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History, Current Situation and Development of Traditional Tibetan Medicine

Qing Jia Ren, Jun Jie Bai, Ma Ci Ren Ni

PII: S2095-7548(20)30061-2
DOI: https://doi.org/10.1016/j.jtcms.2020.06.009
Reference: JTCMS 282

To appear in: Journal of Traditional Chinese Medical Sciences

Please cite this article as: Ren QJ, Bai JJ, Ren Ni MC, History, Current Situation and Development of
Traditional Tibetan Medicine, Journal of Traditional Chinese Medical Sciences, https://doi.org/10.1016/
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 History, Current Situation and Development of
Traditional Tibetan Medicine
Traditional Tibetan medicine (TTM) is a miracle of the treasury of

traditional Chinese medicine (TCM) and has a history of more than 3900

years according to the history of the Tibetan Ben Religion literature. As

early as the ancient times, the ancestors of the Tibetan people living in the

snow-covered plateau gradually got to know the properties of plants and

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minerals and their applications in treatment during their production and

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fight with the nature. In hunting they began to know the pharmacological
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action of some animals. According to legend in the 3rd century BC there
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was a saying "toxicity means medicine", which tells us the principle of

"counteracting one toxin with another", or "toxin makes medicine", based

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on which traditional Tibetan medicine developed. Thus the formation and

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development of TTM has strong regional features, and is also influenced

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by Tibetan Buddhism, ancient traditional Chinese medicine, Indian

Ayuveda medicine and Unani medicine. Education of traditional Tibetan

culture, including TTM, is mostly practiced in temples. In the history of

Tibetan education, temple education has been considered as the

mainstream, so temples are the cradle for training talents of Tibetan

culture. Many temples, in the long period of social development, have

cultivated a lot of talented people, collected and preserved an immense

number of ancient classic books. They have also made brilliant

achievements in architecture, sculpture, painting, astronomical study,

health and medicine, thus having made indelible contributions to

promotion and inheritance of the outstanding Tibetan culture.

With regard to the origin of Tibetan medicine, more and more people

advocate that it was formed during the Ben Religion, an early religion

originally developed by the Tibetan people on the Qinghai-Tibet Plateau.

Historians of the Ben Religion have mentioned that there were nine

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medical collections, including the Yi Fang Si Bu (Four Volumes of

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Medical Classics) found in Tanjur, which has covered extensive contents,
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a complete theoretical system, and rich in clinical practice. It is also
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believed that during the period of the Tibetan King Nyatri Tsenpo, there

was a pill called "Tu Jun Wang Ri" taken from the skull of the animal,
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which was recorded in the Du Yao Liao Fa (Poison Therapy) edited by

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Tibetan medical physicist Dimagexi Danzengpingcuo and written by

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Jiebu Chisi, the apprentice of Shenrao Miozzi, the founder of the Ben

Religion. This book is now available and accessible by people.

In the 4th century Bichi Gechi and Bichi Lazi ,two ancient Indian

physicians went to Tibet and passed on the knowledge of five medical

canons, including Mai Jing (Classic of Pulse), Yao Wu Jing ( Classic of

Medicinals), and Zhi Shang Jing ( Classic of Trauma), which promoted

development of traditional Tibetan medicine. In the 7th century Srongtsen

Gampo, the Tibetan ruler, invited three physicians representing three

ancient medical school systems from ancient India, China mainland and

Caliphate, to translate five books into Tibetan, namely Da Xiao Sha Li

(Big and Small Sand) and Su You Zhi Bei Fa (How to Prepare Butter) by

Bharadevaja, an ancient Indian physician, Shang Shu Lun (On Trauma

Healing) by Hanwen Hangde, a physician of Han nationality, Yi Shu Wen

Ji (Collected Works of Art of Healing) and Ji Kongque Yinwu Bing Zhi Fa

(Treatment of Chicken, Peacock and Psittacosis Disorders) by Galinu, a

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physician of Caliphate. Afterwards, they worked together and compiled

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Wu Wei De Wu Qi (Fearless Weapons) and Men Jie Qin Mo (Complete
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Medical Works) after Wen Cheng Princess was married to the King of
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Tibet bringing many medical classics with her.

