of the Tibetan Autonomous Region (TAR), or in Beijing,
the Chinese national capital. My primary sources are all fairly recent, spanning the mid 1990s to
2‘dzam
gling gso rig bang mdzod nang rin thang gzhal du med ba’i khyad ‘phags kyi nor bu zhig dang
mtshung par phan bde’i gzi ‘od phyogs bcur ‘phros nas. Sman skyi mtsho mo, Mo nad phal pa’i nad la
zhib ’jug dang gso bcos kyi nyams yig (Lhasa: Krung go’i bod kyi gso rig, 2009), 2.
3
Ronald Robertson, “Glocalization: Time-Space and Homogeneity-Heterogenity,” in Global
Modernities, eds., Mike Featherstone, Scott Lash, and Roland Robertson (London: SAGE, 1995) 25–44.
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the early 2010s, and can readily be found in bookstores in Xining and in some cases, surrounding
areas. Significantly, a number of my primary authors are female and offer a perspective of
Tibetan gynaecological thought in a field that had previously been the exclusive terrain of male,
and frequently monastic authors who would not normally have intimate knowledge of women’s
bodies. Most of the authors are forty years of age or younger and have had their primary training
in Chinese Tibet, meaning that they are fluent in and have comprehensive knowledge of at least
the Chinese (Mandarin) and Tibetan languages, a feat not logistically easy in many Tibetan,
especially rural communities.4
The Four Treatises5 is the central and foundational text of the Tibetan medical tradition.
It indicates that experience is needed to illuminate the knowledge of the texts, and that textual
learning alone is not sufficient. Consequentially, when I spoke to doctors for help in locating and
researching texts, especially the ones that they read and considered important, they insisted that I
needed some clinical experience, and that I spend time directly observing and learning about
Tibetan medical practice with a specialist. And so, I gained some clinical experience, which
indeed was invaluable for helping me see the texts as part of a living tradition wherein the
meanings of Tibetan medical knowledge are established, debated and re-interpreted “in
accordance with the times” (dus rabs dang mthun pa).6 The high value placed on practical
experience coupled with textual knowledge in the Tibetan tradition is a theme that I will be
exploring throughout this thesis.
In looking at the education of Buddhist monks in Laos and Thailand, Justin McDaniel
uses the phrase “lifting words” to describe how “Pali words are lifted from texts … then
4
As of 2014, roughly thirty-three per cent of Tibetans are urban, and the remaining sixty-six per cent
are rural. Rongxing Guo et al., eds., Multicultural China: A Statistical Yearbook (2014), (Berlin: Springer,
2015), 71.
5
G.yu thog yon tan mgon po, Dud rtsi snying po yan lag brgyad pa gsang ba man ngag gi rgyud ces
bya ba bzhugs so, ed., Blo bzang tshe ring (Lhasa: Bod ljong mi dmangs dpe skrun khang, 2000). For this
thesis, I exclusively refer to this version of the Four Treatises, which is the widely used standard edition
in Tibet.
6
Dpal bzang rgya mtsho, Bud med bde srung skor gyi rgyun shes phran bu bzhugs (Sichuan: Si khron
mi rigs dpe skrun khang, 2010), 1. This phrase appears in almost all of my contemporary sources.
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creatively engaged with and explained by lectures based on their own experiences.”7 Similarly,
the specialist under whom I studied would select texts, words, and phrases that she felt was
important for me to learn in order to understand Tibetan medicine. McDaniel saw this
methodology as allowing the observation of texts in “their living contexts,” that is, the ways that
knowledge is shaped and transmitted through the relations among “orality and textuality,
temporality and timeless authority, lay life and monastic life, the local and translocal.”8 Like
McDaniel’s study of Buddhist education, my thesis is about “interpretive communities,” that is
“the construction of a particular reading community, one which validates itself through texts
deemed important to a shared sense of culture and cultural attainment.”9 Therefore, I posit that in
the medical literature researching and integrating Tibetan medical and biomedical notions of
hormones, words can be said to be ‘lifted’ from Buddhist and medical sources deemed culturally
important, and re-interpreted to support both Tibetan ‘tradition’ and ‘modern’ interpretations of
that knowledge in a way that is politically, socially and religiously acceptable.
In Tibet, the relationship between lived experience and textual knowledge historically is
and continues to be extremely important. The doctor under whom I studied under is herself
involved in the production of contemporary medical works published in Xining. In one instance,
she contributed as an expert consultant to a home health reference work, The Body and How it
Works,10 which integrates Tibetan and biomedicine (including hormones), and in another, to a
published interview focussed on Tibetan women’s health, Common Views and Questions of
Tibetan Women, edited by Gönpokyi and published in Gansu province.11 There is a symbiotic
relation between medical publishing and clinical practice in present-day Tibet, as there always
has been in the Tibetan medical system, where both comprehensive textual knowledge as well as
7
Justin Thomas McDaniel, Gathering Leaves & Lifting Words: Histories of Buddhist Monastic
Education in Laos and Thailand (Seattle: University of Washington Press, 2008), 7.
8
Ibid., 8.
9
Ibid., 9. quoted in William A. Johnson, “Toward a Sociology of Reading in Classical Antiquity,”
American Journal of Philology 121, no. 4 (2000): 593–627.
10
The Jinpa Project, Mi lus grub tshul dang byed las (Xining: Mtsho sngon mi rigs dpe skrun khang,
2010).
11
Mgon po skyid, Bod mo’i dogs gzhi dang thun mong gi lha tshul (Gansu: Kan su’u rigs dpe skrun
khang, 2010).
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“experience” (nyams myong) were considered equally necessary in order to be a competent
doctor or medical writer.12 Contemporary authors or their publishers often tell the reader that
credibility as a medical writers draws from experience, in addition to the study of the Tibetan
“authoritative literature” (gzhung lugs) and biomedicine. The Tibetan word for experience,
nyams myong, refers to a subjective, integrated kind of knowing, that is, to experience one’s
experience. Depending on the context, this experience can be as exalted as the realized
experience of bliss and emptiness or as mundane as clinical experience. In either case, in Tibetan
thought this kind of experience “indicates a certain kind of depth,” meaning without it one’s
knowledge is merely “superficial” and “they have not thoroughly integrated the teachings of
religion [or medicine] into every aspect of their existence.”13 The assertion by so many Tibetan
medical doctors and writers that they combine their experience with expertise of Tibet’s
authoritative knowledge in addition to the study of biomedicine is clearly a way of showing not
only their medical, and cultural and political authority, but also what constitutes authority itself
in the case of Tibetan medicine in Chinese Tibet.
…
The term, “Tibetan medicine” (bod sman) can potentially cover a wide range of healing
practices and texts that could be considered either ‘medical,’ or ‘religious,’ or a mix of both.
Tibetan healers who belong to the profession of gso ba rig pa, the “science of healing”, are
considered doctors. These people are variously called “Amchi” (am chi; em chi), “Menpa” (sman
pa), and the honorific, “Lhaje" (lha rje). Tibetans also might seek treatment, or advice on healing
options from a variety of Buddhist specialists. These advisors either can be a “lama” (bla ma),
“Tantric practitioner” (sngags pa), “spirit medium” (lha pa, dpa’ bo, and mkha’ ‘gro ma),
12
See: Janet Gyatso, “Healing Burns with Fire: The Facilitations of Experience in Tibetan Buddhism,”
Journal of the American Academy of Religion 67, no. 1 (1999): 113–47 and Kurtis R. Schaeffer, “Textual
Scholarship, Medical Tradition, and Mahayana Buddhist Ideals in Tibet,” Journal of Indian Philosophy
31, no. 5–6 (2003): 621–41.
13
Gyatso, “Healing Burns with Fire,” 118.
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“diviner” (mo pa), and “astrologer” (rtsis pa).14 This thesis looks at the writings of Tibetan
doctors educated in the tradition of gso ba rig pa. Their textual basis, having influence over such
institutions as hospitals, universities, research centres and pharmacies, is principally based on the
Four Treatises and its commentarial tradition. Here, the phrase “Tibetan medicine” refers to gso
ba rig pa, representing the literature and institutions that are explicitly identified as being gso ba
rig pa. “Tibetan medicine” should be pluralized. However, for the sake of simplicity the singular
form of this subject will be used. Tibetan medicine has always existed in vibrant intellectual
communities where different viewpoints were exchanged and debated. Many important schools
of thought and teachings arose, giving rise to a polylithic medical tradition that became hardly
uniform or even consistent.
0.1 The Relation between Medicine and Buddhism in Recent
Tibetan History: Issues of Translation and Integration
Janet Gyatso writes in Being Human in a Buddhist World: An Intellectual History of
Medicine in Early Modern Tibet, that “[s]o much of the intellectual history of Sowa Rikpa has
been occupied with its position vis-à-vis Buddhist structures of knowledge and authority.”15 This
is certainly the case in the contemporary Tibetan medical works that address women and
hormones. In this section I address Gyatso’s historical and intellectual account of the early
modern period, a time in Tibetan medicine closely preceding the works of this dissertation. I
outline in what ways the contemporary sources of this dissertation, and my interpretation of
them, continue the empirical and scientific sensibilities of the early modern Tibetan medical
thinkers, while at the same time, how they closely align modern Tibetan medical thought with
Buddhist sources of knowledge and authority. In the second part, I examine issues surrounding
translation and integration in another East Asian context through Pierce Salguero’s Translating
14 A similar
list of healers, and an explanation of their modes of healing, can found in: Mona
Schrempf, “Introduction: Refocusing on Tibetan Medicine,” in Soundings in Tibetan Medicine
Anthropological and Historical Perspectives, ed. Mona Schrempf (Boston: Brill, 2007), 1–6; and,
Geoffrey Samuel, “Healing in Tibetan Buddhism,” in The Wiley Blackwell Companion to East and Inner
Asian Buddhism, ed. Mario Poceski (Hoboken: John Wiley & Sons, 2014), 278–296.
15
Janet Gyatso, Being Human in a Buddhist World: An Intellectual History of Medicine in Early
Modern Tibet (New York: Columbia University Press, 2015), 13.
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Buddhist Medicine in Medieval China.16 Lastly, I briefly describe another means of medical
syncretism through the collaborative research efforts of Western and Tibetan medical scholars,
practitioners, and anthropologists. From among these sources, I situate the contemporary Tibetan
medical discourse on women and hormones within methodological approaches towards
understanding issues of translation, integration, and syncretic medical (and religious) systems.
Being Human In A Buddhist World, is in Gyatso’s own words, a study of “how knowledge
changes.”17 She contends that the “uneasy fit” between received Buddhist knowledge and
empirically minded scientific sensibilities fermenting among medical thinkers is at the heart of
the changes taking place in early modern Tibetan medicine. Seeking to account for the “double
movements” taking place, Gyatso maintains that Tibetan medical learning, “a mix of the main
Asian health care systems of the day, fostered a probative attitude towards religious authority
even as it grew to maturity within the great institutions of Tibetan Buddhism.”18 Gyatso asserts
that a telling demonstration of this tension is evident by medical scholars doubting that the Four
Treatises was the received (and therefore complete and perfect) teaching of the Medicine
Buddha. Instead, these early modern medical thinkers asserted the text’s human authorship,
displaying a self-reflective awareness of the contingencies of time and place in the making of
knowledge. This awareness is seen by Gyatso as pointing to a scientific sensibility unlike, and
sometimes contradictory to, authoritative Buddhist knowledge and texts. Thus, Gyatso concludes
that, given the all-encompassing nature of Buddhist thought in Tibetan life at the time, these
medical thinkers demonstrated an “outstanding example of alterity in Tibetan intellectual and
cultural history.”19
One might assume that, as described by Gyatso, the integration of hormones into the
Tibetan medical system would represent a continuing of the reaching towards scientific (and
non-Buddhist) sensibilities about the material world and the human body. Present-day sources on
16 Pierce C. Salguero, Translating Buddhist Medicine in Medieval China (Philadelphia: University of
Pennsylvania Press, 2014).
17
Gyatso, Being Human in a Buddhist World, 1.
18
Ibid., 1.
19
Ibid., 2.
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women’s bodies betray an ethos of medical thought that attempts to bridge, and mutually colegitimize, the authoritative knowledge of both Tibetan medical and Tibetan Buddhist texts.
Dissimilar from the “alterity” suggested by Gyatso, today’s Tibetan medical researchers and
writers are well within other mainstream Tibetan cultural and religious thought and firmly rooted
in a Tibetan Buddhist cultural and national identity. And, when Buddhist ideas of reproduction,
obstetric care and gynaecology are lacking evidentiary basis, today’s medical writers tend not to
openly discredit the Tibetan system. Even when writers are critical of aspects of Tibet’s medical
tradition, they tend not to disparage the central texts of Tibetan medicine (or Buddhism). I will
return to the geopolitical context of my sources in a following section, but here it is worthwhile
to indicate that the political stakes of the medical thinkers of the early modern period of Tibet,
and the contemporary era, compel rather different allegiances. It would appear that, in today’s
political climate Tibetan medical experts have more to gain by joining with Tibetan Buddhist
thought, and showing continuity across Tibetan intellectual traditions, than by showing Tibetan
medicine as distinct from Buddhism.
Today’s Tibetan thinkers are ‘scientific’ in their study of the human body, and in this
dissertation, we will see tensions arise between Buddhist and medical conceptions of the body. In
some places medical writers are explicit on the differences between the Buddhist red element
ideas and the medical knowledge of women’s bodies. What can be seen is a strategic use of
Tibetan medical and Buddhist texts to support textual research into the Tibetan medical tradition,
while as well to integrate biomedical ideas. In the same cosmopolitan spirit as their early modern
predecessors, we see contemporary Tibetan medical researchers integrating biomedical ideas by
“intentionally mixing disparate streams of thought and practice,”20 using a range of Buddhist,
tantric, medical and sexological texts to establish hormones in Tibetan medicine. Gyatso’s insight
that medical thinkers “adapted a range of methods and concepts developed in Buddhist
contexts… in novel ways that could inform scientific aims”21 is quite relevant in our examination
on the present-day sources on women and hormones.
20
Ibid., 2.
21
Ibid., 2.
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Gyatso asserts that the Buddhist world kept the medical one “in check” with early
modern medical scholars remaining strategically loyal to Tibetan Buddhist structures knowledge
and authority. This appears, to some degree, still to be formative of the present-day Tibetan
medical tradition. Hence, no clear separation between so-called science and religion has occurred
in Tibetan medicine. Despite the ever present Buddhist influence, Gyatso portrays “no less than
astonishing” the early modern medical thinker’s endeavours to carve a relatively autonomous
space outside the purview of Buddhism. According to Gyatso, the Tibetan case shows us “what it
takes for knowledge to recast its foundations, on conceptual and rhetorical registers alike.”22 The
contemporary sources of this dissertation show a resistance to recast the foundations of Tibetan
medical (or Buddhist) thought, at least in regards to women’s bodies and reproduction.
Biomedical knowledge is positioned to be both a confirmation of Tibetan Buddhist (particularly
Tantric) and medical knowledge of the body, as well as a rich resource to ‘develop’ and
‘modernize’ Tibet’s national medical tradition. Moreover, Tibetan medical knowledge, in
harmonious relation to Buddhist knowledge of the body, is presented as a continuous intellectual
tradition (glossing over the disruptions midway through the twentieth century) that is still being
continued today. Therefore, the integration of hormones marks an innovation in Tibetan medical
thought which has not compelled a shift in medical thinking away from Buddhism. In fact, and
quite to the contrary, many contemporary writers are reaching towards Buddhist thought as a
means of incorporating new (biomedical) ideas.
Whatever their slippery and cross-cutting relation in Tibetan history, in both the early
modern medical sources of Gyatso’s work and the contemporary sources of this dissertation, the
Tantric form of Buddhism is a “site of both engagement and disjuncture.”23 Much like their
predecessors, medical writers debate about the relation between the subtle body of Tantra and the
empirically recognizable physical body possessed by their patients. In their quest to name,
translate, describe, and integrate biomedical ideas of hormones into the Tibetan system, presentday medical writers, much like their early modern counter-parts, “work through tantric
anatomical and physiological categories, arguing about whether they should be taken literally or
22
Ibid., 3
23
Ibid., 3.
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figuratively and finding ways that the insights of an arcane spiritual tradition might sometimes be
useful for their purposes.”24 As will be explored in this dissertation, Tantric notions of the subtle
body have been a particularly useful and advantageous resource for medical researchers to think
about, and craft a Tibetan understanding of hormones and the endocrine system of biomedicine.
Gyatso posits that early modern Tibetan medical thinkers valourized new and local
knowledge while being remarkably cognizant of the historical and geopolitical contingencies of
scientific truth. Based on this, she maintains that these early modern Tibetan scientists shied
away from ideas of universal Buddhist truths and admitted to the existence of knowledge outside
of Buddhism’s reach. She also argues that they favoured evidence over received text because
they rejected the Buddha origins of the Four Treatises. The contemporary medical authors of my
study show a common strand with their early modern counterparts insofar as being forthright
about the social, legal, historical and geographic contingencies of their medical knowledge. This
does not cause these particular medical writers to reject the textual tradition, and quite the
opposite occurs. In my sources, the textual resources of Tibet’s rich medical, Buddhist, and Bön
history form the fundamental basis of new research into their integration with the science of
hormones. As we shall see in this dissertation, a number of my sources propose that the Tibetan
textual sources undeniably demonstrate that Tibetan medical and Tantric experts knew of the
very subtle or microscopic substances that are crucial for life, rebirth and development, and
which today are known as ‘hormones.’ Biomedical knowledge or global medicine is used to
confirm and valourize the ‘old’ knowledge that is found in the revered texts of the Indo-Tibetan
medical and Buddhist traditions.
The issues of translation, integration and medical syncretism are vital in understanding
‘how knowledge changes’ in the case of contemporary Tibetan medical works on women and
hormones. This dissertation closely examines the writings of a select group of medical writers
translating and integrating various kinds of medical ideas, and from these efforts, generating
innovative shifts in thought and new knowledge. Pierce Salguero’s Translating Buddhist
Medicine in Medieval China is an instructive example that highlights the crucial role of the
24
Ibid., 3.
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translator, the process of translating, and the sociopolitical climate in which translation, and the
domestication of foreign ideas takes place. Centering on the translation activities of a handful of
diverse medical and religious scholars, Salguero places “human decision-making at the heart of
the story.”25 In this dissertation, we see the translation decisions made by contemporary Tibetan
writers are strategic, multi-layered and emerging from the personal viewpoints of researchers
embedded in the Chinese Tibetan political context.
In his study of the exchange of Buddhist and medical ideas along the Eurasian silk trade
routes, Salguero outlines tactics that translators developed to walk the fine line between
remaining authentic and close to the meaning of the original text, and expressing these foreign
ideas in language targeted at a domestic audience. Much like today’s Tibetan medical writers,
medieval translators were “purposeful and strategic” in their translation choices and the power
that “seemingly small lexical choices”26 yield over their reader within particular sociopolitical
contexts. Salguero identifies four “translation tactics,” used in the translation choices of Tibetan
researchers integrating biomedical notions of hormones. These tactics include transliteration,
calquing, incorporating pre-existing indigenous terms, and ‘“sinicization of Buddhist
terminology”.
According to Salguero, transliteration, which renders a term phonetically rather than
semantically, signals to the reader that the word is of foreign origin. Calquing is used to
“translate a specific … idea with a calque, an accurate root-for-root reconstruction of the original
term using existing [words]…”27 While introducing a neologism into the textual arena, this
method, according to Salguero, risks being cumbersome, jarring to the eyes of the native reader,
and is “difficult to comprehend without adequate contextualization.” The incorporation of preexisting indigenous terms to translate foreign words and ideas has, according to Salguero, the
advantage of being “familiar” to the reader. However, he also notes that the method of translation
can lose some of the term’s semantic nuances, and conversely, require that native terms “bend”
their meanings so as to accommodate new uses, without losing some of the meanings of the
25
Salguero, Translating Buddhist Medicine in Medieval China, 44.
26
Ibid., 54.
27
Ibid., 56.
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original source.28 Salguero observes that the“‘sinicization’ of Buddhist terminology” appears to
have happened in the medieval sources. He writes that this “fully domesticating tactic involves
translating Buddhist terms with perceived equivalents from the existing Chinese religiomedical
vocabulary.”29 Relating to the contemporary Tibetan medical sources on women, Salguero writes
that by using terms with “indigenous resonances” in an equivalent way, translators “traded
fidelity” to the original sources but gained “the ability to tap into native cultural and linguistic
repertoires.”30
As we can see in these four methods, the process of translating cultural, religious and
medical ideas across cultures is in-itself a deeply integrative process, which produces syncretic
or hybrid kinds of knowledge. As we shall see in the sources for this thesis, contemporary
Tibetan medical writers employ translation stratagems similar to those developed in medieval
China. Salguero also positions these translation tactics, and the syncretic and hybrid types of
knowledge they produced, within the sociopolitical context of the “religiomedical
marketplace.”31 Hence, he places translators (and groups of translators) within the competitive
and diverse medieval Chinese marketplace of medical ideas and practices. He asserts that such
meetings in the ‘marketplaces’ of medical and religious ideas produced inherently syncretic
systems of thought. Such is the case of the integration of Tibetan medicine and biomedicine in
the ethnically and culturally diverse populations of modern-day China.
The collaborative and interdisciplinary efforts on the part of Tibetan, Himalayan and
Western medical scholars, doctors, researchers and anthropologists to translate and produce new
research integrating Tibetan medical and biomedical thought represent another important chapter
28
Ibid., 57.
29
Ibid., 57.
30
Ibid., 58.
31
Ibid., 60.
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in the history of modern Tibetan medicine.32 Here, we see “engaged”33 Western medical
anthropologists and scholars with extensive fieldwork experience across the Tibetan cultural
world spearhead interaction with Tibetan medical practitioners, aiming to co-produce new, and
often state-sponsored knowledge, while at the same time being attentive to indigenous
epistemologies and healing practices. Addressing the objectives of one such collaborative
workshop held in Kathmandu, Nepal, Blaikie, Craig, Gerke and Hofer write:
Our imperative… was to use anthropology in ways that would benefit those whose
positions are compromised by politics and whose voices are silenced by geographic or
social marginalization. Through this process, we hoped to encourage connections and
knowledge exchange between diverse practitioners from across Tibetan cultural worlds,
and also generate new, collective, and more nuanced forms of anthropological knowledge
about Sowa Rigpa epistemology, history, theory, and practice. As such, our method of
choice was collaborative ethnography formulated as a workshop in the most literal sense of
the word: a space where artisanal forms of praxis would be honored and where material
things—medicines—would be collectively made.34
Clearly, the authors are very much aware of the impact such cross-cultural research has on the
development of Tibetan tradition, and show an academic community which continually reflects
on the cachet of their own analytical categories, particularly of ‘religion’ and ‘science’. (More
will be said on Western academic responses to Tibetan medicine’s integration of biomedicine in
the section dealing with the sociopolitical context of Chinese Tibet.) They also see, as do their
Tibetan interlocutors and counter-parts, the potential benefits of such research not only for its
patients but also for Tibetan medicine as a cultural institution.
Among the engaged anthropologies of contemporary Tibetan medicine, integration,
representing the process of “intentionally mixing together disparate streams of thought and
32
For recent examples of this see: Calum Blaikie, Sienna Craig, Barbara Gerke, and Theresia Hofer,
“Coproducing Efficacious Medicines: Collaborative Event Ethnography with Himalayan and Tibetan
Sowa Rigpa Practitioners,” Current Anthropology 56, no. 2 (2015): 178–204, and Mona Schrempf,
“Workshop Report ‘Developing an Interdisciplinary and Multilingual Digital Knowledge Base on Tibetan
Medical Formulas with a Focus on Stress-Related Wind (Rlung) Disorders” IASTAM Newsletter, no.
Winter (2015).
33
Sienna Craig, “The Efficacy of Collaboration: Tibetan Medicine Across Countries and
Conversations,” Asian Medicine 10 (2015): 152–75.
34
Blaikie, Craig, Gerke, and Hofer, “Coproducing Efficacious Medicines: Collaborative Event
Ethnography with Himalayan and Tibetan Sowa Rigpa Practitioners,” 179.
!14
practice,”35 occurs by way of international collaboration among various stakeholders. Therefore,
attention to the choices of individual actors involved in the process of cross-cultural exchange,
translation, and research are essential to their investigations. Consequently, this dissertation
focuses on a small handful of individuals, and through a close textual analysis of their works
examines, in the sociopolitical context of Chinese Tibet, the choices they make from their
research questions to their strategic use of foreign and indigenous terminology.
0.2 “Chinese Tibet” and the Politics of Tibetan Identity
“Chinese Tibet” (Krung go’i bod) is an offensive term for some, and is certainly a
politically fraught expression for many English-speaking scholars. Despite some hesitation, I use
the term for four primary reasons: first, it differentiates Tibetans living inside China from those
living in various exile communities outside of China, such as those in India, Nepal and the West.
Secondly, the term technically describes the geo-political legal status as well as thirdly, the lived
situation of modern day Tibet, that is, as an “ethnic minority” (shaoshu minzu or more
commonly, minzu)36 within a much larger nation state. Lastly, the term “Chinese Tibet” appears
in a variety of published works and other places, including some of my primary sources for this
thesis. In this section I elaborate on these points, not so much to argue for the use of the term,
‘Chinese Tibet’ but rather to provide some background of the political and social context of
contemporary Tibetan medical thought.
As of 1959, the territories of the Tibetan plateau, known formerly as the “three
provinces” (chol kha gsum) of Ü-Tsang (dbus gtsang), Amdo (a mdo) and Kham (khams)—an
consisting of an area roughly 2.5 million square kilometres—have been politically and
administratively re-organized by the People’s Republic of China (PRC). The Tibetan
Autonomous Region (TAR) (bod rang skyong ljongs; xizang zizhiqu) which roughly covers
138,400 kilometres of the former Ü-Tsang region, is the only officially “autonomous” Tibetan
region of China. The vast areas of Kham and Amdo, approximately 1,040,625 square kilometres
35Gyatso,
36
Being Human in a Buddhist World, 2.
Åshild Kolås, On the Margins of Tibet: Cultural Survival on the Sino-Tibetan Frontier (Seattle:
University of Washington Press, 1993), 27.
!15
have become the Chinese provinces of Qinghai (mtsho sngon), Gansu (kan su’u), Sichuan (si
khron), and Yunnan (yun nan).37
As of the 2010 Chinese census, ethnic Tibetans number around 6.2 million nationally,38 a
tiny fraction of China’s 1.3 billion people39 of which 91% are ethnically Han.40 Before 1959,
almost all of the population of the TAR consisted of ethnic Tibetans. Historically, the population
in the other Tibetan provinces was ethnically diverse. However, Tibetans still formed the
majority of the people in those provinces. Qinghai Province, formerly part of the Tibetan
province of Amdo, has the highest number of ethnic Tibetans outside of the TAR.41 As of the
2010 census, Qinghai province had a population of 5,626,723. The Tibetan, then numbering
1,375,059 people, formed the largest ethnic minority group of the province.42
The capital city of Qinghai, Xining (Zi ling; Ch. Tongren) is home to the Arura Medical
Group, which is the chief medical institution of Tibetan medicine in eastern Tibet. Because the
research for this thesis took place within the Amdo Tibetan43 medical community, especially at
QTMH and the Arura medical establishment in Xining, many of my sources on women and
hormones are published in the outlying Tibetan areas of Amdo and Kham, that is, the modernday provinces of Sichuan, Yunnan, Gansu and Qinghai.
There is a significant and highly contentious international argument surrounding the
political and national status of Tibet prior to its incorporation by the PRC, in particular, China’s
37
Nicolas Tournadre and Sangda Dorje, Manual of Standard Tibetan: Language and Civilization,
trans. Charles Ramble (Ithaca, NY: Snow Lion Publications, 2003), 198–200.
38
Rongxing Guo et al., eds., Multicultural China, 350.
39
Ibid., 349.
40
Ibid., xv.
41
Chen Hua, “The Diffusion of Tibetan Medicine in China: A Descriptive Panorama,” in Tibetan
Medicine in the Contemporary World: Global Politics of Medical Knowledge and Practice, ed. Laurent
Pordié (New York: Routledge, 2008), 95.
42
43
Rongxing Guo et al., eds., Multicultural China: A Statistical Yearbook (2014), 391–2.
For more on the topic of modern Amdo Tibetans and modernity see: Lauran R. Hartley, “‘Inventing
Modernity’ in A Mdo: Views on the Role of Traditional Tibetan Culture in a Developing Society,” in
Amdo Tibetans in Transition: Society and Culture in the Post-Mao Era, edited by Toni Huber (Boston:
Brill, 2002), 1–26.
!16
relation with the central Tibetan government in Lhasa historically, and related to this, what
territories were actually ruled by the central Lhasan government. I will not venture far into this
myself, but it is evident that despite indications that show that the three regions of Tibet were not
always politically cohesive, there appears to have been widespread allegiance throughout the
three province towards the Dalai Lama, and his theocracy in central Tibet.44 The Buddhist reach
into nearly all aspects of Tibetan life cannot be underestimated, and Tibet’s governmental
structure was based on a “dual system of religion and politics” (chos srid gnyis), which
ideologically meant a synthesis of the temporal and spiritual world.45 Certain features of Tibetan
Buddhism allowed for this kind of government and society.
Despite degrees of competitiveness, Tibetan Buddhism has always enjoyed a kind of
institutionalized ecumenism, wherein prominent teachers and students travelled, studied and
exchanged texts, teachings and initiations. Given that the extensive web of Buddhist temples,
monasteries, and universities were the most powerful cultural, economic, and political shapers—
and the largest landowners—throughout the Tibetan areas, Buddhism was a powerful unifier of a
Tibetan national identity.46 It could also be said that although the three regions of Tibet
experienced events like the cultural revolution and land reforms quite differently,47 and today
their socio-political situation can be similarly quite different, there has arisen a collective feeling
of “national pride” (mi rigs kyi la rgya).48 Similarly, in the present-day Tibetan works on women
and hormones, authors quote widely—one could say ecumenically—from various medical,
Buddhist, and Bön works in order to demonstrate a cohesive Tibetan understanding of the female
body. This lends itself to not only a unified understanding of Tibetan medicine, but also to a
44
Tsering Shakya, The Dragon in the Land of Snows: A History of Modern Tibet Since 1947 (New
York: Penguin Compass, 2000).
45
Nirmal C. Sinha, “Chos Srid Gnyis Ldan,” Bulletin of Tibetology 5, no. 3 (1968): 13–27.
46
Gray Tuttle, Faith and Nation: Tibetan Buddhists in the Making of Modern China (New York:
Columbia University Press, 2004).
47
48
Tsering Shakya, The Dragon in the Land of Snows: A History of Modern Tibet since 1947.
Hortsang Jigme, “Tibetan Literature in the Diaspora,” in Modern Tibetan Literature and Social
Change, eds., Lauren Hartley and Patricia Schiaffini-Vedani (Durham: Duke University Press, 2008), 287.
In the same volume see also: Tsering Shakya, “The Development of Modern Tibetan Literature in the
People’s Republic of China in the 1980s,” 61–85.
!17
wider Tibetan culture and nationhood that encompasses the three provinces of Amdo, Kham and
Ü-Tsang.
Presenting Tibetan medicine as a unifying force for Tibetan nationalism and cultural
identity within socialist China is actually quite explicit in many present-day Tibetan medical
works, including those focused on women. For example, in the introduction to her textbook,
Healing Women’s Disorders49 Jampa Dolkar outlines the socio-political situation of Chinese
Tibet quite plainly:
Tibetan medicine is an important element of our national traditions, constituting our
medical and healing knowledge. Furthermore, the Chinese medical system is promoting,
and has established a framework for health and sanitation according to the unique features
of the Chinese system of socialism. Likewise, Tibetan medicine must suitably develop and
transform its system of higher education. Under the supervising office of China’s national
medical system, this textbook, which maps out the educational model of the Tibetan system
of medicine, has been produced for the medical organizations throughout central Tibet
[TAR], Qinghai, Gansu, Sichuan and Yunnan, together with the five counties. 50
Also, in the customary publisher’s note at the beginning of Tashi Tsering, Dawa and Rigzin
Dorje et al.’s home-reference book, Clear Mirror of Useful Knowledge of Health and Well-Being
according to Tibet’s Medical Science51 the publisher writes, “Tibetan medicine is the
quintessence of our nation of Tibetan people, which over a thousand years, is the accumulation of
the innermost nectar of the experience gained from realizing the inner methods for curing
disorders at their source.”52 (Incidentally, within the phrase, “innermost nectar” (nying bcud) is
49 Byams pa sgrol dkar, Mo nad gso ba (Beijing: Mi rigs dpe skrun khang, 2004). This textbook was
extensively studied and large sections memorized by my medical student friends specializing in
gynaecology.
50
bod kyi gso ba rig pa ni rang re’i rgyal khab kyi srol rgyun gso rig sman rig gi grub cha gal chen
zhig yin / de yang krung hwa mi rigs kyi phul byung srol rgyun rig gnas gong du spel ba dang / krung hwa
go’i khyad chos ldan pa’i spyi tshogs ring lugs kyi phrod bsten bya gzhag ‘dzugs skrun byed pa / bod kyi
gso rig gi mtho rim slob gso bcos sgyur dang ‘phel rgyas kyi dgos mkho dang ‘tsham pa bcas kyi ched /
rgyal khab krung dbyi gso rig do dam cus kyis rtsa ‘dzugs ‘og bod ljongs dang / mtsho sngon / kan su’u /
si khron / yun nan bcas zhing ljongs lngas mnyams du rgyal yongs bod lugs gso rig dngos tshan slob gso’i
‘char ‘god slob deb ‘di nyid rtsom sgrig par skrun byas pa ste, ibid.,1.
51
Bkra shis tshe ring, Zla ba, Rig ’dzin rdo rje, Bsod nams bag gro, Bkra shis rnam rgyal, Smin grub,
Dbyang skyid, and et.al., Bod lugs gso rig gi bde srung shes bya spang blang gsal ba'i me long (Lhasa:
Bod ljongs mi dmangs dpe skrun khang, 2010).
52
bod kyi gso ba rig pa ni rang rgyal gyi bod rigs mi dmangs kyis lo ngo stong phrag ring nad gzhi sel
thabs nang thob pa’i nyams myong gi nying bcud yin pa… / Publishers note, ibid., 1.
!18
the term, “nectar” (bcud), which is used in some of the present-day sources as part of the word
for hormones.) In the above statement, there appears a tripartite unity among Tibetan
nationalism, religion, and medicine. To describe Tibetan medicine as the nectar of experience
gained from knowing the inner methods evokes the notion of a Buddha-originated knowledge,
conjuring the experience of Buddhist realization, something that is unique to the Buddhist nation
of Tibet.
Evident in the examples above, many present-day Tibetans cannot help but imagine their
futures as a part of China or at least claim to in their published works, and the prevailing climate
is one of working within the system rather than attempting to overthrow it, as some of those
living outside of Tibet might imagine it. There are two sides to this—on the one hand, Tibetans
are making profound efforts to preserve and re-vitalize their national identity, languages,
religious traditions and culture, but on the other hand, they are compelled to do so within the
political and social framework of the PRC. Therefore, although I describe perhaps plainly the
ways that the term “Chinese Tibet” is apt, and I further indicate that Tibetan writers work within
the Chinese state system rather than directly against it, I don’t suggest that Tibetans are not
expressing nationalistic feelings and being strategic in their manner of doing so. I will return to
this point in Chapter One, but I presently suggest that what Tibetan modernity and the future of a
Tibetan national identity looks like and what can be ‘imagined’ by individuals and groups
emerges53 from its relation with and within China.
The authoritative sources chosen by the authors of my sources reflect this approach. For
example, Gendun Chöphel,54 an intellectually gifted and eccentric writer and cultural hero from
53 Craig R. Janes explores this idea in, “Imagined Lives, Suffering, and the Work of Culture: The
Embodied Discourses of Conflict in Modern Tibet,” Medical Anthropology Quarterly 13, no. 4 (1999):
391–412.
54
There are a number of English, Tibetan and Chinese works on Gendun Chöphel, including
biographies, translations and commentaries. For this thesis, I rely principally on: Lauran R. Hartley,
“Heterodox Views and the New Orthodox Poems: Tibetan Writers in the Early and Mid-Twentieth
Century,” in Modern Tibetan Literature and Social Change, eds., Lauran R Hartley and Patricia
Schiaffini-Vedani (Durham: Duke University Press, 2008), 4–10; Donald Lopez, The Madman's Middle
Way: Reflections on Reality of the Tibetan Monk Gendun Chophel (Chicago: University of Chicago Press,
2006); Heather Stoddard, Le Mendiant de l’Amdo (Paris: Société d’Ethnographie, 1985), and; Gendün
Chöpel, Tibetan Arts of Love: Sex, Orgasm and Spiritual Healing, trans. and ed. Jeffrey Hopkins with
Dorje Yudon Yuthok (Ithaca, NY: Snow Lion Publications, 1992).
!19
Amdo, not far from modern-day Xining, who eschewed the conservatism of the Gelukpa
government (seventeenth to twentieth-century) in Lhasa and urged his fellow Tibetans to
embrace modernity, appears in a number of my sources that integrate hormones. He was
connected with the “Association for Improvement of Western Tibet” (nub bod bcos kyi skyid
sdug), a name which not only clearly identifies itself as not east to Lhasa but west to China, and
also mimics the Chinese word used for Tibet, “Xizang”, which literally refers to the “western
provinces.”55 (In contemporary times, “Xizang” refers only to the TAR56 ). He is even said to
have designed the flag for the group: a loom, sickle and hammer.57
Although Gendun Chöphel and his like minded Tibetan contemporaries looked in large
part to foreign models of modernity, such as those in the West and emerging in India and China,
they were certainly dedicated to crafting a Tibetan modernity, one imagined and created by
Tibetans. For Gendun Chöphel this also meant one free from the arch conservative overreach of
the religious and aristocratic elite that dominated Tibetan culture and religion, not to mention the
social and economic structure. He was not in favour of Chinese rule necessarily, but rather was
fearful that if Tibet did not modernize, it would make itself naive and vulnerable to its more
powerful, nation-building neighbours.
Among Gendun Chöphel’s numerous and wide ranging works that include TibetanEnglish-Sanskrit translations and writings on travel, Buddhist philosophy, Tibetan political
history, geography, plants and minerals, and so forth, perhaps his most famous work is his candid
and experience-based sexological work, the Treatise on Passion58 which is evoked in a number
of places in my primary sources as support for Tibetan interpretations surrounding hormones.
Throughout the present-day sources, although authors premise the foundation of present-day gso
ba rig pa clearly and unequivocally on the Indo-Tibetan tradition, overt connections are made
with modern China, its project of modernity and its revolutionary figures. Gendun Chöphel, who
does not disrupt the prevailing narrative that Tibetans were in need of modernity, is a politically
55
Hopkins, Tibetan Arts of Love, 26.
56
Kolås and Thowsen, On the Margins of Tibet, 30.
57
Hopkins, Tibetan Arts of Love, 26.
58
Dge ’dun chos ’phel, ‘Dod pa’i bstan bcos (Delhi: T.G. Dhongthog, 1969).
!20
safe source of authority for contemporary Tibetan medical writers, even while at the same time,
he figures prominently in Tibetan nationalist discourse. This is because people like Gendun
Chöphel appeal to how young Tibetans can live in their present, and imagine their pasts and
possible futures. For many young Tibetans, he is a native, pre-Chinese example of what a
modern Tibetan can be.
Given the pragmatic needs of the present and what kind of future Tibetans can be hopeful
of, it is not perhaps surprising that the term “Chinese Tibet” appears in many different kinds of
contemporary works. For example, the phrase, “Chinese Tibetan knowledge” (krung go’i bod kyi
shes rig pa) appears in the titles of series not uncommonly, as well as the names of publishers,
such as the “Chinese Tibetan Knowledge Publishing House” (krung go’i bod rig pa skrun khang)
based in Beijing. Not too infrequently, medical works use the expression, “Chinese Tibetan
Medicine” (krung go’i bod kyi gso rig pa) in titles, series names, and introductions, although
within the content of the works themselves “Tibetan medicine” is overwhelmingly used to
identify their system. One can hardly argue that these phrases do not reflect the shifting geopolitical and social situation of Tibetans working with the Chinese system. Tibetans are not
unique in this—every citizen of China has a role to play in the national narrative, and good
citizenry requires signs and performances that display this.59
Despite the climate of ‘co-operation,’ there have been significant and multiple protests
and even riots in different parts of Tibet in recent times. The widespread protests of 2008, of
which the reverberations are still felt today, perhaps provide some sober reflection on the stategenerated optimism for the future of Tibetan culture. The situation in Chinese Tibet is
enormously complicated, as is the role of Tibetan medical writers, researchers and doctors who
must navigate its constantly changing landscape so that Tibetan medicine, as both a clinical
practice and body of medical knowledge can survive and remain viable in the PRC.
59 Ann Anagnost,
“The Politicized Body,” in Body, Subject and Power in China, eds. Angela Zito and
Tani E. Barlow (Chicago: University of Chicago Press, 1994), 131–156. See also: Vincanne Adams,
“Saving Tibet? An Inquiry into Modernity, Lies, Truths, and Beliefs,” Medical Anthropology 24, no. 1
(2005): 71–110.
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0.3 Current Trends in Western Studies of Tibetan Medicine
In broad thematic strokes, Western academic studies of Tibetan medicine in present-day
China primarily centre on issues surrounding Tibetan culture; ethnicity and nationalism; science;
religion and morality; and modernity and secularism.60 Some of these studies look into the
problems regarding the integration of the Tibetan medical and biomedical systems in Chinese
Tibet.61
In this section, I examine a common overarching theme among these studies, which
questions whether or not this integration with biomedicine in medical research and practice
might undermine the authority and integrity of the Tibetan medical tradition and its religious
basis. My central conclusion is that the contemporary Tibetan medical writings that speak to
“hormones” show that Buddhist thought still plays a very central role in constituting the Tibetan
medical system. The finding counters the prominent Western narrative that Tibetan medicine, in
60
Works that fall under this general description include: Vincanne Adams, “Particularizing Modernity:
Tibetan Medical Theorizing of Women’s Health in Lhasa, Tibet,” in Healing Powers and Modernity:
Traditional Medicine, Shamanism, and Science in Asian Societies, eds. Linda Conner and Geoffrey
Samuel (Westport CT: Bergin and Garvey, 2001), 222–46; ibid., “The Sacred in the Scientific: Ambiguous
Practices of Science in Tibetan Medicine” Cultural Anthropology: Journal of the Society for Cultural
Anthropology 16, no. 4 (2001): 542–575; ibid., “Randomized Controlled Crime: Postcolonial Sciences in
Alternative Medicine Research” Social Studies of Science 32, no. 5–6 (2002): 659–90; ibid.,“Saving
Tibet? An Inquiry into Modernity, Lies, Truths, and Beliefs,” 71–110; ibid., “Integrating Abstraction:
Modernizing Medicine at Lhasa’s Mentsikhang,” in Soundings in Tibetan Medicine: Anthropological and
Historical Perspectives (Boston: Brill, 2007), 29–44; ibid., “Establishing Proof: Translating ‘Science’ and
the State in Tibetan Medicine,” in New Horizons in Medical Anthropology: Essays in Honour of Charles
Leslie, eds., Charles M. Leslie, Mark. Nichter, and Margaret M. Lock (New York: Routledge, 2002), 200–
220; Vincanne Adams and Fei-Fei Li, “Integration or Erasure?: Modernizing Medicine at Lhasa’s
Mentsikhang,” in Tibetan Medicine in the Contemporary World: Global Politics of Medical Knowledge
and Practice, ed.Laurent Pordié (New York: Routledge, 2008), 105–30; Theresia Hofer, “Socio-Economic
Dimensions of Tibetan Medicine in the Tibet Autonomous Region, China Part One” Asian Medicine 4, no.
1 (2009): 174-200; Craig R. Janes “The Transformations of Tibetan Medicine” Medical Anthropology
Quarterly 9, no. 1 (1995): 6–39; ibid., “Imagined lives,” (1999b); ibid., “Tibetan Medicine at the
Crossroads: Radical Modernity and the Social Organization of Traditional Medicine in the Tibetan
Autonomous Region, China,” in Healing Powers and Modernity: Traditional Medicine, Shamanism, and
Science in Asian Societies, eds., Linda Connor and Geoffrey Samuel (Westport, CT: Bergin & Garvey,
2001), 222–46, and; Sienna R. Craig, Healing Elements: Efficacy and Social Ecologies of Tibetan
Medicine (University of California Press, 2012).
61
Craig Janes, “The Health Transition, Global Modernity and the Crisis of Traditional Medicine: The
Tibetan Case” Social Science & Medicine 48, no. 12 (1999): 1803–20 and Geoffrey B. Samuel, “Tibetan
Medicine and Biomedicine: Epistemological Conflicts, Practical Solutions” Asian Medicine 2, no. 1
(2006): 72.
!22
its integration with biomedicine, is becoming ‘secularized’ and therefore losing its
epistemologically and morally Buddhist underpinning.
The worry that integration of the Tibetan medical system with modern biomedicine
undermines its integrity is voiced by several Western observers. For example, Vincanne Adams
argues that the requirement for so-called “alternative” or “traditional” medical systems to adopt
“modern” methods, particularly those that assess clinical effectiveness (such as Random Control
Trials), leads to the eclipsing of the unique features that makes them locally effective healing
practices. Based on field work in the women’s division of the Lhasa Mentsikhang in 2000, where
she observed “integrated” Tibetan and biomedicine in practice, as well as in clinical trials,
Adams writes that
…integration occurs by way of a prioritizing of, and preference for, biomedical techniques
and practices over those of Tibetan medicine that leaves Tibetan medicine appearing
‘abstract…’ I call this process ‘integrating abstraction,’ in which abstraction has the
meanings of being, in different contexts and in relation to different aspects of Tibetan
medicine, ‘less concrete,’ clinically and theoretically ‘chaotic or disorganized,’ ‘extraneous’
to the real basis of medical efficacy, ‘vague,’ and simply ‘unscientific.’ 62
Also working in the Lhasa Mentsikhang around the same time, Janes similarly articulates what
he sees as the two main practical outcomes of integrating Tibetan and biomedicine: 1) The
increasing inclination to align “essential theoretical elements” of Tibetan medicine with
biomedicine, particularly physiology, and 2) the tendency to “accept rather than resist Western
scientific standards for evaluating treatment efficacy.” These factors, Janes writes, “may not
necessarily result in a complete acceptance of biomedical epistemology; it does however require
that Tibetan medicine accept the cultural authority of science in its production of a ‘modern’
Tibetan medicine.”63
On the other hand, Adams, Dongzhu and Le’s research at the Arura group in Xining in the
early 2000s shows what they claim to be the “reverse” of this trend. They write that “in various
subtle and yet commanding ways, practices of biomedicine are being refashioned and revised in
62 Adams,
63
“Integrating Abstraction,” 30.
Janes, “The Health Transition, Global Modernity,” 1815.
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order to accommodate and even serve Tibetan medicine.”64 But, they also ask: “Can Western
medicine and research be used to legitimise traditional Tibetan medicine or does the use of these
techniques inevitably undermine the integrity of the Tibetan system?”65 Clearly, for many
scholars, the uneasy power relations between Tibetan medicine and biomedicine is central to the
problems of integrating the two systems.
In their explorations of the dynamics of this problem among the Tibetan researchers of
the Arura research department, Adams, Dongzhu and Le describe an active debate that involves
two general lines of research which they write, “pull in opposite directions”: “animal testing and
biochemical analysis versus historical recovery of documents.” The authors consider the former
approach taken by the researchers as “reductionist” in the sense that researchers are using
biomedical techniques, such as “deciphering active ingredients, testing single medicines rather
than combination therapies,” in order to test the validity of Tibetan medical knowledge. The
latter approach is considered “expansionist” by the authors, in the sense that researchers consider
the recovery, analysis and engagement with Tibet’s textual tradition as a means of gathering
“information from the past in order to establish a broader range of relevance and accuracy.”66
Proponents of the textualist view reason that because textual knowledge arose from the
knowledge of skilled practitioners (and Tibetans hold scriptural authority as epistemologically
preeminent), it “provides an accurate guide to truth, no matter how old or how much regional
variation between the texts.”67 Countering this position, according to Adams, Dongzhu and Le,
are those who claim that “since this type of research uses no statistical biometric measures and is
not conducted as experimental knowledge acquisition (that is using experimental methods), it is
not actually a form of scientific research and thus cannot reveal objective truth.”68 Central to this
debate, therefore are conflicting views of ‘proof,’ and how to best ‘test’ the validity of Tibetan
medical knowledge.
64
Adams, Dongzhu and Le, “A Tibetan Way of Science,” 108.
65 Adams,
Dongzhu and Le, “Translating Science,” 112.
66
Adams, Dongzhu and Le, “Translating Science,” 122.
67
Ibid.,122.
68
Ibid., 122–3.
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Conflicting views of what constitutes ‘proof,’ according to Adams in her many individual
and collaborative works, arise in large part from a moral incompatibility, that is, translating
Tibetan Buddhist-medical epistemologies into “secular” biomedical ones. She writes that it is not
the case that one system is moral or more moral than the other, but rather “both approaches offer
insights into different ways of locating “truth.””69 Adams implies that the biomedical system
offers truths based on clinical trials, statistical evidence and other verifiable metrics, whereas
Tibetan medicine locates the true nature of the body in a moral universe.
The Tibetan medical system sees the human body as made up of five elements and three
dynamics. The former are material elements like water, fire, and wind, while the latter are the
materialization of the three poisons which are the afflictive emotions of anger, desire, and
ignorance. It is your “karma” (las), or more precisely your “habitual way” (bag chags) of
thinking, feeling and acting, arising from the afflictive emotions, that determines your present
body and the disorders afflicting it. In this system, which assumes reincarnation (and this is still
the case in my sources that integrate hormones), our present body is the “fruit” or “result” (‘bras)
of the thoughts, actions, and emotions of our previous lifetimes and the bardo experience.70 Of
importance to this philosophy is the requirement of living the morally upright life largely defined
in Tibetan culture by gendered Buddhist ideals.
In the Four Treatises, women’s bodies are defined as being made of “low karmic
merit” (bsod nams dman pa),71 due to an excess of the poison of desire. In the following chapter,
I will examine what some of the early authoritative medical sources say about women’s bodies
and how their statements are regarded by modern writers. Western anthropologists like Adams
note that the Tibetan view of the body, as a morally manifesting one, affects women in particular
ways. Despite burdening women with extra moral baggage over issues like abortion, Adams fears
69
Adams, “Saving Tibet,” 74.
70
Bar do literally means to be ‘in the middle’ or ‘in-between’ and a “bardo being” (bar do ba) refers to
the migrating consciousness between lifetimes. There are a number of works on bardo beings in English,
perhaps the most well-known in the West is: Padmasambhava and Karma gling pa, The Tibetan Book of
the Dead: The Great Liberation by Hearing in the Intermediate States, eds. Graham Coleman and
Thupten Jinpa, trans., Gyurme Dorje (New York: Viking, 2006).
71
G.yu thog yon tan mgon po, Dud rtsi snying po, 375.
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that the culturally salient moral underpinning of the three dynamics and other Buddhist concepts
are being abstracted and erased from Tibetan medicine and replaced with secular biomedical
definitions of the body. For her and others, this erasure is undoubtedly negative and amounts to
the loss of the unique and beneficial features of the Tibetan medical system, and even of Tibetan
culture. Moreover, this erasure of the Buddhist moral underpinning of medical care is to the
disadvantage of women, taking away their ability to express, in a culturally meaningful way, for
example, their moral distress over having an abortion.72
Some Tibetan women do not necessarily agree that the moral associations of Tibetan
medicine is a good thing for them. The Indian-exile Tibetan women-only authored book, Healthy
Body, Healthy Mind: Health Handbook for Tibetan Women73 makes virtually no mention of
Tibetan medicine and refers exclusively to biomedical knowledge and therapies. Fundamental to
the work is a woman-centred response to ideas they see as morally “guilting” women about their
bodies and life decisions. They find many Tibetan-medical perspectives of women to be
discriminatory, and conversely, biomedicine to be free of the moral associations that disempower
them. Hence, we cannot assume that all Tibetan women see their tradition as ideally as some
Western scholars sometimes might do. The Tibetan case tells us that what constitutes proof, and
whether or not it be a moral truth, varies considerably among institutions and individuals.
We see, in works like Adams’, the fear among scholars of the “secularizing” forces of
Chinese sponsored biomedicine leading to the erasure not only of Buddhist morality, but also of
its philosophical elements that are at the scholarly heart of the Tibetan medical system. Janes
writes that, for Tibetan medicine to endure inside China, it must adapt to Chinese modernity
without “losing the depth of its classical scholarly base, the integrity of its theoretically rich
explanatory system, or the principles of its non-materialistic, Buddhist epistemology.”74 Yet, I
have found that nearly all of the recent Tibetan medical writings on women’s bodies resist this
prognosis. The Tibetan medical writings very much trend towards maintaining and strengthening
72
Adams, “Particularizing Modernity,” 222–46, and “Integrating Abstraction,” 29–44.
73
Tibetan Nuns Project, Healthy Body, Healthy Mind: Health Handbook for Tibetan Women
(Dharamsala, India: Tibetan Nuns Project, 2006).
74
Janes, “Tibetan Medicine at the Crossroads,” 218.
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the authority of Buddhist knowledge as part of the philosophical and textual basis of Tibetan
medicine. In these works, establishing the notion of “hormones” in the Tibetan system is through
the study of some of the earliest and most important medical and Buddhist texts of the Tibetan
tradition. Therefore, the scope of Tibetan medical literature integrating biomedical and Tibetan
medical ideas of hormones adds to, and complements, existing Western scholarship.
An assumption sometimes made by both Western and Tibetan scholars is that being
‘secular’ necessarily means being atheistic, therefore implying that, biomedicine, as a ‘secular
scientific’ system, is divorced from the ‘non-rational’ and ‘non-empirical’ notions of ‘religion.’
This line of thinking has been challenged in the wider Western academic world, most notably by
thinkers like Talal Assad,75 who argues that rather than being separate from, or the antithesis of
religion, the notion of ‘secularism’ and secular institutions are the cultural and historical products
of religious thought and religious institutions. In other words, what constitutes the “secular” in
modern life is constituted in part by “religion.”
The notion that to be ‘secular’ necessarily means to be ‘non-religious’ has been largely
debunked in the wider field of the study of religion, medicine and science. So called
“biomedicine,” a term that points to a knowledge about biology that is considered universal and
objective, has been shown to be deeply implicated with Christianity. For example, Pamela
Klassen illustrates in Spirits of Protestantism that the twentieth-century Christians who were to
pioneer Canada’s biomedical institutions saw no contradiction in being dedicated to both
‘secular’ and ‘religious’ ideals. Klassen describes a
network of liberal Protestants whose commitments to science and the social gospel helped
bring into being the very institutions of secular modernity—including hospitals,
universities, the Canadian version of a state-funded health care system, and transnational
nongovernmental organizations—while they maintained a commitment to the reality or at
least the possibility, of supernatural intervention in the world. Their supernaturalism was
bred of habits of prayer, convictions that spiritual energies coursed through the universe
75
Talal Asad, Formations of the Secular: Christianity, Islam, Modernity (Stanford: Stanford University
Press, 2003).
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and the body, and for some, a hope that all religions offered paths, via rituals and spiritual
exercises, to these universal truths.76
These Christians carved out significant ‘secular’ space through biomedical institutions, yet at the
same time they viewed ‘healing,’ whether physical, mental, emotional or spiritual to be an
equally medical and religious endeavour. Moreover, by implicating themselves in the rising
popularity and later establishment of biomedicine, Liberal Protestants could be seen as the most
“modern,” “secular” and “rational” among Christian denominations, thereby retaining some level
of authority and power in local sites of biomedical research and practice.
The spreading of biomedicine as part of missionary activity among Canada’s First
Nations and abroad exemplified how Liberal Protestants could couch modern, secular and
scientific endeavours as compelled by an ethic of Christian love. Likewise, the establishment of
the Canadian healthcare system “gradually came into being over the course of the twentiethcentury partly with the help of Liberal Protestants and Catholics who considered that all people
were equal before God and deserved equal access to medical care.”77 Rather than erasing
religious thought, the science of biomedicine was conceived as mutually reinforcing a Christian
world view of God’s universal love for all humankind. Still today the ideals of Canadian
“universal” or “socialized” medicine is guided by the conviction that healthcare is a human right
and should be free and accessible to all.
Klassen’s work on Canadian Christians is one example, repeated variously throughout the
world, whereby the institutions of biomedical research, teaching and practices are, in implicit and
explicit ways, steeped in the religious worlds of their shapers. Similarly, in the Tibetan world,
Buddhist explanations of life, birth and gender are present throughout their contemporary
medical sources on women. Tibetan researchers, doctors, writers and institutions today position
themselves as ‘modern,’ ‘secular,’ and ‘religious.’ For them, showing Buddhist thought in
Tibetan medicine as inherently ‘scientific’ strengthens the authority of their positions.
76
Pamela E. Klassen, Spirits of Protestantism: Medicine, Healing, and Liberal Christianity (Berkeley:
University of California Press, 2011), 4–5.
77
Ibid., 5.
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Western scholars have tended to focus on the question of ‘science’ and ‘religion’ in
modern Tibetan medicine. There is good reason for this given the precarious and ambiguous
status of Buddhism within the Chinese communist state. Adams, Dongzhu and Le suggest that a
shift in emphasis away from focusing on science and religion and towards an analysis of how
specific theories that incorporate Tibetan and biomedicine work, will “help illuminate how things
are changing and what is potentially lost or what is at stake in the incremental march toward
secular modernisation.”78
I agree that there is much to be gained by a close analysis of how specific biomedical
notions are interpreted and incorporated into Tibetan medical knowledge, and my thesis basically
takes up this method. My work problematizes the notion that the ‘secularizing effects’ of
biomedicine results in the erasure of Buddhist thought from Tibetan medicine. I show that
Buddhist ideas about gender, the body and the origins and nature of human life remain prominent
and influential in contemporary Tibetan medical works on women. And, I contend that presentday Tibetan medicine in Chinese Tibet can be said to be modern, scientific, secular and religious
in many of the works on women’s bodies.
0.4 Medical Authority in a Biomedical World
Beginning more or less in the 1960s, Western scholars have tended to think about
‘authoritative knowledge’ or ‘authority’ chiefly in terms of social, political and cultural
‘power’.79 According to this approach, the authoritative knowledge of any system does not
garner its authority from the content of the knowledge itself, or as Briggite Jordan writes, its
“correctness,” but instead by what a community of people value and consider “consequential”. In
medical systems, to call something “authoritative,” according to Jordan, draws “attention to its
status within a particular social group and to the work it does in maintaining the group’s
78 Adams,
79
Dongzhu and Le, “Translating Science,” 115.
For example, see: Michael Foucault, The History of Sexuality (New York: Vintage Books, 1980),
and Thomas S. Kuhn, The Structure of Scientific Revolutions (Chicago: University of Chicago Press,
1962).
!29
definition of morality and rationality”.80 Further, by means of education, institutionalization and
so on, the community is produced by and reproduces both itself and its particular knowledge.
Therefore, to say that someone ‘has’ authoritative knowledge (or that a text is authoritative),
from an academic point of view, entails an analysis of “how participants in a social setting make
that fact visible to each other, ratify it, elaborate it, and so on…”81 Such insights are applicable to
my Tibetan medical sources on women.
Present-day Tibetan medical writers who integrate biomedical notions of “hormones”
with their system anchor their collective bearing in the authoritative literature of the Tibetan
tradition, namely the Four Treatises and its commentarial literature. Methodologically, they
typically first quote from an authoritative source, then explain and summarize its “intended
meaning” (dgongs don)—often by quoting from other authoritative sources—before presenting
their own interpretation, including biomedical ideas and how these fit within the Tibetan system.
I posit that, in the intellectual space opened through such writings on Tibetan medicine, medical
writers promote Tibetan culture and its national (and ethnic) knowledge systems as authoritative.
Significantly, aside from a not uncommon lament that some other present-day doctors “don’t
even understand the grammar of the authoritative medical texts and so make careless
interpretations”,82 authors tend not to directly engage with or quote from each other; instead they
engage almost exclusively with what they consider authoritative medical, Buddhist and Tantric
literature. They also position new sources for medical authority, including Chinese communist
thinkers and Tibetan modern national heroes such as Gendun Chöphel (Dge 'dun chos ‘phel,
1903 – 1951). Although it is obvious that the authors read one another’s works, for political,
social, religious, nationalist and moral reasons, they do not challenge and discredit one another,
but rather collectively build the Tibetan system up, establishing its authoritative status and
continued necessity for not only Tibetans, but people throughout the world.
80
Brigitte Jordan, “Authoritative Knowledge and Its Construction,” in Childbirth and Authoritative
Knowledge: Cross-Cultural Perspectives, eds., Robbie Davis-Floyd and Carolyn Fishel Sargent
(Berkeley: University of California Press, 1997), 58.
81
82
Ibid., 58.
…sman gzhung lta ci yi ge’i brda dag tsam yang legs par ma go ba’i skyon du zad de. Thub bstan
phun tshogs, Gso bya lus kyi rnam bshad (Beijing: Mi rigs dpe skrun khang, 1999), 42.
!30
Tibetan writers are keenly aware of the relations among language, text and power. Their
collective emphasis on establishing the uniqueness and authority of the Tibetan medical tradition
through textual research and the reinvention of medical-Buddhist-biomedical language
underscores the biggest perceived threat to present-day Tibetan medicine, which is the authority
of biomedicine and its marginalizing effects on traditional healing traditions. The dominance of
biomedicine throughout the world has been explored by a number of Western scholars. For
example, in her study of “Traditional Birth Attendants” in Nepal, Stacy Leigh Pigg explores
“how words organize actions” in the literature surrounding development and its impact on
women’s lives. She examines how the language of development, which tends to de-contextualize,
simplify and obscure what the World Health Organization (WHO) refers to as “traditional
medicine”, positions biomedicine as authoritative at the expense of local knowledge and social
practices. Pigg argues that “traditional healers” are portrayed in development literature as a
homogenous group, and their specific local practices surrounding birth, which varies
considerably in Nepal, are viewed and treated patronizingly as either “harmful” or “not harmful”.
Moreover, as a result of “mistranslations”, local women are often portrayed as ignorant and in
need of further developmental aid, perpetuating the de-valuation of their knowledge, practices
and experience. In this way, in both the texts and practices of maternal development in Nepal, the
role of language is instrumental in the distribution of social power, and is central as to how
medical authority is constituted.83
The existential threat of biomedical authority is implicit in the present-day Tibetan
medical sources, and is countered by reinventing the Tibetan tradition, and in particular through
the reinterpretation of Tibetan medical and Buddhist language. I suggest that rather than
displacing the authority of Tibetan medicine, the discourse of biomedical hormones are
integrated and positioned in such a way to validate and fortify the authority of the Tibetan
system. In multiple and reinforcing ways, in their process of translating biomedicine, Tibetan
writers maintain their knowledge as primary, highlighting how language can indeed empower
83
Stacy Leigh Pigg, “Medical Sciences and Technology in Socio-Cultural Context,” in International
Encyclopedia of Public Health, ed., Harald Kristian Heggenhougen (Oxford: Academic Press, 2008),
321–29.
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and produce authority, and not necessarily to the disadvantage of so-called, ‘traditional
medicine.’
Such a perspective is supported in other studies of contemporary traditional healing
communities. For example, Jean Langford’s study of the contemporary practice of Āyurvedic
medicine in post-colonial India shows that faced with the necessity to confront biomedicine and
the resulting marginalization of their own native traditions, traditional healers often turn this
situation “into an opportunity to (re)invent” their traditions.84 Similar to the Tibetan case,
Āyurvedic doctors often articulate the view that they are recovering the “true essence” of their
ancient Indian medical tradition. Also like Tibetan medical writers, Indian doctor-scholars base
their present-day interpretations of Āyurveda on classic texts of the tradition that predate the
modern era by several hundred years. This reinterpreting and reshaping of the authoritative
classical texts by modern authors, according to Langford, is inextricably linked to the recovery of
Indian culture and the rise of Indian nationalism in a post-colonial India. She writes: “The
inclusion of Āyurveda in the nationalist program exemplifies that peculiar ambiguity of
nationalism, the contradictory need to fashion institutions commensurable with those of other
nations while simultaneously constructing a unique national-cultural identity.” Further, as is
common in the contemporary Tibetan system, this has led Indian doctors and medical scholars to
“create a medicine that was not only parallel to modern medicine, but also in contrast to it.”85 As
such, she argues, the construal of medical authority itself is also being reinterpreted and
reshaped. This insight is crucial in understanding the Tibetan case; not just in the statements
made about the tradition as a whole, but throughout the sources on women’s bodies. In these
works the integration of hormones is clearly taken as an opportunity to reinvent the Tibetan
medical tradition in a way that shows itself to be both parallel to biomedicine, yet uniquely
Tibetan. In other words biomedical knowledge is often used to prop up the cultural and scientific
authority of the medical and Buddhist works that inform the modern Tibetan medical institutions
like QTMH.
84
Jean Langford, Fluent Bodies: Ayurvedic Remedies for Postcolonial Imbalance (Durham: Duke
University Press, 2002), 2.
85
Ibid., 7.
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The integration of Tibetan and biomedical notions of “hormones” is arguably one of the
most significant scholarly issues in the history of Tibetan gynaecology. It is the central
intersection where Tibetan medicine and biomedicine are integrated in the contemporary
literature concerning women’s bodies. Herein, I take the view that both the biomedical and
Tibetan medical systems describe a category of substances that are known in Western
biomedicine as “hormones”—microscopic but potent secretions that originate from the brain and
travel to various sites of action throughout the body, including the ovaries and testes where these
are crucial to reproduction. Essentially, Tibetan and biomedical research communities are
working with the same basic sets of questions about very subtle but profound processes in the
body, but they explore these within their own cultural and social specificity. This is a central
point of the present-day Tibetan medical writers; they maintain that the authoritative works of
their tradition have long established that substances originating from the brain govern many of
the body’s essential functions, including sex differences and the reproductive abilities of men and
women. They do not articulate biomedical hormones as something unheard of, or foreign to, the
Tibetan system. Quite to the contrary, they assert that ‘modern’ biomedical knowledge about
“hormones” is already present in the Tibetan system, and therefore, their integration is mutually
beneficial. In order to demonstrate this, the work of the contemporary Tibetan researcher is to
interpret the “intended meanings” of the authoritative sources with an eye towards their relation
to biomedicine. In this way, they hope to show both the uniqueness and universalism of the
Tibetan medical tradition.
The word “hormone” has no direct equivalent in Tibetan, and may be found variously
translated in that language. Significantly, contemporary writers turn to the conceptual language
of the medical and Buddhist texts of the Indo-Tibetan intellectual traditions to create new terms
and phrases to name and describe hormones in the body. In particular, Tantric ideas of the body
have become a creative and innovative resource for Tibetan medical experts to think about and
articulate biomedical ideas of hormones. Furthermore, such ideas and terms are popular and are
being re-vitalized in today’s political, social and religious climate of reform in China. It can be
said that for all of my sources, because hormones are debated using Tibetan language and are
being interpreted through reference to Tibet’s authoritative body of medical (and Buddhist)
!33
literature, biomedical ideas are positioned in a way to bolster and support the central claims of
Tibetan medicine, rather than detract from or disprove them. In many cases, Tantric texts and
biomedical ideas are both used to substantiate the Tibetan medical understanding of the female
body, which itself is fundamentally rooted in shared Buddhist and medical notions of gender.
This in turn can maintain or sometimes challenge Tibetan gender norms. “Hormones” are far
from being a threat to the integrity of the Tibetan system whose authoritative knowledge has
been taken up by researchers and writers as a crucially strategic way to strengthen the authority
of Tibetan medicine and to promote its use and importance in Chinese Tibet. The language of the
debates surrounding hormones speaks to the ways that medicine and science are never separate
from their social, religious, economic and political worlds, but mirror the concerns, anxieties,
hopes and ideals of their worlds.
Therefore, one of the core assumptions of this thesis in regards to medical authority is
that all medical systems, including the now world-dominant biomedical model, invoke the social
world to give expression to their scientific outlook. Evelyn Fox Keller, a scientist who writes on
scientific language and gender indicates that science is “useful” or “right” when it meets
particular social expectations. Or, in other words, the questions that scientists ask, how they are
answered and how that information or knowledge is used in practice, teaching, and in
dissemination reveals that “choices can be seen to be made that are social even as they are
cognitive and experimental.”86 One of the aims of this thesis is to show how the biomedical and/
or Tibetan medical study of women (gynaecology; mo nad), and in particular the research on
hormones in women (and men) implicates social, religious and political norms of gender. I am
not suggesting that there aren’t bodily or physical material which hormones describe; certainly,
scientists all over the world are working with real material processes in the body and their
systems of examining and testing are not arbitrary, but achieved through detailed study, trial,
error and sometimes fortuitous accident. I am continually astounded by the creativity and
ingenuity in understanding the material world as displayed by my medical colleagues.87 I am
86
Evelyn Fox Keller, Secrets of Life, Secrets of Death: Essays on Language, Gender, and Science
(New York: Routledge, 1992), 3. Emphasis in the original.
