6 Tibetan Medicine

THE SCIENCE OF HEALING

DR. YESHI DHONDEN pressed the three middle fingers of his right hand gently along the inside of William Schneider’s left wrist, bowed his head and listened. The fifty-two-year-old patient smiled, perplexed. The physician before him wore neither a white coat nor a name tag. He asked no questions and carried no charts or instruments. Dressed in maroon robes, head shaved, a turquoise-studded charm box bulging beneath his orange shirt, Dr. Dhonden remained motionless, deep in concentration. A minute later, he took the patient’s right arm and briefly pressed the radial artery as if to confirm his findings. Ushering Mr. Schneider into an adjacent room, the doctor gestured for him to undress, whereupon he pressed selected points along his spine. With each touch, Mr. Schneider cried out in pain. Dr. Dhonden nodded sympathetically and told him to get dressed.

In his guest suite at the University of Virginia, Dr. Yeshi Dhonden offered his diagnosis of William Schneider, a man he knew nothing of and had met only minutes before. “Many years ago you lifted a heavy object,” he said, speaking through an interpreter. “At that time you damaged a channel in the vicinity of your right kidney, blocking the normal flow of wind through your back. The wind has accumulated outside the channel, there is bone deterioration and the disease has become quite severe.” Mr. Schneider was stunned. For three years, he confirmed, he had suffered from acute arthritis along the neck and lower back. The illness had caused incapacitating pain, and he had been forced to give up his job. But he was even more astonished at Dr. Dhonden’s ability to reconstruct his past. “In 1946,” he recalled, “I injured my back lifting a milk can out of a cooler. I was in bed a week, and as soon as I got up I reinjured it and was bed-ridden again. That must have been the start of the whole problem.”

It was a diagnosis that Western physicians could arrive at simply by using an X ray, but Dr. Yeshi Dhonden, the Dalai Lama’s personal physician, sent by him in the winter of 1980 to introduce Tibetan medicine to the West, enthralled American doctors and patients alike with his unique skills. “It’s quite conceivable that in our attempt to be scientific, some of our powers of observation have atrophied,” said Dr. Gerald Goldstein, a professor at the University of Virginia’s Medical Oncology Department, who worked closely with the Tibetan physician during his stay. “Dr. Dhonden, on the other hand, is totally attuned to everything that is going on. He uses all of his senses as his medical instrument. Our patients have been very impressed.” Dr. Richard Selzer, assistant professor of surgery at Yale University, met Yeshi Dhonden in 1974 on his first visit to the United States. “I went to observe Dr. Dhonden with some healthy skepticism,” he recounted. “I was surprised and elated by what I found. It was as if he was a human electrocardiogram machine interpreting the component parts of the pulse. We have nothing like it in the West. It’s a dimension of medicine that we have not yet realized.” “Western scientific documentation of Tibetan claims is nonexistent,” observed Dr. Herbert Benson, leader of a team of Harvard researchers that visited the Tibetan Medical Center in 1981. “It would be nice, though, to discover the worth of what they have developed over thousands of years. If their claims are only partly true they would be worthy of investigation. Therefore, can we really afford to ignore this?”

To test the efficacy of Tibetan drugs by laboratory standards, Yeshi Dhonden agreed, while in Virginia, to engage in an experiment with cancerous mice. On the basis of a visual examination alone, he prescribed a general Tibetan cancer drug, comprised of over sixty ingredients, for nine tumor-implanted mice in a lab in the University of Virginia’s vivarium. Six mice refused the medicine and died within thirty-five days. Three mice accepted it and survived up to fifty-three days. A second experiment involving sixteen animals confirmed the findings, producing the most successful results since work with the particular tumor involved began in 1967. Of even greater interest, though, was the fact that Dr. Dhonden had no knowledge of the nature of the cancer he was dealing with. “There are literally hundreds of kinds of tumors,” commented Dr. Donald Baker, the researcher in charge of the experiment. “How often has Dr. Dhonden encountered a KHT anaplastic sarcoma growing in a highly inbred strain of 3CH/HEJ female mice? It would be utterly unreasonable to ask him to decide what would be the best treatment. If he had been familiar with these conditions he might well have effected a complete cure.” “There is no question that this is a very fertile area for cancer quacks,” added Dr. Goldstein. “In the end, though, things either work or they don’t work. Dr. Dhonden has things that work.”

Sitting cross-legged over a cup of butter tea in his Virginia apartment, Dr. Dhonden offered a brief description of cancer in Tibetan terms. “I’ve treated perhaps one thousand cancer patients of which sixty to seventy percent have been cured,” he maintained. “Our medical texts specify fifty-four types of tumors which appear at eighteen places in the body in one of three forms. We consider cancer to be a disease of the blood. It begins with pollutants in the environment. These, in turn, affect seven types of sentient beings in the body, two of which are most susceptible. They are extremely minute, but if you could see them, they would be round, red and flat. They can travel through the bloodstream in an instant, are formed with the embryo in the womb and normally function to maintain strength. In general the Buddha predicted that eighteen diseases would become prevalent in our time due to two causes, low moral conduct and pollution. Cancer is one of the eighteen.”

Based on the results of his first experiment those physicians working with Yeshi Dhonden hoped to initiate a broader study of Tibetan medicine in the West. Dr. Dhonden, too, was eager to undertake an in-depth exchange of medical lore. “If Western medicine can come to understand the Tibetan view of the human organism,” he commented toward the close of his stay in Virginia, “I feel it will be of inestimable value. Our medicine has many cures for diseases which Western doctors currently don’t understand or have incorrectly identified. We successfully treat diabetes, various forms of coronary disease, arthritis, hepatitis, Parkinson’s disease, cancers, ulcers and the common cold. We have difficulty treating epilepsy and paralysis. But because the Tibetan system is scientific, Western physicians, as scientists, will see what is of value and what is not.” To illuminate an ancient science hidden behind the Himalayas for over two thousand years, Yeshi Dhonden described his own life and training as a Tibetan doctor.