In the reign of Trisong Deutsn, a Tibetan ruler, traditional Tibetan

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medicine witnessed quick development. The King of Tibet invited

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highly-reputed medical scientists from neighboring countries including

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India, Nepal, China, Tu Gu Hun and Turk and worked with them to

translate works of traditional medicine from other ethnic groups and

compiled the most complete existing Tibetan medical works Somaratsa

(namely "Yue Wang Yao Zhen") and so on. Also in this period, nine

distinguished physicians came to the stage of the Tibetan medical history.

Among them Yutuo Nyingma Yundeng Gongbu (708-833), was the most

famous one. He served Tsenpo as the royal physician in the Tuby dynasty

and was the founder of the Tibetan medical theoretical system. He

travelled all over Tibet to collect folk remedies and summarized folk

medical experience. He also visited Mount Wutai, India and Nepal and

officially took famous physicians as his master to study medical theories,

and absorb the essence of different medical cultures. Eventually he wrote

Si Bu Yi Dian the (Four Medical Tantras), known as the world-famous

Tibetan Medical Canon (See picture 1, Jinzhi edition). Its publication is a

symbol indicating formation of traditional Tibetan medicine with unique

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characteristics.

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Yutuo Nyingma Yundeng Gongbu
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headed a delegation composed of his

disciples including Dewabai and went

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to Miling County (currently Nan Yigou

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Township, Miling County), Nyingchi Prefecture and built the first school
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of TTM for training medical professionals. The school was named

"Sudarsana—good to see the city" or "TTM City". He personally chaired

the school, which was funded by his savings and donation from Rubu

Sanbu. The school, exercising 3-9 years' program, applied the Four

Medical Tantras as the textbook. It also formulated a consummated

teaching system and tasks covering teaching system, teaching materials,

academic degree and academic examination. It, for the first time,

established the TTM Academic Degree System and cultivated thousands

of graduates with academic degrees, which were divided into four types

based on academic performance, namely "Gajuba", "Dizaba". "RanJunba"

and "Benranba" are equivalent to doctor, master and bachelor in the

modern education system. Strict assessment content and assessment

systems were available for the award of four degrees. According to

records, the school issued "Benranba" and "Ranjunba" to 50 qualified

students, respectively, and "Gajuba" and "Dizhaba" to 100 students. Yet

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no record could be found on when and why the school was closed. From

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the existing site of the school, however, we can image the unprecedented
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scale and the unprecedented education development model of the school
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and it great contribution to the development of TTM.

During several hundred years after the first TTM school, no new
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TTM education institution and cultivation base was built, so that only the
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master-apprentice system was adopted to cultivate TTM professionals. In

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the 14th century, two TTM schools appeared, namely Jiampa School and

Suka School. They both made further studies of the medical theories,

therapies and identification of medicinal herbs based on the Four Medical

Tantras, to open a period of "letting a hundred flowers bloom and a

hundred schools of thought contend", which forcefully promoted

development of TTM theories. Physicians wrote books and developed

theories one after another, to produce outstanding canons of medicine and

notes and commentaries on Four Medical Tantras.

