The Tibetan medical tradition grew tremendously in the twelfth century, due in large part to the new translations that had been produced since the early decades of the eleventh century. Rinchen Zangpo (958–1055), the famous translator from western Tibet, rendered one of the great Indian medical treatises and its commentaries into Tibetan: V
āgbha
ṭa’s
Condensed Essence of the Eight Branches of Medicine. Despite its name, this is a massive compendium of medical knowledge, treating physiology, pediatrics, spirit possession, head injuries, injuries from weapons, surgery, geriatrics, and virility. V
āgbha
ṭa’s work and a 2,000-page commentary by Candrananda formed crucial sources for the major Tibetan indigenous medical treatise, the
Four Medical Tantras. Many passages read like vernacular Tibetan renderings of the sometimes ponderous translations of the Indian works, and there is no doubt that much of Tibetan medical theory is indebted to India. Yet there is much that is unique in the
Four Medical Tantras; rather than a univocal system, it represents a creative synthesis of medical knowledge available in Tibet during the twelfth century. Certainly the old Tibetan medical tradition (see
chapter 4) survived in some form despite the collapse of empire. Practices such as moxibustion are mentioned in Dunhuang texts and in the
Four Medical Tantras, but not in V
āgbha
ṭa’s work, which shows that the creators of the
Four Medical Tantras were drawing from a variety of sources and not, like their Buddhist colleagues in the twelfth century, striving to avoid any non-Indian influence.
A central figure in the creation of the
Four Medical Tantras is Yutok Yönten Gönpo (1126–1202), a scholar from Tsang who is said to have traveled to India at the age of eighteen to study medicine in V
ār
āṇas
ī. Tradition is divided as to whether Yutok was the author or simply the propagator of the work. For those who claim the latter, the
Four Tantras is an Indian scripture that is no less than the word of the Buddha. Yet opinions still vary as to when and how the work was transmitted to Tibet and popularized after the imperial period. Some claim it was translated by the eighth-century translator Vairocana, concealed like the tantras of the Nyingma and Bön traditions, and revealed by the twelfth-century discoverer Drapa Ngönshé. Whatever the case, it is clear that Yutok initiated a new school of medicine in Central Tibet that would form the basis of medical learning for centuries to come. But the Yutok of the twelfth century is neither the only nor the first medical scholar to bear the name. In fact, this Yutok is typically known by the name Yutok the Younger; his predecessor, Yutok the Elder, is revered as the father of medicine in Tibet and credited with systematizing Tibetan medical knowledge. As is the case with Buddhism, the Tibetan medical tradition looks back to the imperial period as a golden age of cosmopolitanism, in which scholars traveled to India and other cultural regions around Tibet to bring back knowledge for the empire. Yutok the Elder’s several journeys to India may be compared to the journeys of the father of the Tibetan script, Tönmi Sambhota: both are credited with bringing Tibet forms of civilizing knowledge and practice. Yet narratives of the medical tradition have a more expansive view of the place of Tibet in the world. Buddhist narratives of the Great Debate at Samyé, between the Chinese monk Moheyan and the Indian scholar Kamala
śīla, place Tibet in between India and China, only to choose India as its source of culture. Medical narratives include nine different countries that are said to have contributed to Tibetan medical knowledge, and place Tibet firmly in the center of this multicultural world. KRS
Tibetan medical tradition is based largely upon the massive compendium of medical practice, the
Four Medical Tantras. It is not certain which Tibetan intellectual of the past is the source of this work, but the treatise itself is quite clear about its celestial origins. Some believe it was authored by a Tibetan medical scholar, Yutok Yönten Gönpo, in the twelfth century, but the majority consider the
Four Tantras to be the authentic word of the Buddha himself, to be accorded all the reverence due to any other scripture handed down by the founder of the tradition. That the Buddha spoke of medicine rather than meditation is unsurprising, for all the Buddha’s teachings were about healing of one sort or another, and if the medical arts spend more time on healing the physical person, then that is only out of the Buddha’s compassion toward all living beings. The introductory chapter in the
Four Tantras sets the cosmic stage for the Buddha’s preaching of the work. Gods and sages, bodhisattvas and pious attendants are all gathered in the City of Medicine to hear him speak in his guise as divine physician, Aquamarine Light, Master of Medicine. The city is itself a paradise, a physical manifestation of the Buddha’s enlightened blessings. It is surrounded by four mountains, each filled with a wondrous medicinal substance, and holds within its center a palace with a beautiful throne from which the Buddha preaches. With the scene set, the Master of Medicine, Buddha himself, begins the most important technical treatise on the healing arts in Tibet. KRS
THE FOUR TANTRAS. BOOK 1, CHAPTER 1
I prostrate to the king of Aquamarine Light, Master of Medicine, the perfectly accomplished Awakened One, Foe Destroyer and fully endowed transcendent Conqueror who has thus gone beyond. By virtue of his compassion those who hear merely the name of this transcendent, accomplished Subduer, who acts to benefit living beings, are protected from the miseries of evil states of existence.
I prostrate to the Aquamarine Light, the Master of Medicine and Awakened One who dispels the three poisons and three ailments.
Thus I have spoken at one time (because both masters are emanations of the Lord of Medicine).
In the City of Medicine, an abode of sages called “Beautiful to Behold,” lies a palace made from the five types of precious substances. This palace is adorned with various kinds of precious gems for healing the four hundred and four diseases which arise from disorders of wind, bile, phlegm and from combinations of two or all three humors. Moreover, they cool fever, warm cold disorders, pacify the one thousand and eighty types of obstacles to good health and fulfill all needs and desires.