DR. DHONDEN was born in 1929 into a wealthy family of farmers living in the small village of Namro, south of the Tsangpo River, one day’s ride from Lhasa. Much of the land surrounding Namro belonged to the Dhonden family and their relatives. Five thousand sheep, yaks and horses and many fields of chingko or mountain barley were owned by Yeshi Dhonden’s aunt and uncle, who, not having a male child, assumed he would grow up to run the estate. Dr. Dhonden’s parents, however, felt differently. As their only child, they decided that Yeshi Dhonden should devote his life to the Dharma. Accordingly, at the age of six, their son left his home and traveled a short way up the mountain behind Namro, to be accepted as a novice monk in the local monastery of Shedrup Ling. “I remember it all,” recollected Dr. Dhonden. “Becoming a monk, entering into the comfort of the group, living with my teacher. I had a strong wish to learn quickly and my mind was very clear. I could memorize four of our long pages in a single day.” Yeshi Dhonden’s facility for memorization earned him a high position among his peers, on the basis of which he was selected at the age of eleven to represent Shedrup Ling at Mendzekhang, the larger of Lhasa’s two state-run medical colleges. Like all monasteries, district headquarters and military camps, Shedrup Ling was required by the government to send medical students to Lhasa. Upon the completion of their training, they would then return to practice in their region. But while the monastery’s superiors were not averse to receiving the government salary paid to them for their students’ attendance, the four hundred monks were less than enthusiastic at the prospect of medical studies. “Everyone in the monastery was afraid that he would be selected,” recalled Dr. Dhonden, laughing. “No one wanted to become a doctor. You have to spend at least eleven years in classes and there is a tremendous amount of memorization. But because I liked to memorize, when my parents told me that I had been chosen, I was eager to go.”

The medical system Yeshi Dhonden was to study had begun as one of the ten branches of learning originally pursued by all Mahayana Buddhist monks. It flourished for over a thousand years in the great monastic universities of northern India, from whence it was taken to Tibet by two Indian pandits in the first century B.C. Thereafter, it was the province for almost seven hundred years of a single family of physicians attendant on the Royal Tibetan Court. With the introduction of over a hundred Buddhist medical texts in the sixth century, however, it grew into a widespread practice and was ultimately acclaimed by a conference of physicians from nine nations convened in Tibet, as the preeminent medical science of its time. Subsequently, Tibet’s first medical college, called Melung or “Country of Medicine,” was built in the eighth century by King Trisong Detsen in Kongpo, south of Lhasa. Melung inspired the founding of scores of medical schools, most contained in dratsangs or colleges appended to the country’s larger monasteries. In the mid-seventeenth century, the Fifth Dalai Lama built Tibet’s second medical college, called Chokpori, atop Iron Hill, just across from the Potala. There, doctors from all across Tibet and Mongolia were trained to practice a composite of the various schools of medicine that had developed over the years. The need for more physicians in modern times resulted in the Thirteenth Dalai Lama’s construction of Tibet’s most recent central medical college, Mendzekhang or “Medicine House,” in 1916.

Mendzekhang lay on the west side of Lhasa, next to the Tibetan government’s newly built post and telegraph office. It was centered on a flagstone courtyard, with dormitories for students, both lay and monk, occupying two long wings, at the head of which, facing the main gate, stood the classrooms, assembly hall and the Master’s quarters. Outside, the college walls were lined with display beds of frequently used medicinal plants. Inside, life at Mendzekhang followed a spartan schedule. At four each morning a bell sounded in the main temple at the head of the courtyard. Yeshi Dhonden had a few minutes to wash and roll up his bedding before hurrying to his classroom to begin memorizing by the soft light of butter lamps. As the mind was believed to be most fresh on waking, the first three hours before sunrise were given over to the memorization of the 1,140 pages of the four medical tantras, the root texts, preached by the Buddha, which, together with hundreds of commentaries and pharmacological catalogues, were the basis of Tibetan medicine. At seven o’clock instructors quizzed their students on the morning’s work, after which they would return to their rooms for the day’s first bowl of tea. A second bell then rang, and the whole college gathered to pray in long seated rows running the length of the pillared assembly hall, its walls hung with thankas illustrating herbs, anatomy, embryonic development and surgical instruments. On the way back to his room, Yeshi Dhonden would pass patients lined up for treatment beneath the apartments of Kenrab Norbu, the Master of Mendzekhang. Under their instructors’ observation, senior students examined the sick while other professors, along with all the doctors of Chokpori, fanned out into the city on morning house calls, visiting those too ill to come to the colleges. As always in Tibet, medical treatment was free, only the medicines themselves having to be paid for.

Although Yeshi Dhonden’s day was spent mainly in memorization, he often looked in on Mendzekhang’s chief pharmacist and his staff. Two doors east of the front gate, they carried out the first step in the preparation of medicines, pounding into a fine powder the various roots, stems, leaves and branches as well as the numerous gems, minerals and animal products used in the 2,000 drugs routinely made by the college. The demands of their work were so great that Mendzekhang was covered with the raw materials of the trade. Hundreds of pungent medicinal plants, collected on expeditions into the mountains, were laid out to dry throughout the school’s hallways, classrooms and rooftops. Subsequently they were administered either in powder form or as shiny black and brown pills.