87
I am much indebted to my scientist mentors and fellow graduate students at the University of
Toronto’s Collaborative Program in Women’s Health in the Dalla Lana Public Health Department.
!34
interested in the material questions that scientists ask and endeavour to understand—but for now,
this thesis looks at how Tibetan medical experts write about the materiality of the female body.
To do this, I focus on the language, idioms, arguments and overall discussion surrounding the
inclusion (or non-inclusion) of biomedical hormones in contemporary Tibetan medical literature.
0.5 An Intellectual History of “Hormones” in Western Biomedical
Thought
The following section on “hormones” in Western biomedical thought is meant to serve
primarily as a comparative lens into the Tibetan system of “hormones.” My position is that both
the biomedical and the Tibetan medical systems describe a category of substances that are known
in English as “hormones.” However, while the studies of “hormones” within both traditions
implicate the most profound and fundamental ideas of sex, gender, the origins and the
development of human life, neither of these scientific traditions can be viewed as imitations of
the other. Most contemporary Tibetan medical writers state that they have knowledge of
biomedicine, and are therefore either able to incorporate, or at to least compare, their system with
biomedical thought, the bulk of their arguments are textual analyses that show “hormones” as
being already present in the Indo-Tibetan medical tradition. Clearly, the authority of biomedicine
looms large in contemporary medical research in Chinese Tibet, and in showing the Tibetan
perspective of “hormones” writers are clearly responding to, and dovetailing with biomedical
thought.
Hence, in placing this section on biomedical views of hormones into the introduction I
am enlisting a comparative method so as to show that the history of “hormones” in Western
biomedical thought reveals itself to be constituted by its own cultural context well within the
borders of its languages and cultures. In other words, the history of hormones in Western thought
reveals that biomedical ‘knowledge’ is not an objective science that is outside of language and
culture.88
88
For example see: Susan Rako, The Hormone of Desire: The Truth about Sexuality, Menopause, and
Testosterone (New York: Harmony Books, 1996) and Chandak Sengoopta, The Most Secret Quintessence
of Life : Sex, Glands, and Hormones, 1850-1950 (Chicago: University of Chicago Press, 2006).
!35
Emerging in Euro-American culture around the turn of the nineteenth-century, the study
of “hormones” investigated sex differences in the brain, reproductive organs, and sexual
behaviour. The term, “hormone,” is derived from the Greek word “hormaein,” so as to imply “an
agent that can excite, arouse, or stir.”89 Known today as belonging to the field of endocrinology,
the study of hormones in biomedicine implicates a number of medical branches. These medical
branches include the study of behaviour, the biochemistry and molecular biology of steroid
hormones, neurophysiology, neuroanatomy and neuroendocrinology.90 According to Western
medical thought today, “hormones” are microscopic but powerful secretions that are metabolized
in the endocrine glands—the major ones being the pituitary, pineal, hypothalamus, thyroid, and
adrenal glands, as well as the pancreas, testes and ovaries—and transmitted via the blood to their
various sites of action in the body. Although hormones are perhaps most associated with sexual
differentiation and reproduction, several classes of hormones are necessary for numerous and
diverse physiological processes such as “feeding and body weight regulation, pain, memory,
mood, anxiety, reward pathways, arousal, and sleep/wake cycles.”91
Initially, the study of hormones in the Western biomedical sciences was focused on
internal and external triggers in the physiology and reproductive lives of animals, with only a
speculative eye towards human beings. In large part this was because then, as it is today, most
experiments investigating hormones were conducted on animals. For example, based on their
studies using vertebrates and invertebrates92 in the 1920s, neuroendocrinology pioneers, Ernst
and Berta Scharrer worked on the idea of “neurosecretion,” that is, the creation and release of
89 Anthony W. Norman and Gerald Litwack, Hormones, Second Edition, ed., Gerald Litwack (San
Diego: Academic Press, 1997), 2.
90
Gillian Einstein, ed. Sex and the Brain (Cambridge, MA: MIT Press, 2007), xv.
91
Loyd D. Fricker, “Neuropeptides and Other Bioactive Peptides: From Discovery to Function,”
Colloquium Series on Neuropeptides 1, no. 3 (2012): 1.
92
Working as a team, the couple divided the animal kingdom such that Berta would study
invertebrates and Ernst, vertebrates. After Ernst’s death in 1965, Berta continued “to interpret the role of
neurosecretory cells in the central nervous system,” and “was one of the early defenders of the unifying
concept of a diffuse neuroendocrine system.” In the last decade and half of her life and work, she shifted
her focus to neuroimmunology, that is, the relation of the endocrine and immune systems. Andreas
Oksche, “Ernst and Berta Scharrer—Pioneers in Neuroendocrinology,” In Neuroendocrinology:
Retrospect and Perspectives, eds., Horst-Werner Korf and Klaus-Henning Usadel, (Berlin Heidelberg:
Springer, 1997), 1–4.
!36
hormones by neurons of the brain, which then spread in the blood and transmit messages to other
parts of the body. They mused that it “is certainly strange that cells as highly specialized as nerve
cells should also have the faculty of acting as gland cells, and many aspects of neurosecretion,
particularly as it concerns animals and man, are still obscure.”93
From the very beginning, a key element of endocrinological research has been that
whatever can be postulated and inferred from experimental data comes from experiments with
animals that most often entails their sacrifice and dissection. There have been studies on human
cadavers,94 but for obvious reasons, central physiological avenues of research are limited with
humans. Nonetheless, the endocrinological field has been been resourceful in devising ways to
learn about the role of hormones in humans.
In the 1940s, Frank A. Beach and Priscilla Rasquin’s experiments using male and female
lab rats worked to establish the relations among hormones, brain structures and copulatory
behaviour. Some of their experiments involved castrating or ovariectomizing rats and/or
injecting them with testosterone propionate, and then stimulating and observing their sexual
behaviours. Beach and Rasquin found that some female rats would mount like male rats, and
conversely they observed male rats showing lordosis and allowing themselves to be mounted.95
One of their conclusions was that sexual behaviour appeared as a continuum, rather than strictly
being either male or female. They also noted that the behaviour, in part, seemed to depend on
hormones. What this early work demonstrated, according to Gillian Einstein, is the
“individuality” in rodents, leading to Beach’s “perception that has been lost in the literature—
that just like primate behavior, rodent behavior depends on environment and circumstances.”96
93
Ernst Scharrer and Berta Scharrer, “Neurosecretion,” Physiological Reviews 25, no. 1 (1945): 171.
94
See: Laura S. Allen and Roger A. Gorski. “Sex Difference in the Bed Nucleus of the Stria Terminalis
of the Human Brain,” The Journal of Comparative Neurology 302, no. 4 (1990): 697–706.
95
See: Frank A. Beach, “Female Mating Behavior Shown by Male Rats after Administration of
Testosterone Propionate,” Endocriniology 29 (1941): 409–12, and; Frank A. Beach and Priscilla Rasquin,
“Masculine Copulatory Behavior in Intact and Castrated Female Rats,” Endocriniology 31 (1942): 393–
409.
96
Einstein, ed. Sex and the Brain, 2.
!37
Contemporaneously to Beach and Rasquin, Geoffrey Harris helped to establish the
hypothalamus-pituitary connection showing that hypothalamic neurons in the brain secrete
hormones that regulate the anterior pituitary gland, which itself regulates the secretions of
hormones into other parts of the body.97 According to Geoffrey Raisman, Harris’ work solidified
in the field of endocrinology the “view that the brain controls the endocrine system by an
exquisitely regulated pattern of synthesis and release of individual members of a family of
peptide hormones.”98 Significant to Western endocrinology, Harris’s research demonstrated how
hypothalamic hormones found in vertebrates, including humans “are essential for all aspects of
reproduction—courtship, mating, pregnancy and young rearing—and they are responsible for the
seasonal regulation of breeding.”99 Insofar as being part of the larger endocrine system, Harris’
work established that some hypothalamic hormones specifically regulate the secretion of
pituitary growth hormones, while others control the functions of the thyroid and adrenal glands.
Moreover, the secretion of the hypothalamic hormones is itself “regulated by the feedback of the
target gland hormones (such as estrogen and progesterone), which concurrently act on the brain
to elicit appropriate behaviour patterns.”100 Therefore, from the onset, the field of endocrinology
has not been a study of ‘closed’ bodies, but rather an investigation into how various factors of the
external environment, social behaviours, and mating patterns interact with the functions,
mechanisms, and timings of a ‘permeable’ body.
The study of hormones in Western culture presents us with a material-based experimental
lens of investigating the interactions and feedback mechanisms among material physiological
substances inside the body, our (un)natural environments, and human (and animal) social worlds.
Significantly, early Euro-American studies on hormones were open to sexual, and what today we
think of as ‘gender’ diversity—while scientists were looking specifically for physical markers of
sex, they were actually discovering its fluidity. As the field progressed, incredible technological
97 See: Geoffrey W. Harris, “The Induction of Ovulation in the Rabbit, by Electrical Stimulation of the
Hypothalmo-Hypophysial Mechinism,” Proceedings of the Royal Society of London 612 (1937): 374–94.
98
Geoffrey Raisman, “An Urge to Explain the Incomprehensible: Geoffrey Harris and the Discovery
of the Neural Control of the Pituitary Gland,” Annual Review of Neuroscience 20 (1997): 533.
99
Ibid., 533.
100
Ibid., 533.
!38
advancements allowed researchers to see, measure and quantify ever-increasingly minute
particles of animal and human bodies, advancing research into the early insights of
endocrinology’s pioneers.
By the 1980s, Western researchers had come to focus on the concept of sex differentiation
which considers how the male and female phenotype develop into two recognizably distinct
sexes.101 Einstein writes that this step in the history of hormones was to ask: “if female and male
sexual behaviors differ, and behavior is mediated by the brain via the endocrine system, “how
does it get that way?” How does the brain differentiate into one of two sexes?”102 One of the
leading hypotheses was that “hormones, circulating early in embryonic development, move the
fetal nervous system toward a male or female phenotype.”103 Accordingly, if nothing had gone
amiss during development, the brain and endocrine glands, bodily phenotype and the male and
female chromosomes (the XY and XX for male and female respectively), would necessarily be
aligned in either a male or female person, or an animal. Related to this, the “organization” and
“activation” hypotheses, postulated in the early days of Beach, Harris and others, became
established in the field. The former hypothesis refers to the way in which prenatal and postnatal
hormones organize the very structure of the brain and the sexed body during the critical
development stages. The latter “activation” hypothesis points to the ability of hormones to
trigger or to suppress, that is to ‘activate,’ specific actions in a developed adult body.104
The study of the biochemistry and actions of steroid hormones became another important
arm in Western endocrine research. The focus of this sub-field is the study of how sex steroids
101 For example, see: Neil J. MacLusky and Fredrick Naftolin “Sexual Differentiation of the Central
Nervous System,” Science (New York) 211, no. 4488 (1981): 1294–1302, and Robert W. Goy, and Bruce
S. McEwen, “Sex Differences in Behavior: Rodents, Birds and Primates,” in Sexual Differentiation of the
Brain: Based on a Work Session of the Neurosciences Research Program, eds., by Robert W. Goy and
Bruce S. McEwen (Cambridge, Mass.: MIT Press, 1980), 13–58.
102
Einstein, ed. Sex and the Brain, 3.
103
Ibid., 3.
104
See: Charles H. Phoenix, Robert W. Goy, Arnold A. Gerall, and William C. Young, “Organizing
Action of Prenatally Administered Testosterone Propionate on the Tissues Mediating Mating Behavior in
the Female Guinea Pig,” Endocrinology 65 (1959): 369–82, and Michael J. Meaney and Jane Stewart,
“Neonatal Androgens Influence the Social Play of Prepubescent Rats,” Hormones and Behavior 15, no. 2
(1981): 197–213.
!39
are metabolized and converted into other, more specific hormones.105 According to Western
biomedical researchers, all steroids first originate from cholesterol. Pregnenolone is first
synthesized from the cholesterol. The androgen, dehydroepiandroserone (DHEA) and
progesterone is then produced. On one pathway, progesterone is metabolized to androstenedion
which can further metabolize to become either testosterone or estrone. On the other pathway,
DHEA transforms to androstenediol, which is converted to testosterone, and then to
dihydrotestosterone.106 Estrogen, in this system, is metabolized from androgens, but its pathways
are far less known. It is in these successive series of syntheses that the steroid hormones of
testosterone and estrogen are produced.
One of the important insights gained from this field is that these hormones are
specifically neither male nor female. And it possibly could be the case that “it is estrogen not
testosterone itself that “masculinizes” the developing brain.”107 Although in Western culture,
steroid hormones are oftentimes characterized as masculine or feminine, no such hormone is
exclusively male or female; the production of androgens is required to produce estrogens, and
conversely, androgens which have been produced can be converted into estrogens.108 Yet, despite
their non-exclusivity or lack of unique maleness or femaleness, it is the orchestrated actions of
hormones and their receptors, especially during the critical periods of (pre-and post natal)
development that are thought to direct the embryo towards being either male or female. A second
major notion in the study of the biochemistry of steroid hormones is that “although not
exclusively, steroid hormones have their major effects by their synthesis in endocrine organs and
delivery to sites of actions via the blood. They acquire their specificity of action through being
105 Two important examples include: Neil J. MacLusky, Ann S. Clark, Frederick Naftolin, and Patricia
S. Goldman-Rakic “Estrogen Formation in the Mammalian Brain: Possible Role of Aromatase in Sexual
Differentiation of the Hippocampus and Neocortex,” Steroids 50, no. 4 (1987): 459–74, and; Simon W.
Law, Ede M. Apostolakis, Patrick J. Samora, and Bert W. O’Malley, “Hormonal Regulation of
Hypothalamic Gene Expression: Identification of Multiple Novel Estrogen Induced Genes,” Journal of
Steroid Biochemistry and Molecular Biology 51, no. 3 (1994): 131–36.
106
Einstein, ed. Sex and the Brain, 4.
107
Ibid., 4.
108
Ibid., 4.
!40
sequestered and amplified by receptors.”109 The receptors become activated by binding to the
steroid hormones. Because both androgen and estrogen receptors belong to the larger class of the
steroid/thyroid receptor super family, those hormones have many bodily functions outside of
reproduction, and again, are not exclusive to either sex.
Despite the early findings that indicated that hormones are not ‘sexed’ as uniquely male
or female, the model of sexual dimorphism guided the assumptions of many in the field of
Western endocrinological research. There are a few reasons for this. One of the problems is that
the male body is still often taken as the normative human body and the female body is vastly
understudied; sex differences are simply not investigated in most research studies and clinical
trials. Or, often when they are researched, anatomical size, density and volume are measured and
commonly regarded as evidence for meaningful sexual differences—assuming that size matters.
Still today in the West, male pathways and triggers in the brain, the role of sperm versus the
female egg, the switches of the XY chromosome and so on, are far better understood than such
processes in females.
Perhaps the most telling example of this lack of research into female bodies, and the
normalization of equating the male body with the human one can be found in the research into
the SRY, at the time (1980s – 90s), the so called ‘sex-determining gene.’ The SRY gene, located
in a region on the Y chromosome, “turns on the differentiation of the testes and hence, the
synthesis of testosterone.”110 In the absence of SRY, a female phenotype will be born. Initially,
the search for SRY was inspired by the assumption that there exists a single “master gene” that
directs the development of the whole human organism; finding it represented the “holy grail of
109
Ibid., 4.
110
Ibid., 3.
!41
sex difference research.”111 When researchers ‘discovered’ and confirmed the SRY gene,112 that
is, the gene that ‘makes a man a man,’ scientists and media outlets such as the New York Times
characterized the finding rather androcentrically. The male SRY pathway was taken as the
normative sex-determining factor, and the female pathway was labeled as the “default.”113 In
other words, the male was thought of as ‘active’ and the female, as ‘passive’ default, and without
her own active pathways to becoming female.
Gender-critical scientists such as Anne Fausto-Sterling, Jennifer Graves and Roger Short,
who also worked in the endocrinological field, pointed to several problems with the prevailing
view of the SRY gene.114 Sarah Richardson writes that the main argument of Fausto-Sterling’s
article, “Life in the XY Corral” was three-fold:
First, by equating the genetics of testis determination with the genetics of sexdetermination, researchers had neglected parallel investigation into the genetics of ovarian
development. Second, researchers had privileged male over female processes by accepting
a highly resonant metaphor of “male as presence and female as absence.” Male processes
of sexual development were deemed a more interesting, complex, and dynamic object of
investigation than female processes. Third, researchers had assumed that sex organizes into
a “clearcut” binary such that it can be unambiguously determined by genetic assay.115
111
Sarah Richardson, “When Gender Criticism Become Standard Scientific Practice: The Case of Sex
Determination Genetics,” Gendered Innovations in Science and Engineering, ed., Londa Schiebinger
(Palo Alto, CA: Stanford University Press, 2008), 24.
112 David C. Page, Rebecca Mosher, Elizabeth M. Simpson, and Elizabeth M. C. Fisher “The SexDetermining Region of the Human Y Chromosome Encodes a Finger Protein,” Cell 51, no. 6 (1987):
1091–1104; Sinclair, Andrew H. Sinclair, Philippe Berta, Mark S. Palmer, and J. Ross Hawkins, “A Gene
from the Human Sex-Determining Region Encodes a Protein with Homology to a Conserved DNABinding Motif,” Nature 346, no. 6281 (1990): 240–44; Philippe J. Berta, Ross Hawkins, Andrew H.
Sinclair, and Anne Taylor, “Genetic Evidence Equating SRY and the Testis-Determining Factor,” Nature
348, no. 6300 (1990): 448–50, and; Christopher M. Haqq, Chih-Yen King, Etsuji Ukiyama, and Sassan
Falsafi, “Molecular Basis of Mammalian Sexual Determination: Activation of Mullerian Inhibiting
Substance Gene Expression by SRY,” Science 266, no. 5190 (1994): 1494–1500.
113
Richardson, “When Gender Criticism Becomes Standard Scientific Practice,” 24–5, and Einstein,
ed., Sex and the Brain, 5.
114
See: Anne Fausto-Sterling, “Life in the XY Corral,” Women’s Studies International Forum 12, no. 3
(1989): 319–31; Jennifer A. Graves and Robert V. Short, “Y or X—Which Determines Sex?”
Reproduction, Fertility, and Development 2, no. 6 (1990): 729–35, and; Graves, “Human Y Chromosome,
Sex Determination, and Spermatogenesis—A Feminist View,” Biology of Reproduction 63, no. 3 (2000):
667–76.
115
Richardson, “When Gender Criticism Becomes Standard Scientific Practice,” 28.
!42
Richardson’s observations draw attention to the underlying biases in Western culture which
within the study of “hormones” deeply implicates gendered norms and the respective valuing of
males and females. As a result, many gender-critical scholars have examined how cultural,
religious and societal views of women and men became crystallized in endocrinological
research.116
Many of these studies examine the persistent idea among researchers that hormones are
‘sexed’ and produce ‘masculinity’ and ‘femininity’ in men and women. The role of language, and
the conceptual thinking it entails, is as central in many of these arguments as it is in mine. It is
the site where scholars often locate the intersection between science and society. Today, many
humanities scholars who study science and gender seriously challenge any objective, non-social,
non-linguistic approach to ‘science’, arguing that the medical view of sexed bodies is always
foremost informed by social expectations. Judith Butler, a philosopher of linguistics and
psychology, definitively ushered in the present era where many Western gender studies scholars
question the distinction between sex and gender altogether. Butler contends that anything said
about ‘biological sex’ is first necessarily signified by ideas of ‘gender.’ Since language and
linguistic signs are inherently social it is not possible to isolate a pre-social biological ‘sex.’ In
other words, the distinction between biological sex and social gender is a false one that masks the
ways that the inequalities of heteronormative culture are maintained and perpetuated.117
116
For example, see: Ruth Bleier, Science and Gender: A Critique of Biology and Its Theories on
Women (New York: Pergamon Press, 1984); Anne Fausto-Sterling, Sexing the Body: Gender Politics and
the Construction of Sexuality, (New York: Basic Books, 2000); Diana Long Hall, “Biology, Sex
Hormones and Sexism in the 1920s,” in Women and Philosophy: Toward a Theory of Liberation, eds.
Carol C. Gould and Marx W. Wartofsky (New York, NY: Putnam, 1976), 81-96; Bernice L. Hausman
“Ovaries to Estrogen: Sex Hormones and Chemical Femininity in the 20th Century,” Journal of Medical
Humanities 20, no. 3 (1999): 165–76; Ludmilla Jordanova, Sexual Visions: Images of Gender in Science
and Medicine between the Eighteenth and Twentieth Centuries (Madison, WI: University of Wisconsin
Press, 1989); Evelyn Fox Keller, Reflections on Gender and Science (New Haven: Yale University Press,
1985); Thomas Laqueur, Making Sex: Body and Gender from the Greeks to Freud, (Cambridge, Mass.:
Harvard University Press, 1990); Margaret M Lock, Encounters with Aging: Mythologies of Menopause
in Japan and North America (Berkeley: University of California Press, 1993); Emily Martin, The Woman
in the Body: A Cultural Analysis of Reproduction (Boston: Beacon Press, 1989); Nelly Oudshoorn,
Beyond the Natural Body: An Archaeology of Sex Hormones (New York: Routledge, 1994); and, Celia
Roberts, “‘A Matter of Embodied Fact’: Sex Hormones and the History of Bodies,” Feminist Theory 3,
no. 1 (2002): 7–26; and, Elizabeth Siegel Watkins, The Estrogen Elixir: A History of Hormone
Replacement Therapy in America (Baltimore: Johns Hopkins University Press, 2007).
117
Judith Butler, Bodies That Matter: On the Discursive Limits of “Sex” (New York, NY: Routledge,
2011).
!43
According to Carole Worthman, a common problem among humanities perspectives of
medical research is that:
These studies dissect the scientific production and interpretation of knowledge but rarely
provide sustained analysis of how scientific terms and data are selectively appropriated,
distorted, and recast by nonscientists, or “folk,” in the social construction of sex and sex
differences… Such critics of science thus eschew the opportunity for yet more subtle
analysis of social constructions of reality and of the power struggles involved in those
constructions, in favor of simplified readings of science as hegemonic, monolithic, and
unreflexive. 118
While such criticism appears to ignore the wider point of humanities scholars, namely, that
science can never be separated from the social world, regardless of how much non-scientists may
bungle scientific literature—the lack of attention to the realities of scientific research sometimes
reflected in social studies of science is understandably distressing to scientists. Today, it is
generally the case that Western scientists who ‘actually work with hormones’ agree that estrogen
and testosterone are not exclusive to either sex, and further, that the ‘sexing’ of male and female
hormones is a popular public myth, rather than an accepted notion circulating in (peer-reviewed)
scientific thought. However, researchers concede that pervasive views about gender can
contribute to biases at every stage of their work, and that they consistently grapple with the
‘nature vs. nurture’ debate in the course of their research.119 Western endocrinology is a field that
must explicitly consider the role of social gender norms in thinking about human biology. The
gender critical approach taken up by scientists and humanities scholars is pushing endocrinology
into the direction of studying ‘gender’ as a part of ‘sex’ difference. Sarah Richardson argues that
since roughly the 2000s, gender critical research has become “normalized” in the field of sexdetermination genetics.120
The study of “hormones” in Euro-American culture is complicated and involves many
areas and methods of research. It is a study that unravels and disrupts strict sexual binaries,
118
Wothman, “Hormones, Sex and Gender,” 596.
119
For example, Kelly Evans, “Testosterone and Cognition,” Collaborative Program in Women’s
Health,” Sidney Smith Hall, University of Toronto, April 15, 2015.
120
Sarah Richardson, “When Gender Criticism Become Standard Scientific Practice: The Case of Sex
Determination Genetics,” Gendered Innovations in Science and Engineering, ed., Londa Schiebinger
(Palo Alto, CA: Stanford University Press, 2008), 22–42.
!44
showing instead a continuum, and yet at the same time, it examines how hormones are involved
in the developmental organization and activation of dimorphic male and female bodies. It is also
a field that is reaching ever further into other research branches, and few researchers of the
human body can ignore the enormous influence of “hormones” in human and animal bodies, and
in the environment. As we look through the Tibetan sources that speak to “hormones,” it will
become clear that they are considering the same sorts of questions as Western endocrinologists
and are responding to the biomedical system of hormones, albeit within a Tibetan framework.
Hence, I suggest that while we think of “hormones” as being something materially ‘real’ and
tangible, we must also understand their study and explication as within cultural and historical
dimensions.
The first chapter of this dissertation provides a general description of my primary
sources, and medical writing and publishing in Qinghai Province, China. After this, I examine
the methods by which medical authority is established, and the ways in which women’s bodies,
according to the Four Treatises, are interpreted in present-day medical works. Lastly, I provide a
brief overview of the Tantric, or vajra, body of Tibetan Buddhism. In the Second chapter, I
examine “hormones” in two book-length commentaries, Thupten Püntsok’s Knowledge of the
Body in Tibetan Medicine,121 and Mingji Cuomu’s Clinical Experience in Treating Obstetric
Diseases.122 From these two works, I present a basic framework of Tibetan understandings of the
human, and in particular, female body. In the third chapter, I analyze two present-day Tibetan
medical articles, “Study of Menstruation within the Body of Tibetan Medicine”123 by Lhamokyi,
and “A Brief Discussion on the Connection between Reproductive Fluid, Marrow, the Brain and
the Ovaries/Testes”124 by Gönpokyap. In this chapter, I pay special attention to the Tibetan
argument that the biomedical understandings of hormones and the endocrine system can be
established in the authoritative and classical literature of the Indo-Tibetan medical and Buddhist
tradition. In the fourth chapter, I examine two home reference works that specialize in women
ba.
121
Thub bstan phun tshogs, Gso bya lus kyi rnam bshad.
122
Sman skyi mtsho mo, Mo nad phal pa’i nad la zhib ’jug dang gso bcos kyi nyams yig.
123
Lha mo skyid, Zla mtshan gyi rnam par bshad pa blo chung byis pa'i mgul rgyan.
124
Mgon po skyabs, Khu ba dang rkang klad pa bsam bse’u bcas kyi ‘brel ba’i skor phran tsam gleng
!45
and teenage girl’s health, Wangyel’s Knowledge on Maintaining the Health of Mother and
Child,125 and Palzang Gyatso’s Some Common Knowledge about Protecting the Health of
Women.126 In my analysis of “hormones” in these two works, I focus on how political, social and
religious attitudes and perspectives towards women become ‘medicalized.’ In my concluding
remarks, I explore the intersection of religion, gender, and medicine in the contemporary Tibetan
medical literature that speaks to “hormones.”
The way that I have decided to translate and present the Tibetan picture of hormones is by
paying close attention to the language and context of two related but distinct types of
contemporary Tibetan medical works that speak to hormones in women’s bodies, what I call
professional works, and home healthcare references. The first type of works, taking up Chapters
Two and Three, are intended for a medical, or at least, a university educated Tibetan audience.
The book-length works of the second chapter were chosen for their ability to lay out and explain
the Tibetan medical and Tantric body for the uninitiated reader. They also present us first with an
earlier work showing a somewhat tentative speculation on the relation of biomedical notions of
hormones and Tibetan medical thought, and decade-later work which directly integrates Tibetan
medical and Chinese biomedical terms for hormones. The two articles of the third chapter are
technical works that focus on a significant debate within the Tibetan professional sources
involving the key endocrinological relation between the brain, ovaries, testes, and reproductive
fluids. Both of these articles contribute to an emerging trend in the Tibetan sources, deliberating
whether or not the authoritative Tibetan medical, Buddhist, and Tantric sources demonstrated
some knowledge of these endocrinological relationships before gaining some awareness of
biomedical hormones. The fourth chapter, which concentrates on home health reference works
for women and girls, presents a language of hormones as these relate to ideas of women, gender,
and Tibetan nationalism. In this way, we can study the Tibetan view of hormones from a range of
perspectives, target audiences, and methodological approaches.
125
Dbang rgyal, Ma bu bde srung gi rgyun shes (Xining: mtshong mi rigs dpe skrun khang), 2005.
126
Dpal bzang rgya mtsho, Bud med bde srung skor gyi rgyun shes phran bu bzhugs.
!46
1. Contemporary Tibetan Medical Literature on Women: The Primary
Sources in Context
The purpose of this chapter is to examine the origins and orientations of the primary
sources for this thesis before exploring what they say about hormones. Therefore, this chapter
will outline a general description of the primary works, followed by their relation to Tibetan
medical research and publishing in Chinese Tibet, specifically within Xining and Qinghai
Province. In the following section, I examine how contemporary Tibetan medical researchers
who write about women’s bodies and hormones establish themselves and their traditional system
of knowledge as authoritative. Included in this is an examination of the Tibetan response to
biomedicine and how that response is established and positioned in relation to the authority of
their traditional system of knowledge. Following this, I focus on the descriptions of women’s
bodies as found in the Four Treatises, the premier authoritative medical treatise among
contemporary writers. Lastly, the relation of Tibetan medical and Tantric Buddhist bodies in
authoritative and present-day medical writings is examined in the final section.
1.1 General Description of Primary Sources
The primary sources herein are contemporary Tibetan language medical works that
incorporate biomedical notions of hormones with Tibetan medicine.127 I focus on a small
selection of gso ba rig pa works that represent a variety of forms of modern Tibetan medical
publishing: journal articles, books on women, books on the whole human body, gynaecology
textbooks, and home reference books for women and girls. The primary sources of these presentday works are the classic authoritative texts of the Tibetan medical and Buddhist traditions,
principally the Four Treatises and its commentarial tradition. Because of this, I give something
of the history, authorship and context of the authoritative literature and how these are relevant in
the present-day works.
127 All
translations from Tibetan to English in this thesis are my own. On numerous occasions I kindly
received advice on the interpreting and translating these texts by various Tibetan friends and interlocutors
in Toronto, India, Nepal and Tibet. Nonetheless, any and all errors—I have no doubt that there are many
—are my own. Suggestions and alternative readings are welcome.
!47
Many of my sources are published by the major Tibetan publishing houses in the eastern
or Amdo and Khams regions, which are: Xining (Qinghai), Lanzhou (Gansu), Dechen (Yunnan)
and Chengdu (Sichuan).128 A few of my primary sources are published by the Lhasa People’s
Publishing House (TAR), and the Tibetan Publishing House in Beijing, but their authors also
have connections to eastern Tibet in various ways, and sometimes have their works published by
the bigger houses in Beijing and Lhasa. 129
Nearly all of my primary sources that examine hormones are published after 2000,
although some sources date from the mid to late 1990s. Because I have limited my range of
primary sources to the last two decades or so, I am unable to comment upon when or in what
ways biomedical notions of hormones in Tibetan medical thought have developed over the last
century. From my own observations, there appears to be a significant interest in demonstrating
Tibetan medical notions of hormones, and comparing and incorporating them with biomedical
ideas. Among my primary sources, works from the mid to late 1990s are cursory in their
comparisons with biomedical hormones. For example, Thubten Phunstok’s 1999 book,
Knowledge of the Medical Body130 touches on hormones a number of times, but more so in a
cursory, exploratory way, noting that these come from the ovary. He also suggests that a tentative
relationship exists between the channels and cakras of the Tibetan medical-Tantric body and the
Western notion of glands and hormones. In his book, Thubten Phunstok writes that “…if we
examine carefully the nature of the relationship between this and “hormones,” which are taught
in relation to “glands” in the Western system of medicine, I think beneficial fruits will naturally
emerge.”131 Similarly, in the home health book, Means of Preventing and Curing Women’s
128 Lauran R. Hartley and Patricia Schiaffini-Vedani, “Introduction,” in Modern Tibetan Literature and
Social Change, eds., Lauran R. Hartley and Patricia Schiaffini-Vedani (Durham: Duke University Press,
2008), xiv.
129
For example, the Qinghai Tibetan Medical College’s textbook series is published in Beijing.
130
Thub bstan phun tshogs, Gso bya lus kyi rnam bshad.
131
… nub phyogs pa’i gso rig lugs kyi rmen bu la brten nas ‘babs pa’i ho’o mo’u (Hormone) zhes pa
de gnyis ‘brel ba gang yod legs par brtag na rang gzhan gnyis ka la phan pa’i ‘bras bu zhig ‘byung bar
sems, ibid., 125.
!48
Disorders according to the Authoritative Literature of Tibetan Medicine,132 by Palden Thinley
and published in 1996, the author mentions the role of the endocrine system and hormones, but
presents this more as information that is in addition to Tibetan medicine, rather than integrating
ideas from both traditions. Yet he also provides a full colour and very detailed biomedical-style
anatomical illustration with Tibetan language labels.
By the 2000s, Tibetan authors appear confident in their assertion that biomedical ideas of
“hormones” are not only compatible with, but already have been known and written about in the
authoritative literature of Tibetan medicine (and Tantra). As a result, a number of key points of
consensus about “hormones” in the authoritative sources have been established among
contemporary writers. These key points include the relations among sexual difference, the brain,
and the reproductive fluids (the white and the red elements), the connection between digestion
and quintessential or “hormonal” substances, and the relation between “glands” and “hormones.”
Moreover, Chinese biomedical terms began appear as direct correlates to Tibetan words and
ideas. For example, Clinical Experience in Treating Obstetric Diseases133 by Mingji Cuomu, and
a 2010 health handbook for rural Tibetans, The Body and How it Works134 produced by the
Xining-based Jinpa Project135 provide Tibetan-language medical illustrations accompanied with
integrated Tibetan and biomedical explanations of the glands, hormones, and their relations to
reproduction.
Other non-specialist works also published after 2000 and directed at young women, such
as Wang Gyal’s Knowledge on Maintaining the Health of Mother and Child,136 and Palzang
132
Dpal ldan ’phrin las, Bod lugs gso rig gi rgyun mthong mo nad ’gog bcos bya thabs (Lhasa: Bod
ljongs mi dmangs dpe skrun khang, 1996).
133
Sman skyid mtsho mo, Mo nad phal pa’i nad la zhib ’jug dang gso bcos kyi nyams yig.
134
The Jinpa Project, Mi lus grub tshul dang byed las (Xining: Mtsho sngon mi rigs dpe skrun khang,
2010).
135
The Jinpa Project is a NGO grassroots Tibetan-run charity that focuses on improving the lives of
rural Tibetans, and has produced a total of eight health handbooks, including one focussed on the
reproductive health of women. For more on the Jinpa Project see their website: http://www.jinpa.org. Last
accessed May 25, 2015.
136
Dbang rgyal, Ma bu bde srung gi rgyun shes.
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Gyatso’s General Knowledge on the Health of Women137 also directly refer to joined Tibetan and
biomedical notions of hormones and their relation to the glands, ovulation, menstruation and
pregnancy. Among my primary sources, it can be said that the compatibility of Tibetan medical
and biomedical thought in regards to the relations among glands, hormones and reproduction is
assumed, and medical researchers are increasingly focusing their attention on establishing
Tibetan knowledge of hormones in the authoritative literature. A key way that they do this is
through positioning biomedical knowledge in such a way as to confirm and develop Tibetan
knowledge.
While the majority of new Tibetan medical works on women say something on
biomedical notions of hormones and their relation to Tibetan medical ideas, there are exceptions.
Significantly, a core gynaecology textbook used by the Qinghai Tibetan Medical University,
Jampa Dolkar’s Healing Women’s Disorders138 (quoted in the introduction) focusses on a fusion
of Tibetan and Āyurvedic medicine and makes no mention of biomedicine in any of its contents.
The fact that the work belongs to a series of medical textbooks, in part titled “the Standard of
Tibetan Medicine in the Twenty-first Century” (dus rabs 21 pa'i bod lugs gso rig dngos tshan)
perhaps makes it more striking that biomedical notions of hormones are completely absent. Yet,
clearly for Jampa Dolkar the standard study and explication of authoritative literature, rather than
the integration or comparison with biomedical ideas, is one way to maintain the authority of
Tibetan medicine. Jampa Dolkar’s textbook outlines, and explains in thorough detail Tibetan
gynaecological knowledge—if the aim is to provide an unadulterated standard textbook of
Tibetan medicine as a core basis of education for medical students, then her book achieves that
goal.
Other works, such as Dorje Rigzin’s home reference book, Excellent Practices of Tibetan
Medicine: Easy to Understand for Intelligent People, 139 follow similar suit insofar as exclusively
adhering to the Gso ba rig pa-Āyurvedic medical model, and not including biomedical ideas of
137
Dpal bzang rgya mtsho, Bud med bde srung skor gyi rgyun shes phran bu bzhugs.
138
Byams pa sgrol dkar, Mo nad gso ba.
139
Rdo rje rig ’dzin, Gso rig go bde’i rnam bshad blo gsal dgyes pa’i lam bzad (Xining: Mtsho sngon
mi rigs dpe skrun khang, 2008).
!50
hormones. As I stated in the Introduction, some Tibetan researchers argue that the best way to
conduct research into and preserve the Tibetan tradition is through re-publishing the authoritative
sources so as to establish the primacy of textual scholarship. Hence, some present-day medical
works make little to no mention of biomedicine in relation to Tibetan medicine, and do no
integrate hormones into their configurations of the female body.
These examples highlight a striking difference between Tibetan writers that write about
“hormones” and the few who do not. While the former group places great emphasis on locating
the relations among the brain, quintessences and reproductive fluids in the Tibetan authoritative
literature, this triad is largely absent in the works of the latter group. This difference in
perspectives demonstrates just how much contemporary medical researchers who are speaking to
“hormones” are re-interpreting and re-thinking their tradition in relation to modern biomedicine.
In spite of the exceptions, nearly all of the contemporary Tibetan medical sources on
women incorporate and debate the biomedical notions of hormones. The most glaring of these
debates is the naming of hormones. Although there is some overlap, and common conceptual
language, authors use a variety of phrases and terms to describe and name “hormones.” To get at
the heart of this and other debates, I look again to the Tibetan geo-political context, and religious
and social perspectives of sex and gender. Hence, starting with medical practice and publishing
in contemporary Chinese Tibet, the remainder of this chapter provides more detail as to the
context of my primary sources.
1.2 Medical Practice and Publishing in Qinghai Province
Up until the Chinese incorporation of Tibet, medical colleges in what is now Qinghai
province were limited to the monasteries, the main one being the Kumbum (sku ‘bum) monastery
in Rusar (Ru gsar) (Huangzhong) County. After the Chinese takeover, and owing largely to the
destruction and dismantling of the Tibetan Buddhist monastic system as it had existed, Tibetan
medicine moved from the monasteries into more secular institutional settings such as medical
clinics. By 1978, there were several of these clinics, including Tibetan medical divisions within
larger Chinese biomedical hospitals. Beginning in the 1980s, during the “reform and opening up”
(gaige kaifang) period under the leadership of Deng Xiaoping (1904-97), roughly a thousand
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doctors were graduated from two medical courses, the Medical School of Huangnan Tibetan
Nationality Autonomous Prefecture (Huangnan Zangzu Zizhizhou Weisheng Xuexiao) and the
Society of Tibetan Medicine of Qinghai Province. The Qinghai College of Tibetan Medicine was
established in 1987, and has since become one of the leading centres of Tibetan medicine,
drawing students from across China. 140
Today, Qinghai Tibetan Medical Hospital (QTMH) and its related facilities, located in
Xining, serve as the central medical hub for eastern Tibet. QTMH is partly supported by the
Arura Medical Group, which funds five interrelated branches: College of Tibetan Medicine,
Tibetan Hospital, Arura Research Division, Museum of Tibetan Medicine, and Arura Tibetan
Pharmaceutical Factory.141 From within its research division, the Arura group is at the heart of
medical publishing in eastern Tibet, investing heavily in textual research and the re-printing of
Tibet’s authoritative medical literature, in addition to publishing contemporary commentaries.
The Arura medical group also works with other local and regional researchers, and is closely tied
to the Lhasa Menstikhang, with medical students, doctors and researchers often spending time at
each centre.142 QTMH is considered a primary care facility for many of its patients, who are
mostly Tibetan. Not infrequently, Han, Huie, and Uigyur peoples consult Tibetan medical
doctors. I am not aware of any published data showing the ethnicity or place of residence of
QTMH’s patients, but I would gander (from dress and dialect) that the majority of the Tibetan
patients are rural, and also as well, that a number of urban Xining Tibetans use the QTMH’s
facilities. Being a large city, there are number of Chinese biomedical hospitals and Traditional
Chinese Medicine (TCM) medical centres in addition to the QTMH.
The “gynaecology department” (mo nad tshan khag) of QTMH consists of in and outpatient divisions located in separate buildings. The hospital has no birthing facilities, although
many women consult Tibetan gynaecologists as part of their pre-natal and post-natal care.
According to their brochure (and as I witnessed), the doctors who work in the Gynaecology
Division use a “balance” (cha snyoms) of the “traditional practices of the Tibetan system of
140
Hua, “The Diffusion of Tibetan Medicine in China,” 96.
141 Adams,
142
Dongzhu and Le, “Translating Science,” 112.
Personnel communication, QTMH, 2011.
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medicine” (bod lugs gso rig gi phyag len rgyun ‘dzin) with the “new methods” (thabs gsar pa)
investigated by its research arm.143 The doctor under whom I studied is one of the full-time
gynaecology specialists. As advertised in a brochure, just published before I left in 2011, she has
experience treating: “aggravated blood and aggravated wind disorders” (khrag tshabs dang rlung
tshabs), “uterine parasites/infections” (mngal srin), “uterine growths” (mngal skran), “menstrual
problems” (mngal ‘byams pa), “infertility” (ro tsa gso ba), and other “various female
disorders” (mo nad sna tshogs).144 While I studied there and travelled around the villages and
towns outside of Xining, such as Rebkong (Reb kong; Ch. Tongren), it became evident that she
was quite renowned for her skill in treating women’s disorders, which seemed supported by her
status as the daughter of a famous lineage doctor.145 So well-regarded, and despite being a
specialist in gynaecology, not infrequently she had male patients including monks. On one
occasion when I was present, a Chinese policeman (with his mother, sister and wife
accompanying him) was there looking for a remedy for his acne. Although the hospital is largely
organized along biomedical style departments and categories, patients not infrequently ‘cross’
departmental lines and seek whichever doctor they feel would yield the most benefit.
A central reason that I highlight clinical practice at QTMH and the specialist under whom
I studied is because it demonstrates the importance of the relation between practice and
publishing in Chinese Tibet. Having experience as a medical practitioner in addition to having
textual knowledge is a key way Tibetan medical writers establish their authority. By being
experienced with patients, the writers can make claims about having in-depth knowledge, that is,
they have fully integrated the experience of having experience in practical medicine. Similar to
the biomedical researcher, Tibetan medical researchers need to be competent in the literature of
their field. Dissimilarly, biomedical researchers do not have to work directly with patients to gain
the experience that is so necessary for establishing the authority of Tibetan medical writers. In
other words, the outcome of clinical trials are not normally thought to be affected by whether or
143
Mtsho sngon zhing chen bod sman khang, “Mo nad tshan khag,” 2011.
144
Ibid.
145
For more on Tibetan lineage doctors see: Mona Schrempf, “Bön Lineage Doctors and the Local
Transmission of Knowing Medical Practice in Nagchu,” in Soundings in Tibetan Medicine:
Anthropological and Historical Perspectives (Boston: Brill, 2007), 91–126.
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not the researcher is a practicing doctor. The next section deals more specifically with how
Tibetan medical researchers and doctors position their system of knowledge as authoritative and
on equal scientific footing with biomedical thought.
1.3 The Past Becomes Present: Establishing the Authority of
Tibetan Medical and Buddhist Literature
Establishing the authoritative basis of Tibetan medical knowledge in both the past and the
present is an important element of contemporary medical writing. Emphasizing critical and
empirical methods, present-day medical researchers are keen to demonstrate Tibetan medicine to
be a system based on observations of the human body and its various conditions. The common
assertion that Tibetan medicine is a “gem” among the world’s medical traditions, is based on the
axiom that Tibetan medicine is on the same scientific footing as biomedicine insofar as both
disciplines can tell us certain ‘truths’ about the body. This assertion also points to the argument
that biomedicine is not (or should not be) the only authoritative medical system in the world, but
that other national systems of medical knowledge possess equally valid ways of approaching the
human body.
As we shall see in the following chapters, the sources that integrate Tibetan medical and
biomedical notions of hormones equalize the scientific footing of both systems to such an extent
that biomedicine is strategically positioned to substantiate and validate the claims of Tibetan
medicine. Even the most esoteric and subtle anatomical features of Tantric Buddhism are made
more substantially material in their use as a way to speak to the topic of “hormones.”
In this section, I examine two inter-related arguments that Tibetans researchers address in
their construing of the Tibetan system as an authoritative source of knowledge. The first point is
that Tibetan medicine (and Buddhism) is and always has been scientific insofar as it is founded
upon experiential and empirical observations. The second point is that Tibetan medicine is a
system open to new and foreign knowledge that blends the most useful parts of any tradition
from the evidence-based point of view. I observe that in positioning Tibetan medicine as
authoritative medical knowledge, Tibetan researchers achieve their larger aim of promoting
Tibet’s cultural and religious national identity.
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A good example supporting the view that I am describing can be found in Gönpokyap’s
essay, “Brief Discourse Regarding the Necessity to Continually Focus Research on the Unique
Features of the Human Body”146 which is found in his volume of essays, Moonbeam of
Delightful Jasmine: Collected Essays on Tibetan Medicine. Gönpokyap writes:
In general, the system of Tibetan medical science is founded on a thorough examination of
the parts of the human body such that during the reign of the tenth Tibetan King Esho Leg,
flawed bone could be cut out and damaged flesh could be sewn back together. Knowledge
on sewing up skin is clearly expanded upon in Shentön Yeshé Lodrö of Darding’s text, The
Instructional Water that Revives the Dying through the Treatment of Wounds. And
especially, during the time of the eighth-century, His eminence, Yuthok the Senior
composed the text, Essence of Nectar and surgically replaced the skull fragment of the
Muslim king's minister, Sengé Bépa, which is today difficult to imagine.147
In this short passage Gönpokyap name-drops some of the most important figures in Tibet’s early
medical history, dating back to before and during the appearance of Buddhism in Tibet. The first
example of ‘Tibetan empiricism,’ “the sewing up of flesh wounds during the time of the tenth
Tibetan king,” harkens back to Tibet’s imperial and militaristic era from which works on healing
battle wounds and animal husbandry constituted the bulk of known medical writings. 148
Moreover, by referring to the time when the Tibetan empire was so powerful and vast that it
ruled parts of China, Gönpokyap is in keeping with the wider nationalist discourse surrounding
Tibet’s pre-Chinese geopolitical identity.
The second example, The Instructional Water that Revives the Dying through the
Treatment of Wounds, was written by the renowned fourteenth-century Tibetan medical doctor
146
grub pa lus kyi thun mong ma yin pa’i khyad chos dam ‘dzin byas te mu mthud du ‘phel rgyas su
gtong dgos pa’i skor phran tsam gleng ba, Mgon po skyabs, Gso rig dpyad rtsom kundan dgyes pa’i zla
zer (Beijing: Mi rigs dpe skrun khang, 2008), 126–35.
147
spyir bod lugs gso rig dbu brnyes pa dang lhan du mi’i lus kyi grub char zhib ‘jug legs por gnang
ba ma zad bod rgyal bcu ba e sho legs kyi skabs su rus skyon bcad cing sha skyon gshags pa dang / pags
ral btsems pa bcas kyi phyag len rgya cher spel ba ni dar lding gi gshen ston ye shes blo gros kyis mdzad
pa’i rma bcos ‘chi sos la chu’i zhal gdams las gsal zhing / lhag par dus rabs brgyad pa’inang skyabs rje
g.uy thog rnying ma chen mos bdud rtsi snying po’i gzhung mdzad cing kha che rgyal bo’i blon po seng
ge sbab pa’i mgo bor rus tshab gzhugs pa ni nye lam ngo tsho’i rmi lam du ‘byung dka’ ba’i ‘char snang
zhig tu gda’, ibid., 130–1.
148
Frances Garrett, “Critical Methods in Tibetan Medical Histories,” The Journal of Asian Studies 66,
no. 2 (2007): 363–87.
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and writer, Shentön Yeshé Lodrö (Gshen ston ye shes blo gros).149 Significantly, his works
constitute some of the earliest known sources on Bön, a set of religious practices predating
Buddhism in Tibet, which emphasized ritual, symbolic language and cosmogenic narrations. 150
While historically the Bönpos’ were looked down upon by Buddhists, today’s Bön tradition
constitutes a vital part of Tibetan identity and operates ecumenically with the schools of
Buddhism. Moreover, a number of present day medical writers draw from Bön works, not only
in a historical narrative sense like here with Gönpokyap, but in how they position authoritative
sources in contemporary medical thought. Significantly, in both examples so far, it is by virtue of
being Tibetan, rather than necessarily being Buddhist, that counts in the contemporary construing
of authoritative Tibetan medical knowledge.
The third reference, “Yuthok the Senior,” refers to Yuthok Yönten Gönpo (G.yu thog yon
tan mgon po, 708 – 833),151 a central founding figure in Tibetan medicine, who is accredited with
composing an early version of the Four Treatises, to which Gönpokyap refers by the alternate
title, Essence of Nectar.152 Posthumously considered an emanation of the Medicine Buddha and
one of Tibet’s national treasures today, Yuthok Yönten Gönpo was the renowned court physician
of Trisong Deutsen (Khri srong lde’u bstan, 755 – 797 CE).153 Yuthok Yönten Gönpo, being
especially gifted, was said to have learned Sanskrit from Padmasambhava, the famous adept
149
Shentön Yeshé Lodrö is mentioned among a list of “Renowned Tibetan Physicians” in Desi Sangyé
Gyatso’s the Mirror of Beryl; see: Sangs rgyas rgya mtsho, Mirror of Beryl: A Historical Introduction to
Tibetan Medicine, trans., Gavin Kilty (Boston: Wisdom Publications: In association with the Institute of
Tibetan Classics, 2010), 271. For more on Bön and medicine in ancient Tibet see: Namkhai Norbu,
Drung, Deu and Bön: Narrations, Symbolic Languages and the Bön Tradition in Ancient Tibet, trans.
Adriano Clemente and Andrew Lukianowicz (Dharamsala, India: Library of Tibetan Works and Archives,
1995), 133–45.
150 Namkhai Norbu, Drung, Deu and Bön: Narrations, Symbolic Languages and the Bön Tradition in
Ancient Tibet.
151
An English biography of Yuthok Yönten Gönpo can be found in: Rechung Rinpoche and Jampal
Kunzang, Tibetan Medicine: Illustrated in Original Texts, (London: Wellcome Institute of the History of
Medicine, 1973), 141–326.
152
Essence of Nectar (Bdud rtsi snying bo) is the shorter version of the longer, full title of the Four
Treatises, The Essence of Nectar: The Manual of the Secret Teachings of the Eight Branches (Bdud rtsi
snying po yan lag brgyud pa gsang ba man ngag gi rgyud ces bya ba bzhugs so;
Amṛṭahṛdayāṣṭaṅgaguhyopadeśa). It appears that in using the title, The Essence of Nectar, Gönpokyap is
referring to an older abbreviated title of the Four Treatises that is specific to Yuthok the Senior’s version.
153
King Trisong Deutsen is considered the second of three “dharma kings” (chos rgyal) who converted
Tibet to Buddhism, and supported the massive translation of Buddhist thought and literature into Tibetan.
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from Urgyan who subdued the gods and demons of the Tibetan landscape barring any obstacles
to Buddhism taking root.154 According to medical histories, at the request of the king, Yuthok
Yönten Gönpo travelled to and studied the medical traditions of China and India extensively so
that he could appreciate and incorporate the useful aspects of each tradition. According to some
narratives, which are recounted today to show Tibetan medicine’s openness to new and foreign
medical knowledge, he is said to have represented Tibet in the ‘First International Conference of
Tibetan Medicine’ where he debated with the eminent physicians of the three ‘great medical
traditions’ representing modern-day India, China and Persia. After the conference Yuthok the
Senior is said to have composed the Four Treatises based on the best parts of each tradition.
Hence, the early history of Yuthok Yönten Gönpo and the Four Treatises underscores the Tibetan
penchant for debate, innovation and integrating Tibetan and foreign medical knowledge. The
example of Yuthok the Senior “surgically replacing skull fragment of the Muslim king’s
minister” emphasizes a cosmopolitan and empirical spirit underlying the Tibetan tradition that
contemporary Tibetan medical writers like Gönpokyap want to emphasize as they integrate
biomedical ideas.
Gönpokyap, like his contemporaries, also wants to establish a degree of medical authority
in well-known Buddhist figures and works. For example, continuing from the previous passage,
Gönpokyap writes:
After that, one of the ten great Tibetan thinkers, Machik Labdron, from visiting many
cremation grounds, was easily able to gain a clear realization of the condition of the parts
154
Padmasambhava (Padma ‘byung gnas, eighth-century) is equally famous for being the progenitor
of the “hidden treasure” (gter ma) tradition in Tibet whereby manifestations of his teachings, so-called
treasure texts and objects, which had been previously hidden during a ‘dark times’ are ‘revealed’ at the
appropriate time by reincarnations of the disciples. By some accounts, the Four Treatises is said to be a
hidden treasure text. The hidden treasure tradition and its religious and cultural narrative is still active
today, and will likely continue into the future considering the countless religious objects and texts hidden
since the Chinese annexation of Tibet. For more on Padmasambhava and the treasure tradition see:
Herbert V. Guenther, The Teachings of Padmasambhava (New York: E.J. Brill, 1996), and; Janet Gyatso,
Apparitions of the Self: The Secret Autobiographies of a Tibetan Visionary (Delhi: Motilal Banarsidass
Publishers, 2001).
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and aggregates of the body [and based on this] the text, Machik’s Complete Explanation155
was composed [by her students].156
Machik Labdron (Ma gcig labs sgron, 1055 – 1149) is one of the few preeminent female Tibetan
religious teachers, who is known primarily for propagating the practice of Chöd (gcod), meaning
“cutting” or “severing.” This non-sectarian practice, which is a uniquely Tibetan mix of
Mahāyāna and Vajrayāna (or Tantric) Buddhism, is a series of rituals, prayers, and meditative
exercises wherein the practitioner visualizes giving away parts of their bodies to suffering
sentient beings, thereby severing their attachment to their bodies. In this way too, they are
ultimately severing themselves from “saṃsāra” (‘khor ba), the endless cycle of rebirth and
suffering.157 Hence, through the practice of contemplating the body and its severing, one can gain
Buddhist realization, something that lends considerable credibility to Machik Labdron’s medical
authority insofar as what she says about the nature of human bodies. Importantly for Gönpokyap,
Machik Labdron is a popular Buddhist figure who knew about the body from experience,
allowing him to craft a Buddhist identity in relation to medicine. For present-day writers,
demonstrating the commensurability of Buddhist and medical knowledge in regards to the body
is crucial for supporting the modern Tibetan medical tradition as a whole. It is also at the
intersection of Buddhist and medical ideas where biomedical ideas enter the picture, as is the
case for “hormones.”
In their construing of Tibetan medicine as an authoritative and scientific medical system,
contemporary authors also point to, and quote from, the works of popular political figures, such
as the monk-scholar-regent, Desi Sangyé Gyatso (Sde srid sangs rgyas rgya mtsho, 1653 – 1705)
who is largely responsible for the version of the Four Treatises that we have today. In the
155
The full title of this text is Phung po gzan skyur gyi rnam bshad gcod kyi don gsal byed. Although
Machik Labdron is accredited with the contents of the work, the text has been edited from and compiled
by multiple sources and authors, and contains a biography of Machik. See: Ma gcig lab sgron, Machik’s
Complete Explanation: Clarifying the Meaning of Chöd: A Complete Explanation of Casting out the Body
as Food, ed., and trans., Sarah Harding (Ithaca, New York: Snow Lion Publication, 2003).
156
de’i rjes bod kyi bsam blo ba chen mo bcu’i ya gyal ma gcig lab kyi sgron ma dur khrod mang por
zhabs kyis bcags nas mi’i phung bo’i grub cha’i gnas lugs la gom gang mdun spos kyis gsal rtogs thub
pas phung bo zan bskyur gyi rnam bshad ces pa’i bka’ rtsom mdzad. Dgon po skyabs, Gso rig dpyad
rtsom kunda dgyes pa’i zla zer, 131.
157
David Stott, “Offering the Body: the Practice of gCod in Tibetan Buddhism,” Religion 19, no. 3
(1989): 221–26.
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present-day Tibetan medical works, Desi Sangyé Gyatso’s works are frequently cited because he
is an authoritative figure par excellence. As the powerful regent to the Great Fifth Dalai Lama,
Ngawang Lobsang Gyatso (Ngag dbang blo bzang rgya mtsho, 1617 – 1682) he was a key figure
in the political and religious unification of all the Tibetan regions. Because he oversaw one of the
most vibrant periods of Tibetan Buddhist culture,158 he has become a strategic choice to further
present-day nationalist feelings. Continuing with Gönpokyap’s historical account of Tibetan
medicine, he writes:
Furthermore in the seventeenth-century, the famous Buddhist scholar, Desi Sangyé Gyatso,
having consulted earlier medical [texts] and illustrations of the human body, had
commissioned seventy-nine new medical paintings connected with the inner meaning and
theory of the authoritative medical texts. 159
The joining of medical illustrations with the “inner meaning of the authoritative medical texts,” a
phrase found throughout the contemporary sources that integrate hormones, is a further emphasis
of the empirical and therefore, ‘scientific’ nature of Tibetan knowledge. Key to present-day
debates for the scientific underpinning of Tibetan medicine is that the authoritative literature,
especially the Four Treatises, is based on observation, evidence and the scrutiny of time, or “the
discriminating wisdom from the minds of our ancestors.” 160
Crucially, the Four Treatises is considered in important respects to be Buddha-word, that
is, the direct teachings of the Buddha. In this case, the teachings are in the form of a conversation
between the mind and speech manifestations of the Medicine Buddha in a celestial medicinal
paradise. The Buddha-word status of the Four Treatises is thought to have historically lent to its
158
Karmay, Samten Gyaltsen, “The Fifth Dalai Lama and His Reunification of Tibet,” in The Arrow
and the Spindle: Studies in History, Myths, Rituals and Beliefs in Tibet (Kathmandu: Mandala Book Point,
1998).
159
lhag par du dus rabs bcu bdun pa’i nang mi dbang pa nida ta sde srid mchog gis sngar yod sman
dang ro bkra’i ‘dra dpe rnams ‘tshol bsdu byas mthar bod sman gzhung hril bo’i nang don dand ‘brel
ba’i sman thang don dgu gsar bzheng gnang. Mgon po skyabs, Gso rig dpyad rtsom kundan dgyes pa’i
zla zer, 131.
160
mes po dran dbang rnams kyi rnam dpyod kyi shes rab, Lha mo skyid, “Zla mtshan gyi rnam par
bshad pa blo chung byis pa’i mgul rgyan,” (Krung go’i bod kyi gso rig, no. 1, 2007), 111.
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authoritative position, and its perceived infallibility.161 Other Western scholars have closely
examined the Buddhist dimensions of the Four Treatises and the authority of Buddha-word in
Tibetan culture, so that will not be explored here.162
It is important to note that typically, present-day authors do not directly express the
notion that the Four Treatises is authoritative because it is Buddha-word. 163 Instead they point to
the ways that it is scientific, and do hold it, at least strategically, as an ultimate source of
perfected knowledge, in much the same way as is Buddhist knowledge. For example, Garrett and
Adams observe that in the contemporary article, “A Clear Explanation of the Principle Structure
and Location of the Circulatory Channels as Illustrated in the Medical Paintings,” its author
Tsultrim Gyaltsen,164 argues “that the presentation of the body found in Tantric texts describe the
ultimately true condition of the body, and that the Tibetan medical texts are in full agreement
with that presentation.”165 The sources that address “hormones” in biomedical and Tibetan
medical thought likewise appear to agree with such an assertion of medicine and Tantra. In fact,
the Tantric body is often evoked to describe the body’s most subtle features, and is therefore
useful in discussing “hormones.”
The implicit assumption underlying the discussions for various ways of integrating
biomedical thought and interpreting the authoritative literature to do so, is that the Four Treatises
and its commentarial tradition are already ‘completed’ and ‘perfected,’ and in no way erroneous.
The conclusion of Gönpokyap’s historical narrative gives some insight into this position and why
161
An English example of this viewpoint can be found in: Yeshi Dönden and Alan B. Wallace, Healing
from the Source: The Science and Lore of Tibetan Medicine (Ithaca, NY: Snow Lion Publications, 2000),
140–41.
162 For example, see the third chapter, “Word of the Buddha” in Gyatso’s Being Human in a Buddhist
World.
163
Although traditional Tibetan medical paintings—Menthang (sman thang)—of the Medicine Buddha
can be found throughout the doctors offices at QTMH, including the office of the gynaecology specialist.
164
Tshul khrim rgyal mtshan, “Sman thang las ’brel pa rtsa yi gnas lugs kyi dpe ris skor gsal bar bshad
pa,” in Krung go’i mtho rim bod sman shib ’jug bgro gleng ‘dzin grwa’i rtsom yig gces bsdus (Lhasa: Bod
rang skyong ljongs sman rtsi khang, 1990), 83–91.
165
Frances Garrett and Vincanne Adams, “The Three Channels in Tibetan Medicine with a Translation
of Tsultrim Gyaltsen’s ‘A Clear Explanation of the Principle Structure and Location of the Circulatory
Channels as Illustrated in the Medical Paintings,’” Traditional South Asian Medicine 8 (2008): 95.
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it is vital for the overall aim, which is to position Tibetan medicine as an indispensable treasure
of Tibetan culture and national identity, even though it is under threat of possible extinction. He
writes:
These mentioned above are recorded in the history books because they made wondrous,
unsurpassable contributions in previous generations, and this is our unique cultural
treasure. However, in regards to the words of the authoritative texts, a few of the younger
generation, not having a common way of interpreting them, have interpreted them in many
different ways. Or, alternatively, many of those interpretations are not in keeping with the
original meaning [of the authoritative treatises] and remain various. Furthermore, there are
several interpretations of those authoritative texts that count seventy-seven blood channels,
which from looking at illustrations of the body and the human body itself cannot be
identified. This is a very serious situation which, if it continues, the Four Treatises will
become waste-paper. Therefore, in regards to the constitution of the body, we need to be
able to label each body part and specifically be able to refer to any part of the body. 166
Although not explicitly stated, the “original meaning” of the text is that it is as unerring and as
perfect as Buddhist knowledge. This position is quite different from the normative biomedical or
Western scientific perspective. The problem of there being various interpretations of the texts,
and inconsistencies between what is observable and what is not (at least with the naked eye) is a
problem of the younger generation misunderstanding the real intentions of the text. Although
there is not a single case where a specific author or work is named, the problem of ‘not knowing
grammar’ and ‘misreading’ the authoritative literature is routinely expressed in many of my
primary sources and serves as the only place where scholars criticize each other. As a rhetorical
device, it also underlies a strategic assumption fundamental to the authority of Tibetan medical
texts (over and above other kinds of research), which is that their original or intended meaning is
correct and any contradictions between the text and reality is really a problem of interpretation.
In this way, both Buddhist and medical forms of knowledge can be argued as being in harmony
166
gong gi ‘di dag ni kha sang gi lo rgyus deb ther ngos su bkod pa’i bla med rlabs chen gyi mdzad
rjes dang rjes rabs nga tshor bzhag pa’i mdzad med kyi bee rya’i nor bu lta bu ru zad mod / rgyud tshig
‘ga’ shes la rjes ‘jug pa’i lta bar gcig mthun ma byung bar ‘grel tshul tha dad du byung ba’am / yang na
rgyud du grangs tsam bkod par ‘grel b rnams su grangs ka de dag re re’i ngos ma bzung bar rang sor
grangs tsam bkod nas bzhag / yang na gzhung ‘grel rnams su gnas sogs legs par bkod pa’i gtar rtsa don
bdun po’ng da lta ro bkra dang mi’i lus steng nas tshang ma ngos ‘dzin mkhan med pa’i gnas su gyur
‘dug pas ‘di lta bu’i gnas tshul mang du lhag tshe dpal ldang rgyud bzhi yang shog bu’i phung po zhig tu
‘gyur nyen che de na grub pa lus kyi skabs ‘dir nga tshor nye bar mkho ba zhig ni mi’i lus kyi cha shes
rnams la ming re btags nas mdzub mo ri ston gyi tshul tu gtan la dbab rgyu de yin, Mgon po skyabs, Gso
rig dpyad rtsom kundan dgyes pa’i zla zer, 131–2.
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with one another, and that they are both empirical, that is, based on experience, as well as textual
expertise.
The problem of synthesizing and agreeing upon “standard” (tshad ldan) Tibetan
definitions is a major issue in other present-day sources on women. For example, in Clinical
Experience in Treating Obstetric Diseases, Mingji Cuomu writes:
Up until now our medical system, like other traditional medical systems, does not have a
clear synthesis to precisely measure the beneficial results [of treating] illnesses at their
core. Because of this, the advantages of this extraordinary medicine remain slightly hidden,
and therefore as [Tibetan medicine] spreads to the many regions of the world, it is not
accepted as a standard medicine. Moreover, [the future form of Tibetan medicine] depends
upon various internal and external conditions. Insofar as outer conditions, the situation in
the regions of central Tibet, the historical context, and the system governing medical policy
are all relevant. Internal conditions arise from different underlying orientations of the
knowledges of the authoritative literature. Because the unique features of the texts of each
and every one of the bodies of knowledge is different, they have distinct ways to make
evident their conclusions.167
For Mingji Cumo, as well as other present-day writers, it appears important to make cohesive the
differing “conclusions” of Tibet’s Buddhist and medical traditions, as part of the project of
standardizing Tibetan medicine. Yet, the importance of fundamental Tibetan medical notions and
practices, such as the individual-focused basis of diagnosis and treatment are also retained and
emphasized.
Also, we should keep in mind that biomedicine is not entirely a standard system either,
and that diagnoses and treatments are increasingly becoming individualized (for example in
chemotherapy). Moreover, an analysis of the enormous body of biomedical literature (in English
alone) does not demonstrate a cohesive, uniform or standard system at all, and so in many ways,
the Tibetan medical and biomedical systems are similar. Hence, standardization means particular
167
‘on kyang / rang re’i gso rig ‘di nyid la da bar srol rgyun gso rig gzhan dang ‘dra bar nad thog
phan ‘bras la grangs tshad nges gtan gyi phyogs sdom gsal po zhig med stabs / thun min gyi sman bcos
dge mtshan rnams cung zad lkog gyur gyi rnam bar gnas shing da cha ‘dzam gling yul gru mang dag cig
tu yongs khyab ngang tshad ldan gyi gso rig gi gras su ngos len thob med / de yang phyi nang rkyen sna
tshogs la rags las yod de phyi’i rkyen la cha bzhag na bod ljongs kyi sa cha’i gnas bab dang / lo rgyus
rgyab ljongs / sman srid do dam lam lugs sogs dang ‘bral ba yod pa dang / nang rkyen ni rig pa’i gzhung
lugs kyi dgongs gzhi mi ‘dra bar brten nas byung ba zhig yin / de yang shes rig thams cad so so’i rig
gzhung gi khyad chos mi ‘drar brten nas mjug ‘bras thon tshul tha dad yin pa, Smin skyid mtsho mo, Mo
nad phal pa’i nad la zhib ‘jug dang gso bcos bays pa’i nyams yig, 3–4.
