Being Human in a Buddhist World: An Intellectual History of Medicine in Early Modern Tibet

Not only did the Desi mastermind, from the heights of the Potala, an exceptional set of medical paintings. He also was a consummate historian who authored voluminous biographies of both the Fifth and Sixth Dalai Lamas and a detailed history of the Gandenpa school, in addition to his influential history of medicine, among other massive writings. The last and most powerful chief minister appointed by the Fifth Dalai Lama three years before his death, and then regent of Tibet until the enthronement of the Sixth, the Desi is an outstanding example of the lay intellectuals emerging in this period, particularly in circles of power. He was an influential collaborator with the Fifth Dalai Lama on many matters of culture and especially on the vision of the newly unified Tibetan Buddhist state; all of his scholarship fed or reflected his politics and conception of governance. A difficult but rewarding writer, highly subtle and often ironic, he wrote copiously on astrology and calendrical calculations and the principles of administrative law, as well as much about the Tibetan capital, its ritual observances, and its symbolic and geomantical implications.

Scholars have begun to study the rich range of the Desi’s writings for what it tells about his times. But as much as noting what he says, we are also rewarded by appreciating how he says it. Such an exercise is valuable for the rich sense it gives not only of his own character but also of what was possible—how knowledge could be shaped and shifted—in the intellectual and political institutions of his day. Often his innovations consisted in a fine-tuning of long-standing tradition, as is the story for much of South Asian intellectual history in the early modern period.1 But there were also moments when the Desi and some of his predecessors, especially in the field of medicine, were on the brink of disrupting the very foundations of epistemic authority in their world.

One is certainly struck with the Desi’s panache, his confidence, and his vast learning—a point he often wants to impress upon his readers. As we look more closely, we see a restless mind: complex, critical, and yet simultaneously unsure, and often self-contradictory. At one point, in what must be one of the most curious moves in all of Tibetan historiography, the Desi bitingly criticizes the character of one of his most important medical predecessors of the previous century. Most surprisingly, he does this in the very course of relating this figure’s life. A close look at this passage will be a way to introduce a number of questions about the reigning attitudes to tradition, innovation, and the newly centralized Tibetan Buddhist state during the Desi’s day. I would like to ask what the culture around the study and practice of medicine might have contributed to those dispositions.

It is an entirely standard thing for Tibetan historians to relate, in a few lines or pages—and invariably in highly complimentary terms—the lives of the eminent figures in the movement whose history they are recounting. Thus does the Desi’s rendition of the life of Zurkharwa Lodrö Gyelpo, sixteenth-century author of the ground-breaking Four Treatises commentary called Ancestors’ Advice and principal holder of the Zur medical lineage after its founder, Nyamnyi Dorjé (1395–1475), come right up in the section on the Zur school in his history of medicine. So the reader is hardly prepared, upon arriving at the six-page passage on Zurkharwa, for anything other than the standard laudatory overview of birthplace, parents, education, and accomplishments, along with the predictable hagiographical flourishes.²

Indeed, this eminent descendant of the Zur medical line had an excellent pedigree. The Desi’s biography goes through in standard honorific fashion Zurkharwa’s birth in 1509, his ordination as a Buddhist monk by Karma Trinlé (a prominent disciple of the seventh Karmapa), and his education at the Dharma center called Lekshé Ling in logic, poetry, and the sciences, including the classics of medicine.3 His first teacher of medicine was Lingbu Chöjé, a student of Tsomé Khenchen.⁴ Although he was squarely in the Zur tradition, he studied Jangpa works extensively, as well as the Drangti lineage at Sakya Mendrong, a major medical center at the time. The Desi does not fail to give Zurkharwa credit for his original research and scholarship. He graces Zurkharwa’s career by mentioning the rumor that he found precious hand-smudged “golden notes” penned by Yutok Yönten Gönpo himself at Nyangmé.⁵ Then Zurkharwa obtained the patronage of the local king Wangyal Drakpa, and wrote the Ancestors’ Advice commentary in four years.⁶

Then he went to Lhasa, and in the manner of other great minds of the time, posted a set of questions on medical practice and theory on the ancient treaty pillar. The questions were posted three times, and yet no response came back. But his disciples encouraged him, so he wrote his own autocommentary.⁷ This, the Desi relates, seemingly in admiration, was not understood by most people. (Let us not fail to note that this picture—the brilliant commentator whose work no one else understands—would come to portray the Desi’s sense of his own career too.)

Apparently after some time a few luminaries did offer responses, but the Desi notes that Zurkharwa was not in accord with their ideas and therefore wrote his own response to the questions.⁸ The Desi also goes on to mention Zurkharwa’s work in editing the root medical text Four Treatises based on his own research. He recounts a story that Zurkharwa had requested patronage to print the newly edited root text from an important Rinpung leader, who first agreed but then did not deliver the funding. Later, the Desi reports, in the colophon to the Dratang edition of the Four Treatises that Zurkharwa finally got carved and printed at Lhokha Dratang, Zurkharwa praises his patron Yargyapa, who did underwrite the edition, but adds that “previously [the Rinpung leader] said ‘I’ll do this,’ and then many people worked very hard, but just like the crow who came to die, nothing great became of it.” “Thus did [Zurkharwa] utter satirical, rebuking words,” the Desi comments, still using the normal honorifics.⁹ The Desi finds it remarkable that Zurkharwa would criticize the Rinpung leader in this way.¹⁰

The Desi goes on to sketch the other works that Zurkharwa wrote. When he gets to a short essay on whether the Four Treatises were originally taught by the Buddha or not, the Desi summarizes Zurkharwa’s position—that from the outer perspective, the work was taught by the Buddha, from the inner view it is a composition of a pandit, and from the esoteric vantage it is a composition authored by a Tibetan (we will see in chapter 3 why the Desi was so exercised about this).¹¹ Then he comments that in all of Tibetan medical writing, including that of Zurkharwa’s own lineage master, no such point had ever been seen before. Here the tone begins to get sarcastic.¹² For Zurkharwa in this way to sound a great roar and demolish all of the previous authorities, including his own teachers, the Desi notes, is, well, as the great master Sakya Paṇḍita said: “Setting aside their shame for their own deep degeneracy, they hold aloft their own bad talk; some of the royalty in Kāñcīpura beat the drum of victory when they kill their father.”¹³

The Desi then fumes about the one who hangs himself with his own colloquialized and idiosyncratic version of medical science.¹⁴ He broods that while Zurkharwa’s venerable predecessor, Nyamnyi Dorjé, had painstakingly drilled holes through diamonds, Zurkharwa just came along and added the thread.¹⁵ The Desi then goes back to listing more of Zurkharwa’s medical writings, and also a few works on poetic theory and other topics. But soon he returns to his critique. Other than luminaries from the past, Zurkharwa never praised the actual teachers with whom he studied medicine and poetry. The Desi quotes the Final Treatise’s critical description of one who “keeps one’s teacher secret and puts oneself forward as great,” to make the point that Zurkharwa was really just like that.¹⁶

The Desi concludes the story with the sad fact that Zurkharwa never completed his Ancestors’ Advice or his history of medicine, due to a stroke.17 In an acid sum-up, he remarks cattily that Zurkharwa had no prophecy or special memories to confirm that he was a reincarnation; his claim of being the incarnation of Nyamnyi Dorjé was only recognized by the Red Hat Karmapa. (Again the Desi is positioning himself, this time in contrast, for he was very proud of being an incarnation himself; and the Desi had a special dislike for the Karmapas and everyone associated with them, given their battles with the Dalai Lama’s forces in his own day.) In brief, the Desi tells us, Zurkharwa just had superficial knowledge of topics like poetry, logic, and Mahāmudrā, while in medicine he didn’t reach the level of Kyempa Tsewang (Zurkharwa’s peer, discussed in the following chapters). And yet he still demolished teachers in his own lineage and looked down upon many other textual traditions. As for the Rinpungpa lord whom Zurkharwa criticized for never coming through with support to print the Four Treatises—the Desi now supplies his name, Ngawang Jikten Drakpa—well, he could tell the difference between gold and copper. He came to realize that Zurkharwa’s edition of the Four Treatises changed its meaning and had hidden errors. And so what Zurkharwa’s colophon said about the Rinpungpa—that “just like the crow who came to die, nothing great became of it”—was really Zurkharwa’s own lot.¹⁸

In contemplating the severe breach of writerly etiquette that this critical biography represents, we at least have to set aside the silly claim that nothing ever came of Zurkharwa’s work. If nothing else, we know that the Desi himself copied word for word much of Zurkharwa’s Ancestors’ Advice in huge swaths of his own Four Treatises commentary, the Blue Beryl, not to mention Zurkharwa’s medical history, long passages of which show up in the Desi’s own medical history. The reasons for his resentment likely stem from a combination of factors, ranging from Zurkharwa’s association with the Karma Kagyü lords of Tsang who came to oppose the Dalai Lama to a more personal sense of competition that the Desi might have felt with a brilliant predecessor.¹⁹ It doesn’t take rocket science to know that the bad blood was related to the Desi’s severe unhappiness over Zurkharwa’s views on the original author of the Four Treatises; he already makes that clear in the passage itself. Disagreements and competitiveness were common in Tibet’s polemical intellectual climate, and so were considered critiques of the views or practices of other scholars, even those from the same lineage, not to mention those of rival schools.²⁰ But I have yet to discover another case of an author abusing someone on ad hominem grounds in the very course of recounting his life story and achievements. That constitutes a fundamental transgression of the most basic presumptions of the Tibetan genre of life-telling. So we are left with a puzzle.

One line of speculation that I would like to pursue takes off from the simple observation that the Desi’s main explicit reason for abusing Zurkharwa—that he lacked the requisite deference—sounds a lot like the Desi’s own career. This is not to suggest that the Desi as biographer is modeling himself on his subject per se. Rather, perhaps it is just that medicine occasioned a growing sense of license for great minds to be, as part of the job description, short on patience and manners. Certainly if there were ever someone who had the nerve to sound the great roar to demolish previous authorities, it was the Desi himself, and not only on intellectual grounds but in light of an overall assessment of their intelligence and general competence.

In fact, far more frequently than personally attacking a respected figure of the past, the Desi even critically assesses the virtues and capacities of his still-living masters.21 On several occasions he confides to his readers that Lhünding Namgyel Dorjé, whom we met in the last chapter as one of the Desi’s valued resources for the medical paintings, is exemplary, yet in the end a disappointment. While the Desi reserves his most scathing invective for Zurkharwa, this more measured critique is damning nonetheless.

Lhünding Namgyel Dorjé: His qualities and expertise are greatly famed as exemplary. At one point he put a critique of the chapter on recognizing medical plants in Ancestors’ Advice on a stone pillar. But since no rebuttal of his main point appeared, I checked into the kinds of questions he raised about plant recognition and the quality of the plants and so on, and with the exception of fine distinctions regarding certain plants and one or two other points, my investigation of the Four Treatises in light of authoritative sources and reasoning [revealed his ideas] pretty much to accord with my own thinking. Indeed, he was in a lineage of noble physicians (lha rje) that had not been broken since the time of Tri Songdetsen. Even now he has made a vow to memorize a verse every day and he keeps to that. He can rattle off 10,000 pages with no problem. Accordingly, he is very sure on the words of the Four Treatises. What’s more, the amount of words of the root Kālacakratantra, its great commentary, and with respect to the other sciences (rig gnas) that are in his head is vast. But regarding fine detailed issues and medical science, his medicine would seem to be limited. When he does make medications, they are flawed by his conceptual confusion, and there is little care for others in his way of teaching. Other than that, his mind is vast, and he is proud with manifest celebrity. ²²

A number of things are striking here: the apparently common practice for scholars to post questions on a pillar as a challenge to others; the role of noble lineage for Tibetan physicians; conceptions about education; the significance of memorization; the relative emphasis on practice over theory. But let us stick for now with the puzzle of the Desi’s attitude—his gall—in being so candid. Not only did Lhünding have an impeccable medical pedigree, he was also the Desi’s own teacher. In this passage, the Desi was actually in the course of discussing how Lhünding contributed two of the tangkas for the medical illustration set, and also how he taught the Desi human anatomy on the basis of Lhünding’s own father’s teachings.²³ The Desi later also asked him to teach the measurements of the thoracic cavity and the mnemonic diagrams to groups of local doctors.²⁴ And he clearly admired his work enough to be moved to respond to the set of questions that Lhünding had pasted to a pillar, which no one else was able to address. So this was a respected teacher whom the Desi trusted as an authority … at least on certain topics.

