This article examines the transmission of Tibetan medical knowledge in the Himalayan region of Ladakh (India), taking three educational settings as ethnographic ports of entry. Each of these corresponds to a different operating mode in the standardisation of medical knowledge and learning processes, holding profound implications for the way this therapeutic tradition is known, valued, applied and passed on to the next generation. Being at the same time a cause and a consequence of intra-regional variability in Tibetan medicine, the three institutional forms coexist in constant interaction with one another. The authors render this visible by examining the ‘taskscapes’ that characterize each learning context, that is to say, the specific and interlocking sets of practices and tasks in which a practitioner must be skilled in order to be considered competent. The authors build upon this notion by studying two fields of transmission and practice, relating to medicine production and medical ethics. These domains of enquiry provide a rich grounding from which to examine the transition from enskilment to education, as well as the overlaps between them, and to map out the connections linking different educational forms to social and medical legitimacy in contemporary India.
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Tibetan terms are first transcribed in Roman characters corresponding to their pronunciation in Ladakh for recurrent terms in this article, and then transliterated between brackets upon their initial occurrence on the basis of the scheme defined in Wylie (1959). Sanskrit terms are preceded by ‘Skt’.
We employ the term ‘pharmacy’ here as shorthand for the entire process of traditional medicine production rather than to denote biomedically oriented pharmaceutical practice.
Tibetan medicine had composite influences which stemmed mainly from the Indian, Chinese and Persian, but also Greek medical traditions, as well as from Buddhism.
Composed of versified and often metaphorical writings, the Gyushi is difficult to comprehend let alone apply in practice, making recourse to popular commentaries essential in order to explain and clarify the main text.
Two other medical institutes were established in India by Tibetan exiles, namely the Central University of Tibetan Studies near Varanasi (1993) and the Chagpori in Darjeeling (1992).
Master to disciple transmission is called guru-shes in Ladakh, which appears most likely a contraction of the Sanskrit terms guru and śiṣya (master and disciple).
Most study within Ladakh, but some travelled to Himachal Pradesh and the older generation to Tibet in search of good teachers. These options are limited by the domestic situation, agricultural commitments and wealth of the student.
Repetition is also fundamental in the process of memorising religious texts, as in the Gelug-pa (dge-lugs-pa) monastic tradition. In this context, the memory is essentially oral mnemonics (sound and rhythmic recitation environment) and non-visual (Dreyfus 2003, pp. 86, 94).
This is a reflection of practical teaching in the Tibetan world, which seems to have always been based on oral transmission rather than on texts (Meyer 1995, p. 116).
Dbang lung khrid gsum (gsum denoting the number three).
Rinpoche (rin po che) is a title of respect reserved for tulku (sprul sku), Tibetan Buddhist masters who are thought to reincarnate deliberately and with perfect mastery for the benefit of other beings.
Lama (bla ma) is an honorific title for initiated Tibetan Buddhist monks, notably those who are learned, accomplished and/or senior.
These ceremonies directly involve the amchi, but are not exclusive to them. Initiations to the Buddha Master of Remedies are one of the many possible initiations for the lay population and members of the Buddhist clergy (Garett 2009; Pordié 2007).
This type of recitation in front of other students or villagers was also practiced in ancient Tibet (Meyer 1995, pp. 117–118). The only example in the literature on Ladakh we found before writing this text simply states that: “[Over three hundred people] assembled to watch, (…), Tsewang Namgyal, undergo a stringent examination to become an amchi” (Norberg-Hodge 1992, p. 59).
Along with Men-Tsee-Khang and the Central University of Tibetan Studies, the CIBS confers on students the kachupa (dka’ bcu pa) diploma, officialised in English by the Bachelor of Tibetan Medicine and Surgery (BTMS). Two higher diplomas can then be conferred by the Men-Tsee-Khang alone. An amchi with the kachupa diploma can present as a candidate for the smanrampa (sman rams pa, an abridged form of sman pa ‘bum rams pa) on condition that he or she has 10 years of experience and a certain number of publications in the medical domain. After 20 years of experience, an amchi may then claim the smanrampa chewa (sman rams pa che ba) according to the same principle (knowledge, practice and publications), which clearly values the experiential and practical dimensions of knowledge as well as the abstract and theoretical.
“Field of knowledge” would perhaps be a more accurate translation of rig gnas. Nevertheless, several CIBS students made explicit references to the general, universal and scientific character of their medicine in its own terms, implicitly placing it on a level with other fields of contemporary systematic knowledge, such as biomedicine. See Adams (2001) for a discussion of the use of the term science as a means to depoliticize Tibetan medicine in China.
We also examined the initial motivations of rural amchi at the beginning of their studies. Of 47 amchi interviewed, 40 (i.e., 85 %) responded foremost that they entered this path out of compassion, while other responses included following in the family line, the absence of amchi in their native village, the serious illness or death of a loved one, or karma.
See Sagant (1990) for another Himalayan example.
See Pordié (2007) for examples of mantra recited during plant collection.
Although the Men-Tsee-Khang maintains its authority over the CIBS through designing the curriculum and granting the diplomas, it is interesting to note that there is actually quite a strong emphasis on Buddhism within this institution (Kloos 2010), which has not been carried over to the CIBS.
A Ladakh-wide survey of 93 amchi we conducted in 1998 found only 8 female amchi.
This remark refers to the high levels of absenteeism which plague rural health services in Ladakh. Many public health workers attend remote postings sporadically, making service coverage look much better on paper than it does on the ground.
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Pordié, L., Blaikie, C. Knowledge and Skill in Motion: Layers of Tibetan Medical Education in India. Cult Med Psychiatry 38, 340–368 (2014). https://doi.org/10.1007/s11013-014-9389-4
- Tibetan medicine