Following an early dinner at five o’clock, the student body once again assembled, this time to practice debate. Seated by class in the courtyard, the college would, on the Master’s signal, break into a cacophony of shouts, claps and loud retorts as attackers queried their respondents on the correct interpretation of the tantras’ description of the causes, conditions and treatments of various illnesses. Often debates became so heated that when the five-hour session had concluded, individual pairs, a small group of entranced onlookers seated around them, their sens or outer robes wrapped tightly against the chill, continued debating far into the night.

After two years and four months, Yeshi Dhonden completed memorizing the medical tantras. He then recited for a full day before his teacher, declining to divide his first test over a period of time, as was customary. Promoted, despite his youth, to be senior student among the five in his room, he went on to take his official examination. The mornings of four days were set aside. His parents came from Namro to attend, while his home monastery, Shedrup Ling, offered a tea service at each session. Yeshi Dhonden, aged thirteen and a half, then appeared in the Assembly Hall before the Master of Mendzekhang, the faculty and the entire student body and after prostrating three times to the images of the Medicine Buddha and Tibet’s most famous doctor, Yuthok Yonten Gonpo, on the main altar, recited verbatim the one hundred fifty-six chapters of the four tantras—in and out of sequence—as he was requested. Only minor mistakes were accepted—a lapse of any kind being considered grounds for failure. On the afternoon of the fourth day Yeshi Dhonden was informed that he had passed in good standing. Rewarded with a white scarf and a set of brocade book covers, he was admitted into the college to commence his formal education.

Dr. Dhonden spent the next four years absorbed in eleven divisions of study. To provide an overview of the medical system, Mendzekhang’s curriculum began with the Illustrated Tree of Medicine, a diagram wherein each field of learning found its proper place in relation to the whole. Yeshi Dhonden and his fellow students spent long hours laying out on the large flagstones before their rooms the three roots, nine trunks, forty-two branches, two hundred twenty-four leaves, three fruits and two flowers of the tree, using colored thread, sticks and bright plastic buttons from the Barkhor or marketplace. After they had mastered the diagram, they were taught how to collate the appropriate chapters of the tantras with the various parts of the tree, following which they entered into the study of root one, trunk one, branch one, explaining the most important topic in Tibetan medicine, the theoretical basis for the entire system, that of the three bodily humors.

As explained by the Buddha in the First or Root Tantra, three humors govern the condition of all sentient beings: wind, bile and phlegm. Wind is described as rough, hard, cold, subtle and motile in nature; bile as light, oily, acrid and hot; phlegm as sticky, cool, heavy and gentle. Five kinds of each orchestrate the human organism. The five winds control movement, respiration, circulation, secretions and the joining of consciousness to the body; the five biles, digestion, sight and skin tone; the five phlegms, among other functions, the body’s cohesiveness. The quantity of wind in an average adult is said to fill a bladder, that of bile a scrotum, that of phlegm, three double handfuls. Although active throughout the body, wind predominates in the pelvis, bile in the middle torso and phlegm in the upper torso. Wind moves through the skeleton, bile in the blood, phlegm in the chyle, flesh, fat and regenerative fluid. Phlegm prevails in youth, bile in adulthood, wind in old age. When all the humors are in balance, health exists. The smallest imbalance, however, produces disease. Every illness—of which the tantras account for 84,000 in 1,616 divisions—owes its cure to the correction of a humoral imbalance. Equipped with such an all-inclusive theory, the medical system could address itself to any disease, known or unknown, including mental illness, as not just the body but also the personality of each individual was said to be governed by the balance of humors in his makeup.

With a working knowledge of the humors, Dr. Dhonden went on to study embryology, anatomy, metabolic function, signs of death, pathology, treatment and diagnosis. In embryology, conception, followed by the weekly growth of the embryo (including the nature of its consciousness at critical stages of development), was described in texts predating Western medicine’s own findings by 2,000 years. Techniques for determining the sex of the child prior to birth were demonstrated, along with medicines which would reduce labor to between two and four hours, guard against postpartum infection and ease pain. Anatomy was the next subject. As autopsies were performed only if attending physicians disagreed on the cause of death, Mendzekhang’s students obtained their anatomical knowledge from detailed charts first drawn up late in the eighth century when the practice of surgery in Tibetan medicine was at its height. At that time Tibetan surgeons had routinely performed heart and brain surgery until the mother of King Muni Tsenpo, Tibet’s thirty-eighth monarch, died during an operation to lessen swelling from water retention around the heart. Following her death, surgery was officially banned. Nevertheless, minor operations continued to be performed and the use of surgical instruments as well as that of anesthetizing drugs remained part of the Mendzekhang program. While metabolic function and signs of death were relatively brief topics, pathology, treatment and diagnosis were immense undertakings, requiring Yeshi Dhonden’s greatest efforts. Pathology alone, dealt with in the ninety-two chapters of the Third or Oral Tradition Tantra, entailed individual descriptions of the categories, causes, symptoms and complications of thousands of diseases, supplemented by their treatments under varying conditions. It was here that memorization of the tantras proved invaluable as, equipped with commentaries written by Tibet’s long line of physicians, Yeshi Dhonden gradually built up an intricate picture of the entire range of human illness through its expression in single, double and triple humoral imbalances. The study of diagnostic procedure, though, was even more difficult. Unlike academic topics, the three trunks, eight branches and thirty-eight leaves of the Diagnostic Root of the Tree of Medicine could be thoroughly understood only through actual practice. Questioning the patient and analyzing nine aspects of his urine were essential to diagnosis. But it was mastery of the third trunk, pulse diagnosis, that was the hallmark of a leading physician.