Lhünding’s problem, for the Desi, is more nuanced than the socially unacceptable conceit for which he skewered Zurkharwa. The Desi is very particular. He withholds praise and bestows it only on that which he actually respects, and he is willing to criticize the parts of the picture that he finds wanting. He speaks of how he interviewed Lhünding, along with another colleague, Namling Panchen Könchok Chödrak, regarding certain issues about the anatomy of the channels. The Desi shows himself as wavering, at first dismayed at the difficult style of Namling Panchen’s way of speaking, but later in agreement with his ideas and finding now Lhünding’s opinions unconvincing.25 Years later he would return to report on this interview again, adding that Lhünding was very proud and conceited and evinced little regard for others in the conversation. The Desi even says now that he had engaged Lhünding in questioning deliberately, in order to break his pride. And yet with regard to explaining the medical texts, recognizing medical plants, and the details of anatomy and the mnemonic diagrams, the Desi affirms that Lhünding was without peer during this period. So the Desi received many of his medical teachings in private instruction.²⁶

The Desi holds back and retains a superior vantage from which he feels entitled to judge everyone. As he declares a few pages down in the earlier passage,

Few of his would-be respected colleagues are spared the Desi’s ever-ready disparagement of their character and scholarly virtues. Even about Jango Nangso Dargyé—a highly respected physician of the Fifth Dalai Lama with whom the Desi worked closely and whom he praises as being stable even in old age in his knowledge of the Four Treatises—he adds wryly that otherwise this same venerable physician “either had not studied the commentaries very well or it was like the allegory of one’s father’s bowl.” The expression refers to a nonprobative attitude toward what has been passed down from one’s ancestors, and its critique of that approach is telling of the creeping modern sentiments of the time.28 And this is not to mention all the other doctors whom the Desi asked, say, about the channels of the body, and who, let alone about the growth and life channels (which are subject to considerable debate), had “short tongues” even about the connecting channels (the evident arteries, veins, and nerves that doctors regularly use for bleeding and moxa). This mumness renders their ignorance as easy to read, the Desi avers, as the Nepalese se’u (a fruit whose insides can be known by looking at the color on the outside).²⁹

Desi Sangyé Gyatso is intent on scrutiny. He is skeptical of those who are trying to protect their own reputation and look like they know something, and he is often not sure he believes what people say. About one of his local colleagues, Mengongpa, he quips

The Desi is tough, and he looks closely. He shows himself casting a critical eye even upon his closest friends, in his twenties when he lived with the renowned physicians Sumga Lhaksam and Darmo Menrampa.³¹ Speaking of a time when the three were residing together and “extremely familiar with each other,” he addresses his reader with remarkable intimacy, reporting how he could “occasionally [watch them] closely, and roughly see how well they could recognize medicine and were understanding the texts.”³² He reveals that Sumga had only roughly memorized three of the Four Treatises, and mostly based his practice on a few texts and oral tradition. Yet although his knowledge of medical science was as not vast as others’, he had much compassion and made exceptional effort on behalf of patients. The Desi notes jocularly that Sumga’s style matched his name, Lhaksam (lit., “Exceptional Considerateness”): he had virtuous thoughts for all. But even here he adds that his colleague also had some bits of anger in the heat of the moment.³³

Apparently the Desi used the occasion of collaborating with other physicians as a way to spy on them. He feels free in his writings to divulge how one doctor held “great memory of the Four Treatises in his mind, but paid little attention to the practical instructions and supplements, so I could see that he did not practice”; or how another colleague, with whom he was also familiar, fashioned himself as a tantric master, but otherwise had not seen much of medical science.34 As for the principal heir of Lhünding, a physician named Ganden Menla who would have had a prominent position and whom the Desi thanks elsewhere for helping him both to research his commentary to the Instructional Treatise, the most difficult part of the Four Treatises, and to write it down,³⁵ the Desi critiques him quite unabashedly. “He knew the Four Treatises well and could also recognize plants, but he was lazy and indolent and his effort was small.”³⁶ And on another doctor, well known, among other things, for his reply to Zurkharwa’s questions, the Desi is particularly harsh, if also jocular:

Again and again, the Desi scrutinizes and points out the weaknesses of the very colleagues who are his main teachers and collaborators. Given that his critical observations would have been there for all to see, right in his major, very well-known publications, we have to wonder. How was the Desi imagining his audience? Surely his primary readers included the very persons just named. Did he not care what they thought? Did he think that somehow his irreverence was acceptable, or even exemplary for a medical scholar? Or was he using these reflective passages as a kind of modernist autobiographical outlet, a chance to vent and to express himself as “who he truly is”?³⁸ If the latter, was the Desi even thinking about the message his attitude was sending? I am most interested in the possibility that although he may not necessarily have been conscious of it, his candidness and his criticalness were the products of—and models for—medical professional ethics.

Or maybe we should just conclude that the Desi was a very persnickety person, or perhaps better, chalk up his arrogant display to an exaggerated sense of entitlement, in light of his high government position and power. His arrogance likely helped, tragically, to get him executed in the end by the Lhazang Khan.39 Tucci dubs the Desi “crafty”;⁴⁰ there must be much in the foregoing that is a product of the Desi’s own idiosyncratic character. But we need to add in other considerations beyond this personal assessment. We must note at least the growing trend in Tibetan writing toward realistic depiction, which reached new heights during the reign of the Fifth Dalai Lama. In literature, one major site where individualistic and candid description is evident is in diaries and autobiographies.⁴¹ While the Desi himself had much to do with the growth of detailed record-keeping in the period, he left no substantial account of his own life save a few short passages—along with a series of small autobiographical murals of himself in the Potala.⁴² Perhaps the Desi sought other means of self-expression, as I speculated above regarding his handling of Zurkharwa’s life story. We also saw how his medical paintings, with their commitment to realistic anatomy and botanical depiction, participated in (or in fact served to foster) this same trend. There can be no question that the Desi was a major player in developing the very practices that made for more modern and candid kinds of depiction in his day.⁴³

I want to entertain the possibility that medical culture was one of the currents that fed these shifts toward realistic depiction. It is worth asking if the increased confidence in the independent witness of empirical evidence, and especially the idea that knowledge can be improved, made for a shift in attitudes toward tradition and authority that were felt in realms beyond academic medicine itself. In medicine such attitudes congealed as a stance or self-conception that might be characterized as a “mentality,” using this historiographical term in a different but related way to its famous Annales School sense. As Michel Vouvelle has described it, the notion of mentality is deliberately vague in order to contrast with the more intentional nature of ideology.44 Although the present study is based on analysis of elite texts rather than the nonsystematic sources and practices of the larger population to which the term has usually been applied, what Vouvelle dubs the “artistic” nature of the category helps capture for me the wide-reaching disposition, or epistemic orientation, that can be perceived in medical writing even though it was never formulated as such. This orientation would issue out of the demands of clinical practice and its attendant investment in empirically demonstrable fact. Concerns of this kind were not limited to medical circles and had been expressed by master Buddhist scholars like Sakya Paṇḍita (1182–1251) in entirely different contexts, but they seem to have come up remarkably readily in the orbit of discussions around medicine.⁴⁵ Actually some of the most radical expressions of skepticism regarding received traditions about the history of medicine, the articulation of the body’s functioning, and the pursuit of scientific knowledge were voiced by critics whose specialty was not medicine per se.⁴⁶ But no matter who voiced them, it seems the stakes in getting things right in medicine sometimes meant that the usual circumspect style was jettisoned. Such a disposition looked back to the robustly competitive and self-promoting ethos already in operation in Tibetan medicine by the twelfth century, to be studied in chapter 7. But it also continued to evolve down into the Desi’s day, part and parcel of a growing conviction about the rightness of the aims of medicine as it became an increasingly independent site of knowledge formation.

The Desi’s transgression of protocol in his discussion of Lhünding illustrates the impact of the medical mentality well. The meticulous assessment of personal qualities and even impertinence with respect to his teacher have everything to do with what the passage is actually about. It is part of the long concluding section of the Blue Beryl commentary. Significantly, the Desi begins this closing section with a review of the entire history of medicine, first in India and then in Tibet. He frames his efforts to complete his commentary and the painting set—as we saw in the last chapter, the two projects were of a piece—in rhetoric familiar from Buddhist writings about the “degenerate age.”⁴⁷ But both the commentarial and painting projects did not depend only, in standard scholastic fashion, on earlier commentaries and other written sources. The advice of contemporary colleagues and the direct observation of bodies and plant life were also critical to the entire endeavor. Again, fierce disputation was certainly rife across Tibetan Buddhist scholasticism, and self-assertion was also frequently to be found in autobiographical writing.⁴⁸ In addition, creative thought, sometimes based on an author’s personal experience, was not unknown as a claim to epistemic authority, especially in works on meditation.⁴⁹ But the Desi’s self-entitlement and adversarial excess in these medical passages are extreme. I am wondering if the particular challenges in the quest for knowledge of the physical world made a difference in the kinds of rigor and strict precision that were conceivable. Disputation was essential to the growth of science in Europe.⁵⁰ This also is true of ancient Indian medicine, and in fact the principles of logical debate and proof in India more generally seem to have emerged first in the classic Ayurvedic work Carakasaṃhitā.⁵¹ Perhaps it is the combination of the special demands of medical learning with the felt urgency in the Desi’s political sphere, if not the larger zeitgeist of the period, for medicine to improve that can best explain the Desi’s unrelenting drive toward accuracy above all else.

In the passage above, Lhünding, like his other colleagues, is being assessed because he was one of the major sources on which the Desi’s medical work depended. Lhünding’s failings, like those of pretty much everyone else, serve as a sign of the degenerate age, in which accurate medical knowledge is hard to come by. It is an essential feature of the times, in the Desi’s view, that the reign of the Fifth Dalai Lama was marked by obstacles and demons. Most doctors didn’t study hard, many could not even read, people died young, doctors’ reputations were thereby ruined, and new diseases caused by karma were rife.52 This dismal set of conditions also becomes an apology for the Desi’s own present commentary, both its achievements and its shortcomings. As we will see later in this chapter, the Desi was extremely anxious about the vulnerabilities of his own medical knowledge. But the current state of degeneration was equally the justification for his practice of quizzing everyone, to see who really knew what. The candid and discerning review of Lhünding’s merits and shortcomings displays how hard the Desi himself tried to get things right, and how critical he was with his sources. The same probative attitude can be observed in his attitude to written sources. Although he is sure to mention a few reliable works of old, he also shows himself to be furiously “throwing out previous detailed commentaries and summaries, be they printed or not, whose explanations consist in dead words, confusions, and distortions” in the course of his own medical education.⁵³

All this leads to a striking thought. Perhaps trying to get scientific matters right, trying to get the natural world right, made for a particular kind of license to transgress the traditional protocol of unquestioning deference to mentors. Perhaps what went along with this was a shift in attitudes to time and change. In fact, as will emerge in the following chapters, the projects to expand the scope of medical knowledge in which the Desi and other outstanding members of the Dalai Lama’s court engaged had already been anticipated in a previous generation of medical scholarship, and its growing sense that knowledge from the past, generically, could be improved.

Even though he complains that “I passed the time working on politics and other traditions of knowledge, but did not have time to help sentient beings” (i.e., to work on medicine),⁵⁵ the Desi later avers that during this period

Early on in his career the Desi had already produced the definitive work on Tibetan astronomical tradition and astrological calculation, White Beryl.⁵⁷ He also managed to complete his monumental Blue Beryl medical commentary in 1688, nine years after he took power as chief minister of Tibet in 1679.⁵⁸ This was a period taken up with the aftermath of the Fifth Dalai Lama’s death, looking for the new incarnation, completing the Potala Red Palace construction, and many other duties.⁵⁹ He directed the medical paintings at the same time. He wrote several other voluminous works thereafter, concerning largely issues of governance and life in the Tibetan capital, but medicine was also the topic of his last major composition before his death. His influential history of Tibetan medicine, completed in 1703, when he was fifty-two, appears to be the only work he published after he had retired from his government post.⁶⁰

In telling his own story again in the history, the Desi mentions his early interest in medicine, prior to the development of any propensities toward Buddhist realization. As a child he “would collect all kinds of plants and pretend they were medicine.”⁶¹ He grants that he did receive some education in medical theory and practice from Lhünding Namgyel Dorjé, but only regarding the mnemonic diagrams and the anatomical measurements. In a recurring refrain, the Desi complains that expert training in medicine was hard to get, and that he had to fill out what his teacher could not provide by studying texts on his own, especially the problematic Instructional Treatise containing the all-important specifics on therapeutics and remedies.⁶² He emphasizes how he resorted to his own research to teach himself.

The Desi understands the value of medicine in ethical terms. Medicine helps beings. As he says, “This science can pacify all the illnesses of this body of six elements, which is so hard to get a chance to have, and it gives the essence of happiness for body, speech and mind, all three. It is an unsurpassed gem for the general [populace].”⁶⁴

He repeatedly invokes the “benefit of sentient beings” as the bottom-line motivation for studying and protecting medicine.⁶⁵ There can be no mistaking that this motivation echoes Mahāyāna Buddhist ethical discourse. Given the benefits of “the science that takes care of” people, the Desi can be selfless in his desire to protect it.⁶⁶ He does so “out of hopes to be able to benefit beings, and being unable to tolerate it if medicine were to decline. Other than that I have no need for this to be a route to further my own reputation, much less a desire to be known as masterful or knowledgeable.”⁶⁷ That explains his frustration at finding so few trustworthy doctors and medical scholars. Sentient beings need to be helped by medicine; therefore he must be untiring in finding good doctors and creating ways to train new ones. It has nothing to do with his own reputation or esteem.