Gems of humans radiate white, yellow, red, blue and green light and have seven qualities: (1) their color is all purifying; they dispel harms from (2) poisons, (3) spirits, (4) darkness, (5) swellings; (6) they dispel the sufferings of fevers, etc., and (7) fulfill wishes. Devas’ gems have these seven qualities and also (8) accompany them everywhere, (9) are light (in weight), (10) are perfectly pure and (11) have the ability to speak. Bodhisattvas’ gems have these eleven qualities and (12) enable them to see the death and rebirth of others, (13) enable them to see the time of the ultimate liberation of others and (14) can teach in various ways according to the dispositions and aptitudes of disciples.
To the south of that city lies the mountain called Vindhya (Thunderbolt), endowed with the power of the sun. Here are found pomegranate, black pepper, long pepper, white leadwort, etc., i.e., medicines which cure cold disorders and a forest of medicines having hot, sour, salty tastes and hot, sharp (coarse and light) powers. The medicinal roots, trunks, branches, leaves, flowers and fruits are fragrant, attractive and pleasing to behold and wherever their scent pervades no cold disorder will arise.
To the north of the city lies the mountain called Himavata (Snow Mountain) which is endowed with the power of the moon. Here are found sandalwood, camphor, eaglewood, neem, etc., medicines which cure fevers and a forest of bitter, sweet and astringent medicines having cool, blunt and firm powers. The medicinal roots, trunks, branches, leaves, flowers and fruits are fragrant, attractive and pleasing to behold and wherever their scent pervades no fever will arise.
To the east of that city lies the mountain called Pö Ngeden (Fragrant Mountain), upon which grows a forest of chebulic myrobalan. Its roots cure bone disorders, the trunks cure flesh disorders, the branches cure diseases of the channels and ligaments, the bark cures skin disorders, the leaves cure disorders of the vessel organs, the flowers cure disorders of the sense organs and the fruits cure disorders of the heart and other vital organs. At the tops of the trees ripen the five types of chebulic myrobalan which are endowed with the six tastes, the eight natural powers, the three post-digestive tastes and the seventeen secondary qualities. These cure all types of diseases and wherever the scent of these fragrant, attractive and pleasing medicines pervades, the four hundred and four diseases will not arise.
To the west of that city on the mountain called Malaya (Garlanded Mountain) grow the six superlative medicines. All diseases are healed by the five kinds of calcite, the five kinds of mineral exudate, the five kinds of medicinal water and the five kinds of hot spring which are found on this mountain.
All around the city are meadows of saffron with the wafting fragrance of incense and all kinds of mineral medicines and salts are found in the rocks. Peacocks, cranes, parrots and other birds sing sweetly in the treetops of this forest of medicines and on the ground dwell all kinds of animals (creatures bearing excellent medicines, e.g., elephants, bears, musk deer, etc.). Thus the region is adorned with all kinds of medicines that grow and are to be found.
In the center of the palace on a gem throne of aquamarine sat the Master of Medicine, King of Aquamarine Light, the fully endowed transcendent Conqueror who is Guide and Physician. The Master was completely surrounded by four circles of disciples, gods, sages, non-Buddhists and Buddhists. The circle of gods included the celestial physician Kyegü Dakpo Nyurwa and Takar, the divine sovereign Indra and the goddess Dütsima (Amṛtavatī, who offered myrobalan to the Medicine Buddha). These and many other divine disciples were assembled there. The circle of sages included the great sage “Son of Gyünshé” (Atreya), Mizhinjuk (Agniveśa), Mukyudzin (Nimindhara), “Son of Drokyong”, Shöldrokyé, Kanyichö, Tanglabar (Dhanvantari) and Napsokyé. These and many other sages were assembled there.
The circle of non-Buddhists included Brahma, the patriarch of the T
īrthikas, Mah
ādeva, Sri Relpachen (Ja
ṭika; lit. “The One with Matted Hair”), Vi
ṣṇu and Zhönnu Dongdruk (Kum
āra, the son of Mah
ādeva with six faces who holds a small spear and rides a peacock). These and many other non-Buddhists were assembled there. The circle of Buddhists included Arya Mañju
śr
ī, the mighty Avalokite
śvara, Vajrap
āṇi,
Ānanda and the physician Zhönnu (Kum
āra). These and many other Buddhists were assembled there.
At that time each of the four circles of disciples understood the Master’s words to be of the tradition of their own Master.
This particular teaching is called the “Tradition of Sages,” for they are without faults of body, speech or mind, are upright and true and eradicate faults in others.
This concludes the first chapter, on the basis of discussion (introduction), from The Quintessence Tantra, the Secret Oral Tradition of the Eight Branches of the Science of Healing.
[Barry Clark, trans., The Quintessence Tantras of Tibetan Medicine (Ithaca, NY: Snow Lion, 1995), 23–25.]
The Four Tantras of the Tibetan medical tradition has much to say about the ethics and proper conduct of the physician. Chapter 31 of the second tantra details these responsibilities under six topics: 1) the prerequisites for the person wishing to become a physician; 2) the nature of the physician; 3) the meaning of the term “physician”; 4) the classification of different types of physician; 5) the duties or “function” of the physician; and 6) the benefits of the career. Within this outline, the Four Tantras offers a detailed character portrait of the ideal medical scholar and practitioner. He should be a first-rate scholar who has read all the medical treatises and is adept at logic and Buddhist doctrine as well. But of course a doctor’s knowledge is not merely academic; it is applied. Therefore the physician must be well coordinated and have ample on-the-job experience with everything from plant identification to surgery. Finally, he must be at once compassionate toward his patients, acting with a gracious bedside manner, and astute enough to realize when to evade directly telling patients and their families that a cure is unlikely. This latter injunction may seem at odds with a Buddhist ethic that demands truthfulness, yet carefully managing patient information is part of working with patients and relatives compassionately. It is necessary for the physician to maintain a good reputation by carefully controlling public opinion of his activities, especially when the patient’s prognosis is not good. This section of the Four Tantras became a primary source of medical ethics in Tibet. KRS
Then the Sage Yilé Kyé spoke as follows: O Teacher, Sage Rikpé Yeshé, how should one learn the section on the physician in action? Please expound this, O Healer, King of Physicians.
