BOOK REVIEW 

Tibetan Medicine:  The Buddhist Way of Healing DR. DOLKAR KHANGKAR

The author, DR. DOLKAR KHANGKAR, was born in 1959, in western Tibet, and graduated from Men-Tsee-Khang in 1978. Being the daughter of the Late Dr. Lobsang Dolma Khangkar (Ama Lobsang), she has been exposed to a long family tradition of Tibetan medicine. Today, she runs clinics in Delhi and Bombay, travels extensively abroad to teach Tibetan medicine and specialises in herb collection in the Himalayas. Apart from Dr. Dolkar, a second author, BELA BUTALIA, is mentioned on the inside book cover without any further background information provided.

   Tibetan medicine: The Buddhist Way of Healing, recently authored by Tsewang Dolkar Khangkar, Doctor of Tibetan Medicine, reflects a common trend among promoters of Tibetan medicine. It is encouraging to see Tibetan medical doctors themselves publishing books on Tibetan medicine in English. Many publications in modern languages have been written by authors who are themselves not practitioners of Tibetan medicine and often do not know the Tibetan language, resulting in a series of quite superficial introductory writings. But it is unfortunate to see a Tibetan doctor, who has access to all primary medical literature in the Tibetan language, duplicate such Western authors, using secondary literature.

 Although this type of coffee-table book will further the interest on Tibetan medicine among the general readership, it is a step into a direction that will not help to thoroughly study the science of Tibetan medicine. If, perhaps half a century from now, or hopefully earlier, Tibetan medicine will be taught professionally to non-Tibetans (other than in weekend workshops) and presented in its full capacity and knowledge, detailed text books and translations of original material with commentaries are absolutely mandatory. Qualified Tibetan doctors could contribute a lot to this process.

Khangkar is following a popular trend: glossy cover, Buddha images and other traditional Tibetan designs. The unique and illustrative Tibetan medical thankas are very appealing and will certainly help to sell the book. They could have been helpful tools for the author too, but she chose to describe the principles of Tibetan medicine, once again, superficially.

 The attractive layout promises more than the book delivers. About 80% of the content can be found in previous publications on the topic. Numerous paragraphs have been taken word-for-word from Terry Clifford's book The Diamond Healing [1] without acknowledging the source.

Khangkar’s book comprises six chapters, four of which duplicate previously published introductory writings, explaining a brief history of Tibetan medicine, the three-humoural theory, the ways of diagnosis and prognosis and Tibetan psychiatry. Khangkar’s chapter on materia medica, however, is illustrative and based on her own practical experience in Tibetan pharmacology.

 Her narration of the mythological stories on Yitrogma (Tib. yid phrog ma), published earlier by her mother [2], as well as by Clifford (pp. 30), read beautifully. However, it would have been helpful to add the sources of these myths, as they do not appear in the Gyushi (Tib. rgyud bzhi).

 Some of the headlines are captivating: ‘The Diamond Healing’ (actually the title of Clifford’s book, here a chapter on Tibetan medical history), ‘Tears of the Boddhisattvas’ (on materia medica) and ‘The Precious Essence of Mind & Sorrow’ (on demons and Tibetan psychiatry). But the content is rather disappointing.

 Chapter One contains a summary of Tibetan medical history, unfortunately with errors that are not expected from a Tibetan doctor. Already the first sentence, “Tibetan medicine derives from Indian Ayurvedic knowledge,” (Khangkar, hereafter cited as K, page 7) is only partly correct. Tibet’s indigenous streams of Bon and folk traditions, along with Indian, Chinese and Persian influences, were molded into what we now call Tibetan medicine.

 Some factual errors need correction: King Trisong Deutsen  (Tib. khri srong lde’u btsan) reigned not in the early 7th century (K, 7) but from AD 755-797. Khangkar’s statement that Vagbhata authored the Sanskrit original of the Gyushi  (K, 7) has never been proven. If there even was a Sanskrit version of the early Gyushi, it has been lost, and to date neither its existence nor authorship has been confirmed. In this context, most scholars do not mention Vagbhata but rather Vairocana, who is said to have received the teachings of the Gyushi from the Kashmiri Pundit Dawa Gaba (Tib. zla ba dga’ba, Skt. Candrananda; Karmay, 1989, p. 20). The original Sanskrit medical work by Vagbhata that still exists in its original Sanskrit version is the Ashtanga Hridaya Samhita (Murthy, 1991, 95, 97). This text was translated into Tibetan by Rinchen Zangpo (Tib. rin chen bzang po; AD 958-1055) and Jarandhara in the 11th century, and is entitled yan lag brgyad pa’i snying po bsdus pa. Some scholars hold the view that this work by Vagbhata strongly influenced the creation of the Gyushi (Emmerick, 1977).