Although the Desi’s characterization of his impulse to foster medicine was couched in classic Buddhist terms for selflessness, on a more personal—but also political—level, his drive to raise up medicine had much to do with his relationship with his master and mentor, the “Great Fifth” Dalai Lama, Ngawang Lozang Gyatso (1617–82), head of the Tibetan state since 1642. Indeed, the Desi and the Fifth Dalai Lama cannot be thought of separately on many grounds, and their collusion on behalf of medicine in the capital is surely one of them. On the Desi’s own account, the Dalai Lama worked ceaselessly to cultivate good doctors and to acquire badly needed but rare and hard-to-get medicines for the benefit of Tibetans.⁶⁸ His keen interest in supporting and renewing medicine in Tibet was already in full swing before the Desi was born. He explicitly commissioned the Desi to spur the rejuvenation further, an order that the Desi conscientiously endeavors to fulfill.⁶⁹

The Desi was the Dalai Lama’s trusted administrative aide for years before his appointment as chief minister in the last years of the Great Fifth’s reign.70 His statements about his own life emphasize how far their relationship went back. As early as when the Desi was eight years old, he entered service at the Potala and then worked as a servant while the Dalai Lama trained him, “in an easy manner,” in the “two ways” of politics and religion, “however much could fit into my mind at that age.”⁷¹ There was even an earlier moment—the Desi alludes to it more than once—when the Dalai Lama protected him and performed the traditional rite to guard a newborn from demons. In one passage the Desi reports that this occurred right after he was born, when the Dalai Lama had returned from his trip to China.⁷² One wonders why the Dalai Lama was present at his birth. This question is behind the oral tradition, still circulating today, that the Desi was actually the Dalai Lama’s biological son, despite the fact that at least one of the Desi’s writings names his father and refers directly to his passing when he was four.⁷³ In any event, he also calls the Dalai Lama his father, or calls himself the Dalai Lama’s eldest son, in the course of exulting their close relationship, but such terms are easily read as common euphemisms for teacher and close disciple.⁷⁴ If nothing else, the Fifth Dalai Lama and the Desi were certainly that.

The key moment to which the Desi ascribes his commitment to medicine was the Dalai Lama’s ritual transmission of the Heart Sphere of Yutok, a set of teachings in Treasure format that had been associated with the author of the Four Treatises, Yutok Yönten Gönpo.⁷⁵ At one juncture in the rite, the Dalai Lama put the Four Treatises and a set of auxiliary medical writings from the same period, Eighteen Pieces from Yutok, into the Desi’s hand. As the Dalai Lama played a special drum and recited a spell for a long time, the Desi reports that he had sudden clarity about all the medical teachings he had long labored to memorize. When the Dalai Lama then exhorted the Desi to protect and keep the medical teachings, he felt a spontaneous and strong impulse to carry out the order at once. He also realized that everything he had already done for medicine was a matter of his participation in the Dalai Lama’s own body, speech, and mind of blessing and compassion.⁷⁶

If it is hard to disentangle the Desi’s personal bonds with the Dalai Lama from his commitment to fostering medicine, that is because both had everything to do with the new Tibetan Buddhist state. For both men there was a large overlap among medicine, rulership, and their conception of central Buddhist ethical principles. There can be no gainsaying the many ways medicine, more perhaps than any other inroad into new forms of knowledge and governance in the same period, could be said to stand for the aims of the Ganden Podrang government.77 This has as much to do with medicine’s responsibility for the welfare of the people as with its power to protect the well-being of the Dalai Lama himself. The previous chapter considered the Desi’s characterization of his production of medical paintings as causing the Dalai Lama to have a long life and the government to survive for a long time.⁷⁸ This led us to discern not only the paintings didactic value but also their higher order of significance. To have medical learning in place signifies stability and the health of the state and its ruler. We should understand the Desi’s report on his star pupil, Chakpa Chömpel, in the same way, when he recited the entire Four Treatises in one session in front of the Fifth Dalai Lama, as an offering.⁷⁹ Much like the offering of paintings to the Sixth, significance exceeds overt content. The pupil is certainly not reciting the work to give the lama an empowerment, as Tibetan teachers often do, or to convey its information, or even to prove that he has it memorized. More fundamentally, such a performance of mnemic virtuosity in a work of great value would have simply been music to the ruler’s ears.

The semiotics of these episodes’ message is complex, overdetermined by at least two major genealogies that fed the confluence of medicine and the Dalai Lama’s Buddhist state. One has to do with the long association between Buddhism and medicine in India. The other issues out of the close connection between the patronage of Buddhism and medicine in the story of the early Tibetan kings. The upshot, in the particular circumstances of Tibetan history, is that Buddhist symbols, discourse, and institutions directly facilitated the state’s patronage of medicine.

Certainly the traditional overlap of Buddhist soteriology with care for the well-being of people eased the way for the Desi and the Dalai Lama to position themselves as simultaneously taking care of their subjects’ material welfare and their ultimate enlightenment. The Buddha Śākyamuni’s enlightenment had long been associated with his capacities as a healer, “the king of physicians,” and his teachings were frequently characterized as a remedy for both the physical and spiritual ailments of sentient beings. Such an assumption is widely in evidence in the sūtras, both in the Pāli canon and in Mahāyāna works. It has everything to do with the fundamental problematic of suffering in the Four Noble Truths, which is very much about illness, death, and the painful cycle of human life. By the early Mahāyāna there was an entire sūtra devoted to the worship of the Buddha and his ritual healing powers in his specific form as “the Medicine Buddha,” Bhaiṣajyaguru.⁸⁰

The complex relationship between Indian medicine and Buddhism received careful attention in a classic study by Paul Demieveille.81 While most canonical Buddhist writings on healing trade largely in the powers of meditation, ritual, and faith, a few scriptures display some interest in physical medicine, largely drawing on Ayurvedic knowledge. Most of these were well known to Tibetan scholars.⁸² The Suvarṇaprabhāsottamasūtra provides a brief chapter on the physician Jaṭiṃdhara’s teachings on the role of the humors, seasons, elements, and kinds of food.⁸³ The Nandagarbhāvakrāntisūtra contains some information on human embryology.⁸⁴ There are also signs of Ayurvedic knowledge in Vinaya texts in both Pāli and Sanskrit, and in the mention of medical theories, procedures, and diagnostics in the Milindapañha.⁸⁵ Kenneth Zysk has argued that Indian Ayurveda was in large part developed in the first place by the heterodox śramaṇas—rather than in brahmanical circles—since the śramaṇas’ relative lack of taboos regarding purity and pollution allowed individuals to touch and examine bodies freely. Early Buddhist monks took part in this movement. They ran clinics for the monastic community, and some monastic codes required them to serve in caretaking and healing roles (Skt. glānopasthāna, lit., “standing before a patient”) for fellow monks who were ill.⁸⁶ Serious meditators were also exposed to anatomical information in the course of the widespread Buddhist practice of observing decomposing corpses in charnel grounds, as a way to contemplate impermanence. The detailed knowledge of the body so engendered can be seen in the list of body parts in the mindfulness exercises described in Satipaṭṭhānasutta, for example, or in the Visuddhimagga of Buddhaghosa.⁸⁷ The interaction between conceptions of the body for the purposes of Buddhist meditation and those developed in Ayurveda continued into the tantric period, and some traces of the channel systems from late Indian Buddhist tantra even emerge in the Tibetan Four Treatises.⁸⁸

By at least the beginning of the Common Era, Buddhist monastic establishments seem to have had hospitals on their grounds, such as at Nāgārjunakoṇḍa.⁸⁹ The place of medicine and the other “sciences” among Indian Buddhists and even at the major Buddhist monastic college of Nālandā gets outside confirmation in the seventh-century observations of the Chinese pilgrim Xuanzang.⁹⁰ There has even been speculation that some of the great minds of classical Ayurveda in India had Buddhist affiliations. A Chinese version of the Sūtrālaṅkāra suggests that Caraka was doctor to the famous Central Asian Buddhist king Kaniṣka, although the evidence is far from convincing.⁹¹ Some have also wondered if Vāgbhaṭa had Buddhist training, since he had a master with the seemingly Buddhist name Avalokita, but that too is inconclusive. It seems rather that such Ayurvedic writers had fluid and pluralistic religious affiliations.⁹²

In any event, there seems to have been no necessary dissonance between the practice of Ayurvedic medicine and the deployment of Buddhist healing rituals in India, as evidenced for example by the Bower manuscript, found in a stūpa that contained a Buddhist charm against snake bites together with several medical tracts.93 This dual approach to healing continued as Buddhism traveled into East and Central Asia.⁹⁴ Buddhist Tibet, which certainly maintained its own battery of ritual healing traditions, is but one example of this pattern. Even the Four Treatises briefly mentions ritual and magical healing devices on occasion, despite its primary concern with physical medicine; a few of these employ Buddhist deities and basic visualization techniques, while others represent local exorcistic tradition, along with a few cases of ritual lore from Ayurveda.⁹⁵

In this book I am nonetheless pointing to key moments in the case of Sowa Rikpa where distinctive emphases and orientations came into view, suggesting ways that medicine still constituted a separable knowledge system not reducible to formations of Buddhism. And at least in Tibet, despite a plethora of mixed signals, medicine sometimes even characterized itself that way. The entire question of how human malady is conceived is a prime case in point. Ayurveda and the Four Treatises primarily see it as a result of imbalances in the three humors (doṣa, i.e., wind, bile, and phlegm). Buddhist scriptures, on the other hand, pervasively understand the primary source of human pain to be the three passions (kleśa, i.e., ignorance, hatred, and greed), the occasional appearance of Ayurvedic conceptions of illness notwithstanding.96 That is not to say that these two paradigms, one physical and one moral and mental, could not be bridged, as indeed we might expect, given the long interaction between Ayurveda and Buddhism in India. As one example, the important Buddhist scripture Mahāparinirvāṇasūtra argues for a close interdependence between the passions and the humors, although it still distinguishes between physical and spiritual malady.⁹⁷ The Ayurvedic treatises, for their part, do not fail to consider spiritual grounds for illness. From Caraka onward, Ayurveda notes continuities between psychic states and the physical experience of the body. Ayurvedic sources are also quite ambivalent about the status of karma in the etiology of physical states and disease,⁹⁸ while classic Buddhist Abhidharma doctrine acknowledges the role of the material elements in the moral ripening of karmic effects, and passages can even be found that countenance causes of human experience entirely independent of the working of karma.⁹⁹ As Wilhelm Halbfass has demonstrated, natural processes were not always considered to be entirely governed by retributive causality in Indian religious thought.¹⁰⁰ In short, the fact that the question remained open and was at times controversial does suggest that there is no iron-clad boundary between science and religion in India. It says something as well about the Four Treatises’ own ambivalence that it alternates between attributing the condition of an embryo to the condition of the parents’ semen and blood, to the karma of the reincarnating being, and even to the “low merit” of the mother; or again, that it too mentions a relationship between the three humors and the three passions.¹⁰¹ The Four Treatises also on occasion makes general recommendations about religious practice and merit-making, assuming that these are good for the health, or create auspicious conditions, or counteract the noxious influence of local spirits. Recall the medical paintings’ illustration of a man doing a generic meditation or a monk reading a nonspecific Dharma book.¹⁰² In such moments Tibetan Sowa Rikpa is of a piece with religious healing in Buddhist and related contexts across Asia.

Yet overlap and fuzzy borders do not mean that systems cannot be distinguished, especially in terms of primary concerns and conceptual centers of gravity. As Halbfass rightly notes for Buddhism, orthodox doctrine continued to reject or discount materialist accounts of causality and was uneasy with postulating a buddha vulnerable to ordinary conditions outside of his moral control.¹⁰³ And as for medicine, it remains the case that both the Ayurvedic masterworks and the Four Treatises focus first and foremost on material, bodily conditions and material, bodily treatments—even in the case of illnesses caused by demons—and with but few exceptions, their therapies consist in a kind of care that is quite distinct from the ritual approaches to healing emphasized in Buddhist sources.¹⁰⁴

As a sign of how fraught in Tibet was any such suggestion that the epistemic universe of medicine might indeed be separable from that of Buddhism, the Four Treatises took the extraordinary step, as we will study in the following chapter, of presenting itself as the “Word of the Buddha.” In this it far outstrips in scope and comprehensiveness the brief medical passages ascribed to the Buddha to be found in a few canonical scriptures. The Four Treatises makes this move against all historical evidence to the contrary—evidence that members of the Tibetan intelligentsia later cited in protest. It is hard to understand this attribution of a full-service medical textbook to the Buddha without seeing an evident desire to make physical medicine part of the Buddhist dispensation, precisely out of a concern that it might be perceived otherwise.

There were already signs in South Asian Buddhist contexts that the place of medicine was not entirely unequivocal. Important works like Brahmajālasutta and Theragāthā include proscriptions against monks practicing medicine, listing a variety of medical procedures and functions that are prohibited and reflecting concerns about monks being distracted by business and profit.105 Similar concerns are evident in the Chinese version of the Smṛtyupasthāna, which counts medicine as one of thirteen kinds of activity that are harmful for monks since it is a source of greed and envy. The latter even suggests that physicians often wish that there may be many sick people; in short, śramaṇas should heal sentient beings of the three passions rather than the three humors.¹⁰⁶ So when Buddhist scholastic treatises in the early centuries C.E. began to claim that a broad education was essential to the omniscience of the enlightened master, it may have been to counter these long-standing concerns. In the list of the five “sciences” (vidyāsthānas), codified in the Mahāyānasūtrālaṅkāra and other works, medicine (cikitsāvidyā) is positioned along with linguistics (śabdavidyā), logic (hetuvidyā), arts and crafts (śilpakarmasthānavidyā), and “that which is most one’s own” (adhyātmavidyā), i.e., soteriology. These were said to constitute the five areas of expertise needed in order to achieve omniscience.¹⁰⁷ In this curious list in which transcendence, or ultimate truth, is placed alongside topics that can well be conceived apart from the religious, we can see two impulses at once. On the one hand, things like medicine and the plastic arts are listed as separate items, along with—but different from—the summum bonum. That would seem to indicate a certain distinction between what modern scholars have read as what is most “Buddhist” and the other four disciplines, which were explicitly defined as “outer” and “worldly” (laukika).¹⁰⁸ And yet by virtue of this same act of listing, in terms of both academic curriculum and the larger argument that such knowledge is necessary for the enlightened sage, a critical merger has been achieved. Although a major Tibetan scholar like Sakya Paṇḍita still had to argue strenuously for it (his own interest was largely in poetics and grammar),¹⁰⁹ by the time of the Fifth Dalai Lama the prestigious institutions of academic Buddhist learning in Tibet had long been convinced that medicine fell within the purview of a proper education.¹¹⁰

Of course, just because medicine is included in an educational curriculum trained ultimately on Buddhist enlightenment does not necessarily establish that medical theory and its means of implementation are of a piece with the rest of that education in substantive, epistemic terms. In both India and Tibet there were voices that queried that compatibility, and we will study several of these in the following chapters. Thus the larger issues at stake remained open questions into the Fifth Dalai Lama’s day. But for his part, the Dalai Lama, and in important respects the Desi too, was deeply invested in the side fostering close identity between medicine and the teachings of the Buddha, an identity well suited to the religious and political aspirations of each.