When he said this the Teacher replied: O Great Sage Yilé Kyé, the presentation of the section on the active physician, the healer who performs the function of healing, is sixfold: (1) the prerequisites of a doctor, (2) his nature, (3) his designation, (4) classification, (5) his function and (6) the results.
1) THE PREREQUISITES
With respect to the prerequisites, (the doctor) should be (a) intelligent, (b) altruistic, (c) adhering to his words of honor, (d) knowledgeable in practice, (e) diligent and (f) well-versed in social mores.
Intelligence
Firstly with regard to intelligence, by means of great intellect, stable and cautious attitudes, one should internally actualize all the extensive compilations of the therapeutics and thus be without fear of faltering in any practice. By force of such intuitive awareness analytical or extrasensory perception arises which is said to be supreme among the above causes.
Altruism
Altruism entails having an altruistic mind of Enlightenment (which) is threefold: (i) preparation, (ii) performance and (iii) conclusion.
With respect to (i) seeing that the three realms are in the nature of suffering, having the wish to benefit sentient beings and having sincere faith in the Triple Gem, rather than cling to notions of love and hatred towards others as being good or bad, by means of even-mindedness one comes to abide in the four limitless attitudes of compassion, love, joy and equanimity.
(ii) By means of aspiration to attain the highest enlightenment for the sake of all sentient beings, the supreme altruistic mind of enlightenment is generated and one should limitlessly engage in this practice.
(iii) Finally, in order to actualize this one should thoroughly examine the application of therapeutics and treat the patients without prejudice. By having such an attitude the patients will become easier to treat, many will recover and become one’s friends.
Adherence to Words of Honor
The adherence to words of honor is said to be threefold: (i) six factors to be kept in mind, (ii) two to be upheld and (iii) three to be understood.
The six factors to he kept in mind are: the preceptor, his teaching, the medical treatises, one’s fellow students, the patient and the latter’s pus and blood.
Considering the preceptor as the Buddha, his teachings as the speech of the
ṛṣi (“Upright One”), the medical treatises as the Oral Instruction Lineage, one’s fellow students as friends and relatives, patients as one’s children and the pus and blood as one’s pet dog or pig, are the six words of honor to be preserved.
Two factors to be upheld. Secondly, one should maintain the apprehension of the Medicine Holder of Knowledge as an oath-bound protector and one’s medical instruments as the latter’s implements.
Three factors to be understood. Thirdly, medicine is to be understood in a threefold way—as precious gems, as nectar and as offering substances. One should perceive it as a wish-fulfilling gem accomplishing one’s needs and desires. It should also be perceived as a nectar that dispels diseases and as the primary offering substance of a Vidyādhara (Knowledge-Holder).
Firstly, these precious medicines should be sought out and retained.
Secondly, they should be well compounded and consecrated as nectar. The physician should think of himself as the “King of Aquamarine Light,” consider the medicine container as a begging bowl filled with nectar and the visualized retinue of ṛṣis around him as chanting auspiciously.
“O Transcendent Conqueror, Healer King of Physicians, O Medicine Guru Buddha, who dispels the afflictions of the three poisons, whose indigo form emits aquamarine light and whose emanated body is endowed with the major and minor marks; in your right hand you hold a chebulic myrobalan, the antidote to the afflictions of those who are tormented by disorders of wind, bile and phlegm.
“I prostrate to the one who emits Aquamarine Light and who holds in his left hand a begging bowl filled with nectar. He has realized the eighteen supreme sciences and has attained the powerful attainment of essence-extraction which brings mastery over life itself. I prostrate to the ṛṣi Vidyādhara (Sage Knowledge-Holder), the Supreme Being who balanced collective imbalances of the bodily humors and who is endowed with clairvoyance and compassion. To the gods this medicine is like nectar, to the serpent spirits like a crowning jewel and to the sages like essence-extraction pills. May this medicine remain ever at the disposal of you (the patients). May it subdue the four hundred and four diseases of wind, bile and phlegm, which threaten life, also subdue the one thousand and eighty types of harmful interferences, the three hundred and sixty intrinsic spirits, etc., and mental obstacles.”
oṃ namo bhagavate bheṣajye guru vaiḍūrya prabha rājāya tathāgatāya arhate saṃyaksaṃbuddhāya tadyathā oṃ bheṣajye bheṣajye mahā bheṣajye rājāya samudgate svāhā
Having recited this mantra seven times one should conceive the medicine to have been transformed into nectar. Having tasted it, one should imagine that by the powerful attainments that have arisen one’s afflictions and spirits are dispelled and that by the patient’s partaking of it he is relieved even of death.
Through upholding such words of honor blessings will descend upon one and auspiciousness and merit will ensue.
Knowledge in Practice
Being knowledgeable in practices is threefold: physical, verbal and mental. The doctor should be skilled with his hands at preparing medicines and accessory therapies. He should speak, using sweet words so as to be able to give pleasure to the patient. With regard to mind, by means of his bright intellect the doctor has clear unmistaken understanding and one who understands these three is master over all in the aspects of practice.
Diligence
One is diligent with respect to both oneself and others.
Being diligent with respect to oneself is fourfold: (a) one should learn the cause of becoming a doctor, (b) reliance upon the essential conditions (e.g., one’s teacher), (c) diligence with respect to one’s fellow students and (d) attainments of consummate familiarization.
(a) With respect to causes one should learn reading and writing to perfection, since it is clear that one’s becoming learned depends on whether one can master these or not.
