What it is
The fourth great field is Sowa Rigpa, the science of healing. It is a complete system: an account of how the body works, a method of finding what has gone wrong in it, and a pharmacy and set of practices for putting it right. It has been practised without interruption for at least eight centuries across Tibet, the Himalaya and Mongolia, and it is practised today in hospitals and clinics from Lhasa to Dharamsala to Ulaanbaatar.
Where it comes from
At the centre stands the Four Tantras, the Gyüshi: the Root, Explanatory, Instructional and Subsequent tantras, which the tradition associates with Yuthok Yönten Gönpo the Younger in the twelfth century and traces beyond him to the teaching of the Medicine Buddha. The Root Tantra teaches the whole subject as three trees. The tree of the body has two trunks, health and illness; the tree of diagnosis has three, observation, touch and questioning; the tree of treatment has four, diet, conduct, medicine and external therapy. Each trunk carries its branches, each branch its leaves, and a student memorises the entire structure before reading a word of the detail. It is a map of the field drawn as a living thing, and it is why a Tibetan physician can hold the whole of medicine in mind at once.
The body is understood through three principles, the nyepa: wind, bile and phlegm, formed from the five elements. Health is their balance and illness their disturbance. The physician reads the pulse at the wrist, examines the urine, and asks. Treatment begins with food and conduct, proceeds to medicines compounded from dozens of ingredients, plants above all, but also minerals and metals refined by elaborate processes, and reaches, when needed, for the external therapies: moxibustion, bloodletting, cupping, and the oil massage called kunye.
In the seventeenth century the regent Desi Sangye Gyatso wrote the Blue Beryl, the commentary that became the standard, and then had the whole of it painted: seventy-nine thangkas of anatomy, embryology, plants, pulses, instruments and the trees themselves, so that a student could see what the text described. In 1696 he founded the medical college on Chakpori hill in Lhasa. In 1916 the Thirteenth Dalai Lama founded the Men-Tsee-Khang, the Institute of Medicine and Astrology, and it was refounded in exile in Dharamsala in 1961, where it trains physicians and makes medicines to this day.
What is at stake
A physician, an amchi, must know the plants in the field as well as in the book: where each grows, when it is gathered, how it is dried and cleaned and combined. That knowledge passes from teacher to student on the mountainside, and the mountainsides are changing. Some ingredients are now rare; some preparations are known to very few; some lineages of practice are down to a handful of people. Medicine is the field in which Tibet’s own conservation project, the Desi’s, is most complete, and it is still not safe.
On Genla
Medicine holds the Four Tantras, the three humours, diagnosis, the materia medica, the therapies, diet and conduct, and the history of the lineages and institutions. The trees of the Root Tantra will be the field’s first drawn subject.