Some of the imperial ambition in this equation comes through in the Desi’s invocation of duty cited above. The suggestion that medicine is as much the victim of the degenerate times, demons, and black magic as is Buddhism takes on particular significance from the perspective of the ascendancy of the Tibetan state. Just as the Buddha’s dispensation is subject to successively worsening conditions, so is medicine, and both, therefore, require special measures and support from the ruler. Likewise, medicine (again mirroring Buddhism) is well suited to help protect people from the various sufferings that those degenerate times will bring on, and thus an appropriate avenue for the state to carry out its responsibilities.¹¹²

Most significant of all in the homology between the welfare of the Buddha’s teachings, medicine, and the state may be the Desi’s quotation of prophecies from the Tibetan Treasure literature. Those apocryphal but highly valued narratives of Tibetan history purport to represent the voices and intentions of the glory days of the early empire.¹¹³ Treasure prophecies are usually invoked to account for the subsequent decline in religious morals, discipline, and learning in Tibet. But the Desi uses them to describe the state of medical learning during his lifetime as well. When he goes through pronouncements from the ancient ordinances of the kings or the visions of the Northern Treasures about the noxious demons who will plague Tibet, he adduces the result, rather than the usual point about the decline of the Dharma, that “other than having general knowledge, people’s minds won’t get into Ayurveda.”¹¹⁴ Characterizing both his own and the state’s connection to medicine in such terms powerfully brings medicine into the heart of the new Buddhist nationalism.

The Treasure prophecies do more than just align medicine with the Buddha Dharma as something precious to be renewed and cultivated. They also tie medicine to the halcyon days of the specifically Tibetan past: the era of the great emperors of the Yarlung dynasty of the seventh to ninth centuries. The invocation of ancient royal glory had already enhanced the legitimation of the government of the Dalai Lama’s own nemesis, King Tseten Dorjé of Tsang, as well as the previous reign of Pakmodrupa.115 The Treasure medium bolstered that constructed past, and had long served as a means to affirm sociopolitical needs in the present.¹¹⁶ Treasure prophecies could confirm that a ruler had been predicted and even commissioned by the heroes of the past to do whatever he was doing in the present to advance the welfare of the Tibetan people. They also could provide a literary space to voice dissent. But most of all, the Treasure narratives and prophecies were key tools in the thematization of Tibet’s exceptional destiny as a Buddhist land. They pointed repeatedly to Tibet’s enemies, featuring warnings about invading hordes and rallying calls to fend them off. Their legitimating power helps explain why the Fifth Dalai Lama—and the Desi—took so much interest in Old School teachers like Terdak Lingpa who preserved Treasure lore and ritual.¹¹⁷ Since medicine was also featured in the stories of the early kings’ beneficent activities, the Desi’s invocation of such scenes now ineluctably tied the Dalai Lama’s and his own efforts to foster medicine to the dawn of Tibetan Buddhist civilization and its exalted destiny.

When reading the Treasure narratives, it is not easy to separate exuberant imagination and rhetorical flourish from what actually happened. Instances of the “invention of tradition” to be sure, the Treasure works nonetheless serve as veritable treasure troves of historical references and nuggets, even as they color their stories with the agendas of the time of their own composition. But the same can often be said of other Tibetan historiographical genres, such as the accounts of the coming of Buddhism to Tibet (chos ’byung), whose vision of the imperial period is often influenced by the Treasure imaginaire in any case. This is true of the specialized histories of medicine in Tibet as well, about which I will say more below. For now the pertinent point is that both the historical fact of the matter and rhetoric were at play throughout the historiography of medicine in Tibet, and especially for the Desi and the Dalai Lama in the seventeenth century. In short, medicine did indeed figure in the events of the Yarlung court. And then on top of that, the second-order fact that Tibetan medicine had its inception in the glory days of the empire conferred prestige on medicine later. This occurred in a manner quite akin to the way that certain strands of Tibetan Buddhism constructed a glorious past for themselves in Treasure texts.

One obvious place to see both the actual presence of medicine in the imperial past and its symbolic capital in the postdynastic period is the high status accorded to certain medical families. The class of doctors whose position was said to have been bestowed by the Yarlung rulers (gnang rigs) was distinguished from newly established and less honored medical lineages.118 There are also reports of a title of “superior physician” (bla sman) conferred upon court physicians by the time of Tri Desongtsen (late eighth century); it remained in use through the twentieth century. The same stories also tell of the granting of land and inherited rights to medical clans, including release from military duty.¹¹⁹ The medical titles of “high learning in medicine” (sman rams pa)¹²⁰ and “divine lord” (lha rje) are also said to have been granted by the early kings.¹²¹ We have seen one indication of the lasting status of such titles in the Desi’s evaluation of Lhünding Namgyel Dorjé.

The centrality of medicine in the projects of the Tibetan emperors—at the same moment that these rulers were courting Buddhist teachers and also mounting what, at least in retrospect, counted as the first iteration of a centralized Tibetan Buddhist government—is portrayed in most detail in the medical histories.¹²² The story of medicine in the imperial period is recounted repeatedly in an old set of narratives that the Desi copied from previous sources, although the story varies and we are only beginning to sort out what was added by whom.¹²³ But across the board, these narratives present a surprising amount of detail on the initiative and vision of the Yarlung emperors to improve local folk knowledge of medicine, characterized as oral tradition, regarding diet, exercise, and physical therapy.¹²⁴ The means of improvement was to introduce superior foreign learning and expertise. Again, this is part and parcel of the larger story of the kings’ effort to “tame” and benefit the Tibetans, in which both foreign Buddhism and foreign medicine served well. The emperors’ interest in medicine is also tied in these stories to concerns about their own health and attempts to save a ruler’s life when he is ill.¹²⁵

The move to invite physicians from abroad to teach medicine is extended back to the descendants of the semimythical king Lha Totori Nyentsen, who are said to have invited physicians from the Central Asian land of Azha and from China. But it started in earnest with Songtsen Gampo, the warrior king who conquered significant portions of the Tibetan plateau and founded a centralized state in the seventh century A.D.126 This ruler’s Chinese consort is credited with bringing Chinese medical works, which were then translated into Tibetan. The same king is said to have convened an international council made up of an Indian doctor, a Chinese doctor, and one from Takzik, an Arabic or Persian land to the west.¹²⁷ Their names are transliterated into Tibetan script to correspond to Bharadhvāja, the mythical founder of Indic medicine; Huangdi, or the “Yellow Emperor,” the mythical founder of Chinese medicine; and Galenos, the famous Greek physician. Clearly these three luminaries did not manage to visit the seventh- or eighth-century Tibetan kingdom, but there is reason to believe that physicians representing the three major medical traditions of the ancient world did teach and translate in the Yarlung court.¹²⁸ Several old medical writings in Tibetan that were preserved at Dunhuang speak of regional differences in medical traditions and even distinguish physical medicine from religious healing.¹²⁹ We also have the Tibetan translation of the Indian Siddhasāra of Ravigupta, which seems to date from around the end of the imperial period.¹³⁰ But the Tibetan medical histories list, page after page, the titles of scores of works on Greco-Arabic, Indian, and Chinese medicine that were brought to Tibet at this time, although there is little evidence of their existence today. These histories also list titles of works that were newly composed in Tibetan that synthesized or gathered together the various medical traditions circulating in this scene, some of which are familiar, such as the tradition of Caraka. The succeeding Tibetan kings, especially Mé Aktsom, also invited other physicans from Trom (Tib. Khrom, possibly the Greek “Eastern Roman” or Byzantine empire), whom some sources identify as the originators of the important Biji and ensuing Drangti lineages of doctors in Tibet.¹³¹ There were also physicians from Himalayan regions such as the Kathmandu valley, Drugu, Dölpo, and the Kashmir area (Tib. Kha che), as well as parts of Central Asia.¹³² The other great figure of the dynasty, Tri Songdetsen, expanded the project in the eighth century, when a medical college is already supposed to have been in existence. The important physician of the Biji line called Tsenpashilaha also flourished during his reign.¹³³

The capacity to bring a wide-ranging array of medical experts to the court itself connotes the power of the imperium. The kings were not just patrons but also impresarios. They are shown cajoling their guests to stay longer, plying them with gifts. The Fifth Dalai Lama would repeat this gesture. The kings are also shown testing the skill of the physicians, and this reminds us a bit of the Desi. In one story the ailing king lies in another room, assessing his physicians’ pulse-reading abilities by means of a rope tied in turn to a chicken, a cat, a millstone, and finally the king himself.¹³⁴ The sources recount the translation of a host of works by several Chinese teachers, often titled “Hwashang,” and sometimes involving the well-known Tibetan translator Vairocana. An important work called Somarāja, said to combine many medical traditions, appears in this period.¹³⁵ Some medical historiography also locates the appearance of the main root text of Tibetan medicine, the Four Treatises, in this period, although that is disputed.

After the fall of the dynasty, patronage for medical learning was taken up by the emerging Buddhist monastic centers and scholars in central and western Tibet. Rinchen Zangpo (958–1055) translated the last great Indic medical work, Vāgbhaṭa’s Aṣṭāṅgahṛdayasaṃhitā, along with the commentary by Candranandana known in Tibet as Moon Ray.¹³⁶ The Aṣṭāṅga’s presentation of Ayurvedic medicine was influential in Tibet and was reworked into portions of the Four Treatises. The seeds of the main Tibetan medical lineages are in evidence by the following century. One luminary was the famous Buddhist scholar/systematizer Gampopa (1079–1153). Another was Jetsün Drakpa Gyeltsen (1147–1216), who was connected with the establishment of a medical college at Sakya Mendrong during the twelfth century, a school that preserved some of the important Biji medical streams coming from the west of Tibet.¹³⁷ Part of that same generation would have been the twelfth-century medical master Yutok Yönten Gönpo, also from southwestern Tibet, to whom, along with his disciple Sumtön Yeshé Zung, should actually be attributed the composition of the Four Treatises.¹³⁸

Yutok and his disciple also authored other summaries of medical theory and practice.139 As testimony to the symbolic capital of having origins in Indian Buddhism, Yutok or his followers cast his main masterwork as a scripture originally preached by the Buddha. A related story started to be told that the Four Treatises had been translated from Sanskrit into Tibetan by Vairocana during the reign of Tri Songdetsen, then hidden as Treasure, to be rediscovered by Drapa Ngönshé in the eleventh century and then eventually passed to Yutok. This invocation of Treasure transmission is one of several signs of the Old School affiliations of many of the early medical writers. So is the creation of an entire Treasure cycle of Buddhist practices associated with Yutok Yönten Gönpo, the Heart Sphere of Yutok, closely connected to other works on ritual medicine propagated in the Old School lineages.¹⁴⁰ Most of all, the Treasure myth facilitates the claim of the Buddha’s authorship of the Four Treatises, and was therefore enthusiastically taken up and elaborated by the Desi in his own time.¹⁴¹ Treasure lore also served the burgeoning medical tradition by providing a storyline that could enhance the status of a medical work through association—again, with both the Tibetan dynasty and ultimately the Indian Buddha.

The story of the patronage of medicine by the early kings served the program of the Dalai Lama and his minister well. The royal agency in inviting medical scholars from numerous Asian countries to the Tibetan court and commissioning the translation of medical treatises would be commemorated and renewed in the acts of the Fifth Dalai Lama. Medicine is cast as one of the great gifts of the Tibetan kings to their subjects. It would be a great gift of their seventeenth-century descendant too.

Although he did not initiate the momentous upheaval in central Tibet in the middle of the seventeenth century, there can be no question that Lozang Gyatso, the Fifth Dalai Lama, capitalized on the opportunity it offered. In the wake of the bloody battles when the powerful Zhelngo Sönam Chömpel (1595–1657) in the Dalai Lama’s administrative retinue induced the Khosot leader Gushri Khan to defeat the King of Tsang, central Tibet was unified for the first time since the fourteenth century. The “Great Fifth” was anointed king of Tibet in 1642.142 He proceeded to move his Ganden Podrang government (the “Tuṣita Palace”) to the White Palace of the Potala, built to house the new Tibetan state government, in 1649. After a symbolic journey to meet the Manchu emperor Shunzhi in Beijing in 1652–53, he returned to rule until handing over power to the Desi in 1679, and died in 1682.