(b) Relying on one’s preceptor as the essential condition is threefold: (i) his qualities, (ii) the mode of reliance, (iii) the benefit of such reliance.
(i) One should rely upon a preceptor who is extremely learned, endowed with various oral instructions, good-natured, of simple means, compassionate and worthy of veneration.
(ii) The mode of reliance: One should entrust oneself to one’s teacher without harboring doubts about him, perform one’s tasks without being two-faced, make all one’s actions accord with his will and always maintain the awareness of kindness.
(iii) The advantages of such are that one will speedily gain understanding and become learned.
(c) Diligence with respect to one’s fellow students: One should ask and put questions to them about the medical treatises, memorize and contemplate the meanings thereof and avoid laziness because this is one’s prime obstacle and enemy.
(d) Attainment of consummate familiarization. One should see, hear and absorb all aspects of medical practice, retain and have intimate knowledge of all such and dispel all doubts.
Being diligent with respect to others refers to the patient whom one should treat unstintingly and unwaveringly until he recovers or is beyond such. Like someone walking along the top of a narrow wall who is threatened with death if he spills even a drop from a vessel of melted butter, the doctor should apply assiduous and timely effort in treating by means of medication or accessory therapy.
Social Mores
Being well versed in social mores is threefold: (1) one who is proficient in such, (2) one gifted in religious matters and (3) one who is accomplished in both.
With respect to the first one should be (a) learned and adept in the codes of conduct that conform to the standards of the world, (b) with one’s body, speech and mind do all that is necessary to be affable and to please others and (c) subdue them with wrathful means when necessary. By these three means the physician accomplishes his aims.
(2) If one gifted in religious matters is of subdued disposition, friendly and contented, he will be of benefit to others.
(3) If one is adept in both of the above and maintains compassion for the underprivileged, his essential aims will be fulfilled by the Exalted Ones. One who has these six prerequisites will attain positive results. Of that there is no doubt.
2) THE NATURE OF THE DOCTOR
The intimate knowledge of all the characteristics of the three humors, the objects of harm, bodily constituents and excretions and of remedial agents is asserted to be the nature of the physician.
3) THE DESIGNATION MENPA
Because he heals disease and benefits the body he is called men (medicine). He is called pa also, since he is courageous in applying accessory therapy and also because he is like a father (pa) in protecting migrant beings. Because he is held as a lord (jé) by kings, the physician is called lhajé—Lord of the Gods.
Classifications are threefold: (a) the unsurpassed, (b) superior and (c) ordinary physician.
The Unsurpassed Physician
The Medicine Buddha who has overcome the causal three poisons of attachment, hatred and closed-mindedness and the resultant three humors of wind, bile and phlegm is surpassed by none.
The Superior Physician
The superior physician is endowed with love and clairvoyant insight into the minds of others and is upright and true.
The Ordinary Doctor
The ordinary doctor is of four types:
(1) The one of bestowed lineage who is exhorted to become a physician, e.g., by a religious monarch and who passes on his knowledge to his descendants.
(2) The one of subsequent learning who is not aian of the King but who has gone on to study under such and who has thereby become a doctor.
(3) One who is familiar with the work of a physician through having received practical training only. These three are friends to sentient beings.
(4) One who out of desire for material gain merely assumes the guise of a physician is a destroyer of life.
However, physicians may be known as being of superior and inferior types: the former should be of noble family, intelligent, abiding by his words of honor, learned in the hangingof the medical texts, having a profound grasp of the oral instructions, familiar with medical practice, exert himself principally in the practice of the Holy Doctrine and have forsaken desires. He should also be of controlled nature, skilled in practical matters, having a loving attitude towards living beings, diligent, with an outlook that cherishes the welfare of others as his own and unmistaken in his knowledge of all the therapies. Such is the superior physician. He is sole protector of suffering beings, the son who upholds the lineage of the Knowledge Holder Sages. I, the emanation of the Healer, King of Physicians, have stated this.
(
a) One who lacks such qualities, who is seen to have the faults of an inferior doctor and who lacks a noble lineage, is like a fox in charge of a lion’s kingdom. He is neither honored nor respected by anyone.
(b) A “doctor” who is ignorant of the meanings of the texts is like one blind from birth to whom precious substances are shown. He fails to understand the various kinds of disease and cannot distinguish the correct therapies.
(c) A physician who has neither observed nor acquainted himself with the practice of a master is like one who sets out on a new road for the first time. He is assailed by doubts about the symptoms of disease and about the accessory therapies.
(d) The doctor who has no knowledge of diagnostic techniques is like someone wandering in a foreign land without friends or relatives. He cannot recognize a single disease.
(e) The physician who lacks knowledge of pulse and urine diagnosis is like a spy who does not know how to send dispatches. He cannot state even whether a disorder is hot or cold.
(f) A doctor who does not know how to predict the course that the treatment will take is like a minister who cannot express himself properly. He will be affected by disgrace and a poor reputation.
(g) The physician who is ignorant of methods of treatment is likened to someone endeavoring to strike a target in the dark. The remedy will fail to strike upon the disorder.
(h) The doctor who knows nothing of dietary and behavioral factors is like a ruler whose country has turned against him. The force of the disease will be increased and the bodily constituents will be suppressed.
(i) A physician who is ignorant of pacification compounds is like a farmer who is ignorant about agriculture. Because of insufficient, excess or wrong compounding, the disorder will be increased.
(j) The doctor who is ignorant about purgation is similar to one who pours water on a sandhill. His treatment will be unsuited to the disorder and to the bodily constituents.
(k) A physician without medical instruments is like a hero bereft of armor or weapons. He will be unable to overcome the enemy of disease and its accompanying factors.
(l) Any doctor who is ignorant of venesection and moxibustion is like a burglar who lacks inside information. He will be mistaken with regard to the disorder and the accessory therapy.