Although pulse diagnosis was taught for an entire year in Mendzekhang, it was believed to take a decade or more to fully comprehend. The basics were laid out in thirteen sections of the Last Tantra. The first four detail eight guidelines for the evening before an examination. To prepare themselves, both patient and doctor should refrain from the consumption of tea, alcohol and overly nutritious food, also avoiding exercise, sex and any anxiety-producing encounter. The following morning, after the sun has risen but, as the Tantra says, before “its rays have fallen on the mountaintop,” the pulse should be read. In this brief period, two definitive factors characterizing every pulse, disease and medicine—the forces of hot and cold—are believed to be most in equilibrium. Prior to dawn, lunar influences, manifested in an enhanced cold or negative pulse, accentuate wind and phlegm; after dawn, solar influences augment the hot or positive pulse of bile and blood (sometimes spoken of as the fourth humor). Because the patient has not yet eaten, digestion does not obscure other functions, while all the winds have subsided during sleep into the heart of the central channel, where, according to tantric theory, the mind and body are joined.

The best place to read the pulse is said to be on the patient’s wrist, just over the radial artery. The Last Tantra queries itself: “Why is the radial artery used?” It replies that listening to arteries close to the vital organs “is like talking to someone by a waterfall,” whereas using those in the extremities is like receiving “messages brought by distant merchants.” The radial artery is the optimum position and is likened to “a voice in summer shouting across an open field.” “How is it possible to read the quality of the twelve organs at the radial artery?” the tantra continues. “Just as a successful businessman can discern the place of origin and make of wares at a marketplace, so the pulse if read at the radial artery can exhibit the condition of the hollow and solid organs.” Only in children below the age of eight and terminally ill patients is the pulse to be read elsewhere: in the former, on the blood vessels in the lobe of the ear; in the latter, to determine how many days of life remain, at the posterior tibial artery behind the ankle.

The doctor is now instructed in the technique for taking the pulse. If the patient is male, the left arm is examined first; if female, the right. Switching hands, the physician then examines the patient’s other arm. In both cases he uses the three middle fingers of either hand spaced apart the width “of a grain,” while to overcome the thickness of the forearm’s muscle, his index finger presses the skin, his middle finger the flesh and his ring finger the bone. The essential ingredient of pulse diagnosis is explained next. Each of the six fingers used is to be divided into an “inner” and “outer” half. These twelve positions monitor the organs; hollow organs are read on the outer half, solid on the inner. For example, the outside of the physician’s right index finger reads the heart; the inside, the small intestine; the outside of his middle finger, the spleen; the inside, the stomach. The correspondence of all six fingers is the same for both men and women save for one instance. In a male patient the doctor’s right index finger registers the heart; his left, the lung. With a female patient the reverse applies. They are switched because the consciousness of a woman is believed to enter the center of the ovum and sperm at a slightly different position than that of a man at the time of conception. The text then admonishes the doctor to always keep his fingertips “smooth, sensitive, without scars and pliable.”

There is one final consideration before the pulse can be read. One of three “constitutional pulses,” corresponding to the three humors, is said to dominate every person. The male pulse, similar to wind, is bulky and prominent; the female, similar to bile, subtle and rapid; the neuter, similar to phlegm, slow and smooth. Unless the patient’s particular type—any of which can be had by either a man or a woman—is known to the physician (either by examining the patient when healthy or by being told), a diagnostic error can easily be made. Furthermore, once the constitutional pulse is known, it is crucial to factor in the “seasonal pulse”—each season manifesting an influence on the characteristic pulse imprint of a particular organ, such as heat in summer, which affects the heart, and cold in winter, which affects the kidneys.

The doctor begins by ascertaining whether the illness is hot or cold in nature. He does so by using his own respiratory cycle, to determine the rate of the patient’s pulse. If the pulse beats five times per breath, the person is in perfect health. More than five beats denotes a hot disorder; less than five, a cold. Above eight in a hot disorder or below three in a cold disease means an extremely severe, usually incurable problem.

One of twelve general pulse types is now sought. The six hot beats are strong, ample, rolling, swift, tight and hard. The six cold beats are weak, deep, declining, slow, loose and hollow. If the moment all his fingers touch the radial artery a hot beat is superficially felt, the physician knows that the disorder is new and minor. If, after pressure is applied, they are felt deeply, the illness is chronic and complex. The reverse holds true for cold disorders; superficial pulses reveal old, serious ailments; deep ones indicate new, minor imbalances. From this second step the history of an ailment is known.

The state of the three humors in the body is now explored. Each humor, as well as its combinations, possesses a characteristic pulse type. When it has been identified, the individual pulse of one of a huge number of conditions is sought. If the patient is pregnant, the “pregnancy pulse” will reveal it, as well as, after the sixth week, the sex of the child. If worms are present, the pulse is “flat” and seems to knot as it beats; if bacteria, it is incomplete, with “sudden, irregular and unpredictable cessation in the rhythm of the beat.” In leprosy, the pulsebeat is “quivering,” and contracting at its conclusion “like a person who limps.” Wounds manifest a “bulky, hard and quick” pulse. A bullet lodged in the body produces a “limping and double” pulse as if there were two arteries, not one, being read. After describing tests to distinguish pulse types, the tantra instructs the physician to investigate the individual organs through the twelve positions on the fingertips. His exam complete, over a period of roughly one hundred breaths, the doctor knows what the humoral imbalance is, its severity, which organs are affected and in what manner.

As Yeshi Dhonden and his classmates discovered, however, the topic of pulse diagnosis was far from exhausted. In the remaining sections numerous exceptions to the rules were cited as well as the uses of the pulse in determining lifespan, spirit possession and, in an extremely complex section known as the “Seven Amazing Pulses,” the future course of an illness. In the eleventh section, those pulses which reveal that a disease will be terminal are described, showing how vivid the tantra’s descriptions can be.