The period is documented in detail in the Dalai Lama’s own diaries and then continued in the three-volume journalistic biography authored by the Desi. It marks a watershed in the establishment of bureaucratic structures that would remain in place until the middle of the twentieth century. We are only beginning to think about the relationship between the changes in the organization of political power under the Ganden Podrang and corresponding shifts in the intellectual and religious climate of the Tibetan cultural sphere.143 The government oversaw in a newly systematic way the levying of taxes, estate governance and finances, the granting of serf households and land to worthy individuals both secular and religious, distribution of grain and other provisions in times of need, repair of bridges and ferries, construction of canals, setting of workers’ wages, standardization of systems of corvée services, censuses, supervision of the judiciary networks and the penal system (on which the Desi wrote at length¹⁴⁴), codification of calendrical calculation (on which again the Desi’s writings were key), establishment of hunting-free zones, building of Buddhist images and installing of portraits, and the supervision and conscription of various monasteries and other religious groups to do particular rituals at particular intervals on behalf of the long life of the Dalai Lama and the welfare of the Ganden Podrang government (yet again, laid out in detail in the Desi’s writings).¹⁴⁵ Another important part of the new state structure included the oversight and control of monastic property and authority. In the Desi’s record of his administrative work after the death of the Dalai Lama there are detailed accounts of monasteries in central, eastern, and western Tibet, their assets, what rituals they were conscripted to do for the state, what offerings they were obliged to give to the government, and the appropriate conduct of monks in various categories.¹⁴⁶

A major part of what was new and had significant cultural implications were the very practices of record keeping. A prime example is the assiduousness and comprehensiveness in the diaries of the Dalai Lama, with reams of details on the cost of all these governmental activities, the kind and amounts of offerings received, grants given back, prayers done, rites performed.¹⁴⁷ The contemporary scholarly community does not yet have free access to the archives of the Potala and the various monastic administrative units in central Tibet, but such documents do survive in massive numbers, and some in scattered smaller collections and archives have begun to be studied, especially by Dieter Schuh and his students.¹⁴⁸ We can expect that one product of the new documentary habits, beyond their pragmatic value, was a certain reflexive pride, a self-consciousness and an accompanying sense of control, accomplishment, completeness. I argued in chapter 1 that this sense is visually represented—and celebrated—in the beautiful systematicity of the medical paintings. It was celebrated and reiterated in state rituals and other cultural domains as well.

The expanded sense of the ability to rule and control was coupled with the glory of the past at the foundation of the new state. All converged in the Dalai Lama’s person and how he was portrayed.149 Not only was he the emanation of the bodhisattva Avalokiteśvara, he was also an incarnation of Songtsen Gampo, the first of the conquering emperors from the Yarlung period.¹⁵⁰ This once again ties him to the imaginaire of the Treasure literature. The Desi also had his own identity tied to the royal period when the Dalai Lama recognized him as the incarnation of Muné Tsenpo, or sometimes Mutik Tsenpo, both sons of Tri Songdetsen.¹⁵¹ Military power, administrative reach, exalted Buddhist attainment, recuperation of early royal charisma: it was a potent mix. That the Dalai Lama inhabited these virtues well and channeled the mythical early kings’ penchant for culture-building magnanimous acts is why he is known as the Great Fifth.

Although famously hegemonic in dealing with sectarian rivals such as the Jonangpas and the Karmapas, converting monasteries into Gelukpa establishments, and attempting to expand Tibetan control into Bhutan and Ladakh, the Dalai Lama’s government also pursued a diplomatic course to strengthen his circle of allies. He negotiated with Mongol tribes and the new Qing court, and in South Asian arenas as well.¹⁵² His government even allowed European missionaries at court.¹⁵³ The eclectic atmosphere in the capital served not only instrumental and political ends but also cultural advances such as were fostered by his patronage of medical science. This was well under way before the Desi came into office.

According to the Desi, the Great Fifth did not have much education in medicine himself, although we have to remember the Desi’s own rhetoric regarding the scarce availability of medical education and the virtues of learning on one’s own.¹⁵⁴ The Dalai Lama seems to have studied parts of the Four Treatises and various medical traditions current in central Tibet by the time he was twenty-three. Several of the early Tibetan medical lineages had by his day been established for centuries, even if some were in decline or had diminishing institutional bases.¹⁵⁵ There had been flourishing medical academies, at least through the fourteenth century, not only at the Buddhist monastic center at Sakya but also at Zhalu, which specialized in the Aṣṭāṅgahṛdaya system, and at Tsurpu, which fostered eclectic medical scholarship. The same was true for É Chödra at Bodong in the early fifteenth century. By the time the Jang line of physicians was consolidating at Ngamring, the capital of the Jang myriarchy, in the fifteenth century, there were oral medical examinations and regimes of memorization. There was also much medical learning at Latok Zurkhar, which became the home of the other major line of Tibetan medicine, the Zur. The Drigung Kagyü developed a further medical lineage, branching off from the Zur. The Dalai Lama’s mentors were products of these major lines, including the eminent aristocratic physicians Jango Nangso Dargyé and Darmo Menrampa, as well as many other doctors and teachers at the court.¹⁵⁶

Despite the Dalai Lama’s education at the hands of these teachers, the Desi attributes his commitment to medicine to his assumption of the identity of the Medicine Buddha, particularly in the ritual context of conveying initiations.157 There might be truth in that, for it seems that while the Dalai Lama entertained a growing conviction about the importance of the academic traditions stemming from Four Treatises study, he was also deeply invested in tantric healing traditions, several major transmissions for which he had conveyed by 1672.¹⁵⁸ It may well be that his confidence in conceiving his role in the preservation of Sowa Rikpa was buttressed through his ritual offices.

As early as 1645, even before his move to the Potala, the Dalai Lama had already undertaken major initiatives to build academic medical institutions. He established a medical school, Sorik Dropen Ling, first in the western wing of his own Ganden Podrang at Drepung and appointed Nyitang Drungchen Lozang Gyatso as the main instructor. The Dalai Lama also granted the school the right to “wage teas” and other provisions. Grants to support the students’ living would be a recurring component of his patronage. At one point the Desi makes a key point explicit: under the Dalai Lama’s instructions, he arranged for a grant of grain to Lhünding Namgyel Dorjé at his medical institution Tsoché Lhünding, in order to create an exemplary situation for the teaching of medicine and to support the students.¹⁵⁹

The emphasis upon institution building continued throughout the period. Soon after starting the school at Drepung, the Dalai Lama established another medical college called Drangsong Düpé Ling at Samdruptsé, the fortress at Zhikatsé that became a prototype for the Potala architecture, and appointed Pöntsang Tsarongpa Tsewang Namgyel as its main teacher. There too he supplied the requisite provisions.¹⁶⁰ The Desi remarks that the number of scholars at these schools who had memorized and could recite the entire Four Treatises was more than in the past.¹⁶¹

After the Dalai Lama moved to the Potala, he established yet another new medical school, called Lhawang Chok or Sharchen Chok, which was put under the direction first of Jangopa and later of Darmo Menrampa. Again he gave supplies and scholarships; at least two names of particular students, Lhaksam, whom we have also already met, and Naza Lingpa are recorded.¹⁶² The administration of these institutions participated in larger new trends in bureaucracy. So, for example, when Jangopa took over management of Dropen Ling at Drepung in 1646, he saw the need for more standardization and requested the Dalai Lama to write a charter (bca’ yig)—a regulation manual for behavior and operations—for the medical school, to which the hierarch assented.¹⁶³ At the urging of Pöntsang Tseten Dorjé, the Dalai Lama composed a charter for medical practice at Samdruptsé as well.¹⁶⁴

At some point the school at Drepung was apparently pronounced a failure. The Dalai Lama looked to other venues. This eventuated in the establishment of what was to become the central institution for medical learning in Tibet into the twentieth century. The new medical school on Chakpori, the “Iron Mountain,” was actually built by the Desi, who reports that the project first dawned upon him as a vision. It came to him just after he had completed a set of 100,000 circumambulations around the central temple of Lhasa, a reminder of how deeply imbricated were religious ritual and imagery with the state-level fortunes of medicine in Tibet. The Desi continues that he had been practicing the austerity of circumambulating the Jowo Śakyamuni statue not for his own merit but to eliminate any impurities collected by the Dalai Lama.165 On the afternoon of its completion, he climbed Iron Mountain, and when he reached the top he saw something different from how previous texts had characterized its shape. He saw it as the very city-on-the-mountain Tanaduk: the site of the Buddha’s imputed preaching of the Four Treatises.¹⁶⁶ The Desi notes that this vision was at odds with Iron Mountain’s empirical shape of three sides (Tanaduk would have had four). He sent his trusted student, Lhünding Ganden Menla, to reconnoiter. He was delighted at the auspicious sign that there were many medicinal herbs growing on the hill, contrary to what everyone had thought.¹⁶⁷

The new school that came to be built on this hill was underwritten by the Ganden Phodrang government.168 Completed in 1696, it was called in full Chakpori Rikché Dropenling (Iron Mountain Science Island That Benefits Beings). It quickly became a magnet for students in central Tibet. It was seen as a monastery, but may have allowed lay students of medicine as well.¹⁶⁹ While embedded in Buddhist ritual cycles and in much of the academic culture cultivated over the previous millennium in Tibetan Buddhist monasteries, the institution was exceptional as a freestanding school dedicated to the study of medicine. The Desi made his own works on medicine, the Blue Beryl and the Practical Manual, the center of the curriculum.¹⁷⁰ The student body quickly grew from an initial group of thirty older scholars to an assembly of seventy monks. The Desi had a strong hand in determining the nature of the oral examination and could boast by the end of his life that the student body included more than a few doctors at the sman rams level.¹⁷¹ Contemporary Tibetan historiography understands the school as initiating significant changes in educational practice. A modern-day historian of Tibetan medicine adds that the basis for evaluation introduced by the Desi was distinctive for its method of praising and promoting the good and demoting the bad as a stimulus for improvement.¹⁷²

The creation and support of new medical schools initiated by the Dalai Lama marked a new emphasis on medical learning. The actors in these developments saw themselves as revitalizing what had already been fostered in earlier centers, but also as producing new resources, methods, and practices. There was a new urgency for the production of specific medical compounds, and that in turn meant assembling the requisite ingredients, efforts at which the Desi details at some length. One of the key medical accomplishments of the Fifth Dalai Lama that the Desi celebrates was a major production of medicines.¹⁷³

It is significant that some of the most important substances were only obtained on the Dalai Lama’s tour to China. That medicine could be renewed and advanced through foreign sources hearkened back, again, to moments in Tibetan history when Buddhist lineages and forms of knowledge were renewed and reconstituted by influxes of teachers from afar. But it is also emblematic of the unprecedented cosmopolitan atmosphere in Lhasa in the seventeenth century and the growing international interaction under the Dalai Lama’s reign. Some of his impetus to search further afield for new medical knowledge was also his own personal needs, such as his problems with cataracts, but it quickly snowballed into a general zeal to expand medical sophistication in his court and for the benefit of the state. A good illustration is the Dalai Lama’s discovery, around 1675, of an Indian doctor, Manaho, who was skilled in eye treatment and who was in Yarwo. He invited the doctor to Lhasa, gave him all the material support he needed for as long as he was there, and issued him travel documents. The Dalai Lama then placed his own physician, Darmo Menrampa, in Manaho’s training.¹⁷⁴

He also searched out medical experts from far-flung areas of Tibet itself who might have special techniques or medical traditions unknown in the capital. One such expert was Neluk of the Tö lineage from Drachi, who was brought to court to teach the methods of eye operation according to Mitrayogin and certain older Tibetan traditions. The Dalai Lama reports on the cataract treatment that he eventually received from Darmo Menrampa, which ameliorated the problems he was having with his vision.175 Another Tibetan doctor brought from afar was Nyanang Namkha Lha, summoned to teach the method of making, boiling, and washing mercury, originally attributed to the Indian master Śabarīśvara, who passed it to the Tibetan siddha Orgyenpa Rinchen Pel (1229/1230–1309). These methods were conveyed to Darmo and Lhaksam and some local doctors, again for the purpose of benefiting the people, as the Desi puts it.¹⁷⁶

In addition to soliciting new techniques, the Dalai Lama supported foreign medical scholars to translate new medical texts from India. Manaho was one of these. I am following the reading of contemporary Tibetan historians in observing that by commissioning the translation of foreign medical works, the Dalai Lama renewed and carried forward the benevolent medical activities of the kings. As one contemporary historian of medicine writes, many medical texts from other countries were translated during the reigns of the kings, but in later times no one was looking to do more new translation work, and Tibet had fallen behind in the medical knowledge of the day.¹⁷⁷ A striking moment in the court’s efforts to correct that situation is captured in a colophon to one of the new translations, and it gives a sense both of the desire for more knowledge and of the urbane atmosphere at the time.¹⁷⁸ The colophon recounts that a group of scholars from India were standing in the courtyard of the Potala in 1664. Darwa Lotsawa, a scholar of grammar, was sent to search for someone in the group whom the Dalai Lama had heard was knowledgeable about medicine. When he found Godararañja, he asked Darmo Menrampa to study with him. Godararañja was later sent to bring back medicines from South Asia and to translate his own summary of Ayurveda into Tibetan with the help of Darmo and Darwa—this is the work in which the colophon appears. There were numerous other such figures. The Desi was aware of the significance of this enterprise and also listed the translation work of the Indian physician Dānadāsa, who rendered a circle diagram of seventy-two kinds of medical formulae, and an Ayurvedic practitioner named Raghunātha, who translated other works.¹⁷⁹

Unlike in the past, the medical scholars commissioned by the Dalai Lama and his court were mostly translating not classics, but rather new Indic works. Although not everything old from India on medicine had been translated into Tibetan—the Aṣṭāṅgahṛdaya and its commentaries were the main classic Ayurvedic sources available to Tibetan readers180—there seems to have been more interest, in the Dalai Lama’s day, in new techniques and knowledge, and a desire to get up to speed. To what degree this urge was participating in the larger movement afoot in the development of science during the period is hard to specify exactly. We can say at least that it was chronologically of a piece with other moments of medical innovation, including in India on the verge of its own, more abrupt encounter with modernity and colonialism.¹⁸¹

The Dalai Lama and his circle were concerned to recuperate medical knowledge from the past as well. But the backward-looking gaze seems to have centered upon Tibetan medicine rather than foreign resources. Active efforts were made to preserve what was perceived to be ancient knowledge and especially to seek out lineage holders of rare traditions and save them before they were lost (despite the ruler’s concerted suppression on other fronts of the literary heritage of rival religious sects).¹⁸² The Desi recalls with pride how the Dalai Lama asked Gelong Zhenpen Nyingpo to teach an old Tibetan commentary on the Aṣṭāṅgahṛdaya entitled Snying po bsdus pa and also the Zin tig bces bsdus, the Gser bre from the Drangti tradition, and the Explanatory Treatise commentary by Jangpa Namgyel Drakzang.¹⁸³ The Dalai Lama is also reported to have been looking for old teachings on the medical use of mercury. He searched at monasteries known for their old collections such as at Shelkar Dzong and inquired among scholars at the famous libraries of Sakya, but with no success. After much effort he located the material at Nyanang.