 According to the Tibetan tradition, Nagarjuna (2nd century AD) is said to have authored numerous medical and allied works (Dash, 1985, p. 66). Five of his Ayurvedic treatises have been included in the Tanjur (Tib. bstan ’gyur; Dash, 1985, pp. 9).   Khangkar mentions only three works (K, 8), and her statement that “the original Sanskrit versions of these works have been lost to posterity,” does not apply to the Yoga-Sataka. Its Sanskrit version is available and has been published along with its Tibetan and English translations and a commentary by Vaidya Bhagwan Dash (1985).

  Repeating the statement of several previous publications on Tibetan medicine, Yuthog Yontan Gonpo the Younger [3] (Tib. gyu thog yon tan mgon po gsar ma) is once again mentioned as the author of the medical work The 18 Auxiliary Aids (or The 18 Implementations; Tib. cha lag bco brgyad; K, 10). A comparative study based on four different Tibetan historical sources has shown that only eight of the 18 texts are likely to have been written by Yuthog (Texts 11, 13 and 17 with certainty and Texts 7, 9, 10, 14 and 15 most likely). The other texts have originated either from his students or other physicians related to the lineage (Taube, 1981, pp. 39).

  The institution of the Dalai Lamas was established in 1578 through the visit of the third Dalai Lama Sonam Gyatso  (Tib. bsod nams rgya mtsho; AD 1543-1588) to Mongolia, not in the late 17th century (K, 10). Also, to call Desi Sangye Gyatso (Tib. sde srid sangs rgyas rgya mtsho; AD 1653-1705), who was the regent of the fifth Dalai Lama, “prime minister of Tibet,” as she does (K, 10), is politically rather inappropriate.

 The Chakpori Medical College in Lhasa did not house a hospital. [4]  Moreover, the 79 medical thankas were not painted by Desi Sangye Gyatso himself (K, 13). He steered their creation as well as the establishment of the Chakpori Medical College following the wish of the fifth Dalai Lama, who died 14 years before Chakpori was established.

Khangkar  mentions that the vaidurya ngon po [5] by Desi Sangye Gyatso is “the third and most important commentary on the Gyushi,” and that the “earlier two commentaries had been written in the 14th century by two famous Tibetan doctors, Jangpa and Zurkapa,” (K, 10). This error has been copied from Clifford (p. 59). Khangkar and Clifford both must be referring to Jangpa Namgyal Trazang (Tib. byang ba rnam rgyal grags bzang; AD 1395-1475) and Zurkha Nyamnyi Dorjee (Tib. zur mkhar mnyam nyid rdo rje; AD 1439-1475), two active physicians and authors of the early and mid 15th century. The latter wrote the famous commentary man ngag bye ba ring brsel [6] and several other commentaries (Yontan, 1988, p. 109). The former alone authored twelve commentaries on the Gyushi (Yontan, 1988, p. 97). Still, these are not the only commentaries on the Four Medical Tantras. Commentaries were written abundantly by various doctors throughout the centuries since the Gyushi became popular in Tibet in the 11th century. Another very famous commentary on the Gyushi that was written prior to Sangye Gyatso’s vaidurya ngon po is the mes po’i shel lung [7] by Zurkha Lodo Gyalpo (Tib. zur mkhar blo gros rgyal po; AD 1509-1579). A complete bibliography on all of the commentaries on the Gyushi is yet to be compiled.

Khangkar’s description of the Gyushi mentions that “the Last Text or Uttantra is basically an explanatory account of the first three Tantras” (K, 15, copied from Clifford, p. 99). This is incorrect in so far as the ‘Last Tantra’ (phyi ma’i rgyud) is devoted to pulse and urine diagnosis, pacification, evacuation and accessory therapies, all of which have not been explained in detail in the previous Tantras. The contents of the ‘Last Tantra’ are, however, correctly listed by Khangkar on page 17.