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things to each writer and, what ought to be standardized are important debates in contemporary
Tibetan medicine. What is centrally important is that both Buddhist and medical knowledge can
be considered authoritative, and therefore continue to constitute the framework of Tibetan
medicine as a national (and ethnic) tradition. This is further evident in the way that Mingji Cumo
points to what is unique about Tibetan medicine, while at the same time appealing to a notion of
universal or global knowledge. She writes:
All over the globe, knowledge of science and technology, and likewise, the general
economy is developing like a waxing moon. Especially since travel is easy between
different countries [allowing for the meeting of] people of different ethnicities, the
spreading of new knowledge is increasing. Owing to these positive conditions, research
knowledge is developing and ways of doing research are likewise increasing. The
possibility to research and disseminate knowledge is successively becoming like that. [ … ]
In terms of getting at the core of illness, Western medicine is not able to determine what
kind of treatment to give for chronic illnesses (diseases of a slow nature), whereas Tibetan
medicine not only can identify and cure these, but also with little side effects. That
traditional knowledge known as the science of Tibetan medicine is one among the treasury
of world medicine, a priceless and amazing gem that is equally famous in the ten directions
for emanating the radiance of happiness and benefit. My hope, similar to a thirsty person
wanting water, is that these medical cures will be a huge benefit for many patients inside
and outside [Tibet] as it has become a subject of interest of many domestic and foreign
medical scholars. 168
Like this example shows, Mingji Cuomu attempts to establish a middle ground between
what may seem like occupying two positions. On the one hand, she argues that being able to
regulate and standardize Tibetan medicine in a way similar to biomedicine is necessary so that it
is accepted as scientific throughout the world. For example, she uses a hybrid of Tibetan and
Chinese biomedical terms to name and describe male and female hormones, thereby asserting a
168
go la’i khyon du tshan rig shes bya dang / lag rtsal / de bzhin spyi tshogs kyi dpal ‘byor dang sgrig
gzhi sogs yar ngo’i zla ltar gong ‘phel du phyin yod la / lhag par du rgyal khab dang mi rigs mi gcig pa’i
bar ‘grim ‘grul stabs bde dang / gnas ‘phrin brgyud sprod bya lam je mang du song ba sogs kyi mthun
rkyen la brten nas / shes rig zhib ‘jug dang khyab spel bya thabs la yang de bzhin du ‘gyur ba thebs yod
de / dper na / yul lung mi gcig pa’i zhib ‘jug pa rnams rang rang gi zhib ‘jugs khyab khongs ltar dpyad
‘bras bgro gleng gyi go skabs je mang dang khyab tshad je cher phyin yod pa ni mthong chos su grub / …
/ nad thog dngos kyi thog tu’ng nub phyogs gso rig sogs kyis thag gcod ma thub pa’i gcong nad (dal ba’i
rang bzhin nad) khag cig la bod sman gyis bcos bskyed nus pa thon pa ma zad / zhor skyon chung ba’i
khyad chos ldan pas / bod kyi gso ba rig pa zhes pa’i srol rgyun gyi gso rig ‘di nyid ‘dzam gling gso rig
bang mdzod nang rin thang gzhal du med ba’i khyad ‘phags kyi nor bu zhig dang mtshungs par phan
bde’i gzi ‘od phyogs bcur ‘phros nas / phyi nang rgya che’i gso bya mang po’i sman bcos kyi re ba skom
pa chu ‘dod ltar yod pa de skong bzhin yod pa ma zad / rgyal phyi rgyal nang du yod pa’i gso rig mkhas
pa du ma’i do snang byed yul du gyur yod, ibid., 2–3.
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cross-conceptual and importantly, standard Tibetan translation that points to the same thing
across Tibetan medicine and Chinese biomedicine. On the other hand, she asserts that because
the Tibetan system treats illness according to the unique constitution of each individual, two
people with the same illness will not necessarily or likely receive the same treatments. Thus, she
concludes that it is the inability to be completely standardized that is its unique strength of the
Tibetan medical system.
Few authors echo the Chinese biomedical sources so closely in their explanation and
naming of hormones Mingji Cuomu does, but she does not in any way discredit Buddhist
knowledge. For example, she presents the Tibetan view of reincarnation as part of her medical
explanation of reproduction, as would befit Tibetan obstetrics. In the Second Chapter, where I
more closely examine her integration of “hormones,” I point to how Mingji Cuomu incorporates
biomedical knowledge in such a way as to bolster (her interpretation of) some of the most central
claims of the Tibetan Buddhist world. Her work highlights the fine and subtle art of balancing
standardization with retaining that which is unique to Tibetan medicine. Indeed this tension is
evident throughout contemporary Tibetan textual-focused research writings.
Again, I suggest that such a tension reflects the two poles of glocalization, wherein both
the unique and universal characteristics are emphasized to carve out particular national identities.
It appears that Tibetan authors agree that some elements of Tibetan medicine ought to be
standardized in a similar way to biomedicine, but done so in a way that is appropriate to the
tradition of Tibetan medicine. In Mingji Cuomu’s work, like many of my primary sources, the
ideals of progress and development are coupled with maintaining the fundamentals of the
Tibetan tradition. Or in other words, it is through research of the authoritative Tibetan sources
that they will be shown to be ‘correct,’ and through development, such knowledge can be
confirmed and expanded upon. For example, Mingji Cuomu writes that research into the Tibetan
medical scholarly tradition needs to be in keeping with modern times “for the reason of
accomplishing the aim of developing our own ancestral scholarly medical tradition.”169 A basic
assumption underlying her argument is that Tibetan medicine can be developed to be in keeping
169
… rang gi rig gzhung rgyud ‘dzin dang gong ‘phel gtong rgyu’i re smon sgrub pa’i phyir, ibid., 51.
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with contemporary society and environment, and by doing so they are enriching, or making more
comprehensive Tibetan medical knowledge. Using this method, fundamental notions of the
Tibetan medical model provide the framework on which debate and innovation, the hallmarks of
progress, are based.
As I have been showing with various examples from my primary sources that write on
hormones in women, Tibetan medical researches do not appear to be purging Tibetan medical
thought of Buddhism, but rather they tend to embrace it and both implicitly and explicitly argue
for its empirical and scientific merits. For example, as already mentioned, in virtually all of the
contemporary Tibetan medical writings on women and reproduction, things which might be
considered religious, such as the consciousness of bardo beings and the logistics of reincarnation
are considered and presented as materially-based and scientific. Gönpokyap argues this point
explicitly, where he writes:
How the body is constituted is according to the texts of modern medicine, solely by the
flawless semen and blood of the father and mother. And yet, in the land of snows [Tibet],
according to our texts of the Tibetan medical system, it is said that the meeting of the
father's semen, the mother's red element and the consciousness of the bardo being is
necessary. After having been liberated [by the Chinese], at the time it was said that the
consciousness was considered superstitious, and all of the wisdom of the Buddhist
teachings were labelled as superstitious and remained that way until the end of the 1980s.
At the end of the 1980s and beginning of the 1990s Buddhist teachings were considered to
contain some authentic scientific elements, and not only this, by the beginning of the
twenty-first century [Buddhist teachings] began to be taught at the universities. This
situation gives reason to be happy. The necessity of confirming everything by empirical
observation is also a sign that [we should] begin to abandon superstitious [thinking].170
Directly following this, Gönpokyap quotes from a small number of famous Chinese
thinkers who, he claims, have written that Buddhism has a scientific and materialist basis.
Among these are, Song Jiaoren (Sung krung hran; 1882 – 1913), a republican revolutionary
170
lus khams chags pa’i rgyu’i skor la deng rabs gso rig gzhung du pha ma gnyis kyi khu khrag skyon
med de kho na yin par bshad cing / ke la sha yis bskor ba’i rang re’i bod lugs gso gzhung du pha’i khu ba
dang ma’i khams dmar / bar ma do’i rnam par shes pa bcas lhan cig tshogs par gsungs / bcings grol byas
rjes rnam shes zer tshe rmongs dad du brtsis shing nang bstan shes rig tshang mar rmongs dad kyi ming
btags nas lo rabs brgyad cu ba’i mjug tsam du lus / lo rabs brgyad cu ba’i mjug dang dgu bcu ba’i mgor
nang bstan shes rig ni tshad ldan rig gnas kyi grub cha zhig tu brtsis pa ma zad / dus rabs nyer gcig pa’i
mgor slob grwa che khag dag nas khrid byar bzhag / gnas tshul ‘di ni dga’ ‘os pa’i bgyi ba zhig tu mchis
la / yod tshad mig lam nas ra sprod byed dgos pa’i rmongs dad las thar mgo brtsam pa’i mtshon rtags
shig kyang yin. Mgon po skyabs, Gso rig dpyad rtsom kun dan dgyes pa’i zla zer, 127.
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leader who was instrumental in the overthrow of the Qing dynasty and forming the Kuomintang
or, Chinese Nationalist Party together with Sun Yat-sen, and Lu Xun, a revered Chinese
revolutionary intellectual and writer.171 Gönpokyap also finds support for his argument that
Buddhism is ‘scientific’ in the writings of one of the architects of communist thought, Friedrich
Engels (1820-1895), who along with Karl Marx (1818 – 1883) wrote The Communist Manifesto,
the blueprint of communist thought. Gönpokyap writes:
Just because there are things that are not understood by science doesn’t mean that they
should necessarily be considered superstitious. The knowledge spoken of in our Buddhist
teachings comes from the times of ancient society. In present times, people are unable to
interpret these and say that a deity created the world, or even go as far as to say that our
karma is a creation of god. But this is nothing but foolish chatter, and trusting in material
origins is the sophisticated scientific viewpoint of Chinese revolutionaries and intellectuals.
[…] Engels, speaking on an explanation of dialectical reasoning writes:
The unique feature of the Buddhist religion is that it has reached a very high level of
dialectical reasoning. The Buddhist world-view does not accept a wondrous or unrivalled
deity. [But rather], all phenomenon, from beginning to end, is based on the web of cause
and effect.
Being said like this, it is easy to see that the teachings of our Buddhist knowledge are wishfulfilling, having been born from a scientific materialist foundation. The subject I am
writing on relates to this in the following way: According to the authoritative texts of our
Tibetan medical tradition, for pregnancy to occur the joining of the semen, blood and
consciousness is necessary. It is precisely because the consciousness is an extremely
hidden phenomenon that it can't be pointed to, and so forth, and because of that from the
the materialistic point of view, the so-called consciousness is not accepted. In reality,
sometimes when we see someone laughing, we also involuntarily laugh, and similarly,
when we see people cry we cannot help but feel like crying. 172 During the thirty-eight
weeks that our body is in the process of being created, the consciousness, together with the
function of thirty-two different winds are the support for the growth and development of
the body. It is precisely this knowledge that modern science is not able to accept as
scientific; even if you circle the globe three times it would be difficult to find. Because of
171
The activities of these figures can be found in several parts of: Jonathan D. Spence, The Search for
Modern China (New York: W.W. Norton, 1999).
172
That is, it occurs even though there is no visible cause for it to occur.
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that we need to zealously pursue the unique and uncommon features of our [medical
tradition].173
Far from being erased, like we see here in Gönpokyap, Buddhist knowledge is both
explicitly and implicitly promoted throughout the contemporary sources that integrate Tibetan
medical and biomedical notions of hormones. Yet also, like this example shows, arguments for
materialist interpretations of Buddhist teachings go hand-in-hand with the narrative of a
“liberated” Tibet. Moreover, these works speak to the present socio-political and religious
context of Chinese Tibet. The nod to Chinese revolutionaries and communist thinkers like Mao
(in another section of the book) and Engels, paint a particular narrative that draws from
politically acceptable sources of authority. In this way too, Tibetan writers are strategic in their
choice of authoritative sources from their tradition. Collectively, they tend to point to many of
the same authoritative Tibetan medical and Buddhist texts, thereby establishing a coherent
Tibetan body of knowledge.
Like the examples in this section show, present-day Tibetan medical researcher-writers
appear to share the perspective that Tibetan medicine always has been and always will be a
legitimate and authoritative system of knowledge alongside biomedicine and other systems.174
173
tshan rig gis ma rtogs pa tshang ma rmongs dad la ye nas brtsi mi rung / rang re’i nang bstan du
gsungs pa’i shes bya rnams gdod ma’i spyi tshogs kyi skabs nas da lta’i yun mi rnams kyis ‘grel ma thub
pa’i rigs la lhas bskrun pa red zer ba’m tha na mi’i las dbang yang ‘gran bral gyi lhas bkod ‘doms byed
pa red zer ba’i rmongs gtam zhig min par dngos don gyi bgyi bar gzhi bcol nas ches mtho sa’i tshan rig
gi lta ba zhig yin pa ni krung go’i gsar brje ba dang bsam blo ba / […] gzhan en ke si yis rang byung
rtsod sgrub smra ba ru bshad don / sangs rgyas chos lugs kyi khyad chos ni mi’i rigs kyi rtsod sgrub rig
lam gyi cung mtho sar slebs ‘dug / ‘jig rten lta bar sangs rgyas chos lugs kyis ches rlabs chen ‘gran bral
gyi lha zhes khas mi len pa dang / bya dngos la mgo dang mjug mtha’ bcas med par rgyu ‘bras kyi dra
bar gnas ‘dug” / ces gsungs pa dag gis rang re’i nang bstan shes rig ni tshan rig gi zhing sa nas ‘khrungs
pa’i bla med dgos ‘dod kun ‘byung zhig yin pa rtogs sla / bdag gis ‘di ltar brjod don ni rang re’i bod lugs
gso rigs gzhung du lus chags pa’i rgyur khu khrag sems gsum ‘dzoms dgos / rnam shes ni ches lkog gyur
zhig yin pas ‘di zhes ston rgyu med pa sogs kyi rkyen pas dngos gtso’i lta bas rnam shes pa zhig yod par
khas mi len / don ngo mar nga tsho dgod pa’i gdong la bltos nas dgod pa dang / ngu ba’i bzhin la bltos
nas ngu ba lta bu’i kha phyogs med pa zhig gtan nas byed mi rung / nga tsho’i grub pa lus kyi skabs su
bkod pa’i rnam shes dang bdun phrag so brgyad por rlung mi ‘dra ba so gnyis kyi byed las su brten nas
lus ‘phel zhing rgyas pa’i rig pa ‘di da lta’i tshan rig gis rtogs ma thub pa’i tshan rig cig yin pas / go la
zlum po ‘dir len gsungs bskor ba brgyab kyang rnyed dka’ / de’i rkyen gyis rang nyid kyi thun mong ma
yin pa’i khyad chos ‘di dag dam ‘dzin byed dgos. Mgon po skyabs, Gso rig dpyad rtsom kun dan dgyes
pa’i zla zer, 128–9.
174
Such is the case made in: Ruiping Fan and Ian Holliday, “Which Medicine? Whose Standard?
Critical Reflections on Medical Integration in China,” Journal of Medical Ethics 33, no. 8 (2007): 454–
61.
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Explicitly, or methodologically, they assert that it is through comparison with other empirically
based medical systems that Tibetan medicine can ‘progress,’ and that the development of their
medical system can come about through the exchange of ideas and adoption of new information.
The underlying message among my primary present-day sources is that Tibetan medicine has
always been an empirical and cosmopolitan tradition. Therefore, researchers can reinterpret and
find new and expanded meanings within the authoritative sources of their medical tradition in
order to be in accordance with the present context of Chinese Tibet.
1.4 Contemporary Interpretations of Women and their Disorders
according to the Four Treatises
The Four Treatises forms the bedrock of contemporary Tibetan medical writing. Among
my sources on women’s bodies, no other text is quoted from as frequently or held in the same
utmost regard. However, in the present-day sources, medical writers most often avoid using the
text’s overtly negative statements on women. For example, according to the Four Treatises (and
much of its commentarial literature), women are defined as beings manifesting “lesser merit [or]
virtue” (bsod nams dman pa).175 Such assertion reflects the shared position of both the Tibetan
medical and Buddhist traditions, that is, that bodies reflect their karmic (or ethical) virtue. These
traditions view the body to be an ongoing effect or fruit of previous causes and conditions, and
that the acquisition of female body is the result of previous deeds generating lesser karmic merit.
In the present-day sources, this line defining women as manifesting lesser karmic virtue is
mostly omitted. Medical writers display a concern for women’s equality, and attempt to purge the
current Tibetan medical system of its less than generous appraisal of women arising from the
earlier (pre-Chinese) Tibetan society and its “old ways of thinking” (bsam blo rnying pa).176
What contemporary readings of the Four Treatises tell us is that notions of gender and the
construing of male and female bodies can be interpreted, edited and selected, so as to reflect the
current socio-political and religious climates.
175
G.yu thog yon tan mgon po, Dud rtsi snying po, 375.
176
Dpal ldan ’phrin las, Bod lugs gso rig gi rgyun mthong mo nad ’gog bcos bya thabs, 77.
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In this section, I first outline the contents of the Four Treatises, and in particular the
chapters that speak to women’s bodies. Following this, I offer a translation and brief analysis of
key passages from the Four Treatises’ gynaecology chapters. In my analysis, I point to how some
of these passages are prominent in the present-day medical writings on women, while others are
omitted.
The Four Treatises consists of four parts:
I.
The Root Treatise (rtsa rgyud) introduces the contents of the four parts and outlines the basic
theory of the three dynamics.
II. The second part, Explanatory Treatise (bshad rgyud), contains chapters on such topics as
embryology, descriptions of the human body, classifications and causes of disorder, food and
diet, and the requirement for being a good and virtuous doctor.
III. The third part, Instruction Treatise (man ngag rgyud), contains descriptions of a large
number of specific disorders, including three chapters on women's disorders (mo nad).
IV. Lastly, the fourth part, Auxiliary Treatise (phyi ma rgyud) contains chapters of various
diagnostic and healing techniques, such as pulse and urine diagnosis, the ingredients and
making of a variety of medicinal substances, such as pills and powders, and the use of
therapies such as blood-letting and cauterization.177
Attention to women’s reproductive bodies is found in a handful of places in the Four
Treatises, including the chapter on “embryology” (grub pa lus kyi gnas), the “virility” (ro tsa bar
bya ba) and “fertility” (bu med pa brtal ba) 178 chapters as well as the three gynaecology
chapters, seventy-four to seventy-six, which are devoted exclusively to women’s disorders. In the
narrative at the beginning of the seventy-fourth chapter the topic of gynaecology in general is
177
Galvin Kilty, “Introduction,” in Mirror of Beryl: A Historical Introduction to Tibetan Medicine,
trans., Gavin Kilty (Boston: Wisdom Publications, 2010), 67.
178
For a gender critical reading of the virility and fertility sections see: Gyatso, “Spelling Mistakes,”
81–98.
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introduced (through a conversation between the medicine Buddhas’ mind and speech
emanations) as the “means of curing female disorders” (mo nad gso ba).179
The three chapters on women’s disorders are:
I.
“Treatment of Root and Universal Female Disorders” (mo nad gtso bo spyi bcos pa),
II. “Treatment of Particular Female Disorders” (mo nad bye brag), and
III. “Treatment of General Female Disorders” (mo nad phal pa gso ba).
Counted together, the three gynaecology chapters take up ten pages in the 2006 Lhasa edition.180
This is a significant amount, considering how densely the Four Treaties is written. Combined,
the three chapters outline what is unique about women’s bodies, the different disorders that can
harm them, and how (or whether) such maladies can be treated.
The description of the origins of male and female bodies together with the specific
characteristics that define women are outlined at the beginning of the seventy-fourth chapter of
the Four Treatises:
The body which is made of the three poisons and the four elements manifest as male and
female by the influence of previous karma and desire. By having less merit one obtains the
female body. The distinguishing characteristics of [women’s bodies] are the breasts, uterus
and menstruation, as well as the two, white and red reproductive fluids which are the
essence of the [seven] bodily constituents. Upon reaching the age of twelve, the red
[element], menstruation, comes out. The inside of the uterus grasps [and] holds the
reproductive fluid and grows the flesh [of the fetus]. The white [element causes] the breasts
to fill and expand [becoming breast milk]. 181
The “three poisons” of ignorance, desire and anger, and the “four elements” of water, fire, earth
and wind are explained in more detail in the subsequent chapter. Here, I focus on what the Four
179
G.yu thog yon tan mgon po, Dud rtsi snying po yan lag brgyad pa gsang ba man ngag gi rgyud ces
bya ba bzhugs so, 375.
180
181
Ibid., 375–384
dug gsum ‘byung ba bzhi las grub pa’i lus // sngon las ‘dod chags dbang gis pho mor snang // bsod
nams dman pas za ma mo lus thob // nu ma mngal dang zla mtshan khyad par lhag // lus zungs phyi ma
khu ba dkar dmar gnyis // zla mtshan dmar po bcu gnyis lon nas ‘dzag // mngal nang khu ba ‘dzin zhing
sha lus skyed // dkar po nu ma la rgyas gso su ‘gyur, ibid., 375.
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Treatises’ passage says about women’s defining characteristics according to contemporary
assertions among medical doctors and researchers.
The statement that the male and female bodies manifest as such “by the influence of
previous karma and desire” (sngon las ‘dod chags dbang gis pho mor snang) appears to be
interpreted in two main ways. Many of my Tibetan interlocutors understood the passage as
referring to the prevalent Buddhist notion that women are bound by ‘stronger’ sexual desire than
men. According to this logic, stronger sexual desire and previous karma manifest as the extra
features of women, that is, the uterus, menstruation and breasts, which themselves hinder
meritorious Buddhist behaviours. While the text itself does not appear to indicate explicitly that
women have stronger sexual desire than men, the quite common claim by many present-day
Tibetan medical experts is that this is the passage’s implicit meaning.
Others argue that the ‘stronger sexual desire’ interpretation ‘just isn’t in the text’ and that
the verse simply refers to common Tibetan embryological ideas found in the Buddhist
Abhidharma182 and Tantric literature. In these Buddhist gestational accounts, the migrating
consciousness of the “in-between” bardo being is witness to their future parents copulating. If
the bardo being is attracted to their mother and feels hatred towards their father, they become a
male. Conversely, if they feel sexual attraction to the father and hatred for their mother the bardo
being will be born a female. Proponents of this interpretation suggest this to be the meaning of
“previous karma and desire.” Oftentimes however, Tibetan doctors and researchers assert that
both interpretations are in effect, suggesting that in this instance, the text is operating on both the
implied and the explicit levels.
The line “By having less merit one obtains the female body (bsod nams dman pas za ma
mo lus thob)” is explicit in its relative valuing of male and female bodies. Taken literally, the
182
The body of literature known as the Abhidharma is one of the three principal kinds of Buddhist
writings attributed to sayings of the Buddha Shakyamuni. It describes the material existence of human
beings and the universe. The Abhidharma’s history and contents are discussed in more depth in the
Second Chapter in relation to the constitutive parts of human beings in Tibetan medicine.
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term for woman here is za ma mo.183 “za” means “to eat.” This is followed by the negative
marker, “ma.” In conjunction with the feminine ending “mo,” a non-sensical noun-phrase is
created that could mean ‘a female being who doesn’t eat.’ Overwhelmingly, within its social,
cultural and religious context, the phrase is interpreted to show women to be in contrast to, and
to be inferior to men.
One such present-day reading of za ma mo was offered by a female medical intern with
whom I worked. She noted that a woman is ‘fed by a man,’ because she cannot ‘feed herself’
meaning that a woman relies on a man for her sustenance and livelihood. She suggested that this
understanding is supported by the Abhidharma where this phrase means that men must go out
and hunt for meat, and so they can feed themselves. On the other hand, women depend on meat
being brought to them and therefore, ‘cannot feed themselves.’ A male intern suggested that the
phrase has sexual connotations. Having a penis, a man can ‘eat,’ that is ‘go out,’ and have sex
whenever he desires. But women, having a vagina, cannot ‘go out’ and ‘eat.’ In any case, despite
being key to the definition of “women” in the Four Treatises, and being set within the most
widely quoted verses from which contemporary authors quote, these lines regarding women as
manifesting lesser karmic merit than men and not being able to feed themselves are omitted in all
of my primary sources comparing Tibetan medical and biomedical notions of hormones.
The next line in the Four Treaties, introduces the idea of the “white and red
elements” (khams dkar dmar) in female bodies, and the related notion of the “seven bodily
constituents” (lus zungs bdun). According to Tibetan medical thought, the white and red elements
are the product of consumed foods and drinks, which are ultimately the material basis of the
bodily constituents, or more simply, the body. The notion of the white and red elements is a chief
point of intersection between Tibetan medicine and Tantra, and in the present-day sources on
“hormones” in women’s bodies. This is because in all of my primary present-day sources, the red
element holds, or has at its core (or root) the quintessential growth-propelling substances known
as “hormones.” Because the elements are at the heart of modern Tibetan medical thought
183
Not to be confused with the class of people, known in sanskrit as ṣanḍḥa who can’t join the
monastic order of monks and nuns because of “sexual irregularities.” See Gyatso, “One Plus One Equals
Three,” 113, fn. 76.
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surrounding hormones, we will go into considerable depth as to their mechanics and properties in
the chapters that follow. For now, I will continue with the framework of Tibetan gynaecology,
summarized and outlined in the first few passages of the seventy-fourth chapter of the Four
Treatises.
Following from the passage above, the disorders particular to women are outlined.
According to the Four Treatises,
By the influence of previous karma, diet, behaviour and demons there are forty disorders of
women: five uterine disorders, sixteen channel disorders, nine tumour disorders, and two
types of disorders caused by parasites [tiny insects]. That makes thirty-two major disorders
of women, plus the eight common disorders together totals forty. Because of their inferior
birth women have these extra disorders. 184
Here, although women have their own category of disorders, as do children and the elderly, it is
explicitly because of their inferior birth, and by that, it is because they possess breasts,
menstruation and the uterus, that they are susceptible to the forty additional disorders of those
three features. The Four Treatises also considers karma, demons, diet and behaviour (that is
whether one exercises, or has sex at appropriate times) are also considered factors of health.
According to the Four Treatises, the initial cause of all female disorders is problematic
menstruation, which if left untreated, can progress to the more serious disorders. Following from
above:
The first cause is because of the arising of menstruation. If it is a new disorder, it is known
as “excessive blood.” By becoming chronic, it joins with the wind, becoming “excessive
wind.” The symptoms of minor excessive blood are characterized by boiling-like pain in
the bones of the lower back, the lower intestines feel very hot, and there is great pain in the
back of the diaphragm at the back. The pulse is rapid, and small blisters and pimples arise.
Too much uterine blood comes out or it does not come out and becomes pus. “Excessive
wind” feels like the bones are being boiled and the mind-heart is anxious. The head is
dizzy and the bones of the head feel cold and there is a ringing sound. The entire body is
184
de la sngon las zas spyod gdon rkyen gyis // mngal nad lnga dang rtsa nad bcu drug dang // skron
nad dgu dang srin bu’i nad rigs gnyis // mo nad gtso bo sum bcu rtsa gnyis dang // phal pa’i nad brgyad
bzhi bcu tham par ‘gyur // skye ba dman phyir bud med lus la lhag, G.yu thog yon tan mgon po, Dud rtsi
snying po, 375.
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cold, and there is pain in the lower body. The skin shivers, the upper part of the body is
numb, the eyesight is diminished, and one is crazy and forgetful.185
Here, as is characteristic of Tibetan medicine, mental, emotional and physical factors are all
considered crucial to the understanding and diagnosing of disorders of the mind and body.
Considering the perception that women are constituted by lesser karmic merit in the Four
Treatises, one should perhaps take some of the comments on women’s minds and emotions with
a grain of salt. On the other hand, one can see that medical writers were interested in
understanding and treating specific women’s disorders based on observation and experience.
Following from the passage above, and for the remainder of the gynaecology chapters
each of the forty types of women’s disorders, including its symptoms and treatment are outlined.
The three chapters on gynaecology are important because they trace much more than just
disorders of the uterus, menstruation and the breasts. These chapters define “woman” herself,
and in particular a Tibetan Buddhist-medico vision that provides a rich resource for present-day
medical writers. Today’s authors being selective and strategic with the material abstracted largely
omit passages that deem women as inferior to men and manifesting low merit. They clearly want
to align the contemporary Tibetan medical tradition with modern ideas about women’s equality.
Hence, although the Four Treatises is held as the definitive authoritative source of Tibetan
medical knowledge on women for present-day medical writers, they are discriminate between the
parts they use, and those which they omit.
1.5 The Tantric Body in Tibetan Buddhism
Given that Tibetan medicine and Buddhism grew up together in Tibet, Buddhist and
particularly Tantric ideas of the body and gender have been enormously influential in the medical
construing of women and men. In the language and research behind “hormones” in contemporary
Tibetan medical thought, Tantric ideas of “winds” (rlung; Skt. prāṇa), “channels” (rtsa; Skt.
185
de rgyu dang po zla mtshan las byung phyir // gsar ba’i dus na khrag tshabs zhes bya ste // rnying
nas rlung dang bsdongs pas rlung tshabs // de rtags khrag tshabs spyi yi mtshan nyid ni // rked so man
chad rus pa ‘khol zhing na // rgyu zhabs tsha ‘brab ro rgyab mchin dri gzer // rtsa rnams tsha ‘khyug shu
ba ‘brum phran ‘ong // mngal khrag ‘dzag gam ‘khyil dang rnag tu ‘gyur // rlung tshabs rus pa ‘khos
zhing snying mi bde // mgo ‘khor mgo yi rus pa grang sil byed // lus kun grang zhing sha mthang bar du
na // sha rnams g.yo zhing sbo la sbrid pa dang // mig ‘grib smyo ‘am ‘bog gam brjed pa ngas, ibid., 375–
6.
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nāḍī), “drops” (thig le; Skt. bindu), as well as ultra purified “quintessences” (bcud and bdud rtsi)
often play a prominent role. Therefore, it is quite useful to say a few things about Tibetan Tantric
Buddhism, particularly as it relates to human bodies. In this section, I first make some general
comments about Tantric Buddhism, followed by a description of basic Tantric human anatomy.
Following this, I give a short overview of the medical perspective of the Tantric body and
suggest why this subtle anatomy appeals to medical writers who are researching Tibetan medical
and biomedical notions of “hormones.”
Tantric186 (also known as Vajrayāna and ‘secret mantra’) Buddhism refers to meditative
and ritual practices that aim to transform and enlighten the practitioner. “Tantras” (rgyud), which
form a substantial arm of Buddhist literature in Tibet, are esoteric religious texts that give
instruction and guidance on Tantric practices. Originating in India, the texts and practices of
Tantra were well established by the seventh-century C.E. From there, they spread to different
parts of Asia, and especially taking root and becoming prominent among Tibetans who
themselves composed Buddhist Tantras as well as large numbers of commentaries.
Tantras are typically devoted to a single deity or buddha known as a “yidam” (yi dam;
Skt. iṣṭadevatā), or to a “yabyum” (yab yum), meaning “father and mother” or “husband and
wife” typically depicted as a male and female deity couple in sexual embrace. In these
configurations, the male symbolizes “skillful means” (thabs; Skt. upāya), and the female is
associated with “insight” or “wisdom” (shes rab; Skt. prajñā). Their sexual union symbolizes the
inseparability of these two principles as necessary in order to gain Buddhist realization. In
advanced Tantras, the practice of visualizing and then becoming the deity is known as “deity
yoga” (lha’i rnal ‘byor). In these, the Tantric practitioner propitiates and then assumes the
186
This section about the Tantric body draws from: Janet Gyatso, Apparitions of the Self: The Secret
Autobiographies of a Tibetan Visionary , 185–197; G.W. Farrow, and I. Menon, The Concealed Essence of
the Hevajra Tantra with the Commentary Yogaratnamālā (Delhi: Motilal Banarsidass, 1992), vii–xlii;
Kong sprul blo gros mthaʼyas, The Treasury of Knowledge: Book Eight, Part Four: Esoteric Instructions:
A Detailed Presentation of the Process of Meditation in Vajrayāna, trans. Sarah Harding (Ithaca, N.Y.:
Snow Lion Publications, 2007); John Powers, Introduction to Tibetan Buddhism (Ithaca, N.Y.: Snow Lion
Publications, 1995); Garrett and Adams, “The Three Channels in Tibetan Medicine,” 86–114; and, Bstan
ʼdzin rgya mtsho, The Kālachakra Tantra: Rite of Initiation for the Stage of Generation: A Commentary
on the Text of Kay Drup Ge Lek Bēl Sang Bō, ed., trans., Jeffrey Hopkins (London: Wisdom Publications,
1985), 23–38.
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identity and characteristics of these deities as an instructive path towards Buddhist realization of
the true ultimate nature of reality, “emptiness” (stong pa nyid; Skt. śūyatā).
Deity yoga practices, being the most advanced of Tibetan Buddhist ritual and meditative
practices, belong to the “Highest Yoga” (Bla med; Skt. Anuttarayoga) Tantras, which are
considered the highest of Tibet’s fourfold classification of Buddhist Tantra. According to their
Gelukpa proponents, Highest Yoga Tantras 187 are distinguishable from other Tantras by nature of
being able to bring about enlightenment in a single lifetime, and therefore their practices
“involves the most esoteric of the esoteric, the most complex of Tantric contemplative and ritual
practices.”188
Highest Yoga Practices are divided into two stages. The first part, known as the
“creation” or “generation stage” (bskyed rim; Skt. utpattikrama) prepares the meditator’s mental
perceptions for the even more advanced practices of the second part, the “completion” or
“perfection stage” (rdzog rim; Skt. saṃpannakrama), also known as the “path of
methods” (thabs lam). Perfection stage practices involve controlling and directing the “vajra
body” (rdo rje lus) of the winds, channels and drops. It is this vajra body where medicine and
Tantra chiefly intersect, both in past and in present medical texts.
Generally, the Tantric, or vajra body, is conceived as being so extremely subtle that it is
imperceptible to the naked eye. It is manifested through meditative visualization of the internal
Tantric body of the yidam or yabyum. Although descriptions and specific details vary, the Tantric
body is generally conceived as being made up of three channels: the “middle” or “central” (dbu
ma; avadhūtī), the “left” or “solitary” (rkang ma; Skt. lananā), and the “right” or “flavour” (ro
ma; Skt. rasanā).
These channels are imagined as tubes running vertically through the middle of the body.
The central channel is thought to extend from the crown at the head to the sex organs, and from
its lower end, semen is emitted. The right and left channels run alongside the central channel, and
187
For more on the Highest Yoga Tantras, see: Daniel Cozort, Highest Yoga Tantra: An Introduction to
the Esoteric Buddhism of Tibet (Ithaca, N.Y.: Snow Lion Publications, 2005).
188
Garrett, Religion, Medicine and the Human Embryo in Tibet, 112.
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are said to be the reverse in females. The solitary channel is white and faces downwards, and the
flavour channel is red and faces upwards. The upper ends of the right and left channels are at the
nostrils, and are therefore thought to control ordinary breathing. At the lower ends they are
responsible for the emitting of wastes, such as feces, urine and menstrual blood. In advanced
completion stage meditative practices, the right and left channels have a role in allowing vital
winds to enter the central channel.
Along the central channel there are “channel wheels” (rtsa ‘khor lo; Skt. cakra), the
number of which can vary from Tantra to Tantra. The number of cakras, can range from four to
seven, but are generally located at the head, throat, heart, navel, and the groin. Each cakra has a
number of ‘petals’ or ‘spokes’ that branch to smaller channels and minor cakras throughout the
body. Individual cakras along the central channel are associated with a specific “seed
syllable” (yi ge; Skt. bīja), such as Aa and Hụm, which are associated with the material and
psychic origins and workings of the universe, or in other words, they are the “essence and origin
of all.”189
Within the cakras are drops which are ultra reified quintessences. In Tantric thought, the
drops are considered the material stuff of bodhicitta or “buddha-nature,” that is, the (potential)
mind of enlightenment. The drops are said to originate from the white and red reproductive fluids
of the father and mother respectively. In many Tantras, the white drop, which is symbolized as
the moon is imagined as the white upside down Ham seed syllable that resides at the cakra at the
crown of the head. The red drop, symbolizing the sun, resides at the cakra at the lower end,
normally at the pelvis. The two right and left channels intersect at various points along the
central channel to form “knots” that block the flow of winds in the central channels. Advanced
Tantric practitioners aim to ‘untie’ these knots in order to allow wind to move to the central
channel, and thereby open the cakras. In advanced Tantric practices, such as “inner heat” (gtum
mo) the meditator works to cause the lower drop, the blazing sun, to melt the moon drop at the
189
Carmen Meinert, “The Conjunction of Chinese Chan and Tibetan Rdzogs Chen Thought:
Reflections on the Tibetan Dunhuang Manuscripts IOL Tib J 689-1 and PT 699,” in Contributions to the
Cultural History of Early Tibet, eds., Brandon Dotson and Matthew Kapstein (Boston: Brill, 2007), 239–
299.
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crown, allowing them to meet at the heart centre in the middle, thereby generating bliss and
emptiness (bde stong), the hallmarks of Buddhist enlightenment.
The main role of the channels is to carry the “winds” (rlung; Skt. vāyu) which includes
“breath” (rtsol; Skt. prāṇa), as well as the “life-force” (srog; Skt. jīva), both of which are
essential for life. Moreover, in Tibetan Tantric thought the consciousness is thought to ‘ride’ on
these internal winds, hence gaining mastery of the body’s system of winds, channels and drops
are said to bring equilibrium to one’s thoughts and emotions.
As for highest yoga practices, specifically deity yoga, in general, the meditator first
visualizes a particular scene, usually a maṇḍala (dkyil ‘khor), which is a circular diagram
containing images of deities and their retinues within a celestial surrounding. The maṇḍala is
thought to be a powerful meditative tool, symbolizing and leading one to internalize the nature of
reality and the universe, as well as the enlightened mind. It is here in the visualized maṇḍala that
the practitioner imagines their ordinary selves as dissolving into emptiness, and from this
emptiness, a seed syllable forms which gives rise to the body of the deity. After creating a mental
image of the yidam or yabyum and their ritual instruments, the practitioner assumes their identity,
merging with, and then becoming the buddha or bodhisattva, thus enacting a transformation of
the self from an ordinary samsaric being into a fully enlightened Buddha. It is here that
completion stage practices, involving the skillful manipulation of the internalized deities’ body of
winds, channels and drops are developed. At the practices’ conclusion, the meditator causes the
deity to dissolve back into emptiness, which is the ultimate reality from which it arose.
Included among the completion stage practices of High Yoga Tantras are the ritual and
meditative practices that utilize sexual passion as a method. Because all Tantric practices are
aimed at transforming the ordinary individual into an enlightened being, one must employ
methods that shatter the illusion of self and other, pure and impure. This requires a “non-dualistic
attitude towards spiritual development.” Therefore, “[i]nstead of rejecting certain “impure”
aspects of human existence…[the] tātrika, or Tantric practitioner, is supposed to accept
everything…[and] he or she should use everything.” 190 Normally, sexual desire is considered a
190
Janet Gyatso, Apparitions of the Self: The Secret Autobiographies of a Tibetan Visionary, 186.
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worldly pursuit that chains one to the endless cycle of rebirth and suffering, and therefore should
be avoided and suppressed in the serious Buddhist follower, such as the case for celibate
monastics. However, the sexual yoga Tantras take the opposite view. Instead of expending a great
deal of energy keeping desire at bay, Tantric practitioners harness that sexual passion as a means
“to redirect the force of desire by utilizing it in the spiritual path, so that desire itself becomes a
means to overcome desire.”191 Therefore, in sexual yoga texts, the vajra body and in particular its
system of sexual fluids, drops channels and winds becomes the central focus of meditation. This
genre of Tantra also provides a rich conceptual and linguistic resource, as we shall see, for
contemporary Tibetan medical writers in their debates surrounding Tibetan medical and
biomedical notions of “hormones.”
Throughout the history of Tibetan medicine, writers have debated whether certain Tantric
ideas of the subtle body such as the white and red drops, the cakras and the central, left and right
channels could be understood and incorporated medically without contradicting the Four
Treatises. At the heart of the problem, of course, is that the channels and cakras cannot be seen
or physically located in the body. But given the Buddhist underpinning of medicine in wider
society, Tantric anatomies and ideas are often argued to be compatible with medical ones. This
co-existence has been ambivalent. For the most part, Tibetan medical writers, past and present
have shown allegiance to the Tantric system chiefly because they neither would want to disprove,
nor to argue against, the ‘word of Buddha,’ which the authentic Tantric texts including the Four
Treatises are purported to be.192 As a result of their devotion to Buddhist ideas, “the world of
Tantric discourse, imagination, and even soteriology remained fundamental to the conceptual
universe of all of the Tibetan medical writers.”193 Therefore, medical writers have often argued
that although the three channels and other Tantric anatomies can’t be empirically seen, evidence
for their real existence is the fruition of Tantric practice wherein these channels have been
manipulated to produce soteriological outcomes.
191
John Powers, Introduction to Tibetan Buddhism, 225.
192
See: Frances Garrett, “Buddhism and the Historicising of Medicine in Thirteenth-Century Tibet,”
Asian Medicine 2, no. 2 (2006): 204–24.
193
Janet Gyatso, “The Authority of Empiricism,” 89.
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According to Garrett and Adams, contemporary medical writer Tsultrim Gyaltsen’s
viewpoint is that the medical and Tantric traditions are “ultimately in agreement on the existence
of the three channels in the human body.”194 The explanation for this is that because the medical
tradition focuses on understanding and healing the material body, the subtle Tantric body is only
“alluded to” whereas it is the central focus of Tantric texts, which describe “the ultimately true
condition of the body.” Therefore, he asserts, the medical tradition does not contradict the Tantric
position of the human body, but rather is in “full agreement” with it.195 Moreover, as Janet
Gyatso observes of Tibetan medical literature, “tantric theorizations of subtle matter helped
medical description on a number of occasions to talk about imperceptible functions in the
body.” 196 This insight is especially true in the contemporary sources that speak to “hormones”
using Tantric ideas and language.
Tantric Buddhism, and especially the vajra body of the Highest Yoga Tantras continues to
be a valued and valuable body of knowledge for Tibetan medical writers. Contemporary writers
debating hormones often refer to Tantric ideas of the subtle body to name, describe and explain
the microscopic workings of “hormones.” Indeed, Tantra is a crucial avenue for medical writers
to argue for native (or pre-modern) Indo-Tibetan understandings of substances that resemble (or
are equivalent to) biomedical notions of hormones. Present-day authors emphasize that the
Tantras do not contradict the Four Treatises and other authoritative medical texts, and vice versa.
Rather, the medical texts allude to the existence of the vajra body as the subtle and basic
underpinning of the material body that medicine concerns itself with. Moreover, Tantra can
explain the imperceptible aspects of the body which modern technology brings to light,
demonstrating a considerable ability of the Tibetan tradition to ascertain the causes from the
effects of previously invisible events. In this way the tradition seems ultimately true in its
timelessness, and seemingly buddha-like omniscient ability to get at the heart of the matter. From
a wider perspective, the use of Tantra to help establish “hormones” in the Tibetan medical
194
Garrett andAdams, “The Three Channels in Tibetan Medicine,” 95.
195
Janet Gyatso, “The Authority of Empiricism,” 95.
196
Ibid., 93.
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tradition ensures that Tibetan Buddhist ideas of the body remain prominent in not only the
medical tradition, but in Tibet’s wider intellectual and national consciousness.
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2.
“Hormones” in Present-Day Book-Length Commentaries
In this chapter I examine two book-length works which are best described as
contemporary commentaries on the Four Treatises and the gso ba rig pa tradition. The first book
is Thupten Püntsok’s Knowledge of the Body in Tibetan Medicine197 published in 1999, and the
second is Mingji Cuomu’s Clinical Experience in Treating Obstetric Diseases198 published ten
years later. These two works are similar insofar as they present biomedical thought as a verifying
supplement to Tibetan medical knowledge. Even when they integrate new information and
propose new terminology to describe biomedical ideas, these innovations are placed within the
overarching framework of Tibetan medicine. Another crucial way in which they are similar is
through their allegiance and devotion to the Tibetan Buddhist tradition. Both authors refer to
several Buddhist sources throughout their works, and present Buddhist thought as a rich resource
of knowledge about the body.
Thupten Püntsok’s book, Knowledge of the Body in Tibetan Medicine, is concerned with
the whole human body but focuses on causes for conception, neonatal development and (briefly)
normal functioning of the matured adult body. The work is notable for its lengthy discourse on
the Tantric body in relation to the medical one, presenting both as two sides of a largely unified
system. The topic of reproduction and the reproductive bodies of women come to the forefront in
a number of sections. Although Thupten Püntsok is primarily explaining a Tibetan view of the
body, he also integrates biomedical notions and terms, albeit briefly, and among these are
hormones. Unlike my later sources, his referencing of hormones and their relation to the Tibetan
medical body is preliminary and exploratory. Yet, his work clearly points to some of the key
questions about hormones that constitute the debate surrounding their inclusion.
Mingji Cuomu’s work, Clinical Experience in Treating Obstetric Diseases, is focused on
women’s reproductive abilities and their obstetric care. She also explores, at considerable length,
the relation of Tibetan medicine to biomedicine in terms of new research and the trajectory of
197
Thub bstan phun tshogs, Gso bya lus kyi rnam bshad.
198
Sman skyi mtsho mo, Mo nad phal pa’i nad la zhib ’jug dang gso bcos kyi nyams yig.
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current textual research as part of the contemporary tradition. Her stated overall aim is to
research and develop the Tibetan medical tradition in order to educate doctors and women, and
thereby contribute to social progress. As does Frances Garrett in her study of Tibetan
embryology,199 she points out that Tibetan medicine did not really develop obstetrical care in the
same way as conceived in the West. Although there is some mention of care for pregnant women
in some of the authoritative Tibetan sources, and the emotional thoughts of women during
pregnancy is considered to be important, little has been written about the women’s obstetrical
health, and far less about the actual process of birthing a child. Mingji Cuomu's central aim is to
ameliorate this situation and to develop a Tibetan tradition of obstetrics.
I introduce Thupten Püntsok’s work first from among my primary sources because his
book focuses on how the body is formed and how it functions, allowing us to examine the basics
of the Tibetan medical body before moving into the more complex topic of how Tibetan medical
and biomedical notions of “hormones” are integrated, as is the case with Mingji Cuomu’s book.
Hence, I use his work to outline the Tibetan medical body, and to show, albeit in a cursory way,
one way that biomedical and Tibetan medical ideas of hormones have been integrated. Also, we
will have the opportunity to look at descriptions of Tantric anatomies since his work is explicit in
its incorporation of these details.
Given that all present-day medical accounts of women begin with menstruation, Chapter
Two begins with Thupten Pünstok’s description of menstruation. Following this, I look at his
explanation of Tibetan embryology, which is an area where Thupten Püntsok explicitly points to
the tension between ‘modern science’ and the Buddhist-medico Tibetan account of the body. In
the two sections that follow, I examine Thupten Püntsok’s explanation of the Tibetan account of
the human body as a whole, beginning with its constituent parts, extending to its subtle Tantric
aspects and concluding with his interpretations of biomedical hormones in relation to the Tibetan
system. Afterwards, I examine “hormones” in Mingji Cuomu’s book, focusing on the sources she
employs and her interpretive strategies.
199
Garrett, Religion, Medicine and the Human Embryo in Tibet, 80–3.
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2.1 Menstruation: A Fundamental Condition of Womanhood
Thupten Püntsok’s explanation of women’s bodies begins with “menstruation” (zla
mtshan), a topic most authors describe as the “fundamental nature” (chos nyid) of women’s
bodies. This is based on a common understanding of the Four Treatises that all of women’s
disorders initially stem from problems surrounding menstruation. Hence, before any discussion
of women can take place, authors explain the causes and conditions of healthy menstruation, and
its relation to reproduction. The correct way of viewing the nature and causes of menstruation
and its relation to conception is the focus of the first section, “Explanation on the causes and
conditions for the body”200 from the fourth chapter, “Explanation on How the Body is
Formed.”201
Thupten Püntsok begins this section with an oft-cited passage of the Four Treatises
regarding a crucial element of conception: “The initial [cause for pregnancy are the] flawless
semen and blood of the parents.”202 Having established the exact phrasing of the primary
authoritative source of his work, he points to what he sees as a common misinterpretation of this
passage in relation to menstrual blood: “It is said [by some] that this passage indicates that
women possess [both] blood and menstruation [and therefore they] understand women’s uterine
blood as being different from menstrual [blood]. But this system is not in keeping with the
meaning of the Four Treatises.”203 The principle cause for a fetus to arise, clarifies Thupten
Püntsok is the “seed” (sa bon) of the parents: the seed of the father is the “semen” or
“reproductive fluid” (khu ba)204 of the “white element” (khams dkar), and the seed of the mother,
known commonly as menstruation, is classified as being a product of the “red element” (khams
200
lus chags pa’i rgyu rkyen bshad pa, Thub bstan phun tshogs, Gso bya lus kyi rnam bshad, 40.
201
lus chags tshul bshad pa, ibid., 39.
202
dang po pha ma’i khu khrag skyon med pa, ibid., 40.
203
zhes pa’i khrag dang / zla mtshan ldan pa skyes pa ‘dod pa’i rtags / zhes pa’i zla mtshan gnyis bud
med kyi mngal khrag tu go nas ‘grel bshad byas pa mi ‘thad pa’i tshul bshad par, ibid., 40.
204
Khu ba can refer to both male and female reproductive fluids; in women, blood or the red element
is also called reproductive fluid, and in many cases the three terms are synonymous.
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dmar). Here, in the case of medicine, Thupten Püntsok establishes the male and female
reproductive fluids as the white and red elements respectively.205
Thupten Püntsok continues by explaining that part of the confusion over the identity and
nature of menstrual blood and its relation to the red element arises from a conflation of Buddhist
and medical ideas. He explains that such misunderstandings surrounding the blood and the seed
arise from the mistaken notion that during menstruation, the uterine blood that comes out each
and every month is merely “refuse” (snying ma), and therefore not the reproductive seed of the
female. Hence, Thupten Püntsok argues, that saying this menstrual blood is the red element, as
understood in the Four Treatises, is incorrect because in medical language, unlike Buddhist
understandings, the red element is not just the blood that comes out every month but the entire
sequence of events which takes place during each month of which the uterine blood coming out
as “menstruation” is but one part. More concisely, the red element, which is present as a
feminine principle in Buddhism, in medicine refers to the entirety of the menstrual cycle, and not
just the “red blood” that comes out for a few days. In this way, the menstrual blood is the seed,
albeit, one that hasn’t been fertilized.
Thupten Püntsok further explains that according to “the specific conventions of medical
literature, the meaning of menstruation refers to the essence of food and drink that has gathered
in the ovaries for the purpose of grasping the seed in the uterus.”206 He continues, “Every month
those essences gathered in the ovaries descend to the uterus by way of two tubes to the right and
left [of the uterus], eventually becoming what is known as menstruation.”207 Then, “if the causes
205
This question of identifying “menstrual blood” and “ovum” is addressed in Āyurvedic medicine as
well. See for instance, Rahul Peter Das, The Origin of the Life of a Human Being: Conception and the
Female according to Ancient Indian Medical and Sexological Literature (Delhi: Motilal Banarsidass
Publishers, 2003).
206
zla mtshan zhes pa gso ba rig pa’i gzhung gi ched spyod tha snyad cig ste / de’i don ni kha zas kyi
dwangs ma bsam se’u ru bsags pa de mngal ‘dzin pa’i sa bon byed pa’i ched du, Thub bstan phun tshogs,
gSo bya lus kyi rnam bshad, 41.
207
dus las mi yol ba zla ba re re bzhin bsam se’u yi rtsa lam g.yas g.yon gnyis brgyud nas bu snod du
‘bab bzhin yod pa des na zla mtshan zhes zer, ibid., 41.
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and conditions for pregnancy are not present”208 (usually meaning that sexual intercourse hasn’t
transpired), the refuse inside the uterus becomes blood and comes out through the cervix.
After this interpretation, he emphasizes that if we consider only the uterine blood to be
“menstruation,” then this is not in keeping with the meaning of the Four Treatises, and
furthermore, in Tibetan medical literature, the red element has many meanings related to the
whole process of menstruation. He continues that part of the confusion comes from varieties in
local dialect and “common [misunderstandings] among the majority of Tibetan people who are
not medical doctors or experts,” 209 and so do not know what is meant by “menstruation,” and that
“the majority of those who have knowledge [of the texts]” 210 know the correct meaning of the
passage from the Four Treatises regarding the “flawless blood” and “menstruation.”
This point about clarifying the medical and Buddhist understandings of the red element
appears as a significant entry into the topic of women and menstruation, not only in Thupten
Püntsok’s work, but in the other sources as well. As we do here, we shall see in other present-day
works that the “red element” is the fundamental basis or foundation of any medical research on
women,211 and identifying its nature and how it functions is not only considered key to
understanding the “inherent nature” (chos nyid) of women’s bodies, but is increasingly the
central locus or site where “hormones,” and how they function, are researched.
The assertion that some people “mistakenly” consider the “red element” to be solely the
menstrual blood is an opening into the examination of what it is that constitutes the red element.
From a medical perspective, it is a fundamental condition of womanhood, and its mechanics,
particularly in light of biomedical insights into hormones, is at the heart of contemporary
208
de nyid mngal ‘dzin pa’i rgyu rkyen ma tshogs pa’i tshe na, ibid., 41.
209
spyir btang sman pa dang yon tan can ma yin pa’i bod mi mang che ba, ibid., 41.
210
shes mkhan phal cher yod pa, ibid, 41.
211
This emphasis on menstruation is noticeably absent in Western biomedicine, wherein the menstrual
cycle, with the exception of birth control, is virtually never taken into account in medical or
pharmaceutical research. In fact, it is because women menstruate that they are considered to be not ‘good’
test subjects. It is not surprising then that women suffer more reverse side effects from drugs which have
only been tested on male bodies. Including the menstrual cycle at every level of medical research would
dramatically change the biomedical landscape.
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medical debates. Moreover, to call out mistaken interpretations seems in some ways a rhetorical
statement. A few authors point to this same misunderstanding that Thupten Püntsok does, yet I
have not come across a single source that ‘makes’ this mistake, and so I am not sure as to who or
to which text they are responding. It could be that they are responding to an earlier source that I
have not consulted. It also could also be that this is a writing strategy to get at the heart of
medical thinking of women, which principally relates to the red element and its proper
connection to menstruation. I am also inclined to suggest the latter possibility because these
‘others’ are not directly cited, nor are sources provided. Moreover, at the end of this section
Thupten Püntsok seems to suggest that mistaken interpretations are made by ‘lay’ or non-medical
readers (although it wouldn’t be common for lay people to be reading medical texts like the Four
Treatises) and that properly trained “doctors” would know better. In any case, the clear
distinction being made between Buddhist and medical understandings of menstruation and the
red element may also remind us of the separation of medicine from Buddhism. On the other
hand, in the following sections of his work on the human body, Thupten Püntsok refers to Tantric
anatomies of winds, channels and drops, and works to show how they are harmonious with
medical views of the body. Certainly, in Thupten Püntsok’s work Buddhist and medical
understandings of the body are related in some ways, but their differences need also be clarified.
2.2 Establishing the Reproductive Fluids in the Authoritative
Literature
In the next section, Thupten Püntsok establishes the development, movement and
functions of the reproductive fluids, and does so by referring to the Four Treaties, and two of its
most influential commentaries which are still widely used today.
The first is Zurkar Lodrö Gyalpo’s (Zur mkhar blo gros rgyal po, 1509 – 1579)212
Ancestral Advice (Mes po’i zhal lung),213 written between 1560 – 1570 and later revised and
212
For more on Zurkar Lodrö Gyelpo see: Olaf Czaja, “Zurkharwa Lodro Gyalpo (1509-1579) on the
Controversy of the Indian Origin of the rGyud Bzhi,” The Tibet Journal 30–31, no. 4 (2006-2005): 131–
153. In relation to embryology, see: Frances Garrett, “Embryology and Embodiment in Tibetan Literature:
Narrative Epistemology and the Rhetoric of Identity,” in Soundings in Tibetan Medicine: Anthropological
and Historical Perspectives, ed. Mona Schrempf (Boston: Brill, 2007), 411–25.
213
Zur mkhar pa blo gros rgyal po, Rgyud bzhi’i ‘grel pa mes po’i zhal lung (Beijing: Krung go’i bod
kyi shes rig dpe skrun khang, 1989).
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completed in the seventeenth-century by two doctor-writers214 at the request of the ‘Great’ Fifth
Dalai lama. Ancestral Advice is used throughout the present-day medical sources on women. One
reason for this is articulated by Mingji Cuomu who writes that Zurkar Lodrö Gyalpo’s Ancestral
Advice outlines a four-point approach to healing, which is a hallmark of Tibetan medicine:
To identify the medical ingredients to be used; to diagnose the disease to which the
medicine should be applied; to discover how to use medicines through the practice of
formulating a remedy by combining the ingredients; and finally to make sure that the
proper formulation ensures the quality of the remedy.215
Further, she maintains that these four factors “are a useful starting point for thinking about how
to create a new paradigm for Tibetan medical research” and such “historical suggestions have
contemporary salience.” 216
The second commentary used prominently in Thupten Püntsok’s section on the
reproductive fluids is Desi Sangyé Gyatso’s Blue Beryl,217 also an enormously influential treatise
on Tibetan medicine commonly used today in the sources on women and hormones. Its author is
the already mentioned, powerful regent to the Fifth Dalai Lama, who wrote a number of highly
influential works on numerous topics spanning religion, government and science.
It is notable that both of these commentarial works were completed in the seventeenthcentury, the hey-day of Tibetan civilization according to modern scholars, and that both are
connected to the emblematic figures of that time, the much celebrated ‘Great Fifth’ Dalai Lama
and his regent, Desi Sangyé Gyatso. Today both of these figures are seen by many Tibetans as
nationalist heroes, who unified Tibet on religious, cultural, intellectual as well as geographic
214 These two doctors are Darmo Menrampa Lozang Chodrak (Dar mo sman rams pa blo bzang chos
grags, 1638-1710) and Namling Panchen Konchog Chodrak (Rnam gling paNchen dkon mchog chos
grags, 1646-1718).
215
Mingji Cuomu, “Qualitative and Quantitative Research Methodology in Tibetan Medicine: The
History, Background and Development of Research in Sowa Rigpa,” in Medicine Between Science and
Religion: Explorations on Tibetan Grounds, eds. Vincanne Adams, Mona Schrempf, and Sienna R. Craig
(New York: Berghahn Books, 2010), 261
216
217
Ibid., 261.
Sde srid sangs rgyas rgya mtsho, Rgyud bzhi’i gsal byed baidūrya sngon po, 2 vols, Bod kyi gso ba
rig pa’i gna’ dpe phyogs bsgrigs dpe tshogs 018 (Beijing: Mi rigs dpe skrun khang, 2005).
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levels. Consequently, their use as authoritative sources in contemporary Tibetan medical research
is significant.
Returning to the reproductive fluid, Thupten Püntsok begins this section by again quoting
from the Explanatory Tantra: “The reproductive fluid, which is the last of the seven bodily
constituents separates into two: essence (dwangs ma) and refuse (snying ma). The essence
becomes quintessence, and the refuse creates the seed for conception.”218 According to Thupten
Püntsok, those who mistake the uterine blood for refuse, or in other words say that the refuse is
the blood and not the seed, misunderstand grammar, and so make careless misinterpretations. He
writes that according to all of the authoritative commentaries to the Four Treatises, such as
Ancestral Advice and the Blue Beryl, “the refuse of reproductive fluid is that which trickles
downwards, and becomes, by stages, the seed for conception in the uterus.”219 He then
problematizes this claim by admitting that a reasonable cause of confusion could be that some
“older commentaries” (rgyud ‘grel rnying pa) do in fact state that the essence becomes the seed
for conception, rather than the refuse. Thupten Püntsok asserts that this seeming contradiction in
meaning arises from two different ways of identifying the essence and refuse, which relate to
notions of “thick” (sra ba) and “thin” (sla ba). These ideas of thick and thin reappear again in
debates about hormones and technically this is a crucial point. He writes that it is customary that
the essence is thin and the refuse is hard and solid, by giving the decidedly Tibetan examples of
“butter” (mar) and “beer” (chang):
For example, by churning milk to take out the butter, the refuse is the milk which is a thin
liquid, and the essence is identified as the butter, which is solid. Similarly, reproductive
fluid is like the taking out of the refuse of beer, wherein the fibrous part is solid and [is
considered] the refuse, and likewise, the beer, being thin, is identified as the essence.220
218
lus zungs bdun gyi tha ma khu ba de dwangs snyigs gnyis su phyes pa’i dwangs mas lus kyi mdangs
dang // snyigs mas mngal ‘dzin pa’i sa bon byed ces bshad pa de. Thub bstan phun tshogs, Gso bya lus
kyi rnam bshad, 42.
219
khu ba’i snyigs ma ni thur du ‘dzag ste mngal ‘dzin pa’i sa bon du rim par ‘gyur ba yin no, ibid.,
42.
220dper
na / ‘o ma dkrogs nas mar bton zin pa’i rjes su sla ba’i cha ‘o ma la snyigs ma dang / ril po
mar la dwangs ma ngos ‘dzin pa dang / yang / chang gi snying khu bton zin pa’i rjes su sra ba’i cha
sbang ma la snyigs ma dang / sla ba chang la dwangs ma ngos ‘dzin byed srol yod pa ltar red, ibid., 42–
3.
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Accordingly, he suggests that there are two types of reproductive fluid, one being thick and the
other being thin, and that calling them either essence or refuse points to the same process and is
therefore not contradictory. He writes, “from mixing together [the reproductive fluid] with blood,
the constituents take the form of thin water, and this becomes the bodily constituents, and the
thick liquid trickles downwards by way of the channels from the ovaries and becomes the seed
for conception in the uterus.”221 In this way, Thupten Püntsok is able to make an interpretation on
a variety of texts without contradicting the “meaning” (don) of the Four Treatises.
Like we see in Thupten Püntsok, the insistence that there are “no contradictions” among
older authoritative sources is the normative position of my primary sources. Instead of disputing,
or showing the seminal medical texts to be even slightly ‘wrong’ or ‘dated,’ they are presented as
timeless in their flexibility to contemporary interpretations. In this manner the Tibetan system is
also open to incorporating foreign medical knowledge, in a way that does not discredit any of its
fundamental assumptions. That appears to be the case where, having clarified the root text and
countered any discrepancy with the relevant commentaries, (and immediately following the
passage above)222 Thupten Püntsok concludes this section on Tibetan knowledge of the
reproductive fluids by offering his own interpretation of how the biomedical system of hormones
is related:
In the modern texts of Western medicine, that which comes out from the ovaries is
[called] ‘hormones.’ They mix with the blood to make up the bodily constituents. And,
through pathways from the ovaries, the egg-seed of conception descends, becoming the
seed [in the uterus]. Hence, the [Tibetan] explanation and Western medical one is
conceived in roughly a similar manner. 223
221
‘dir khu bar ska sla gnyis su bye ba’i sla ba chu’i rnam pa can de zungs khrag dang lhan du ‘dres
nas lus zungs byed pa dang / ska ba’i cha de bsam se’u yi rtsa lam brgyud thur du ‘dzags te mngal ‘dzin
pa’i sa bon byed tshul bshad pa ni, iIbid., 43.
222
Here the author finishes the previous sentence with the particle, ni - a grammatical marker that
indicates that which follows is a kind of definition or explanation of what came before. In this way, the
explanation of the perspective of the authoritative Tibetan texts agrees with, defines, or is perhaps
describing the same processes as what biomedicine calls “hormones.”
223deng
dus nub phyogs pa’i gso rig gzhung du bsam se’u nas ho’o mo’u (Hormone) babs te khrag
dang lhan du lus zungs byed pa’i tshul dang / yang / bsam se’i nas mngal ‘dzin pa’i sa bon sgo nga de
nyid bsam se’u yi rtsa lam du babs nas mngal ‘dzin pa’i sa bon byed tshul bshad pa dang phyogs tsam
mtshungs par snang, ibid., 43.
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Although cursory and seemingly tentative in here, Thupten Püntsok’s assertion that hormones
and the “essence of food and drink” are conceived in a similar manner is taken up, greatly
expanded upon, and debated by later writers. The straightforward connections among nutrition,
essences, wastes, the menstrual cycle and hormones form the crucial nexus in Thupten Püntsok’s
assertion. That biomedical notions of “hormones” are equivalent to the very refined essences, or
quintessence, of food and drink, and specifically of the white and red elements, is an idea found
to be central in the other primary sources. It is also noteworthy that Thupten Püntsok is the only
author among my sources who uses the English term, “hormone,” as well as its Tibetan
transliteration of ho’o mo’u. Although he spills considerable ink on the close connection
between the Tibetan medical and the Buddhist body, unlike the later medical writers, he does not
use Tantric language to name “hormones.”
We also see in this section a pattern common among the sources on women and
hormones, which is to first quote the Four Treatises, clarify any interpretations not in keeping
with the “intended meaning,” posit a correct understanding (which is often where innovation
occurs, or where one puts forth their own explanation), followed by comparison with biomedical
knowledge. Thupten Püntsok’s statement of equivalency, namely that the red element is “roughly
conceived in a similar manner” in biomedicine—speaks to the argument that Tibetan medicine is
a ‘world medicine.’ Because it is based on empirical and ‘scientific’ evidence and experience, it
can point to the same processes in the body that biomedicine does, albeit differently named and
uniquely understood.
Lastly, one notices here and in other contemporary sources, that biomedicine is
strategically used as a way to support the Tibetan system, and more widely Tibetan knowledge
and culture—rather than as a means to offer a contrasting account. Biomedicine, it seems,
confirms the findings of Tibetan medicine which is made known by experience and the
authoritative textual sources. This stance has its hiccups, as becomes evident in the following
section where Thupten Püntsok outlines the Tibetan perspective of embryology.
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2.3 Problems in Tibetan Embryology: Strategies of Ignoring the
Modern Evidence
Contemporary medical writers like Thupten Püntsok typically emphasize a harmony
between Tibetan medicine and religion, even though this relation has its tensions and
ambiguities. We can see an example of this discord in his next section, “Causes and conditions
for the formation of the body” (lus chags pa’i rgyu rkyen).224 Thupten Püntsok gives an
explanation of his understanding of Tibetan “embryology,”225 suggesting significant
discrepancies not only among Tibetan medical texts and illustrations, but also with the visual
evidence of ultrasounds and modern medicine.
In Religion, Medicine and the Human Embryo in Tibet, Frances Garrett explores the
shared history of medical and Buddhist thought surrounding Tibetan embryology. Hence, using
her work as a reference, I will speak only briefly about this branch of Tibetan medicine because
it plays an important part in present-day works on women and hormones. Furthermore, the
biomedical literature on hormones is also very much engaged with embryology, the field known
as development, owing to the fact that hormones are thought to be instrumental in the
organization of the male and female embryo. In both cases, a large part of research into
“hormones” necessarily involves attention to prenatal development or embryology.
Embryology, the account of how the fetus is conceived and gestated, has been a fertile
topic in the intellectual history of Tibet, and can be found in a broad range of Buddhist and
medical literature. In the eleventh and twelfth centuries Tibetans inherited and translated
numerous Indian medical (Āyurveda) and Buddhist texts (Sūtras and Tantras) on embryology,
and its closely related topic, the reproductive bodies of women. They also produced a staggering
number of such texts throughout the following centuries. Garrett indicates that part of the reason
embryological narratives gained such popularity and pervasiveness in Tibetan literature was due
to the proliferation of commentarial literature, from roughly the thirteenth-century onwards, that
224
Ibid, 43.
225 As
Frances Garrett points out, the term, “embryology” is a product of Euro-American thought, and
there is “no direct terminological or conceptual correlative in Tibetan.” Religion, Medicine and the
Human Embryo in Tibet, 12–3 (author’s emphasis). What we typically call Tibetan “embryology” is
commonly known as “how the body is formed” (lus chags pa’i rgyu) in Tibetan literature.
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imagined Buddhist soteriology to be a graded path, giving rise to a wide genre of writing and
practice known as “stages of the path” (lam rim).
In Mahāyāna Buddhist writings, such as the Entering the Womb sūtra and its
commentaries, the embryological narrative, which is chiefly concerned with how ‘ordinary
beings come into existence,’ explains doctrinal understandings of karma, inter-dependence and
rebirth. Beyond being intellectually instructional, by contemplating the embryological narrative,
explaining the gradual and causative steps by which one gains a material body, a Buddhist adept
can realize deeper soteriological ‘truths,’ such as impermanence and emptiness, the
pervasiveness of suffering, and more importantly, the means to be reborn as a fully enlightened
being.
In Tantric writings such as the Indian Kālacakra Tantra and its vast Tibetan commentarial
tradition which continues in Buddhist and medical writings today, the embryological account
serves as an especially fruitful metaphor for the Buddhist meditator and/or the gradual stages of
Buddhist insight that lead to liberation. In these texts, increasingly elaborate and intricate
meditative practices, mostly based on a subtle Tantric anatomy of winds, channels, and drops, are
vividly presented by way of human physiology in the process of conception, gestation and birth,
allowing the advanced contemplative to experientially know how one is born with a human body,
and also, how one can be liberated from ordinary rebirth. As in Tibet’s medical history, Buddhist
Mahāyāna and Tantric ideas of fetal development are present in the contemporary sources, such
as Thupten Püntsok’s.
Thupten Püntsok’s account of embryology is based primarily on the Four Treatises and
Ancestral Advice. It should be noted that the embryological details vary amongst authoritative
and present-day commentaries, and as Garrett points out, these details, reflecting the social,
political, religious, and cultural worlds of their origin, were “controversial” in their time, and
“[e]xamining this controversy will tell us a great deal about intellectual history in Tibet, much as
debates over embryology are a mirror into our own history.”226 Thupten Püntsok’s embryological
226
Ibid., 9.