Although most of these efforts were trained on academic medicine of Ayurvedic ilk or the legacy of Yutok Yontan Gonpo, the period also saw the recuperation of old healing rituals. One example is the massive ritual reinstituted by the Dalai Lama to produce a kind of pill based on an arcane system from Zur and Drigung, with many rare ingredients collected from many places.¹⁸⁴

Antiquarian projects to save, compile, edit, and revitalize the old must always be Janus-faced: even if such an effort is trained on the past, it is for reasons that speak to the current situation, that is, to something new. Thus the Dalai Lama’s accomplishments in recuperating old Tibetan medical literature also served to standardize, canonize, create orthodoxies, foster the allegiances of the medical intelligentsia, and extend the ruler’s reach over contemporary culture. They are comparable to the larger-scale but similar efforts to consolidate and control scientific scholarship by the Qianlong emperor a half-century later.¹⁸⁵

One of the major accomplishments of the Dalai Lama’s circle was a new compilation and blockprint publication of a set of writings, called Eighteen Pieces from Yutok, attributed to Yutok Yönten Gönpo and his disciples.186 This is an important historical artifact whose riches have yet to be fully plumbed by scholars today. It includes, among other things, earlier drafts of the Four Treatises by Yutok and valuable works on techniques of treatment, which the Desi reports were already rare in his time.¹⁸⁷ With the encouragement of the Dalai Lama, the collection was pulled together by Darmo Menrampa after seeking out whatever prototypes (ma dpe) he was able to recover from a variety of sources.¹⁸⁸ The blockprint publication was sponsored by the Dalai Lama at the Ganden Püntsok Ling printery.¹⁸⁹ It appears that it was the first blockprint edition of the set, and which works belonged in the collection was debatable.¹⁹⁰ The authenticity of some as attributable to Yutok had already been questioned by previous scholars,¹⁹¹ and it is unclear when it first came into existence as a set.¹⁹² The Desi himself was quite disdainful of several works in the collection on the questionable reliability of their attribution to Yutok, among other grounds.¹⁹³ His objections may have also had to do with their content. One of the works, an early commentary on parts of the Four Treatises (the basis of the final chapter of this book), lays out a picture of medical ethics that, while fascinating for its instrumentalist ethos, may well have been embarrassing to later generations. And yet it was published and preserved regardless, in recognition of the value of old documents.

Preservation efforts can also require new creations. The very place of Yutok Yönten Gönpo as the founder of Tibetan medicine was only being fully codified in this period, as was the fixation on the Four Treatises at the expense of other medical works that had been circulating on the Tibetan plateau for centuries.194 But there was considerable debate about whether Yutok was really the author of the Four Treatises, given that the work is framed as an original sermon by the Buddha. At some point around 1680 the Dalai Lama asked the medical scholars in his court to produce a full biography of the master. This alone would count as another of his great accomplishments for medicine, but it had a special twist. His scholars actually produced two biographies.¹⁹⁵ In effect they split the figure of Yutok into two, a Younger and an Elder. The Younger would be the twelfth-century historical person,¹⁹⁶ but the so-called Elder, who would have lived in the eighth and ninth centuries, appears to have been either entirely an invention or based on lore connected with a physician with that name who actually lived in the imperial period. Yang Ga suggests that such a figure did exist, albeit with no connection to the Four Treatises.¹⁹⁷ We do not know if the biography of the Elder Yutok produced in the late seventeenth century was based on any older prototype¹⁹⁸ or was created de novo out of certain auto/biographical fragments connected to the twelfth-century Younger Yutok, which also fed the latter’s newly codified biography.¹⁹⁹ The Desi’s own summary of the lives of the two Yutoks includes a few telling comments, to the effect that there has been some confusion between their careers, and that during the life of the Elder a goddess gave a prediction about a distinction between a Younger and Elder Yutok in the future.²⁰⁰ Indeed, both figures have the exact same name; both of their fathers are named Yutok Khyungpo Dorjé; both travel to India multiple times to receive medical teachings. Still, the Desi himself strongly supported the thesis that there were two Yutoks.²⁰¹ And it is testimony to the influence of the seventeenth-century reworking that ever since, Tibetan medicine has thought in terms of two Yutoks.²⁰² But in fact, as Yang Ga has shown, an Elder Yutok from the imperial period who was involved with the Four Treatises does not seem to be known in Tibetan medical historiography prior to this moment.²⁰³

It is not entirely clear what was gained by creating a double to the twelfth-century Yutok who lived four hundred years earlier. We can say at least that the long biography of the Elder provided an opportunity to recount stories about medical ethics and the enlightened nature of medicine. But the rationale for locating the patriarch of Tibetan medicine during the imperial period is less obvious. The Treasure narrative that had been in place since the thirteenth century—whereby the Four Treatises was translated from Sanskrit into Tibetan at the imperial court and then hidden and later passed to the twelfth-century (Younger) Yutok—had already deflected authorship from the latter and located it instead with the Buddha. Perhaps the placement of an Elder Yutok in the imperial period served to acknowledge that someone with the name Yutok had a strong role in the formulation of the Four Treatises, but associated him with the royal dynasty several hundred years earlier. Having the father of Tibetan medicine live in the same glory days as the kings and the introduction of Buddhism to Tibet tied medicine all the more securely to that mythic topos. As the Desi himself says, the Dalai Lama commissioned new biographies to be created out of “a collection of old documents, to accord with students’ minds.”204 What he probably was implying was that composing biographies of the Yutok patriarchs was meant to offer an inspirational story for medical practitioners of his day. I would add that codifying the lives of the Yutok masters in light of readers’ appetite for the imperial mythos was a crucial piece in the consolidation of the Four Treatises’ canonical status.

Yet a third key literary accomplishment for the advancement of Tibetan medicine and the legacy of Yutok Yönten Gönpo was the recognition of the phenomenal contribution of the scion of the Zur school, Lodrö Gyelpo—the very figure the Desi disparaged some decades later. At some point in the 1670s the Dalai Lama worked with the scholars in his court to publish the brilliant commentary on the Four Treatises that Zurkharwa had written in the previous century, Ancestors’ Advice. Zurkharwa had only finished his comments on the Root and Explanatory Treatises plus two chapters of the Final Treatise when he suffered a stroke. According to the Desi’s account, the original idea to bring this valuable work to light came from Darmo Menrampa and Namling Panchen. It was Namling who edited the existing Ancestors’ Advice, and again the Dalai Lama provided material support for the printing. An odd comment by the Desi—that the Dalai Lama thought that to edit and print this incomplete work was “better than nothing”—further suggests that the mere resurrection of a classic was not enough.²⁰⁵ The Dalai Lama and his associates did go on to complete the work. This resulted in the writing, by Darmo Menrampa, Namling Panchen, and others, of a new commentary to the rest of the Four Treatises under the same name of Ancestors’ Advice.²⁰⁶ Apparently they were able to base this partly on notes left by Zurkharwa himself. It was fortunate that those notes survived, especially with regard to the Instructional Treatise, which contains the bulk of the diagnostic, therapeutic, and physiological information. As the Desi tells us, commentaries on the Instructional Treatise were exceedingly rare.²⁰⁷ The Dalai Lama gave the order to begin the project; it was commenced in 1678 and finished the next year. The blocks for printing were carved by 1681.²⁰⁸ This work’s completion is another example of preserving the old while simultaneously creating something new, in this case offering new readings on any number of medical issues.²⁰⁹ Ancestors’ Advice came to exert enormous influence, including on the Desi himself, whose own commentary on the Four Treatises, the Blue Beryl, written ten years later, copied many long passages from it, including from the parts written by Darmo and his team.

Finally, the importance of one more key medical achievement under the Great Fifth, the production of a definitive blockprint edition of the Four Treatises, cannot be gainsaid. Here the inextricability of old from new becomes more tangled yet. There had already been several blockprint editions of the root medical text, and before that several manuscript versions, but their accuracy seems to have been a recurring point of contention.210 We can also detect the prestige that the Desi associated with producing the most correct version. The effort to republish the classic began while he was young and seems first to have been a matter of preservation, when at the urging of Jangopa, the Dalai Lama asked Döndrup Pelwa and others to reproduce the old Dratang edition. This appeared in 1662 under the direction of Jangopa, with a new colophon by the Great Fifth himself.²¹¹ The Dratang had been the first blockprint of the work, edited and produced by Zurkharwa in the previous century.²¹² Zurkharwa’s own efforts to locate the original manuscripts (phyag dpe dngos) and commentarial golden notes (gser mchan) of Yutok and his successors as a “witness” (dpang) attest to the antiquarian mentality already in place a century before the Dalai Lama’s initiatives.²¹³ Since then several other editions had appeared. But when the Desi came, in the course of his own medical education, to study the latest version of the Dratang that his elder colleagues had reproduced under the auspices of the Dalai Lama, he found interpolations and omissions. He wanted to return to the other editions and to do better.²¹⁴ Recounting the story, he reviews with subtle disdain the qualifications of Jangopa, calling into doubt his pronouncement that the Dratang Four Treatises was “very excellent.”²¹⁵ The Desi characterizes his doubts in terms of the discrepancies he found regarding certain medicinal plants’ habitats; he also complains that some of the outline structure of the text was out of order and that words had been dropped. But I don’t think it is entirely accidental that the Dratang he critiqued so strongly was originally the handiwork of Zurkharwa.

Whether or not the Desi’s push for another edition had to do with rivalry, it represents a rare case in which he suggests that even the Dalai Lama was mistaken on something and indeed that his lord’s knowledge of medicine was wanting. As he says so diplomatically, “My lama the Great Fifth is omniscient with respect to the definitive meaning of all things and can see everything there is to be known in terms of how they are and what they are in reality, like the shape of a myrobalan in the palm of the hand. But as for the perspective of people with lower merit, it appears in his precious biography that he only memorized the Root, Explanatory, and Final Treatises and the way to listen roughly to the outline and the mnemonic diagrams. He shows himself as otherwise not knowing medicine in detail.” In fact, the Desi avers, the Great Fifth was wrong in supporting the Dratang edition and writing a colophon to it. He whispered this assessment to the ruler himself, letting slip into his ear that the colophon was “a little over the top.”216

The comfort with criticism and candidness in the Desi’s day made this breach of protocol feasible. Even so, it remains astonishing that the Desi not only could make that comment orally but also wrote about it, delicate locutions notwithstanding. It is pertinent to note one other ingredient in this episode that marked the climate of academic medicine and its patronage in the period, at least at this uppermost echelon: the evident intimacy and trust between the Desi and his master. We can appreciate its significance in light of what Steven Shapin has shown to be at the heart of the growth of science in seventeenth-century England.²¹⁷ The close bonds marked by civility and shared elite social status in the Dalai Lama’s circle might also explain how the Desi could be so forthright in his written assessments of his other colleagues that he shares in retrospect with his readers. As for the event in question, the underlying trust meant that the Great Fifth was comfortable enough—and committed enough to the quest for truth—to brush the insult off with grace. The Desi reports that the ruler responded “with some amusement, ‘If we set aside what Jangopa and the others have said, and since what you are saying is true, if you could do a bit more research and comparison that would be good. So do it!’”²¹⁸

And so the Desi got a chance to put his mark on the prized root medical text. Years after getting the Dalai Lama’s approval, and after writing his own commentary to it, he finally completed a new edition of the Four Treatises itself, in 1690.²¹⁹ He writes in retrospect how he produced what he calls the Dzonga edition with a committee of colleagues, looking into all the versions known to him.²²⁰ He also examined the “manuscript chapters written with an iron pen,” and especially “the inner old Treatise box of Zurkhar and the hand-smudged manuscript” that had been discovered by Zurkharwa.²²¹ The Desi assures his readers of his own thorough and detailed research, in which he did not take the “easy way.” As he adds,

The projects initiated by the Dalai Lama reached toward a range of kinds of newness and suggest broad participation with other movements in the early modern period in the region.²²³ The Desi and his colleagues at court were invested in the recuperation of old knowledge, but also in the importation of new knowledge. They made new compilations of data about the past; new codification and completion of older works; new corrections of mistakes in past work. There were assumptions about the virtues of the ancient but also concerns about consistency and proper organization. It is not entirely clear how much of the Desi’s new edition of the Four Treatises was seen as restoring the original and how much as representing new improvements. There can be no doubt at least that to correct the location of medicinal plants, which is one of the things he says he did, would have constituted additions that, as we saw in the last chapter, were based on new empirical knowledge from the field.²²⁴ Here as elsewhere, the invocation of the empirical seems to require no justification at all. Especially in the Desi’s commentary to the detailed chapter on materia medica we find him repeatedly describing the occurrence of things in the natural world that have no standardized description, i.e., from the old systems of classification (’khrungs dpe). He can dismiss the lack of classical prototype for what he and his colleagues were newly recognizing, on the grounds that the specimens in question were easy to classify now.²²⁵ Here the authority of what is seen in the world trumped other considerations—certainly it trumped the textual, a point we will see again.