The “changing” death pulse is said to “flutter like a flag in the wind”; while the “irregular” death pulse appears “like a vulture attacking a bird, who stops, plunges, beats its wings quickly, stops again and then resumes flight.” In a combined wind-bile disorder, the patient’s pulse will resemble “a fish leaping out of water to catch a fly, who quickly shimmers back.” Accumulation of phlegm and wind producing death are like “the pecking of a hen eating grain”; that of a triple humoral imbalance, like “the saliva of a drooling cow, moving in the wind.” The text then enumerates death pulses unrelated to the humors. If a healthy person who has had an accident has a thin pulse, he will die shortly. If in a person who has been sick for some time the pulse suddenly turns strong or violent, death is imminent. The amount of time left to live, within a period of eight days, is shown by the absence of pulse. Death will occur in three days if the liver or gallbladder pulse is missing; in two if the lung or large intestine pulse is absent; in one if the tongue is black, the eyes are in a fixed stare and the pulse of either the heart or the small intestine is gone.

Dr. Dhonden’s true education in pulse diagnosis came only after his studies were completed. At the age of eighteen he was sent by Kenrab Norbu, Mendzekhang’s principal, to undertake a four-year internship with a master physician practicing in Lhoka, who was already surrounded by many disciples. During this second stage in his training, Dr. Dhonden rose before dawn each day to take pulse, analyze urine and present his diagnosis of patients’ ailments to his new teacher. While his understanding of the myriad pulse types grew, he came to have a profound regard for the efficacy of the entire medical system. Although patients in advanced states of illness could not be cured, others, afflicted by a number of usually fatal degenerative diseases, such as cancer and diabetes, responded with complete remission. In the case of diabetes, seen in one out of every two to three hundred patients, he witnessed many cures occurring within six to nine months. When medicine proved ineffective, he and his teacher used accessory treatments: emetics, purgatives, moxabustion, cauterization, bloodletting and acupuncture or “Golden Needle” therapy, which, according to Tibetan medical histories, originated in Tibet and spread to China via Mongolia. Among the most successful treatments Yeshi Dhonden found were those for senility (employing memory pills), those included in the divisions covering women’s and children’s diseases as well as those in the eight branches of infertility, itself an entire category of medical practice. Although rarely prescribed, due to Buddhist ethics, two types of birth-control pill existed. One had to be taken for a few consecutive days, whereafter its effect lasted for a year; the other eliminated fertility for life.

Having administered rejuvenation treatment for two millennia, Tibetan physicians considered it a normal component of their medical practice. However, one group of drugs, as venerable as those of chu-len, excited particular interest—rinchen ribus or “Precious Pills.” Whenever Dr. Dhonden returned to Mendzekhang to replenish his professor’s medicines, he made sure to inquire which Precious Pills had most recently been manufactured in the college’s pharmacy. Seven types existed, the weakest composed of eighteen ingredients, the strongest, known as the King of Medicines, of one hundred sixty-five. Wrapped in colored cotton, tied with rainbow-hued thread and sealed with wax, the Precious Pills received their name for two reasons: for their contents—gold, silver, mercury, pearl, ruby, sapphire and diamond, specially treated and then mixed with various medicinal plants—and for their function—as panaceas for the entire body. Precious Pills, it was believed, could cure the most intractable ailments. As their manufacture sometimes took up to three months of around-the-clock labor by a team of twenty druggists, they were extremely potent and administered only under strict conditions. The stronger ones often incapacitated the patient for a day, while toxins were eliminated and imbalances in the body corrected. Though Yeshi Dhonden was familiar with their ingredients, his internship was primarily geared toward expanding his knowledge of Tibetan medicine’s vast pharmacopoeia. To check his progress, Kenrab Norbu required Dr. Dhonden to accompany the college each year on its annual outing to pick herbs in the mountains.

The journey commenced at the start of July and was attended by those who had completed memorization, generally 300 students and faculty in all. As a rule, each traveler brought three changes of clothing, the Buddha having stressed the importance of cleanliness while collecting medicinal substances. With one pack animal and a groom serving every two students, the caravan left Mendzekhang and, skirting Lhasa, proceeded a day north to Dhakyaba, a region of peaks and alpine meadows considered ideal for herb gathering. A large tent camp provided by the government, staffed with cooks and fully provisioned, already awaited the college. For seven weeks, changing location every three days, small groups of students and teachers set off at eight o’clock each morning to collect herbs just below the snow line. While harvesting, they recited prayers to the Medicine Buddha, intent on keeping the mind as well as the body pure. Thirty classes of plants, subdivided into fifty-nine categories, with each plant having nine divisions, were initially sought. Hundreds of herbs with less universal value were also taken. With the waxing of vegetative processes and the onset of pollination, barks and plant secretions received less attention; flowers, fruits, seeds and leaves, more.

Halfway through the summer, large wooden crates began arriving from Lhasa. Ordered from district governors months in advance, the crates contained dozens of medicinal plants that were unavailable in Central Tibet. They had been carefully picked with earth still around their roots and immediately packed in snow and ice. By the end of August, when all had arrived, the students had completed their own collections and were ready to take the year-end test on the identification of plants.

The exam took place inside a large tent surrounded by a high cloth wall. Within, stacks of wood covered with white cotton lined the enclosure, two hundred selected plants laid out haphazardly on top. With Kenrab Norbu presiding from a high seat at the far end, three faculty members, each assisted by a secretary, escorted students past the tables. While the secretaries recorded their replies, the students were asked to describe each specimen by type, species and the medicinal power of the active part. Guided out the tent’s rear, they were separated from those yet to be examined, and the next group of three took their places. While they did, the scores were tabulated and given to the Master, who had them announced to the whole gathering—a procedure guaranteed to increase the tremendous tension the students already felt. The test completed, students once more were taken around, this time to have their mistakes pointed out.