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section (continuing directly following the last translated section ending on hormones) contains
the basic requirements for conception present in Tibet’s intellectual traditions. He writes,
The causes and conditions for the formation of the body are the flawless wind, and so forth
of the father’s semen and the mother’s menstrual [blood], and the consciousness of a bardo
being, of whose karmic merit, whether virtuous or non-virtuous is suitable [with the
parents]. It is by the arousal of the “passion winds,” (nyon mongs pa’i rlung; Skt. kleśa)
ignorance and so forth that the three—semen, blood and mind—together with the five
elements suitably gather and assemble, becoming the cause for the formation of a child in
the uterus.227
While the reproductive fluids appear safely ‘medical’ to a Western reader, the latter requirement
for human life, a consciousness of a bardo being would appear more overtly Buddhist. Tibetan
Buddhist views surrounding the bardo consciousness, like we saw in Gönpokyap’s argument for
the Buddhism’s materialist basis, are asserted throughout present-day Tibetan sources on
women’s bodies and reproduction. Thupten Pünstok does not so much explain or define what a
bardo being is, but instead continues to outline the main points on embryology found in the Four
Treatises and Ancestral Advice.
Following from above, Thupten Pünstok writes about how the “five elements” (‘byung
lnga)—“earth” (sa), “fire” (me), “water” (chu), “wind” (rlung) and “space” (nam mkha’)—
interact to form the fetus’ body, and which parts are formed by the father’s semen and the
mother’s blood—both significant debates in Tibetan and Āyurvedic medicine. In terms of the
ovulatory cycle, he writes about which days are the most fertile for women, and makes
comparisons with the biomedical system, showing it is similar to Tibetan medicine. He also
outlines the process of “digestion” (‘ju ba) and the making of the seven bodily constituents
through the gestative process, something largely absent in sūtric and Tantric sources, but of great
importance in many medical sources.
Notably, Thupten Pünstok concludes the first half of the fourth chapter by pointing to
possible discrepancies between Tibetan and biomedical embryological understandings:
227
lus chags pa’i rgyu rkyen ni / pha’i khu ba dang ma’i zla mtshan la rlung la sogs pa rnam pa gyur
pa’i nad kyi skyon med pa de la / bar do’irnam pa shes pa de nyid dge mi dge gang rung gi las dang / ma
rig pa la sogs pa’i nyon mongs pa’i rlung gis nye bar bskul nas khu khrag sems gsum gyi ‘byung ba lnga
po lhan cig tu tshogs shing ‘dus pa rung ba ni mngal du bu la sogs pa chags par ‘gyur ba’i rgyu yin.
Thub bstan phun tshogs, Gso bya lus kyi rnam bshad, 43.
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The clear and precise manner of the development [of the fetus] according to each and
every specific week is clearly outlined in the Explanatory Treatise. Yet, my impression is
that the literal meanings of the words of the Explanatory Treatise have not been analyzed
carefully, and because of that many mistakes and errors arise in the commentaries. In
the Lhasa Tibetan hospital, there is a medical painting that illustrates the manner of how
the fetus’ body is formed, which if you match it against the precise meaning of the words
of the Explanatory Treatise, is very different. These days, ultrasounds are able to
investigate the stages of fetal growth through visual images and again, they are different
[from the Tibetan accounts]. Nevertheless, with respect to that, there is no need at this time
to elaborate on the discrepancies, and [we will] put [the issue] aside. Here, I provide a
summary of the way the fetus’ body is formed from the point of view of the literal meaning
of the root words of the Explanatory Tantra.228
Although Thupten Püntsok points to clear contradictions, for the latter part of the fourth chapter
he presents a detailed summary of each month of gestation relying on the Explanatory Treatise of
the Four Treatises and Ancestral Advice. For example, he writes that it is in the fourth week of
pregnancy, after the male and female seeds have properly joined and formed an embryo, and the
fetus’ own “existence wind” (srog rlung) has taken root that the indicators of gender arise. He
writes,
During the fourth week, the wind [causes the fetus’ body] to form into the same shape and
consistency as a thick yogurt, from which it can be determined whether the [child] will
have the mark of a male or female. As for this indication of sex, if the form of the fetus is
round shaped and has the quality of being hard and dense, it will be a boy. If it is oval
shaped and its form has the aspect of being thin and subtle, it will be a girl. If it is an
elongated shape and its form takes the aspect of being a bit thick, it will be a neuter
[child].229
It is not likely that these details would hold up either to biomedical scrutiny, or to biomedical
views regarding how and when one’s ‘sex’ is established, or whether this can be changed by
228
bye brag bdun phrag re re bzhin ‘phel ba’i tshul gsal zhing zhib pa bshad rgyud du gsal yang / ‘grel
pa rnams su bshad rgyud kyi tshig don la zhib tu ma dpyad par rang gi ‘char snang ltar ‘grel bas nor
‘chug mang po byung yod stabs / lha sa sman rtsis khang gi lus chags tshul gyi dpe ris bris pa’i thang ka
de ni / bshad rgyud kyi tshig don dang zhib tu sbyar na ha cang mi mthun zhing / deng dus tshan rig gi
‘phrul chas kyis brtags nas rtogs pa’i lus chags tshul gyi par ris dang de bas kyang mi mthun / ‘on kyang
de la dgag gzhag gi spros pa’i dgos gal ma mthong bas re zhig bzhag nas / ‘dir lus chags tshul bshad
rgyud kyi rtsa ba’i tshig don ji bzhin mdor bsdus pa’i sgo nas ‘grel bar, ibid., 49–50.
229
bdun phrag bzhi pa’i skabs su rab tu byed pa zhes bya ba’i rlung gis lus dbyibs rags pa zho’i rnam
pa lta bu chags pa de la pho mo gang yin gyi mthan ma gtan ‘khel bar byed cing yod pa ste / de’ng
mtshan ma’i rtags su gor gor po ste cung zad sra zhing ‘dril ba’i rnam pa chags na pho dang / mer mer
po ste sla ba’i rnam pa chags na bu mo dang / nar nar po ste cung zad ska ba’i rnam pa chags na ning du
‘gyur bar bshad, ibid., 52.
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ritual, behaviour or some other means. These are long-standing ambiguities in Tibetan medicine.
Notably, biological sex is not strictly binary in the Tibetan medical (or Buddhist) system, and a
‘third gender’ which is neither male nor female, is recognized by medical and
Buddhist writers.230 Also, it is significant that Thupten Pünstok does not show the Four Treatises
either to be contradicted or to be shown ‘false’ because of the evidence of modern ultrasounds
and the discrepancies among Tibetan texts. Rather, he clearly maintains the Four Treatises’
medical authority in terms of fetal development. He suggests in the passage quoted earlier, and
throughout his work, that there are other ways to interpret or ‘read’ the texts such that they are
‘correct or ‘true’ in some ways.
2.3 The Body’s Constituents: A Tibetan Medical and Buddhist
Framework for Life
In the fourth chapter dealing with embryology, Thupten Püntsok explained how the body
is conceived and gestated. In the fifth chapter, “Explanation of the Characteristics of the
Body,” 231 he shifts to precisely what it is that constitutes the body. In this chapter, Thupten
Püntsok begins with an outline of the basic and essential building blocks of the body, gradually
moving towards a more complex and multidimensional body. In this section I look at the terms
and ideas that describe what the body is most ‘basically’ made up of: aggregates, elements, the
seven bodily constituents and the three dynamics.
Thupten Püntsok explains that according to Tibetan medicine the “body” (lus) is
essentially made up of “aggregates” (phungs po; Skt. skandha) which are the assembly of two
spheres of “material elements” (khams; Skt. dhatu). The first sphere consists of the “material
elements of the body’s constituents” (lus zungs kyi khams), which are the “object[s] of
harm” (gnod bya). The second sphere is the material elements of the “three dynamics” (nyes pa;
Skt. doṣa) of “wind” (rlung; Skt. vāta), “bile” (mkhris pa; Skt. pitta), and “phlegm” (bad kan;
Skt. kapha), which are the “objects that harm” (gnod byed). He also adds that the bodily
constituents, (or more basically, the ‘body,’ also understood as khams) are the ‘objects’ (or the
230
Janet Gyatso examines the ‘three genders’ of Tibetan Buddhism in: “One Plus One Makes Three:
Buddhist Gender, Monasticism, and the Law of the Non-Excluded Middle,” 89–115.
231
lus kyi mtshan nyid bshad pa, Thub bstan phun tshogs, Gso bya lus kyi rnam bshad, 63.
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body itself as the object) that can be ‘harmed’ by nature of being subject to the changeability of
the three dynamics or ‘faults.’232 To unpack this understanding of the body, it helps to understand
the wider religious context that informs Thupten Püntsok’s medical perspective.
The concept of “aggregates,” which Thupten Püntsok identifies as that which makes up
the human body in the Tibetan system of medicine, is deeply informed by philosophical ideas
dating back to the early days of Indian Buddhism. Ideas about the aggregates, also known as the
“heaps” or “piles” that make up impermanent things such as humans, are found throughout the
various genres of Buddhist literature from the Theravada, Mahāyāna and Vajrayāna traditions.
In the early Buddhist literature, the aggregates of human (and cosmological) existence is
treated extensively in two of the three “baskets” of the the Tripiṭaka (sde snod; Pāli. Tipiṭaka Skt.
pitakas). These texts of the Buddhist Pāli cannon are considered to be the ‘word of the Buddha.’
Two233 of these groups of texts are the “sūtras” (mdo; Pāli. sutta), the “discourses of the
Buddha,” and “Higher Knowledge” (chos mngon pa; Pāli. Abhidamma) (known chiefly in
Western scholarship by its Sanskrit title, Abhidharma). The Abhidharma contains a system of
classifying and understanding all phenomena. 234 A commentarial tradition based on the sūtras
and the Abhidharma flourished in Tibet from the ninth-century, and the topics contained in these
works are still considered foundational philosophical topics in Buddhist (particularly monastic),
education.235 Mahāyāna and Vajrayāna Buddhism adopted and elaborated upon these earlier
Buddhist views of the body. Hence, in the wider Tibetan Buddhist and medical traditions, notions
232
Ibid., 63.
233
The third ‘basket’ of the Pāli cannon is the Vinaya (‘dul ba)—the rules of the Buddhist monastic
community.
234
For more information on the Abhidharma in the Indian context see: Susanne Mrozik, Virtuous
Bodies: The Physical Dimensions of Morality in Buddhist Ethics (New York: Oxford University Press,
2007); Noa Ronkin, Early Buddhist Metaphysics: The Making of a Philosophical Tradition (London:
Routledge Curzon, 2005); and, Alexander von Rospatt, The Buddhist Doctrine of Momentariness: A
Survey of the Origins and Early Phase of this Doctrine up to Vasubandhu (Stuttgart: F. Steiner Verlag,
1995).
235
For more on the Abhidharma in Tibet see: Robert Kritzer, Rebirth and Causation in Yogācāra
Abhidharma (Wien: Arbeitskreis für Tibetische und Buddhistische Studien, 1999); John Powers, The
Yogācāra School of Buddhism: A Bibliography (Metuchen, N.J.: Scarecrow Press, 1991); and Tsong kha
pa blo bzang grags pa, Ocean of Eloquence: Tsong Kha Pa’s Commentary on the Yogācāra Doctrine of
Mind, trans., Gareth Sparham and Shotaro Iida (Albany: State University of New York Press, 1993).
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of the aggregates as constituent parts of human beings, as well as the three dynamics and the
elements, is normative.
According to the Tibetan Buddhist tradition, there are five psychosomatic aggregates that
make up the human being, or more accurately, the false sense of ‘ego’ or ‘I’ that is said to be an
illusion. These aggregates are 1) “form” (gzugs; Skt. rūpa); 2) “feeling” (tshor ba; Skt. vedanā);
3) “perception” (‘du shes; Skt. saṃjñā); 4) “compositional factors” (‘du byed; Skt. saṃskāra),
and; 5) “consciousness” (rnam shes; Skt. vijñāna). 236 Together, these aggregates constitute the
entirety of the physical, mental and emotional parts of human embodiment. Therefore, these
parts are said to constitute experience itself. Accordingly, the experience of our body, feelings,
and thoughts, appears to us as an unitary and coherent ‘self’ or ‘I’ when in reality it is only an
illusory notion. The erroneous belief in our ‘self’ causes us much suffering. When one thinks of
themselves as unique and separate from others, the thoughts give rise to human problems such as
greed, jealousy, hatred, and anger. In Buddhist terms, this false ego is both produced by and is
the cause for ignorance, the first of the ‘three poisons’ 237 that cause an individual to suffer
continuously throughout their successive lifetimes. A part of Buddhist enlightenment is the
realization that this so-called self is “empty” (stong nyid; Skt. śūnyata), meaning impermanent,
changeable, transitory, and made up of parts.
Thupten Püntsok’s description of the body tells us that these aggregates are made up of
two kinds of “material elements” (khams). Khams is a wide-ranging term imbued with a host of
social, religious and medical meanings in Tibetan culture. Interpreting how the term khams is
being used often depends on the context. Generally speaking, khams can refer to region, realm,
land or domain. It can also refer to ideas similar to the English, ‘element,’ insofar as being
something that is “material” (ngo bo) that is found in, or makes up the nature and characteristics
of the external world and the body. In Tibetan medical and Buddhist cosmological thought, the
five “external elements” (phyi khams) of wind, water, fire, earth and space exists in or make up
the “inner elements” (nang khams) of the body. Khams can also refer to the “attributes” of
236
237
Jeffrey Hopkins, Meditation on Emptiness (London: Wisdom Publications, 1983), 271.
The “three poisons” (dug gsum) and their relation to the “dynamics” (nyes pa) will discussed
further in this chapter.
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human existence, our nature, character, abilities and propensities, as described in Abhidharmic
literature. In Buddhist Mahāyāna and Tantric philosophy, this understanding of khams extends to
one’s inherent “buddha nature” (de bzhin gshegs pa’i snying po; Skt. tathāgatagarbha).
In medicine, khams can refer to one’s state of health, to the body itself, or to its parts or
constituents. In medical literature concerning human reproduction, khams signifies the two,
“white and red elements” (khams dkar dmar), effectively the ‘white’ semen of the male and the
‘red’ menstrual blood of the female which result from the process of digestion. Thupten Püntsok
speaks to several of these meanings in his fifth chapter on the characteristics of the body, and in
the subsequent chapters describing his vision of a harmonized Tantric-medical body of winds,
channels and drops. Throughout our exploration of contemporary medical sources on women, it
is this last meaning of khams that is most prevalent, particularly in relation to Tibetan notions of
“hormones”.
In Thupten Püntsok’s description of the Tibetan medical body, his first usage of khams
refers to the “material elements of the body’s constituents” (lus zungs kyi khams). This
understanding of khams denotes the process of digestion and the making of the “seven bodily
constituents” (lus zungs bdun). The digestive process and its relation to menstruation and
conception are central in all of my sources that speak about hormones. The details of their
interrelation takes up a considerable part of the medical debates concerning biomedicine and
women’s bodies. I will introduce the topic of digestion here by way of Thupten Püntsok’s
summary of the Tibetan medical perspective.
According to Thupten Püntsok’s presentation of Tibetan medical thought, the body
consists in “seven bodily constituents” that are initially produced through the consumption of
“food and drink” (kha zas). In order of their emergence, these seven constituents are: “essence”
or “nutrition” of the food and drink (dwangs ma and sometimes bcud), “blood” (khrag), “flesh”
or “meat” (sha), 238 “fat” (tshil bu), “bone” (rus pa), “marrow” (rkang mar) and “reproductive
238
Sha can be difficult to translate since this term can have one of several meanings such as “flesh,”
“meat” or “muscle.” A similar problem in exists Greek medicine surrounding the notion of ‘muscle.’ For
example, see Shigehisa Kuriyama, The Expressiveness of the Body and the Divergence of Greek and
Chinese Medicine, (New York: Zone Books, 1999).
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fluid” (khu ba). In this system, it takes seven days for the essence of consumed food and drink to
be digested, becoming on the second day blood, on the third day, flesh, and so on.
During the process of digestion, the “refuse” (snyigs ma) is separated from the essence.
The refuse refers to waste products expelled from the body such as urine, feces, sweat, and
mucus. The “essence” (dwangs ma) is that which moves to become the following bodily
constituent, wherein again, through the digestive processes of the body, specifically the body’s
“heats” (me drod), the refuse is separated out, leaving the essence. For example, the refuse of the
first bodily constituent, consumed foods and drink (or other comestibles), is feces and urine. The
essence of the essence of consumed foods is that nutrition which, having been absorbed by the
body, becomes blood. In this way, stage by stage, the seven bodily constituents are made. Many
intricate processes are involved in this, including the workings of the three dynamics, four (or
five) elements, environment, season, diet, and one’s life situation.
The reproductive fluid, considered to be the most refined of the bodily constituents, is the
seventh bodily constituent. It is divided into the “white element” (khams dkar) and the “red
element” (khams dmar). These elements are normally considered to be present in both men and
women but function differently in male and female bodies. (Tibetan medical students explained
to me that there is some debate as to whether men do have the red element, and if so, what would
be its function.) In men, the essence of the white reproductive fluid, and in women, the essence
of the red reproductive fluid, are separated further into essence and refuse. Among contemporary
writers, the refuse of the reproductive fluid in women is generally agreed to be menstrual blood.
In both men and women, the essence of the essence of the reproductive fluids, the seventh bodily
constituent, becomes the “quintessence” (mdangs). In some of the more Tibetan medico-Tantric
envisioned anatomies (like Thupten Püntsok’s), the essence of the essence of the reproductive
fluids becomes the “drops” (thig le) that reside in the central channel of the vajra body. As we
shall see in the present-day medical works, many authors assert that the “quintessences,” which
are produced from nutrition, can be understood as substances similar to, or the same as,
biomedically understood “hormones.”
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The second kind of khams that Thupten Püntsok identifies are the “material elements of
the three dynamics” (nyes pa khams). As a Buddhist term, the “faults” or “blemishes” (nyes pa)
refer to the three mental and emotional afflictions, also known in Buddhism as the “three
poisons” (dug gsum; Skt. triviṣa) of “desire/ passion/ greed” (‘dod chags; Skt. rāga), “anger/
aggression/ hatred” (zhe sdang; Skt. dveṣa), and “ignorance/ confusion/ delusion” (gti mug; Skt.
moha). In Tibetan medical thought, these three afflictions become materially embodied as the
“three dynamics” (nyes pa gsum; Skt. doṣa) of wind (rlung; Skt. vāta), bile (mkhris pa; Skt.
pitta) and phlegm (bad kan; Skt. kapha) respectively.239 It should be noted that the English
translations of wind, bile and phlegm, do not adequately correspond to their Tibetan meanings.
The three dynamics are “the basic principles of Tibetan medical physiology that are embedded
within the larger cosmology of the five elements which considers these to be water, fire, earth,
wind and space.”240 As such, each dynamic shares in the qualities of the elements. The wind
dynamic is dominated by wind, the bile dynamic is dominated by fire, and the phlegm dynamic
is dominated by earth and water. As such, wind is responsible for the function of movement, bile
moderates the body’s temperature and digests food, and phlegm lubricate joints, forms the soft
tissue and “gives stability” to the whole body.241
Each of the three dynamics has a predominant ‘seat’ in the body. For example, the
predominant seat of wind is the lower body and pelvis, based on its relation to desire. Each of the
three dynamics is further divided into five specific kinds which are related to their function and
location in the body. For example, the five kinds of wind, quoting Thupten Püntsok’s summary
from the fifth chapter, are
239
For a contemporary example see: Rin chen don grub, “Sems byung ’dod chags zhe sdang gti mug
gsum gyis gzugs rlung mkhris bad kan gsum ji ltar bskyed tshul la dpyad pa,” krung go’i bod kyi gso rig 2
(2008): 26–41. The three dynamics are discussed in a number of English sources—See: Terry Clifford,
Tibetan Buddhist Medicine and Psychiatry: The Diamond Healing (Delhi: Motilal Banarsidass, 2001);
Yeshi Dönden and Jeffery Hopkins, Health through Balance: An Introduction to Tibetan Medicine (Ithaca,
NY: Snow Lion Publications, 1986); Yeshi Dönden, and Alan Wallace, Healing from the Source; and,
Tsering Thakoe Drungtso, Tibetan Medicine: The Healing Science of Tibet (Dharamsara, India: Drungtso
Publications, 2004).
240
Barbara Gerke,“On the ‘Subtle Body’ and ‘Circulation’ in Tibetan Medicine,” in Religion and the
Subtle Body in Asia and the West: Between Mind and Body, eds. Geoffrey Samuel and Jay Johnston (New
York: Routledge, 2013), 84.
241
Ibid., 84.
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1) The ‘life-sustaining wind’ which is the root condition that compels the body to be
formed. The root of all the winds, the life-sustaining wind resides at the crown of the head
in the region of the brain. Its pathway for movement is the windpipe and chest. Its function
is to cause the swallowing of food, inhalation and exhalation of breath, expelling of spit,
and sneezing. It clarifies the intellect and consciousness. In terms of the senses, [when the
life-sustaining wind] moves to the eye sense power it causes forms to be clear; [when it]
moves to the ear sense power, sounds are clarified; [when it] moves to the nose, smells are
clarified; [when it] moves to the tongue tastes are clarified, and; [when it] moves to the
body, the experience of feeling tangible objects, etc., is clarified.242
2) The ‘upward-moving wind’ is located is the chest. Its pathways for movement are the
nose, tongue, and throat. Its function is to compel the coming out of sounds and speech, to
increase the strength of the body and give it lustre, to give the skin its complexion, to
generate perseverance and energy, and to clarify the memory.243
3) The ‘all-pervading wind’ is located at the heart. Its pathways for movement are the
inner, outer, upper and lower parts of the entire body. Its function is to lift and move the
legs, straighten and bend the limbs, opening and closing the [body’s] orifices. Any
movement of the body is primarily dependent upon this wind. 244
4) The ‘fire-accompanying wind’ is located in the stomach, and more specifically, in the
large intestine… The pathway for its movement is through all of the internal organs, such
as the small intestines. Its function is to digest food, separate the essence and the refuse,
and mature the bodily constituents. 245
5) The ‘downward expelling wind’ is located in the pelvis. The pathways for its movement
are the large intestine, bladder, genitals and the inner thighs. Its function is to control the
emission and retention of men and women’s reproductive fluids at the climactic moment of
242 lus chags par byed pa’i rkyen gyi gtso bo / rlung thams cad kyi rtsa ba srog ‘dzin gyi rlung de’i
gnas sa’i yul spyi bo klad pa’i cha / rgyu ba’i lam gre ba dang brang gzhung / byed las ni zas skom mid
pa dang / dbugs ‘byin rngub byed pa dang / mchil ma ‘dor ba / sbrid pa ‘byin pa / blo ste shes pa gsal bar
byed pa dang / dbang po ste mig gi dbang po la rgyu ste gzugs gsal bar byed pa dang / de bzhin du rna ba
la rgyu nas sgra gsal bar byed pa / sna dbang la rgyu nas dri gsal bar byed pa / lce dbang la rgyu nas ro
gsal bar byed pa / lus dbang la rgyu nas reg bya la sogs pa’i tshor ba mtha’ dag gsal bar byed cing yod
pa red, Thub bstan phun tshogs, Gso bya lus kyi rnam bshad, 70–1.
243
gyen rgyu rlung gi gnas sa’i yul brang / rgyu ba’i lam ni sna dang / lce / lkog ma byed pa’i las ni
smra ba’i sgra tshig ‘byin pa / lus kyi stobs rgyas zhing mdangs gsal ba / pags pa’i kha dog ‘byin pa /
snying stobs dang ‘bad rtsol skyed pa / sems kyi dran pa gsal bar byed pa bcas so, ibid., 71.
244
khyab byed kyi rlung gi gnas sa’i yul snying / rgyu ba’i lam lus kyi stod smad phyi nang ma lus pa’i
cha thams cad / byed pa’i las ni rkang pa ‘degs ‘jog dang / yan lag brkyang bskum / bu ga ‘byed ‘dzum
byed pa sogs lus kyi g.yo ‘gul gyi bya ba phal cher rlung ‘di nyid la rags las pa yin, ibid., 71.
245
me mnyam rlung gi gnas sa’i yul pho ba ste bye brag long kha /… / rgyu ba’i lam rgyu ma la sogs
pa’i nang khrol thams cad / byed las ni kha zas rnams ‘ju zhing dwangs snyigs ‘byed pa dang / lus zungs
rnams smin par byed pa yin, ibid., 71–2.
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blissful love-making. [It also retains and emits] menstrual fluids, feces, urine, and the
fetus. 246
As one can see from this summary, the wind dynamic, like bile and phlegm, is involved in a wide
range of bodily activities. Like all of the dynamics, wind has a predominant seat, but also
concentrates in other locations, and ultimately pervades the entire body. It is for these reasons
that in the contemporary sources, the winds are what move the “hormones” allowing them to
pervade the entire body, as well as to have a key role in many of the bodily processes.
2.4 The Body’s System of Channels: The Movers
Moving from the fifth chapter which outlined digestion, the seven bodily constituents and
the three dynamics, Thupten Püntsok’s sixth chapter, “Explanation of the System of Establishing
the Body’s Channels”247 maps a human body using Tibetan medical and Buddhist thought, which
in the end, is compared with and confirmed by biomedical ideas. Thupten Püntsok’s presentation
of the Tibetan medico-Buddhist body is immensely sophisticated, and cannot be easily
summarized, and here I will focus mostly on notions surrounding “hormones.” In this section, I
begin with the end by presenting Thupten Püntsok’s concluding remarks on the possible relation
between the Tibetan Tantric-medico body and biomedical hormones. Afterwards, tracing his
conclusion backwards, I focus on a number of key terms from the sixth and seventh chapters
which feature prominently in contemporary medical literature on hormones.
In his concluding summary of the medical and Tantric understandings of the winds,
channels and drops described in his sixth and seventh chapters, Thupten Püntsok briefly suggests
that the seed syllables located at the “locations of the life-force” (bla gnas) within the body’s
circuits of channels might be the “glands” (rmen bu) that transmit the “hormones” (ho’o mo’u) of
Western medicine. He writes:
246
thur sel gyi rlung gi gnas sa’i yul gzhang / rgyu ba’i lam long dang / lgang pa / gsang gnas / brla’i
nang bcas so / byed las ni ‘khrig pa’i bde ba rtser son pa’i skabs su ‘byung ba’i pho mo’i khu ba dang /
mngal khrag / bshang ba dang / gcin pa / mngal nang / gi bu la sogs pa rnams ‘byin sdom byed cing yod
pa red, ibid., 73.
247
lus kyi rtsa’i gnas lugs skor bshad pa, ibid., 80.
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The statements made in texts such as Ancestral Advice and so forth, which indicate the
“location of the daily migration” (bla gnas) of the “life-force” (bla) and where it takes the
form of such syllables as the Ah and Ee in each of the individual channels, should be
examined in detail in order to determine whether the meaning of these is “channel” (rtsa)
or “gland” (rmen bu). If we examine carefully the nature of the relationship between this
and “Hormones,”248 which are taught in relation to glands in the Western system of
medicine, I think beneficial fruits will naturally emerge249
There are a number of things to explain in order to understand Thupten Püntsok’s claim that the
seed syllables at the bla gnas, or even possibly the cakras of the central channel of the vajra
body, could be considered equivalent to the endocrinological glands of biomedicine. First, I will
briefly explain the Tibetan idea of the “life-force” (bla) and following this, examine the term
Thupten Püntsok uses for “gland,” rmen bu. Afterwards I will look at Thupten Püntsok’s sixth
chapter which focuses on the “channels” (rtsa).
The so-called “life-force” (bla) ought to be understood in relation to two other key terms
that describe ‘life,’ namely, the “life-length” (tshe) and the “life-energy” (srog). Although they
each function slightly differently, together, the so-called “trinity of life” (tshe srog bla gsum) are
considered the necessary supports for life to exist. A common Tibetan way of explaining these is
through the metaphor of a lamp. The life-length is like the lamp’s oil in that it underpins the
length of one’s life. The life-force is said to be like the wick insofar as providing the physical
mechanisms and conditions necessary for life. The life-energy is said to be like the flame,
meaning that it is the spark that initiates and maintains the potential for life to exist.250 According
to Gerke,
Srog is life itself. It indicates the key vitality of a person… Its decline leads to a loss of
tshe; its loss leads to death… Bla in the astrological and medical contexts is a subtle life-
248
Note that in the original, Thupten Püntsok first gives the English to Tibetan transliteration, ho’o
mo’u, followed by the English word, “Hormones” in brackets.
249
‘dir nyin re bzhin bla gnas ‘pho ba’i yul rtsa’i gnas so sor yi ge Aa dang Ai sogs kyi dbyibs su yod
pa mes po’i shal lung sogs su gsungs pa ‘di dag don du rtsa’m rmen bu gang yin zhib tu dpyad dgos pa
zhig dang /‘di dang nub phyogs pa’i gso rig lugs kyi rmen bu la brten nas ‘babs pa’i ho’o mo’u
(Hormone) zhes pa de gnyis ‘brel ba gang yod legs par brtag na rang gzhan gnyis ka la phan pa’i ‘bras
bu zhig ‘byung bar sems, ibid., 125.
250
Barbara Gerke, Long Lives and Untimely Deaths: Life-Span Concepts and Longevity Practices
among Tibetans in the Darjeeling Hills, India (New York: Brill, 2012), 8.
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essence that supports srog… Bla can be lost through shocks and accidents or stolen by
demons… The loss of bla weakens srog and if untreated cuts short tshe.251
There is a constellation of Buddhist, medical and popular ideas about bla that are related, but
should not be necessarily conflated into any single understanding.
In Tibetan medicine, the life-force, bla, is postulated as travelling around the body
according to daily, monthly, seasonal, and yearly patterns, which are predicated on the lunar
cycle. The locations of to where the life-force migrates are known as “places of the lifeforce” (bla gnas). In men, the life-force travels from the toe on the right side of the body, to the
crown of the head, and then down the left side of the body. This travel direction is the reverse in
women. Tibetan medical scholars sometimes disagree on whether or not this sex-opposite
dualism is really the case in material bodies (as opposed to the vajra body) since women’s and
men’s pulses are often read on opposite wrists due to the differently sexed cycles of life-force.
Because a sudden shock or accident can cause life-force to be lost, this sex-opposite dualism
provides Tibetan doctors the means to determine the life-force’s migration and place in the body.
It is also noted that Tibetan doctors will not perform surgery over the bla gnas when the bla is
present.252
According to Gerke, both Ancestral Advice and the Blue Beryl state that the medical
understandings of the bla gnas are “certainly in conformity with the principal meanings
elucidated in the Kālacakratantra.” 253 In both texts, thirty points of the bla gnas are identified on
a temporal map of the body. As we saw in Thupten Püntsok, at each of these points of bla gnas, a
seed syllable arises and the bla “takes the form of such syllables as the Ah and Ee.” These
syllables are postulated as possibly drawing from Hindu numerology and systems of classifying
time. In the Kālacakra Tantra, the syllables are also associated with different locations and
characteristics of the body, but they are also located at the cakras of the channels of the Tantric
body.254
251
Ibid., 7–8.
252
Ibid., 137–147.
253
Ibid., 143.
254
Ibid 143–4.
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By the seventeenth-century, Tibetan medical painters illustrated the blas gnas together
with the three channels and five cakras of the Tantric tradition. These paintings show that during
the waxing moon the bla moves in the right side of men and the in left side of women, and
during the waning moon the bla moves in the left side of men and in the right side of women.
Gerke writes that according to the Blue Beryl, the reason for “the female cycle moving from right
to left, and the male from left to right is that masculinity is represented by the left white channel
(rkyang ma), and femininity by the right, red channel (ro ma).”255 This idea is present in Thupten
Püntsok’s explanation of the bla and its daily migration through the body.
The term for “gland,” rmen bu (and a related new term, gsher rmen which will be
discussed in relation to Mingji Cuomu’s work) appears in a number of contemporary ChineseTibetan medical sources on women’s bodies as equivalent to the “glands” of the biomedical
endocrine system. Yet, in wider Tibetan medical literature, including English translations and
writings of Tibetan medicine, the rmen bu (Skt. granthi) can also be found to refer to cysts,
ulcers, swellings, tumours, and most commonly, the lymph nodes of the lymphatic system. The
sixty-seventh chapter of the Four Treatises, “Treating the rmen bu” (rmen bu bcos pa), is
devoted to treating disorders of the rmen bu. It reads that by “having powerful causes and
conditions [disorders of the rmen bu results] in pain and disturbs wind and blood, and there is a
swelling in the rmen bu.”256 It further lists some of the locations of these rmen bu, such as at the
“centre of the neck” (ske mjing) and the “corners of the eyes” (mig zur) but indicates that they
are throughout the body. There are eight kinds of disorders of the rmen bu which point to a
variety of symptoms and locations in and parts of the body.257 There are disorders of the “fatty
tissue” (tshil rmen), “muscle tissue” (sha rmen) and “veins” (rtsa rmen). Other rmen bu disorders
affect the three dynamics: “wind”(rlung rmen), “bile” (mkhris rmen) and “phlegm” (bad kan
255
Ibid., 139. Also see: Yuri Parfionovich, Fernand Meyer, and Gyurme Dorje, eds., Tibetan Medical
Paintings: Illustrations to the Blue Beryl Treatise of Sangye Gyamtso (1653-1705) (New York: H.N.
Abrams, 1992), 39–40.
256
rgyu rkyen drag shul rkyen gyis ‘grams pa ‘am // rlung khrag ‘khrugs pa rmen bu la brten skrangs,
G.yu thog yon tan mgon po, Dud rtsi snying po, 356.
257
Ibid., 356.
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rmen bu). The other two disorders of the rmen bu are the “blood” (khrag rmen) and “tumour” or
“cancer” (‘bras rmen).258
Many contemporary Tibetan-English sources identify the rmen bu as being the lymphatic
glands or nodes and their disorders. Barry Clark defines rmen bu in the Four Treatises as
“lymph-caused cancer-like tumors in the form of lumps and swellings in the glands.”259 Gavin
Kilty translates rmen bu in Sangyé Gyatso’s Mirror of Beryl as “lymph caused tumors and
glandular swellings.”260 The contemporary Indian-exile Tibetan doctor and scholar, Yeshi
Donden translates rmen bu as “cyst,” “subcutaneous nodule,” “lipoma,” and “nodule mass.” 261
Similarly, Christa Kletter and Monika Kriechbaum define rmen bu’i nad as disorders of the
lymph nodes. They write, “according to the medical texts, the lymph nodes develop from blood,
muscle tissue and fatty tissue. The nodes are lumpy and oval in shape. They are located near the
ears and around the neck and in other parts of the body such as the armpits and groin.”262 In
similar fashion, the Tibetan-English dictionary of Tibetan medicine and astrology by Tsering
Thakchoe Drungtso and Tsering Dolma Drungsto translates the rmen bu as a “lymph node” and
“nodule mass.” These two authors translate rmen bu’i nad as “lymphadenopathy” which is “a
disease which affects the lymph nodes and is characterized by swelling of the lymph nodes. It
generally occurs near the ears, in the neck, armpits and groin.” They also list and describe each
of the “eight kinds of lymph disorders,” as outlined in the Four Treatises. Their final entry for
rmen is rmen bu’i rman bzhag, which they translate as “the endocrine system.”263 Lastly, The
New Tibetan-English Dictionary of Modern Tibetan, edited by Melvyn Goldstein defines rmen
258
Tsering Thakchoe Drungtso and Tsering Dolma Drungtso, Tibetan-English Dictionary of Tibetan
Medicine and Astrology (Dharamsala: Drungtso Publications, 2005), 344–5
259
Barry Clark, trans. The Quintessence Tantras of Tibetan Medicine (Ithaca, N.Y., USA: Snow Lion
Publications, 1995), 29.
260 Sangs rgyas rgya mtsho, Mirror of Beryl: A Historical Introduction to Tibetan Medicine, trans.
Gavin Kilty (Boston: Wisdom Publications, 2010), 569.
261
Yeshi Dönden and Alan Wallace, Healing from the Source, 154, 194, 202.
262
Christa Kletter and Monika Kriechbaum, eds. Tibetan Medicinal Plants (CRC Press, 2001), 360–1.
263
Drungtso and Drungtso, Tibetan-English Dictionary of Tibetan Medicine and Astrology, 344–5.
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bu simply as “lymph nodes.”264 Other interpretations, not related to the modern biomedical idea
of the lymphatic system appear as well. For example, according to Garrett, among children’s
disorders, rmen bu’i nad refers to “skin ulcers.”265 The Encyclopedia of Tibetan Medicine edited
by Vaidya Bhagwan Dash translates the sixty-seventh chapter of the Four Treatises as the
“treatment of tumours.”266 In this chapter, both Thupten Püntsok and Mingji Cuomu use rmen bu
to refer specifically to biomedical ideas. Thupten Püntsok uses rmen bu to refer to what in
English biomedical thought is considered “nodes,” as understood as the “nodes of the lymphatic
system” (chu ser rgyu lam gyi rmen bu) 267 as well as “glands,” as in the “system of glands that
moves hormones” (ho’o mo’u (mdangs) rgyu ba’i rmen bu’i rigs), or more simply, the
“endocrine system.”268 Hence, in the present-day Tibetan sources, rmen bu is used as a more
wide-ranging term than what are considered their biomedical equivalents.
The variety of meanings given to the Tibetan notion of the rmen bu in the above
examples makes it clear that this term has flexible connotations within its various contemporary
interpretations. Hence, Thupten Püntsok’s quote at the beginning of this section is essentially
asking whether or not the “places where the life-force travels” (blas gnas) ought to be
understood as “channels” (rtsa) or “glands” (rmen bu) in relation to biomedical understandings
of the pathways that move “hormones.” Similarly to biomedical endocrinology, the key to
understanding hormones in the Tibetan system, according to Thupten Püntsok, is researching
how substances move through ‘channels’ and how they perform their function through ‘glands,’
which are body parts that receive, transform and produce other substances that have their effects
264
Melvyn C. Goldstein, T. N. Shelling and J. T. Surkhang, eds. The New Tibetan-English Dictionary
of Modern Tibetan (Berkeley: University of California Press, 2001), 835.
265 Frances Garrett, “‘What Children Need’: Making Childhood with Technologies of Protection and
Healing,” in Little Buddhas: Children and Childhoods in Buddhist Texts and Traditions, ed., Vanessa R.
Sasson (New York: Oxford University Press, 2013), 205.
266
Dash, Bhagwan, Encyclopaedia of Tibetan Medicine: Being the Tibetan Text of Rgyud Bzhi and
Sanskrit Restoration of Amr̥ ta Hr̥ daya Aṣtāṅga Guhyopadeśa Tantra and Expository Translation in
English. Vol. 1. (Delhi, India: Sri Satguru Publications, 1994), 104.
267
Thub bstan phun tshogs, Gso bya lus kyi rnam bshad, 145.
268
Ibid., 146.
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in the body. This question is better understood in Thupten Püntsok’s sixth chapter containing his
account of the channels in the Tibetan medical and Tantric systems.
Thupten Püntsok’s sixth chapter, “Explanation of the System of Establishing the Body’s
Channels” is structured around various understandings of rtsa, a multivalent and allusive term
variously translated into English as “channel,” “pulse,” “vein,” “artery” and “nerve.”269 Thupten
Püntsok states that the various kinds of rtsa arise in the body and become the support which
“moves” or “circulates” 270 (rgyu) wind, blood, and other motile substances. Thupten Püntsok’s
introductory paragraph on rtsa begins with the following passage from the Explanatory Treatise:
“That which reveals the fundamental nature of the ‘channels of connection’ are the four:
‘channels of formation,’ ‘channels of existence,’ ‘channels of connections,’ and the ‘vitality
channel.’” 271 Further, the types of channels of the human body can also be divided into the two,
“blood channels” (khrag rtsa) and “white” or “water channels” (rtsa dkar ram chu rtsa). Thupten
Püntsok then writes that blood channels can be further divided into: “‘phar rtsa (artery) and sdod
rtsa (vein).”272 Here, Thupten Püntsok’s correlation between the blood channels of Tibetan
medicine and the arteries and veins of biomedicine is common enough in the contemporary
sources. Although, he does little to further unpack the English biomedical terms he uses their
presence seems to confirm, empirically at least, the Tibetan system of rtsa.
269 Several notable works have looked specifically at rtsa. See: Garrett and Adams, “The Three
Channels in Tibetan Medicine,” 86–114; Gerke, “On the ‘Subtle Body’ and ‘Circulation’ in Tibetan
Medicine;” Geoffrey Samuel, “The Subtle Body in India and Beyond,” in Religion and the Subtle Body in
Asia and the West: Between Mind and Body, eds. Geoffrey Samuel and Jay Johnston (London: Routledge,
2013), 33–47; and Zhen Yan, “rTsa in the Tibetan Manuscripts from Dunhuang,” Asian Medicine 3, no. 2
(2007): 296–307.
270
Tibetan medical and Buddhist notions of ‘circulation’ are not necessarily the same as biomedical
understandings and likewise, have changed over time. Barbara Gerke cautions us against imagining the
channels of classical medical literature, especially the ‘connecting channels’ as being a ‘circulatory
channel’ in the same way that biomedicine posits ‘closed circulatory pathways.’ However, Gerke also
motions towards a shift in contemporary understandings of rtsa in Tibetan medicine noting that presentday Dharmasala (India) based Men-Tsee-Khang textbooks include illustrations and explanations of
biomedical notions of blood circulation. (“On the ‘Subtle Body’ and ‘Circulation’ in Tibetan Medicine,”
2013).
271
brel pa rtsa yi gnas lugs bstan pa ni // chags srid ‘brel pa tshe yi rtsa dang bzhi, Thub bstan phun
tshogs, Gso bya lus kyi rnam bshad, 80.
272Ibid.,
80.
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After the introductory paragraph, Thupten Püntsok methodically sets out to explain the
body’s system of channels and dynamics as they develop in the fetus. Embryology in his sixth
chapter is focused on the fetal channels and winds which become the supports for life. This
presentation differs in focus from his earlier presentation in the fourth chapter where he writes
about embryology in terms of the necessary conditions for conception, and the growth of the
fetus’ body in relation to the three dynamics and five winds. In the earlier presentation, which is
based on the “literal meaning of the root words” (rtsa ba’i tshig don ji bzhin)273 of the Four
Treatises and Ancestral Advice, the embryological narrative is more closely aligned with the
‘stages of the path’ literature of both Mahāyāna and Vajrayāna Buddhism,274 resulting in some
‘discrepancies’ among texts and with the evidence of ultrasounds.
In the introductory paragraph, Thupten Püntsok writes that among the “channels of
connection” (brel pa rtsa) that first arise in the fetus, there are four types: “channels of
formation” (chags pa’i rtsa), “channels of existence” (srid yi rtsa), “channels of
connections” (‘brel yi rtsa) and the “vitality channel” (tshe yi rtsa). The first, the “channel of
formation” is the initial support for the “existence wind” (srog rlung) that forms the fetus’s body.
It is also from the channel of formation that the three channels—white (water), blood and wind—
emerge.
According to Thupten Püntsok, the first channel, the “white channel” (rtsa dkar po)
extends upwards, and from it, the brain is formed. The fault of ignorance, dwelling in the brain,
produces phlegm which is predominantly located in the upper body. This channel moves the
“water or moon elements” (chu’am zla ba’i khams) through the direction of the left side of the
body, and gathers at the “wheel centres” (‘khhor lo; chakras) in the central channel at the “heart
opening” (snying kha), throat, and crown of the head. For these reasons, the problems of
delusory thinking, mental heaviness, and depression predominantly arise from the head.
Therefore, as Thupten Püntsok quotes from Ancestral Advice, “from ignorance phlegm is
273
274
Thub bstan phun tshogs, Gso bya lus kyi rnam bshad, 50.
For more on ‘stages of the path’ and the embryological narrative see: Garrett, Religion, Medicine
and the Human Embryo in Tibet, 43–4.
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produced, which is located—with its causes, immediate conditions and effects—in the upper part
of the body.”275
The “blood channel” (khrag rtsa) moves to the middle of the body and forms the “central
life channel” (srog rtsa chags), which is often correlated with the “central channel” (dbu ma;
suṣumnā) of Tantra. Blood is said to be the “substantial cause” (nyer len) and “cooperative
condition” (lhan cig byed rkyen) for anger, and the fault of anger, dwelling in the “life blood
channel” (srog rtsa khrag), produces the bile dynamic.
Thupten Püntsok writes that the “wind channel” (rlung rtsa) descends to the pelvis and,
from it, the genitals are formed. Furthermore, the fault of desire, by residing in the male and
female genitals, produces wind which is located in the lower regions of the body. In this way, the
reproductive fluid is considered the substantial cause and cooperative condition for both desire
and wind. Wind disorders, he writes, are produced by the desire that secretly abides in the
genitals. Therefore, the cause (the reproductive fluid), conditions (the fault of desire) and the
effects, or fruit (wind disorders), are all located in the lower part of the body. 276
Following this explanation of the three channels of formation, Thupten Püntsok then
directly links these to the three channels of Tantric anatomy, the middle (dbu ma), the left (rkang
ma), and the right (ro ma). It is evident that, in his initial explanation of the major channels that
first develop in the fetus, Thupten Püntsok presents a deeply intertwined Buddhist and medical
vision of the human body.
In here, it is not feasible to go through each of the four channels of connection and their
sub-divisions. Instead I will focus on the fourth channel, the vitality channel, because this is
where Thupten Püntsok outlines the relations among digestion, the reproductive fluids, and the
migrations of the life-force which, he suggests, might be related to the biomedically understood
endocrine glands (as we noted in his conclusion).
275
gti mug de las bad kan skyed pas na rgyu rkyen ‘bras bu gsum ka stod na gnas par grub pa yin no,
ibid., 81.
276
Ibid., 80–2.
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Thupten Püntsok begins his discussion of the vitality channel (from the fourth section of
his sixth chapter) with a quote from the Explanatory Treatise:277
The human being has three types of “vitality channels” (tshe yi rtsa).278 One exists
pervading the head and entire body. One moves by accompanying respiration. One is [one
that] wanders [and] is the same as the “life-force” (bla).279
Thupten Püntsok clarifies the meaning of “life-length” (tshe) in the context of tshe yi rtsa, and
writes that in this instance, tshe refers to general expressions of time, such as “the life of
beings” (‘gro ba’i tshe), and “long or short life” (tshe ring thung). In this sense, it means how
long one’s “life-force” (srog) is going to stay (gnas) in the body.
Thupten Püntsok then writes: “Further, the “channel of abiding” (srog gnas pa’i gnas)280
is the three: [1] the essence of the reproductive fluid, the quintessence of the body, [2] the
movement of the breath, and [3] the digestive fire of the body.”281 Because these three are the
basis of embodied life, once they become exhausted through old age or sickness, the person dies.
Hence, the “vitality” or “abiding” channel literally can point to how long one’s life will last.
Thupten Püntsok first explains the body’s “digestive fire” (me drod) and its role in
digestion. Quoting first from the Four Treatises, followed by a passage from the Buddhist
Abhidharma, which reads: “life’s duration is dependant upon digestive heat and the
consciousness,”282 Thupten Püntsok writes:
277
I am grateful to Frances Garrett for sharing her unpublished translation of this section of text.
278
The ‘vitality channel,’ is discussed most recently in Gerke, “On the ‘Subtle Body’ and ‘Circulation’
in Tibetan Medicine,” 92–4.
279 mi la tshe yi rsta ni gsum yod de // gcig ni mgo lus thams cad khyab par gnas // gcig ni dbugs dang
‘grogs nas rgyu ba ste // gcig ni bla dang ‘dra ste ‘khyam pa yin, Thub bstan phun tshogs, Gso bya lus kyi
rnam bshad,101.
280
Note that the “channel of abiding” is synonymous with the “vitality channel,” and both are
considered in many texts correlated to the Tantric “middle channel.”
281
de yang khu ba’i dwangs ma lus kyi mdangs dang / dbugs kyi rgyu ba / lus kyi me drod gsum po ni
srog gnas pa’i rtsa ba yin pa, ibid., 102.
282
102
srog ni tshe yin drod dang ni // rnam shes rten gang yin pa’o, quoting from the Abhidharma, ibid.
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The digestive fire is the main cause for increasing the “quintessence” (mdangs) and power
of the body. When one becomes old, the bodily heat diminishes and the quintessence leaves
[the body]. The main base of the digestive bile is the stomach, but beyond this, [it exists] as
a part of each of the seven bodily constituents, in particular the blood and blood channels.
[Both] the essence and refuse of the bodily constituents are separated, causing the
quintessence to increase, and because this supports the existence of life, it is known as the
‘vitality channel.’ 283
By using both a medical and a Buddhist classic text, Thupten Püntsok points to their shared
understanding of key concepts of the body. Essentially for one’s ‘life to abide,’ its duration
depends on having a consciousness and the ability to digest food and increase one’s
quintessence. Hence, the process of digestion is vitally important in propelling, growing,
sustaining, and diminishing one’s life (srog).
According to the Four Treatises, the second type of vitality channel is one that moves the
breath. Thupten Püntsok writes that this is “known as the wisdom wind, which moves together
with the breath or as the essence of wind.” 284 He supports that assertion with another quote from
Ancestral Advice:
Moreover, karmic wind is explained as that very breath which moves always in the nostrils
from the pathways of the right and left channels. The wisdom wind from the pathway of
the central channel, separates into two parts. One part generates the ability of the internal
“existence wind” (srog rlung), and the other part moves by mixing with the karmic
wind.285
Thupten Püntsok’s citation from Ancestral Advice shows how the life duration of the physical
body, as understood by medicine is interdependent with the very subtle karmic material that
Buddhism envisions as underpinning the consciousness. His account accords with the panBuddhist notion of reincarnation, and in particular the Tibetan notion of a bardo being whose
283
me drod ni lus kyi stobs dang gzi mdangs ‘phel bar byed pa’i rgyu gtso bo yin la / rgas pa’i dus su
lus drod nyams zhing mdangs zad ‘gro zhing yod pa red / me drod de’i rten gtso bo pho ba dang / gzhan
yang lus zungs bdun po so so’i cha dang / khyad par khrag dang lhan du khrag rtsa rnams la brten nas /
lus zungs so so’i dwangs snyigs ‘byed cing / gzi mdangs ‘phel ba dang / tshe srog brten par byed pa’i cha
nas tshe yi rtsa zhes ming btags pa yin no, ibid., 102–3.
284
dbugs dang lhan cig tu rgyu ba’i ye shes kyi rlung ngam / rlung gi dwangs ma de la zer te, ibid.,
103.
285
de yang las kyi rlung ni ro rkyang gi lam nas sna’i sgor rtag tu rgyu ba’i dbugs ‘di nyid la bshad
cing / ye shes kyi rlung ni dbu ma’i lam nas brgyud de /‘di la cha gnyis su phye ba’i gcig gis nang du srog
rlung gi nus pa bskyed cing / gcig ni las kyi rlung dang ‘dres pa’i tshul gyis rgyu ba yin la, ibid., 103.
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stores of very subtle karmic materials influence its rebirth. He also points to the breath as being
the source of life, without which the body perishes. As we have already seen, the “existence
wind” (srog rlung), in both the Tibetan medical and Buddhist traditions is the wind or breath
which is necessary for life.
Thupten Püntsok then goes into some detail outlining the numbers and locations of the
body’s system of channels, concluding that the vitality channel is the structural basis for the lifeforce. He writes: “That very wisdom wind or essence of the wind, which moves with the breath,
by nature of being supported by the channels and forming the basis of life, it is called the vitality
channel.” 286
According to Four Treatises, the third type of vitality channel is “a wanderer that is
similar to the life-force” (gcig ni bla dang ‘dra ste ‘khyams pa yin). Thupten Püntsok describes it
as follows:
The essence of the reproductive fluid produces the strength and quintessence of the body.
That is, it is that kind of material stuff which makes the essence of all the elements, the
bodhicitta element, increase. Also, that very part of the essence of the male and female—
the white and red elements—moves along the pathways of the right and left channels, and
proceeds daily through the upper and lower parts of the body. This is what is called the
body’s life [force] support. Also, in terms of it supporting life, it is called a vitality channel
because it depends on the channels and blood, and is the essence of the elements. 287
The “bodhicitta” element (byang chub kyi sems) is translated into English as the “mind of
enlightenment” or the “altruistic aspiration to enlightenment” and refers to the Mahāyāna
Buddhist bodhisattva ideal of vowing to seek enlightenment for the sake of all sentient beings.
According to Mahāyāna and Tantric Buddhism, although covered over or clouded by the poisons
of ignorance, desire and anger, every sentient being possesses the bodhicitta mind, that is, the
potential to realize enlightenment. In Mahāyāna thought, a central way of uncovering the
286
dbugs dang lhan cig tu rgyu ba’i ye shes kyi rlung ngam rlung gi dwangs ma de nyid rtsa la brten
nas srog brten par byed pa’i cha nas tshe yi rsta zhes ming btags pa yin, ibid., 103.
287
khu ba’i dwangs ma lus kyi stobs dang mdangs byed pa ste / ngo bo ‘byung ba thams cad kyi
dwangs ma khams byang chub kyi sems rgyas ‘gyur gyi rigs de nyid yin / de yang pho mo’i khams dkar
dmar gyi dwangs ma’i cha de nyid ro rkyang gi rtsa lam brgyud nas lus kyi stod smad du nyin re bzhin
‘pho nas ‘gro ba de la lus kyi bla gnas zhes zer / ‘di’ang khams kyi dwangs ma de nyid khrag dang rtsa la
brten nas srog brten par byed pa’i cha nas tshe yi rtsa zhes ming btags pa yin no, ibid., 103–4.
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bodhicitta mind is through cultivating compassion and loving-kindness towards all sentient
beings as though they have been one’s own mother. In Tantric Buddhism, the bodhicitta element
is further imagined as a drop (thig le) made up of the quintessence of the essences of the white
and red elements residing in the central channel of the vajra body. Before Thupten Püntsok
presents his understanding of the Tantric notion of the drops, he outlines the daily migration of
the life-force.
In his explanation of the daily migration of the life-force, Thupten Püntsok points to how
various medical and religious texts and genres have different emphasis and interests in their
treatment of life-force but that they are mutually supportive and do not contradict one another.
He writes:
If you ask about the locations where [the life-force] migrates, there are many systems of
explanation. There are those that belong to the Tantra class, such as the Kalachakra, as
well as the treasure traditions’ system, Zurkhar’s system, 288 astrological systems, and so
forth… [Generally], the bodhicatta element of the man starts on the left side, because it is
compelled by the power of the left channel. The bodhicitta of the woman starts on the right
side because it is compelled by the left channel.289
Interestingly, throughout these Buddhist and medical systems, symbolic gendered dualisms are
maintained and used as an example of the fundamental (Buddhist) unity among Tibet’s
knowledge traditions. Like many of his contemporaries, Thupten Püntsok maintains the Tibetan
Buddhist system of ordering universal principles through the use of gendered pairs. Even when
adherence to a gendered pairings can be difficult to show empirically, they are often sustained in
the medical literature, as was shown in the case of embryology in the fourth chapter. This would
demonstrate that in works like Thupten Püntsok’s, Buddhism is not being effaced from Tibetan
medical thought.
288
289
Here, Thupten Püntsok is referring to Zurkar Lodrö Gyalpo’. See fn 191.
gnas gang du ‘pho zhe na / ‘di la dus ‘khor la sogs rgyud sde’i lugs dang / gter ma’i lugs dang / zur
mkhar b’i lugs dang / gtsug lag rtsi kyi lugs sogs mang du yod pa las /… / skyes pa’i khams byang chub
kyi sems ni rkyang ma’i dbang las ‘byung ba’i phyir g.yon phyogs dang / bud med kyi byang sems ni ro
ma’i dbang gis ‘byung ba’i phyir na g.was phyogs nas thog ma rtsom pa yin gyi, ibid., 105.
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Thupten Püntsok concludes his explanation of the daily migration of the life-force in the
body’s system of channels, making a somewhat bold, but well-travelled claim that the three
vitality channels are the same as the three Tantric channels:
Therefore, if we identify the vitality channels as the three—the body’s digestive heat,
wisdom wind, and the essence of the elements—then these are the same characteristics as
those of the three vitality channels that are taught in the Tantras, and according to the real
situation of embodiment. 290
It is important for Thupten Püntsok to show that Tibet’s medical model is in keeping with its
religious model of the body, both being based on the “real situation of embodiment” (lus kyi gnas
lugs). Despite the fact that the relation between the medical and Buddhist descriptions of the
body’s system of channels have been controversial and debated in Tibetan history,291 for him,
like other contemporary writers, maintaining the authority of the Tantras is an important part of
the pressent-day medical tradition.
The final section of the sixth chapter on the body’s system of channels turns on “channels
of the meditative system according to the Secret Tantras of [Nāropa’s] Six Yogas” 292 which refers
to exemplary Buddhist Tantric practices that seek to cultivate realized enlightenment in a single
life time. The Indian Buddhist “Great Adept” (Grub thob chen po; Mahāsiddha), Nāropa (Na ro
pa; 1016-1100) is one of the most important figures of the Indian (and later Tibetan, especially
Kagyu) Buddhist world. As a Great Adept, that is, one who has accomplished the siddhis (dngos
grub) or “powers” born from advanced meditative techniques that manipulate the subtle body,
Nāropa’s teachings on the nature of human embodiment are authoritative in Buddhist Tibet. One
of his most famous works outlining these practices is the Six Yogas of Nāropa.293 Thupten
290 de ltar lus kyi me drod dang / ye shes kyi rlung / khams kyi dwangs ma gsum po la tshe yi rtsa zhes
ngos ‘dzin byas na rgyud du bstan pa’i tshe’i rtsa gsum po’i so so’i khyad chos dang mthun la / lus kyi
gnas lugs dang yang mthun pa zhig red, ibid., 105.
291
See for example: Garrett and Adams, “The Three Channels in Tibetan Medicine” 86–114.
292
sgom lugs kyi rtsa zhes pa chos drug la sogs gsang sngags kyi rgyud, Thub bstan phun tshogs, Gso
bya lus kyi rnam bshad, 106.
293
NA ro pa and Tai lo pa, “Chos drug gi man ngag” In Bstan ’gyur (dpe bsdur ma), trans. Chos kyi
blo gros (Beijing: Krung go’i bod rig pa’i dpe skrun khang, 1994), 26:1725–29.
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Püntsok references that work both here and again in the seventh chapter where he explains the
drops and their relation to the channels and winds.
The last section of the sixth chapter on the body’s system of channels is Thupten
Püntsok’s summary of the Tantric body as described by Nāropa. Thupten Püntsok has also
imported into this chapter several several ideas and terms that speak to Tibetan notions of
“hormones” both by himself and his contemporaries. Indeed, making sense of the Tibetan Tantric
body is key to understanding the central debates surrounding the incorporation of biomedical
notions of hormones. The main reason for this, I argue, is that Tantras lend not only cultural
authority, but also are a rich resource to think about and to speak of hormones in relation to male
and female bodies.
Thupten Püntsok elucidates Nāropa’s and other Tantric meditative systems starting with
the three channels of the vajra body and their relation to male and female bodies according to
medicine. These relationships may be summarized as follows. The “left channel” (rkyang ma) is
described as white coloured, residing on the left side of the body, and facing downwards. The
“right channel” (ro ma) is described as being red in colour, residing on the right side of the body,
and facing upwards. The “central channel” (dbu ma) runs through the middle of the body at the
locations of the cakras. The upper tips of both the right and left channels are connected to the
two nostrils, and in their form of bending upwards, they become the two “brain nail” (klad pa’i
gzer) channels.294 Bending downwards, the right and left channels “spiral” (lu gu rgyud) at the
six cakras, first at the armpits and breasts before shifting forwards to above the kidneys, the
“mouth of the central channel” (dbu ma’i kha) and proceeding downwards, ending at the bottom
tip of the central channel. The distance between the top of the head and the genitals is thirteen
“units of measurements” (rang sor) roughly the width of one’s fingers. 295 At the two channels’
lower tips, their “extension” (nar ba), in both males and females allows urine to pass. In women,
at the tip of the right channel there is an extension, and because of this once the elements become
294
This term, “brain nail” (klad pa’i gzer) comes up again in other sources where it is more explicitly
tied to the pituitary gland of biomedicine, although here Thupten Püntsok is describing Tantric anatomy.
295
Ives Waldo, s.v. “rang sor.” We shall see this measurement of thirteen rang sor again in
Gönpokyap’s article.
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fully “ripened” or “completed” (rdzogs), menstruation occurs, glossed here in Tantric language
as the “monthly moon falling as the sun” (zla ba re la nyi ma ‘bab).296
Making extensive use of Ancestral Advice, Thupten Püntsok also describes how the right
and left channels are identified with the black (blood) and white (water) channels mentioned
earlier in discussion of the dynamics, and that these are organized along gender lines. The
primary ‘dwellers’ that move inside of the white/left and black/right channels are respectively,
the male and the female, white and red elements. Further, he writes, the black life channel
generates all the major and minor blood channels of the body, “like the trunk of a tree.”297 From
the left channel’s upper tip, the brain is formed generating all the white channels in the body.
This basic outline of the meditative body shows a sex-differentiated vision of the human body
that, for Thupten Püntsok, is reflected at both the subtle Tantric level, and also the grosser levels
of the body that principally concern medicine.
Thupten Püntsok augments his description of the three medico-Tantric channels by
detailing how such an anatomy functions during Buddhist meditation. Near the end of this
section, summarizing his view of the meditating subtle body, he states that the central channel of
medicine and Tantra is the place where the life-wind moves, and that it is known as the channel
wherein the “very essential elements of the winds” 298 move in conjunction with the breath.
Thupten Püntsok then concludes:
Therefore, the so-called ‘central channel’ is called the pulse channel or the red channel of
wind (artery), and; the left channel is called the water channel or white channel (nerve),
and; the right channel is called the blood channel or the black staying channel (vein). 299
Here, Thupten Püntsok directly correlates Tibetan medical, Tantric and English biomedical terms
in a such way so as to say that they are all pointing to the same ‘material thing’ (in the ngo bo
296
Thub bstan phun tshogs, Gso bya lus kyi rnam bshad, 106–7.
297
sdong po lta bu, ibid., 108.
298
rlung gi khams dwangs ma, ibid., 109.
299
des na dbu ma zhes pa ‘phar rtsa’am rlung rtsa dmar po (Artery) de dang / rkyang ma zhes pa chu
rtsa’am rtsa dkar (Nerve) / ro ma’i zhes pa khrag rtsa’am sdod rtsa nag po (Vein) bcas de dag la zer,
ibid., 109.
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sense). He does not unpack the English terminology, but does include biomedical ideas which
both validate Tibetan perspectives of the body and show their place among the world’s ‘standard’
medical traditions.
It is compelling that Thupten Püntsok makes such seamless connections among the
channels of Tibetan medicine, Tantra, and biomedical notions of veins and arteries. Like many
contemporary medical writers from Chinese Tibet, Thupten Püntsok shows that biomedical
knowledge and Tibetan knowledge are equal and potentially compatible, even when each system
understands the body differently. Given the political expediency to ‘modernize’ Tibetan medicine
in China, it is not surprising to witness among my primary sources the trend to view biomedicine
and Tibetan medicine as something that can be successfully integrated together, mainly because
both systems are pointing to the ‘same’ or ‘roughly equivalent’ phenomena in the body. Herein,
we also see signs, similar to the other present-day sources, that effectively demonstrate
biomedicine to be firmly positioned as the authoritative interlocutor with Tibetan medicine.
2.5 The Relationship between the Vajra Body of Winds, Channels,
and Drops and the Medical Body of Hormones and
Reproductive Fluids
In the seventh chapter, “Explanation of the Wind and the Drops,”300 Thupten Püntsok
delves deeper into the Tantric and Tibetan medical ideas of the most subtle parts of the body. He
refers extensively to the Four Treatises and authoritative medical literature in relation to the
“vajra body” (rdo rje lus) according to the system of the “secret Tantras” (gsang sngags), and in
particular, the Six Yogas of Nāropa and Secret Vajra Body. The conclusion to his section on the
drops is where we began in the previous section, that is, where we saw Thupten Püntsok suggest
that Tibetan conceptions of “channels” and “glands,” as well as the migration of the life-force
through the locations of the seed syllables, are comparable to the “hormones” and the endocrine
glands of Western medicine. To understand how Thupten Püntsok comes to this conclusion
requires some discussion of the “drops” (thig le). His seventh chapter is extremely detailed, and
here, I only focus on the parts that most directly relate to hormones.
300
rlung dang thig le’i skor bshad pa, ibid., 113.
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Beginning from the seventh chapter’s second section, entitled, “Explanation of the
Drops”301 Thupten Püntsok writes:
In general, among the so-called channels, winds and drops, the drops are defined as the last
of the seven bodily constituents, the reproductive fluid, of which the “essence” (dwangs
ma) of the two, white and red elements, becomes “quintessence” (mdangs). They are
sometimes called the white part and red part. According to the Explanatory Treatise, “From
the final bodily constituent, reproductive fluid, the most excellent quintessence resides in
the heart and pervades the entire body, and provides the most resplendent radiance for
life.” 302
In this passage, Thupten Püntsok explains the Tibetan medical point of view of the drops,
describing them as the quintessence of the essence of the white and red reproductive fluids. In
other words, the drops are the result of the process of digestion, whereby the refuse, having
continually been expelled, leaves only an entirely (or completely) purified form which moves to
the heart and pervades the entire body.
Following this, Thupten Püntsok provides a Tantric account of the drops and their relation
to the reproductive fluids. He writes:
According to the secret mantras, the drops are essentially divided into two: the “root
unconditioned drop” (spros bral gyi thig le) and the “drop of delusion and
ignorance” (‘khrul pa me rig pa’i thig le), which is further divided into the “antidote
drop” (gnyin po’i thig le). In reality, they are identified as having the potencies and
functions as the quintessence, or the two, white and red parts. Also, according to the Lamp
Illuminating the Practices of the Six Doctrines of Nāropa,303 “first, the unconditioned drop
301
thig le’i skor bshad pa, ibid., 118.
302
spyir rtsa rlung thig le zhes pa’i thig le’i mtshan gzhi ni / lus zungs bdun gyi phyi ma khu ba’iam
khams dkar dmar gnyis kyi dwangs ma’i cha ste mdangs sam / dkar cha dang dmar cha zhes pa de yin
zhing / de yang bshad rgyud las / lus zungs khu ba’i mthar phyin mdangs mchog ste // snying la gnas
kyang lus kun khyab pa dang // tshe gnas gzi mdangs bkrag dang ldan par byed // ces gsungs so, ibid.,
118.
303
Zla ba grags pa (Chanrakirti), “Sgron ma gsal bar byed pa zhes bya ba’i rgya cher bshad pa
(Pradipoddyotana-nama-tika),” in Bstan ’gyur (dpe bsdur ma), trans., Rin chen bzang po (Beijing: Krung
go’i bod rig pa’i dpe skrun khang, 1994), 15:850–1355.
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is the “primordial wisdom” (ye shes) of one’s intrinsic mind. The residing place of this
drop is the life-sustaining wind.” This therefore, is the basis of purification.304
Thupten Püntsok’s explanation of the drops according to the “secret mantras” (gsang sngags)—
another term for Tantra that indicates one of its central methods—points to the notion of
bodhicitta mentioned earlier, that is, that there exists an already realized Buddha-nature inherent
in every sentient being, but that it is covered by our ignorance, desire and anger. According to
Thupten Püntsok, in Tantra, such as that of Nāropa’s, the “primordial wisdom of one’s intrinsic
mind” or one’s “buddha-nature” is imagined as a drop of ultra refined quintessence that is
covered or made impure by the “drop of delusion” which carries within it the “antidote drop.”
The “antidote drop” has the ability to purify the “drop of delusion” in order to restore the
“primordial wisdom” of the “unconditioned drop,” which is, of course, Buddhist realization.305
Significantly, Thupten Püntsok asserts that the drops that reside in the central channel of
the vajra body have the same “potencies and functions” (nus pa dang byed las rnams) of the
“quintessence” (mdangs) of the white and red reproductive fluids that medicine principally
describes. In both the medical and Tantric systems, the quintessence of the reproductive fluids
and the quintessence that resides as a drop in the central channel are related through taking the
form of “white and red parts” (dkar dmar gyi cha). The gendered pairing of the white semen of
the male and the red menstrual blood of the female is a key way for many contemporary writers
who research “hormones” of connecting the Tantric body of literature and thought with the
Tibetan medical one.
Thupten Püntsok continues to explain the function of the drops in relation to the vajra
body. He writes:
The ‘drop of delusion and ignorance’ comes from falling into the confusion of “dualistic
perceptions” (gzung‘dzin gnyis) which arise from not being able to recognize one’s own
‘unconditional drop.’ Within that ‘drop of delusion and ignorance’ are two essences, as
304
gsang sngags kyi rgyud sde rnams las / rtsa ba spros bral gyi thig le / ‘khrul pa ma rig pa’i thig le /
de’i gnyin po’i thig le bcas kyi dbye bar phyes yod kyang don du mdangs sam dkar dmar gyi cha gnyis
po’i nus pa dang byed las rnams la ngos ‘dzin gnang ‘dug ste / chos drug nyams ln gsal ba’i sgron me las
dang po spros bral gyi thig le ni // rang sems lhan cig skyes pa’i ye shes yin la // gnas sa ni srog ‘dzin thig
le // zhes gsungs pa de ni sbyong gzhi yin no, Thub bstan phun tshogs, Gso bya lus kyi rnam bshad, 119
305
Ibid., 119–20.