 In the 17th century, the fifth Dalai Lama, with the aim to advance

TTM, advocated training of more medical professionals and thus aroused

a new upsurge in development of TTM. In 1643, in the west hall of

Drepung Monastery, he set up a medical academy known as

"Zuopanlang" headed by Nitangzhonggan Luosangjiacuo and managed

by Qiange Nangsuo Dajie. In Shigatse he established "Changsong

Duibailang", known as the "Immortal Assembly", managed by Charongba

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Cidanduojie. The fifth Dalai Lama wrote in person the regulations on

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teaching and management in about ten thousand words. This precious
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document is now kept in the archives center of the Tibet Autonomous
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Region. Afterwards, Rosan Jiachu, a famous physician, set up another

medical school in Sampni Matang. In addition, a new medical school was

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set up in Lawangjue, the eastern turret of the Potala Palace and headed by
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Qiange Nangsuo Dajie and managed by Damo Manran Baluosang Qiezha

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(See Picture 2, "Lawangjue" TTM school). The school also provided

living allowances and necessary facilities to the students. Since the fifth

Dalai Lama attached great importance to training of TTM professionals,

most of the students passed examination of the Four Medical Tantras.

Although TTM got flourished in his period, it was a pity that in 1682,

several years after his death, all the medical schools were closed because

of improper management or shortage of fund.

In 1696, to fulfill grand of the fifth

Dalai Lama, his disciple Disi Sangjie Jiacuo set up a medical college on

the Yaowang Mountain (Mount of King of Medicine), just opposite to the

Potala Palace. The college was named the "Medical College of Mount of

King of Medicine", the biggest medical college in modern Tibet history

(See picture 3, frescoes in the college, Picture 4, former site of the

college). To guarantee long-term development and management

mechanism of the college, Disi decided all the students were admitted

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from all the Tibetan temples under the local government of Tibet. The

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local government had the power of appointing leaders of the college, and
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in turn the local government assumed the responsibility for infrastructure
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construction, faculty, improvement of teaching attachments, which as a

result, solved the problems facing development smoothly. After

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establishment of the college, Disi Sangjie Jiacuo appointed Damo

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Manranba Luosang Qiezha and Zhaba Gelong Luosang Awang to take

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charge of the teaching affairs. It exercised a 9-year system, divided into

three levels, namely the lower, middle and higher one. It also provided

opportunities for students to receive clinical training, and do field work in

local small pharmaceutical factories. The curriculum of the college

covered two parts: medicine and Buddhism. In terms of medicine, besides

learning the Four Medical Tantras, other textbooks also included

Annotation to the Four Medical Tantras, Mi Jue Bu Yi (Addendum to

Secrets), Jing Zhu Ben Cao (Jinzhu Materia Medica), Yi Xue Gai Lun
Xian Ren Xi Yan (Introduction to Medicine), Shi Yong Yi Xue Xuan Ji · Da

Ri Guang Cang (Practical Medicine Collection), and Yu Tuo Xin Yao Mi

Han (Yutuo’s Secret Documents). Meanwhile, students learned Buddhism

and took part in religious activities. Students had regular classes and also

received teachers’ face-to-face guidance and took part practice as well as

detailed contents and daily activities including identification of herbs in

the field, practical operation training and examinations on learning by

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heart. On Mondays, Tuesdays, Thursdays and Saturdays, students spent

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all the time on learning the Four Medical Tantras; on Wednesdays and
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Fridays they did practice. Every week or for a certain period of time, each
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student must go to the principal in charge to recite the Four Medical

Tantras one by one, a practice carried forward to this day. Upon

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graduation, the system of awarding the Geshe degree by three temples in

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Tibet was strictly exercised. Those who passed all four examinations of
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the Four Medical Tantras were awarded with the "Kanbu" degree.

Students who failed to pass the examination after nine years of study in

the school would be expelled and then new students recruited. In such a

way, many eminent physicians had been trained, for example, Gesang

Jiacuo, royal physician of the 7th Dalai Lama, Jiayang Kezhu, royal

physician of Zhangjia ·Rubeiduojie, teacher of Emperor Qianlong, and

the celebrated figures such as Zangman Yexi Sangbo, Jiayanggesang,

Gesangqunpei, Gesang Yapei, and Qianrao Nuobo, who were eminent

monks with profound medical theories. Also during this period, some

famous temples, Ta'er Temple, Labuleng Temple, Xiaqiong Temple,

Lajia Temple, Saiku Temple, Youning Temple, Lamu Deqing Temple,

Dege Temple and Lamu Temple successively set up medical colleges in

Andu and Kanba (currently Qinghai, Gansu and Aba and Ganzi

Prefecture of Sichuan), which gradually became the Tibetan medical

education base and medical and health center. In 1745, Beijing’s Lama

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Temple set up a TTM school too and the notable temples in Hali Hage