Therefore such bad doctors give wrong treatment because of their invariably wrong conceptions. Being demons in the guise of physicians they hold the noose of the Lord of Death and are the lever which topples the abode of life. One should not establish any connection with such doctors, who are the ruin of one’s dependents.
5) THE FUNCTION
The function of a doctor is twofold: ordinary and particular.
Ordinary Function
The ordinary function of a doctor is threefold according to function of (i) body, (ii) speech and (iii) mind.
Body. Physically he amasses the necessary medicinal ingredients and instruments and strives for the patient’s welfare.
Speech. The function of his speech is to predict the course of the patient’s treatment and through his realizing the nature of the disorder he can pronounce such in the manner of blowing a conch in the marketplace. The physician should either guarantee the patient’s survival or discreetly announce the time of his passing. If he cannot determine the nature of the disorder he should make ambiguous pronouncements like the tongue of a snake. Thus being astride either possibility the physician should then have recourse to whichever is the more positive pronouncement.
Otherwise, if both the doctor and patient are agreed about the apparent nature of the disorder then the former should clearly express this to the latter. Once the physician is convinced of the nature of the disorder he should still outwardly agree with the patient’s opinion whilst prescribing according to what he has ascertained the disorder to be. When the avenues of different possibilities are open then the doctor can retire safely to the fortress of the stable pronouncements that he has made.
(a) In the first case, if the doctor realizes the condition to be as the patient suspects, then, agreeing with the latter, he should express clearly that the disorder is indeed the same.
(b) In the second case, the patient may suspect his problem to be poisoning and the physician diagnoses otherwise. Since it is possible that the patient may denounce the doctor as being unskilled, because the latter has not concurred on the basis of what the patient believes, the doctor should manifest agreement and, having thoroughly examined the syndrome, he should treat the disorder as it actually is.
(c) Thirdly, whether the patient will survive, whether death threatens, whether the danger is great or small, are all influenced by the four conditions of the “good fortune,” the karma, power and merit (of both the doctor and
(
d)
the patient). Since he may die or may survive the physician cannot make predictions with absolute clarity. Even though the danger may be great the physician may still state that a cure is feasible and even if there is little danger, one should stress the necessity of taking great care of the patient’s condition. Moreover, one should conform with the customs and accepted standards of the world.
Mind. With respect to mental function the doctor should examine unerringly, thoroughly and with much deliberation.
Particular Function
Particular function is threefold: (a) view, (b) familiarization and (c) conduct.
Regarding view, the physician should have realized the view of the Middle Way with respect to all phenomena and by means of this supreme view, the perfect view of the Middle Way, he should have abandoned the extremes of inferiority, of excess and of error.
With regard to familiarization one should abide by the Four Immeasurables. It is imperative not to lose oneself down any of the four “wrong turnings” of:
(i) pampering ungrateful patients and therefore affording less attention to other patients,
(ii) overdoing compassion for those who have hatred for the Holy Doctrine or sentient beings,
(iii) feeling joy when the patients of other doctors pass away,
(iv) being indifferent to whether patients live or die.
Of the two types of conduct, i.e., that which is to be adopted and that which is to be abandoned, one should abandon non-virtues. Specifically, one should refrain from deluded conduct, talking nonsense, “showing off,” harmful and negative actions.
With regard to conduct to be adopted, one should practice generosity, ethics, patience and energy, as well as concentration and wisdom.
6) THE RESULTS
The results of being a physician are both temporal and ultimate.
Temporal Results
Temporally in this life one will be endowed with happiness, influence, prosperity, joy and bliss. One achieves these through Medicine and one should display one’s qualities to others. Harmful people should be treated affectionately like relatives. They should be examined, checked thoroughly and treated in accordance with their behavioral pattern. By force of practicing in this way one will win merit and renown and the food and possessions one wishes will appear.
At these times one should be modest and apply what one has learned. When one is in demand one should accept food, money or measures of grain, etc., for if this is deferred then later when the patient has forgotten the kindness rendered to him by the doctor he will offer nothing to repay him.
Ultimate Results
With respect to ultimate results, a physician who has abandoned deceit and desire and who engages in healing will proceed to the unsurpassed state of Buddhahood.
This has been stated by the Healer, King of Physicians. Having thus spoken, the sage Rikpé Yeshé dissolved back into the crown protrusion of the King of Medicine.
This concludes the thirty-first chapter, on the healer physician, from The Quintessence Tantra, the Secret Oral Tradition of the Eight Branches of the Science of Healing.
The Explanatory Tantra of The Quintessence Tantra, the Secret Oral Tradition of the Eight Branches of the Science of Healing is here concluded.
[Barry Clark, trans., The Quintessence Tantras of Tibetan Medicine (Ithaca, NY: Snow Lion, 1995), 223–233.]
The author of Yutok the Elder’s biography, Darmo Lopsang Chödrak (1638–1710), was the court physician to the Fifth Dalai Lama. As such he was instrumental in the seventeenth-century renaissance of Tibetan medicine. Lopsang Chödrak wrote extensively on the
Four Medical Tantras, on pharmacology, and on new medical practices imported to Lhasa from Nepal and India during his time. He also wrote lives of the two founding figures of the tradition, the Elder and Younger Yutoks. He was no doubt drawing on early materials to redact his narratives of the founders, and his narrative likely represents historiographic tradition going back to the twelfth century, the time of Yutok the Younger. In the following passage Yutok the Elder meets nine foreign medical specialists at the court of Emperor Tri Songdetsen. As in the narrative of the debate at Samyé (
chapter 5), Tibet is presented as host to an international coterie of experts. Yet the vision here is grander than in the debate narrative: nine medical scholars from throughout greater Eurasia share the hospitality of the Tibetan leader, now placed at the center of a cosmopolitan world. As the foreign physicians ask questions on medical history and practice, we learn that Tibet in fact already has the best among physicians, in the person of Yutok. KRS
Yutok and King Tri Songdetsen were of the same age. When they were twenty years old, they invited nine foreign doctors, and Yutok debated with them. Then the Chinese doctor Tongsum asked Yutok: “Are there doctors in Tibet?” Then Yutok told him the history of Tibetan doctors from King Lha Totori Nyentsen and his doctor Dunggi Torchok to King Tri Songdetsen and his own story. Then the Indian doctor asked him: “How was the task of bringing medicine to India, China, Nepal, Khotan, and Tibet fulfilled?”
