The Three Great Medical Systems

I.

During the time I was a student at the Shang Shung School of Tibetan Medicine, I encountered a copy of the Mirror of Beryl in the school library. The Mirror of Beryl is a 17th century text on the history of Tibetan Medicine, written by the great scholar-physician Desi Sangye Gyatso. In this work, Gyatso traces the philosophical and cultural influences on Tibetan Medicine through India, China, and Central Asia. It is a comprehensive work that illustrates the status of Tibetan Medicine as the global medical system of its time.

In the introduction to this publication, I came across the following quote:

A passage from a work called Weapons of Fearlessness, cited in Mirror of Beryl, talks of three great medical systems, and that ignorance of any one of them would exclude one from being counted among the great physicians.

—Introduction to Mirror of Beryl, p. 2

This passage is the first reference I had found that directly encouraged the study of Indian, Chinese, and Tibetan medical systems. As neighboring cultures, there is ample evidence of cross-cultural exchange between these countries in the domains of philosophy, medicine, arts, etc. The desire to integrate neighboring streams of knowledge illustrates the disposition of the great scholar-physicians of the past who synthesized these various influences into the Tibetan medical system practiced today. Tibetans, in particular, have championed an integrative approach to medicine.

As for the beginning of the appearance of medicine in Tibet, to begin with there were just some bits of knowledge about nutrition. Later the Chinese consort, brought the [text] called The Great Medical Treatise [Sman dpyad chen mo], which was translated by the monks (ho shang) Mahadeva and Dharmakosa. Then, three doctors were invited, from India – Bharadvāja, from China – Hen-weng-hang-de and from Khrom of Stag-gzigs, Galenos. They translated much from their individual schools. Jointly they compiled the seven-volume text called the Weapon of the Fearless [Mi ’jigs pa’i mtshon cha]. 4

In the 7th-8th century, the Tibetan king invited physicians from neighboring countries to exchange medical knowledge. Later, in the 17th century, Desi Sangye Gyatso invited scholars and practitioners from Europe and Asia to Tibet for a grand conference in which medical knowledge was exchanged. The famous Greek physician, Galen, also resided in the Tibetan courts. Thus, even Greek humoralism was integrated into the Tibetan system alongside Ayurvedic tridosha and Chinese zang-fu theory. The Tibetans were not shy of these facts either. The title of the Root Tantra is written in both Tibetan and Sanskrit, a way of paying homage to the Ayurvedic classic, Astanga Hridayam, which was highly influential in Tibetan medical thinking. The Tibetans were the great preservers of the existing medical knowledge of the time.

Today, Tibetan culture has been threatened since the Communist Revolution of 1959. A holistic and indigenous culture which once stood at the roof of the world has been collapsing under authoritarianism and intolerance. The fate of Tibet speaks to the fate of holism, tradition, and universality altogether. As a result, modern practitioners of Tibetan medicine are seemingly less enthused about the cross-cultural influences on their medicine, and with good reason. Tibet is often reduced to a mere synthesis of the political and cultural superpowers that surround it, particularly India and China. Tibetan medicine is typically seen as a form of Ayurveda mixed with Chinese medicine, rather than a system with indigenous roots. My teacher, Dr. Wangmo, and her teacher, Namkhai Norbu, often highlighted the uniquely Tibetan aspects of their medical tradition. Norbu points to the origins of Tibetan medicine nearly 4,000 years ago in the ancient kingdom of Shang Shung and supports his claim with historical, linguistic, and archaeological evidence (see Zhang Zhung: A History of Tibet). Further, a close study of the Four Tantras of Tibetan Medicine reveals an abundance of theoretical and clinical principles drawn from the native Bön tradition that have no parallel in Ayurvedic or Chinese medicine. In some cases, the nomenclature for some materia medica is still in the original language of the Shang Shung Kingdom. Given all of this, I find it ironic that Tibetan Medicine—the great integrator of Indian, Chinese, Greek, Persio-Arabic, and Mongolian systems—has found itself subordinated to Ayurveda and Chinese Medicine and even reduced to a mere synthesis of these two traditions.

When I graduated from Shang Shung, Dr. Wangmo addressed the class of graduates with parting words of wisdom. With great emotion, she admonished us to always remember and champion that the root of Tibetan Medicine is in Tibet.

II.

I am often asked why I pursued a study of all three systems (Ayurveda, Tibetan Medicine, and Chinese Medicine). However, it was never my overt intention to study all three systems. Rather, my medical path unfolded organically and intuitively, as I followed one thread to the next in my pursuit of a greater understanding. Now I see that my path was, in fact, rather traditional in nature.

The study of these three systems is itself paradoxical and full of contradictions that take years to resolve within oneself. As a path of study and practice, it is not one I would recommend for the faint of heart. But for those interested in challenging and broadening their perspectives, it is incredibly valuable. Initially, I found many resonances between the systems, and there can be no doubt to their common philosophical ground and orientation. But the more I studied, the more I discovered vast differences. This has required me to integrate three similar but entirely distinct approaches—at first intellectually and then in application.

Those who are familiar with the study of languages will be able to relate to my experience. A language has its own conventions but also carries within itself a unique worldview. Medicine is very much a language, a means for describing the world, according to the culture within which it arose. In clinical practice, it is challenging to hold three languages in one’s mind and hope to achieve good results. It is more important to integrate these languages as different modes of truth, discovering the universal they point to while still remaining capable of drawing upon their distinctiveness at will. In practice, each system has its strengths. There are times when an Ayurvedic diagnosis feels natural and fitting to describe what I am seeing. But I may take a Tibetan herbal approach in treatment. At other times, a Chinese or Tibetan medical diagnosis feels more fitting and accurate.

In my experience, these three systems have deep cultural and theoretical relationships. Each system has helped me to appreciate and better understand the other. Even if one does not choose to study all three systems in depth, I do feel it is very enriching to have a basic exposure to all three of the great medical systems.