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Xihuoer, Inner Mongolia established TTM schools to cultivate Tibetan
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medical professionals from different ethnic groups, mainly the Mongolian
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ethnic group.
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 In 1916, on the site of the former Medical College of Mount of King

of Medicine a new college was established, known as "Menzikang" or the

College of Medicine and Astronomical Study (See Picture 5. the former

site of Lhasa "Menzikang"(TTM hospital)), with Qinrao Luobu as the

president. Qinrao Luobu widely recruited disciples and spread medical

theories. He set up two majors: medicine and astronomic study and

graduates were divided into three levels, namely the lower, middle and

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higher level. Initially, the medicine program required 3 years, the

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astronomic study program 2 years, and the two-major program, 5 years.
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Later, the medicine program was changed to 5 years, the astronomic
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study program 3 years, and the two-major program, 8 years.

Basic theories of TTM consist of the

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"doctrine of five sources" and "doctrine

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of three causes". The former refers to

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earth, water, fire, wind and vacancy,

while the latter "Long", "Chiba" and

Peigen". Both are used to elucidate physiological and pathological

activities of human, pharmacology, diagnosis, treatment and health

preservation, making the key of Tibetan medical theory. The two

doctrines were first raised by Yutuo·Yundan Gongbu (708-833) in the

classic works The Four Medical Tantras. Under his teaching, the Tibetan

physicians made efforts to improve Tibetan medical theories. As a result,

more outstanding practitioners came to the stage, such as

Songdunyixisong, Qiangba·Langjiazasang, Suka·Luozuijiebu,

Disi·Sangjiejiacuo, who wrote more than 100 books including Yue Wang

Yao Zhen (Somaratsa), Lan Liu Li (Blue Colored Glaze), Qian Fang She

Li (Qianfang Sarira), Zu Chaun Kou Shuo (Ancestral Oral Teachings).

After peaceful liberation of Tibet, CPC and the Chinese government

attached great importance to TTM development. Thanks to strong support

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of the Party Committee of the Autonomic Region, more than 50 Tibetan

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medical practitioners were trained from 1963 to 1973. The Lhasa Health
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School set up a special class for TTM from 1974-1981 and trained more
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than 140 Tibetan practitioners, which marks the beginning of modern

Tibetan medical education. The Traditional Tibetan Medical School

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established in 1983 trained about 130 talents until 1989. In September,

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1989 the Traditional Tibetan Medical School of the Tibet Autonomous

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Region and the Traditional Tibetan Medicine Department of Tibet

University (starting from 1985) were incorporated to form the Traditional

Tibetan Medicine College of the Tibet University. After the reform and

opening-up in 1978, the Traditional Tibetan Medicine Research Institute

and Astronomy Study Institute were established. In February, 1993, with

approval of the State Education Commission, the Traditional Tibetan

Medicine College was separated from the Tibet University and became an

independent college with the name of College of Mount of King of

Medicine (but still called Tibet Traditional Tibetan Medicine College). In

July, 2001, the Ministry of Education approved College of Mount of King

of Medicine to be renamed as Tibet Traditional Tibetan Medicine College.