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well as the refuse of the body, the thirty-six elements. From those, the two essences are the
objects that are to be purified. 306
Here, ‘dualistic perceptions’ refers, in part, to the false perception of self and other, which leads
to the mental, emotional and physical poisons which manifest as afflictions of the body. At the
root of this distorted dual-minded perception of reality is an attachment to a false sense of self or
‘I’ (bdag; ātman) that all methods of Buddhist practice are meant to dispel.
Enlightenment is itself the realization of the non-dual mind and the indivisibility of
existence, in other words, the recognition that the world and self are both “empty” (stong) of a
permanent form. Hence, in Buddhism, the materials of the body and universe are momentary and
in flux. And, in Tantric thought, according to Thupten Püntsok, dualistic thinking distorts our
perceptions of reality, making us unable to recognize that a drop of delusion and ignorance
covers an unconditioned drop.
Thupten Püntsok relates the Buddhist understanding of the drops to the medical body by
telling us that within the drop of delusion and ignorance are the “essences” (dwangs ma),
“refuse” (snyigs ma) and “thirty-six unclean elements” (mi gtsang ba’i khams so drug po). Here,
the thirty-six unclean elements refers to an early Buddhist, as well as Hindu, notion that the
thirty-six elements are the body; that is, the body is inherently dirty and made up of thirty-six
unclean parts—as well as the refuse and essence.307 Among these, the essences are the parts of
the drops that need to be purified.
Next, Thupten Püntsok describes the white and red essences that are the objects to be
purified. He writes:
First, the white part abides as the self-arising seed syllable, Ham at the upper tip of the
central channel at the crown of the head. The red part abides as the self-arising small Ah at
the meeting point of the three channels below the navel. Between these two, the ‘basis for
306
‘khrul pa ma rig pa’i thig le ni / spros bral gyi thig le de rang ngo ma shes nas gzung ‘dzin gnyis
kyi ‘khrul pa shar ba ni ’khrul pa ma rig pa’i thig le ste / de la dwangs ma gnyis dang / zungs kyi snyigs
ma / khams so drug bcas so / de las dwangs ma gnyis ni sbyong bya ste, ibid., 119.
307
For more on the thirty-six unclean elements see: Tsong kha pa blo-bzang grags pa, A Lamp to
Illuminate the Five Stages: Teachings on Guhyasamja Tantra, Trans. Galvin Kilty (Boston: Wisdom
Publications, 2013), 177–9.
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all’ and the ‘existence wind’ (srog rlung)308 are supported. When one with a body dies,
because the white part goes downwards, and the red part goes upwards, the life wind [no
longer being supported], disperses, and the consciousness is made to go elsewhere. When
one is alive those two form the basis of the existence wind and the “consciousness” (rnam
par shes pa). 309
Here, Thupten Püntsok describes the white and red drops as manifesting as the seed syllables at
the cakras of the central channel of the Tantric body. The term, “basis for all” (kun gzhi; Skt.
alaya), is variously translated as “basis of all,” “all-ground,” “foundation of all things,” and
“storehouse of all consciousness.” As the basis of everything in existence, the ‘basis for all’ is
said to be the foundation of nirvana and samsara, and pure and impure phenomena.310 Therefore,
that which is impure is able to be purified, which is the function of the antidote drop.
Thupten Püntsok asserts that, in Tantra, Buddhist realization of non-duality and emptiness
can be accomplished through meditative and yogic practices that manipulate the subtle body of
winds, channels and drops. This is because the antidote drop resides within the drop of delusion
and ignorance. He writes:
The ‘antidote drop’ is the method by which one purifies the channels and holds the winds,
gradually purifying the impure parts of the mind, the perceptions of afflictive emotions, as
well as the impure parts of the body, the thirty-six unclean elements. Lastly, it is the
method by which one’s body becomes a “rainbow body” (‘ja’ lus) and the mind becomes
the “truth body” (chos sku; Skt. dharmakaya) 311
The “rainbow body” and the “truth body,” refer to the outcomes of advanced Buddhist
realization born from Tantric practices. The rainbow body is achieved through a Dzogchen
308 If we recall from Thupten Püntsok’s sixth chapter on the body’s system of channels, soon after
conception, the first ‘channel of formation’ is the initial support of the “existence wind,” (srog rlung)
which is essential for life.
309
dang po dkar cha ni spyi bo dbu ma’i yar sne HAM yig gi rang bzhin la gnas pa dang / dmar cha ni
ste ‘og rtsa gsum ‘dus mdor AH thung gi rang bzhin du gnas la / de gnyis kyi bar la kun gzhi dang srog
rlung brtan par byed cing / lus can ‘chi ba na dkar cha thur du ‘gro / dmar cha gyen du ‘gro bas / srog
rlung brdal nas rnams pa shes pa gzhan du ‘gro bar byed cing gnas pa’i tshe na / de gnyis kyis srog rlung
dang / rnam par shes pa’i rten byed do, Thub bstan phun tshogs, Gso bya lus kyi rnam bshad, 119–20.
310
311
Rangjung Yeshe, s.v. “kun gzhi.”
gnyen po’i thig le ni / rtsa sbyong zhing rlung bzung ste sems kyi ma dag pa’i cha nyon mongs pa’i
rtag pa rnams dang / lus kyi ma dag pa’i cha mi gtsang ba’i khams so drug po rnams rim bzhin sbyong
zhing dag par byas te mthar lus ‘ja’ lus dang / sems chos skur bsgyur bar byed pa’i thabs so, Thub bstan
phun tshogs, Gso bya lus kyi rnam bshad, 120.
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technique known as trekchö (khregs chod), meaning “cutting through,” which results in being
able to dissolve the body into rainbow light upon death.312 This method is coupled with the
“body of light” (‘od sku), which is achieved through tögyel (thod rgyal) practices, meaning
“direct crossing,” and refers to an even more advanced set of practices involving manipulating
“light” in order to quickly or more directly obtain Buddhist realization.313 The truth body or
dharmakaya, 314 is in some contexts, synonymous with kun gzhi, the “basis of all,” referring to the
true, ‘unconditioned’ nature of reality once impurities, via advanced Buddhist practices, have
been removed from the mind and body. Thupten Püntsok tells us that “in order to know these
methods, one must look to the Six Yogas of Nāropa and other secret Tantras.”315
Following this, Thupten Püntsok turns specifically to methods of manipulating the vajra
body, focusing in particular on “inner heat” (gtum mo) practices, one of the six yogas of Nāropa.
According to Thupten Püntsok, tummo or inner heat practices are a “way of generating the
unconditioned bliss and emptiness of the blazing and dripping tummo, which holds the antidote
drop.”316 He describes the tummo itself by quoting from the Secret Union (Gsang ba ‘dus pa;
Guhyasamāja),an early and extremely influential tantra which is classified as belonging to the
‘Unexcelled Yoga Tantra’ (Rnal ‘byor bla med rgyud; Anuttarayoga) class of the Buddhist
Tantras.317 According to the Secret Union:
312
Rigpa Shedra, s.v. “Rainbow body.” See also: Namkhai Norbu, The Crystal and the Way of Light:
Sutra, Tantra and Dzogchen: The Teachings of Namkhai Norbu, ed., John Shane (Boston: Snow Lion
Publications, 2000).
313
Rigpa Shedra, s.v. “tögyel.”
314
Rangjung Yeshe, s.v. “chos sku.”
315
de’i thabs rgyas pa chos drug sogs sngags kyi rgyud sde rnams las shes par bya dgos kyang, Thub
bstan phun tshogs, Gso bya lus kyi rnam bshad, 120.
316
gnyen po’i thig le ‘chang zhing gtum mo ‘bar ‘dzag gi zag med kyi bde stong bskyed tshul, ibid.,
120.
317
The Secret Union (Guhyasamāja) has been republished in the Beijing Tengyur: “gsang ba ‘dus pa,”
in Bka’ ’gyur (dpe bsdur ma) (Beijing: Krung go’i bod rig pa’i dpe skrun khang, 2006), 81:289–441. On
the content and title of this work, Francesca Fremantle writes: “The fundamental concept of the Tantras is
unity: the integrating of the conflicting elements in the nature of living beings, the oneness of all forms of
existence, and the identity of saṃsāra with nirvāṇa. All these aspects are implied in the title of this
Tantra, which may be simply translated as ‘The Secret Union,’ but which in its full form is ‘The Union (or
assembly) of the Secret Body, Speech and Mind of all Tathāgatas.’” Fremantle, “A Critical Study of the
Guhyasamāja Tantra” (PhD diss. University of London, 1971), 15.
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In actual reality, the tummo is merely pin-sized. The clear red [part] blazes upwards, and
the Ham syllable, its triangular head facing downwards, melts into bright light, [causing]
sixteen bodhicitta drops to drip. In respect to that, the way that great bliss is generated is
by [the drips] falling from the middle of the “brain centre” (klad dkyil). Half of those, eight
[drops], drip to the throat, and in that way the joy of excelled bliss is generated. Half of
those, four [drops], drip to the heart, generating the joy of transcendent bliss and
emptiness. Half of those, two [drops] drip to the navel generating a joy that feels like
having no body—this is the most awesome of the blisses, the indivisible bliss and
emptiness generates the joy of innate primordial wisdom of which the experience of is
inexpressible. 318
Here, Thupten Püntsok speaks specifically to the Tantric understanding of the drops and the inner
heat practices meant to cause them to melt and drip. The drops are located at the cakras along the
middle channel, and it is through their ‘opening’ or ‘untying of their knots’ that Buddhist
realizations of bliss and emptiness are experienced by the Tantric virtuoso.
Thupten Püntsok explains that “parts of this very drop or the white and red element” (thig
le’m khams dkar dmar gyi cha de nyid) circulate throughout the body in yearly, monthly and
daily cycles that are in accordance with the laws of the motion of the sun, moon, and space.
Therefore, the external universe, which shares in the same elements as the white and red parts,
corresponds with the “manner of cycling of the town of the internal vajra body” (nang rdo rje’i
lus kyi grong khyer la ‘khor ba’i tshul).319
Thupten Püntsok gives an account of the manner of the cycling of the drops according to
Yangönpa Gyeltsen Pel’s (Yang dgon pa rgyal mtshan dpal, 1213 – 1258) Secret Vajra body.320
This text is the focus of Willa Miller’s dissertation, “Secrets of the Vajra Body: Dngos po'i gnas
lugs and the Apotheosis of the Body in the work of Rgyal ba Yang dgon pa.” 321 In her study,
318 don du gtum mo rgya khab tsam // dmar gsal gyen du ‘bar ba yi ham mgo thur la bstan pa de // ‘od
du ltems kyis bzhugs nas kyang // byang sems thig le bcu drug ‘dzag // de la bde chen skyes tshul ni // klad
dkyil babs pas dga’ ba skyes // de phyed mgrin par brgyad ‘dzag pas // de yis bde ba mchog dga’ skyes //
de phyed snying khar bzhi ‘dzag pas // dga’ bral bde stong dga’ ba skyes // de phyed lte bar gnyis ‘dzag
pas // lus med mnyam pa’i dga’ ba skyes // bde stong dbyer med bde ba’i mchog // lhan cig ye shes dga’
ba skyes de nyams ‘di ‘dra smra mi shes, Thub bstan phun tshogs, Gso bya lus kyi rnam bshad, 120.
319
Ibid., 120–1.
320
Yang gdon pa rgyal mtshan dpal, “Rdo rje lus kyi sbas bshad,” in Gsang chen thabs lam nyer mkho
rnal ’byor snying nor (Beijing: Mi rigs dpe skrun khang, 1991), 1–109.
321
Willa Miller, “Secrets of the Vajra Body: Dngos Po’i Gnas Lugs and the Apotheosis of the Body in
the Work of Rgyal Ba Yang Dgon Pa.” Harvard University, 2013.
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Miller’s central argument is that the Secret Vajra Body is unique in that it posits the body as the
means and basis of Buddhist salvation. In her own words, the text is “an outstanding attempt in
Buddhist history to theorize the role and status of the body as the prime focus of soteriological
discourse.”322 Miller suggests that it is more than likely that this Tantric work, the Secret Vajra
Body, was influential in medicine. This is certainly the case in the contemporary Tibetan medical
works that speak about “hormones.” In fact, in other sources besides Thupten Püntsok’s, such as
Mingji Cuomu’s Clinical Experience in Treating Obstetric Diseases, and Lhamokyi’s Study of
Menstruation, the Secret Vajra Body is specifically used to support the argument that notions of
“hormones” are already present in Tibetan thought.
According to Thupten Püntsok, in Tantric works like the Secret Vajra Body, the
“drops” (thig le), that is, the quintessence of the essence of the body’s nutrition that is divided
into white and red parts, are what migrates within the vajra body (akin to the migration of the
life-force (bla) as explained earlier in relation to the channels). The daily migration of ‘parts of
the white and red drops’ can be divided into twelve time periods of two hours each (amounting to
twenty-four hours) which correspond with the positions of the sun and moon in both the sky and
the internal vajra body. Also, the locations of where the parts of the drops travel are identified
with the locations of the cakras, again, akin to the bla gnas.
As for the migration of the drops, according to Thupten Püntsok’s citation of the Secret
Vajra Body, “at around eight in the morning [when they are at the big toe] the strength [of the
elements] of fire and wind increase, outside becomes hot, and whatever food has been consumed
is able to be digested.”323 Then, “around the period of ten in the morning, because [parts of the
drops] reach the navel, desire and attachment are born. Because of cause and effect, on the
outside [people] show the appearance of desire by singing, dancing and joking.”324 After that,
“around noontime, because they reach the heart, the consciousness becomes a little dull… [and]
322
Ibid., 1.
323
nyi ma ‘char / me rlung stobs ‘phel / phyi rol du drod g.yo / zas gang zos ‘ju, Thub bstan phun
tshogs, Gso bya lus kyi rnam bshad, 121.
324
nyi ma dros pa na lte bar slibs pas ‘dod chags skye / phyi rten ‘brel du glu gar dang bzhad bgad
sogs ‘dod chags kyi rnam ‘gyur ston / tshor ba bde ba shas che, ibid., 121.
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sleepiness, heat and fogginess predominate.”325 Next, “at around two in the afternoon, because
[parts of the drops] reach the throat, a feeling of sadness [and] weariness emerges…”326 Then, “at
four in the afternoon, because they reach the crown of the head, the body is cold, it is difficult to
digest food and the potency of [the elements of] fire and wind decrease.” 327
During the evening and early morning hours, the drops are described as dripping or
falling as they migrate from the crown of the head, and back down the right or left side of the
body (depending on whether one is male or female). Continuing, “at six in the evening, the drops
are melted by the heat of the fire” 328 and because of that “at eight o’clock, sixteen parts of the
drops go to the bodily constituents—the sixteen drops fall to the throat. The sharpness and
brilliance of the moon and the stars becomes greater. Internally, the “elements” (dwangs ma)
inside the channels move and gather together, and for this reason, outside, the dakas and dakinis
gather only at night, and all of the evil spirits also gather. The other drops of the body are weak.
”329 For that reason, “at ten in the evening, terrifying experiences occur. Then, eight parts of the
drops go to the bodily constituents—eight fall to the heart.”330 Next, “at midnight, one falls into a
deep sleep.” 331 Then, “at two in the morning, four parts of the drops go to the bodily constituents
—four fall to the navel.”332 Next, “at four in the morning, one feels the cold more. Two parts [of
the drops] go into the bodily constituents. Because two fall to the genitals, it is at dawn that the
drops of meditators drip.333 The vajra organ is aroused. It is at this time that ordinary lay people
325
nyi ma phyed na snying khar slebs pas cung zad shes pa lci /… / gnyid dro rmug pa shas che, ibid.,
121.
326
phyed yol mgrin par slebs pas skyo shas skye / snying mi dga’, ibid., 121.
327
dgong phyogs spyi bor slebs pas lus grang / zas ‘ju dka’ / me rlung gi nus pa zad, ibid., 121.
328
nyi rgas dus su me’i drod kyis thig le zhu nas., ibid., 121.
329
mun srod la thig le’i cha bcu drug lus zungs su song / cha bcu drug mgrin par babs / zla ba dang
skar ma’i bkrag mdangs rgyas / nang du rtsa nang gi khams dwangs ma rnams g.yo zhing ‘du bas phyi rol
du dpa’ bo mkha’ ‘gro ma rnams mtshan mo kho na ‘du zhing gdon thams cad kyang ‘du ba yin no / lus
kyi thig le gzhan rnams stobs chung bas, ibid., 121.
330 srod ‘khor la ‘jigs skrag gi snang ba ‘ong / de nasthig le’i cha brgyad lus zungs su song / brgyad
snying khar babs, ibid., 121–122.
331
nam phyed tshes bco lnga’i zla ba nam gyi dkyil slebs / gnyid mthug por log, ibid., 122.
332
nam phyed yol la thig le’i cha bzhi lus zungs su song / bzhi lte bar babs, ibid., 122.
333
This is a reference to nocturnal emissions.
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enjoy sexual relations.”334 Finally, “at around six in the morning, those two drops arouse the
power of the red drops at the genitals, making tomorrow’s sun rise. This is why people have a
good complexion in the morning and a bad complexion at night.” 335
After presenting the twelve locations of the daily migration of the drops, Thupten
Püntsok summarizes a general Tantric perspective of the monthly cycling of the drops. Referring
to the ‘inner heat practices’ attributed to Nāropa, the Secret Vajra Body, Ancestral Advice and
Chanting the Names of Mañjuśrī336 (‘Jam dpal mtshan brjod; Skt. Mañjuśrīnāmasaṃgīti), he
writes,
The drops, or the essence of all the elements, are the very type [of thing] which causes the
bodhicitta elements to increase. From the first day of the waxing moon, starting from the
man’s left big toe and from the woman’s right big toe, [the drops] abide in the form of the
seed syllable, Ah. On the second day of the month, [the drops] abide in the form of [the
seed syllable] Om. It goes on like this. These are known as the ‘locations of the lifeforce.’ 337
Here, Thupten Püntsok connects together the lunar cycle of the drops with the sacred syllables
that manifest at the cakras. He identifies the cakras as being at the same locations of the ‘places
of the life-force.’ He also maintains the Tantric system of gendered opposites. Hence, he builds a
bridge between the medical and Tantric understandings of the body through the notion of internal
cycling, and the confluence of the “drops” (thig le) and the “life-force” (bla), as well as the
cakras and “places of the life-force” (bla gnas).
334 tho rangs grang ba’i reg bya che / de nas cha gnyis lus zungs su ‘gro / gnyis gsang gnas su babs
pas tho rangs sgom chen rnams kyi thig le ‘dzag / rdo rje las su rung / tha mal pa rnams chags pa spyod
do, ibid., 122.
335
nam langs par thig le gnyis po des gsang gnas kyi thig le dmar po’i nus pa skye bas nang pa nyi ma
‘char te mi rnams snga dro’i dus na mdog bzang ba dang / dgong mo’i dus na mdog ngan pa’i rgyu
mtshan yang de yin no, ibid., 122.
336
Ye shes rgyal mtshan, ’Jam dpal mtshan brjod kyi ’grel pa bstod sprin gyi sgra dbyangs (Lhasa: Ser
gtsug nang bstan dpe rnying ’tshol bsdu phyogs sgrig khang, 2010).
337
thig le’m ‘byung ba thams cad kyi dwangs ma khams byang chub kyi sems rgyas ‘gyur gyi rigs de
nyid / zla ba yar ngo’i tshes gcig nas skyes pa’i rkang mthe g.yon dang / bud med kyi g.yas nas ‘go
brtsams te yi ge a’i gzugs su gnas pa dang / tshe gnyis byin par aom’i gzugs su gnas pa sogs yongs grags
su bla gnas zhes pa de yin la, Thub bstan phun tshogs, Gso bya lus kyi rnam bshad, 124.
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As we saw earlier, Thupten Püntsok concluded his summary of the winds, channels and
drops of both the Tibetan Tantric and medical traditions by making reference to biomedical
thought. He suggested that the very same cakras described in the Tantric system, the bla gnas of
the medical tradition, are also the “glands” of the biomedical tradition. Therefore, he suggests
that more research is needed to determine whether or not the ‘places of bla’ or (in Tantric terms)
the ‘cakras,’ should be understood as “channels” (rtsa) or “glands” (rmen bu). He further implies
that if they are found (through examination of medical texts) to be glands, and they are therefore
pointing to the same “glands” of biomedicine, then the “drops,” that is, the quintessence of the
essences of food and drink, could be the “hormones” of the biomedical system. According to
Thupten Püntsok’s presentation, in the Tibetan medical, the Tantric and the biomedical systems,
the cakras, bla gnas and glands are all understood as particular ‘organs’ or ‘centres of activity’
that are located along cyclical pathways that move very subtle material substances that are
extremely potent, effecting extraordinary effects on the body, mind and emotions.
Thupten Püntsok’s assertion that the “hormones” of biomedical thought could be
equivalent to Tibetan notions of the “quintessence” (mdangs) and “glands” (rmen) is solidified
by way of a Tibetan-biomedical hybrid illustration entitled, “Types of glands that move the
hormones (quintessence).”338 The illustration is a basic sketch of a nude woman, wherein the
following Tibetan-biomedical terms are indicated: klad rmen (pituitary gland), aig rmen
(thyroid), brang rmen (thymus gland), gsher rmen (pancreas), mkhal rmen (adrenal gland), and
bsam se’u (ovaries or testicles). Here, in a relatively simple illustration, Thupten Püntsok
assumes that the “glands” of biomedical thought are the same as the “glands” of Tibetan
medicine.
Compared against the development of hormones and endocrine research in Western
thought, Thupten Püntsok’s work draws on several important parallels. He points to the
relationship among hormones, the brain, the endocrine glands, and the reproductive system, a
relationship further elaborated elaborated in the following chapter of this dissertation.
338
ho’o mo’u (mdangs) rgyu ba’i rmen bu’i rigs, ibid., 146.
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Similarly to biomedical endocrine research, Thupten Püntsok views embryonic
development and its organizing (or structuring) effects on the embryo as being mediated by the
hormones, which he understands as being core quintessences of the white and red elements.
Hence, we can see hints, developed by other writers, that Tibetan medical thought could perceive
the white and red elements as having organizational and activating effects on the body which
direct a person towards a male or female bodily phenotype, gender identity and reproductive
behaviour. We also can see the view that hormones are potent and purified (and possibly
fundamental) quintessences that have gone through successive stages of refinement; possibly
analogous to the biochemical and molecular structure of steroid hormones, whereby the
production of evermore specific hormones are produced from other hormones. Lastly, as in so
many biomedical studies, Thupten Püntsok presents a sexually dimorphic system in which
hormones, like the white and red elements organize and activate the male and female sex and all
of the activities which that entails. In this way, we see a trend that becomes more solidified in the
other contemporary sources, namely, that the white and red elements and hormones guarantee
and maintain the inherent nature of males and females.
However tentative, Thupten Püntsok’s ideas about the relation between biomedical
hormones and Tibetan understandings of the body do serve a number of functions. Firstly, and
foremost they support Tibetan knowledge claims, rather than discredit them. Secondly, they
promote a Tibetan national identity. By arguing that the endocrine system and hormones are
conceived in a roughly equivalent manner in Tibetan medicine, Thupten Püntsok asserts that
Tibetan medicine and Western biomedicine are on an equal scientific footing. Concentrating on
the relation of Tibetan Buddhist and medical knowledge about the body, he nevertheless
includes, and to some degree, integrates biomedical ideas. Although he admits to being merely
speculative in their relation, the postulation that the cakras and the blas gnas could be
understood as the endocrine glands serves to underscore Tibetan knowledge about the body as
well as to point out future avenues of research.
This strategy validates his research method. By researching and re-interpreting
authoritative sources, biomedical ideas as well as modern disorders can be understood and
incorporated into the Tibetan system. In this way, not only can Tibetan medicine be updated, but
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it can also remain loyal to its authoritative knowledge roots thus helping thus helping to promote
a Tibetan Buddhist national, intellectual, and cultural identity.
2.6 Women’s Reproductive Bodies in Mingji Cuomu
Mingji Cuomu’s work, Clinical Experience in Treating Obstetric Disease, written ten
years later than Thupten Püntsok’s, is far more assertive in relating hormones to Tibetan medical
thought. She maps Chinese biomedical terms directly onto Tibetan medical nomenclatures, by
illustrating the Chinese characters for specific biomedical terms for “hormones” and
endocrinological anatomy. This neither implies nor suggests that Tibetan medical thought in
regards to reproduction has been replaced by biomedical notions. Shared medical and Buddhist
concepts like the white and red elements, quintessences, drops and the bardo being are
maintained and emphasized as being compatible with biomedical thought. Mingji Cuomu is
persuasive in explaining how the earliest authoritative sources of the Tibetan medical and Tantric
traditions had their own understanding of what are today known to be “hormones.” Therefore, in
these sections examining Mingji Cuomu’s work, I briefly outline her basis of the reproductive,
and as such, the endocrinological body. Then I centre on her discussions and direct translations
of Tibetan and Chinese biomedical terms of that body.
Mingji Cuomu’s Clinical Experience in Treating Obstetric Disease consists of three
parts. The first part, some of whose pages were discussed above, is an introduction of
approximately forty pages in length. The second part is titled “Preliminary remarks: On the
method of developing research into Tibetan medicine”339 and amounts to about the first fifty
pages of the work. The third part, taking up the remaining one hundred pages, forms the “actual
main topic.”340
The “actual main topic” is organized into seven chapters, each containing several sections
and sub-sections. The first chapter exclusively details the Buddhist perspective of the nature of
human birth, rebirth, and the contrasting roles of male and female bodies. Building from this
339
sngon ‘gro’i gtam / bod kyi gso rig zhib ‘jug gi las don spel thabs skor, Sman skyid mtsho mo, Mo
nad phal pa’i nad la zhib ’jug dang gso bcos kyi nyams yig, 2–48.
340
dngos gzhi’idon ston pa, ibid., 49–152.
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framework, Mingji Cuomu’s second chapter, “Dissemination of the precise meanings regarding
the connection between the body’s material constituents and the topic of birth,” 341 that discusses
“hormones.” The second chapter consists of two sections, with the latter being further organized
into six subsections. In the following pages I highlight parts of the second chapter, narrowing in
on the fourth and fifth sub-sections of the second chapter where “hormones” are the central
focus.
The first section of the second chapter, “The nature of the universal four channels of
existence”342 is where Mingji Cuomu lays the foundation for comparing Tibetan and biomedical
perspectives of human reproductive physiology and material substances known in English as
“hormones.” She begins this section on the general topic of reproduction, and how it is made
possible by “channels” that circulate the essence of digested food and drink throughout the body.
She writes:
In order for the seven bodily constituents to be continually circulated, and also for each of
them to become ripened, they must depend on the activities of the universal four channels
of existence. As for explaining the nature of how those channels manifest, [we must] start
from the very beginning, from the Explanatory Tantra:
The ‘great existence channel’ is four—
the channel which perceives the objects of the senses
circulates via five hundred subtle existence channels in the brain.
The channel which clarifies the memory
circulates via five hundred subtle channels in the heart.
The channel which creates the aggregates of the body
circulate via five hundred subtle channels at the navel.
The channel which increases the lineage of sons
circulates via five hundred subtle channels at the genitals.343
341
skye don rnams gzhag lus khams dngos la sbyar nas zhib don ‘phros pa, ibid., 61.
342
srid pa’i rtsa ‘khor chen po bzhi’i spyi’i gnas lugs, ibid., 61.
343
de yang lus zungs bdun po rgyun chad med par ‘khor bskyod byed cing rang rang gi gnas su smin
par byed pa la srid pa’i rtsa ‘khor chen po bzhi’i byed las brten dgos te / de dag gi rtsa ba’i gnas lugs nas
brjod bya thog mar brtsam pas na / bshad rgyud las / srid pa’i rtsa bo che ni rnams bzhi yi // dbang po
yul la ‘char bar byed pa’i // klad pa la srid rtsa phran lnga brgyas bskor // dran pa’i dbang po gsal bar
byed pa’i rtsa // snying la srid cing rtsa phran lnga brgyas bskor // lus kyi phung po chags par byed pa’i
rtsa // lte ba la srid rtsa phran lnga brgyas skor // bu tsha rigs rgyud ‘phel bar byed pa’i rtsa // mtshan ma
la srid rtsa phran lnga brgyas bskor, ibid., 61.
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Mingji Cuomu writes that this passage outlines how “the aggregates of the body are created,
maintained and have the ability to continually propagate the ancestral lineage of children and
grandchildren.”344 Hence, for Mingji Cuomu a starting point for discussing the place of
“hormones” in Tibetan medical thought begins with the origins and functioning of the four
channels of existence together with the seven bodily constituents according to the Four Treatises.
She establishes that it is through the successive ripening and circulation of the seven bodily
constituents throughout the body that reproduction is possible. One notes the close resemblance
of this medical body with a general Tantric perspective of the channels, cakras (or wheel centres)
and drops.
Mingji Cuomu writes that the four channels of existence are organized into three parts of
the body: the upper, middle and lower. Continuing from above, she further explains the passage
from the Four Treatises:
Furthermore, if it is explained little by little, that wheel channel, which [enables] each of
the five “sense faculties” (dbang rten) to perceive their object, exists in the ‘white channel’
of the brain. [It] performs its functions by being like a root that projects downwards. 345
The wheel channel [at the heart] clarifies the memory, and separates the two, the wind and
the blood. [Being the wheel channel] that possesses the root of the branches, [it is where
wind and blood] gather as a heart beat, and spread outwards from the heart. The heart, by
becoming the support of the entire life-force and the mind, make possible the clarity of
memory. 346
The wheel centre that creates the aggregates of the body is located at the middle, or at the
navel. [Being the wheel channel] that possesses branches and limbs, through a root vein
extending from the liver, the “essence” (bcud) of consumed food and drink is broken down
and digested. In separating the essence from the refuse, [the wheel centre at the navel]
creates the source for the basis of the essence of the body. When an aggregate is first
344
lus kyi phung po chags shing gnas par byed pa / bu dang tsha bo sogs pha mes kyi rigs rgyud de
rgyun mi chad par spel ba, ibid., 61.
345
de yang re re bzhin ‘chad na dbang po lnga rang rang gi yul la ‘char bar byed pa’i rtsa ‘khor ni /
klad par gnas pa’i rtsa dkar rtsa ba lta bu thur du zug pa dag gis byed pa, ibid., 62.
346
yid kyi dran pa gsal bar byed pa’i rtsa ‘khor ni / snying nas gyes pa’i rlung khrag gnyis ‘doms kyi
‘phar rtsa yan lag dang bcas pa rtsa ba snying nas gyes shing / snying ni tshe srog sems kun gyi rten du
gyur pas dran pa gsal ba’i nus pa yod pa, ibid., 62.
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created, the nourishment from the mother’s body, travelling through a path to the navel of
the child, becomes the root basis of the earth [element]. 347
The wheel centre that performs the function of increasing the lineage of sons is that which
causes the propagation of the ancestral lineage [and depends upon] the ripening, gathering
[and] movement of the white and red drops (which, possessing the potency of internal
drips) move through the sense organs and [internal] pathways. The special characteristics
of the male and female body, especially the genitals, function to propagate the lineage of
children. 348
Here, Mingji Cuomu explains how the “wheel channels” (rtsa ‘khor) at the brain, heart, navel
and genitals function together with the essences of the seven bodily constituents to create,
develop, maintain and reproduce the human body. The body is imagined as being similar to a
tree, beginning with its ‘root’ projecting downwards from the wheel centre at the brain. The brain
is that which ‘thinks,’ in that it allows the mind and body to interpret and interact with the world.
The ‘root of the branches’ is at the heart wheel centre. The heart pumps blood and wind (or
breath) throughout the body. The ‘branches and limbs’ are imagined at the wheel centre at the
navel, where a root vein extending from the liver separates the wastes (or refuse) from the
essence of digested foods, thereby producing the foundational essence for the body. Here, Mingji
Cuomu points to the “umbilical cord” that allows for the mother’s nourishment to pass to her
child. The part of the tree which is the wheel centre at the genitals is not specifically named, but
is implied as the ‘seed’ that allows for reproduction.
It is in her elaboration of the wheel channel at the genitals that Mingji Cuomu alludes to
“hormones,” using the phrase, “those internal drips which are emitted out” (nang gi gzags ‘don).
She writes that it is through “the sense organs” (dbang rten)—which are “the physical sense
347
lus kyi phung po chags par byed pa’i rtsa ‘khor te / lus kyi lte ba’m dkyil gyi tshod mchin pa nas
sdod rtsa’i rtsa ba gyes shing yan lag dang bcas pas kha zas kyi bcud dag myag bzhu dwangs snyigs
‘byed par brten lus khams kyi dwangs ma’i rtsa ba ‘byung ba ma zad / phung po thog mar chags pa’i
skabs su ma yi lus khams nas ‘tsho bcud ‘dren sa’i gzhi gtso bo yang byis pa’i lte ba’i lam nas brgyud pa
zhig yin, ibid., 62.
348
bu tsha rigs rgyud ‘phel bar byed pa’i rtsa ‘khor ni / bu tsha rigs rgyud spel byed kyi rgyu thig le
dkar dmar smin gsog rgyu bar byed pa’i (nang gi gzags‘don gyi nus pa ldan pa’i) dbang rten dang rgyu
lam ste / phung khams su pho mo’ khyad chos mtshon pa’i dmigs bsal gyi skye lugs khyad chos sam
mtshan ma’i yul las bu tsha rigs brgyud ‘phel ba’i bya ba byed pa bcas so, ibid., 62.
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organ that supports the inner subtle sense faculty,” 349— that the “white and red drops” (thig le
dkar dmar) possess the “potency” (nus pa) of the internal drips.
Although Mingju Cuomu’s innovative term “internal drips” appears to be a neutral and
non-specific term for a category of potent substances that are emitted from the white and red
drops, it is clearly an implicit nod towards the biomedical notion of “hormones.” It is here, in
using this term that Mingju Cuomu begins to establish the argument that Western ideas of
“hormones” have already been known and written about in the authoritative works of the Tibetan
tradition. Further evidence that “internal drips” is a kind of place holder for native Tibetan ideas
of “hormones” can be found later in her second chapter, where Mingji Cuomu uses the term skul
rgyu as an explicit translation of Chinese biomedical terms for “hormones.” Hence, the use of
“internal drips” is a sort of ‘in-between’ term that points to substances that are known about in
both the Tibetan medical and biomedical systems.
In Mingji Cuomu’s account so far, the white and red drops, which form the essence of
the essence of digested foodstuff, are the key bridge between biomedical and Tibetan medical
thought on “hormones.” She also points to how the brain influences the white and red
reproductive elements (or the drops) through the “sense organs.” Here, the brain, being the
support and director for the other processes in the body, allows the white and red drops to contain
the potency of the “internal drips” or “hormones.” Hence, Mingji Cuomu effectively establishes
two of the central axis of biomedical endocrinology which are the causative role of the brain in
reproduction, and its role in circulating very subtle yet potent substances throughout the body.
Hence, biomedical understandings of “hormones” are established as equivalent to the white and
red elements, or at least, as pointing to the same material substances. Lastly, Mingji Cuomu
establishes that the white and red elements of Tibetan medicine, like the biomedical notions of
“hormones,” are viewed as necessary for human growth, development, sexual dimorphism, and
reproduction.
349
Ranjung Yeshe, s.v. “dbang rten.”
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In the next section Mingji Cuomu elaborates upon shared Tibetan Tantric and medical
ideas of conception, specifically the relations among the brain, the essence of the elements and
the reproductive drops.
2.7 Establishing the Relations Among the Seeds, the Drops, and
Hormones in Tibetan Medical and Buddhist Literature
The second section, “Examination of the white and red drops: The innermost essence of
the seven bodily constituents that cause rebirth,”350 of Mingji Cuomu’s second chapter, is in two
main parts. The first part titled, “The characteristic features of the universal male and female
genitals which are born from the self-nature of means and wisdom”351 establishes the Tantric
perspective of sex and conception by citing a passage from Yangönpa Gyeltsen Pel’s Secret Vajra
Body. The second part titled, “Detailed examination of the system of how the white and red
drops cause conception,”352 explains Tibetan medicine in relation to biomedical notions of
“hormones” and the larger endocrinological system. And it is in this section that Mingji Cuomu
introduces the directly corresponding Tibetan translations of Chinese biomedical terms. In
Section 2.7 of this thesis, I present both of these parts of Mingji Cuomu’s second chapter.
In “The characteristic features of the universal male and female genitals which are born
from the self-nature of means and wisdom,” Mingji Cuomu concentrates on human conception
and sexual dimorphism from a shared Tibetan medical and Buddhist perspective. Her larger aim
is to show that the points of convergence between the medical and Tantric body underscore a
single coherent system of Tibetan knowledge about the body.
On the topic of birth, Mingji Cuomu writes:
Being a product of its own self-nature and belonging to the six realms of birth, the human
body establishes the separate body’s of wisdom and means. Among all sentient beings, the
[human] branch is the most excellent. The man, whose self- nature is method [possesses
the] mark which can reproduce. And, the woman, whose self-nature is wisdom [possesses
350
khyad par skye ba’i rgyu lus zungs bdun gyi yang snying thig le dkar dmar la dpyad pa, Sman skyid
mtsho mo, Mo nad phal pa’i nad la zhib ’jug dang gso bcos kyi nyams yig., 63.
351
thabs dang shes rab kyi rang bzhin du gyur pa’i pho mo’i mtshan ma’i spyi’i khyad chos, ibid., 63.
352
mngal sbrum pa’i rgyu thig le dkar dmar gyi rnam gzhag la rgyas par dpyad pa, ibid., 64.
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the] mark which can reproduce. Whichever body, whether the [genitals] are on display or
hidden, their difference lies in the way of establishing their respective activities. The white
and red elements, which grow and increase inside the genitals and cause the creation of the
[fetal] body, are emitted through the downward-clearing wind. The special feature of
women is their power to become pregnant.353
Then, Mingji Cuomu repeats a common Tibetan Buddhist tenet to the effect that among the six
realms of possible rebirth, the human one is the most excellent because the respective bodies of
men and women manifest as the means and wisdom needed both for reproduction and Buddhist
enlightenment. She uses the term, rang bzhin, meaning, something’s “own way of arising,” “self”
or “intrinsic nature,” or “essence.”354
Rang bzhin is an important term throughout this thesis because it is used frequently in all
of my primary sources. Primarily, the term is used to define attribute features from material
substances and forms, to masculinity and femininity and even the nature of the vajra body.355 In
the above Mingji Cuomu uses rang bzhin, “self-nature,” to establish the origins of the physical
attributes of male and female genitals and their ability to yield reproductive seeds. In the
following chapter of this thesis we shall examine this term again but in relation to a similar and
sometimes synonymous term, gnas lugs, meaning something’s “way of abiding.”
Despite being clearly Buddhist in orientation, her description of how the reproductive
seeds are made in and emitted from the body is presented as medical knowledge. In so doing, she
demonstrates how Tibetan Buddhist and medical ideas on reproduction support one another
without contradiction. For Mingji Cuomu, the essential thrust of this first section establishes the
co-referential relation of the Tantric understandings of the “drops” with the reproductive “seeds”
as understood in medicine.
353
skye khams drug dang ldan pa’i mi yi lus rten ‘di nyid bskyed bya’i rang bzhin nyid kyis thabs dang
shes rab lus rten tha dad du grub pa ma zad / de’i yan lag kyang sems can gzhan las phun sum tshogs pa
yod pa ste / skyes pa la thabs kyi rang bzhin gyi skye ‘phel mtshan ma dang / bud med la shes rab rang
bzhin gyi skye ‘phel mtshan ma grub yod / gang yin rung lus phung gi phyir mngon pa dang mi mngon pa
las bya byed sgrub tshul tha dad yin te / nang gi skye ‘phel mtshan mas lus khams chags pa’i rgyu khams
dkar dmar grub cing thur du sel ba’i rlung gis phyir phyung ba dang / bud med la khyad par mngal
sbrum pa’i nus pa yod, ibid., 63.
354
355
Rangjung Yeshi s.v. “rang bzhin.”
For example, Thupten Püntsok uses rang bzhin to describe the self-arising nature of the seed
syllables at the cakras and the places of bla. See footnote 279.
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It is here that Mingji Cuomu turns to the Secret Vajra Body,356 quoting a passage that
outlines the “five inner awakenings” (nang gi mngon byang lnga; Skt. abhisambodhi)357 which
are meditative visualizations associated with one of each of the five chakras along the central
channel of the body. Both Mingji Cuomu and Willa Miller358 quote and translate this passage
from the Secret Vajra Body, clearly showing its relevance in contemporary Buddhist scholarship
and medical research. Because one can consult a full Tibetan and English version of this passage
in these two works, I will only cite its beginning for purposes of demonstrating the connections
that Mingji Cuomu is establishing between the medical and the vajra body of Tibetan thought.
From the Secret Vajra Body:
If one wants to consider the “five inner awakenings” then according to the High Yoga
Tantras, first [the consciousness of the bardo being] enters father’s anus, and comes to
abide in the penis beneath the navel, and from there the father’s drop is emitted. This is an
awakening through the moon, mirror-like wisdom.359 Then, if it comes to abide in the
womb of the mother, it is wrapped in the essence of menstruation. 360
Here, we see that the Secret Vajra Body presents a strikingly unified or holistic understanding of
conception, from its most physical and ‘gross’ elements, to its most subtle. Both the vajra and the
actual human reproductive bodies are intertwined and mutually reinforcing. The reason for this
envisaging is that Yangönpa Gyeltsen Pel’s work was meant to provide practical instruction on a
meditative practice that uses the body as its imaginative and soteriological basis. Also
noteworthy, Yangönpa Gyeltsen Pel implies that “menstruation” includes the activities of the
essence and refuse, and does not merely refer to the blood that comes from the uterus. The
remainder of the passage from Secret Vajra Body (taking up half of the section) outlines
356
Mingjo Cuomu writes that she is quoting from “the Shakyapa, Gyeltsen Palzang,” (Sa skya ba rgyal
mtshan dpal bzang) who complied the Secret Vajra Body, but the author is in reality Yangönpa Gyeltsen
Pel.
357
Rangjung Yeshi, s.v. “nang gi mngon byang lnga.”
358
See: Miller, Secrets of the Vajra Body, 170–2.
359
The “awakening through the moon, mirror-like wisdom” is the first of the five awakenings, and is
located at the crown of the head.
360
rnal ‘byor chen mo’i rgyud kyi rjes su brang pa nang gi mngon byang lnga dang sbyar na dang po
pho’i bshang lam nas zhugs te lte ba’i ‘og rdo rje lam na gnas pa la pha’i thig le ‘phul te ‘ongs pa ni zla
ba me long lta bu ye shes mngon par byang chub pa / de ma’i skye gnas su phyin pas na ra ka ta’i dwangs
ma phyi, Sman skyid mtsho mo, Mo nad phal pa’i nad la zhib ’jug dang gso bcos kyi nyams yig, 63–4.
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conception and the stages of the fetus’ gestation, speaking to both the vajra body of cakras and
meditative visualizations, and the physical body of concern to medicine.
Mingji Cuomu establishes Secret Vajra Body as her primary Tantric source in the sections
that follow and lead up to “hormones.” One can imagine why she would find such a work, that
places the flesh and blood body at the soteriological heart of Tantric yogic practices, useful
within her explanation of contemporary Tibetan knowledge of conception and rebirth. It is a
work that lays out the connections between the physical body and the vajra body, and in so
doing, provides a rich resource for the interpretation and support of “hormones” in the Tibetan
medical system.
In the second chapter’s second part, “detailed examination of the system of how the white
and red drops cause conception,”361 Mingji Cuomu moves to explain how the process of
digestion produces the white and red elements and, by stages, the seed and egg that conceive a
child. Like her contemporaries, showing the origins and nature of the white and red elements as
they manifest in various ways in the body is a necessary step in connecting them to biomedical
ideas of hormones.
The title of the first sub-section of the second part of the second chapter is “the origins of
the white and red elements” (khams dkar dmar ‘byung khung). In this section Mingji Cuomu
turns to the Four Treatises and three enormously important treatises to explain the Tibetan
medical view of the white and red elements. These are the Heart of the Eight Branches (Yan lag
brgyad pa’i snying po bsdus pa; Skt. Aṣṭāṇgahṛdayasaṃhitā),362 Ancestral Advice (already
encountered in Thupten Püntsok) and Medicine of the Moon King (Sman dpyad zla ba’i rgal po;
Skt. Somarajabhaisajyasadhana), which is known in Western scholarship as the Somarāja.363
361
mngal sbrum pa’i rgyu thig le dkar dmar gyi rnam gzhag la rgyas par dpyad pa, ibid., 64.
362
Pha khol, “Yan lag brgyad pa’i snying po bsdus pa,” in Bstan ‘gyur nang gi gso ba rig pa’i skor gyi
dpe tshogs: gso rig pa’i rtsa ’grel bdam bsgrigs (Beijing: Mi rigs dpe skrun khang, 1989), 1:112–756.
363
Klu sgrub (Nāgārjuna), Sman dpyad zla baʼi rgyal po, trans., Ma ha ya na, Bai ro tsa na, and Tsan
pa shi la (Beijing: Mi rigs dpe skrun khang, 2006).
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These three works were early sources of the Tibetan medical tradition, 364 and are used in a
number of the present-day sources that integrate Tibetan and biomedical notions of hormones. I
will briefly describe them and their summary by Mingji Cuomu.
The first, the Eight Branches (Also known as the Heart of Medicine Compendium), is
written by Vāgbhaṭa (Pha khol; seventh-century), a principal scholar of classical Āyurveda. The
Eight Branches is considered a masterful synthesis of Indian medical systems, and was to
become immensely influential in the development of medicine in Tibet and throughout south and
central Asia.365 The text is also said to have served as a guide for Yuthok Yönten Gönpo before
he ‘received,’ and made known, the Four Treatises. 366
The translator of the Eight Branches from Sanskrit into Tibetan, Rinchen Zangpo367 (Rin
chen bzang po, 957 – 1055), was enormously influential in what is known as the “later
spread” (phyi dar) of Buddhism in Tibet.368 He translated, from Sanskrit, several important texts
of the Tibetan Buddhist cannon, among them the Secret Union and The Discourse of Śrī Heruka
(Bde mchog ‘khor lo; Cakrasamvara) 369 Tantras. He also translated Āyurvedic texts, including
the Eight Branches and its extremely important and still oft-cited commentary, Moonlight: A
Commentary on the Eight Branches (Yan lag brgyad pa’i snying po’i rnam ‘grel tshig don zla
zer; Padārthacandrikāprabhāsanāma-aṣṭāṅgahṛtti) by Candranandana (Zla ba mngon dga).370 It
364
Frances Garrett examines the role of these four works in the development of Tibetan embryology
in: “Embryology and Embodiment in Tibetan Literature: Narrative Epistemology and the Rhetoric of
Identity.” In Soundings in Tibetan Medicine: Anthropological and Historical Perspectives, ed., Mona
Schrempf, (Boston: Brill, 2007), 411–25.
365
Garrett, Religion, Medicine and the Human Embryo in Tibet, 24–5.
366
Ibid., 25.
367 Desi Sangyé Gyatso includes a short biography of Rinchen Zangpo in his Mirror of Beryl. See:
Sangs rgyas rgya mtsho, Mirror of Beryl: A Historical Introduction to Tibetan Medicine, trans. Gavin
Kilty (Boston: Wisdom Publications, 2010), 168–171.
368
Hera Paul Gangnegi, “A Critical Note on the Biographies of Lo Chen Rin Chen bZang Po,” Tibet
Journal 23, no. 1 (1998): 38–48.
369
“Bde mchog ‘khor lo’i ti ka,” in Bstan ’gyur (dpe bsdur ma) (Beijing: Krung go’i bod rig pa’i dpe
skrun khang, 1994), 42:1153–58. For more on this Tantra see: David B. Gray, “The Cakrasamvara Tantra:
Its History, Interpretation, and Practice in India and Tibet,” Religion Compass 1, no. 6 (2007): 695–710.
370
Kha che zla ba mngon dga’, Yan lag brgyad pa’i snying po’i rnam ’grel tshig don zla zer. 2 vols.
bod kyi gso ba rig pa’i gna’ dpe phyogs dpe tshogs 026 (Beijing: Mi rigs dpe skrun khang, 2006).
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is significant that all of these sources are cited throughout the contemporary Tibetan medical
works, thereby forming the authoritative basis of the Tibetan medical system.
According to Garrett, despite the fact that the Eight Branches has been widely quoted
throughout Tibetan medical literature, in terms of reproduction, pregnancy and fetal
development, key parts have been ignored by Tibetan writers, most notably, the attention to
women’s bodies. Garrett writes that the Eight Branches places a central “emphasis on pregnancy
and the experience of the woman” but that this “is all but lost” in later Tibetan embryological
accounts. Furthermore, she writes: “This omission becomes more striking over time, as centuries
of Buddhist cultural authority replace the concerns of Indian medicine with those of Buddhist
literature in which women are marginalized at best, or, at worst, ostracized or even
eliminated.”371 It is interesting then, that this same work would be so central to Mingji Cuomu’s
explanation of reproduction.
The origins of Mingji Cuomu’s second source, Somarāja, is unclear. It is said in Tibetan
histories to be Chinese in origin, having been translated by the Chinese monk scholar Mahāyāna
(Hwa shang ma hA ya na) and Vairocana (Bai ro tsa na) in the seventh-century at the request of
king Tri Songdetsen (Khri srong lde btsan, 742 – 798), who reigned at the height of the Tibetan
empire.372 Other scholars attribute the work to Nāgārjuna, including the publishers of the 2006
Beijing edition (cited above) who also accredit the Chinese monk translator and Vairocana for
having translated it from the Sanskrit and its Chinese version.
Mingji Cuomu endeavours to define “the origins of the white and red elements,”373 first
within the Four Treatises, and then in the Eight Branches. Paraphrasing her citation of the Four
Treatises, “digestive heats” (me drod) create and sustain each of the seven bodily constituents by
371
Garrett, Religion, Medicine and the Human Embryo in Tibet, 25.
372
Fernard Meyer, “Theory and Practice of Tibetan Medicine,” in Oriental Medicine: An Illustrated
Guide to the Asian Arts of Healing, eds., by J. van Alphen and Anthony Aris (London: Serindia, 1995),
112. See also: Garrett, “Embryology and Embodiment in Tibetan Literature,” 413, and; Yan, Zhen, and
Cai Jingfeng. “Tibetan and Chinese Pulse Diagnosis: A Comparison—with Special Reference to
Locations for Pulse-Taking,” in Soundings in Tibetan Medicine: Anthropological and Historical
Perspectives, ed., Mona Schrempf (Boston: Brill, 2007), 333.
373
khams dkar dmar gyi ‘byung khungs, Sman skyid mtsho mo, Mo nad phal pa’i nad la zhib ’jug
dang gso bcos kyi nyams yig, 64.
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separating the essence from the refuse, ripening the white and red elements and thus producing
the reproductive seeds in the testicles and ovaries. The essence of the seventh bodily constituent
is “the most superior of quintessences of the final perfected state of the bodily constituent of the
reproductive fluid. It abides at the heart, and also spreads throughout the body, imbuing the body
with radiance and lustre.”374 Similarly, according to the Eight Branches, “the bodily constituents
are the essence (bcud) of consumed foods, which [move throughout the body] in a circular
way.” 375
Summarizing the Four Treatises and Eight Branches, Mingji Cuomu writes:
The ‘three digestive heats,’ by decomposing and digesting food, separate the essence and
refuse, functionally establishing, as was explained earlier, the support and supported, of the
five vital organs and the six hollow organs. The essence of the five elements is the support
of the five vital organs. The refuse of [those five elements] accumulates in the six hollow
organs. The last of the seven bodily constituents, the reproductive fluid, is connected with
the left kidney, the uterus and the ovaries. The essence [of the seventh bodily constituent],
ripens into its fullest possible radiance and resides at the heart. The refuse are the white and
red elements that gather in the ovaries [or testes]. 376
Hence, we see in here Mingji Cuomu establishing the connections among the digestion of
nutriments, the circulation of the essences of the seven bodily constituents, and the functioning
of the body’s internal organs, before moving more specifically to the reproductive fluid and its
relation to the organs of reproductive anatomy. She explains how the process of digestion creates
and is maintained by the body's organs, such as the heart, liver, kidneys, and ovaries. Mingji
Cuomu’s statement to the effect that the essence of reproductive fluid gathers at the heart from
where it is pumped throughout the body becoming its “radiance” (gzi mdangs) and
“lustre” (bkrag) is noteworthy. As we shall see further in this and other works, this kind of core
essence or quintessence that gives the body its look of health and vitality is connected with
374
lus zungs khu ba’i mthar phyin mdangs mchog te // snying la gnas kyang lus kun khyab par byed //
tshe gnas gzi mdangs bkrag dang ldan par byed, ibid., 65.
375
376
lus zungs ni zas kyi bcud // ‘khor lo lta bu yongs su ‘khor, ibid., 65.
me drod rnam gsum gyis zas skom dag myag bzhu dwangs snyigs ‘byed pa’i byed las de don lnga
dang snod drug tu rten dang brten pa’i tshul gyis sgrub te / ‘byung ba lnga dwangs ma’i rten don lnga
dang / de’i snyigs ma gsog snod snod drug yin pa dang / lus zungs bdun gyi mtha’ ma khu ba ni don
mkhal ma g.yon dang snod bsam se’u ‘brel ‘byor gyis dwangs ma mdangs mchog tu smin te snying la
gnas pa dang / de’i snyigs ma khams dkar dmar yin te bsam se’ur gsog pa, ibid., 65.
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biomedical ideas of hormones. Further, Mingji Cuomu’s assertion that the left kidney is
functionally connected with the ovaries and uterus preludes its comparison with the adrenal
glands attached to the kidneys, as understood in Western endocrinology.
After this, Mingji Cuomu continues to establish the “origins” (‘byung khungs) of the
white and red elements, by first quoting from the Four Treatises, followed then by the Somarāja
and Ancestral Advice. Using these references as supporting sources, she then moves towards
explaining the role of the “brain marrow,” (klad gzhung) the sixth bodily constituent, from which
reproductive fluid is made.
Quoting this passage from the Oral Instructions Tantra: “The brain marrow ripens the
two, white and red seeds,” 377 Mingji Cuomu states that the ability for the brain marrow to ripen
the white and red elements depends upon the activities of the phlegm dynamic. Her statement is
supported in this line found in the Explanatory Tantra: “The satisfying phlegm, residing at the
head, is the controlling power of the “sense faculties” (dbang po).”378
Mingji Cuomu further expands on the role of the brain in emitting reproductive fluids.
Her support is found in the following from Somarāja: “That which gathers at the crown of the
head is [moved] by the winds to [the organ] that grasps the seeds of the body. The cakra at the
chamber of Brahma’ is the “channel” (rtsa) for [producing] the body’s reproductive seed.379
The “cakra at the chamber of Brahma” (tshangs pa dung gi ‘khor lo; Skt. brahmarandra)
refers to a version of the hindu Tantric body wherein the God Brahma is envisioned as
manifesting at the cakra in the centre of the head, that is, at the brain.380 Hence, Mingji Cuomu
asserts that according to the Somarāja, it is a function of the brain to plant the reproductive seeds
in the ovary. She writes that:
377
klad gzhung sa bon dkar dmar gnyis su smin., ibid, 65.
378
tshim byed mgor gnas dbang po tshim par byed., ibid., 65.
379
spyi bo dag tu ‘dus pa ni // rlung gis lus kyi sa bon bzung // tshangs pa dung ‘khor lo ste // lus
zungs sa bon rtsa yin no, ibid., 65.
380
Ives Waldo, s.v. “tshangs pa dung gi ‘khor lo.”
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It is the power of the satisfying phlegm, which resides at the crown of the head, that
sharpens the ability of the five senses of sight, sound, smell, taste, and touch to
comprehend their objects. The power of the sense of touch allows for the experience of the
pleasurable sensation created by the bliss of the sexual embrace of means and wisdom.
This in turn, ripens the four primordial elements of the white and red elements. Because of
this, [the ripening of the reproductive seed] is closely connected with the activities of the
satisfying phlegm.381
Mingji Cuomu’s point is that because the satisfying phlegm resides at the brain, its central
function there is to sharpen its workings, that is, to aid the brain to act as the central interpreter of
all of the body’s sensory input. Sexual pleasure, being made possible through the body’s senses,
is therefore necessarily mediated by the brain and, by receiving and processing such pleasure,
ripens the material elements of the reproductive seeds in the ovaries and testes. Since it is the
cakra located at the “channel” (or possibly “gland”) (rtsa) of the brain that ripens the
reproductive seeds, according to the Somarāja, it is possible to see how biomedical notions of
“hormones” easily fit within this picture.
Lastly, to substantiate this view, she quotes the following from Ancestral Advice: “The
essences of the elements, through causes and conditions, spread everywhere in the body, going to
the internal organs—but mostly, it is explained, as going to reside in the ovaries [or testes].” 382
This final note leads to the topic of the nature of ovary as a vessel of the reproductive seed. That
subject is found in the following section of her second chapter.
In this section, Mingji Cuomu explains the “white and red drops to be the innermost
essence of the seven bodily constituents that cause rebirth.” 383 In the first, and shorter part, she
establishes the Tibetan perspective on the origins of the male and female reproductive bodies
through the Tantric text, the Secret Vajra Body by Yangönpa Gyeltsen Pel. Through this work she
outlines the Tibetan conception of rebirth, embryology, and the functioning human body through
381
bad kan tshim byed mgor gnas shing / dbang po lnga dag yul gzugs sgra dri ro reg bya sogs la ‘jug
pa’i skabs tshim par byed nus pa bzhin / lus dbang gi bde ba thabs shes zung du sbyor ba’i bde ba yang
de nas smin pas / khams dkar dmar gyi thog ma’i ‘byung gzhi de nyid bad kan tshim byed kyi byed las
dang nye bar ‘brel, Sman skyid mtsho mo, Mo nad phal pa’i nad la zhib ’jug dang gso bcos kyi nyams
yig, 66.
382
khams kyi dwangs ma lus zungs thams cad la rgyu rkyen gyi tshul du khyab pas don snod de la’ng
gnas mod lhag par bsam se’u nang du gnas par bshad, ibid., 66.
383
khyad par skye ba’i rgyu lus zungs bdun gyi yang snying thig le dkar dmar la dpyad pa, ibid., 63.
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the lens of the vajra body of winds, channels, drops and cakras. What she establishes is that men
and women have inherent “self-natures” (rang bzhin) that manifest the separate but
interconnecting male and female genitals and reproductive organs. It is through the meeting of
these genitals, which she euphemizes through the Buddhist symbol of means and wisdom, that
human beings can reproduce. Importantly, she uses a Tantric text as an authoritative source on
the material human body to show that the subtle body of Tantra has relevance in modern-day
Tibetan medicine.
In the next, and longer section, Mingji Cuomu draws on these four authoritative medical
sources, Four Treatises, Eight Branches, Somarāja and Ancestral Advice, in order to illuminate
the white and red drops, where they originate, their composition, how they produce changes in
the body, and their role in reproduction. Through these authoritative works, she enables a
teaching of the system of digestion, wherein the separation of refuse from the essence produces
and maintains the seven bodily constituents.
According to the authoritative sources the seventh bodily constituent is the reproductive
fluid. The fluid is derived from the “brain marrow” or the “brain [understood as] marrow” (klad
gzhung) which itself is derived from the marrow forming the the sixth bodily constituent. Here,
Mingji Cuomu implicates the role of the brain as a causal factor in the creation of the
reproductive seeds and their ability to conceive a baby.
Also implicated by the brain, Mingji Cuomu asserts, is the central role of the satisfying
phlegm in affecting the reproductive drops. She writes that the satisfying phlegm, which aids the
brain in apprehending objects of the five senses, allows for the pleasurable sensations brought
about by sexual activities, which in turn, ripen the reproductive seeds. She also finds support for
the role of the brain in producing the reproductive seeds in the vajra body, specifically the cakra
at the ‘chamber of Brahma’ located at the crown of the head.
Her last point, from Ancestral Advice, summarizes the section well, stating that the
essence of the elements of consumed food and drink spread everywhere in the body, most
notably, to the ovary, the focus of the following section.
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2.8 The Function of the Ovary in Relation to the Reproductive
Seed
This part of the thesis examines the second and third segments of the second section of
the second chapter. The second segment is titled “Examination of the definition of the ovary”384
and the third is titled, “Way of identifying the bsam se’u (testes and ovaries) as a sense faculty by
researching each of its functions.” 385 The second segments deals exclusively with the Tibetan
description of the ovary and its functions. The third segment directly translates biomedical terms
involving hormones and provides the concomitant Chinese characters in several places. This is
also where she gives details of specific hormones and glands and how they function to impact the
ovary.
In Tibetan medical thought, the term bsam se’u can refer to either the female ovaries or
the male testes. In the general description below, Mingji Cuomu implies the reproductive vessels
of both sexes. However, in the third segment, she narrows in on their specifically separate
functions. At the beginning the second segment, Mingji Cuomu describes briefly the Tibetan
medical understanding of the “ovary [and] testes” (bsam se’u):
Generally speaking, the so-called ‘ovary [and] testes’ is one of the six hollow organs. It
ripens the white and red elements and is also able to directly ‘grasp’ owing to its being an
accumulating vessel. The constant circulation of the seven bodily constituents is what
allows the white and red drops to ripen. Whether or not [the drops] have the opportunity to
accumulate depends upon the transformations of their function. For example, by the time
ordinary men and women pass the age of fifty, the “vital essence” (bcud) of the bodily
constituents is finishing, and by becoming exhausted there isn’t the opportunity for the
gathering of the white and red elements, and the capacity to ripen is diminished. 386
Owing to the constant replenishing process of digestion, the essences of the seven bodily
constituents circulate throughout the body and cause the ripening of the reproductive fluids.
384
bsam se’u yi nges tshig la dpyad pa, ibid., 66.
385
dbang rten so so’i byed las la dpyad nas bsam se’u yis ngos ‘dzin bya tshul, ibid., 67.
386
spyir na bsam se’u zhes pa snod drug gi ya gyal zhig yin te / khams dkar dmar smin zhing gsog
snod dngos la ngos ‘dzin chog kyang / lus zungs bdun gyi ‘khor bskyod las thig le dkar dmar gnyis smin
zhing gsog par byed pa’i skabs yod med dang yang na byed las la ‘gyur ba phyin yod med dang bstun
dgos te / dper na / skyes pa’m bud med nar ma son pa’m lo na lnga bcu las yol tshe lus kyi zungs bcud
yongs su ma rdzogs pa’m nyams par gyur paskhams dkar dmar gsog pa’i skabs med pa’m smin par byed
pa’i nus pa nyams pa dang, ibid., 66.
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These fluids reside in the reproductive “vessels” (snod) of both sexes. The ovary (and testes)
‘grasps’ and ‘ripens’ the seed (whereas, the uterus ‘grasps’ and ‘grows’ or ‘ripens’ the
fetus).Whether or not someone has the ability to reproduce depends upon the ability of the
digestive system to produce “vital essence” (bcud) from the essences of the body’s constituents.
Hence, the first requirement of men and women is that they need to be of reproductive age to
conceive a child, but other factors, such as nutrition also play a role.
Mingji Cuomu continues her description of the bsam se’u by closing in on the ovary and
its ability to cause the monthly transformations of the menstrual cycle, or in other words, to ripen
or prepare the egg for conception. She writes:
In the case of women’s bodies, after grasping the seed for the body, the “innermost
essences” (nying bcud) of the body necessarily nurture and grow the child, and the
circulation of the seven bodily constituents gradually comes into being. And, although it
seems a bit odd, if the ovary is identified as being one and the same as a “sense
faculty” (dbang rten), it is owing to its being the causal reason for planting the
transformations that result from the [cyclical process of] gathering and accumulation of the
red element before the pregnancy.387
The reason that Mingji Cuomu suggests that it “might seem a bit odd” (cung ‘tshams po med par
mthong) to call the ovary or testicle a “sense faculty” (dbang rten) is because according to
Tibetan Buddhist and medical thought, this term normally refers to the five sense “organs” or
“faculties” that underlie the ability to see, hear, smell, touch, and taste. In some accounts, there
are six sense faculties if one were to include the “consciousness” (rnam par shes ba), that is, the
thinking mind that interprets the information being absorbed by the other five faculties.
Normally, the ovary and testes would not be considered as one among these sense faculties, but
Mingji Cuomu argues in the next few pages that they ought to be considered as being
functionally a sense organ, if not in name.
Mingji Cuomu explains that the category of “sense faculty” applies to the ovaries and
testes is because they are a unique vessel of the body:
387
yang na bud med kyi lus la las kyi sa bon ‘dzin rjes lus kyi nying bcud dag gis byis pa gso skyed
byed dgos pas / lus zungs bdun gyi ‘khor ba la ‘gyur ba rim can byung zhing / khams dmar smin gsog gi
brgyud rim de sbrum ldan gyi gnas stangs las ‘gyur ba thebs pa bcas kyi rgyu mtshan la gzhigs nas dbang
rten gcig kho nar mtha’ gcig tu bsam se’u la ngos ‘dzin byas na cung ‘tshams po med par mthong, ibid.,
66–67.
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The so-called bsam se’u possesses special characteristics that make it particularly unique
from other vessels. The white and red elements are the principal elemental sources that
ripen [in the ovary] dependent upon the power of the wind dynamic. The power of that
wind naturally changes in accordance with the necessities of the body, and likewise,
according to the activities of the ovary. [The wind] is the cause for the transmigratory
being to be transferred [into the womb] (at the time when a woman is pregnant). Because
of these reasons, the ovary could be considered to be the same as a ‘sense faculty,’ but
according to scripture and reason it would be considered a little bit unacceptable, and
owing to that, the conventional label of bsam se’u, that is, through the perspective of its
function [and activities], is asserted. 388
According to Mingji Cuomu there are a few reasons that the testes and ovary can be considered a
unique kind of vessel. The testes and ovaries ripen the white and red reproductive seeds which
contain all of the “principal elemental sources” (gtso bo ‘byung ba), meaning the elements of
earth, water, fire, wind and space—that make up the child’s material body. This is all made
possible by the wind dynamic, which moves and circulates the body’s substances throughout all
the parts of the body.
The wind is the motile mechanism that allows the ovary to gradually transform and ripen
the egg. It is also the wind that carries the consciousness of the transmigrating bardo being to the
fertilized egg. Because the ovary and testes are both the support and mechanism by which the
essence of the white and red elements become matured, they provide the principal elemental
sources for the fetus should conception occur. Therefore, the testes and ovary support the
ripening of the elements of life, which underlie the other sense faculties. Hence, Mingji Cuomu
asserts that the testes and ovary functionally can be considered as being the same as the
normative Buddhist understanding of the five (or six) sense faculties.
Here too, Mingji Cuomu makes a rare concession that the Buddhist sources disagree with
the medical understanding of the body in relation to the above. Although identifying the testes
and ovaries as a sense faculty seems a bit odd in Tibetan Buddhist thought, she argues that we
should understand the bsam se’u to be as such. In the next passage she asserts that the etymology
388
bsam se’u zhes pa ‘di snod gzhan dang mi ‘dra ba’i dmigs bsal gyi khyad chos ldan te / khams dkar
dmar gnyis ni gtso bo ‘byung ba rlung gi nus pa la brten nas smin gyi yod pa dang / rlung nus de yang
zungs kyi dgos mkho ltar ‘pho ‘gyur ‘gro yi yod cing bsam se’u yi byed las yang de dang bstun nas ‘phos
(bud med sbrum ldan skabs) ‘gro ba’i rgyu mtshan gyi / dbang rten gcig kho na la bsam se’ur ngos ‘dzin
byas na lung rig gnyis ka nas mi ‘thad pa’i rgyu mtshan la gzhigs nas bsam se’u zhes pa’i tha snyad de
byed las kyi sgo nas btags par ‘dod, ibid., 67.
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of the term itself reveals that functionally speaking, it is a sense faculty even if it is known
conventionally as “testes and ovaries” (bsam se’u). She concludes the second segment by
writing:
The term, ‘bsam’ signifies that it produces the elemental nature of the six senses of the
consciousness. And, the term, se’u, means something that is small. Each person’s rebirth in
samsara is owing to the power of previous lives, and therefore, [such a rebirth is]
connected with the ability to propagate the family lineage. Hence, [it is worthwhile to]
consider designating the bsam se’u as one of the sense faculties based on its function to
gather and ripen the white and red elements, which are the innermost essences of the seven
bodily constituents.” 389
Thus, Mingji Cuomu asserts that the term for the ovary and testes itself defines their function as
one of the body’s sense organs. In the cases of the ovaries and testicles, their name “bsam se’u”
means that they are small vessels that ripen and produce the elemental nature of the “six sense
consciousness,” or the “six aggregates of consciousness” (rnam par shes pa tshogs drug).