Yutok replied: “The Indians have made a special study of the
Tantra of Wisdom. In China they excelled in prognosis by means of astrology and other methods, in Nepal they specialized in the mechanical arts, in Kashmir in chemistry, in Mongolia
1 in bloodletting, in Garlok [Qarluq] in cauterization, in Taxila in the treatment of poisoning, in Trom [Rome, i.e., Byzantium] in the examination of urine, in Zahor [Sauv
īra, i.e., Sindh] in cupping with a horn, in Kesar in healing by means of mantras, in Zhangzhung in curing by purging, in U
ḍḍiy
āna by vomiting, and in Tibet by the four remedies. The Bönpo system lays the greatest stress on curing by means of heating, balneology, and the use of ointments. The titans had the system of spell-binding diseases, the system of Brahm
ā is the
Medical Science in a Hundred Thousand Ślokas, the bodhisattva system follows the text of
The Mercy of Self-Release, the
ṛṣi’s system is the
Eight Sections of Caraka, the non-Buddhist system is the
Mahādeva Tantra, the Buddhist system the
Tantra of the Lords of the Three Families.”
Then the Nepalese doctor asked: “How many different founders of systems are there?” Yutok said: “There are two kinds of systems. The systems of the nine foreign doctors and those of the nine Tibetan doctors. For the curing of diseases in general there is a text called
Elixir Stream by the Indian doctor
Śāntigarbha. The system of the Chinese doctor Tungsum Kangwa is contained in the
Sunlight of Examinations for the Small for the curing of children’s diseases. In the system of Mah
ādeva the women’s diseases are cured. It is called
Maṇḍala of the Moon. In the system of Dharma-Buddha the diseases caused by demons are cured. It is called
Adamant Vajra. In the system of the Nepalese doctor D
āna
śīla the cure of old age is taught. It is called
Pointing out the Essential. The Kashmiri doctor Khuna Vajra follows the system of curing poisonous diseases called
Pace of the Tortoise. The special skill of the Mongolian doctor Nala Shandipa was the curing of old age according to the text called
Ocean of Spirits for the Limbs. The doctor from Dölpo called Gadé Peljé used the system
Kyoma rutsé for increasing vitality. The doctor from Drugu [Turkestan] called Senggé Öchen Peljé was the founder of the system called
Magical Mirror of the Corpse’s Hairs about anatomical measurements.
“The prince of Tsampa Shila, the son of Mujé Tetrom, the king of Trom, taught the teaching of Six Divisions of Trom.
“The system of the nine Tibetan doctors will gradually come into being in the following manner: Through the system of Doctor Biji which is called the Yellow Titled Volume and that of Doctor Ukpa which is called Lamp Clarifying Practice to the system of Doctor Cherjé which is called Drop of Recollection and that of Doctor Drangti called Golden Measure and Silver Measure and the system of Doctor Minyak which is the Great Mineral Composition to the system of Yutokpa which is the Eighteen Aspects of the Tantra, Guidance Written According to Experience on Behalf of the Son, to the system of Nyapa which is the Explanation of the Clear Light Sent Forth from the King of Initiations, to the system of Tongmen which is the Explanation of the Thousand Splendors of the Blazing Light, to the system of Tazhi which is the Doctrine of the Torch on the Path of Healing.” This is what he prophesied.
Then the Kashmiri doctor asked him: “Why are you prophesying the future of the nine Tibetan systems?” Yutok replied: “There will be many learned men, like the essence of butter, in the lineage of the renowned nine Tibetan doctors. I have prophesied the kind of instruction in each one’s system of teaching before they are to appear.” Then he asked: “What are the names of the nine? Will they come all together or one after another?” Yutok replied: “These learned men will appear one after another. Biji Lekgön, Ukpa Chözang, Cherjé Zhikpo, Minyak Rongjé, Yutok Gönpo, Drangti Gyelzang, Nyapa Chözang, Tongmen Drakgyel, and Tazhi Darpo. These nine will further the science of medicine in Tibet in general, and specially the study and practice of the Four Medical Tantras.” He asked him: “Where are the Four Tantras at present?” Yutok said: “At the moment they are with the paṇḍita Candradeva. From him the translator Vairocana will take them and give them to King Tri Songdetsen. He will gradually give them to the Tibetan learned men. Also fifty-seven famous promulgators [of the Four Tantras] will come and cause medical science to flourish in Tibet and make it clear as daylight.” He asked: “What are the fifty-seven means of increasing medical science and what is their name?” Then Yutok taught him and told him the prayer of the lineage of ṛṣis called Victorious Gem. On this text, the summary, the detailed explanation, and the conclusions I could write, but this text, with its commentary, has been written down elsewhere.