Most of Mendzekhang’s aspiring physicians took up to five exams before they could correctly identify a majority of each year’s plants. In his first and second attempts, Yeshi Dhonden placed sixty-second, then forty-fifth in the ranking. By the age of twenty, though, with his internship completed, he captured third place. By coincidence his old roommates took first and second, giving the three friends a clean sweep of the top positions. Because their scores were so close, Kenrab Norbu ordered a retest. This time the young men were taken around the tables blindfolded. One by one their examiners held up plants, requesting that they be identified by odor and taste alone. As Yeshi Dhonden recalled, “This was very difficult, but fortunately all of us were able to answer correctly. When the test was over, it was announced that I had come in number one. Later, though,” he added, laughing, “I found out there had been a catch. Because I was graduating, my friends had pretended to make little mistakes. In reality I was number three, but thanks to their trick I was chosen as the best student in the college.”

Following the exam, a large celebration, equivalent to graduation day, was held. Hundreds of people came from Lhasa and the surrounding villages to watch as the students were publicly ranked. Those who took first and second places received long silk scarves embroidered with the words “Luck in the Day. Luck in the Night.” Those who came in last didn’t fare so well. The fifth from last was pronounced “Carrier of the Medicines”—a barb equivalent to “nurse”—and given a blue doctor’s bag to hold, of the kind used by every physician’s assistant. The fourth from last, called “The Doorman,” was dressed in the black robes of a government servant and placed at the entrance to the tent; the third from last, costumed as a muleteer, escorted the second from last and the last—banished not just from the race of physicians but that of men—known, respectively, as the “White” and “Black Donkeys.” With bells, reins and halters on their necks and medicines loaded across their backs, the “donkeys” were driven around the camp, bellowing and braying, to the great amusement of the crowd, after which a picnic was shared by all. The next day the college returned to Lhasa, where a ceremony at the Central Cathedral took place and the year ended for a week’s vacation.

After graduating, Dr. Dhonden served as Kenrab Norbu’s special assistant for three years. In the evenings he continued to debate with Mendzekhang’s senior students and faculty members. Once a month he went to the Lingkhor, Lhasa’s Holy Walk, to treat the hundreds of poor pilgrims and beggars who rarely came on their own for help. In conjunction with this, he paid special attention to cultivating the eleven vows of the physicians’ code which attempted to instill an altruistic motive as the basis of a doctor’s practice. As Yeshi Dhonden commented, concerning his own application of the ancient code, “I am just an ordinary person afflicted by desire, hatred and ignorance. But through contemplating the suffering I see in my work, I have tried to increase my compassion. As doctors we are expected to put kindness before all else.” Out of his own curiosity, Dr. Dhonden also went, two hours a day, to the British Legation, to acquaint himself with Western medicine. Finally, in 1951, Kenrab Norbu sent Yeshi Dhonden’s diploma to the office of the Cabinet, where it was officially confirmed. The Kashag then dispatched letters to district officials in Lhoka, as well as the government transport center, from which Yeshi Dhonden received free passage home. Thirteen years after his education began, Dr. Dhonden left Lhasa, looking forward to taking up practice on his own.

He didn’t have long to wait. An epidemic had broken out along the Bhutanese border, imported—along with chocolate, batteries, silks and the beloved fedora hats—by traders returning from India. In Tibet’s high, germ-scarce environment, those who contracted the disease—a form of intestinal influenza—died quickly. Scores of doctors had already flocked to the area.

Traveling to a monastery called Sungroling Gonpa, Dr. Dhonden joined three physicians who had been attempting, unsuccessfully, to check the epidemic. Nine of the monastery’s 300 monks had already died, as well as many of the inhabitants of the village below its walls. Arriving just before nightfall, Dr. Dhonden was shown to a private room, where, after his regular evening meditation session, he went to sleep, expecting to see his first patients in the morning. During the night, however, he experienced an unusual dream, one which, though seemingly inexplicable by Western standards, demonstrated the close relationship of religion to science in Tibetan medicine. “In the night I dreamt that a naked woman came before me, a khadroma,” said Dr. Dhonden, referring to a spiritual being believed, in a manner similar to that of an angel, to aid practitioners in meditation. “In her right hand she held a tantric drum; in her left hand she held a skull. She carried a bag of medicine under her left arm. A white tin cup with a red design and a slight crack on its rim, filled with urine, appeared before her. Then the woman asked me, ‘After examining this urine can you tell me the disease of the patient? What is your diagnosis?’ In the dream I looked at the urine and replied, ‘This is today’s epidemic, one of sixty-five types of the eighteen new diseases predicted in the tantras for this era.’ ‘What is its cause?’ she asked. I responded that it was due, as the tantras state, to environmental pollution and that it was a hot disease. ‘You said that externally it is a fever, but are you sure that internally it’s not cold?’ she said. At that time, because my memory was fresh from constant study, I recalled that the thirteenth and fourteenth chapters of the third Tantra address the topic of cold and hot diseases together. I answered her in debate form, quoting the text as proof, stating that there was no hidden cold fever, but that the ailment was hot both inside and out. We debated back and forth for some time and finally she said, ‘What treatment will you give?’ I replied, ‘Because the bacteria causing the disease have mixed the blood and bile, medicine should be given to separate them.’ Then she asked what the patient’s behavior and diet should be—two aspects of treatment that always accompany medicine. I answered and she said, ‘Tell me again. How will you cut the tail of this disease?’ Once more we debated vigorously and then she laughed and suddenly disappeared. There was complete silence and I woke up.”