Consequently, Mingji Cuomu reasons that because the bsam se’u ripen and mature the elemental
nature, and are vital in producing the consciousness, the ovaries and testes should be considered
as one of the sense organs.
The third segment, “Way of identifying the testes and ovaries as a sense faculty/endocrine
gland by researching each of its functions”390 is divided into five short pieces. These are: “The
main and subsidiary branches of the virility [organs] in men” (skyes pa’i skye ‘phel ma lag),
“The main and subsidiary branches of the fertility [organs] in women” (bud med kyi skye ‘phel
ma lag), “Examination of the connections among the sense organs/endocrine glands” (‘brel yod
dbang rten bzhan la dpyad), “The special changes that occur during pregnancy” (sbrum ldan gyi
gnas skabs su dmigs bsal gyi ‘gyur ba), and lastly, “Summary in regards to the definition of the
ovary” (bsam se’u yi ngos ‘dzin skor mjug bsdu ba).
389
bsam zhes pa rnam par shes pa tshogs drug gi bdag nyid kyi byed pa dang / se’u zhes pa chung
ngu’i don la sbyar te / ‘khor ba’i rgyun du rang rang gi sngon gyi las dbang dang rjes su ‘brel ba’i rigs
brgyud rgyun chad med par spel ba’i nus pa ldan zhing / lus zungs bdun gyi yang snying khams dkar
dmar gnyis smin zhing gsog pa’i byed las sgrub nus pa’i dbang rten dag gi ming la bsam se’u zhes brjod
‘dug snyam, ibid., 67.
390
dbang rten so so’i byed las la dpyad nas bsam se’u yis ngos ‘dzin bya tshul, ibid., 67.
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The first two pieces examine the anatomical and functional features of the male and
female reproductive organs respectively. The third piece looks at the system of endocrinological
glands. The fourth piece outlines the unique anatomical, functional and endocrinological features
of the pregnant body, and within this, includes a large portion that is subtitled, “That which is
infused with the inner secretions” (nang gi zags thon nus pa ldan pa) in which the so-called
pregnancy hormones are discussed. In the last piece, Mingji Cuomu summarizes her account of
reproduction according to the authoritative sources of her native tradition.
Combining Tibetan medical and Chinese biomedical thought, the first piece, “The main
and subsidiary branches of the virility [organs] in men,” presents male reproductive anatomy.
Together, they give a more detailed picture of the testicle and its primary function which is to
ripen the white element, and emit the ‘masculine’ hormone. Notably, this is a rare instance where
male anatomy in relation to endocrinology is examined. (Normally, women are the subject of
research into hormones in Tibetan medical works on human reproduction.) The following
passage is the first piece in its entirety:
The body parts of the man’s genitals have two divisions: displayed and hidden. The
‘invisible’ or ‘inner growth’ parts are principally the testicles and the circulatory paths [that
facilitate the movement] of the white element, and, connected to these, three glands.
The “testicle” ((") 391 has the power to establish the white element, and emit the
hormone, “androgen” (), which causes the arousal of the self-nature of method
[masculinity]. The ability to store [and] protect the white element, as well as to completely
ripen and become that very core nutrition [of the fetus’ body] is allowed by the combined
activities of the three: the “epididymis” (()392 which is the circulatory path for the white
element, the “sperm duct” [also known as the “vas deferens”] () and the “ejaculatory
duct” (). Together, the sperm duct and the ejaculatory duct have the ability to give
vent to the white element. 393 Connected to these are the three chief glands: the “gland of
391
In this and every instance in this thesis, the Chinese characters brackets are used in the original
source.
392 According
to biomedicine, the epididymis is a whitish mass of tightly coiled tubes cupped against
the testicles. It acts as maturation and storage space for sperm before they pass into the vas deferens (also
known as the sperm duct) that carry sperm to the ampullary gland and prostatic ducts.
393
There is a variation in spelling for the sperm duct: khams ‘dren sbu gu and, in the second instance:
khams drangs sbu gu. Their difference lies in the temporal aspect of the verb to ‘draw’, ‘pull’ or ‘induce’
or ‘offer.’ Further, in the following section on women’s reproductive organs, khams‘dren sbu gu is used to
refer to the oviducts.
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the seminal vesicle” ( #), the “prostate gland” ( #), 394 and the “bulbourethral
gland” ( #), which together with “[seminal] alkaline” (&) establishes the
reproductive fluid of men from the mixing of the white element with the emissions of the
of the reproductive hormones. The outer marks of virility are chiefly the two, the penis and
the scrotum, as they are commonly known. 395
There are a number of important points worth mentioning about Mingji Cuomu’s shared Tibetan
medical and biomedical description of the testicle.
According to Mingji Cuomu, the “testicle” (sgong ‘bras) performs two functions. The
first is to “establish,” “accomplish” or “cultivate” (sgrub)396 the white element, meaning to
prepare the white seed to go out and fertilize the female seed. The second function is to emit
“androgen,” a biomedical hormone thought to produce and maintain the masculine,
“method” (thabs), features of the male body, including the development and ‘management’ of the
genitalia. As such, the testicle is understood as one of the organs of the endocrine system in that
it produces and transmits a specific hormone which causes transformations at various sites of
action throughout the body, including within the organ itself.
Mingji Cuomu indicates and describes the ‘male hormone’ in the following way: “thabs
kyi rang bzhin gyi skul rgyu () zags ‘don bya.” Thabs means “method,” and in this specific
context, implies the masculine element, in reference to the Buddhist symbolic pairing of wisdom
394 According
to biomedical thought, the prostate gland’s function is to add vital nutrients and fluid to
sperm.
395 skyes pa’i skye ‘phel mtshan ma la lus khams kyi phyir mngon pa dang mi mngon pa’i dbye ba
gnyis / phyir mi mngon pa’m nang gi skye ‘phel mtshan ma la gtso bo sgong ‘bras dang / khams dkar
rgyu lam / ‘brel yod gsher rmen bcas gsum / sgong ‘bras ((") su khams dkar grub nus shing thabs kyi
rang bzhin gyi skul rgyu () zags ‘don bya’o / khams dkar rgyu lam la sgong zur (() dang / khams
‘dren sbu gu () / khams dbyung sbu gu () bcas gsum du dbye ba las sgong zur du khams dkar
nyar tshags bya nus shing de nyid bcud can du gyur nas legs par smin bcug pa / khams drangs sbu gu
dang khams dbyung sbu gu bcas kyis khams dkar phyir ‘byin par nus so / ‘brel yod gsher rmen la gtso bo
gsum yod de / khams dkar snod kyi gsher rmen ( #) dang / mdun chags rmen bu ( #) / gcin lam
gsher rmen ( #) bcas gsum las cung zad bul shas (&) ldan pa’i gsher khu zags don bya ba de
khams dkar dang ‘dres nas skyes pa’i khu ba grub bo / phyi’i skye ‘phel dbang po la gtso bo pho mtshan
dang gsang sgro gnyis yod pa kun gyi shes gsal ltar yin, ibid., 68–9.
396
Rangjung Yeshi, s.v. “sgrub.” For a good description of the term, “sgrub” in relation to medicine
and Tibetan Buddhist ritual see: Garrett, “The Alchemy of Accomplishing Medicine (sman sgrub),” 209–
10.
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(women) and method or means (men). Rang bzhin (like we have seen) refers to something’s or
someone’s inherent or definitional “self-nature.” Mingji Cuomu’s noun phrase, skul rgyu, is an
innovative term which she translates as “hormones.” Skul is a verb which means to “arouse,”
“entreat” and “incite,”397 and coupled with rgyu, meaning to “cause” implies “causing to arouse”
or “incite.” Hence, Mingji Cuomu’s word for “hormones”—“that which causes to arouse
[changes]”—focuses on their ability to act as chemical messengers that cause other organs and
parts of the body to function in particular ways.
The Chinese characters, indicate that the specific hormone, “androgen” is meant.
Mingji Cuomu does not translate androgen into Tibetan. Zags means to “dissipate,” “drop,”
“leak” or “flow downwards” 398 and ‘don translates to “elicit,” cause to emerge” and “eject.”399
Bya is a wide-ranging verb generally meaning “to do,” “to make” or “to perform.” Therefore,
Mingji Cuomu’s phrasing to indicate “hormones” in relation to the testicle is that “the testicle
emits the hormone androgen, which causes the arousal of the self-nature of method.”
Significantly, she writes that it is androgen that compels or causes to emerge the “self-nature of
method” (thabs kyi rang bzhin), or in other words, androgen is implicitly a ‘male hormone.’
In the case of male reproductive anatomy, Mingji Cuomu uses both the Chinese
biomedical terms (in brackets) and Tibetan terms, many of which are being used in innovative
ways or are new medical terms entirely. For example, Mingji Cuomu uses the term, gsher rmen
to refer to biomedical understandings of the “glands,” such as the “gland of the vessel that holds
the white element” or the “seminal vessel” (khams dkar snod kyi gsher rmen), and the
“bulbourethral gland” (gcin lam gsher rmen).
The term gsher rmen, while having andecents in Tibetan medical thought, is a
contemporary idea. The first part, gsher translates into English as either “moisture,” “liquid” or
“wetness.”400 Rmen bu, while present in the Four Treatises, has a modern usage that typically
397
Ranjung Yeshi, s.v. “skul.”
398
Rangjung Yeshi, s.v, “zags.”
399
Rangjung Yeshi, s.v, “‘don.”
400
Rangjung Yeshi, s.v, “gsher.”
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indicates the “glands” or “nodes.” The term, gsher rmen, literally meaning something like the
“wet glands” is (as far as I know) a contemporary innovation that specifically identifies certain
glands of the reproductive and endocrine system. She also uses the term rmen bu, to name the
“prostate gland” (mdun chags rmen bu), which once again is a contemporary Tibetan medical
term used to describe a specific biomedical idea.
Lastly, Mingji Cuomu uses another term, gsher khu to indicate the “reproductive” (khu)
hormones of the “endocrine glands” (gsher). Like her earlier term for hormones, skul rgyu, she
uses similar phrasing to describe the actions of the hormones: gsher khu zags don bya ba, that is,
“the emission of the endocrine (or reproductive) hormones.” She asserts that the mixing together
of the white element with hormones, together with the male reproductive glands and anatomy
establishes the reproductive fluid in men. Mingji Cuomu does not elaborate on the outer marks of
the male, that is, the penis and scrotum, because they don’t necessitate a discussion of hormones.
Mingji Cuomu then writes about female reproductive anatomy in the following segment:
The inner reproductive anatomy includes the two ‘great channels to the right and left of the
uterus,’ together with their related gland, the “ovary” (%$),401 the “oviduct” (%),
“uterus” () and the “vagina” (). The source of the red element is the gland related
to the two, right and left fallopian tubes. Having the self-nature of wisdom, the hormone
“estrogen” (') is emitted [from the ovary]. The oviduct gives vent to the red element
and is the path that grasps the white element. The uterus is the support of pregnancy, and
likewise is the place where menstruation comes from. The vagina is the pathway for the
fetus, and the pathway for menstruation. 402
Here, the “two large channels to the right and left of the uterus” (bu snod rtsa chen g.yas g.yon
gnyis) is most likely referring to the “fallopian tubes” as understood in modern biomedicine.
However the precise meaning of the expression is unclear and has been a source of debate
401 Curiously, the general Tibetan word for the ovary or testes, bsam se’u, is not given, but only the
Chinese character, which specifies the “ovary” in brackets.
402
nang gi skye ‘phel mtshan ma la bu snod rtsa chen g.yas g.yon gnyis dang ‘brel ba’i gsher rmen
dang (%$) / khams ‘dren sbu gu (%) bu snod () / mtshan lam () bcas so / bu snod rtsa chen
g.yas g.yon gnyis dang ‘brel ba’i gsher rmen las khams dmar ‘byung zhing / shes rab rang bzhin gyi skul
rgyu (') zags ‘don byed pa dang / khams ‘dren sbu gus khams dmar phyir ‘byin pa dang khams dkar
‘dzin pa’i rgyu lam yin pa / bu snod kyis mngal ‘dzin skyong bya zhing dus babs ltar zla mtshan ‘bab pa /
mtshan lam ni phru gu skye lam dang zla mtshan ‘bab lam yin pa, Sman skyid mtsho mo, Mo nad phal
pa’i nad la zhib ’jug dang gso bcos kyi nyams yig, 69.
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amongst Tibetan medical scholars since the tradition’s early days.403 In other contexts, including
further in this second chapter of Mingji Cuomu’s work, the ‘two great channels’ refer to the
pathways between the adrenal glands on top of the kidneys and the ovaries.
Mingji Cuomu uses the same term for “hormone,” skul rgyu, as she did earlier in the
section on male bodies. The word for “estrogen” is indicated by its Chinese characters and is not
translated into Tibetan. She also indicates that the ovary is a gland of the endocrine system, even
though its descriptors rmen bu and gsher rmen are are not used to make such a connection.
Mingji Cuomu then explains that the ‘outer mark’ of the man has the self-nature to fit
with the ‘inner mark’ of the woman. The ‘inner mark’ of the woman is her physical self-nature.
In other words, the penis and vagina manifest to fit one another.
Mingji Cuomu concludes the second segment with the reiterated observation that “both of
these, [the ovary and the testicle] possess the ability to directly mature and gather the white and
red elements.”404
In the third part, “Examination of the connections among the sense organs/endocrine
glands” (‘brel yod dbang rten bzhan la dpyad), Mingji Cuomu begins as follows:
Furthermore, for all that to occur, about which I have been writing, it is [made possible] by
the power of being connected with the solid organs, which are the adrenal glands (#)
on the top of each of the right and left kidneys. It is from the adrenal glands that the male
and female hormones are emitted. Those hormones are able to have the effect of
supplementing the maturation of the white and red elements.405
Here, Mingji Cuomu points to the connection between the adrenal glands (of the endocrine
system) that rest on the solid or vital organ of the kidneys, and the reproductive fluids. She writes
that it is from these glands, that the “male and female hormones” (pho mo’i skul rgyu) are
403
See: Gyatso, Being Human in a Buddhist World, 315–16.
404
‘di gnyis su khams dkar dmar dngos su smin zhing gsog pa’i nus pa ldan pa’i phyir ro, Sman skyid
mtsho mo, Mo nad phal pa’i nad la zhib ’jug dang gso bcos kyi nyams yig, 70.
405
gong gi ngos ‘dzin phud gzhan yang don snod gyi ‘brel ‘byor dbang gis mkhal ma g.yas g.yon gnyis
kyi steng du gsher rmen (#) re yod pa dang / de dag las pho mo’i skul rgyu zags don byed cing / skul
rgyu de yis khams dkar dmar smin par ram ‘degs kyi nus pa thon thub, ibid., 70.
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emitted. Further, it is these male and female hormones that “supplement” (ram ‘degs) the
maturation of the white and red elements. Like her contemporaries, Mingji Cuomu asserts that
hormones are related in some way to the white and red elements. For her, hormones both mix
with and act upon the white and red elements. The hormones are not, as other researchers
suggest, equivalent to or the same as the white and red elements.
Here too, it is clearer that Mingji Cuomu intends to align the “endocrine glands” (gsher
rmen; rmen bu) of the biomedical system with Tibetan understandings of the ovaries and the
testes understood as “sense organs” (dbang rten). Mingji Cuomu asserts that the functions of the
ovaries and testes are to mature the white and red elements, and thereby produce the reproductive
seed which becomes the basis for life, that is, the underlying elemental and organizational grid
for the other sense organs. Dove-tailing with biomedical thought, her presentation of hormones is
that they act as a kind of chemical messenger that causes other organs and glands to perform
their functions. “Hormones” incite and support many of the necessary functions for life, and
most importantly, reproduction. It would make sense then, to view the “ovaries and testes” (bsam
se’u), understood as the endocrine glands of biomedicine, as being in function, if not in name, a
kind of “sense organ” (dbang rten). As we shall see, she summarizes her viewpoint on this at the
conclusion of these parts.
Continuing, Mingji Cuomu makes the case that the biomedical notion that the adrenal
glands produce hormones that affect the maturation of the reproductive fluids can also be found
in the authoritative works of the Tibetan medical system. She demonstrates this primarily
through the Four Treatises and Somarāja. She writes:
From page four hundred and thirty four of the Oral Instruction Tantra: “There are fourteen
upper and lower joints surrounding the ovary.” Based on those measurements then, there
are thirteen joints underneath the kidney, and the glands on the top of each of the kidneys
are the upper boundary. It is this gland (which does the function of emitting the hormones
which have the self-nature of wisdom) that by producing the auxiliary power to ripen the
white and red drops, makes them suitable to be grasped by the ovary. From the Somarāja:
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The activity of the so-called ovary is to be a vessel into which drops drip. Its size depends
upon its distension. [The one that] coils to the left of the navel is connected to the left
kidney. 406
Mingji Cuomu asserts that long before twentieth-century science established the relations among
the adrenal glands on the tops of the kidneys, the thirteen “joints” beneath them, and the ovaries,
the Four Treatises, Somarāja and presumably other authoritative works, implicitly knew of this
connection. For this reason, research into biomedical understandings of the “hormones” and their
links to the endocrine glands can only serve to confirm and enhance Tibetan medical knowledge
about the reproductive body.
The fourth segment is concerned specifically with the changes that occur in the woman’s
body to accommodate and develop the fetus during pregnancy. The first half details Tibetan
understandings of these processes. The second half, sub-titled “Power of inner secretions” (nang
gi zags thon nus pa),407 targets the biomedically understood hormones as integrated within an
overall Tibetan framework of the white and red elements. Beginning from the second half,
Mingji Cuomu writes:
Early pregnancy is successively supported by secretions from the “chorion membrane” (
) through the “trophoblast cells” ( ) which have their origins in the glands
[that affect] growth and development. For this reason, the glands which are connected with
the big channels to the right and left of the uterus [that is, the ovaries], continually
influence the ‘yellow sac,’ the “corpus luteum” () that is produced inside of them. All
of these are able to continue and maintain the pregnancy. Another aspect which
successively supports [the pregnancy] is the hormone “estrogen” (') which has the
self-nature of wisdom, and as a pregnancy hormone, directly causes the thickening of the
406
man ngag rgyud shog grangs 434 nang / bsam se’u tshigs pa bju bzhi’i mtho dman mtshams su
gnas yod la / de’i steng gi tshod dam tshigs pa bcu gsum gyi ‘og na mkhal ma’i steng du gsher rmen re
yod pa de’i gnas mtshams yin pa dang / gsher rmen (shes rab rang bzhin gyi skul rgyu zags ‘don bya ba)
‘dir yang thig le dkar dmar smin par ram ‘degs kyi nus pas thon gyi yod pas bsam se’ur ngos ‘dzin byed
rung ste / sman dpyad zla ba’i rgyal bo las / bsam se’u zhes bya’i ‘dzag snod de / che chung byed pa
skrangs pa ‘dra / lte ba dag nas g.yon du ‘khyil / mkhal ma g.yon pa dag dang ‘brel, ibid., 70.
407
Ibid., 73.
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“decidua” () on the inside of the uterus thus becoming the support for the
pregnancy. 408
In this description of the reproductive body during pregnancy, Mingji Cuomu refers almost
entirely to biomedical understandings of the hormones, cells, and glands. In this passage, her
only direct mention of the Tibetan system is her re-assertion that estrogen is the “hormone with
the self-nature of wisdom” (shes rab rang bzhin skul rgyu). As in the earlier sections on
reproductive anatomy, Mingji Cuomu uses the term skul rgyu as a general biomedical term for
“hormones,” and gsher rmen for “glands.” And, as in other places, Mingji Cuomu does not fully
translate biomedical terms. She provides a general Tibetan word, usually a new term or reinterpretation of an old one, for a category of things, such as “hormones” or “glands,” and uses
Chinese biomedical characters to specify exactly which one is meant. For example, as seen in the
above, she translates “cells” into the Tibetan “phra phung” but specifies, solely through the
Chinese characters, that these cells are “trophoblast cells.” The word for “cells” is a
contemporary term that re-interprets or expands Tibetan medical ideas. Phra refers to something
very fine and subtle, and phung is short for phung po, an “aggregate.” Hence, the Tibetan
translation of the biomedical term for “cells” literally means “a very fine or small aggregate.”
Similarly, “yellow sac” (ser gzungs) is a modern term that is meant to correspond to the
biomedical idea of the “corpus luteum.” The “corpus luteum” is the hormone-secreting sac that
develops the egg and gradually perishes after the egg is released from the ovary and moves
through the fallopian tubes.
As is evident in the above passages, Mingji Cuomu addresses two important objectives.
The first intention is that of integrating Tibetan medical and biomedical knowledge about the
body. The second goal is to show that Tibetan medical texts demonstrate knowledge similar to
modern biomedicine.
sbrum ldan snga dus su ‘tsho skyong rim can phra phung ( ) nas spu phran phyi lpags (
zags thon byas te skye ‘phel gsher rmen byung ba dang des bu snod rtsa chen gyas gyon dang ‘brel
ba’i gsher rmen nas byung ba’i nang gi ser gzungs () mu mthud gnas par shugs rkyen thebs pa / de
dag gis mu mthud sbrum ldan du gnas par srung ‘dzin dang rgyun ‘khyongs thub pa / gzhan yang ‘tsho
skyong rim can phra phung nas shes rab rang bzhin skul rgyu (') dang sbrum rgyu zags don byed pa
ma zad bu snod kyi nang lpags () mu mthud mthug tu ‘gro rgyu dang sbrum ldan du gnas par ‘gan
srung byed pa, ibid., 73.
408
)
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Mingji Cuomu asserts that knowledge about “hormones” and the “glands” of the
endocrine system can be established in a range of medical and Buddhist texts, and concludes this
part with the following:
It is clearly evident from what has been written that the principal source of the [nutritional]
essence for the fetus is the placenta. Moreover, the connection between the white and red
drops and the glands [that cause] their growth and development is through the secretions of
the hormones that have the self nature of wisdom; by having all of these factors explained,
[it is clear that] during pregnancy, the ovary influences the development of the uterus. The
authoritative texts of our tradition are capable of establishing and showing similar
knowledge.409
In the above summary, Mingji Cuomu indicates that it is the secretions of the hormones that
cause the glands to ripen and to develop the red and white elements. She further reasons that
during pregnancy, secretions of hormones acting on the ovary cause the changes that the uterus
undergoes to grow the fetus. Clearly, she views estrogen as a female hormone, phrasing it as that
hormone which manifests the self-nature of wisdom. Finally, she points to the overarching
assertion and goal of her work as a whole, which is to show that the authoritative literature of
Tibetan medicine (and Buddhism) both show and predate similar insights of modern medicine.
Therefore, she asserts that research into the scholarly texts of Tibetan medicine and Tantra yield
a reliable source of ‘scientific’ knowledge about the body.
In the final part of this chapter, “Summary in regards to the definition of the
ovary” (bsam se’u yi ngos ‘dzin skor mjug bsdu ba) Mingji Cuomu quotes extensively from the
Somarāja to show the relations among the ovary, uterus and the “root quintessence of the
seed” (sa bon bcud kyi rtsa).410 Her summary of this final part ties together her assertion that the
Tibetan tradition can demonstrate the relations among the glands, the hormones, the reproductive
organs and the reproductive seeds. She writes:
409
zhes bkod ‘dug / gong gi ‘grel bshad las mngal gnas kyi dwangs ma’i ‘byung khungs gtso bo sha
ma yin pa gsal bar ‘grel yod cing / lhag par du thig le dkar dmar dang ‘brel ba’i skye ‘phel gyi gsher
rmen rang bzhin shes rab rang bzhin gyi skul rgyu zags ‘don byed pa sogs kyi rgyu mtshan dag la brten
nas sbrum ldan gnas skabs su bsam se’u yi nus pa bu snod du ‘phos yod pa de rang re’i gzhung lugs su
bstan pa bzhin rig pas sgrub thub pa’o, ibid., 73–4.
410
Referencing an article by Lhamokyi, the expression, “sa bon bcud kyi rtsa” will be examined in
more detail in the following chapter of this thesis.
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Within its normally understood context, the meaning of what has been written [in
Somarāja] is this: In human beings, the egg is recognized as being connected to the gland
at the top of the kidneys. In women, the gathering of the root quintessences of the seed at
the thirteenth joint411 is connected with the female genitals. This means that the glands that
are connected with the large channels to the right and left of the uterus are understood as
the glands at the top of the kidneys. 412
In this summary, Mingji Cuomu asserts that the “large channels connected to the right and left of
the uterus” can be understood as the adrenal glands which, according to biomedical thought,
produce the androgens that respectively can be converted into estrogen and testosterone in the
ovaries and testes. Therefore, she is showing how the Tibetan texts can establish the
endocrinological connections among the adrenal glands, ovaries, testes, and the egg and the
sperm.
Mingji Cuomu further summarizes and concludes that according to the authoritative texts
of the Tibetan tradition, it can be established that the ovary and the testes have the power to
gather and ripen the white and red elements by nature of their being connected to the “endocrine
glands” (skul gsher), which she asserts could be understood as being the same in function as the
Tibetan medical and buddhist notion of the “sense organs” (dbang rten). She reiterates that the
particular changes that happen to the uterus before and during pregnancy, that is, the regular
menstrual cycle versus gestating a fetus, depend upon the secretions of the hormones from the
ovaries. She writes: “The so-called ovaries and testes are connected to the sense organs and
glands by nature of possessing the ability to gather and ripen the white and red elements
according to their fluctuations.” 413 Lastly, she writes that this conclusion is in keeping with the
“quintessential teachings of scripture and reason” (lung rig man ngag). 414
411
Keep in mind, the “thirteenth joint” is the “adrenal gland,” according to Mingji Cuomu.
412
zhes gsungs pa’i don las rgyun ldan gnas skabs su skyes pa la sgong ‘bras dang mkhal ma’i steng
gi gsher rmen la ngos ‘dzin zhing / bud med la tshigs pa bcu gsum pa nas sa bon bcud kyi rtsa rnams ‘dus
nas mo yi mtshan mar ‘brel ba de win par gsungs pa las bu snod g.yas g.yon gyi rtsa chen dang ‘brel ba’i
gsher rmen dang mkhal ma’i steng gi gsher rmen du ngos ‘dzin / mdor na rang re’i gzhung lugs su bsam
se’u yi ngos ‘dzin ni / khams dkar dmar gyi rgyu tshul la gzhigs nas de nyid smin gsog gi nus pa ldan pa’i
‘brel yod dbang rten nam gsher rmen dag la bsam se’u zhes brjod pa, 74–5.
413
khams dkar dmar gyi rgyu tshul la gzhigs nas de nyid smin gsog gi nus pa ldan pa’i ‘brel yod
dbang rten nam gsher rmen dag la bsam se’u zhes…, ibid., 75.
414
Ibid., 75.
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2.9 Final Remarks on Thupten Püntsok’s and Mingji Cuomu’s
Works
Thupten Püntsok’s Knowledge of the Body in Tibetan Medicine and Mingji Cuomu’s
Clinical Experience in Treating Obstetric Diseases have much in common. Central to this study,
both works employ textual research to integrate Tibetan medical and biomedical notions of
“hormones” and the system of “glands” that produce, synthesize and emit them. In this last
section of my second chapter, I highlight some of the similarities between these two works, and
conclude that for both authors, biomedicine and Tibetan medicine can establish independent
insights into the substances known in English as “hormones.”
In their presentation of ‘modern’ Tibetan medicine, both authors are as dedicated to
establishing the authority of Buddhist religious knowledge as they are to adhering to the
‘universal’ tenets of ‘science.’ Thupten Püntsok and Mingji Cuomu both indicate that Buddhism
and medical science share many of the same fundamental truths about the body. This is evident
by their extensive use of both medical and Buddhist (particularly Tantric) texts to establish
contemporary interpretations of the Tibetan medical body. Assertions made about the
transmigrating bardo being, the locations of the cakras and the places of the life-force, and the
gendered pairings of wisdom and means, are but a few examples of the explicitly Buddhist ideas
making their way into Thupten Püntsok’s and Mingji Cuomu’s works. For them, to be modern
and scientific does not mean to be non-religious, and Buddhist thought is a key component in
their books.
Thupten Püntsok and Mingji Cuomu assert that the authoritative Tibetan medical (and
Buddhist) literature can account for (or show similar knowledge to) biomedical perspectives of
the body. They claim that the Tibetan medical tradition has independently established insights
into the material substances known today in English as “hormones,” and the “endocrine glands”
that emit them.
In their books, Tibetan Buddhism and medicine are shown to be without significant
contradiction. Also, biomedicine is presented in such a way as to confirm and to augment the
claims of Tibetan medical literature. It may be said that while biomedicine appears to have been
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recruited into a supporting role, nevertheless and especially in Mingji Cuomu’s work,
biomedicine occupies the central position as the world arbiter of truths about the body. Clearly,
biomedicine is an over-reaching authoritative voice in Thupten Püntsok’s and Mingji Cuomu’s
works. For Tibetan medical experts, credibility and authority is gained by showing that Tibetan
medical and Buddhist knowledge can be seen in ‘modern’ biomedicine. These insights also
contribute to their arguments that Tibetan medicine is a ‘world medicine.’
Both authors agree on certain ‘facts’ integrating Tibetan medical and modern biomedical
reproductive anatomy and functioning. Similar to other contemporary Tibetan sources,
“hormones” are located within the white and red elements (or drops). The white and red
reproductive fluids are established as the seventh bodily constituent, and both Mingji Cuomu and
Thupten Püntsok state that they emerge from the sixth bodily constituent, “marrow,” understood
in its expanded sense as “brain marrow” (klad rkang). Both argue that the textual evidence on
brain marrow points to Tibetan knowledge of the “endocrine glands” in the centre of the brain,
and their relation to the reproductive organs, fluids and cycles. They both agree that the ovaries
(and testicles) mature and emit the reproductive seeds, and further, that the ovary (and testicle) is
a gland of the endocrine system that synthesizes and emits hormones which cause other changes
in the body. Hence, both authors tap into the central pillars of Western endocrinology, the
relationships found among the brain, the endocrine glands, the reproductive organs, the sperm,
the egg, and the hormones, which form the microscopic substances that tie these elements
altogether.
Mingji Cuomu explicitly asserts that hormones, just like the white and red reproductive
elements, organize and activate the masculine and feminine features that manifest in men and
women. According to her, testosterone is the ‘male hormone’ and estrogen is the ‘female
hormone.’ This trend of perceiving the hormones as producing and maintaining the genderspecific bodies of men and women continues in the other sources of this thesis. Thupten Püntsok
is less specific in this regard. Unlike Mingji Cuomu he does not name specific hormones.
Nonetheless, like all contemporary Tibetan authors, he adheres to the functional organization of
the white and red elements in the bodies of men and women. Both authors remain close to the
traditional Tibetan medical view of women’s bodies.
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Present-day authors like Mingji Cuomu and Thupten Püntsok find Tantric works that
focus on the vajra body to be quite useful in thinking about biomedical ideas of hormones and
the endocrine system. One reason is that the language and ideas surrounding “hormones” can be
more easily comparable to the vajra body which is described as being activated by very subtle,
microscopic, but powerful essences (or materials), that are organized along the gendered lines of
the white and red drops. Another reason is that Tantric texts speak to the gender-specific bodies
of men and women, and to the sexual activity between those bodies, which is really at the heart
of reproduction. Here, Bernard Faure’s insights into the relations among gender, purity, and
desire in Buddhism are particularly useful. He argues that the Western scholarly notion of
‘gender’ as an “analytical mode tends to become overly purified, epistemologically but also
morally, severed from its rowdier elements, turning at times into a rather aseptic notion…” He
further writes that it “may have been necessary to detach gender from sex, but the oblivion or
obliteration of sexuality has its own dangers, when the real need is to connect the two (or more)
discourses on women/gender and on sex/sexuality.”415 The contemporary Tibetan medical
sources on women are in large part, although it is normally implicit, about sexuality and the
sexual relations between men and women. Therefore, by looking at the descriptions of hormones
and women’s bodies we are looking not only at the “heart of the differentiating process” in terms
of ‘gender,’ but also at the sexual (and social) relations between genders.
Given that the study of hormones in the West is also heavily invested in the study of sex
(understood as bodies and activities), the Tibetan appeal to Tantric literature that speaks to these
topics is not surprising given Tantra’s sexual elements. Hence, this is why it is important for
contemporary writers like Mingji Cuomu and Thupten Püntsok to position Buddhist Tantric
thought as an authoritative source on the material body. Lastly, as has been noted earlier,
throughout Tibetan medical history, Tantric ideas of the vajra body have frequently been enlisted
to weigh in on medical debates over ambiguous and unclear texts and their interpretations. Thus,
it is perhaps no surprise that notions of the vajra body are a rich resource in today’s debate as to
the nature of “hormones” in the Tibetan system.
415
Bernard Faure, The Power of Denial: Buddhism, Purity, and Gender (Princeton, N.J.: Princeton
University Press, 2003), 9.
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Lastly, we can see in these two works, ten years apart, how the research into the
endocrine system has become more developed in the Tibetan system. While Thupten Püntsok’s
work is somewhat tentative in its inclusion of biomedical ideas of “hormones,” Mingji Cuomu’s
work makes direct Tibetan translations of biomedical words and includes Chinese characters to
specifically name hormones. Yet, neither author ever diverts from the fundamental Tibetan
medical framework of gender-specific male and female bodies or the overall Tibetan Buddhist
world (and universe) view of the origins of human life. Biomedical ideas fit onto the Tibetan
picture in both their works. Both authors present biomedical descriptions of hormones and the
reproductive systems in men and women as within the Tibetan blueprint of the seven bodily
constituents, the white and red elements, and the body’s system of winds, channels and drops.
We will see this trend continue in all of the present-day Tibetan sources.
In the next chapter, I examine two article length works that focus even more narrowly on
how hormones are produced from the relations among the brain marrow, digestion and the seven
bodily constituents, and the reproductive fluids.
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3.
Brain Marrow and Reproductive Fluids: A Case for Interpreting
Hormones in Authoritative Medical Literature
In this chapter I closely examine two present-day Tibetan medical articles that advance
the argument that the Tibetan medical tradition has its own independently established insights
into, and knowledge of, the “hormones” that concern Western endocrinology. The two articles
are premised on textual research and are technical works that extensively reference a range of
authoritative Tibetan medical and Buddhist works. The first article, “Study of Menstruation
within the Body of Tibetan Medicine”416 is published by the Arura medical journal, Chinese
Tibetan Medicine, and written by Lhamokyi. The second article, “Brief Discussion on the
Connection between Reproductive Fluid, Marrow, the Brain and the Ovaries/Testes”417 is by
Gönpokyap from his book of essays, Moonbeam of Delightful Jasmine. This chapter will
examine how each author constructs the Tibetan medical picture of “hormones” through the
authoritative sources of their tradition.
3.1 Lhamokyi on Menstruation
Lhamokyi’s article covers the topic of “menstruation” (zla mtshan) as it is understood in
Tibetan medicine. Although her article contains practical knowledge and advice of the mundane
day-to-day aspects of the menstrual cycle, including the time of its first onset, intimate care and
the appropriate times for sex, Lhamokyi is foremost in making the case that Tibet’s body of
authoritative medical literature can be shown to demonstrate knowledge equivalent to, and
preceding, biomedical notions of “hormones.” Hence, Lhamokyi presents her interpretation of
“hormones” in Tibetan medicine thought through the extensive use of citations from authoritative
sources, starting with the fundamental Tibetan definitions of “menstruation.”
Lhamokyi prefaces her article by defining the term “menstruation” (zla mtshan) and why
it is important for study. She writes:
416
417
Zla mtshan gyi rnam par bshad pa blo chung byis pa'i mgul rgyan, Lha mo skyid, 103.
Khu ba dang rkang klad pa bsam bse’u bcas kyi ‘brel ba’i skor phran tsam gleng ba, Mgon po
skyabs, 238.
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Menstruation is not only a fundamental condition of mature women’s bodies, but it is also
the root and origin of all female disorders such as uterine disease. Because of that, there is
an important need to develop a clear understanding and knowledge of menstruation. 418
Lhamokyi’s definition of menstruation as being a “fundamental condition” (gnas lugs; Skt.
tathātva/tathātā) for women is a common starting place among the present-day Tibetan sources
that introduce the topic of women’s bodies. The term, gnas lugs, variously meaning
“fundamental nature,” “natural condition,” “way of abiding,” “actual situation,” “nature,”
“essence” or “truth” 419 is polysemous in that it allows for a host of possible meanings.
We have already seen in Thupten Püntsok and Mingji Cuomu’s works that the term gnas
lugs is often used in contemporary sources as a way of describing and defining bodies and their
attributes. Herein I examine the term’s historical and philological context because it will help us
to better understand how Tibetan ideas of the basic nature of sexed bodies are aligned with the
notion of male and female sex hormones.
Gnas lugs has both medical and Buddhist meanings and is often found as a compound or
in conjunction with other terms. For example, gnas lugs appears in the title of the immensely
influential Buddhist poetic work, Treasury of the Way of Abiding (Gnas lugs mdzod)420 by
Longchenpa (also known as Drimé Özer) (Klong chen rab ‘byams pa dri med ‘od zer; 1308 –
1364). He was a seminal teacher of the advanced Tantric practices known as “Great
Perfection” (rdzogs chen) in the Nyingma school of Tibetan Buddhism.421 In this text, gnas lugs
refers to a quality of “suchness” or “thusness” that describes an enduring existence of a buddha
“nature” or “essence.” This idea is related to a common Sanskrit epithet for the Buddha,
418 zla mtshan ni nar son pa’i bud med rnams la dmigs su mchis pa’i lus kyi gnas lugs shig yin pa mad
zad / mngal nad sogs mo nad thams cad kyi rtsa ba’m ‘byung gzhi yang yin stabs ‘di la rgyus mnga’ dang
shes rtogs gsal bo zhig byung rgyu ni shin tu gal ‘gangs che, Lha mo skyid, Zla mtshan gyi rnam par
bshad, 103.
419
Tibetan Himalayan Library, s.v. “gnas lugs.”
420
Dri med ’od zer, “Yid bzhin mdzod dang gnas lugs mdzod,” in The Collected Writings (Gsung
’bum) of Dri med ’od zer, Beijing: Bod ljongs mi dmangs dpe skrun khang, 2009), 14:339–61.
421
For more on the author Longchenpa and The Treasury on the Way of Abiding see: Gregory A. Hills,
“The Rhetoric of Naturalness: A Critical Study of the Gnas Lugs Mdzod” (PhD diss. University of
Virginia, 2003); and, David Germano, “Poetic Thought, the Intelligent Universe, and the Mystery of Self:
The Tantric Synthesis of rDzogs Chen in Fourteenth Century Tibet” (PhD diss. University of Wisconsin,
1992).
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Tathāgata, meaning “Thus Gone” or “Thus Come,” which refers to an enlightened being who
has transcended saṃsāra, the cyclical rounds of rebirth and suffering. This idea is further related
to the crucial notion of “buddha nature” (de bzhin gshegs pa’i snying po; Skt. tathāgatagarbha),
which is both the general name for an influential Mahāyāna sūtra and its commentarial tradition,
as well as a philosophical idea that has a number of closely related understandings.
According to one reading, the Sanskrit term garbha can be interpreted as referring to
either the “womb” or the “embryo,” rendering the expression either, the “embryonic buddha” or
the “buddha to be,” hence the “cause” for the buddha’s arising. Conversely, a second
interpretation of garbha is that it is the “womb of the buddha,” meaning a being who already
possesses the essential attributes of a fully realized buddha, hence the “fruit” of the buddha.422
Another similar interpretation of the phrase, “buddha nature” points to the notions of ‘pure’ and
‘impure’ insofar as the term, garbha can point to the way the womb “covers” or “conceals” one’s
buddha-nature.423
Brian Edward Brown suggests that the Tibetan translation of garbha, that is, snying po,
which normally means “heart” in Tibetan does not properly refer to the “womb” (usually
rendered as mngal). He notes that according to David Seyfort Ruegg’s analysis of the
Ratnagotravibhāga, refers to an “embryonic essence,” “kernel,” or “heart.”424 According to this
reading, the point is that there exists a buddha “essence,” “nature” or “seed” that is carried by,
and exists at the “heart” of all living beings. Hence, in the Treasury on the Way of Abiding, one
could say that gnas lugs refers to the ‘suchness’ or ‘way of being’ of the enduring reality of
buddha-nature at the seed, kernel, or heart of all sentient beings.
The concept of gnas lugs as referring to an enduring and indestructible Buddha-nature is
taken up by Tantra via the Tantric physiology of drops. It is the red and white drops, symbolized
422
Sallie King, Buddha Nature (Albany: State University of New York Press, 1991), 3–5.
423
Takakusu, Junjirō, The Essentials of Buddhist Philosophy, eds. Wing-tsit Chan and Charles
Alexander Moore (Honolulu: University of Hawaii, 1947), 118.
424
David Seyfort Ruegg, La Théorie Du Tathāgatagarbha et Du Gotra: Études Sur La Sotériologie et
La Gnoséologie Du Bouddhisme (Paris: Ecole française d’Extrême-Orient, 1969), 505, quoted in Brian
Edward Brown, The Buddha Nature: A Study of the Tathāgatagarbha and Ālayavijñāna (Delhi: Motilal
Banarsidass Publishers, 1991), 43–7.
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in Tantra as the male and female principles and their non-dual union, that carry the very subtle
quintessence of the body, that is, one’s Buddha-nature. This idea is exemplified in the important
twelfth-century Tantric work of which gnas lugs appears in the title, Nature of the Vajra Body
(rdo rje lus kyi gnas lugs) by Phagmo Drupa Dorje Gyalpo (Phag mo gru pa rdo rje rgyal po,
1110 – 1170).425 In this work, gnas lugs can also generally be said to signify an enduring,
quintessential, indestructible and inherent nature of human beings, an underlying Buddha-nature
covered by impurities of the mind and body.
Gnas lugs also often appears in conjunction with dngos po (Skt. vāstu or bhāva), an
important Buddhist and medical term denoting something “material” and “substantial” to form
dngos po’i gnas lugs.426 It also has a related, often synonymous term, dngos po’i rang bzhin,
wherein rang bzhin, as we have already seen, refers to one’s “self nature,” or “inherent
nature.”427 The terms, gnas lugs, ngo bo and rang bzhin frequently appear either in combination
or their own in the contemporary Tibetan medical works on women.
According to Willa Miller, the only work of Indian origin in the Tibetan Buddhist canon
to have dngos po’i gnas lugs appear in the title is Training in the Nature of Things 428 (Dngos po’i
gnas lugs bsgom pa; Skt. Mūlaprakṛṭistha-bhāvanād) by the Paṇḍita Sukhavajra (Nor bu gling
pa bde ba’i rdo rje).429 The Sanskrit original of this work is still extant, and is thought to be a
“possible conceptual/linguistic precedent for dngos po’i gnas lugs”430 in later Tibetan Buddhist
writings. Paṇḍita Sukhavajra’s works belong to the Sāṃkhya school of Indian philosophy that
425
Willa Miller suggests that Nature of the Vajra Body was a likely inspiration for Yangönpa Gyeltsen
Pel’s Secret Vajra Body. See: Willa Miller, “Secrets of the Vajra Body,” 97–98.
426
For a detailed analysis of the phrase, dngos po’i gnas lugs in the Buddhist context see: Miller,
“Secrets of the Vajra Body,” 59–103.
427 If we recall, the term rang bzhin has already appeared several times in both Mingjo Cuomu and
Thupten Püntsok’s works. Mingji Cuomu uses the term to describe the ‘self-nature’ of men’s and
women’s bodies and male and female hormones, among other things. Thupten Püntsok uses rang bzhin in
a number of places as well, such as where he describes the self-arising nature of the seed syllables at the
cakras and the places of bla.
428
Rangjung Yeshi, s.v. “dngos po’i gnas lugs bsgom pa.”
429
Bde ba’i rdo rje, “dngos po’i gnas lugs bsgom pa,” in Bstan ’gyur (dpe bsdur ma), (Beijing: Krung
go’i bod rig pa’i dpe skrun khang, 1994) 26:1570–83.
430
Miller, “Secrets of the Vajra Body,” 65.
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developed in the early centuries CE in India, and that had close ties to the Indic Tantric tradition.
In her analysis of this text, Miller suggests that dngos po’i gnas lugs could be translated as “an
essential nature that underlies the physical human body.”431 She further suggests that early Indian
understandings of terms like dngos po’i gnas lugs, despite their distance in time and space, were
to become important in the thinking about the body in the Tibetan Buddhist tradition,
specifically, the works of Yanggönpa Gyeltshen Pel and his disciples. As noted earlier, Miller
also tantalizingly hints that in spite of the fact that texts like the Training in the Nature of Things
and Tibetan Buddhist compositions on the body were also influential in the development of
Tibetan medicine, but research into this area is still lacking.
The use of the term gnas lugs in Lhamokyi and others to describe the physical features
and attributes of women, and in particular the ability to menstruate, conceive and lactate, tells us
a few things. In all of the instances outlined above, gnas lugs refers to a fundamental and
enduring essence, nature or condition that underlies one’s being. It can refer to the subtlest and
most esoteric parts of humans, such as the drops residing in the central channel, and also, it can
refer explicitly to the material and substantial things, such as menstruation.
In Lhamokyi and other present-day Tibetan sources, the ability to menstruate is the gnas
lugs, that is, the fundamental nature of women. Without menstruation, one is not a woman. This
condition for being a woman is somewhat different from the Western endocrinological view that
a woman normally has a female phenotype, an XX chromosome, and a ‘feminine’ sexual
expression.432 This is not to say, however, that menstruation is not a central topic, and a key site
of controlled normalcy in biomedicine since the inability to menstruate is considered a medical
problem in people deemed biologically female. In the Tibetan sources, the ability to menstruate
is explicitly linked to the ability to conceive and gestate a child. Thus, to say that these
reproductive abilities are the fundamental nature of women, may perhaps portray a view of
women in their roles as mothers and sexual partners. Lastly, as this examination of the Indian and
431
432
Miller, “Secrets of the Vajra Body,” 66.
This does not refer to sexual orientation, but rather to sexual behaviours such as ‘mounting’ versus
being ‘mounted.’ As noted earlier, sexual expression in animals and humans is actually various and
doesn’t necessarily follow strict ‘gender’ or ‘sex’ divisions.
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Tibetan precedents of gnas lugs shows, the use of this term as a way of describing menstruation
as a fundamental condition or the fundamental nature of being a woman can evoke not only
medical meanings, but also religious and symbolic ones.
Following the preface, the first section of Lhamokyi’s article is titled “The defining
characteristics of menstruation” (zla mtshan gyi mtshan nyid). Here, she writes that it is by the
action of the downward-clearing wind that, every month for a few days, the “refuse [which is]
uterine blood” (mngal khrag snyigs ma) is emitted in the form of blood out of the cervix and
vagina. She continues that the term “moon” (zla), which can also mean “month,” signifies its
“monthly occurrence” (dus kyi zla ba re re), while “mark” (mtshan) refers to that as being a
“sign” (rtags), or “characteristic” (mtshan ma), of a physically mature woman. 433
Lhamokyi supports this definition of menstruation with quotations from two authoritative
sources of the Indo-Tibetan tradition. First, she quotes Tagtshang Sherab Rinchen (Stag tshang
shes rab rin chen; 1404 – 1477), the influential Sakya scholar-saint who wrote numerous works
ranging from Buddhist philosophy, Tantra, to medicine.434 A large number of these works have
recently have been republished in Chinese Tibet, making his works politically safe and available
to modern writers. Lhamokyi quotes the following from the “Translator Tagtshang:”435
Like the time of the new moon every month a characteristic sign is the opening of the
cervix. The force of wind causes the uterine blood, which is the refuse
to trickle out, and that is known as menstruation.436
In her second reference, Lhamokyi quotes the following from Moonlight (a text we have
already encountered):
433
Lha mo skyid, Zla mtshan gyi rnam par bshad, 103.
434
TBRC: P79.
435
Lhamokyi simply writes Stag tshang lo tsa’ ba without the name of the text.
436
zla ba re bzhin dkar phyogs dus // mngal kha ‘byed pa’i rtags mtshan du // mngal khrag snyigs ma
rlung stobs kyis // ‘dzag pa zla mtshan zhes su bshad, Lha mo skyid, Zla mtshan gyi rnam par bshad, 103.
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Reproductive fluid is reproductive water. Blood is that which is produced in intervals.
Because of this, it is the blood known as menstruation. 437
Using these citations, Lhamokyi establishes the terminology and foundation of what
“menstruation” is according to her interpretation of the Tibetan sources. In doing so, she points
to the important Tibetan concept of someone or something’s “inherent” or “fundamental
nature” (chos nyid). Summarizing and explaining her use of these two authoritative sources,
Lhamokyi writes:
Generally speaking, at the time of the new moon every month, by virtue of possessing the
inherent nature of being a physically mature woman, for three, four or five days, and so
forth, the refuse blood which has gathered inside the uterus trickles out. 438
Lhamokyi, like her contemporaries, understands that the ability to menstruate is a
defining feature of women’s “inherent nature” (chos nyid; Skt. dharmatā). The term chos nyid is
polysemous, and its meanings include, “inherent,” “intrinsic” or “innate nature,” a “quality,”
“law,” “ultimate nature,” or “suchness.”439 This expression, and its synonymous term “selfnature” (rang bzhin) (also mentioned earlier), are used throughout this and other sources to
define the category and characteristics of women’s bodies, particularly in relation to
menstruation and “hormones.”
The philosophical view of the term chos nyid is debated in many classes of Indo-Tibetan
Buddhist literature. Generally, chos nyid refers to something’s or someone’s intrinsic, inherent
and necessary feature. For example, the chos nyid of fire is heat. The chos nyid of water is
wetness; without wetness, water ceases to be water.440 Again, this meaning indicates a Buddhist
understanding of an essential, inherent and unconditioned nature of reality that cannot be
destroyed or reduced into further parts. This is further related to the ‘mind of the Buddha,’ which
unobstructed by defilements, and realizing emptiness and non-duality, is cognizant of the true
437
khu ba ni khu chu’o // khrag ni dus tshigs su byung bas zla mtshan zhes bya ba’i khrag go, ibid.,
103.
438
nar son pa’i bud med phal mo cher zla ba re re’i dkar phyogs kyi dus la chos nyid ldan pa’i sgo nas
nyin gsum mam bzhi lnga sogs la mngal du bsags pa’i khrag snyigs de phyir ‘dzag pa la, ibid., 103.
439
440
Rangjung Yeshi, s.v. “chos nyid.”
See: Maitreyanātha, and Asaṅga, Distinguishing Dharma and Dharmata, trans., Jules Levinsion
(Delhi: Sri Satguru Publications, 2001).
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nature of existence, which is Buddhist enlightenment. While a discussion of chos nyid and
similar terms could lead deeply into the “ultimate reality” (don dam pa; Skt. paramārtha) of
Buddhist philosophy, the term also carries more mundane and “relative” (kun rdzob; Skt.
saṃvṛti) medical uses.
In the passage quoted above, Lhamokyi writes that the “inherent nature” of a woman is
her ability to menstruate. If that ability is somehow obstructed (and she is female and not a thirdgendered person), then medical or perhaps other kinds of cures will be needed to remedy and
establish a healthy menstrual cycle. A crucial point here is that despite their disparate aims, in
both medical and Buddhist works, both chos nyid and gnas lugs point to an ‘inherent,’ ‘essential,’
and ‘enduring essence’ or ‘nature’ that defines a being or thing. In using these terms Lhamokyi
likewise claims that there is an underlying essential nature of women’s bodies. For her, the
menstrual cycle, being, a key element defining the female embodiment, has a primary role in
regulating and being regulated by an “inherent nature” intrinsic in female bodies.
Lhamokyi concludes this section, which sets out to define “menstruation,” by naming
synonymous terms for the “mark of women” (bud med kyi mtshan ma), “lotus menses” (pad ma
rdul), “lotus flower” (pad ma’i me tog), “uterine blood” (mngal khrag), “monthly blood” (zla
khrag), “monthly drop” (zla zags), and “uterine vermillion” (mngal mtshal dag).441 The central
aim of this section, which is to define “menstruation,” is accomplished through clarifying the
language and meanings of important authoritative sources. Central to the process of defining
menstruation is the concept of the essential or intrinsic material nature of women. In her article’s
next section, she asserts that the mixing together of the red element with “hormones,” regulates,
maintains, and establishes women’s inherent or essential nature.
3.2 Digestion, Menstruation and “Supreme Quintessences”
In the above, Lhamokyi defined menstruation. She now turns her attention to the “The
system of becoming menstruation” (zla mtshan ‘gyur tshul) 442 by outlining the role of digestion
and the making of the white and red elements according to Tibetan medicine. It is also in this
441
Lha mo skyid, Zla mtshan gyi rnam par bshad, 103.
442
Ibid., 104.
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section that she lays the groundwork for the central claim of her article, that the core nutrition of
the red element of Tibetan medicine and the “hormones” of biomedicine are describing the same
material substances and physiological phenomenon. Like other contemporary Tibetan medical
sources on women’s bodies, Lhamokyi asserts that menstruation occurs through the process of
digestion, and the system of the “seven bodily constituents” (lus zungs bdun). The role of
digestion, and in particular the relations among the brain, ovaries, marrow, and reproductive
fluids, is central in her comparison of Tibetan medical and biomedical notions of substances
known in English as “hormones.” The following presents Lhamokyi’s discussion of digestion,
which is quite detailed and technical owing to the fact that it is so central to her account of
hormones.
Initially, Lhamokyi describes how foods and drinks of the “six tastes” (ro drug)443 travel
to the stomach, are broken down into essence and refuse, and move to the liver, becoming the
second bodily constituent, “blood” (khrag). She writes:
Whatever food and drink of the six tastes are consumed, they go to the stomach where the
three digestive heats gradually break down the nutrients and separate the essence from the
refuse. From there [the stomach], the essences travel to the liver through secondary
channels on the surface of the stomach and the intestines. Then, the three heats that
circulate in the liver decompose and digest that essence of the initial food and drink, and
from that, by [further] separating the essence from the refuse, the action of the colour
changing bile transforms the essence into blood. 444
As Lhamokyi writes, according to the Tibetan system, after the food has been properly digested
in the stomach, its essence, having been shed of the refuse, moves from the stomach to the liver
through a network of channels. There, “the three digestive heats” (me drod gsum) in the liver,
again, break down and separate the refuse from the essence, transforming it into blood. The
“three digestive heats” refers to the three dynamic factors needed to digest food which are the
443 According
to the Four Treatises, the six “tastes” (ro) are “sweet” (mngar), “sour” (skyur),
“salty” (lan tshva) “bitter” (kha), “pungent” (tsha) and “astringent” (bska), G.yu thog yon tan mgon po,
'Dud rtsi snying po, 63.
444
ro drug khongs su gtogs pa’i zas skom gang zos pa rnams pho ba’i gnas su slebs pa’i tshe pho ba
na gnas pa’i gtso bo’i me drod gsum gyis rim bzhin myag bzhi dwangs snyigs phye ba las dwangs ma
rnams pho ba dang rgyu ma’i ldebs kyi rtsa phran rnams la brgyud nas mchin pa’i gnas su song / de nas
mchin pa na gnas pa’i ‘khor gyi me drod gsum gyis zas skom gyi thog ma’i dwangs ma de myag bzhu
dwangs snyigs phyes nas dwangs ma de mdangs sgyur mkhris pa’i byed las kyis khrag tu gyur pa, Lha mo
skyid, Zla mtshan gyi rnam par bshad, 104.
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digestive bile, the decomposing phlegm and the fire-accompanying wind. According to the Four
Treatises, “digestive heat is the basis of all of the digestive system” (me drod cis bya ‘ju ba’i gzhi
yin).445
Lhamokyi then describes the network of channels by which the blood moves from the
liver to the heart, and from there, is moved throughout the body. She quotes from three
authoritative, and somewhat diverse sources. The first is the influential Eighteen Additional
Practices,446 a collection of writings attributed to Yuthok Yönten Gönpo (twelfth-century) and
his students. It contains some of the earliest indigenous Tibetan works still extant, including a
history of early Tibetan medicine which, according to Garrett, emphasizes “a presentation of
medicine as an essential and original component of Buddhism.”447 The section from Eighteen
Additional Practices that Lhamokyi quotes concerns the making and dissemination of blood. The
passage reads,
Rising upwards in front of the black life channel, the upper ends of the liver and the
diaphragm are connected at the place where the heart and the lungs are rooted. 448
Summarizing this, Lhamokyi writes,
Just as it is written [in the Eighteen Additional Practices], the strength-producing blood
that resides in the liver goes to the heart by means of the black central life channel. The
pervasive wind at the heart, by ‘opening and closing,’ continuously pumps the strengthproducing blood through the channels, eventually spreading [blood] everywhere in the
body. 449
445
G.yu thog yon tan mgon po, Dud rtsi snying po, 26.
446 This work has been republished as part of the Arura series: Yon tan mgon po, Cha lag bco brgyad,
Bod kyi gso ba rig pa’i gna’ dpe phyogs bsgrigs dpe tshogs, 25 (Beijing: Mi rigs dpe skrun khang, 2005).
447
Garrett, Religion, Medicine and the Human Embryo in Tibet, 42. See also her article “Buddhism
and the Historicising of Medicine in Thirteenth-century Tibet,” Asian Medicine 2, no. 2 (2006): 204–24.
448
srog rtsa nag po de mdun nas yar rgyu ste mchin pa dang mchin dri ‘brel nas yar sna snying dang
glo bu gnyis su zug, Lha mo skyid, Zla mtshan gyi rnam par bshad, 104.
449
ces gsungs pa bzhin mchin par gnas pa’i zungs khrag rnams srog rtsa nag po brgyud nas snying la
song / snying du gnas pa’i khyab byed rlung gi ‘byed ‘dzum byed ps zungs khrag rnams rgyun mi chad
par rsta’i nang ‘bud pas lus yongs la gtor ba ste, ibid., 104.
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Her second authoritative source on the matter is A Canopy over a Precious Cloud,450 a work
attributed to the fifteenth Karmapa, Khakyab Dorje (Mkha’ khyab rdo rje, 1870/71 – 1921/22), a
prominent Buddhist figure in the “non-sectarian” (ris med) movement that spread across Tibet
beginning in the nineteenth-century.451 He writes,
The pervasive wind located at the heart opens and closes the heart’s aperture. And by that
action, moves the essences throughout the body. Just like going around in a circle, they [the
pervasive winds] spread through the hollow channels. 452
Lastly, she quotes from the The Crystal Mirror,453 written by Deumar Tenzin Püntshok (De’u
dmar dge bshes bstan ‘dzin phun tshogs, 1672 –?), 454 a polymath of the Bön tradition who also
has an immense body of Buddhist and medical works attributed to him, many of which have
been republished in China. The passage Lhamokyi quotes from his work reads,
Beneath the throat cavity and above the lower navel spans the pulsating channel [that
pumps] the wind and blood that reside there. Connected with the heart are the actions of
the life channels, and inside of them, the black life channels circulate the blood, spreading
it through very small channels [until it] fully pervades all of the parts of the body. For
450
Rin chen sprin gyi lding khang. I have been unable to verify this source in a Chinese Tibetan copy,
however Khakyab Dorje’s collected works have been republished in India. The full title of this work,
according to the Indian source is Mchod phreng nam mkha’ mdzod kyi ‘khor lo’i drwa ba me tog sprin gyi
lding khang.
451 Lama Kunsang, Lama Pemo, and Marie Aubèle, History Of The Karmapas: The Odyssey Of The
Tibetan Masters With The Black Crown, trans. Jonathan C. Bell (Ithaca, N.Y: Snow Lion, 2012), 191–202.
452
khyab byed rlung ni snying la gnas // snying gi bu ga ‘byed ‘dzum byed // de tshe lus kyi dwangs
ma’i rgyun // ‘khor lo ‘khor ltar rtsa sbubs gtor, Lha mo skyid, Zla mtshan gyi rnam par bshad, 104.
453
Shel dkar me long. I have not been able to locate a Chinese publication of this particular text,
however at least three of his medical works have been republished in Chinese Tibet, one in Xining. His
well-known medical work, Shel gong shel phreng has been republished in India, China and the U.S.
According to Mona Schrempf, the Crystal Mirror is well-known among Bön lineage doctors in Nagchu
prefecture, TAR, China (Schrempf, “Bon Lineage Doctors and the Local Transmission of Knowing
Medical Practice in Nagchu,” 119.) There is an Indian reprint of Crystal Mirror which was reproduced
from a manuscript held in the Library of Sog Tsandan dgon. The full title of this work is me bsta’i gdams
pa rgyas spros shel dkar me lon—see the bibliography for more details.
454 A contemporary
Tibetan-language biography of Deumar Tenzin Püntshok appears in: Byams pa
phrin las, Bod gyi sman pa rim byon gyi rnam thar phyogs bsgrigs (Beijing: Mi rigs dpe skrun khang,
2000), 405–9.
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example, just like a canal draws water from a lake, each and every essence is led to its
respective place.455
The major point that Lhamokyi is making is that several Tibetan sources—from wide-ranging
times, places, and religious affiliations—agree as to the nature of how blood moves from the
liver to the heart, and then is pumped throughout the rest of the body. Like her contemporaries,
Lhamokyi consistently works to show that there are no contradictions amongst the authoritative
medical and Buddhist sources of the Tibet’s intellectual way of discerning the body. In this way,
Tibet’s medical knowledge appears timeless and without error and thus, its ‘correctness’ (or
usefulness) depends on research and new interpretations.
From the production and movement of blood throughout the body, Lhamokyi summarizes
how the remaining bodily constituents are made, and narrows her focus onto the reproductive
fluid, the seventh and final bodily constituent. She writes:
Just as it is written, the system of how the ‘strength-producing blood’ spreads throughout
the entire body is clearly established. From there, the digestive heats that abide in each and
every individual body part, gradually, by means of decomposition and digestion separate
the essence from the refuse and by this system mature and develop the latter parts of the
body.
The Four Treatises and its authoritative commentaries very clearly explain [the digestive
process], and here, although the explanation is brief, for the time being it is established [by
the authoritative literature]. As [it is written in these works], once the reproductive fluid,
the last of the bodily constituents, has become totally ripened through gradual stages, its
essence and refuse are separated. The essence becomes the body's quintessence and, the
refuse, from having gathered in the ovaries, becomes the cause for the seed of
conception.456
455
ske stong man dang lte ‘og yan bar du // gnas pa’i rlung khrag gnyis ‘dom ‘phar rtsa de // snying
dang ‘brel nas srog gnas rtsa byed cing // nang du khrag rgyu srog rtsa nag po bshad // de las gyes pa’i
khrag rtsa phra mo yis // stod smad phyi nang kun tu rab khyab nas // dper na rdzing chu yur bur drangs
pa ltar // dwangs ma rang rang gnas su ‘dren par byed, Lha mo skyid, Zla mtshan gyi rnam par bshad,
104.
456
ces zungs khrag lus kun la khyab tshul gsal kh gtod ‘dug / de nas lus zungs rang rang gi cha na
gnas pa’i me drod kyis myag bzhu dwangs smyigs phye ba las rim bzhin lus zungs phyi ma rnams ‘phel
zhing smin par ‘gyur tshul rgyud dang gzhung ‘grel khag tu ha cang gsal bor gsungs yod pas ‘dir yig
tshogs bskyungs phyir re zhig btang snyoms su bzhag go / de ltar rnam par smin zhing rim gyis gyur nas
mthar lus zungs phyi ma khu ba de nyid dwangs snyigs phye nas dwangs ma lus kyi mdangs dang snyigs
ma bsam se’u yi gnas su bsdu bar byas nas mngal ‘dzin sa bon gyi rgyu gyur, ibid., 104.
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This passage says that the digestive heat operating in each of the bodily constituents causes the
maturation and separation of the essence and refuse. Lhamokyi’s next statement, that the
“essence” (dwangs ma) of reproductive fluid becomes the “quintessence” (mdangs) for the body,
and the refuse becomes the reproductive seed is, as we have already seen, a much debated
question among contemporary medical writers. Researchers are interested in whether or not the
reproductive seed is produced from the essence or from the refuse of the seventh bodily
constituent, and how that transformation actually occurs.
Lhamokyi next elaborates on the reproductive seed. At this point she introduces the term
“bcud chen po,” meaning “great” or “supreme” “essence,” or “quintessence,” that she alone uses
among my primary sources. This phrase, which I translate as “supreme quintessence,” is
Lhamokyi’s way of identifying very subtle (or microscopic) substances written about in Tibet’s
authoritative literature that are called “hormones” in modern biomedicine. Like Mingji Cumou
who uses the phrases, “inner secretions” (nang gi gzags or gzags ‘don) as a general Tibetan
derived term alluding to biomedical “hormones,” and “skul rgyu” plus the Chinese biomedical
term to name specific hormones, Lhamokyi uses bcud chen po to name a general Tibetan
category of ‘hormone-like substances’ and, as we shall see further on, “mo skul rtsi,” literally
meaning, “female-arousing nectar” to specify the hormone estrogen. She writes,
Furthermore, in regards to the outer elements, during the time that occurs every month
from the sixteenth day of the month, up until and including the thirtieth day, the power of
the sun increases. The root quintessence of the seed at the heart of the brain,457 together
with the “supreme quintessence,” establish the materiality of the body’s vital nutrition. The
actions of the downward-clearing wind and the pervasive wind cause the brain’s subtle
nerve channels and blood channels to transmit and plant the causal power of the white and
457
There could be two interpretations for wording for “heart of the brain” (klad snying) in this
instance: in the first, which I think is more likely, she is pointing to the pituitary-hypothalamus complex
which is located in the near centre of the brain. Secondly, klad snying is often translated into biomedicine
as referring to the cerebellum, the area of the brain where it meets with the spinal cord. Because it is made
of two hemispheres and is necessary for much of the bodies key motor functions it is known in
biomedicine as the ‘little brain.’ Clearly here though, this is not what Lhamokyi is referring to.
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red elements inside the ovaries and testes, wherein they successively increase and ripen
becoming either the reproductive seed or the red element. 458
In this passage, Lhamokyi establishes the Tibetan framework for a central pillar of Western
endocrinology, that is, the relation between the brain and the ovaries (and testes). Also, like
Western endocrinological studies, she concentrates on how the substances known as the
“supreme quintessence” (or “hormones”) are transmitted and move through the body to their
sites of action, such as the ovaries.
Lhamokyi asserts that the supreme quintessence is spread throughout the body through
the “subtle lymphatic channels and blood channels” (klad pa’i dbang rtsa dang khrag rtsa phra
mo rnams), which “transmit” (rgyu) and “plant” (thebs) the “power” (nus pa) of the white and
red elements. Further, she states that the supreme quintessences propel the maturation of the red
and white reproductive seeds as well as the onset of the menstrual period through the ovaries
and testes.
It is clear from Lhamokyi’s description of the “supreme quintessence” (bcud chen po)
from the above and further in her article that she is directly referring to a Tibetan interpretation
of biomedical notions of “hormones.” In other words, “supreme quintessence” should be
understood as a Tibetan word for “hormones.” Hence, Lhamokyi presents a complex integration
of Tibetan medical and biomedical ideas that may at first glance, by its very language, seem
entirely native to Tibetan medical thought. However, she is directly referring to the biomedical
account of hormones and the endocrine system, and using Tibetan medical and Buddhist ideas
and language in innovative ways to do so. Therefore, before continuing with Lhamokyi’s
interpretation of “hormones” in Tibetan medicine, it is worthwhile to look at bcud, the operative
word in bcud chen po, and with it, another closely related term, bdud rtsis, meaning “nectar” or
“elixir,” which also appears in the language surrounding and naming “hormones.”
458
de’ng zla ba re re’i hor zla’i tshes bcu drug nas gnas gang gi bar du phyi’i ‘byung khams nyi ma’i
stobs lhag par ‘phel ba’i skabs ‘di rnams la / klad snying sa bon bcud kyi rtsar gnas shing zungs bcud kyi
ngo bo grub pa’i bcud chen po de srog ‘dzin rlung dang khyab byed rlung gi bya bas klad pa’i dbang rtsa
dang khrag rtsa phra mo rnams brgyud de bsam se’u’i nang gi khams dkar dmar gyi rgyu la nus pa thebs
nas rim bzhin ‘phel zhing smin te mthar mngal ‘dzin gyi sa bon nam khams dmar la gyur, ibid., 104.
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For the remainder of this section I look more closely at the constituent parts of the term
that Lhamokyi uses to speak to integrated Tibetan and biomedical notions of “hormones,”
namely, bcud chen po. In doing so, we are taken, again, to the world of Tantra and ideas of very
subtle material substances and core essences and quintessences that make up and circulate in the
body. Through this we see another important aspect of the relation between medicine and tantra,
that is, the dietary practices that centre on notions of digestion and the refining processes that
produce pure ‘essences’ of material elements. Lastly in this section, we will see how the term,
bcud, is used in another contemporary Tibetan medical setting outside of China, pointing to a
trend of reinterpreting Tantric and medical ideas to fit within the context of ‘modern medicine.’