Thus did the medical mentality not only foster an urge for realism, an urgent desire to get the facts right, and a willingness to criticize peers and even elders or the venerable writings of the past if they did not measure up. It also brought into high relief a tension between what was encountered empirically in the world and what the classical sources said. And yet the prospect of the Four Treatises as correctable remained a source of tension. The root text had by this time acquired an authority on par with scriptural works in the Buddhist canon. The fact that the Desi considered the Four Treatises to be Buddha Word alerts us to the delicacy of introducing any corrections to it. No doubt there was grand prestige in having produced the definitive edition, but there was simultaneously a need to be very careful.

Writing a commentary on a work is different than editing it. But it still does not constitute something completely new. Rather, it occupies an ambiguous place in between. One is commenting on, and thus constrained by, an authoritative text, but surely one is saying at least something new—otherwise why write it at all?²²⁷ To be sure, writing a commentary to the Four Treatises had long provided an arena to express dissent and differing opinions, not to mention new ideas. However, the very question of the grounds for and especially the implications of writing commentary had not been meditated upon before, at least not in such personal detail.²²⁸ The Desi took up such questions overtly, apparently obsessed by them. His complex discussion at the end of the Blue Beryl is a good place to see how his nimble negotiation of newness, innovation, and criticism allowed him to advance medical knowledge and the place of authority therein.

The Desi is clearly conflicted about the status of the new. There seems to have been an earlier moment in his career—or perhaps he only portrays it as such in retrospect—when he was quite confident of the newness of a treatise on astrology that he had composed. Speaking of his White Beryl, written between 1683 and 1685, he can taunt potential critics to “scrutinize it carefully, clarifying whether or not it is an elegant teaching without precedent, coming out of the energy of intelligence. And if you have doubts, I have evidence to offer through authority and reasoning.”²²⁹ The White Beryl did produce controversy, prompting the Desi to write two further treatises with even more detailed specifications.²³⁰ But the very idea of an “elegant teaching without precedent” boldly signals his bravado in characterizing his ideas on astrology and divination as issuing out of not only authoritative sources (though he is quick to add he can supply those too) but also his own genius.²³¹ And yet he is saying these things in the context of much more complicated feelings on the occasion of concluding his medical commentary; his satisfaction with the White Beryl serves to highlight a contrast with his quite uncertain sense about the Blue Beryl.

The Desi is both detailed and inconsistent. He can cite the obvious motivation—rife in the medical circles of his day—that to flesh out medical knowledge was to “save” medicine from decline.232 But how does he think that this can be done, and was done, by himself? The problem of newness now takes center stage.

The Desi evinces an ethos that gives highest credence to tradition and authority. He also expects to be criticized if he is thought to be introducing something new. And yet he still manages to claim to be doing just that—while protecting his tail in the same stroke. In his extraordinary conclusion to the Blue Beryl—extraordinary, that is, for the way it waffles back and forth—he ends up having it both ways. He writes,

He is defending against a charge that he simply made up the information in his commentary, but deploys a half-full/half-empty strategy: the Blue Beryl is only half my own words; don’t blame me since I did not make it all up, but do give me credit since I did make some of it up. Elsewhere he notes he actually had an associate, Chakpa Chömpel, write up the first draft of the Blue Beryl based on the Desi’s notes, since he himself was so busy.235 He also refers to the Blue Beryl as something that was “compiled” (phyogs bsgrigs) rather than using one of the usual words for composition.²³⁶ But he does consider the commentary to be his own. To return to the statement we just looked at, what he is really concerned with is the issue of innovation as such, rather than whose it actually is. And on this we find him talking out of two sides of his mouth at once. When he moves in the next sentence to critique his predecessors, he is justifying the need for something new: “Moreover, I did not find a satisfactory way to introduce these topics from explanations by others that I could trust definitively, nor did I find greatly reliable and complete commentarial texts.”²³⁷ And yet in the next sentence he returns to defending against his imagined critics, displaying the conventional humility and showing that he is not conceited enough to trust his own ideas.

By the next line he has found a happy medium. He has done as much research as possible, then gone further based on what he knows, but he is always careful to check it. He is referring to his immediately preceding discussion of his research into various old botanical classification texts along with consultations and examination of actual plants, eventuating in his adjustment of and additions to the information in the plant recognition chapter of the Four Treatises.²³⁹ And yet he still would like it to be known that he is not quite comfortable, not as confident as he is about his previous work on astrology.

He gets to have it both ways. As we go on through this closing statement, though, and also other statements, we find a further and important dimension to the problem he is facing. He is worried not only that he will be accused of adding something new but also about the possibility that he will make a mistake and say things that are not true. While the exact parameters of the Desi’s standards of such truth have yet to be discerned—and remember, at least regarding knowledge of materia medica, he even thought that the Four Treatises itself had room for improvement—there is a clear sense of a standard out there in the world. This palpably undergirds his critiques of the unsatisfying commentaries of the past. Other than a few shining luminaries, “the other earlier ones diluted [the knowledge in the Four Treatises] like milk from the market, such that it morphed into all sorts of things.”241 The Desi does identify those “earlier ones” who actually could be trusted, namely the Jangpa masters Namgyel Drakzang and Mi Nyima Tongwa Dönden, and the founder of the Zur school, Nyamnyi Dorjé. But he was eminently comfortable critiquing other teachers of the past—far beyond his usual whipping boy, Zurkharwa Lodrö Gyelpo. This is why new commentary is needed: the existing commentaries are not reliable.

The Desi is critical in particular of the few existing commentaries on the Instructional Treatise, which provides the bulk of the practical instruction.²⁴² Indeed, issues of procedure opened up the biggest space for revision and innovation. A special genre of medical writing that addressed the diagnoses and therapies of the Instructional Treatise, but which was not a commentary as such, had already begun to appear several centuries before the Desi’s time. The source of information was cast as the clinical experience of the physician. Such works were called, appropriately, “writing from experience” (nyams yig).²⁴³

A key ingredient in the attitude that experience and innovation are requisite for effective medicine is a concept of error—especially the ability, or license, to acknowledge it. The Desi avers that many of his shorter writings on medicine were efforts to correct the errors and confusion of others.244 He maintains that it is inevitable that a later generation will find things to correct in writings from the past. “When an earlier work is examined by later people, they see faults—this is natural,” he maintains.²⁴⁵ He even allows this observation to account for some of the criticism that his nemesis Zurkharwa leveled at his own predecessors.²⁴⁶ Apparently mistakes have to happen; they are part of the way things are. Several times in this discussion, he uses a classic term (chos nyid; Skt. dharmatā) that in Buddhist philosophy denotes the most basic and unchanging level of metaphysical reality. For the medical mentality evinced here, it is change in knowledge over time that is deemed to be “natural.” That would mean that this law will also pertain to his own work: “So since I myself am not so confident, I hope that more mistakes will be pointed out.”²⁴⁷ He knows that he too will have gotten some of it wrong.

The assumption that mistakes will always occur is coupled with its social implication: the need to exhibit humility and openness to critique. The Desi had already showed his White Beryl to others for comments; now he is recalling how he did the same for the Blue Beryl. But it is telling how he characterizes what people told him. The Desi cannot resist a jab at his own reviewers, questioning whether they are really up to the task. He reports saying to Lhünding Namgyel Dorjé, Nyemo Tseden, and Namling Panchen, “If there are any doubts or faults I need you to send them my way.” But then he adds, “And so they acted like they were assessing it, but they could not manage it.”²⁴⁸

The Desi shows that he can actually receive criticism in his account of ten responses that apparently he received on what he might add or cut in the Blue Beryl. One point had to do the meaning of a single arcane syllable in a particular medical concoction that the Desi had glossed as meaning “smoke,” but that was not supported by the root text. He also mentions a few further small revisions that he assented to, including corrections that were advised regarding the paintings that illustrated the Blue Beryl. He clearly feels the need to record these issues. And yet he also is motivated to point out that he rejected some of the other suggestions. One issue, already mentioned in the last chapter regarding the shape of a particular leaf, was decided in a way that was quite definitive: the Desi adjudicated it by sending someone to get the real thing (ngo bo) from the field. In that case the proof of what was correct and what was a mistake was out in the world.²⁴⁹ We will return to this point repeatedly.

Overall, the Desi remains “unsatisfied” and “unconfident” about the Blue Beryl. This may be as much a display of etiquette as a fully representative report. But etiquette says a lot about the parameters of discourse within which the Desi had to operate. He projects a critical audience of powerful scholars whom he entreats for their tolerance and from whom he feels subject to criticism.250 But as much as he expects criticism, he also feels entitled to give it. At one moment he evinces a real sense of being alone, of having no one out there to receive his work and judge it properly, such that producing his commentary is like “doing transference for a corpse without a head,” as he quips (the esoteric “transference” rite involves expelling consciousness out of the top of the skull as a person dies: there would be no point in doing it for someone who lacked a head). Despite his lack of confidence, there is no one who can really assess its mistakes.²⁵¹ In another moment, now at a late point in life and writing about his other main medical work, his history of medicine, he reverts to the conventional diffidence. Here he imagines his judgmental audience as a bemused group of slightly critical sages who spy “out of the corner of their laughing eyes at the one who composed this festival of attachment-making, just like Brahmā with the girl who issued from his own imagination.” But in the very next lines he is in yet a third, quite balanced and reasoned mood, praying for the good effects of the work and urging his readers to use their analytical powers to assess his history without bias.²⁵² He can say something like that about his Blue Beryl too: “I don’t have a lot of capability, but I am not very ashamed of this either.”²⁵³

What is common in all of these moments of self-reflection is the powerful ingrediency of a critical readership on his horizon. The question remains of how distinctive were the Desi’s dispositions toward self-correction and revision, compared to the larger world of religious scholastic culture in Tibet. Other cases outside the domain of medicine where scholars sent provisional drafts of their writing to colleagues for comments and critique, as the Desi did on several occasions, are not unknown.²⁵⁴ The same can be said of posting challenging statements in public places, although I am not aware of such statements posing technical intellectual questions, as those of Zurkharwa and Lhündingpa did. But even if it is not unique, we can recognize a signature expression of the Tibetan medical mentality with respect to disputation and authority in the foregoing passages, most of all in the last sentence of the Desi just cited. There, leaving behind both bravado and diffidence, he forges a middle position marked by cautious confidence … and a deep investment in being realistic. This reasonable—and human—attitude is discussed in the last chapter of this book, at the heart of a formative account of professional medical ethics. Once again a related disposition may be recognized in broader practices in Tibet around writing autobiography—a genre also fraught with concerns about etiquette and a tension between deference to tradition and the impulse to write realistically.²⁵⁵ But the expressions of such concerns take on a particular inflection in medical discourse, especially by the Desi’s day.

Most of all, we can understand the Desi’s critically probative attitude as a function of his desire to get it right in medicine. A large part of what that would mean would be to adhere to publicly observable criteria. That is what the adversion to empirical evidence amounts to; it is behind the all-important question of how to handle the potential death of a patient that takes up much of the medical ethics, and it made both for a certain caution in one’s own claims and a license to pounce vociferously upon the shortcomings of others.