On June 24, 2016, Tibet Autonomous Region Government and State

Administration of Traditional Chinese Medicine signed an agreement

on joint establishment of Tibet Traditional Tibetan Medicine College,

which in 2017, became the "2011" TTM Regional Corporative

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Creation Center. In 2018, The College was authorized to grant TTM

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doctoral and master’s degrees. In the same year, with the approval of
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Ministry of Education, the College was renamed Tibet University of
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Traditional Tibetan Medicine. Over past 30 years, it has cultivated more

than 6,000 professionals, established 2 studios of TCM masters, 14 TTM

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inheritance studios, 9 grassroots-level expert inheritance studios and 20

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autonomous region level famous expert inheritance studios. So far it has

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cultivated 2 national TCM masters, 1 TCM specialist, 3 national

outstanding TCM masters, 1 national TCM and herbal master and 36

celebrated TTM practitioners, making great contributions to the

development of TTM. In May 2018, the Four Medical Tantras was

elected to the Asia/Pacific Regional Register of MOW.

The TTM Development Congress held in 2014 clearly stipulated the

guidelines, principles and missions for development of TTM. The Outline

for the TCM Development Strategy Planning of the Tibet Autonomous

Region (2016-2030) issued by the Tibet Autonomous Region in 2017

provided a favorable policy environment for TTM development. Today,

the TTM service system has been consummated with establishment of 43

public TTM institutions with in-depth standardized management and

connation construction, 5 country-level clinical specialties, and 7 key

specialties under the State Administration of Traditional Chinese

Medicine. Besides, 289 kinds of hospital preparations have obtained 1031

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registrations, and 352 kinds of Tibetan medicinals and 128 kinds of "Ka

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Cha" have been listed in the Catalogue of Basic Medicines and
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Traditional Tibetan Medicines of Tibet Autonomous Region. There are
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2,412 TTM beds in the Region, with number of patients reach 3.29

million annually. 89% of township hospitals and 38% of village clinics

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are capable of providing Tibetan medicine services.

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In the 21st century, both development needs of contemporary

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science and technology and improvement of China's higher education

system all require forward-looking perspectives to analyze and predict the

future prospects and development trends of higher education on TTM.

The Outline of the National Medium- and Long-term Education Reform

and Development Plan (2010-2020) has stated that by 2020, the higher

education structure will be more reasonable and boast more distinctive

features, and the overall level of personnel training, scientific research,

and social services will be improved in an all-round manner. A group of

internationally renowned, featured and high-level advanced education

institutions will be built. A host of universities will reach or approach the

level of world-class universities. The international competitiveness of

higher education will be significantly enhanced. It has explicitly required

that higher education shall optimize its structure and create unique

features. The Outline has given a clear direction for development of the

higher education specialty system with Tibetan characteristics.

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The lack of medicine in the Tibet Autonomous Region, especially in

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remote areas, has always been one of the important difficulties affecting
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people's health. Traditional Tibetan medicine has played a supporting role
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to a large extent, but failed to solve this problem fundamentally. In Tibet,

the development of Tibetan medicine and lack of talents is the core. In

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terms of modern scientific research, the rapid development of technical

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research has played a vital role in promoting the research of Tibetan

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medicine. Currently, there is still much space for research on Tibetan

medicine. In terms of industrial development, the cultivation and

production of herbal medicines has not yet taken shape. Vigorously

promoting the cultivation of suitable herbal medicines in the Tibet

Autonomous Region will help improve the natural environment, help

promote employment, and elevate living standard and quality of life.

Especially the establishment of the industry-university-research

integration model can effectively ease the problem of lack of talents,

insufficient resources of medicinal materials, inadequate jobs, and low

levels of research and production.

Traditional Tibetan medicine is a treasure of China's national

medicine. This is the common aspiration of our entire nation to ensure

happiness and health of all the people. In the foreseeable future, we have

reason to believe that it will bring more health and well-being to people

all over the world!

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Figure: Graduation Seal of Lhasa Medical College of Mount of King of Medicine

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Figure: Diploma of Medical College of Mount of King of Medicine in 1696

Figure: Diploma of Lhasa Menzikang

 Figure: Traditional Teaching Thangka --- —Tree

Illustration Picture

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