The first part of bcud chen po, bcud (Skt. rasa), is a polyvalent term that can be translated
as “essence,” “vital essence,” “elixir,” “nectar,” “juice,” “moisture,” “potency,” “nutrition,” “core
nutrition,” “quintessence,” “distillation,” and “distilled essence or drink.”459 It is often found as
part of the conjunction, bcud len (Skt. rasāyana), meaning “extracting the essence,” which has
both medical and Tantric meanings. The practice of “extracting the essence” appears in a number
of Tibetan medical works, including the Four Treatises, where the term appears chiefly in the
chapters dealing with promoting longevity and restoring virility.460 In both the medical and
Buddhist context, bcud refers to the very pure and potent essences or vital nutrition that has been
“extracted” (len) not only from material substances like “flower petals” (me tog gi bcud len) and
“minerals” (rdo’i bcud len), but also from “breath” or “wind” (rlung gi bcud len), and even
(seemingly) immaterial sources such as Buddha-fields and one’s own meditative
“awareness” (rig pa’i bcud len).461 Once extracted and then consumed, the “nectar” or “distilled
essence” nourishes the body and its constituents through their absorption by digestion.
459
Rangjung Yeshi, s.v. “bcud.”
460
Barbara Gerke,“‘Treating the Aged’ and ‘Maintaining Health’: Locating Bcud Len Practices in the
Four Tibetan Medical Tantras,” Journal of the International Association of Buddhist Studies 35, no. 1–2
(2013): 332.
461
Barbara Gerke, “Treating Essence with Essence: Re-Inventing Bcud Len as Vitalising Dietary
Supplements in Contemporary Tibetan Medicine,” Asian Medicine 7, no. 1 (2012): 197.
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Ideas of “extracting the essence” are found in a variety of Buddhist works. Two key areas
that have received scholarly attention are within the larger context of “health and longevity”
practices (tshe grub; Skt. āyuḥsādhana), and in the closely related set of texts and practices
known as “empowering the medicine” (sman sgrub). Similar in many ways, “longevity” and
“empowering the medicine” are practices that have a long and intertwined textual tradition.
Today, both of these practices continue to be ritually performed throughout Tibet, its surrounding
regions and in the West.
Works by Frances Garrett,462 Barbara Gerke 463 and Geoffrey Samuel464 explain these
traditions in considerable detail and breadth, so here, I will only give a brief summary and pay
attention to the substances they describe, that is, bcud and bdud rstis (Skt. amṛta), which is often
translated as “elixir,” “nectar,” “juice” and “sap.” Bdud rtsis often is found interchangeably with
bcud in both the “empowering the medicine” and “longevity” works. Both terms, bcud and bdud
rtsis appear in contemporary Tibetan medical works to describe and name “hormones.”
Within the sphere of Buddhist “longevity” or “long-life” practices and texts, of which
there are many hundreds in Tibet, an important blueprint for essence extraction still in circulation
today is the Essence of Immortal Life (‘Chi med srog thig), which first appeared in twelfthcentury India. This Tantra centres on the deity Amitāyus (Tshe dpag med), whose name means
“Buddha of boundless life,” and features him in sexual union with a female partner. The ritual
and meditative practices of the Essence of Immortal Tantra are said to produce “universal
nectar”—bcud or bdud rtsi—that can restore lost vitality and lengthen the life span.465
462 Frances Garrett, “Shaping the Illness of Hunger: A Culinary Aesthetics of Food and Healing in
Tibet,” Asian Medicine 6 (2011): 33–54; “Tapping the Body’s Nectar: Gastronomy and Incorporation in
Tibetan Literature,” History of Religions 49, no. 3 (2010): 300–326, and “The Alchemy of Accomplishing
Medicine (sman sgrub): Situating the Yuthok Heart Essence in Literature and History,” Journal of Indian
Philosophy 37, no. 3 (2009): 207–30.
463
Barbara Gerke,“‘Treating the Aged’ and ‘Maintaining Health,’ and Long Lives and Untimely
Deaths.
464
Geoffrey Samuel, “Tibetan Longevity Meditation,” in Dimensions of Meditation, ed., Halvor
Eifring (Honolulu: University of Hawaiʻi Press, forthcoming), and “Amitāyus and the Development of
Tantric Practices for Longevity and Health in Tibet,” in Transformations and Transfer of Tantra in Asia
and Beyond, ed., István Keul (New York: De Gruyter, 2012), 263–86.
465
Samuel, “Amitāyus and the Development of Tantric Practices.”
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In the Essence of Immortal Life Tantra, the “nectars” are made of the purest and most
refined essences of the five outer elements. As such, they are infused with life-giving properties,
which through their digestion, enhances the health of the five inner elements that form the body.
This particular idea of bcud and bdud rtsi draws heavily from the Sanskrit understandings of
these terms. According to its Indian understanding, amṛta (bdud rtsi) is an “immortal nectar”
made from the churning of the oceans by the gods at the beginning of time. Therefore, it is a lifegiving nectar. Rasāyana (bcud len), is sometimes translated as “alchemy” because it “refers to a
series of pharmaceutical, physiological and meditational practices aimed primarily at the
attainment of longevity and ultimately immortality.”466 Hence, the idea of extracting “immortal
nectars” conjures the idea of nutrient-rich properties and substances that prolong and ameliorate
life.
The second area where we find overlapping uses of bcud and bdud rtsi is in the
“empowering the medicine” (sman grub) practices. The ritual processes described in this work
transform medicinal substances into a consecrated “nectar,” or “elixir,” (bdud rtsi or bcud) said
to “empower” or “accomplish” (grub) the substances, thereby, increasing their benefit for the
patient. The most famous and still utilized work of this genre is the Yuthok Heart Essence,
attributed to Yuthok Yönten Gönpo the senior, which contains references to both bdud rtsi and
bcud len. This text and its ritual prescriptions show the intersection of Buddhist and medical
thought, and underscores the nature of their relation. 467
Today, as the contemporary sources show, the Buddhist elements of Tibetan medicine are
held as authoritative even while their meanings are being debated and reinterpreted to integrate
biomedical ideas. For example, the pharmaceutical division of the Dharmasala Men-Tsee-Khang
in India manufactures “vitalizing dietary supplements” and “health tonics” that are made from,
and advertised as, the extracted essences—bcud and bdud rsti.468 Among these products are the
“Invigorating Medicine, Ocean of Assembled Essences” (stobs sman bcud ‘dus rgya mtsho), a
466
Ibid., 273.
467
Garrett, “The Alchemy of Accomplishing Medicine (sman sgrub).”
468
Gerke, “Treating Essence with Essence,” 196–224
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tonic supposed to help with sexual stamina;469 the “Elixir of Rejuvenation” (rgas pa gso ba bcud
len chen mo), which is meant to slow down aging and give the body a revitalizing boost, and
therefore recommended for elderly patients;470 the “Energize the Body” (gcong chen bcud len),
presumed to provide vital nutrition to the body in order to boost the immune system, and
therefore good for chronic illnesses, especially those affecting the immune system; and, the
“Life-Span Increasing Nectar” (tshe ‘phel bdud rtsi), which helps to build the strength of a
weakened body so as to prolong life.471 In all of these instances, the claimed active ingredient is
either bcud or bdud rtsi purported to be an ultra purified quintessence whose consumption
promotes a number of benefits, such as longer life span, or an improved immune system or
renewed sexual vigour.
Importantly, bcud or bdud rtsi are thought to nourish the consumer by moving through
their digestion and forming the seven bodily constituents of the body. The meanings associated
with bcud and bdud rtsi in the modern-day dietary supplements and tonics draw equally from
shared medical and Tantric understandings and associations. This is made clear in an
instructional leaflet included with the “Elixir of Rejuvenation,” which describes “a longevity
practice involving visualizations that facilitate the extraction of bcud from surrounding elements
as well as the recitation of the Amitāyus (Buddha of Long Life) mantra.” 472
Terms like bcud and bdud rtsi are rich in medical, religious and social meanings, giving
contemporary thinkers a deep resource to reinterpret and innovate their meanings in accordance
with the times. For the same reasons that Tibetan pharmacologists in India use bcud to describe a
‘life-enhancing vital essence’ in their products, Lhamokyi uses bcud to describe and name shared
Tibetan medical and biomedical understandings of “hormones.” In both instances they are
thought to be potent, ultra-refined quintessences that are produced by, and have their producing
effects, through digestion and other distillation processes. By using bcud as a way to name and
characterize “hormones,” Lhamokyi asserts that they should be principally understood as
469
Ibid., 210.
470
Ibid., 212.
471
Ibid., 214.
472
Ibid., 212.
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substances made of the ‘core nutrition’ or ‘vital essence’ that propel growth and change in the
body. By identifying them with the white and red elements, Tibetan ideas are not contradicted by
biomedical ones,and the integration of biomedically understood “hormones” appears to support,
further to explain, and to substantiate, the claims of Tibetan medicine.
3.3 The Relation between the Brain and Reproductive Fluid
After introducing the “supreme quintessences” as a Tibetan term referring to biomedical
“hormones,” Lhamokyi enters into a core debate surrounding the nature of hormones and how
they are produced in the brain and transmitted from there to the ovaries so as to make the egg
ready for conception. Just as her contemporaries indicate, Lhamokyi maintains that Tibetan
notions of the red element are compatible with biomedical understandings of hormones.
Like Thupten Püntsok and Mingji Cuomu, Lhamokyi also enters into the debate
surrounding the so-called ‘confusion’ over whether menstruation is the essence or refuse of the
seventh bodily constituents. In her explanation, Lhamokyi also looks to notions of ‘thick’ and
‘thin,’ by studying the nature of ‘marrow’ and the ‘brain.’ Beyond this debate, she presents two
other Tibetan words that are direct translations for specific biomedical terms for “hormones.” In
this section, I present each of these issues together with the conclusion of her article.
Lhamokyi’s explanation of the ‘marrow and brain debate’ is as follows:
In regards to this [debate], some people who quote from a limited selection of texts
stubbornly insist that from their point of view, because both the brain and marrow have a
common material basis, the reproductive fluid must arise in the brain. If the reproductive
fluid is perceived in this way, that is, as postulated as being produced in the brain, then it
would be necessary for there to be quite large [and] thick male and female sub-channels
that would move the reproductive fluid from the brain to the ovaries, given the inherent
nature of material substances. [If this were the case], how could that occur given that the
reproductive fluid is not only inherently heavy and oily, but sticky too? 473
473
‘di’i thad la kha cig gis klad pa dang rkang gnyis ngo bo gzhi mthun gyi sgo nas gzung ga ge mo
zhig las tshig dum bu kha shas lung ‘dren byas nas U tshugs tsha bos mtha’ skyel te klad pa las khu ba
‘byung bar bshad / gal te mthong chos su gyur pa’i khu ba de klad pa nas ‘byung bar brjod na / klad pa
nas pho mo tha dad du gnas pa’i bsam se’u dbar khu ba rgyu ba’i rtsa cung sbom pa zhig nges par du
yod dgos pa ni dngos po’i chos nyid yin la / ci’i phyir khu ba de ni lci snum gyi rang bzhin can zhig yin pa
ma zad ‘byar bag dang ldan pas so, Lha mo skyid, Zla mtshan gyi rnam par bshad, 104.
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To understand this passage, we should remember that the sixth bodily constituent is
“marrow” (rkang ma), and through the body’s instillation process, its essence, separated from the
refuse, goes on to become the seventh bodily constituent, which is the reproductive fluid.
As I have mentioned earlier, the brain is said to be a kind of marrow. According to this
thinking, the term “marrow” applies to several parts of the body. Lhamokyi postulates that if the
reproductive fluids originate from the brain, as is claimed by biomedical endocrinology, then
there must be a way for them to travel to the reproductive organs. In other words, she explains
how it cannot be the case that the egg and the sperm mature in the brain (and travel to the ovaries
and testicles in that form), but rather they are matured by the brain in the ovaries and testicles.
Hence, to explain how this is so, she first debunks the nonsensical postulation that there could be
“thick male and female sub-channels” directly between the brain and the ovaries. She writes:
The way of modern science is very quickly becoming familiar here [in Tibet]. If we use
a microscope and other [modern technology] to see subtle [material substances] then even
small particles and cells which the physical eye cannot see become clearly visible, just like
seeing a sour fruit in the palm of the hand. Thus, if one were to claim that there is a channel
that moves the reproductive fluid [directly between the brain and the ovaries], then it not
only harms the intended meaning of the Treatises, but it also lacks the capacity to keep up
with the new developments. Furthermore, because it is not in keeping with actual reality,
other people become critical [of Tibetan medicine] and think it to be senseless.
Therefore, I myself think that at this time when the reproductive fluid is the ‘root
quintessence of the seed,’ being heavy and oily, possesses the nature of phlegm. Its
“essence” (dwangs ma) is that which establishes the materiality of the “core
nutrition” (bcud), and it is clear that the “supreme quintessence,” which is invisible to the
naked eye, is not the actual seed of conception.474
474
gsar dar tshan rig gi gom ‘gros shin tu mgyogs pa’i deng gi nyin mo ‘dir / phra mthong che shel
sogs spyad na chu bur mig gis mi mthong ba’i ‘byung ba’i rdul phran nam phra phung rnams kyang lag
mthil du skyu ru ra bzhag pa ltar gsal bor mthong bas na bshad ma thag pa’i khu ba’i rgyu lam de ‘dra
zhig yod par bzhag na rgyud kyi dgongs don la gnod pa ma zad / gsar gtod kyi nus pa dben zhing dngos
yod kyi gnas lugs dang yang mi mthun pas gzhan gyis kyang ‘phya ba’i gnas su ‘gyur ba las bab col gyi
rigs pa ‘di ‘dra su zhig gis tshad mar ‘dzin / der brten kho mo’i bsam par skabs ‘di’i sa bon bcud kyi rtsar
gnas pa’i khu ba de ni bad kan lci snum gyi rang bzhin ldan zhing / bcud kyi ngo bo grub pa’i dwangs
shing mig gis mi mngon pa’i bcud chen po zhig yin pa las mngal ‘dzin gyi sa bon dngos min par mngon
te, ibid.,104–5.
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It is here that Lhamokyi, eschewing ridiculous ideas about the sperm travelling from the brain,
really begins to present her position on how the biomedical notions of “hormones” can be
understood and interpreted within the Tibetan medical framework.
First, she brings up the idea of the “root quintessence” (or “core nutrition”) of the
seed” (sa bon bcud kyi rtsa). This term, which we saw briefly in Mingji Cuomu’s work, refers to
the very subtle (or microscopic) and powerful embryonic nutritional essence that is matured by
digestion into a viable reproductive seed in the ovaries and the testes. Then she makes a few
technical clarifications concerning her use of the term bcud in explaining reproduction.
Lhamokyi asserts that the “essence,” the dwangs ma of the “root quintessence of the seed,” the
sa bon bcud kyi rtsa, establishes the “core nutrition,” which is the bcud of the reproductive seed
when it is in its earliest stages in the brain.
According to Lhamokyi, the “supreme quintessence” (bcud chen po) is a ‘hormone-like
substance that is related to but different from the fully matured reproductive seed that comes
from the genitals. They both, however, share in the nature of the dynamic of phlegm. Focussing
on the dynamic of phlegm, Lhamokyi clarifies its relation to the reproductive fluids further:
The reproductive fluid originates from the “core nutrition” (bcud) of the seven bodily
constituents, which are the ripened “essences” (dwangs ma) of consumed food and drink. It
is through the [digestive] separations of each of the bodily constituents that the seventh
one, the reproductive fluid, which has the nature of phlegm, that is, heaviness and oiliness,
has become ‘heavy.’ 475
Here, Lhamokyi asserts that the reproductive fluid, which contains the core nutrition of ripened
essences, has the self-nature of phlegm, which has the self-nature of being white in colour, heavy
and oily. Thus, she reasons that the sperm and the egg, from their very beginnings as the core
nutrition at the root seed in the brain, have the nature of phlegm, and it is through the digestive
process, whereby subtle things become more and more coarse, that the phlegm-like nature of the
reproductive fluids becomes more manifest.
475
khu ba ni ‘byung bas grub pa’i zas skom rnams kyi dwangs ma zungs su smin pa’i lus zungs bdun
gyi bcud yin pa dang / lus zungs bdun po phyi ma phyi ma lci zhes pa las khu ba de nyid lci snum gyi rang
bzhin ldan pa dang, ibid., 105.
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Lhamokyi then claims, that despite being different, the “quintessence” (bcud) of the “root
quintessence of the seed” (sa bon bcud kyi rtsa) and the “supreme quintessence” (bcud chen po)
share in the same self-nature of the phlegm dynamic. She writes:
Therefore, the “supreme quintessence” possesses the self-nature of phlegm’s heaviness and
oiliness, whether or not it stays in the upper [parts of the body], or whether or not it
descends to the lower parts, that is its inherent material nature. The life-sustaining wind
circulates the essence of the core nutrition, controlling the brain’s system of channels [or
nerves]. The pervasive wind governs the circulation of the subtle blood channels by which
the [reproductive fluid] descends and is carried to the ovaries. From there, by having
planted the power to cause parts of the reproductive fluid or red element residing there,
[the core supreme quintessence] not only accompanies, but stimulates [the reproductive
fluid] to ripen. If one asks, it is not possible to identify a channel [that directly moves the
reproductive fluid from the brain to the ovaries]. There is no conflict with the intended
meaning of the [Tibetan] texts, including the older texts; there are no contradictions.476
In this passage, Lhamokyi explains how the “supreme quintessences,” that is, the “hormones”
cause the reproductive fluid to move from the brain to the genitals by way of the body’s system
of winds and channels. She is the only author among the primary sources of this thesis who
identifies “hormones” as having the nature of phlegm. In doing so, she is able to show how the
Tibetan system can explain the endocrinological claim that the reproductive fluid is ‘planted’ and
matured in the ovaries and the testes by way of hormonal ‘messages’ from the brain.
Noteworthy in this passage, is her ability to explain what is an essentially biomedical idea
entirely within the language and framework of Tibetan medicine. She invokes Tibetan notions of
the phlegm and the wind dynamics, the channels, digestion, and the white and red elements to
explain how “supreme quintessences” are produced, synthesized and then circulated within the
body. Her use of the term, bcud, as part of a general Tibetan term for “hormones” expands upon
already well-established medical and religious ideas connecting quintessences, core nutrition,
476
des na bad kan lci snum rang bzhin can gyi bcud chen po de stod na gnas kyang smad du lhung bar
byed pa ni dngos po’i chos nyid yin la / bcud kyi dwangs ma’i rgyun srog ‘dzin rlung gis kha lo bsgyur
pa’i klad pa’i dbang rtsa dang / khyab byed rlung gis kha lo bsgyur pa’i khrag rtsa phra mo rnams la
brgyud nas snod kyi bsam se’u’i nang la babs pa’m skyel bar byed / de nas der gnas pa’i khu ba’i cha
shas sam khams dmar gyi rgyu la nus pa thebs nas de dag rnam par smin pa la bskul ma dang ram ‘degs
mi dman pa byed pa ma gtogs rtsa ‘di dang ‘di’o zhes ngos ‘dzin byed rgyu med ce na / gzhung gi dgongs
pa dang mi ‘gal zhing snga phyi kun la mi mthun pa cher med snang, ibid., 105.
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vitality, and sexual and reproductive vigour. Significantly, as she clearly states, her discussion of
hormones does not disrupt the Tibetan medical or Buddhist account of the reproductive body.
Following her explanation of the how the core nutrition and “supreme quintessences”
travel to the ovaries by way of the winds and subtle channels, Lhamokyi describes how
conception occurs.
Therefore, at the time when the cervix opens, or at the time of fertility, that red element
which has ripened and gathered in the ovaries is carried by the downward-expelling wind
from the ovaries to the inside of the uterus through the two [fallopian] tubes. During this
time of fertility, if both the male and female seed are flawless, and the male’s white
element meets with female’s seed in the uterus, and a bardo being’s consciousness is
mutually compatible [with the parents], then the gathering [of those conditions] apply [and]
that sentient being enters the mother’s uterus, establishing the pregnancy. Or, if the red
element does not have the occasion of meeting with the white seed, or [in other words] the
mother’s blood and the father’s semen do not intermingle, the bardo being does not have
an occasion to enter [the uterus], and then that red element loses the ability to conceive, so
becomes refuse. 477
In this passage, Lhamokyi explains that each monthly cycle of the red element results in a
reproductive seed which either becomes a child conceived in the uterus, or in the event that
conception does not occur, the refuse that comes out as menstrual blood. In listing the flawless
reproductive seeds of the parents, the consciousness of a bardo being, and their mutual karmic
attraction as requisites for conception, Lhamokyi’s presentation of conception follows the
standard Tibetan embryological narrative. Thus, Lhamokyi demonstrates her loyalty and
adherence to authoritative Tibetan medical and Buddhist ideas about human life.
Following her outline of the Tibetan account of conception, Lhamokyi focuses for a
moment on the refuse of reproductive fluid, the menstrual blood, and in doing so, turns again to
“hormones.” She writes:
477
de ltar bsam se’u bsags shing smin pa’i khams dmar de mngal kha ‘byed pa’i dus sam mngal len
pa’i dus la slebs tshe thur sel rlung gis bsam se’u nas mngal zur gyi khams rgyu ba’i sbu gu gnyis la
brgyud nas bu snod kyi sbubs su bskyal / gnas bab de lta bu’i dus su pho mo gnyis kyi sa bon la nyes pa’i
skyon med pa dang / mo’i mngal ‘dzin sa bon de pho’i khams dkar dang ‘phrad pa / phan tshun gyi las
mthun pa’i bar do’i rnams par shes pa zhig de la ‘jug par byed pa bcas ‘dzoms na ma’i mngal du sems
can zhig chags srid / ‘on te khams dmar de pho’i sa bon dang ‘phrad pa’i skal ba zad pa dang / yang na
pho mo gnyis kyi khu khrag lhan cig tu ‘dzoms kyang bar do’i sems can ma zhugs tshe khams dmar po de
rim bzhin mngal ‘dzin pa’i nus pa shor nas ngo bo nyes can gyi snyigs ma’i rnam pa can du gyur te, ibid.,
105.
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From the first until the fifteenth [days of the month], the power of the sun decreases and
the power of the moon element increases. During that time, the [red element] gathering in
the uterus [also] increases. The ‘blood,’ which is refuse, becomes an ‘object of harm’ by
gradually increasing. The gathering [of the refuse blood] for a regular interval every month
damages the inside surface of the uterus, and from being afflicted thusly, the lining on the
inside surface of the uterus becomes rotten. Then, the downward expelling wind moves
[the uterine blood] to the outside of the body, becoming menstruation.
Therefore, that which gathers in the ovaries is the refuse of the reproductive fluid, which is
the final bodily constituent, which [itself] has been produced by the six tastes of food and
drink. From that, the constituents of the seed’s root quintessence, by the power planted by
the “supreme quintessence,” resume once again the beginning of a new menstrual cycle. 478
In this passage, Lhamokyi points to Tibetan understandings of the lunar cycle and its relation to
the red element and menstruation. She is also speaking to and integrating biomedical ideas of
hormones. She writes that it is the “supreme quintessence” that “plants the power” to compel the
menstrual cycle. Again, biomedical knowledge about hormones are integrated in a way that both
fits within and expands (or develops) the Tibetan medical framework.
In the third section of the article, “The time of menstruation,” (zla mtshan ‘bab pa’i dus),
Lhamokyi remarks further on the occurrence of menstruation, its duration, its symptoms, and
when it first begins. She describes the actions of “hormones” in very close relation to Tibetan
ideas of digestion and the making of core nutrition (bcud). And for the first time, she also
includes a direct Chinese biomedical term. In the following, she outlines the reasons why young
girls do not menstruate. She writes:
Generally, for girls under the age of twelve, the body’s elements grow the quintessences of
the body that are produced from the natures of the six tastes of food and drink. Because
this energy is used to transform, nourish and grow the bodily constituents, menstruation
does not have a cause to occur. In regards to that, according to contemporary medical
science, before young women reach physical maturity, menstruation is said not to arise
because the function of the “pituitary gland” (!) in the brain is not completely mature,
478
tshes gcig nas bco lnga’i bar nyi ma’i stobs ‘bri zhing zla ba’i khams ‘phel ba’i dus der bu snod du
gsog cing ‘phel bar byed / de ltar nyes pa dang bcas pa’i khrag snyigs de rim bzhin ‘phel zhing bsags nas
tshad dang dus nges can zhig ste zla ba re re’i dus tshigs la slebs dus bu snod nang ngos kyi gnod bya
rnams la gnod par byed pa’m nyen pa las bu snod nang ngos kyi skyi pags ral ‘drul du gyur nas mthar
thur sel rlung gis lus kyi phyi la ‘ded de zla mtshan ‘byung / de nas ro drug gi bza’ btung las byung ba’i
lus zungs phyi ma khu ba’i snyigs ma bsam se’ur bsags pa der sa bon bcud kyi rtsa’i zungs bcud chen
po’i nus pa thebs nas slar yang zla mtshan gyi ‘khor yun gsar ba zhig gi ‘go tshugs kyi yod, ibid., 105.
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and therefore, there is not enough strength to compel [the growth] of the uterus and the
ovaries.479
As in Mingji Cuomu, Lhamokyi includes the Chinese characters for a biomedical term, in this
case, the “pituitary gland” of the endocrine system. Lhamokyi refers again to the six tastes,
digestion and the resulting “quintessences” (bcud) to augment the existing Tibetan tradition with
biomedical knowledge about the hormones.
For women over the age of fifty, according to Lhamokyi, “because the power of the
body’s elements are diminishing, they become old and their negative emotions grow stronger.” 480
Due to the quintessence (mdangs) and core nutrition (bcud) gradually weakening, “the
reproductive fluid that establishes the material substance of the core nutrition exhausts, together
with the production of menstruation.”481 In her explanation of menopausal and post-menopausal
women, “hormones” are not mentioned. Instead, she enlists the standard Tibetan medical
position on the waning elements of the body during one’s advancing years.
In her discussion on pregnant women and the reasons that they do not normally
menstruate, Lhamokyi introduces new terms for “estrogen” and “pregnancy hormones.” She
notes that:
According to modern medical texts, the reason that menstruation is not produced during
pregnancy is because in that situation, secretions of the “estrogen hormones” (mo skul
rtsi)” arising from the ovaries, together with the “pregnancy hormone” (sbrum skul rtsi)
establish their potency in the uterus. Because of [the secretions of those hormones], the
479 spyir bu mo lo bcu gnyis ma lon pa’i gong du ro drug gi mtshan nyid can gyi zas skom las byung
ba’i zungs bcud rnams lus khams ‘tshar longs dang lus zungs gso skyed kyi gsos su ‘gyur stabs zla mtshan
‘bab rgyu med / ‘di’i thad la deng rabs gso rig gi ‘dod pa ltar na lang tsho ma rdzogs gong klad pa’i
‘phyang gzugs (!) kyi byed nus yongs su ma rdzogs pas bsam se’u dang bu snod la skal ‘ded gtong ba’i
mthu stobs zhan stabs zla mtshan mi ‘byung zer, ibid., 106.
480
… bzungs ‘byung ba’i stobs nyams nas rgas pa’i dus te rlung shas che’i dus la slebs par ‘dug, ibid.,
106.
481
… bcud kyi ngo bor grub pa’i khu ba zad p dang chabs cig zla mtshan yang mi ‘byung, ibid., 106.
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lining on the inside of the uterus is supplemented and transformed, and the mother is
supplied with the necessary core nutrition [needed to develop] the fetus. 482
In this passage it is striking that Lhamokyi uses a term different than bcud chen po to describe
and name specific “modern” medical words for “hormones.”
Lhamokyi’s first innovative noun phrase, mo skul rtsi, is a translation of the biomedical
term “estrogen.” Although estrogen is popularly known as a ‘female hormone,’ it also performs
many non-reproductive functions in both male and female (mammalian) bodies. And estrogen
has a dominant role in organizing and activating sex-based ‘differences’ from the brain and
genitalia to behaviour. Reading the Tibetan more literally, Lhamokyi’s term could be read as
‘female-inducing nectar.’ This is because mo is a female marker, skul means to “arouse” or
“induce,” and rtsi, as discussed above in relation to bdud rtsi and “Extracting the essence”
tradition, refers to either “elixir,” “nectar” or “sap.” Of note, Lhamokyi’s Tibetan translation for
“estrogen” as “female-inducing nectar” indicates that she views estrogen to be a ‘female
hormone.’ This is common among the present-day Tibetan medical sources.
The second specific hormone that Lhamokyi names is popularly known in the West as the
“pregnancy hormone” (sbrum skul rtsi), which is more precisely, in biomedical thought, the
human chorionic gonadotropin (HCG) hormone. This hormone is said to be produced by the
placenta following conception. By interacting with the receptors of the ovaries, the HCG
hormone induces (or causes to function) the different parts of the body that establish and
maintain the pregnancy. Lhamokyi’s noun phrase for the “pregnancy hormone” is similar to
“estrogen” but instead of the female marker mo as the first syllable, she uses a word for
“pregnancy,” sbrum. Hence, literally, Lhamokyi’s term for the HCG hormone could mean
‘pregnancy-inducing hormone.’
Her choice of words in the naming of these hormones can be examined in a few ways.
Both ‘female-inducing nectar’ and ‘pregnancy-inducing nectar’ closely mirror their respective
482
deng rabs gso rig gi gzhung du’ng mngal sbrum pa’i skabs zla mtshan mi ‘byung ba’i rgyu mtshan
ni bsam se’u las zags thon byung ba’i mo skul rtsi dang sbrum skul rsti rnams skabs de dang de’i dus su
bu snod la nus pa thebs nas bu snod nang skyi sha ma’i cha shas su ‘gyur ba la ram ‘degs byas te mngal
gnas la ma’i zungs bcud mkho sprod byed pas na zla mtshan mi ‘byung, ibid., 106.
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biomedical functional equivalents. In that naming, Lhamokyi reaches to Tantric words and ideas
of the vajra body, such as rtsi from bdud rtsi to identify biomedical hormones. In the Extracting
the Essence and Empowering the Medicine Tantras, the terms bcud and bdud rtsi are
synonymous and can mean any one of “quintessence,” “nectar,” “elixir” and “sap.” In medicine,
bcud also can refer to the “essence” of food and drink, and in those cases is synonymous with
dwangs ma. Hence it would seem that in using bcud chen po and skul rtsi, the “hormones” are
chiefly identified by terms that are based on shared Tibetan medical and religious ideas
surrounding ultra-reified essences in the body. Particularly, in the use of rtsi in such phrases as
mo skul rtsi and sbrum skul rtsi, Lhamokyi is asserting that Tantric terms describing the subtle
vajra body can be used to translate biomedical terms for “hormones.”
If we recall, Mingji Cuomu used the term, skul, in her term for estrogen, shes rab rang
bzhin skul rgyu, literally meaning, “the hormone which induces the inherent self-nature of
wisdom.” Wisdom, as noted earlier is a Buddhist euphemism for women. Lhamokyi’s term for
estrogen, mo skul rtsi, is similar to Mingji Cuomu’s insofar as pointing to the biomedical
understandings of the functions of “hormones.” Although using different terms for “estrogen,”
both Mingji Cuomu and Lhamokyi explicitly name estrogen as a ‘female hormone.’
As discussed above, Lhamokyi, like many of her contemporaries, asserts that the proper
interpretation of the authoritative literature of Tibetan medicine can establish knowledge of the
“hormones” studied in biomedical endocrinology. When Lhamokyi establishes “hormones” in
Tibet’s authoritative literature, she uses the very general ‘name-holder’ phrase, “bcud chen po” to
indicate ‘hormone-like substances.’ And, when she provides direct Tibetan equivalents, or
translations of biomedical words, she uses a more exacting phrase such as mo skul rtsi. Hence,
Lhamokyi integrates the two systems, while maintaining a number of Tibetan distinctions,
including her central position which is that Tibet had its own independently established
understanding of “hormones,” which she terms, bcud chen po.
Continuing her focus on the reasons for menstruation not to occur, Lhamokyi turns to
delayed or suspended menstruation. She writes that if, since the first occurrence of the menstrual
period, at least two years have passed without menstruation, then the “essential nature of the
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menstrual cycle has not yet materialized.”483 Further, “the essential bodily strength, and
specifically the energy and power of the ovary, is not quite complete and not quite mature.” 484
She then writes that women are like a ripened fruit in that they show signs of being “ripe” (dmar
mdangs), because mature and healthy women have a “radiant and ruddy red complexion.”485
Lhamokyi finds her textual evidence for this assertion, that is, that reproductively mature
women show signs of being such, in Gendun Chöphel’s Treatise on Passion. According to him,
“femaleness is achieved at the age of thirteen [and] is exhausted at the age of sixty.”486 Lhamokyi
reinforces this statement with a similar quotation from her second authoritative source, the Eight
Branches written by Vāgbhaṭa, and translated into Tibetan in the eleventh-century by Rinchen
Zangpo.
In this instance, Lhamokyi’s choice of authoritative sources is striking. Gendun Chöphel
is an eccentric and iconoclastic figure. He was at one time a renowned, brilliant but controversial
monk-scholar, who later disrobed and advocated for the modernization of Tibet. Among his
various writings, Treatise of Passion became (perhaps understandably) his most famous. In this
work, Gendun Chöphel writes about the methods of sexual pleasure, and his own experiences
with and ‘appreciation’ of various kinds of women.487 What is perhaps unusual is that Treatise on
Passion is a sexological work rather than a medical one, and so one might not expect to see it
quoted in medical works. But his knowledge of women’s bodies is clearly considered by many
present day authors to be authoritative.
Beyond being sexual partners, Gendun Chöphel frequently urges his male readers to
value and respect women as equal to themselves. Some of his ideas may seem antiquated to
483
zla mtshan gyi dus‘khor la da dung chos nyid cher med, ibid., 107.
484
gtso bo lus kyi stobs dang lhag par bsam se’u’i nus mthu cung zad rdzogs pa tsam las yongs su ma
smin pa ste, ibid., 107.
485
Rangjung Yeshi, s.v. “dmar dmangs.”
486 mo ni rang lo bcu gsum lon na // na tshod dar zhing bcu drug lo la rdzogs, ibid., 107. This passage
is also quoted in Gönpokyap’s article on Gendun Chöphel: Mgon po skyabs, Gso rig dpyad rtsom kundan
dgyes pa’i zla zer, 25.
487
In his Treatise on Passion, Gendun Chöphel outlines the different categories that included
physical features, personality and mental capabilities of men and women.
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some readers. For example, he writes that a woman partner is “a goddess,” “a field that
producing a good family lineage,” “a nurse,” “a poet,” “a servant who does all of the work of the
household,” and a “friend.” 488 Yet in many ways he was an advocate for women’s equality, which
was in contradistinction to the social conservatism of the monastic elite of his (and arguably our)
day. It is not surprising then that many contemporary writers and gender equality activists in
present-day Amdo cite his Treatise on Passion as an authoritative source on women’s rights in
Tibet. For example, in her book of interviews with prominent Tibetan women thinkers,
Perspectives on Common Discrimination against Tibetan Women, Gönpokyi asks one expert: “Is
Gendun Chöphel’s Treatise on Passion, a weapon against the degradation of and discrimination
against women?”489 Hence, it is telling that this same work, Treatise on Passion appears as a
medical authority in medical articles, such as Lhamokyi’s article on the inner workings of female
bodies.
The other authoritative source that Lhamokyi refers to in this section is the Eight
Branches, an immensely influential work for the development of Tibetan medicine (and other
medical systems throughout south and central Asia).490 Lhamokyi’s choice of authoritative
sources is revealing of her research methods and the sort of intellectual narrative she is piecing
together. In integrating biomedical and Tibetan medical thought on menstruation, she juxtaposes
one of the earliest and most influential sources from the Indo-Tibetan tradition with a somewhat
notorious sexological work by a famous (and equally notorious) twentieth-century Tibetan
intellectual.
In contrast, twenty first-century Western biomedical thinkers tend to view the methods of
their scientific systems as a clear break from the earlier, ‘non-scientific’ medical traditions that
488
Hopkins, Tibetan Arts of Love, 52.
489
Dge ‘dun chos ‘phel gyi ‘dod pa’i bstan bcos kyis bud med la dma’ ‘bebs dang mthong chung byas
pa mtshon thub bam, Mgon po skyid, Bod mo’i dogs gzhi dang thun mong gi lha tshul (Gansu: Kan su’u
mi rigs dpe skrun khang, 2010), 26.
490
Garrett, The Human Embryo in Tibet, 24–5.
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preceded them.491 For example, while modern-day biomedicine can trace its lineage to fifthcentury BCE classical Greece, it is not common to cite Hippocrates (460 – 377 BCE) as an
authoritative medical source in contemporary scientific literature, unless as a sage anecdote
about the art of medicine. In the Tibetan case, it is quite the opposite. The details of works like
Vāgbhaṭa’s Eight Branches constitute a vital source of authority and are engaged as such in their
medical research. Similarly, a modern treatise on sexual pleasure is able to show the same
insights as a text written over a thousand years earlier on the Indian sub-continent. Her narrative
is clear: Tibetan medicine is a continuous tradition that is maintaining and developing scientific
knowledge about the body. More importantly, the texts of Tibet’s intellectual world, whether they
be strictly medical or not, can constitute authoritative medical knowledge that is both unique and
universal and should be researched as such.
What both the Eight Branches and Treatise on Passion are pointing to, according to
Lhamokyi, is that without the bodily strength and energy garnered from the core nutrition of food
and drink (and a properly working digestive system), a woman cannot menstruate even if she is
of the age to do so. Her larger point is that menstruation is an inherent nature and defining
characteristic of woman. She explicitly ties this definition of woman to Buddhist thought through
the use of the symbolic gendered pair of wisdom and means. Lhamokyi writes:
What we are able to know from what has been written, is this: As far as the ‘self-nature of
wisdom’ that belongs to females, at sixty years of age the strength of their youth is
exhausted. Therefore, the ovaries, and other [reproductive parts]—the faculties of fertility
—become devoid of the power to increase the family lineage, that is, to produce and to
develop children. 492
Hence, according to Lhamokyi, so-called menopausal women do not menstruate because their
body’s “self-nature of wisdom” (shes rab rang bzhin), marked in its youth by signs of fertility, is
491
For example see: Alfred North Whitehead, Science and the Modern World: Lowell Lectures, 1925
(New York: Free Press, 1967), and Don G. Bates, “Why Not Call Modern Medicine ‘Alternative’?” The
Annals of the American Academy of Political and Social Science 583, no. 1 (2002): 12–28.
492
zhes pa’i shugs las nga tsho mtshon thub pa ni shes rab rang bzhin gyi bu mo rnams lo bcu drug
ma lon gong du lang tsho’i stobs yongs su ma rdogs pa ste / bsam se’i sogs ro rtsa’i dbang po la rigs
rgyud spel ba dang phru gu gso skyed kyi nus pa dben par mthong ngo, Lha mo skyid, Zla mtshan gyi
rnam par bshad, 107.
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no more. It is exhausted by age. Her use of the Buddhist symbolic term for women, “wisdom,”
points to the notion of ‘femininity’ and the physical marks that distinguish the female body.
Much like the Western endocrinological explanations, Lhamokyi then cites physical
illness, mental or emotional stress, and environmental changes as also being reasons for
disruptions of the menstrual period. Lastly, she concludes this sub-section by reiterating women’s
“inherent self-nature” (chos nyid rang bzhin): “For each and every woman, her individual
menstrual cycle depends on her own inherent self-nature.”493 Here again, like at the beginning of
the article and throughout, Lhamokyi asserts that the ability to menstruate is an inherent nature of
women.
Lhamokyi’s consideration of ‘non-menstruating women’ immerses the biomedical
understanding of hormones into the context and language of Tibetan thought, principally through
understandings of digestion, core essences and the white and red elements. This integration
substantiates and maintains the authority of the Tibetan system. At the same time, it expands and
reinterprets the meanings of the Tibetan textual tradition so as to innovate and to advance its
knowledge, and most importantly for political reasons, to show its signs of ‘contemporary
relevancy.’ What is key, is that biomedical hormones and their relation to sex and gender appear
to substantiate Tibetan religious and medical ideas that define what a woman essentially is.
Significantly, in the sixth and final section of her article, “The connection between
menstruation and the red element,” (zla mtshan dang khams dmar bar gyi ‘brel ba)494 Lhamokyi
bases her final analysis of menstruation principally on the Tibetan medical system. In her final
summary, Lhamokyi emphasizes that the red element and menstruation have the same “material
basis” (ngo bo bzhi), and therefore, the term “red element” encompasses the entire menstrual
cycle, including the ovulatory cycle.
In this last section, Lhamokyi reiterates the relations among the brain, the ovaries, the
marrow and the reproductive fluids. She writes that the white and red elements and their
493
bud med rnams kyi zla mtshan gyi dus ‘khor lo so so rang gi chos nyid rang bzhin yang mchis so,
ibid., 108.
494
Ibid., 109.
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respective fluids are produced from the essence of marrow, which includes the brain. She asserts
that this is because the brain and marrow share the same material basis, and their relation is
based on the metabolizing processes of digestion. Lhamokyi’s reasoning is an implicit nod
towards hormones and the endocrinological system of biomedicine.
In conclusion, Lhamokyi’s overall argument is that the Tibetan medical system has, from
its very beginnings in the Indian tradition, independently established insights into what
contemporarily is called “hormones.” Hence, further research into biomedical notions of
“hormones” can only enrich the Tibetan medical system, rather than replace or undermine that
system. Lhamokyi’s work shows that the ideas and language of the authoritative Tibetan
Buddhist and medical literature can be reinterpreted to integrate the new ‘modern’ knowledge of
biomedicine. In fact, Lhamokyi does this so well, that Tibetan medicine remains central
throughout her article, while biomedicine, clearly having a much larger authoritative voice both
on the global stage of medicine and in Chinese Tibet, appears to play only a supportive, auxiliary
role in her article.
3.4 Brain, Marrow and Reproductive Fluid in Gönpokyap
Gönpokyap’s article, “Brief Discussion in regards to the Connections among the
Reproductive Fluid, Marrow, Brain and the Ovaries and Testes” is singularly focused on the role
of the brain. What is remarkable about this article is that although it is clearly aimed at
establishing the Tibetan textual account of the biomedical endocrinological system, “hormones”
themselves are not explicitly mentioned. Even more so than Lhamokyi, Gönpokyap concentrates
on the Tibetan medical picture of the relation between the ‘brain marrow,’ the ovaries and the
testes, by relying exclusively on a wide range of Tibetan sources. This part of the thesis looks
closely at how he creates a Tibetan ‘endocrinological’ account of the reproductive body without
direct reference to biomedical “hormones.”
Gönpokyap begins his article by describing the seven bodily constituents with a quotation
found in both the Root and Explanatory Tantras of the Four Treatises:
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By the method of condensing the most important parts of the essences of the bodily
constituents, there are seven: essence, blood, flesh, fat, bone, marrow and reproductive
fluid.495
Commenting on this, Gönpokyap writes:
Later generations of people mostly interpreted these root texts in the following way. From
the essence comes blood and from blood, flesh; from flesh, fat; from fat, marrow, and from
marrow, arises the reproductive fluids. Because it is stated like this, the subject to be
explained in this [article] is the brain, because it is difficult to ascertain whether it is the
essence or the refuse. For example, according to Ancestral Advice and Blue Beryl, the
initial essence comes to reside in the liver. In dependance on the functions of the wind, bile
and phlegm [dynamics] that reside in the liver, those essences become exclusively blood.
Again, the essence of blood goes to constitute the flesh; those essences [of blood]
exclusively become flesh. Likewise, the essence of flesh, goes to constitute fat; the essence
of that [flesh] exclusively becomes fat. The essence of fat becomes bone; the essence of
bone becomes marrow, and; again from the [essences of] marrow become the reproductive
fluids, that is, the white and red elements. Likewise, according to the Eight Branches:
“Flesh is from that blood which comes from the essence; bone is from that fat which comes
from flesh, and reproductive fluid comes from the marrow which comes from the bone.”496
According to Gönpokyap, when people read these lines from the early authoritative sources like
the Four Treatises, Ancestral Advice, Blue Beryl and the Eight Branches, they normally interpret
them as meaning that the essence of marrow, that is the marrow from inside of the bone,
becomes the reproductive fluid. They therefore do not associate the ‘brain as marrow’ as being a
cause for reproductive fluid because, according to Gönpokyap, it is not mentioned in these lines
from the Four Treatises as one of the seven bodily constituents. Gönpokyap’s response to this
misreading of the ‘later generations’ is that the four authoritative texts mentioned above are
495
lus zungs kyi dwangs ma’i cha rnams ches mdor bsdus sgos dwangs ma khrag sha tshil rus rkang
khu ba bcas bdun gyi khongs su ‘dus par byas shing, Mgon po skyabs, Gso rig dpyad rtsom kundan dgyes
pa’i zla zer, 238.
496
gzhung tshig ‘dir phyi rabs pas ‘grel mdzad skabs mang che bas dwangs ma las khrag dang khrag
las sha / sha las tshil / tshil las rkang / rkang las khu bar ‘gyur zhes gsungs pa las / skabs ‘di’i brjod gzhir
gyur ba’i klad pa ni dwangs snyigs gang gi khongs su gtogs pa’i nges pa rnyed dka’ / dper na mes po’i
zhal lung dang baidūrya sngon po du thog ma’i dwangs ma de yang mchin pa’i gnas su slebs pa’i tshe /
mchin pa la gnas pa’i bad mkhris rlung gsum gyi bya ba byas pa la brten nas de’i dwangs ma rnams
khrag ‘ba’ zhig tu gyur la / khrag gi dwangs ma de yang sha’i gnas su song ba’i tshe de’i dwangs ma de
rnams las sha ‘ba’ zhig tu ‘gyur ro / de bzhin du sha yi dwangs ma de tshil gyi gnas su song ba’i tshe de’i
dwangs ma de rnams tshil du ‘gyur zhing / tshil gyi dwangs ma de las ni rus par ‘gyur la / rus pa’i
dwangs ma de las rkang mar du ‘gyur ba dang / rkang mar de las kyang khu ba ste khams dkar dmar du
‘gyur ba yin no zhes gsungs / dpa’ bo’i yin lag brgyad pa ru’ng / dwangs ma las khrag de las sha // sha
las tshil te de las rus // rus rkang de las khu ba yin, ibid., 238–9.
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extremely condensed works that summarize all of the body’s constituents into the seven central
categories, and that the brain is therefore not mentioned here. But, he emphasizes, in many of the
commentaries of these works, the brain is elaborated upon as marrow, the sixth bodily
constituent.
For the remainder of the article, Gönpokyap argues that the brain is already established as
marrow in the Tibetan system, and further, is therefore already understood as having a direct
relationship to the reproductive fluids, including the menstrual and ovulatory processes. One of
the central issues that Gönpokyap examines is whether the brain (understood as the sixth bodily
constituent, marrow) is the essence or refuse of ‘bone,’ the fifth bodily constituent. Similar to
biomedical endocrinological studies, Gönpokyap is working to establish the physical pathways
and mechanisms that produce the relations among the brain and the body’s reproductive parts.
In the second half of his introduction, Gönpokyap introduces two of his primary guiding
sources, the Somarāja and Treatise on Passion. He argues that both of these texts confirm the
relations among the brain, marrow and reproductive fluids in the Tibetan medical tradition.
Setting up his discussion, Gönpokyap writes:
Many people really familiar with these texts basically say that they think that the two white
and red reproductive fluids come directly from marrow, but according to the Somarāja:
“In the middle of the ‘heart of the brain,’ or some also say, the ‘centre of the
brain,’ is the ‘root quintessence of the seed,’ which increases the health of the body.”
And, according to the authority of Gendun Chöphel’s work, Treatise on Passion:
“Blood is the essence of the human body, and [when it is] gathered together, the essence
of blood are the drops.” 497
According to Gönpokyap, both the Somarāja and the Treatise on Passion show that, within the
Tibetan medical tradition, the male and female reproductive fluids arise (indirectly) from the
brain. The Somarāja claims that they arise from the “root quintessence of the seed” (sa bon bcud
497
gzhung lugs ‘dir rgyus mnga’ che ba’i skye bo gang mang zhig gis rkang las thad kar khu ba dkar
dmar gnyis su ‘gyur bar bsam / yang so ma ra’ dza ru / klad pa’i snying dang ‘brel ba ste // la la klad pa’i
rgya yang zer // dbus na sa bon bcud kyi rtsa // lus kyi bde ba rgyas par byed // ces dang / mkhas dbang
dge ‘dun chos ‘phel gyis mdzad pa’i ‘dod pa’i bstan bcos su / skyes pa’i lus kyi dwangs ma khrag yin cing
// khrag gi dwangs ma ‘dus pa thig le ste, ibid., 239.
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kyi rtsa) at the “heart of the brain” (klad pa’i snying) or the “centre of the brain” (klad pa’i rgya).
However, the connection between the brain and the reproductive fluids may seem less obvious
from the Treatise on Passion, unless we consider (according to earlier sources) that the
“drops” (thig le) refer to the quintessences (or essence of essences) of the white and red elements
that reside at the brain. 498
Essentially, both of these texts show that the brain is connected to the reproductive fluid.
In this regard, Gönpokyap writes that interpreted correctly, and according to their genre and
purpose, the respective viewpoints of all three works, the Four Treatises, Somarāja and Treatise
on Passion, can be maintained as correct or true. Like many of his contemporaries, Gönpokyap
refers to works that span the Tibetan medical tradition, reaching back to the earliest sources of
Āyurveda, to the standard text of Tibetan medicine, the Four Treatises, and to Gendun Chöphel’s
twentieth-century treatise on sex. A primary reason for this effort is to show that contemporary
interpretations of the authoritative texts are part of a continuous, and long-standing world-class
medical tradition.
Gönpokyap divides the remainder of his article into two sections titled, “The connection
between the brain and reproductive fluid” (klad pa dang khu ba’i ‘brel ba), and “The connection
between the ovaries/testes and reproductive fluid” (bsam bse’u dang khu ba’i ‘brel ba).
On the relation between the brain and reproductive fluid Gönpokyap begins:
The essences of the bodily constituents, are gradually transformed by a sequence of events,
to become the marrow inside [the bone] cavities. [Both] the brain, and the inside of the
bone or the ‘place on the interior of the bone’ are included as ‘marrow.’499
498
If we recall, Thupten Pünstok makes this claim. See: Thub bstan phun tshogs, Gso bya lus kyi rnam
bshad, 103–4 and 118–120.
499
lus zungs rnams dwangs ma nas rim bzhin phyi mar ‘gyur ba’i brgyud rim nang sbubs su yod pa’i
rkang rnams su ‘gyur la / klad pa dang gzhung pa’ng rus sbubs su gnas pas rkang gi khongs su gtogs,
ibid., 239–40.
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As his first piece of textual evidence to support this claim, Gönpokyap quotes the following from
Kyempa Tsewang’s (Skyem pa tshe dbang, fifteenth-century)500 work, Commentary to the
Explanatory Tantra:501
The ‘digestive bone heat’ belonging to the bone ripen [the essence of the fat], and by
separating the essence from the refuse, the essence goes to become marrow. The brain and
the inside of the bone are included within the [category of] ‘marrow.’ 502
In this passage, it is explained how marrow, understood as that which is on the inside of the bone
and the brain, is produced from fat. The “digestive bone heats” (rus pa’i me drod) refers to the
digestive heats that exists in each of the seven bodily constituents and are needed to further
separate essences from refuse throughout the entire body. As noted above, Lhamokyi stated that
the “three heats” refer to the digestive bile, the decomposing phlegm and the fire-accompanying
wind. In Kyempa Tsewang’s work, it is explained that the digestive bone heats produce the
marrow.
Following from above, Gönpokyap continues to establish how marrow is made, quoting
the following from Nāgārjuna’s Commentary:503
The ‘digestive bone heats’ inside the opening of the bone ripen and separate into the
essence and the refuse. The essence of bone goes to the marrow, where the marrow softens
[to become] the cartilage of the brain. That essence of the brain is [produced from] the
essences of marrow from the inside of the bone. The refuse of the bone becomes teeth,
500 According to Olaf Czaja, very little is know about Kyempa Tsewang, except that he lived during the
fifteenth-century. See: Olaf Czaja, “The Making of the Blue Beryl—Some Remarks on the Textual
Sources of the Famous Commentary of Sangye Gyatsho (1653 – 1705),” in Soundings in Tibetan
Medicine: Anthropological and Historical Perspectives, ed., Mona Schrempf (Boston: Brill, 2007), 368,
fn. 81.
501
Skyem pa tshe dbang, Rgyud bzhi’i rnam bshad (Xining: Mtsho sngon mi rigs dpe skrun khang,
2000).
502
rus pa rus pa’i me drod kyis smin cing dwangs snyigs phye ba las dwangs ma rkang mar dang //
de’i khongs su gtogs pa klad pa dang gzhung par gyur zhes, Mgon po skyabs, Gso rig dpyad rtsom
kundan dgyes pa’i zla zer, 240.
503
Gönpokyap simply refers to this text as Nāgārjuna’s commentary (Dpal mgon gyi ‘grel ba).
Nāgārjuna wrote several important medical commentaries that have been republished in Tibet. I am
unsure from which text this particular passage is taken.
!199
fingers, and toe nails. The ‘marrow heats,’ inside the opening of marrow, ripen and separate
into essence and refuse. The essence of marrow becomes reproductive fluid. 504
According to Gönpokyap, these two passages clearly indicate that the brain is understood to be
the essence of marrow. Hence, Gönpokyap writes:
Kyempa Tshewang and Nagarjuna’s thoughts are not at all dissimilar from the Four
Treatises, Ancestral Advice and the Blue Beryl. The Explanatory Tantra is an extremely
condensed [explanation of] the bodily constituents. And, because of that, the Ancestral
Advice and the Blue Beryl are similarly written in an extremely condensed commentarial
style.505
Gönpokyap deduces that all these various sources of the Indo-Tibetan medical tradition point to
the fact that the brain is marrow. Each of the seven bodily constituents are really, in Gönpokyap’s
analysis, a ‘category header’ for a number of body parts and substances that fit under that
classification. Hence, “marrow,” includes the marrow that exists inside of bones and the brain.
Therefore, according to Gönpokyap, even though the brain is not listed as one of the seven
bodily constituents in the Four Treatises and its major commentaries, it certainly is considered as
such by those sources.
To further support the argument that the brain is indeed included as marrow in the Four
Treatises, Gönpokyap quotes the following from the chapter on poison: “That which comes from
bone, subsequently becomes brain matter, and the brain and [marrow] inside the bone comes
from the bone transforming into marrow.”506 And further, from the Explanatory Tantra, he cites
the following: “Exhausted marrow makes the hollow [parts] become empty, causes dizziness,
and obscures the eyes.” 507 According to Gönpokyap, the ‘hollow parts’ refer to the brain, and
504 rus pa’i bu gar rus pa’i me drod kyis smin par byas pa las // dwangs snyigs gnyis su phye nas rus
pa’i dwangs ma rkang mar la yang rkang zhun bu dang lha ba klad pa’o // klad pa’i dwangs ma de rkang
dang gzhung pa’i dwangs ma rnams so // rus pa’i snyigs ma so sen mor ‘gyur ro // rkang pa’i bu gar
rkang pa’i me drod kyi smin par byas pa las // dwangs snyigs gnyis su phye nas // rkang gi dwangs ma
khu bar ‘gyur zhes gsungs pas so, ibid., 240.
505
de na skyem pa tshe dbang dang dpal mgon gyi dgongs pa rgyud dang mes zhal Baidurya sngon po
sogs dang ma mthun pa yin nam zer na / de gtan nas min te / bshad rgyud du lus zungs rnams ches mdor
bsdus sgos gsungs shing / der mes zhal dang Baidurya sngon po du de bzhin ches mdor bsdus ‘grel ba
mdzad la, ibid., 240.
506
rus las klad gzhung rkang du ‘gyur ba’i phyir, ibid., 240.
507
rkang zad sbubs stong mgo mkhor mig ‘grib ‘gyur, ibid., 240.
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when it becomes exhausted, one feels lightness and dizziness in the head. Hence, these examples
from the Four Treatises show that the brain is definitively the “marrow” (rkang) produced from
the essence of bone.
The next step for Gönpokyap is to explain how the brain, correctly understood as marrow,
produces the reproductive fluid which is the seventh bodily constituent. To do this, Gönpokyap
returns to the Somarāja, Blue Beryl and Treatise on Passion to lay out how “the brain is the
actual basis of the arising of the reproductive fluid.”508 Gönpokyap quotes the following from
Somarāja:
There are four roots of the inner tree. That which is gathered at the head is the wind, which
holds the seed for the body. The chakra at the ‘conch shell of Brahman’ is the root seed for
the bodily constituents.509
The point that Gönpokyap is making in using this somewhat cryptic text is that the chakra at the
crown of the head, which is said to hold the drop for the “root seed of the body” (lus zungs sa
bon rtsa) indicates the brain. Therefore, the brain can be said to be the basis or source for the
reproductive fluid. Gönpokyap further supports this idea quite definitively through the Blue
Beryl, from which he quotes: “The brain and bone marrow ripen the two, white and red
seeds.”510
After some further reasoning that the brain is clearly understood as a part of marrow, and
is the source of the reproductive fluids, Gönpokyap turns to a more modern source demonstrating
that the brain is the source of the reproductive fluid, the Treatise on Passion. He writes:
[According to] the authority of Gendun Chöphel’s Treatise on Passion, “the essence of the
human body is blood, and the gathering of the essence of blood is thig le.” It is also written
in [the Treatise on Passion] that “a mere seven drops of the essence of food establishes one
drop of blood in the human body. And roughly one cup of drops of blood establishes
roughly one subtle drop of reproductive fluid.” If one is not experienced in [Tibet’s]
glorious science of healing they believe that reproductive fluid comes directly from blood.
508
khu ba’i ‘byung gzhi dngos klad pa yin, ibid., 241.
509
nang gi ljon shing rtsa bzhi dang // spyi bo dag tu ‘dus pa ni // rlung gis lus kyi sa bon bzung //
tshangs pa dung gi ‘khor lo ste // lus zungs sa bon rtsa yin no, ibid., 241.
510
klad pa dang gzhung pa nas sa bon dkar dmar gnyis su smin, ibid., 241.
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But that holy man [Gendun Chöphel] is a person who has great knowledge of the body’s
systems. On this occasion, the actual subject matter is [the seven bodily constituents]: from
blood, comes flesh. And from that, fat, and from that, bone, and from that, marrow, and
from that, the reproductive fluids which have been gathered from the transformative
sequence of events that have already been explained.511
In this passage Gönpokyap asserts that although Gendun Chöphel’s Treatise on Passion is about
sexual pleasure (and its ethical, spiritual and Tantric dimension), he also knew a lot about
medicine. Clearly then, argues Gönpokyap, “the seven drops of the essence of food” (zas kyi khu
ba thigs pa bdun tsam) quoted from Gendun Chöphel, is directly referring to the Tibetan medical
understanding of the digestive system and the seven bodily constituents. Therefore, as we can see
here, Gönpokyap is working to establish the medical authority of both the person, Gendun
Chöphel, and the Treatise on Passion. In essence, he interprets the Treatise on Passion as being a
medically informed sexological work.
Gönpokyap concludes this first section on the relation between the brain and reproductive
fluid by pointing to the Buddhist philosophical notion of “cause and effect” or “seed and
fruit” (rgyu ‘bras). He writes:
Between the two, ‘direct primary cause’ and ‘indirect cause,’ the brain is the ‘indirect
cause’ of reproductive fluid. If it were the case that the brain was the ‘direct cause’ of
reproductive fluid, then the fruit [semen and the egg] that is produced would not require
any middle means, that is, the causes and conditions of transmission and [the brain] would
have the causal power to produce [reproductive fluid] on its own. For something to be an
‘indirect cause,’ the ‘effect’ requires a ‘cause’ in order to be produced. [Therefore], for the
511
yang mkhas dbang dge ‘dun chos ‘phel gyis mdzad pa’i ‘dod pa’i bstan bcos su / skyes pa’i lus kyi
dwangs ma khrag yin cing // khrag gi dwangs ma ‘dus pa thig le ste zhes dang / yang de las / zas kyi khu
ba thigs pa bdun tsam gyis // mi yi lus la khrag thigs gcig ‘grub cing // khrag gi thigs pa dkar yol gang
tsam las // khu ba thigs pa phra mo gcig tsam ‘grub ces gsungs par / dpal ldan gso rig la rgyus mnga’
dpen pa’i mi zhig gis bltas tshe khrag las thad kar khu bar ‘gyur bzhin pa’i snang ba zhig ster mod / dam
pa khong nyid de tsam mi rtogs shing mi’i lus kyi shes byar rgyus mnga’ med pa’i skye bu zhig gtan nas
min / skabs ‘di’i brjod don dngos ni khrag nas sha dang / de nas tshil de nas rus de nas rkang de nas khu
ba rnams su ‘gyur ba’i brgyud rim dag bsdus nas gong ltar gsungs, ibid., 241–2.
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brain to ripen the white and red elements that are needed for pregnancy, it requires the
meeting of other causes and conditions, so that is why it cannot be a direct cause. 512
In this passage, Gönpokyap asserts that the brain is “indirect cause” (brgyud rgyu) of the
reproductive fluid, arguing that the reproductive seed undergoes transformative stages that are
mediated by the digestive system. Like Lhamokyi, he argues that the reproductive fluid cannot
be a “direct cause” (dngos rgyu) because fully matured reproductive fluids do not move directly
from the brain, and through a channel to the ovaries or testes. Therefore, according to
Gönpokyap, the brain, acting as ‘marrow,’ the sixth bodily constituent, ripens the white and red
reproductive fluids in the testes and ovaries through a complex series of ‘digestive processes.’
How these processes happen is the topic of the second and final section of the essay.
Gönpokyap’s central aim in the last section of his article, “The connection between the
ovaries/testes and reproductive fluid,” is to explain how the ovaries and testes function as those
vessels of the body that hold and ripen the reproductive fluids by their relation to the brain. To
set up his discussion, Gönpokyap quotes from the Eight Branches, “all of [the essences of] the
elements [of the body] accumulate as the white and red [reproductive elements]. The refuse [of
the seven bodily constituents] is what gathers in the vessels of the testes and ovaries.” 513
Commenting on this, Gönpokyap writes: “As it is said, the ovary is a container that gathers the
reproductive fluid, which has been ripened by the brain and dispersed everywhere in the
body.” 514 For the remainder of the article, Gönpokyap presents Tibetan medical and Tantric
sources to substantiate, and demonstrate beyond any doubt, that Tibet’s authoritative literature on
the body includes knowledge about the brain and its relation to reproduction. Implicitly,
Gönpokyap shows that Tibetan medicine has its own version of the biomedical endocrine system.
512
klad pa de khu ba’i dngos rgyu dang brgyud rgyu gnyis las brgyud rgyu yin / dngos rgyu yin tshe
rang gi bskyed bya’i ‘bras bu de dang bar du rgyu’i chos gzhan brgyud mi dgos par skyed nus pa’i rgyu
yin dgos shing / brgyud rgyu yin tshe rang gi ‘bras bu de skyed byed yin yang rang gis dngos su skyed par
‘bras bu de’i rgyun zhig skyed cing de brgyud nas rang gi ‘bras bu de skyed par byed pa’i rgyu yin dgos
pas / klad pa nas bu ‘dzin byed kyi khams dkar dmar la smin dgos pa’i bar du rgyu’i rkyen gzhan dang
‘phrad dgos pa’i phyir ro, ibid., 243.
513
514
khams kun ‘dus pa dkar dmar gyi // snyigs ma gsog snod bsam bse’u, ibid., 243–4.
zhes gsungs pa ltar bsam bse’u ni klad pa nas smin pa’i khu ba de lus kyi gang sar khyab pa rnams
bsdu gsog byed mkhan gyi gsog snod cig yin, ibid., 244.
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One of the first sources that Gönpokyap turns to in order to demonstrate the relation of
the brain to the reproductive fluids is a Tantric work by the Nyingma treasure revealer, Dorje
Lingpa (Rdo rje gling pa, 1346 – 1405). 515 Gönpokyap writes:
If you ask how the reproductive fluid is successively ripened [beginning] from the brain,
and descends through a channel pathway to the reproductive sac, then [it is useful to look
at] the channels, winds and drops according to Dorje Lingpa, who writes:
You may wonder from where in the body does the essence of the five elements, known
as the ‘drop of the enlightened mind’ descend from? For example, if there is a drop of
rain on the top of a tree, whether it is moved by the wind or someone’s hand, or by any
other circumstances, the drop, by falling to the ground, moistens the earth and grows the
plants and vegetables. Similarly, the essence of the elements of the five elements are
dispersed throughout the entire body. And from being in that state, when a person with
sexual desire enters into the state of union of bliss and emptiness, the action of the
pervasive wind causes that essence, which is the stirring of all of the elements, to gather
in the ovary and testes, which is at the thirteenth cakra on the left side. After [gathering]
there, the downward clearing wind draws [the essence] downwards from the penis and
carries it through the canal to the opening of the uterus. The mother’s downward-clearing
wind and grasping wind grasps the seed [that causes] pregnancy. 516
Here, the principle subject is the “drop of the enlightened mind” (khams byang chub sems kyi
thig le) which is a Tantric idiom for the quintessence of the five elements (earth, water, fire, wind
and space) that make up the body. In Dorje Lingpa’s account, these essences of the elements are
dispersed throughout the body, and when ‘stirred’ through sexual desire and passion, they gather
at the ovaries, becoming the reproductive seed. Commenting on this, Gönpokyap writes: “As it
says [in Dorje Lingpa’s text], just like earth vapours dissipate in the sky, the [essence of the
515
516
TBRC: P6164.
klad pa nas rim bzhin smin pa’i khu ba de rgyu lam gang du brten nas gsang sgror babs pa yin zhe
na / rdo rje gling ba’i rtsa rlung thig le’i skor las / ‘byung lnga’i dwangs ma khams byang chub sems kyi
thig le zhes pa de lus gnas gang nas babs pa yin snyam na / dper na lo ‘dabs ldan pa’i shing gi rtser char
gyi zil ba chags pa de rlung gis g.yos pa’m skyes bu gang dag gi lag pas bskul ba sogs kyi rkyen las zil ba
de dag sa yi steng du lhung bas sa gzhi brlan zhing rtsi thog skyes pa ltar / ‘byung lnga’i khams kyi
dwangs ma rnams lus kyi cha shas kun la khyab cing gnas pa las skyes bu gang dga’ bzhi’i bde ba ‘phel te
bde stong zung du ‘jug pa’i tshe khyab byed rlung gi byed las kyis khams kun g.yos pa’i dwangs ma de
bsam bse’u zhes tshigs pa bcu gsum gyi g.yon ngos kyi rtsa lam der ‘dus skabs thur sel rlung gis thur du
drangs te padom’i lam nas mngal gyi sbubs su bskyal bas / ma’i thur sel rlung ngam ‘dzin ‘bri’i rlung gis
‘dzin pas mngal chags pa’i sa bon byed pa yin no, Mgon po skyabs, Gso rig dpyad rtsom kundan dgyes
pa’i zla zer, 244–5.
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elements] similarly gather in the reproductive sac.” 517 As one can imagine, such an account
dovetails nicely with biomedical notions of hormones.
Supplementing this, Gönpokyap again quotes the following from Gendun Chöphel’s
Treatise on Passion:
If material forms are stirred and churned, then their self-essence, that is, their inherent
nature is emitted. If clouds are churned then rain falls. If trees are churned, the tongues of
fire come out. Similarly the essence of milk is butter, but first, it is milk. Moreover, if milk
is churned from being poured in a barrel then it gradually heats up, and from that, the
essence (bcud) from inside the [milk] separates and rises. Similarly, the essence of blood
are the drops. At first, [the drops are] absorbed in the blood. However, if there is ‘churning’
from the joining of the male [and] female [bodies], then the power of desire, [causes] heat
to arise in the blood, and the reproductive fluid, similar to butter, arises. Seven drops of the
essence of food establishes one drop of blood of the human body, and roughly a bowl of
drops of blood establishes roughly one subtle drop of reproductive fluid. 518
Here we see more examples of the Tibetan penchant for using metaphors of milk, butter-making
and “churning” (bsrub pa). This aside, Gönpokyap is attempting to show a few things by
quoting this passage from Treatise on Passion.
Principally, Gendun Chöphel is speaking to the “inherent nature” (chos nyid) of material
things. As we have been reading, when things become heated, digested or metabolized in the
body, the “essence” (dwangs ma) is separated from the refuse. The “quintessence,” (bcud or
mdangs) or “drops” (thig le) are the ultra distilled ‘super essences’ which have been produced
through many stages and transformations owing to the digestive process. In the above passage,
Gendun Chöphel is asserting that similar to butter being separated from the milk by being heated,
the reproductive fluids ripen in the testes and ovaries by being ‘heated’ with sexual pleasure.