What’s more, by the time that the Desi is writing his own history of medicine, there is second-order reflection on what it means to write such a work. The elaboration of standards to which medical history writing should be held had already begun in preceding centuries. But an exceptional passage in the final section of the Desi’s own khokbuk amounts, for the first time, to a veritable history of writing medical history. As might be expected from the Desi, this proceeds in exceedingly critical terms. And yet his efforts to delimit the telling of Tibetan medicine’s history run up against a conflicting need to place it within a larger Buddhist universe.256

Many of the conventions of medical historiography are familiar from the more well-known histories of Buddhism in India and how it came to Tibet. The medical histories also draw on other Tibetan narrative genres, including accounts of ruling families, histories of other clans and families, and other kinds of Tibetan genealogical discourse, memorably characterized by R. A. Stein as “necessary for upholding the order of world and society.”²⁵⁷ Two of the earliest Tibetan histories of medicine were published in the Eighteen Pieces from Yutok collection and are close to contemporary with the composition of the Four Treatises itself. One of them, entitled Soaring Garuda and already labeled as a khokbuk, is taken up with justifying the status of medicine, and then the Four Treatises in particular, as a teaching of the Buddha.²⁵⁸ As Frances Garrett has noted, Soaring Garuda addresses only in the briefest terms the main topics proper to the history of Tibetan medicine as found in other works from the same period.²⁵⁹ But its strenuous effort to provide medicine’s Buddhist pedigree suggests an early felt need to counter a competing assessment that medicine was not fundamentally a product of the Buddha’s dispensation.²⁶⁰

Other early works do provide a conventional history of medicine in Tibet, recounting the various medical practitioners and scholars who came to the court during the imperial period to teach and translate medical treatises, the formation of early schools, and new systematic and practice-based works composed by Tibetan doctors. The other medical history in the Eighteen Pieces collection, Crucial Lineage Biography, is an important example.²⁶¹ It appears to have been written, at least in part, by the principal student of Yutok, Sumtön Yeshé Zung, and most of it focuses on the early Tibetan physicians who inherited the Four Treatises from Yutok. Another important early khokbuk history, The Way That Medicine Arrived, probably written in 1204 by Chejé Zhangtön Zhikpo, deals primarily with the figures associated with the Indian Aṣṭāṅgahṛdaya.²⁶² It also mentions teachers and teachings entering Tibet from all seven schools of medical learning in the world according to the author’s knowledge, including Tangut/Xixia (Tib. Mi nyag), Khotan (Tib. Li), Trom, and China. This work displays a conception of the genealogy of Tibetan medicine that has little to do with the importation of Indian Buddhism. It was well known to the Desi, who cites it as one of his own sources.²⁶³

A key sign of the growing sense of an autonomous medical tradition was the very use of this distinctive genre term khokbup, or khokbuk. It appears in the titles of two of the three early works just mentioned, and the third glosses itself with the same phrase.264 To be sure, the term is not always included in the titles of medical histories, and even when it is, it is not used consistently, in that the contents and structure of works so named can vary widely. The term is also occasionally used in other literary contexts quite apart from medicine, for example to name a liturgical manual. Still, khokbup/k has a special resonance for medical historiography, and it is part of the title of the two most influential such works, those of Zurkharwa and the Desi. Both look backward to a whole series of what they call khokbup or khokbuk texts as the models for their own histories.²⁶⁵ I suggest that the adoption of this moniker served to distinguish medical history from other kinds of histories, especially those of religion, and suggested an alternate textual space.²⁶⁶

The label itself is curious. Among other things, the two main variants have different literal meanings: khokbup (i.e., khog ’bubs) translates as something like “pitching, or framing, an interior,” while khokbuk (i.e., khog ’bugs) would mean “piercing the core.”²⁶⁷ Modern scholars have puzzled over the term, and the genre.²⁶⁸ I would argue that both spellings/senses refer reflexively to the genre as such. To put it another way, both metaphors reference what it means to be a book. This is especially so for khokbup, which contemporary Tibetan lexicographers understand to be the main term, and which most commonly occurs in titles.²⁶⁹ It is listed as one of five ways of presenting a book’s content, specifically, that which lays out the general structure of a topic. While khokbup more colloquially refers to the pitching of a tent, in book terms it is that which sets out a structure of classifications, or more generally, covers a topic. The metaphor is felicitous for the purposes of forging medical tradition. The writing of khokbup would mark the pitching of a tent or raising of a roof over an interior space thereby created—in other words, a space apart. Its further sense of framing or laying out highlights the fact that classification is a key part of what it means to write medical history. Indeed, a key question was how, and if, medicine and its root texts are to be classified as the teachings of the Buddha.

We can also see this reflexivity in the variant spelling, khokbuk. Soaring Garuda defines it as “that which reaches all understandings of the meaning, once one knows all the ways to explain.” This describes what the text is doing, both for the classification of medicine within the five sciences and for a “piercing of the core of this very Four Treatises, since it is the essence of all medical knowledge.”270 In that the goal of Soaring Garuda is to demonstrate that medicine in general, and then the Four Treatises in particular, is a genuine teaching of the Buddha, the work “pierces the core” of its fundamental concern—the heart of the matter, as it were—about the nature and authority of medical knowledge.

It is especially instructive that the Soaring Garuda and Zurkharwa’s history of medicine use both versions of the genre term as a verbal noun, or even an indicative verb.²⁷¹ This suggests that the genre accomplishes something by virtue of its very writing—not unlike what a speech act does, quite apart from whatever semantic content a statement like “I do” denotes. Thus did the khokbuk/p accomplish a kind of “book act.” Its very writing established a zone of medicine with its own history and its own core virtues.

The medical histories by Zurkharwa and the Desi were landmarks, authoritative sites for establishing medical tradition, and also arenas where key historical issues were contested. Both owe much to the earlier tradition of writing such works, especially a medical history by the fourteenth-century Drangti Pelden Tsoché that provides important evidence of the influence of Greco-Arabic medicine in Tibet in the royal period, along with detail on the early history of Tibetan medicine.²⁷² But Zurkharwa’s rendition expanded the purview of medical historiography exponentially.²⁷³ Zurkharwa couches the history of medicine in a detailed account of the entire world as he knew it. In many ways he phrases this in Buddhist scholastic terms, drawing on Abhidharma discussions of cosmology and materiality. Still, his account is inflected with a special interest in the origin of physical matter, and he treats questions like the relation of sentience to materiality at some length. He also shows far more interest in the “defiled world” than in the “purified” one, i.e., that which would intersect with Buddhist soteriological concerns. In fact, he characterizes his comments on the purified world as an “aside,” and they take up but a single page.²⁷⁴

Zurkharwa continues with the development of medicine as such, including much of what Tibetans knew about the history of medicine in India. But he interjects into that a lengthy (over 70 pages in the modern Chinese edition) account of the Buddha and the history and categorizations of his teachings. He gives a history of medicine in the heavenly realms, then in the realm of humans, then in the Buddha’s teachings, and finally, on page 246 of the 384-page modern edition, begins the story of Tibetan medicine in the royal period. This goes down to the life of Yutok; I will say more about his treatment there in the next chapter. Zurkharwa closes his history with a lengthy section on how to educate oneself in medicine and its practices.

The Desi’s own khokbuk history, written about 130 years later and at the end of his career, seems to reverse this trend, restricting its topics to medicine but reaching new levels of detail as well as self-consciousness of what medical history should be doing. The Desi reviews the teaching of medicine from the gods’ realms to Indian medicine, the medical teachings of the Buddha, and their transmission in Tibet. Far more than anyone before him, he goes on to provide a sustained historical account of the development of Tibetan medicine after the time of Yutok the Younger, with detailed biographies of the major figures of the Jang and Zur lineages, the history of institutions of medical learning, and the life of the Great Fifth. The Desi also treats himself as a topic of discussion, adding a 24-page section (in the modern edition) on his own contributions to medicine.

The Desi goes on to work through about twenty such histories, written from the eleventh century up to his day. But he is not merely listing his sources, as Tibetan authors often do. He is using the occasion polemically to assess the relative merits of these works and to place them in a tradition whose standards are important to articulate and to advance. Indicating that medical history is a domain unto itself, the Desi expresses disapproval of examples that spend too much time on irrelevant topics.

He is especially explicit in critiquing his nemesis on just this point. Zurkharwa’s medical history is also the only one of his sources for which he gives a chapter-by-chapter summary. The Desi is overtly disdainful when he says that Zurkharwa’s history of medicine “ends with a three-part practice outline that he set up, and a calculated explanation of the five sciences in brief, and an explanation of letters, [but given the previous chapters about] the world and its contents, and the deeds of the Buddha, and so on, it is a huge heap of words about everything that he himself saw, flaunted as if it belonged to the history of medicine.”275 The same criticism is echoed in the Desi’s resumé of Zurkharwa’s student Ruddha Ananta’s even more expansive medical history. This work discusses the classic twelve deeds of the Buddha, the Buddhist canon, and the future appearance of Maitreya; it’s another “huge heap of words.”²⁷⁶

At this point it is not a complete surprise to find another case of criticizing something in a context where critique is highly unusual, i.e., in listing one’s sources at the end of a work. But there is an interesting twist that goes quite beyond the simple protest we might lodge that actually Zurkharwa’s medical history is significantly shorter than the Desi’s, and hardly such a “huge heap of words.” Rather, from the Desi’s description of the other histories of medicine in this section, the ones he doesn’t critique but just summarizes, they too apparently had lots of what surely would be extraneous material, on the Buddha’s teaching and the Dharma in general and so on, at least if we are to believe what the Desi says about them.²⁷⁷ So a good guess is that the real reason he singles out the Zurkharwa writers for their verboseness is his far more momentous irritation with them for maintaining, as he says here, that “the Four Treatises were taught by Yutok,” i.e., a historical human author.²⁷⁸ In contrast, the histories that he doesn’t critique are the ones that make the Four Treatises the Word of the Buddha. In fact, the main information that the Desi provides about these more acceptable medical histories is how each of them makes the Four Treatises the Word of the Buddha—whether they argue that the Buddha Śākyamuni and the medical Buddha Bhaiṣajyaguru are the same; whether they say that Buddha taught as Vajradhara or not; and so on. Their stance on the status of the Four Treatises’ ultimate expounder seems to be the main criterion for his approval.

And so when the Desi takes to task the Zurkharwa histories for trying to “attach a nonmatching lion’s upper jowl to the lower jowl of a camel,”279 he is saying that despite their flamboyant display of Buddhist learning, their denial nonetheless of the Four Treatises’ status as Buddha Word is a move in the opposite direction, creating an unacceptable distance between the field of medicine and the Buddha’s teachings. Hence the discrepancy between the two kinds of jowl. In other words, these Zurkharwa scholars can say all they want about Buddhist topics, but they hit a false note, and they’re not fooling anyone. But note the ironic upshot: the Desi is singling out the Zurkharwa writers for talking too much about general Buddhist topics in their histories of medicine. Even as he insists that the Four Treatises is Buddha Word, he is arguing that medicine deserves a separate kind of historiography that just focuses on medicine. The Desi, it seems, was up to his chin in lion and camel jowls too.

The question of Buddha Word and the Four Treatises had been a serious point of contention well before the Desi. We will follow the fortunes of this defining debate in the next chapter. The Desi’s interventions came at the end of it, after the most interesting cultural and intellectual issues had been thoroughly thrashed out. His own actual position on the matter is examined in the Coda following chapter 5. Surprisingly, when he gets down to substance, he mostly agrees with Zurkharwa. Nonetheless, the animus in his blustering rhetoric to the contrary bears our attention. It has everything to do with the special burden that medicine’s new political capital meant for the regent. Even though he himself had been involved in a slew of activities that pushed medicine toward autonomy—founding the first freestanding medical academy in the capital, directing a monumental set of medical paintings that relativized Buddhist images, arguing for the authority of the evidence of the physical world, arguing that the truths of old could be subject to improvement—he tried to hold the line in insisting on the Buddha’s authorship of the Four Treatises. It is all about authority. The foundation of the new state rested on the absolute truth of intentional reincarnation and the accompanying yogic power and apotheosis of the Dalai Lama—all deeply dependent on the magisterial authority of the Buddha’s teachings.

This is a double movement that we find repeatedly. The Desi moved medicine further into a critical and empiricist direction, but tried simultaneously to keep it domesticated under the sign of Buddhism. If it is sometimes hard to keep track of the Desi’s position, the same is true for Zurkharwa, to whose own wrestling with the problems of science and religion I will turn in the next three chapters. I would actually concur with the Desi that Zurkharwa inappropriately padded medical history with extraneous information about Buddhist teachings, no doubt fueled by a similar pressure to present his ideas under the aegis of the Buddha’s teachings even as he, perhaps even more than the Desi, tried to come to terms with the independent witness of direct observation and empirical verities. We will see in the next chapter how Zurkharwa continuously blurred his own positions. Just when he made his most radical moves that would truly create an epistemic space apart for medicine, he also obscured the effect, precisely, I would say, so as to effect an allegiance to a Buddhist universe on every other front.

No one—not the Desi, not Zurkharwa, not the many other medical scholars who also struggled over this issue—doubted the deep imbrication between Buddhism and medicine. None of them doubted that the Buddha was a master healer and that his teachings incorporated considerable medical knowledge. None was oblivious to the long-standing place, in Buddhist scholasticism, of medicine as one of the five sciences. All were the product of a Buddhist education with shared assumptions about root texts, the purposes of commentaries, and the exemplary role of biography, not to mention the very practices of bookmaking.280 And then there were the particularities of the Tibetan state that cast both Buddhism and medicine as valuable foreign imports to advance civilization. This was true in imperial times, and it was repeated during the era of the Desi, for whom the fate of medicine was very much framed in the same terms as the fate of the Buddha’s dispensation]: both were in danger of falling prey to the degenerate age, both were in need of constant renewal, purification, and preservation. We have seen the parallel between the modus operandus of medicine and the Treasure tradition, which provided the perfect schema to justify the Four Treatises as Buddha Word. Equally momentous was the ethical homology vis-à-vis the state: both medicine and the Buddha’s teachings are good for the people. The ruler, be he a Dharma king or the Dalai Lama or a lay regent, has a responsibility to take care of the people, just as a bodhisattva or buddha does for sentient beings. Both Buddhist teachings and medical care figure as ways to do that.