 In Chapter Two, the author takes the reader on an introductory journey through the principles of Tibetan medicine. The humoral theory with the five different kinds of wind, bile and phlegm are explained, concluding with dietary advice on how to keep the humours in balance and thus remain healthy.

 Once again, the difficulty in finding exact English equivalents for Tibetan medical terms becomes apparent. For example, Khangkar translates rlung, one of the three humours, as ‘vital energy’. But she also uses ‘wind’, ‘air’ and ‘energy’ as synonyms for rlung throughout the text. The term ‘energy’ is too freely used and undefined: the five elements (Tib. ‘byung ba lnga) are called ‘cosmic energies’, the seven bodily constituents (Tib. lus zungs bdun), ‘physical energies’ (K, 23), and rlung itself is also ‘energy’ (K, 25).

 A few coloured anatomical medical thankas depict a brief view on the Tibetan understanding of human anatomy, but without any detailed explanations, as the subject turns to ‘Diagnosis and Prognosis’ in Chapter Three. Visual diagnosis, and diagnosis by touch and interrogation are briefly explained here. Khangkar’s recommendations on diet and behaviour (K, 45) mostly relate to the traditional diet of  Tibet (for example, fermented barley beer and meat of high altitude animals). Also, the translations from ancient Sanskrit texts, recommending staying in the shade of a sandalwood tree to treat bile imbalances, are outdated. For the Western reader it would have been more helpful to adapt the Tibetan medical principles, which are universal in their character, into a modern diet and behavioural world.

 The classification of diseases are listed in chapter twelve of the second Tantra of the Gyushi. Referring to this classification, Khangkar talks about “imaginary diseases caused by demons” (K, 43), which are treatable by ritual means. Even if, as Khangkar later explains in her chapter on psychiatric diseases, ‘demons’ are a symbolic term and only “forces of life and emotion that can drive the mind insane” (K, 71), the diseases caused by them are very real to the patient and cause tangible suffering, which perhaps should not be called ‘imaginary’. The more appropriate English translation by Barry Clark (1995) reads, “... disorders (caused by) spirits and imputed (by the mind),” (Clark, 1995, p. 97).

In Chapter Four, Khangkar gives an outline of the Tibetan materia medica and preparations of medicines, beginning with the mythical past and the stories of Yitrogma and the legendary mountain Tanaduk (Tib. lta na sdug).  In the Gyushi, the Goddess planting the medicine is called Lamo Dutsima (Tib. bla mo bdud rtsi ma; TMAI, 1993, p. 329). Khangkar writes that Yitrogma is an emanation of Goddess ‘Dusolma’, which should probably read ‘Dutsima’ (copied from Clifford, p. 50).

Chapter twelve of the second Tantra of the Gyushi on the classification of illness, mentions 404 diseases (Tib. nad bzhi brgya rtsa bzhi), which apply to four different categories, totaling to 1616 diseases (Chakpori Medical Institute, 1993, p. 34).  These are mentioned by Khangkar on page 15. But later she talks about 424 diseases (K, 54).

Further, while trying to explain the link between Tibetan medicine and Buddhism, Khankar writes, “There is believed to be a vital link between the origins of medicines and Buddhism, as certain medicines are considered to benefit diseases coming from wind, bile and phlegm,” (K, 52). The fact that certain medicines cure imbalances of the three humours cannot be a logical reason for linking the origins of Tibetan medicine with Buddhism. While not denying this link, the explanations given in this book are unsatisfactory.

The Fifth Chapter of the book deals with the treatment of psychiatric disorders. Its contents have mostly been taken directly from Clifford’s book. Khangkar then continues in a way which leaves the reader with a lot of unanswered questions. The chapter devotes its greater part to explaining that there are no living demons in Tibetan medicine but that they are merely a ‘symbolic term’ (K, 69, copied from Clifford p. 148). However, in Khangkar’s chapter, the ‘symbolic term’ sounds apologetic, as an attempt to turn Tibetan demonology into the more scientific Western subject of psychiatry, or into what she may believe are Western concepts, like ‘it is all in your mind’. It is evident from history that Tibetans have a very integrated belief of elemental spirits, demons and all kinds of beings of different realms with good and harmful effects on humans. Tibetan traditions teach the pacification and transformation of these beings through rituals. Khangkar clearly sets apart such ‘magic’ from the actual Buddhist ‘religion’ (K, 68). Later, however, she mentions that “tantric and anti-ghost procedures of exorcism are also resorted to ... as religious medicine,” (K, 74). The confused reader is left with the question of what part of Tibetan psychiatry is considered to be ‘magic’ and what is termed ‘religious medicine’.