517
zhes gsungs pa ltar sa’i rlangs pa nam mkhar ‘thim pa’i dpe bzhin bsam bse’u’i gnas su gsog, ibid.,
145.
518
gzugs can dngos po dkrugs shing bsrub pa na // rang gi snying bo ‘byin pa chos nyid de // sprin dag
bsrubs na char ba’i rgyun ‘bebs shing // shing dag bsrubs na me lce ‘byung ba ‘dra // de bzhin ‘o ma’i
bcud ni mar yin kyang // dang po ‘o ma’i nang du ‘dres te gnas // ‘on kyang zom du blugs nas dkrogs pa
na // ‘o ma rnams la rim gyis drod lngas nas // nang gi bcud rnams thon nas zur du ‘ong // de bzhin khrag
gi dwangs ma thig le yang // dang po khrag gi nang du thim nas yod // ‘on kyang pho mo sbyar nas
bsrubs pa na // chags pa’i stobs kyi khrag la drod langs nas // mar dang ‘dra ba’i khu ba ‘thon te ‘ong //
zas kyi khu ba thigs pa bdun tsam gyis mi yi lus la khrag thigs gcig ‘grub cing // khrag gi thigs pa dkar
yol gang tsam las // khu ba’i thigs pa phra mo gcig tsam ‘grub, ibid., 245
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This is because the drops, which originated in the brain, are dispersed throughout the body and
through the action of sexual heat, they separate and the essence goes to ripen the white and red
reproductive fluids in the testes and ovaries. It is therefore, not by a direct ‘channel,’ or ‘path’
that reproductive fluid moves from the brain to the testes and ovaries, but by complex processes
of circulation and distillation.
If we recall, Gönpokyap’s central aim for this section is to explain how the white and red
reproductive fluids, the seventh bodily constituents, are produced in and compelled by the brain,
understood as marrow, the sixth bodily constituent, to descend downwards to the testes and
ovaries where they are matured into viable reproductive seeds. Therefore, he asked by which
“pathways” (lam) or “channels” (rtsa) the seventh bodily constituent moves from the brain,
where it originates, to the reproductive sac. Gönpokyap finds his answer by looking at the vajra
body and the sexual aspects of Tantra according to Dorje Lingpa and Gendun Chöphel. A reason
for this is because both of these sources can speak to extremely subtle ‘essences’ that are
dispersed throughout the body and have a crucial role in sexual behaviour and reproduction. It is
telling that here Gönpokyap does not turn to medical sources to explain how ‘the root
quintessence of the seed’ located at the centre of the brain is compelled to descend to the
reproductive sacs to become ripened seeds. This is in large part because Gönpokyap is speaking
(or providing the Tibetan answer) to the biomedical account of the endocrinological system.
Gönpokyap’s summary of these two passages from Dorje Lingpa and Gendun Chöphel
centres on establishing the relation of the brain to the testes and ovaries and the reproductive
fluids. He writes:
The underlying meaning of what has been written [by Dorje Lingpa and Gendun Chöphel]
in the passages above is that parts of the reproductive fluids pervade the entire body. As for
that reproductive fluid which is pervasive, if one has the ‘mark’ of being male, then at the
time of coitus it is transmitted to the principal reproductive organ, falling to the scrotum.
Here, the action of descending is necessarily by the inducing power of the brain. It is
because of that ‘inducing power’ that parts [of the reproductive fluids] spread everywhere
in the body. Just like butter is drawn from milk, because of the circulation of blood, parts
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of [the body’s essences] will necessarily end up being gathered in the reproductive organ of
the scrotum. 519
In this passage, Gönpokyap writes that it is the “inducing power” (skul nus) of the brain that
causes the red and white reproductive fluids to descend to the ovaries and testes to be ripened
into the seed for conception. If we recall, the term, skul, meaning to “arouse” and “incite,”
appears in both Mingji Cuomu’s and Lhamokyi’s works to indicate “estrogen.” Mingji Cuomu
uses the phrase, shes rab rang bzhin skul rgyu, literally meaning, “the hormone (or, that which
causes) the inducement of the inherent self-nature of wisdom,” and Lhamokyi employs the noun
phrase, mo skul rtsi, which can be translated as “female-arousing nectar.” In these two works, the
term skul is used in part for the author’s own particular translation for biomedical “hormone”—
skul rgyu and skul rtsi. Although Gönpokyap does not use skul to directly indicate “hormones”
like other contemporary authors do, he shares in their language to describe the particular function
of the brain to plant and ripen the reproductive fluids.
Further in his summary of the Dorje Lingpa and Gendun Chöphel works, Gönpokyap
implicitly alludes to the biomedical endocrinological system and its role in the reproductive
body. He does not directly name the “adrenal glands” of biomedicine, but refers to their possible
interpretation in the Tibetan system by writing that the reproductive fluids gather “first
underneath the thirteenth joint [or rib]” (thog mar tshigs pa bcu gsum ‘og ‘dus) before moving to
the ovaries and testes where they are ripened. Mingji Cuomu similarly interpreted the “thirteenth
joint” of Tibetan medicine as the “adrenal glands” on the top of the kidneys according to
biomedicine.
In his final analysis, Gönpokyap returns to the brain and its role in producing and
directing the reproductive fluids in the testes and ovaries. He reiterates an early quote he began
from the Somarāja: “In the middle of the ‘heart of the brain,’ or some also say, the ‘centre of the
brain,’ is the ‘root quintessence of the seed,’ which increases the health of the body.” Here,
519
ces gsungs pa yang gong gi dgongs don dang gcig tu ‘khums te / de ni khu ba’i cha rnams lus kyi
gang sar khyab yod cing khyab yod pa’i khu ba de phor mtshon na ‘khrig sbyor skabs gtso bo’i bsam
bse’u’i gnas brgyud de gsang sgror ‘bab / ‘dir ‘bab par byed pa klad pa’i skul nus dgos shing / skul nus
der brten nas lus kyi gang sar khyab pa’i cha rnams ‘o ma las mar bton pa bzhin khrag gi ‘khor skyod du
brten te mjug mthar cha shas kyi bsam bse’u gnas gsang sgror gsogs dgos pas so, ibid., 245–6.
!207
Gönpokyap is showing that it is not only the ‘brain as marrow,’ the sixth bodily constituent that
creates the reproductive fluids, but also a specific part of the brain, that is the “heart of the brain”
(klad pa'i snying) or “the centre of the brain,” (klad pa'i rgya), phrases we have seen in other
contemporary and authoritative sources.
Gönpokyap then returns to the question of how the reproductive fluid moves from the
brain to the ovaries and testes by looking again to the Four Treatises. He writes:
According to what has been [written], there is no direct path for the white and red elements
to [move] directly from the brain to the ovaries and testes. According to the Four Treatises:
“The brain is a great ocean of channels and acts just as a root projecting downwards. [Of
the channels,] there are nineteen functional channels. 520”
Gönpokyap then explains what he means by quoting this passage from the Four Treatises. He
notes:
The ‘root’ [which house the quintessential seed] is included among the ‘nineteen channels,’
but really, this is not understood as being literal, but rather, the expression, ‘nineteen
channels’ is but an approximate [or] gross [as in counting only the coarser or thicker
channels] statement. Otherwise, there is no question that what is being said is that there are
many, many functioning white channels. For that reason, it is from the brain that the
quintessential root of the seed originates, and it is from the brain’s workings that the white
and red elements which have spread everywhere in the body gather together [in the
ovaries], just as it has been described. 521
In that conclusion, Gönpokyap assures the reader that there is no doubt that the reproductive
fluids originate from a root source in the brain, and as they move all around the body through the
extremely subtle white channels, are transformed either into the mature sperm emitted from the
testicles, or into the mature egg emitted from the ovaries.
520
gzhan yang so ma ra dza ru / klad pa’i snying dang ‘brel ba ste // la la klad pa’i rgya yang zer //
dbus na sa bon bcud kyi rtsa // lus kyi bde ba rgyas par byed // ces gsungs pa de ni klad pa nas khams
dkar dmar thad kar bsam bse’u ru rgyu sa’i nges gtan gyi lam zhig min la / de yang rgyud las / klad pa
rtsa yi rgya mtsho chen po las // rtsa ba lta bur thur du zug pa yi // bya ba byed pa’i chu rtsa bcud dgu
yod, ibid., 246.
521
ces gsungs pa’i rtsa bcu dgu po’i khongs su rtsa ‘di thad kar mi gtogs kyang bcu dgu zhes pa ni
rags pa’i dbang du gsungs pa las de min gyi bya ba byed pa’i chu rtsa gang mang yod pa’ng smras med
yin / de’i rkyen gyis klad pa las byung ba’i sa bon bcud kyi rtsa ‘di’i byed las kyis lus kyi gang sar khyab
pa’i khams dkar dmar lhan cig bsdu bar byed pas na de bzhin brjod do, ibid., 246–7.
!208
In this article Gönpokyap does not explicitly refer to biomedical notions of hormones. He
is indirectly responding to them by establishing the Tibetan precedents for thinking about
“hormones” as substances that propel growth and connect the brain with the testes, ovaries, and
the reproductive fluids. In that frame of reference, biomedical notions of hormones can quite
seamlessly be integrated with, or at least confirm and not contradict, Tibetan medical and
Buddhist conceptions of the body.
Similarly to the contemporary researchers we have seen above, Gönpokyap presents a
textually based argument showing that key endocrinological insights were already present in the
earliest Indic, and Tibetan medical, and Tantric sources of the tradition. In this way Gönpokyap
needed only to allude to “hormones.” In framing the biomedical understanding of hormones as
something already present in the Tibetan tradition, these biochemicals do not appear either to be
new or foreign, but rather as a confirmation, or another way of speaking of the same material
substances and their functions in the body. For this reason, I think that his exclusion of any direct
mention of hormones is strategic. He is clearly motioning towards their current state of being
integrated with Tibetan medical literature, yet he sticks to an entirely Tibetan description for
what he and others claim is the same phenomenon that biomedicine describes. In this way,
Tibetan medicine is presented as being in confluence with other national medical traditions, thus
representing an objective that Tibetan medical writers are eager to show.
3.6 Concluding Remarks on Lhamokyi’s and Gönpokyap’s Works
In this section we examined two contemporary Tibetan medical works that looked
specifically to the mechanisms by which the reproductive fluids, which began as tiny
microscopic materials in the brain, are successively transformed and moved to the ovaries and
testes to be matured into the reproductive seed. Lhamokyi and Gönpokyap are interested in this
question primarily because modern Chinese Tibetan medicine must be able to account for
biomedical notions of the hormones and the endocrine system. To this end, both authors research
and expand upon the meanings of Tibetan medical and Buddhist texts in order to establish a
Tibetan understanding that integrates biomedical ideas of the relations of the brain and the
reproductive body. Lhamokyi and Gönpokyap, it could be said, present quite convincing
!209
evidence to support the argument that Tibetan medicine already has its own pre-modern
knowledge of substances like “hormones.” Both authors borrow from the Tantric vision of the
vajra body, as well as the medical literature, to first establish and then to integrate these Tibetan
insights with the biomedical notions of hormones. The only significant difference between the
Lhamokyi and Gönpokyap writings is that the former directly names and translates “hormones”
into Tibetan from the Chinese while the latter’s article is largely an implicit nod to the
biomedical endocrinological system.
It is significant that all of the contemporary Tibetan medical writers shown above looked
to both the medical body and the Tantric body of winds, channels and drops to understand and
interpret biomedical notions of “hormones.” Thupten Püntsok, Mingji Cuomu, Lhamokyi and
Gönpokyap explicitly assume Buddhist understandings of the body, and make liberal use of
Tantric language and thought to interpret biomedical notions of hormones in relation to the
Tibetan authoritative medical literature. Words that cross over medical and Buddhist meanings,
such as chos nyid, thig le, and bcud, appear throughout the present-day sources.
Crucially, authors tell us directly and through the authors and works they quote from, that
the best way to understand how very subtle materials circulate and function at various sites of the
body is by looking at the intersection of biomedicine and Tantra. So far, in the integration of
“hormones,” shared Tibetan Buddhist and medical epistemologies are not being replaced or
eroded by biomedical thought, but rather are being substantiated and reinforced in new ways.
It is also quite revealing of the geo-political context of Chinese Tibet, and especially
Xining and its surrounding Tibetan areas, that Gönpokyap and Lhamokyi position Gendun
Chöphel as a modern medical authority. They present his Treatise on Passion as being able to
both supplement and illuminate authoritative Indo-Tibetan religious and medical works. This is
because both authors understand the Treatise on Passion to be a religiously infused (or virtuesoaked) sexological work that is informed by empirical knowledge about the body. For both
Gönpokyap and Lhamokyi, this makes the Treatise on Passion an authoritative source on
women’s bodies, sexuality and reproduction. It also makes sense for both researchers to look to
Gendun Chöphel because much like his Treatise on Passion, he is viewed as a present-day
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paradigm of mixing traditional ideas with modern ones, and his liberal and sympathetic views
towards women matches new ‘modern’ ideals about gender equality.
Lastly, some comparison of biomedical and Tibetan medical understandings of
“hormones” in the medical works we’ve looked at thus far would seem to be useful. In both
Western endocrinology and contemporary Tibetan gynaecology, hormones are understood as
being produced from the body’s nutrition and energy. In biomedicine this is initially cholesterol,
and in Tibetan medicine, bcud, dwangs ma or dmangs. In both systems, the movements and
activities of hormones are perceived, and articulated, as an orchestra of movement,
metabolization and action. Hormones, like the red element, go through numerous microscopic
changes and processes that produce outcomes in other parts of the body. As shown in this
chapter, a key point in both systems was establishing the connection between the brain,
reproductive fluids, the ovaries and the testes. Further to this, the white and red elements, like
hormones, are perceived as being involved in human sexuality and reproduction, governing the
body’s ability to become aroused, to produce the reproductive seed, to conceive, and to nourish a
developing fetus.
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4.
Hormones in Home Reference Works for Women
In this chapter I examine the integration of biomedical notions of hormones with Tibetan
medicine in two works which are devoted exclusively to women’s bodies, and are specifically
written for ‘modern’ young adult Tibetans, particularly women and girls. I refer to these slim,
popular books as ‘home reference’ guides. While far more than two such resources exist, this
chapter scrutinizes Wangyel’s Knowledge on Maintaining the Health of Mother and Child522 and
Palzang Gyatso’s Some Common Knowledge about Protecting the Health of Women.523 Both of
these sources present medical literature with a public health message and the objective of
educating the ordinary masses. As such, they constitute a new genre of medical writing in Tibet.
Given that these are home reference works, the contents and complexity of writing are far
less ‘academic,’ and authors tend to provide neither extensive quotes of authoritative sources nor
any citations. Instead, the writers present a simpler instructional account of the body for the
modern reader. The preface to Wangyal’s work states that the book
has easy composition and small glossary, and that medicinal compounds (Tibetan, foreign
and Chinese) are arranged clearly. Therefore, being simple and for every-day use, ordinary
doctors or the masses of nomads and farmers can have the benefit of coming to understand
and recognize common knowledge about [women’s bodies].524
This is important because in the section on the time of menstruation, Wangyal writes that, “some
women in real life do not know how to take care of their bodies when they are menstruating, so
at the time of menstruation their mood is not stable, and a great deal of anxiety, embarrassment
and fear arises.” 525 Such an assertion belies what I heard often from Tibetan medical experts,
522
Dbang rgyal, Ma bu bde srung gi rgyun shes.
523
Dpal bzang rgya mtsho, Bud med bde srung skor gyi rgyun shes phran bu bzhugs.
524
… tshig sbyor bde zhing tshig tshogs nyung la / zhib cing gsal bor bkod pa’i smin sbyor (bod phyi
krung lugs) rnams kyang rgyun spyod can sha stag yin pas sman pa dkyus ma’m rong ‘brog mang tshogs
kyis ‘di’i skor gyi rgyun shes la ngos ‘dzin dang rgyus lon byed par phan thogs yod pa, Dbang rgyal, Ma
bu bde srung gi rgyun shes, ii.
525
‘tsho ba dngos kyi khrod du bud med mi nyung ba zhig gis zla mtshan ‘bab skabs kyi ‘phrod bsten
thad kyi shes bya mang bo mi shes pas / zla mtshan ‘bab skabs su blo kha rtan po min pa dang ‘tshub cha
che zhing ngo tsha ba’m skrag snang skye ba dang, ibid., 6.
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among others in Xining, which is that Tibetan women often do not talk about menstruation with
their daughters, and by and large, many rural women in particular are ignorant of ‘proper’
hygiene and care during menstruation. These ‘modern’ works are not only meant to fill in this
‘knowledge gap,’ but more importantly, to modernize and to open up the very discussion,
between mothers and daughters, husbands and wives, and doctors and patients, about women’s
bodies and their particular needs.
Similarly, Palzang Gyatso writes in the introduction to his Some Common Knowledge
about Protecting the Health of Women:
These days, it is not necessary to learn first hand all that has been taught in earlier treatises
such as the sutras on the household, sutras on sexual desire, as well as the Sutras and
Tantras on health and well-being from throughout the world, the sciences, arts and
literature. What is relevant from [all] these, [including] the sutras on the home and sexual
desire, is explained here, in addition to modern knowledge about women’s health. 526
As he tells us, the purpose of his book is to present the culmination of his experience and
knowledge such that one does not need to be an expert to have some basic, yet crucial knowledge
of how to care for the female body.
At this point, Palzang Gyatso does not name the specific sources on sex, the household,
or medicine. However, he does list the “sutras, Tantras and commentaries” (mdo rgyud bstan
bcos) on the final page of the book. In the last page, he names four works that form the
authoritative sources of his work. The first is the Four Treatises, which he describes as the “great
treatise of our Tibetan medical system.”527 The second is the Enumeration of Terms Derived from
Art, Medicine and Astrology528 by Longdöl Lama Ngawang Lobsang (Klong rdol bla ma ngag
526
de yang sngon kyi bstan bcos rnams su khyim gyi mdo dang ‘dod pa’i mdo sogs ‘jig rten thams cad
bde bar ‘tsho ba’i mdo dang rgyud sde / rig gnas / sgyu rtsal mang du bstan yod pa ni deng dus kyang
mig mthong lag zin du gyur pa / bshad ma dgos pa yin la / de dag las ‘dir bshad pa skabs su babs pa ni /
khyim gyi mdo dang ‘dod pa’i mdo’i phyogs su bstun zhing / dus rabs dang mthun pa’i bud med kyi bde
srung gi skor phran tsam bshad pa, Dpal bzang rgya mtsho, Bud med bde srung skor gyi rgyun shes
phran bu bzhugs, 1.
527
528
rang re bod kyi gso ba rig pa’i bstan bcos chen mo, ibid., 134.
Ngag dbang blo bzang, Klong rdol bla ma, Bzo rigs sogs las byung ba’i ming gi rnam grangs (’bar
khams: si khron rnga ba khul bod yig rstom sgyur cus, 1985).
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dbang blo bzang; 1719 – 94), an influential Buddhist scholar and encyclopaedists. 529 The third
and fourth works are Tibet’s two famous treatises on sex, each of the same title, namely, Treatise
on Passion. One of these is by the extremely well-known and prolific Buddhist scholar, Ju
Mipam Gyatso (mi pham ‘jam dbyangs rnam rgyal rgya mtso; 1846 – 1912),530 and the second
other is by none other than Gendun Chöphel. It is revealing then, that aside from the Four
Treatises, the other three works are relatively modern, and only two of them could be considered
‘medical.’ A whole half of the primary sources for Palzang Gyatso’s home reference work for
young women consists of treatises on human sexuality and sexual practices.
In this chapter I look at the explanations of “hormones” in Wangyal’s and Palzang
Gyatso’s home reference works. In the concluding remarks I explore religious and social ideas
behind the notion of the ‘good’ Tibetan Buddhist woman, and how this ideal ‘limits’ how women
and their bodies are considered and presented in contemporary Tibetan language home reference
medical guides. Lastly, I look at how the term for “estrogen,” used in the two home reference
works examined here, mo rsti, evokes social and religious ideas about women’s essential
underlying nature, and their role as sexual partners.
4.1 Hormones in Wangyal
Like the title states, Wangyal’s Knowledge on Maintaining the Health of Mother and
Child is a home reference work that focuses on women’s well-being as related to reproduction,
pregnancy, and post-natal care for mother and child. About one hundred and fifty pages long, the
book is mostly text accompanied by a few simple black and white anatomical sketches. Except
for the opening section of the book, which describes menstruation and its relation to hormones,
throughout the work, Chinese biomedical and Tibetan medical explanations are presented
separately.
529
For more on this work and its author see: Ekaterina Sobkovyak. “Classifications of the Fields of
Knowledge According to One of Klong Rdol Bla Ma’s ‘Enumeration of Terms,’” in Tibetan Literary
Genres, Texts, and Text Types: From Genre Classification to Transformation, eds., Henk Blezer, Alex
McKay, and Charles Ramble (Leiden: Brill, 2015), 54–72.
530
TBRC: P252.
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This part of the thesis, examines the first two and a half pages of Wangyal’s work, which
establish the connection he makes between the “hormones” of biomedicine and the “red
element” of Tibetan medicine.
Wangyal begins his work on the workings of the female body by explaining that the
ability to menstruate is the defining and inherent nature of all mature female bodies. He relates:
That which is known as the ‘uterine lining’ is a fine lining that goes through successive
transformations inside the women’s uterus. Before the age of eleven or twelve, a woman
has a very small uterus, but after [this age] it becomes bigger and bigger. Once she reaches
maturity, the uterine lining goes through changes each and every month. 531
Describing menstruation principally in terms of the “uterine lining” (mngal skyi) that goes
through regular, successive changes every month, Wangyal tells us that a sign of a matured
female is the perpetuation of the monthly cycle. To explain the menstrual transformation of the
uterine lining Wangyal, perhaps more so than any other writer we have met so far, explicitly
conflates “hormones” with the basic building blocks of the “red element.” He states that:
Those [monthly] changes are the result of many regular causes and conditions that arise
due to transformations at the ‘source’ of the red element. Inside the ‘material source’ of the
red element, there are cells that grow and increase the red element until it ripens and is
secreted out. The ‘yellow shapes’ [in the ovaries] grow, increase, and degenerate. Based on
the particular [individual timing] of those transformations, estrogen arises inside of the
‘source’ of the red element. The arising of the secretions of estrogen can be a little or a lot.
The specific, inherent nature of the changes of a little or lot depends on one’s own cycle.
Based on the effects of the arising of estrogen, the lining on the interior of the uterus
expands and becomes thicker and thicker.532
531
bud med kyi mngal sbubs su skyi mo srab mo rim pa zhig yod pa de la mngal skyi zer / bud med ni
lo bcu gcig nas bcu gnyis kyi sngon la mngal je cher gyur pa las gzhan ‘gyur ldog ha cang chung / lang
tsho dar ba’i skabs su mngal skyi der zla rer ‘gyur ldog thengs re ‘byung nges yin, Dbang rgyal, Ma bu
bde srung gi rgyun shes, 1.
532
‘gyur ldog de ni khams dmar ‘byung gnas kyi ‘gyur ldog las rgyu rkyen mang bor tshod ‘dzin thebs
pas yin / khams dmar ‘byung gnas kyi grub cha’i nang du khams dmar phra phung skye ‘phel ‘byung
zhing smin pa dang khams dmar thon pa / ser zugs skye ‘phel ‘byung ba dang nyams pa sogs yod / ‘gyur
ldog de rigs dang bstun nas khams dmar ‘byung gnas nang du mo rtsi ‘byung srid / mo rtsi thags thon
byung ba de nyung ba nas mang bar ‘gyur ba dang / mang ba nas nyung bar ‘gyur ba’i chos nyid nges
gtan zhig dang dus ‘khor rang bzhin gyi ‘gyur ldog yod / mo rtsi byung ba’i shugs rkyen la brten nas
mngal sbubs nang skyi rgyas shing je mthug tu ‘gro ba yin, ibid., 1–2
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In this passage, Wangyal translates the biomedical term “hormones” using rtsi, the shortened
form of bdud rtsis, meaning “nectar” or “elixir” in Tantric thought. Foremost, he asserts that the
red element, or more specifically, its “material” or “elemental source” (‘byung gnas kyi grub
cha), that is, at the red element’s microscopic level, “cells” (phra phung), produce and increase
the red element itself. This is possible because, as Wangyal explains, on the inside of the
“source” or “origin” (‘byung gnas) of the red element, secretions of “estrogen” (mo rtsi) direct
the menstrual cycle, including the monthly transformations of the uterine lining.
Wangyal’s term for “estrogen,” mo rtsi, actually appears in the Four Treatises to indicate
“female fertility.” Hence, in using mo rtsi to refer to “estrogen,” Wangyal is drawing from
Tibetan medical and Tantric ideas surrounding women’s fertility and sexuality, but ascribing new
meanings that expand these notions. If we recall, Lhamokyi translates “estrogen” as mo skul rtsi,
meaning more literally “female-arousing nectar.” Wangyal’s use of mo rtsi, could be interpreted
as a simplified home reference version of its more technical counterpart. Whatever the case, it is
clear that the term “mo rtsi” or “female nectar” is understood by the lay educated reader to
indicate biomedical notions of “estrogen.”
Wangyal introduces other innovative present-day terms in the passage above. The
“yellow shapes” (ser gzugs) refer to the “corpus luteman” which we encountered earlier, that is,
the hormone-secreting sac that develops the egg and gradually perishes after the egg is released
from the ovary. There is a curious spelling discrepancy between Wangyal’s term for the corpus
luteman, ser gzugs, “yellow shape” or “form” and Mingji Cuomu’s spelling which is ser gzungs,
meaning, “yellow sac.” It is unclear if the former is a spelling error, or as is more than likely,
there is not yet an agreed upon standard Tibetan term for “corpus luteman” since both terms are
contemporary innovations in the Tibetan medical tradition. Also, Wangyal’s term for “cells,”
phra phung, is common among today’s medical researchers, even though it is a new term made
of compound parts, as noted in the above discussion of Lhamokyi’s article.
Of note in the passage above is Wangyal’s assertion that estrogen is secreted from the red
element, implying that at the cellular level, the (white and) red elements produce and emit
hormones. The secretion of these hormones, or more exactly, “estrogen,” mo rtsi, compels the
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synchronized growth and decline of both the uterine lining and the reproductive seed in the
ovary, giving rise to either menstruation or conception. No other writer so concretely moors the
biomedical notions of hormones with the red element of Tibetan thought. Unfortunately, being a
home reference work, he does not expand on the mechanisms by which the red element creates
and emits hormones. But it is significant that for a general, educated readership, he conflates the
red element with hormones.
Next, Wangyal develops the functioning of hormones in conception and menstruation. He
infers that:
Based on the effects of the ‘pregnancy hormone’ and the common [female hormone]
‘estrogen,’ the lining on the inside the uterus [is able to] grasp [the embryo]. It is the
arising of those secretions [of hormones] that transform the uterine lining and by that,
prepare the uterus for pregnancy. If the white and red elements do not intermingle, then the
white element does not transform the red element. The decreasing [amounts] of those two
types of hormones cause the degeneration of the ‘yellow shapes,’ and the ability of the
uterine lining to continue [growing]. Because of that, [the uterine lining] becomes
exhausted at the root because of atrophy. Those parts of the uterine lining that come out
with the blood through the cervix is what is known as ‘menstruation.’ It takes roughly three
to five days for the pieces of the lining to emerge from the uterus. Afterwards, a new lining
grows on the inside surface of the uterus, as well as new cells of the red element, which
ripen and repeat [the cycle]. 533
In this passage, Wangyal describes more specifically how secretions of the “pregnancy” (sbrum
chags rgyu rtsi) and “estrogen” (mo rtsi) “hormones” cause the production, growth and
destruction of both the uterine lining and the “yellow shapes” (corpus luteman). Both the yellow
shapes and uterine lining are discarded once their ability to grow have become exhausted. The
lining takes the form of the menstrual blood, and when completely expelled, once again, new
cells of the red element compel the cycle of growth and decomposition.
533
sbrum chags rgyu rtsi dang mo rtsi’i thun mong gi shugs rkyen la brten nas chags pa’i mngal sbubs
nang skyi de zags thon byung ba’i skabs su mngal sbubs nang skyir gyur nas mngal chags pa’i gra sgrig
byed pa yin / gal srid khams dmar dang khams dkar ma ‘dres na khams dkar dang ‘dres pa’i khams dmar
du ma gyur pa yin / ser gzugs nyams dus rgyu rtsi rigs gnyis je nyung du ‘gyur ba dang / mngal sbubs
nang skyi’i rgyun ‘khyongs nus pa shor zhing ‘khums te rtsa ba nas nyams pa / nang skyi brul nas khrag
thon pa de skye sgo nas ‘bab par zla mtshan zer / mngal sbubs nang skyi brul nas phal cher nyin gsum
nas lnga ‘gor rjes / mngal ngos su nang skyi gsar ba skyes te / khams dmar phra phung gsar ba zhig
bskyar du smin pa yin / de bzhin yang skor byed pa der zla mtshan dus ‘khor zer, ibid., 2.
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Wangyal comes full circle in his presentation of “hormones” in relation to the red element
of Tibetan medicine. According to his account, hormones are produced and emitted from the
material source or origin of the red element. Then, the secretions of these hormones cause the
proliferation of more red cells. In essence, the red element has the ability to regulate the
reproductive cycles in the female body by continually re-creating itself.
Then, Wangyal hones into the anatomical mechanisms by which hormonal secretions
from the red element regulate the ovulatory and menstrual cycles. He claims that:
One menstrual cycle, if it is regular, takes twenty-eight days, and whether it is early or late
depends upon the state of one’s body. A menstrual cycle which is consistently regular is a
sign that the woman’s body is healthy. The arising of the transformations that are in
accordance with one’s own individual menstrual cycle is regulated by the brain’s
membranes and nerves, as well as the system at the navel.534 Especially, the interdependent
functioning of the brain’s pituitary gland and the hypothalamus together with the source of
the red element, produce and increase [the parts of the body], and are important factors in
the regulation of menstruation. The outside environment also surely affects the time
periods of the menstrual cycle, but I don’t need to explain this.535
This passage concludes the first section of the first chapter. Wangyal touches on the major pillars
of endocrinological thought, and again, does so principally through the red element, the lens of
Tibetan medicine and thought. In this particular passage, Wangyal writes that the red element,
together with the pituitary gland and hypothalamus, the adrenal and other endocrine glands, and
the brain’s system of membranes and nerves, compel and regulate not only the menstrual cycle,
but also other important bodily functions. Thus, Wangyal having earlier described specific
hormones earlier, now has related the anatomical parts needed for the red element to perform its
reproductive functions.
534
535
This is referring to the “adrenal glands” and the endocrine system.
zla mtshan dus ‘khor gcig la cha snyoms byas na nyin nyer brgyad re dgos pa dang / lus kyi skye
khams gnas tshul dang bstun nas zla mtshan snga ‘bab dang ‘phyi ‘bab byed srid / zla mtshan dus ‘khor
de chos nyid ldan zhing nor ba med par ‘bab pa ni bud med kyi lus khams bde thang yin pa’i mtshon rtags
red / zla mtshan la dus ‘khor rang bzhin gyi ‘gyur ldog ‘byung ba ni klad skyi dang dbang rtsa / lte ba’i
ma lag sogs kyis tshod ‘dzin byed pa yin / khyad par du klad ‘bur dang klad dril / khams dmar ‘byung
gnas bcas kyi bar du phan tshun nus pa skyed pa ni zla mtshan snyom sgrig byed pa’i lhu tshigs gal chen
zhig yin / phyi rol gyi khor yug sogs kyis kyang zla mtshan dus ‘khor la shugs rkyen nges can thebs su ‘jug
pa ni bshad ma dgos so, ibid., 2–3.
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By importing and integrating biomedical thought into the Tibetan medical system,
Wangyal has given new meanings to the ideas and words found in the authoritative Tibetan
medical texts. The passage incorporates a number of new and contemporary Tibetan medical
terms describing the brain and the endocrine system. Some of these terms are the “brain’s
membranes” (klad skyi), literally meaning the ‘skin [on the inside of] the brain,’ and the brain’s
“nerves” (dbang rsta), which could be translated as the ‘channels that empower.’ Likewise, the
term for the “hypothalamus,” klad ‘bur, means literally, the “protuberance of the brain,” and the
“pituitary gland,” hanging from it, is translated into Tibetan as klad bril, “the bell [shape] of the
brain.” Many of these new Tibetan terms that Wangyal has used so far to describe hormones and
reproductive anatomy highlight both the functional and the physical characteristics of the parts
being described.
The reader may notice that there is no mention of digestion, the seven bodily constituents
or other features we have come to expect from reading about women’s bodies in the researchfocused sources. Aside from the mention of the red element, the first three pages of Wangyal’s
book are almost exclusively a Tibetan translation of biomedical endocrinological thought. In
later sections on conception and menstruation, Wangyal presents mostly traditional Tibetan
medical ideas such as the five elements, the three dynamics, the white and red elements and the
consciousness of a bardo being, while hormones and the endocrine system disappear. Hence,
Wangyal’s home-reference book places no emphasis on showing how the Tibetan medical system
can address hormones independently of biomedicine. Wangyal conflates “hormones” with the
“red element,” but beyond this, there is no deep ‘integration’ of the Tibetan medical and
biomedical systems as seen in the previous four sources. Instead, the biomedical and Tibetan
medical accounts of the female body, largely are kept separate throughout the book.
It is telling then that the only place where there is a clear and explicit intersection and
‘integration’ between Tibetan medicine and biomedicine in Wangyal’s work is in regards to
“hormones.” This would seem to indicate the perceived need among contemporary Tibetan
medical writers, even those writing home reference works, to explain the biomedical notions of
hormones in their descriptions of women’s bodies because hormones are too important in ‘world
medicine’ to be ignored even by the non-biomedical traditions.
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4.2 Hormones in Palzang Gyatso
Palzang Gyatso’s Some Common Knowledge about Protecting the Health of Women, is a
pink, rose-covered one hundred and thirty-five page home reference work that encompasses
topics pertaining to women’s bodies ranging over self-care during menstruation and pregnancy,
the legal age of marriage, sexually transmitted infections, the means of arousing a woman (for
the male reader), and beauty tips (for the female reader). Palzang Gyatso’s book is less technical
than Wangyal’s home reference work. To indicate biomedical “estrogen” Palzang Gyatso uses the
term “mo rtsi” which is the same term as that used by Wangyal. This section examines Palzang
Gyatso’s description of hormones. It also pays attention to the wider Tibetan context of female
reproductive bodies. Of note is the fact that the writing style is in a manner that would be
understood by a home-reference audience. This work, meant for young adults, particularly girls
and women, is a highly popular book about sex, relationships and reproductive health. 536
The outset of the first chapter explains how the male and the female bodies emerge.
Palzang Gyatso writes that:
The way in which ordinary men and women come into existence is [explained in the
following quote from] that great Tibetan medical treatise, the Four Treatises: “men and
women manifest by the force of previous karma and sexual desire.” Therefore, the force of
previous karma, the power of the affliction of sexual desire, one’s own consciousness, and
the inner and outer five elements produce the differences between male and female
bodies. 537
The Four Treatises’ Gynaecology chapters indicate that women’s bodies are produced from low
karmic merit. Palzang Gyatso’s explanation of the origins of female body, in concurrence with
modern sources, omits this idea. However, he appears to maintain the negative implications of
sexual desire, traditionally described as an “affliction” (nyon mongs pa).
536
The Toronto Public Library has a copy of Some Common Knowledge about Protecting the Health of
Women, attesting to the book’s popularity and global reach.
537
spyir ‘jig rten pa’i pho mo gnyis kyi snang tshul ni / bod kyi gso ba rig pa’i bstan bcos chen mo gso
rig rgyud bzhi las // “sngon las ‘dod chags dbang gis pho mor snang” // des na tshe sngon ma’i las dbang
brtsan po dang / nyon mongs pa ‘dod chags kyi dbang dang / rang gi rnam par shes pa dang / phyi nang
gi ‘byung ba lnga’i byed las sogs la brten nas pho mo tha dad du snang zhing, Dpal bzang rgya mtsho,
Bud med bde srung skor gyi rgyun shes phran bu bshugs, 3.
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Palzang Gyatso, concentrating on digestion and the white and red elements, then outlines
the unique characteristics of women’s bodies according to Tibetan medical and Tantric thought.
Women are different from men, insofar as they possess the unique features of the activities
of the uterus and the breasts [which are the ability to] menstruate and [to produce] breast
milk. The essence of consumed foods, the blood, the meat, the fat, the bone, the marrow
and the reproductive fluids make up the [digestive] process which forms the basis of the
body. The final of the seven bodily constituents, the reproductive fluid, comes in two
[forms]: the white and the red. According to the Mahayoga Tantras, from the white and red
elements, the essence of the white part abides in the body’s central channel at the upper end
of the pulsing blood vessel between the eyebrows. The essence of the red element abides
four finger lengths below the navel towards the lower tip of the central channel. Parts of
these two [essences] permeate the entire body.538
In this passage and throughout the book, Palzang Gyatso presents a mixed Tibetan medical and
Tantric perspective of the female body for the young adult reader. First, he gives the medical
explanation as to the process by which reproductive fluids are made, and then follows this with
the more popular, Tantric understanding of the vajra body of white and red drops. Palzang
Gyatso’s description of the reproductive fluids is thoroughly Tibetan, and despite being a
‘modern’ account of the body, it is permeated with religious ideas.
Because we have read professional works, we can recognize and understand Palzang
Gyatso’s description of the white and red elements in the body. Indeed, he is drawing from the
same authoritative sources as the research-focused sources we have read. Yet, his presentation is
far more simplified, contains very little by way of citations and passages from authoritative
works, and he does not explicitly work towards establishing Tibetan medical knowledge of
“hormones” before the birth of the field of endocrinology during the modern era. He does,
however, include hormones further along in the first few pages of his book where he outlines the
female reproductive body.
538
des na bud med la skyes pa las / nu ma dang / mngal gyi byed las dang / zla mtshan ‘o ma bcas kyi
khyad par du lhag cing / kha zas kyi dwangs ma dang khrag / sha / tshil / rus pa / rkang mar / khu ba ste
lus kyi gzhi ‘dzin par byed pa’i zungs bdun gyi phyi ma khu ba dkar dmar gnyis las / rgyud sde rnams su
khams dkar dmar du grags pa’i dkar cha’i dwangs ma ni rang gi lus kyi rtsa dbu ma ste ‘phar rtsa’i yar
sne smin mtshams su gnas pa dang / dmar cha’i dwangs ma rtsa dbu ma’i mar sne lte ba’i ‘og tu sor
bzhi’i thad du gnas pa de gnyis kyi cha shas lus kun la khyab pa las, ibid., 4.
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After telling us about the red and white drops according to Tantric thought, Palzang
Gyatso then describes the white and red elements in a bit more medical detail. For example, he
writes that the refuse of the red element goes on to become the menstrual blood and the refuse of
the white element becomes the breast milk. He also writes that the essence of the white element
becomes the body’s source of “glorious youthful splendour” (lang tsho’i dpal) and “sexual
arousal” (‘dod pa’i dbang po).539 In his written explanation, he does not outline what the
‘essence of the red element’ is. But, at the bottom of the page, Palzang Gyatso identifies that
essence to be “estrogen” (mo rsti) through the following diagram, titled, “The system by which
reproductive fluid is produced from the seven bodily constituents in women,”540 as translated and
reproduced below.
!
Although mo rsti is not explained in the passage preceding it, its presentation in this diagram is
in keeping with other contemporary home reference books claim, including Wangyal’s, that
estrogen is the essence of the red element. We also notice here, the notion of the “lifeforce” (bla) which we have encountered earlier. Hence, Palzang Gyatso presents an integrated
perspective of the female body, drawing from Tibetan medicine, Tantra and biomedicine.
539
Ibid., 5.
540
Bud med kyi lus zungs bdun pa de khu ba’i ‘gyur tshul, ibid., 5.
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Next, Palzang Gyatso presents and explains medical illustrations depicting external and
internal female reproductive anatomy. “Estrogen” is further explained within his description of
the inner reproductive anatomy, which includes the vagina, the uterus, the fallopian tubes and the
ovaries.
Regarding the fallopian tubes, Palzang Gyatso notes that:
The red element moves through hollow tube (also known as the “great channel”) that runs
from the middle lower edge of the uterus to the left and the right ovaries on either side of
the uterus. By that pathway, the ‘product’ 541 of the red element moves from the ovaries to
the uterus. Thus, the red element produces the reproductive fluids that are pulled through
this pathway. 542
And, on the ovaries and estrogen, he continues:
The ovaries are formed on the right and left sides of the uterus. The shape [of the ovary] is
that of an oblong and flat container, and its size is roughly that of a thumb. [Inside the
ovary], the red element having accumulated and increased, is emitted together with
secretions of estrogen. Estrogen also maintains the distinguishing features of women. 543
In these two passages, Palzang Gyatso explains how the red element, together with the secretions
of estrogen, move the reproductive seed from the ovaries, where it has been produced, through
the fallopian tubes to the uterus. His account of “estrogen” follows the basic biomedical script
insofar as being emitted from the ovaries, and responsible for the physical characteristics of
female bodies. Unquestionably, estrogen is viewed as a “female” (mo) property.
4.3 Conclusions on Home Reference Works
Prior to the twentieth century, works such as Wangyel’s Knowledge on Maintaining the
Health of Mother and Child and Palzang Gyatso’s Some Common Knowledge about Protecting
541
Here, the “product” (‘byung ba) refers to the reproductive egg.
542
khams dmar rgyu ba’i sbu gu ni (rsta chen yang zer) bu snod mthil zhabs kyi zur g.yas g.yon gnyis
nas re re gyes te phal cher bsam se’u dang ‘brel yod pa dang / des bsam se’u nas ‘byung ba’i khams dmar
bu snod du rgyu sa’i lam dang khams dmar gyis skyes pa’i khu ba ‘then sa’i lam byed pa yin, ibid., 7.
543
bsam se’u ni bu snod kyi gzhogs g.yas g.yon gnyis su chags yod la / dbyibs ‘jong leb can gyi snod
mthe bong gi che chung tsam yod / des khams dmar gsog ‘phel byas nas phyir gtong ba dang sbrags da
dung mo rtsi zags thon byed pa yin la / mo rtsi des kyang bud med kyi khyad chos rnams srung ‘dzin byed
pa red, ibid., 7, 9.
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the Health of Women would be unthinkable in a conservative Buddhist theocracy wherein the
monasteries were by and large the driving force behind textual production in Tibet.544 The
creation of such works in the late twentieth-century needs to be understood within the sociopolitical context of Chinese Tibet, and from the perspective of the PRC’s stated efforts to
‘modernize’ Tibet and improve the lives of Tibetans. Thus, these home reference guides, which
are meant to teach women and girls about their bodies and how to care for them, constitute a new
genre of Tibetan medical literature.
While this thesis has been concentrated on the subject of hormones, the home reference
works show this topic only to be a small part of the larger project. Far more attention is paid to
having a healthy pregnancy, preventing the spread of sexually transmitted infections, and in
particular HIV/AIDS and hepatitis, which are said to be in epidemic numbers in some Tibetan
communities. Moreover, maternal and infant mortality rates remains high.545 Among ethnic
Tibetans, life expectancy in 2010 was 70.52 years (an improvement over the 2000 census of
66.67 years of age), compared to the national life expectancy of 74.83 years of age.546 Tibetans,
like nearly all other ethnic minorities in China live shorter lives than their Han compatriots.
Cleary, from a public heath perspective, home-reference works such as Wangyal’s and Palzang
Gyatso’s are intended provide a vital service to their intended readers who are young and adult
women.
These home reference works provide much more than just medical information and
‘facts.’ They promote a particular view of the ‘good’ Tibetan woman. For example, in the section
titled, “Common things that girls need to pay attention to”547 Palzang Gyatso warns his readers:
544 Incidentally, in a bookstore near Namgyal Monastery in India, I found the copies of Healthy Body,
Healthy Mind: A Health Handbook for Tibetan Women separated from all of the other books and
somewhat hidden under a case. Despite being a hometown publication, it was difficult to find copies
because the material was considered too controversial.
545
On the problems of measuring these rates see: Adams, “Saving Tibet?”
546
Rongxing Guo et al., eds., Multicultural China, 72, 74.
547
spyir btang bu mo tshos do snang byed dgos pa ‘ga’, Dpal bzang rgya mtsho, Bud med bde srung
skor gyi rgyun shes phran bu bshugs, 20.
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Generally, some girl students become influenced by mistaken thoughts, and because of that
wear skimpy clothing and are fond of wearing tight clothes on their chest. What is worse,
is that some girl students, because they worry about looking fat, and thinking to prevent
this, wear a tight girdle around their waist. But, by tying a tight girdle around the waist
causes great damage to the body while it is still growing.548
Similarly, by means of an illustration he tells the pregnant reader to avoid wearing skimpy
“underwear” (brla thung), and wear instead, what can only be described as “puritan drawers.” In
the same section of illustrations, he also suggests that Tibetan women wear traditional “Tibetan
style clothes” (bod chas).549 Just these few examples give some picture of what I have personally
witnessed in Tibet, India and Nepal, which is that Tibetan women, particularly young women and
girls are expected to dress conservatively and behave modestly. In Buddhist Tibet, despite all of
the Tantric images of deities in sexual embrace, female sexual desire is largely considered dirty
and dangerous, and a woman showing signs of overt sexuality is extremely taboo. 550 And,
pregnancy is often hidden because it ‘shows’ that the woman has had sex.551
Also, in the case of Chinese Tibet, the symbol of the ‘good’ Tibetan woman is intimately
tied to Tibetan ethnic and national identity. A so-called ‘pure’ Tibetan woman is analogous to a
‘pure’ (pre-Chinese) Tibet. This view results in a palpable fear among older, as well as young
generations of Tibetans, that young Tibetan women are becoming sinicized in that they are
interested in wearing make-up, tight clothing and conducting themselves in an ‘immoral’ fashion.
For Tibetan women, overt or even subtle signs of female sexuality, such as wearing tight-fitting
clothing, is linked to ‘Chinese ways of being.’ These ways are considered immoral and
decisively contrary to of the teachings of Buddhism.
548 spyir btang bu mo slob grwa ba ‘ga’ re la nor ‘khrul gyi bsam blo’i shugs rkyen thebs nas gon chas
zheng chung gyon te so so’i brang khog dam por bcing rgyur dga’ po byed pa yin / da dung slob phrug bu
mo re ‘gas rang gi rked pa sbom po chags mi yong ba’i ched du yin bsams nas sems khral dang bcas pa’i
sgo nas ska rags dam por bcing ba yin / brang khog dam por sdom pa dang / rked par ska rags dam por
bcing ba’i byed stangs ni / gzugs po ‘tshar longs yong rgyur gnod skyon chen po yod par bshad, ibid., 20–
1.
549
Ibid., 62–3.
550
Charlene E. Makley, “On the Edge of Respectability: Sexual Politics in China’s Tibet.” Positions:
East Asia Cultures Critique 10, no. 3 (2002): 575–630.
551
Vincanne Adams, Suellen Miller, Jennifer Chertow, Sienna Craig, Arlene Samen, and Michael
Varner, “Having a ‘Safe Delivery’: Conflicting Views from Tibet,” Health Care for Women International
26, no. 9 (2005): 821–51.
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In Tibetan culture, women are thought to be less able than men to control their sexual
desires. Hence, this is the rationale behind the restrictions or the gentle suggestions on dress and
behaviour which are said to be ‘needed’ to ‘protect’ women. Therefore, being a ‘good’ Tibetan
woman in Chinese Tibet means dressing and behaving modestly. This view appears to be
reflected in Palzang Gyatso’s advising against the wearing either of skimpy or of tight clothing.
The home reference medical literature suggests that being a ‘good Tibetan woman’
centres on taking care of the body. Therefore, how that body is characterized in the home
reference sources is revealing of Tibetan social attitudes concerning women. Paradoxically, we
find that even in works that are meant to be ‘modern’ and sympathetic to women’s rights,
permeate with ideas and notions that are less than emancipatory. For example, one commonly
finds in home reference and professional works instructions on what women should avoid doing
(and thinking) while they are menstruating.
Palzang Gyatso provides a pretty extensive list of things menstruating women should
avoid. He writes that menstruating women should “neither eat hot, spicy, or sour food, nor touch
cold water, nor most importantly, have sex.”552 Further, in regards to work, menstruating women
should only engage in “light labour” or “activities” (ngal rtsol yang bo), and avoid any “hard
labour” (ngal rtsol yang bo), and further, it is “unsuitable to swim, run, or engage in other strong
exercises.”553 Also, “Because the ability to prevent illness is weakened in women during
menstruation”554 it is “not suitable to stay in the water, or in marshland, bluish-green grasslands,
in the shade, or on soft earth. One must be careful of staying [in these places].”555 He further
tells the reader that “you should be careful to not wash your feet or hands in cold water, ride
552 kha zas tsha skyur rigs bsten mi che ba dang / chu grang la mi rig cing / ‘dod pa de bas kyang
spyad mi nyan pa yin, Dpal bzang rgya mtsho, Bud med bde srung skor gyi rgyun shes phran bu bshugs,
16.
553
rgyug shad dang ‘gran bsdur byed pa / yang na de min gyi shugs drag che ba’i lus rtsal nang gzhug
mi rung ba red, ibid., 18.
554
bud med rnams la zla mtshan ‘bab dus gzugs po’i nad ‘gog nus pa cung zad zhan po yin pas, ibid,
19.
555
chu’i nang la zhugs mi rung la / brlan zhad yod pa’i sngo ljang spang thang dang grib nag sa ‘bol
dag la’ng sdod rgyur gzab dgos la, ibid., 19.
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animals, or travel long distances.”556 As for specific foods, women should avoid eating “chilies,
green vegetables, onions, garlic, and raw, cold or spicy foods.”557 Lastly, as for
“behaviour” (spyod), if you are a menstruating woman then “during these days, you need to
make your mind happy, and not become angry, be peaceful, and do not engage in sexual
intercourse.” 558 Anyone who has ever menstruated (or knows someone who has) knows that this
list is ‘excessive’ to say the least. Moreover, the list is certainly an embellishment in the
Foucaultian sense.559 I have not found such advice in earlier authoritative works.
Instructions similar to Palzang Gyatso’s can be found throughout the many present-day
Tibetan works on women’s bodies considered and not considered in this thesis. The standard
position throughout these works is that “during [menstruation] the body’s immune system
becomes weak,” 560 and therefore all these extra precautions are needed to avoid illness. Many
professional and home reference sources report that during menstruation women’s minds, bodies,
and even appearances are said to be “weakened” (zhan po).
It could be said that a general theme of the majority of these works is that women are
presented as constrained by their bodies. Menstruation and child-bearing are seen as inherently
weakening times. Moreover, these ideas appear to spill into the views that women can only
accomplish or achieve what their bodies will allow them to perform. Lhamokyi, a notable
exception to this above paradigm, states that “generally if [menstrual] symptoms are not too
severe and if there are no signs of a developing disorder, then there is no harm for women to do
their work or study throughout the day and the [symptoms] will dissolve naturally on their
556
chu grang mos rkang lag ‘khrud pa dang / zhon pa bzhon pa / sa thag ring por ‘grul bzhud byed pa
bcas kyi rigs la do snang dang nyams ‘jog byed dgos, ibid., 19.
557
si pan dang / sngo tshal tsong sgog pa la sogs pa’i zas skom rjen pa’m grang mo, ibid., 19.
558
da dung sems skyid po yong thabs byed dgos pa dang / rlung mi langs par blo sems skyid po byed
cing / ‘dod pa spyad mi nyan pa yin, ibid., 19.
559
560
Michel Foucault, The History of Sexuality.
skabs ‘dir lus khams kyi ‘gog shugs zhan par ‘gyur ba, Dbang rgyal, Ma bu bde srung gi rgyun
shes, 6.
!227
own.”561 Lhamokyi evidences that the increasing number of female doctors and researchers will
change and reshape the future of Tibetan gynaecology and medicine into the future.
The home reference works serve a crucial public health function, in that they provide
potentially life-saving information. However, they are not without the social and religious
baggage that can perpetuate the view that women’s bodies have ‘limited abilities,’ and therefore
actually can limit the (perceived) abilities of women. The warnings against doing any exercising,
traveling, labour or hard thinking for a few days every month gives medical authority to what are
essentially social and religious views about what women ought to be allowed to perform or to
achieve. In general, they tend to portray women’s bodies as inherently burdened and weak.562
They also generally lean towards more conservative religious views of women’s bodies and
sexualities. Hence, while home reference works serve a public health mandate, they also
perpetuate certain attitudes that are limiting to women.
The language of “hormones” in Palzang Gyatso’s and Wangyal’s home reference works
somewhat reflect and reinforce these Tibetan Buddhist attitudes about women. The term that
both authors use to translate “estrogen,” mo rtsi is a new twist on an older idea that supports
traditional Tibetan Buddhist ideas about women. Essentially mo rtsi communicates the notion
that women have an “inherent,” “innate,” or “fundamental self-nature” (chos nyid, rang bzhin) or
“essence” (bdud rtsi) that compels their bodies, minds and emotions to co-align into something
essentially and inherently female. Moreover, as the authors say, because estrogen plants and
compels the menstrual cycle, one could conclude that the hormone mo rtsi has built within its
functional core, an inherent and reoccurring ‘weakening’ feature. Such notions imply that the
ingrained nature and essence of woman is an inherently debilitating one.
The language of mo rtsi, evoking the nectars and pure essences of the vajra body draws
from the popular Tibetan imagination about women as sexual partners. For example, in his
561
spyir btang tshabs mi che zhing nad ‘gyur gyi rtags ma yin pas bud med kyi bya las dang slob
sbyong la gnod ‘tshe mi ‘byung bar nyin kha shas rang bzhin du yal ‘gro ba yin, Lha mo skyid, Zla
mtshan gyi rnam par bshad, 109.
562
I did not discuss this point for the thesis, but it is worthwhile mentioning that the vagina and other
reproductive parts are also presented in a number of works, and especially in the home reference guides,
as inherently open to disease and in need of various forms of ‘protection.’
!228
description of the “vagina” (skye lam) and its functions Palzang Gyatso uses the term chu rtsi,
literally meaning, “nectar water” to name the sexual fluid that naturally arises when women are
aroused.563 In the section “Observable signs of sexual desire in men and women,”564 Palzang
Gyatso more explicitly refers to the vajra body, in his “advice on the manner of sexual arousal in
your woman, wife, or consort.”565 He tells the (presumably) male readers: “when one finds
himself in a close intimate encounter, the centre of neck and chest of the woman expands and
blooms very white. The [cakra at the] armpit possessing the three knots gently loosens. If
touched, great pleasure expands under the navel and at the root between the female thighs.”566
Therefore, it could be said that in Palzang Gyatso’s work, mo rtsi, translated as “estrogen”
alludes to female sexual desire as well as the ability to reproduce. This is perhaps not surprising
given that in the Four Treatises, mo rtsi refers to female fertility.
Within the two present-day home reference books we have looked at, the Tibetan
language of hormones allows authors to communicate salient cultural, religious, political and
medical meanings about women and gender to a wide audience of young Tibetans. Under the
auspices of public health and a veneer of medical authority, a politics of gender and ethnicity is
afoot. The integration of biomedical ideas of hormones does not undermine the religious or
moral associations of Tibetan medical thought. Hormones like “estrogen” are recruited to bolster
and to lend the authority of the Tibetan medical account of the female body. It is revealing that
both Wangyal and Palzang Gyatso saw it fit to include a Tibetan account of the biomedical
notions of hormones within the first few pages of their works. Clearly, the insight into hormones
proved to be a central piece of ‘modern’ Tibetan knowledge of the female body.
563
Dpal bzang rgya mtsho, Bud med bde srung skor gyi rgyun shes phran bu bshugs, 7.
564
skyes pa pho mo gnyis la ‘dod pa skyes pa’i mngon tshul brtag pa, ibid., 32.
565
bud med dga’ ma’m chung ma sogs la chags pa slong tshul phran tsam la, ibid., 32.
566
rang gi rtsar bcar tshe rab dkar gzhon sha rgyas pa’i bu mo’i ske dang brang gzhung / lhod ‘jam
drod gsum ldan pa’i mchan khung / reg na bde dga’ rgyas pa’i lte ba’i ‘og dang brla bar ma’i rtsa ba,
ibid., 33.
!229
5.
Conclusions
Involving the ‘mixing’ of (at least) two ways of considering and explaining the body,
ultimately, this thesis has explored the integration of medical systems in our present time. As this
thesis has shown, mixing two medical traditions is not a straight-forward ‘scientific’ affair. The
peculiar social, religious, and geo-political contexts of human cultures, plays a dominant role in
determining and giving expression to ‘scientific’ and medical knowledge. The study of
“hormones” in Tibetan medicine reveals how issues surrounding gender, nationalistic, ethnic,
and religious identities, play a significant part in determining the manner in which the
endocrinology of women is researched, debated, and documented.
Demonstrating the relationship between medical and religious ideas in the contemporary
Tibetan medical research on “hormones,” I have shown how the religious perspectives of women
and their bodies have influenced the Tibetan understanding of scientific and medical
‘knowledge.’ Their use of Tantric language and thought in the naming and their nomenclature of
“hormones” demonstrates the influential role Buddhist thought has in contemporary Tibetan
medicine in Chinese Tibet.
Both the professional and the home reference works impart a gendered perspective and
language of the female body that is steeped in Buddhist thought. Hence, the integration of
Tibetan medical and Chinese biomedical notions of “hormones” is an example of the ways in
which medicine, gender, and religion intersect to create ‘knowledge’ (and with it, the power) that
determines the nature and (dis)abilities of female bodies. Ultimately, such knowledge has an
impact on women’s lives.
The study of “hormones” shows that neither the biomedical, nor the Tibetan medical
system, is immune to social and religious issues of gender. Gender and science scholars have
shown that what is ‘true’ or ‘correct’ about any medical or scientific system indicates that such
knowledge meets social expectations. The analysis of “hormones” in the Tibetan research on
women’s bodies shows how social, political and religious ideas become fused with medical ones.
!230
This is especially apparent in the Tibetan terms authors use to name the hormone “estrogen.” The
Tibetan language of “hormones” generally tells us that women have an innate nature that is tied
to their bodies, and which, in Tibetan medicine, is compelled and maintained by a female
quintessence identified as the red element, while in the biomedical system it is “hormones.”
We can intimate from the contemporary Tibetan sources that the language of hormones
helps to reinforce Tibetan perceptions of the female body, and more importantly, what it is that
women are capable of performing and achieving. The integration of “hormones” also allows
researchers and writers to claim that biomedical knowledge of hormones substantiates and
reinforces what Tibetan medicine, that up until very recently had been a virtually exclusive male
(and monastic) writing community, had long known about women and their bodies.
The substantial role that Buddhist, and in particular Tantric ideas, have played in the
Tibetan medical literature on hormones also shows that religious thought is a still highly relevant
in the contemporary Tibetan medical tradition. Throughout the present-day sources referenced in
this thesis, Buddhist texts are used to establish credible knowledge about the “real
situation” (gnas lugs) of the body. Despite the concerns that Tibetan medicine is being ‘eroded’
or ‘erased’ by the ‘secular’ approach of biomedicine, the works that integrate hormones show an
opposite trend. Indeed, they show, like Klassen’s study of Canadian biomedicine and its relation
to Christianity, that ‘secularism’ and ‘religion’ are not mutually exclusive categories, and that
medical researchers and writers can be devoted both to the ideals of ‘secularism’ and ‘religion’ in
the research and the practice of medicine. That is, a medical tradition can be both scientific and
religious. Tibetan medical writers are clearly as loyal to the Tibetan medical and Buddhist
traditions as they are open and eager to research and incorporate new (biomedical) knowledge.
Moreover they see their own tradition as being scientific because it rests upon a Buddhist
framework of knowledge, which is said to be about the real, and actual situation of human
embodiment.
Therefore, biomedical thought is not presented as a ‘threat’ to the authority or integrity of
Tibetan medicine in the present-day Tibetan medical sources of this study. On the contrary,
especially in the professional sources, Tibetan medical and Tantric texts are interpreted to
!231
demonstrate insights into very subtle material substances circulating throughout the body, which
biomedical scientists, with the help of modern technology, are only beginning to reveal.
Biomedicine is positioned to provide collaborating evidence of Tibetan knowledge of
“hormones” such that the integration of biomedical ideas serve to bolster, to augment and to
develop the contemporary Tibetan medical system.
Although biomedicine is positioned as being additional evidence for the veracity of the
Tibetan explanations of “hormones,” it is clear that in the bigger picture, biomedical knowledge
is the looming, ever present authoritative voice in these sources. In its integration with
biomedicine, modern Tibetan medical writers must present the knowledge of their tradition, to
some degree, in response to biomedical authority. Hormones and the endocrine system, and the
role they play in menstruation and reproduction are clearly too important for Tibetan medical
writers not only to include at the beginning of their works on women, but also to incorporate into
their ‘traditional’ Tibetan medicine.
The Tibetan study of hormones also demonstrates the enormous importance given to
textual knowledge in the contemporary Tibetan medical tradition. Clearly, textual research is a
significant methodological branch in the larger picture of medical research in present day
Chinese Tibet. This is because the traditional texts, seemingly immutable, and yet always open to
new interpretations, are one of the few ways of concretely preserving and giving life to the
authoritative medical and Buddhist works of Tibet. This is why present-day writers are using
texts that reach back as far as the ninth and tenth centuries to establish the medical authority of
today’s writings. As demonstrated in the case of “hormones,” Tibetan medical writers have
‘lifted’ words from Buddhist and medical texts so as to interpret and craft new ‘modern’
meanings. By such method, Tibetan texts and textual knowledge remain prominent features of
the Tibetan tradition.
The Tibetan authors of this study position authoritative medical texts as the vital life force
of the Tibetan medical system by presenting their contents as being both ‘universal’ and ‘global,’
that is, parallel to the knowledge of other national medical systems (including biomedicine), and
yet culturally ‘unique’ and ‘local.’ Thus, the Tibetan medical system is presented as being both
!232
thoroughly ‘scientific,’ and therefore as having global or universal significance. It is also
considered to be the unique Buddha-originated, intellectual tradition, and property of the Tibetan
people.
The figure of Gendun Chöphel, whose works figure so prominently in the literature on
women’s bodies, embodies this juxtaposition between the modern and the ancient, and the global
along with the local. He knew of the modern world, and wanted to experience everything it had
to offer, as much as he wanted to understand and debate the authoritative masterpieces of Tibetan
Buddhism. He had both deep textual knowledge of Tibet’s intellectual traditions, and familiarity
with Western science and technology. He was open-minded about change. And he is thought of
today as both a local and national hero who represents the best of Tibet’s modern ethnic, national
and religious identity. Gendun Chöphel’s mixing, or integrating, of the Tibetan and ‘modern’
worlds is clearly held as an example for young Tibetans to emulate.
Additionally, something should be said on the comparison between the Tibetan medical
and the biomedical perspectives of “hormones.” Certain parallels stand out in both traditions,
such as the relations among the brain, the glands and the ovaries. Although these differ in detail,
the present-day Tibetan authors agree that the “hormones” and the “white and red elements” are
equivalent ideas, and ultimately point to the same substances. While the Tibetan authors focus on
showing the similarities of the biomedical and Tibetan medical traditions, it is revealing to
consider the ways in which these insights differ.
Western endocrinology is moving away from a binary ‘sexed’ model of hormones, and
has shown that estrogen is involved in some of the most important functions of both the male and
the female bodies. However, Tibetans consider hormones to be strictly ‘male’ or ‘female.’
Estrogen, aligned with the red element, is unquestionably a female hormone in the Tibetan
medical system, whereas this is not the case in Western biomedicine. This could be partly due to
their close integration with the white and red elements of Tibetan medicine, and the postulation
that estrogen is inherent to the red element. It is interesting to note that in contemporary and
historical Tibetan medical texts, both the white and red elements are thought to function in
women, and it is debated as to whether or not men have the red element.
!233
Although further research is needed in this direction, the contemporary Tibetan medical
system better appreciates ideas surrounding ‘internal cycling’ in both women and men. In
Western biomedical thought, and as regards hormones, men are not thought to ‘cycle’ in the ways
that women are. Men do not have a menstrual or an ovulatory cycle, and male ‘cycling’ is not
thought to be involved in the reproductive functioning of men’s bodies. Tibetan medical writers,
on the other hand, either directly or by implication, indicate that men, through the white element
and “testosterone,” have a male ‘self-nature,’ and like women, go through various levels of
cycling from the digestive process to the daily, monthly and seasonal cycles that cause the body
to go though regular and predictable transformations. Men’s virility is an important topic in
Tibetan medicine, and more research in this direction would enrich our picture of the Tibetan
views of hormones.
The disciplinary reach of hormones is increasingly widening in contemporary Western
medical thought, and whether this translates to changes in wider Tibetan medical thought outside
the reproductive functions of hormones, and in conjunction with other bodily systems, such as
the immune system, remains to be seen.
This dissertation notes that present-day Tibetan writers integrate and innovate biomedical
knowledge in order to augment and to develop Tibetan medical knowledge of women. By
integrating notions of hormones, Tibetan medical writers do so through the language and cultural
repertoire of Tibetan Buddhist thought. Throughout my sources, the common thread of the red
element encompasses an enormous range of indigenous medical and Buddhist thought, enabling
contemporary authors a rich resource to incorporate, interpret, bend, and to expand modern
Tibetan medicine. On the other hand, in using Tantric ideas of the body, larger and fundamental
Buddhist ideas involving all manners of human life, including conception, gestation, or
development, (re)birth, gender, and sexual desire, are maintained as pillars of the Tibetan
medical framework on researching and configuring female and male reproductive bodies.
Biomedical notions of hormones are made to fit onto a Tibetan Buddhist-informed medical
model. Some medical writers, using an ecumenical assortment of Buddhist, medical, sexological
and other works, maintain that the intellectual giants of Tibetan history were already motioning
!234
towards knowledge of the very subtle, or microscopic, potent and life-enabling substances
known today as hormones.
Instead of couching hormones as something entirely new or foreign to the Tibetan
system, the medical authors in this study employ a range of ‘translation tactics’ to infuse
biomedical thought into the Tibetan medical lexicon. Thupten Püntsok uses a phonetic
transliteration of hormones, “ho’o mo’u”, indicating a foreign word possibly equivalent to the
Tibetan medical and Tantric understandings of the body’s system of winds, channels, and drops.
Mingji Cuomu’s use of the calque skul rgyu , meaning to “cause to arise, arouse or incite,” for
“hormones,” mimics the Greek word “hormaein,” “an agent that can excite, arouse, or stir,”567
thus signalling a translation that remains close to the original biomedical sources on hormones.
Lhamokyi’s rendering of “hormones” as bcud chen po uses pre-existing indigenous ideas about
the body, but in an innovative way, stretching their meanings to accommodate new biomedical
knowledge. Similarly, other neologisms for hormones that we see in the home reference works
such as mo rtsi, more literally meaning, ‘female nectar’, also evoke Tibetan medical, Buddhist,
and cultural ideas about the female body, but perhaps lose some of the closer associations with
biomedical hormones. Throughout the contemporary Tibetan medical works on women, we see
numerous examples of direct translations between perceived equivalencies, particularly in
anatomy. As we have seen, even though biomedical understandings of the functions of
reproductive sacs, the ovaries, and testicles diverge from Tibetan understandings, contemporary
authors use the Tibetan medical term, bsam se’u to refer to these biomedical terms. A few authors
hint to an equivalency of ideas between the Tibetan medical and biomedical endocrine system,
however, the only direct use of biomedical terms appear in Chinese characters. Therefore, as we
have seen in the various nomenclatures for “hormones” examined in this dissertation, “this
seeming chaos is simply a sign that translation norms [have] yet to emerge”568 in the modern
Tibetan medical system.
567
Norman and Litwack, Hormones, 2.
568
Salguero, Translating Buddhist Medicine in Medieval China, 54.
!235
The study of hormones in any given culture and geopolitical context continually deepens
our understandings of the interactions between humans and their social and material worlds.
Hidden in plain sight, Tibetan works on gynaecology and obstetrics, and home health references
for women and girls, reflect the contemporary geopolitical context of Chinese Tibet, and the
perceived roles of women and men in the performance of a modern Tibetan Buddhist identity.
Given the current trend, we can expect to see further Tibetan research and integration into
biomedical endocrinology and hormones. In what form this will take place will depend in large
part on the translation and collaborative activities of various human actors, making strategic
social and political choices that determine the shape and content of medical knowledge. In the
current geopolitical context of Chinese Tibet, I expect that Buddhist and Tantric ideas about the
body, will continue to play a vital role in Tibetan medical research as it continues to ‘mix’ with
biomedicine.
!236
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