Before saying this prayer to the lineage of the
ṛṣis, one should, as in all other rituals, take refuge to the Three Jewels and direct the mind towards Enlightenment. Then one should meditate on the subject of everything being self-emptiness. Out of that emptiness arises the letter
bhrum. It is turning into a wide throne made of various jewels supported by eight great lions; on that is the letter
pam which turns into a lotus flower, the moon and the sun respectively. Above that is the letter
hūṃ which turns into a (blue)
vajra which has the letter
hūṃ in the middle. The
vajra is of the nature of one’s Guru and appears in the form of a blue victorious Vajradhara [the primordial Buddha] holding
vajra and bell in his hands which are crossed over the chest, with his
śakti [female partner] Dorjé Pakmo of dark-blue color holding a crooked dagger and a blood-filled skull (in her hands) embracing him as her consort. Both are adorned with ornaments made from bones and jewels. From their united bodies flows a nectar which gives inexhaustible bliss to all beings. In the Vajradhara’s crown of the head (one should visualize) the letter
oṃ, in his throat the letter
āḥ and in his chest the letter
hūṃ. Above him one should invite all the saintly lineage of ras in the sky and then pray. It is more efficacious with all prayers and rituals if one takes the bodhisattva vow [to achieve enlightenment on behalf of all beings] beforehand, and at the end one should say twenty-one times: “I bow before the Victorious Tath
āgata Arhat Sadzin Gyelpo …”
Then a Mongolian doctor asked: “What is the very first origin of the science of medicine, generally speaking?” Yutok said: “Five hundred and fifty great kalpas after the external world had come into being, gradually beings with the internal world came into existence. In India there was a brahmin named Hala Mikyang. His wife was the brāhmanī Selwé Nyima, and after some time her body caused her sickness. She said to her husband: ‘You have achieved the miraculous powers resulting from a constantly truthful speech. Please, expel my sickness!’ Then the brahmin spoke, and by the strength of his truthful words the cry ‘SOWA RIKPA!’ (‘science of medicine!’) came from the sky. Then the brahmin went out to search for Sowa Rikpa. One day he met a brahmin called Sorik-pel who asked Mikyang: ‘Where are you going, Mikyang?’ He said: ‘I am trying to find Sowa Rikpa.’
“Then Mikyang went into the jungle Gawatsel (Happy Forest) and he saw a naked
ṛṣi holding in his right hand a myrobalan plant and in his left hand the bowl of the Victorious Medicine filled with nectar. With him were the goddesses and the lineage of saints and also many other
trülkus (manifestations). The brahmin Mikyang asked him: ‘Where is the king of medicine, Karma Drimamepa, staying?’ One very beautiful woman asked: ‘What is it you want?’ He said: ‘I want to learn the teaching of Sowa Rikpa.’ Then she pointed to the naked
ṛṣi. The brahmin (Mikyang) bowed before the
ṛṣi and presented him with a piece of unwrought gold and told him all about his wife’s illness. The
ṛṣi said: ‘Bé-gyel, Bé-gyel,’
2 and made a threatening gesture into the sky. In the sky appeared, surrounded by lights and rainbows, the Medicine Buddha and said: ‘First the external world existed and then, for the sake of the welfare of beings, the Sowa Rikpa (science of medicine) came into being. Then the
Sowa Bumpa (Hundred thousand philosophical analyses of medicine), and then the
Pelden Gyüzhi (Glorious Four Tantras), then the
Yenlak Gyepa (Eight Branches). Then gradually all the different systems of instruction in the practice of medicine by many learned doctors will arise. Be happy and study them!’
“Then the divine system containing fifty chapters of the Medicine Sūtra, a hundred chapters on the subject of mixing medicines (pharmacology), a thousand chapters on the pulse, twenty-five chapters on bleeding, moxa and acupuncture, one hundred and ninety chapters on curing wounds, and twelve thousand short instructions (aphorisms) on other matters came from the sky. The doctor Karma Drimamé said to the brahmin Mikyang:, The heaven of Yangpachen was situated countless trichiliocosms above. You, Hala Mikyang, who are the fountainhead of the science of medicine, are the incarnation of the buddha Marmedzé (Dīpaṅkara), and were called Great Brahmin. There is no doubt that the brāhmanī Selwé Drömé [= Selwé Nyima] who is appearing as the incarnation of the goddess Sarasvatī, will be instrumental in spreading the light of the teaching of medicine in all the ten directions.’
“Then he disappeared. The brahmin took all the texts and brought them to his own country. Then the brāhmanī said to him: ‘Because of your constant truthfulness in the past you have become one whose words always come true and have found those medical texts and have been prophesied to by Karma Drimé. You are successful in finding medical texts for yourself and other beings. The Yangchenma (Sarasvatī) in the prophecy is me.’
“Then Lord Banuma came to see the brahmin Mikyang and taught him: ‘You, good brahmin, incarnation of Marmedzé who has obtained a prophecy from Karma Drimamé, you are the glory of beings who are founding the science of medicine which has never been established before, and you are increasing its number of followers. Please, teach me the science of medicine.’
“‘Dampa Tokkar (the Venerable
Śvetaketu, name of Gautama Buddha while he was waiting in the Tu
ṣita heaven), You, Master of the Heaven of the Thirty-three (the high heaven of the Vedic gods), the protector of beings, were born in India for the sake of beings, in the great country of Pemaling. You took the br
āhman
ī Chöki Lodrö to wife and, for the sake of beings, two sons were born to you: Dorjé Tokbep and Sherap Reldri. You have become the founder of the teaching of medical science, and to your hands I will entrust all the texts of the science of medicine.’ And he told him the early history of medicine and gave the texts to him. Banu passed the teaching on to Sherap Reldri who passed them on to king Gawé Lodrö who passed them on to King Pemapel. He gave them to King Pelden Püntsok. He gave them to King Dongdumkyé. He passed them on to King Ngachenpo. From him they were passed on to Biji Gajé. From him to Doctor Dunggi Torchokchen. From him to Yutok’s family lineage in Tibet.” Then the doctor from Dölpo asked Yutok: “What are the eight branches of medicine and what are the eight kinds of diseases called?” Yutok replied: “The eight kinds of medicine are: curing, healing, expelling, pharmacology, application of oil, reciting mantras, surgery, and regeneration. The eight kinds of diseases are general diseases of the body, children’s diseases, women’s diseases, diseases caused by demons, lack of sexual power, wounds caused by weapons, diseases caused by poison, and old age caused by the diminishing of the elements.