 Although from a spiritual point of view “anything whatsoever that obstructs the attainment of liberation is a demon,” [8] later in the book we come across ‘spirits’ and ‘ghosts’ which remain undefined. We read that the presence of a ‘ghost’ can be diagnosed through pulse and urine analysis (K, 71), and that psychiatric disturbances can be caused by harmful ‘spirits’ (K, 74). But the reader never comes to know how ‘ghosts’ and ‘spirits’ are defined in contrast to ‘demons’. Are they synonyms for ‘demons’ and thus also ‘symbolic’, or are they living beings? The reader will find no answer in this book. Comparatively, Clifford is much more profound in her later expositions on ‘spirits’ and ‘ghosts’, and she admits their existence on the supermundane level. She also stresses the need to protect oneself from their harmful influence. Only on the plane of the ultimate Truth have they no inherent existence (Clifford, 1986, p. 161).

 Regarding the evaluation of Tibetan drugs, Khangkar explains that Tibetan medicine is a ‘soft’ treatment of diseases, as the medicines cannot cause harm, due to their natural ingredients. Her presumption that “even if a particular cure prescribed does not help the disease, it also does not harm the patient” (K, 52), should be taken cautiously. A paragraph further, she then admits that Tibetan medicine can cause side effects, which contradicts her earlier statement. Readers should be aware that Tibetan medicines have certain contraindications, can cause side effects such as allergies, and should certainly not be viewed as harmless simply because they contain only natural ingredients.

Chapter Six of Khangkar’s book is certainly a ‘revolution’ for Tibetan medicine and it will probably cause controversy. Her ‘do it yourself’ Tibetan home remedies range from aphrodisiacs, face packs and decoctions for the common cold, gastric problems, indigestion and lung infections, to powders for jaundice and a tea for amoebiasis. Fortunately, the chapter begins with the advice that “Tibetan medicine is cautious in prescribing home remedies, and always advises consulting a doctor so that the side effects of any medication are also taken into account.” (K, 74).

 Nevertheless, Khangkar has decided to publish some of these ‘harmless herbal cures’. That some of these medical problems, like lung infections, amoebiasis, jaundice and colitis require the professional service of a qualified medical practitioner, seems obvious. If this trend is going to give rise to further publications, in the fashion of ‘The Concise Handbook of Tibetan Herbal Remedies’ or ‘The Great Guide to Tibetan Home Remedies’, a valuable medical tradition which requires deep scientific and clinical research will lose the high place among medical traditions it so rightfully deserves. Let us hope that the Tibetan doctors themselves will realise their responsibilities and abilities in this process.
 

NOTES

[1]   Clifford, T., Tibetan Buddhist Medicine and Psychiatry: The Diamond Healing, Samuel Weiser Inc., York Beach, ME, 1984). German edition:Tibetische Heilkunst, S. O. W. Barth, Munich, 1989. All page numbers referring to Clifford are taken from the  English version.
[2]    Dolma Khangkar, Lobsang, Journey into the Mystery of Tibetan Medicine, New Delhi, 1990, p. 33.
[3]    Yuthog’s dates are controversial. Some scholars, for example, Bolsokhoeva, 1993, p. 12., mention 1112-1203 and not 1126-1202 (K, 9).
[4]   This erroneous information was likely copied from Clifford, 1986, p. 59.
[5]   Full title, gso ba rig pa’i bstan bcos sman bla’i dyangs rgyan rgyud bzhi gsal byed bai dur sngon po ma lli ka, reprinted in Lhasa, 1982, 2 vols.
[6]   Full title, man ngag bye ba ring bsrel pod chung rab ‘byams gsal ba’i sgron me, reprinted in Dharamsala, 1993.
[7]   For the full titles of all three volumes see, AyurVijnana Vol. 6, 1999, p. 38, note 17. The mes po’i shal lung was reprinted in Dharamsala in 1992,  2 vols.
[8]    This citation is by Machiglabdron (Tib. ma gcig lab sgron; 1055-1145), female Tibetan master, founder of the gcod School. Khangkar, p. 71, copied from Clifford, 1989, p. 149.

BIBLIOGRAPHY

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