In a short while, as the day began, Dr. Dhonden was brought tea. Afterwards he was asked to visit his first patient, a twenty-three-year-old monk, infected by the illness, languishing in his room. “I went to see the young man,” continued Dr. Dhonden. “It was a very serious case. The room he lay in stank. Diarrhea mixed with blood was pouring from him onto the bed and he was semi-comatose; he couldn’t talk. I asked for his urine specimen and it was brought to me in a tin cup. All of a sudden I remembered my dream. It was the exact cup, even with the crack on the rim. ‘Oh, I have already examined this before,’ I thought. I was amazed. Then the whole dream came back. I recalled the debate and the treatment and immediately I prepared the correct medicines. The man recovered and after that, the epidemic in the village was completely stopped. Now when I look back on it,” Dr. Dhonden said, “I feel that whoever came to me in the form of a khadroma that night was actually administering my true final examination.”

As Dr. Dhonden’s reputation spread, he spent the remainder of the 1950s traveling from one district to another. “Each day I rode from village to village, returning periodically to Lhasa to obtain medicines,” he recounted. “I was able to cure three quarters of my patients. And because I gave penicillin injections for skin disease—a great novelty among Tibetans—my reputation continued to increase. I never had a free day.” A group of young relations began to study with him, but before long the uprising against the nine-year-old Chinese occupation broke out in Lhasa and the Dalai Lama fled. “I saw His Holiness when his party came through my area,” recalled Dr. Dhonden. “Those who weren’t following him had joined the guerrillas to put up a last fight for our freedom. My students all had family members whom they couldn’t leave. My own mother’s legs were too poor for her to walk out and my father had said that he was too old to cross the high passes into Bhutan. As a monk, I wouldn’t fight. So I felt that I had no other choice but to leave. I borrowed a horse, said farewell and set off.”

Though Namro was only a few days from the border, the presence of Chinese troops forced Dr. Dhonden to hide for over a month before finally, in the company of eighty other refugees, he descended a steep snow-covered slope, trekked through a valley and crossed a glacial stream into the forests of Bhutan. With only a few texts, instruments and medicines in his possession, he then walked across Bhutan begging day to day. “After I was forced to flee my homeland, I was overwhelmed by a deep sense of renunciation,” reflected Dr. Dhonden. “I saw life as essenceless, without real stability. I only wanted to practice religion.” Arriving at Buxa, Yeshi Dhonden requested permission to remain with the monks there while the rest of his group was transferred to road work. The Tibetan government official in charge replied, “You have the right to practice religion and you are also young and fit to work on the roads. However, if the Kashag asks me, ‘Has any doctor come out of Tibet?’ and I’ve sent you elsewhere, what will I say? Therefore, you studied medicine at the government’s expense, and now the time has come for you to help us.”

Dr. Dhonden was sent to Dalhousie, where 3,000 refugees, including the elite monks of Lhasa’s two Tantric colleges, Gyudto and Gyudme, were camped in squalid conditions. Tuberculosis, hepatitis and amoebic dysentery were rampant. Preparing what medicines he could from the few herbs available in Indian stores, he set up a clinic and went to work. “One day a sweeper in my clinic was bitten by a poisonous snake,” he related. “Just as I was applying a Tibetan tourniquet, an Indian doctor arrived. He examined the bite and declared that unless his leg was amputated immediately the man would die in half an hour. I told him this was unnecessary; I had already given the man Tibetan medicine effective for poison. The doctor turned to the sweeper and said, ‘You will die within minutes unless I operate, but this Tibetan’—indicating me—‘thinks otherwise.’ He asked him whose diagnosis he wished to accept. The sweeper had seen my work and so he replied mine. The doctor then compelled me to sign a paper releasing him from all responsibility in the case. There were many aspects to my treatment, but after ten days the sweeper could move about and in a month he was completely cured.”

Despite the man’s recovery, the episode proved to be the start of a serious conflict. Once a week Indian doctors came to inspect the refugees, in the course of which they dropped by Dr. Dhonden’s clinic to demand that, as he was not certified in India, he discontinue practice. “During one of their visits I was examining a patient with skin disease,” continued Dr. Dhonden. “The physicians saw this woman and together announced that she had chicken pox. They claimed that unless she was isolated an epidemic would sweep over all the refugees. I said bluntly that they were wrong. It was a minor heat disorder and no more. They departed, leaving medicine for her to take. I forbade her to. In a short while they came back and tried to remove her to an isolated house in the forest. I refused to let her go. They asked if I was willing to have an outbreak of chicken pox on my hands and I replied, ‘The Tibetans are my own people. How could I ever harm them?’ I then demanded that now they sign a paper, just as I had been made to, certifying that indeed this woman had chicken pox. They stalled and within a few days the woman was cured.” Despite this minor victory, more battles ensued, until, in mid-1960, Yeshi Dhonden was unexpectedly summoned to Dharamsala. Word had reached the government-in-exile that a Mendzekhang-trained physician had escaped. Apprised of his existence, the Dalai Lama had called for Dr. Dhonden personally.