“Now we come to the treatments of these eight kinds of diseases: although there are many diseases between the top of the head and the soles of the feet, their totality can be divided into two kinds: hot and cold. Although there are many divisions of medicine, one can distinguish two main divisions: those with a cooling effect and those with a heat-producing effect. Although there are many ways of dealing with diseases, their totality can be divided into four principal ones: medicine, treatment, diet, and regulation of activities.”
Then the Drugu doctor asked:
3 “Who were the first doctors and under which kings did they introduce medicine into the different countries like China, Nepal, Kashmir, Mongolia, Dölpo, Drugu, and Trom and so on?” Yutok replied: “The brahmin Hala Mikyang during the reign of King Tachichen in India, in China Doctor Haladhara under King Sengpakchen, in Turkestan Doctor Biguta under the reign of King Bagadur (Bahadur), into Nepal Doctor Racana during the reign of King Radzugé, into Kashmir Doctor Dzugepel under the reign of King Pel-ö, into Mongolia Doctor Bhayaha under the reign of King Barita, into Garlok Doctor Harina under the reign of King Gaga, into Tazik (Persia) Doctor Rasita (Rhazes?) under the reign of King Bharibha, into Trom Doctor Karnakeri under the reign of King Sakshu, into Gesar Doctor Rikzangbu under the reign of King Pawo, into U
ḍḍiy
āna Doctor Bhoyatayé under the reign of King Za, into Zhangzhung Doctor Zirana under the reign of King Yungdrungpel, into Tibet Doctor Biji Gajé under the reign of King Totori Nyentsen.”
Then the nine foreign doctors said: “It is truly astonishing that in Tibet excellent teachers like you exist.” And they praised him in the following manner:
We bow to you who is renowned as a Saint.
Yours is perfected knowledge acquired through study and merit,
Accumulated in former lives,
Who are the great protector of innumerable helpless beings,
You who are called Yutokpa, the most learned amongst the learned,
Above all, you are the very life of medical science,
The only protector of the sick,
You are the sun of Tibet who has dispelled the clouds of darkness there,
We bow at the feet of the great Yutok.
Then they chose him to be their protector. The king and his attendants were astonished when they saw the nine foreign doctors bowing before Yutok and praising him and they conceived great faith.
Among the foreign doctors, the Chinese doctor requested him: “Please, teach us the method of treating R
āhula paralysis, and dog and bird.”
4 Yutok replied, “They are very harmful.” They said, “Do you know how to propitiate R
āhula, dog, and bird?” Yutok said: “I do not know it. Please, teach me.” The Chinese doctor said: “The treatment of paralysis is called the Wheel of Life. The treatment of Bird is called the Wheel of Signs. The treatment of Dog is called the Wheel of Razors.” He offered them to Yutok who, with the three rituals, learned to propitiate the three gods causing the diseases.
In the 29th night since he started, Śrī Vajrapāṇi, the Treasurer of the Secret Teachings, leading a white man with a crystal staff in his hand and a red man with a bird’s head and a black man with a dog’s snout, said to the three: “You three, offer each one of you to the learned Yutok instruction in the method of treating your disease! If you do not offer it I shall banish you to the other side of the ocean.” The three answered: “If he gives us a cake offering and keeps us as protectors of his teaching we will give it to him.” Yutok promised to do as they requested, and they offered him their instruction in the ritual for the treatment of their respective diseases. Since then Yutok’s disciples and followers have to offer sacrificial tormas (offering cakes) to the three, Rāhula, Bird, and Dog, and keep them as their protectors, and especially they keep as their protector Rāhula who has promised to fulfill all their wishes.
Then Yutok asked the Chinese doctor: “Where is the
Ārya Mañju
śr
ī staying at present?” The Chinese doctor said: “He is staying here,” and cut his trunk open, and simultaneously with him all the nine foreign doctors showed each one their miraculous power. In the Chinese doctor’s chest Mañju
śr
ī was clearly discernible; in the Indian doctor’s chest the Buddha
Śākyamuni, in the Nepalese doctor’s chest Avalokite
śvara, in the Kashmiri doctor’s chest the goddess T
ār
ā, in the Mongolian doctor’s chest Vajrap
āṇi, in the Dölpo doctor’s chest the Medicine Buddha, and in the Drugu doctor’s chest the buddhas of the five families. And they said: “We bow before the Guru and the Tutelary Deities. If one can look with the eye of faith at us nine foreign doctors one can see that we are definitely manifestations of those who are beyond the nature of ordinary people. Anyone showing disbelief in us will fall down into hell. If anyone prays to us he will get our blessing. If your Excellency Yutokpa would like to see a spectacle, then see this!” Then Yutok conceived great faith in them and exclaimed: “Oh, how wonderful are these nine foreign doctors who are real buddhas and bodhisattvas. They are the great protectors of all beings. Whoever can pray to them they will lead undoubtably to the abode of bliss. They are merciful and contact with them always brings benefit. I put your feet on the top of my head and am offering you my whole person. Give your blessing to me and to all sick people. We will not be separated from you in this life and all other lives. Our minds are mingled,” and he bowed to them. At that moment the king also conceived great faith in Yutok and the nine foreign doctors. Then the foreign doctors gave Yutok and the king a great number of medical texts and many instructions by
ḍākinīs. Then they went back to their own countries.
[Rechung Rinpoche Jampal Kunzang, Tibetan Medicine (Berkeley: University of California Press, 1976), 202–209. Edited for the present publication by MTK.]