“I arrived in Dharamsala just before sunset,” Dr. Dhonden remembered. “The hills were covered with tents. People were living in very poor conditions. They had refused to leave His Holiness and were going wherever he went.” Directed to the kitchen area of the Secretariat compound at Mortimer Hall, Yeshi Dhonden sat and waited. He was finishing his tea when the Dalai Lama arrived. “Suddenly I heard His Holiness in the other room. ‘Where is the doctor?’ he said. I stood up, folding my hands in prayer, praying for his long life. I had a very strong mind of faith. But when he entered the room I began to weep. I had never wept upon meeting someone before. I must have been thinking of Tibet …”

The Dalai Lama questioned Dr. Dhonden on his escape and then requested him to treat those camped around Dharamsala. Working out of the Nursery at Conium House, Dr. Dhonden began seeing patients under the observation of Tibetan government officials. Having met with their approval, he was summoned to the Dalai Lama once more, this time in the capacity of examining physician. After curing the Dalai Lama of a skin disorder, he was asked to see Kyabjé Ling Rinpoché, the Dalai Lama’s senior tutor and head of the Gelugpa sect, who was bedridden in a hospital in Calcutta suffering from a severe case of pericarditis, an inflammation and swelling around the heart. In little over a year Ling Rinpoché was cured and Dr. Dhonden was officially appointed to be the Dalai Lama’s personal physician, a post normally filled by up to four doctors in Tibet. His enthusiasm for his practice now fully recovered, he set about the monumental task of preserving Tibetan medicine in exile.

Only two other doctors had escaped from Tibet, neither of whom could assist Dr. Dhonden in Dharamsala. Alone, he began to train ten students in the rudiments of his science, their progress hampered by an almost total lack of funds. Yeshi Dhonden could do little until, one day in 1963, his many run-ins with Indian doctors yielded an ironically positive result.

Responding to repeated complaints from local physicians that the Tibetan was “stealing” their patients, a senior minister in the Indian Health Department arrived in Dharamsala to investigate. For a week he watched Dr. Dhonden diagnose patients by their pulse and urine, after which he carefully asked each individual his ailment. At one point, five officers from the nearby army cantonment came in to refill prescriptions. “When the minister saw them he exploded in a rage,” recalled Dr. Dhonden. “ ‘We give you the best health care in India and now you’ve come here to eat shit from a Tibetan!’ he yelled.” The officers replied that in many cases they had been ill for fifteen years or more. Where Western medicine had failed, Tibetan medicine had succeeded. “Unlike other doctors,” they said, “we don’t have to tell Dr. Dhonden what’s wrong. He tells us.” The day before he departed for New Delhi, the minister came to Yeshi Dhonden’s office. “You are doing very good work here,” he said. “There is only one problem. You don’t have enough students. I’m going to give you thirty thousand rupees a year and a twenty-bed hospital.” In this manner, the Tibetan Medical Center was formally organized.

Dr. Dhonden assumed the roles of director and pharmacologist as well as chief examining physician. In 1965 he was joined by a second physician, who assisted in teaching the now seven-year curriculum, leading expeditions into the mountains behind Dharamsala to collect herbs and manufacturing 165 principal drugs. With 15 students graduating to join the 150 or so doctors practicing Tibetan medicine outside of Tibet and plans underway for a research wing, a museum and nine outpatient clinics in the settlements, Dr. Dhonden resigned from the Center in 1969. Opening a private practice in McLeod Ganj, he continued to see the Dalai Lama, taking his pulse each day just after sunrise, until in 1978 another physician was appointed to assist him. Dr. Dhonden was then freed to introduce Tibetan medicine to the West.

“THE INFORMATION REQUIRED before Tibetan medicines could be approved for use in the United States would take an army of lab technicians years to develop,” commented Dr. Gerald Goldstein, speculating on the future of an exchange between Tibetan and Western doctors as Yeshi Dhonden’s visit in Virginia drew to an end. “Each ingredient must be individually identified, purified from its crude state and then thoroughly tested. Who is going to pay for it?” “Research today is a cost-benefit situation,” concurred Dr. Donald Baker. “How is a drug company going to collect all of these medicines in northern India and still make a profit at it?” “The impetus for the work, though, is clear,” added Dr. Goldstein. “Over one third of our pharmacopoeia comes from plants and microorganisms, specifically some of our oldest and most effective cancer drugs. These are just the sort of materials Tibetans have acquired experience with over centuries of use. Personally, I think the drug companies are missing a bet. Some of these medicines are definitely going to be active.”

In the East, the bet has not been missed. Whereas Peking destroyed every institution of the old Tibet soon after 1959, it preserved and later expanded Mendzekhang. Now called the Hospital of Tibetan Medicine, Mendzekhang’s 127-member staff treats 700 to 800 patients a day. Though the doctors have been forced to curtail their unique knowledge of the mind’s relation to the body (considered, as a basic component of Buddhist teachings, anathema), volumes of color photographs cataloguing medicinal plants have been compiled, while many of the most valuable herbs indigenous to the Himalayas have begun to be cultivated on high-altitude farms. Concurrently, Tibetan drugs are in widespread use throughout mainland China though they are referred to as Chinese in origin and not Tibetan.

“Tibetan and Western medicine begin from completely opposite standpoints,” said Dr. Dhonden, summing up his view of the two sciences after visiting the United States. “To start with, a Western scientist looks through a microscope to examine the cause of a disease in terms of its molecular particles. Only then does he take into account the particular patient. Tibetan doctors begin with the patient. We consider his disposition in terms of wind, bile and phlegm. And then we approach the disease. The difference, I feel, makes for weakness and strength in both. We lack many of the symptomatic treatments modern physicians possess. On the other hand, it would be useful for Western doctors to understand the Tibetan presentation of the humors, their balance and imbalance in the human body. Without this, their medical system remains incomplete. It cannot establish a clear view of the correct causes and conditions governing all disease. If young Western doctors would come and train with us for a period of years—as well as relating their own system’s analysis of disease—then, I feel, a true exchange could occur. So each of us it seems,” he concluded, judiciously, “has something of value to learn from the other.”