127 Chapter 6 Correlating Biomedical and Tibetan Medical Terms inAmchi Medical Practice Barbar a Gerke Introduction This chapter discusses the process of how classical Tibetan medical terms acquire new meanings, especially when practitioners of ‘ Tibetan medicine’ in both t he Tibet Autonomous Region (T AR) and Indian exi le 1 are exposed to ideas about biomedicine. The ethnographic examples presented are based on doctoral fieldwork (2004–2006) carried out among Dharamsala Men-T see-Khang trained Tibetan doctors working i n the Darjeeling Hills, India. In the second part of this chapter I give the example of two biomedical terms, ‘oxygen’ and ‘haemoglobin’, and analyse how they are used and interpreted in the Tibetan clinical practice of Amchi Jamyang Tashi at the Kalimpong Men-Tsee-Khang branch clinic in 2004/05. Men-Tsee-Khang medical practitioners in India often evaluate the effects of Tibetan medication through biomedical blood tests even t hough Tibetan concepts of ‘blood’ or tragas such have little to do with the chemical analysis of blood parameters. I look at how the biomedical term ‘haemoglobin ’ has entered into Tibetan medical practice and acquired the meaning of ‘vitalized blood’ (zungtrag), which is said to be rich i n ‘ oxygen ’, which in turn is related to Tibetan medical ideas of the ‘life-sustaining wind’ or sogdzin lung. What underlies the Tibetan amchi correlation ofzungtragwith ‘haemoglobin’ and sogdzin lungwith ‘oxygen’? How has this form of correlation influenced understandings of physiology and notions of treatment efficacy? The discussion is set in the broader context of the
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has observed that Tibetan doctors often believe they will gain more respect
and acceptance from foreign biomedical practitioners by using biomedical
terminology (Prost 2006b: 135). From her article, it appears that thetranslation process happening at Mentsikhang in the TAR has been
‘substantially modifying both the theory and practice of Tibetan medicine’,
while in the Indian exile community this process seems to be more of a
‘comparative’ nature, in the sense that Tibetan doctors employ more
‘selective translations’ of terms in order to clarify the differences and
similarities between their system and biomedicine (Prost 2006b: 137).
However, the process of translating medical terms is not straightforward
and needs a careful nuanced approach. I would agree with Prost that there
is certainly a striking difference between the way translations are carried
out in Dharamsala and Lhasa, but this apparent distinction should not lead
to premature generalizations on either side. There are, in fact, important
differences in how these translation processes play out among patients and
physicians and even among the community of medical practitioners
themselves. There is scope for more valuable research here, and I only
introduce two examples from existing publications to sketch the landscape.
In Lhasa, translation issues are by no means a debate with unified views
between ‘Tibetans’ versus ‘non-Tibetans’. Adams shows that among Tibetanmedical practitioners at the Lhasa Mentsikhang, the views on translating
and interpreting certain anatomical structures differ sharply. She illustrates
this point by citing the example of how the three invisible channels, tsasum,
are translated. Some doctors try to establish ‘that the channels in the adult
body are equivalent to the anatomically visible nervous system, the arterial
flow of the blood and the venous flow of blood which, respectively, stand for
the white, red and black channels in the Tibetan system’ (Adams 2002a: 550).
Others argue that the invisible channels ‘are the location of the body’s subtlewind’ and are integral to scientific Tibetan medical theory (Adams 2002a:
546). Interestingly, both sides have labelled their investigation ‘scientific’.
This example shows that establishing medical terminology can be seen as
‘scientific’ from various perspectives, but that finding biomedical equivalents
for Tibetan medical terms plays a major role in just one side of this debate.
Obviously, ideas of ‘science’ are not uniform among Tibetan amchi and are
also not necessarily limited to the use of biomedical terminology.
In India, the range of translation methods that are found in recent
Tibetan medical literature (e.g., literal translation, phonetic appropriation,
recasting the medical meaning into Tibetan terms, or using the biomedical
term itself) shows that the community of Dharamsala Men-Tsee-Khang
Correlating Biomedical and Tibetan Medical Concepts in Amchi Medical Practice
137
Wangdu’s plates support one side of the debate in which ‘the only aspects
of traditional theory that are scientific are those with Western equivalents’
(Adams 2002a: 551). The anatomical sketches by Wangdu are similar to theplates published in Lhasa in 1978 in the medical book The New Dawn SowaRigpa Compendium (Gso rig snying bsdus skya rengs gsar pa),9 (see
discussion by Prost 2006b: 136–37). Both works reflect approaches taken
in the TAR to introduce the biomedical anatomical gaze to the
Tibetanmedical curriculum. In India, I have seen both textbooks used
frequently by Chakpori as well as by Men-Tsee-Khang medical students.
However, Tibetan doctors in Indian exile have developed a different
strategy to deal with biomedical terms. This analysis is partly based on the
published proceedings of a Men-Tsee-Khang conference on clinical
research on cancer and diabetes in Tibetan medicine (Men-Tsee-Khang
1998; cf., also Czaja, in this volume). To understand which methods of
correlation, translation or transliteration are available to amchi and to come
to an understanding of how they impact on medical dialogue, I outline two
In some of the articles biomedical terms have not been translated into
Tibetan but instead have been phonetically transcribed into the Tibetan
script using Sanskritic letters. The biomedical term is linked to a Tibetan
term, but is not reduced to an equivalent. This allows the Tibetan term to
retain a definition in its own right. The publication has applied this method
mainly to two biomedical terms that are discussed in the two main sectionsof the book: diabetes (transcribed as D’a ya sbe T’is), which is linked to the
Tibetan term cinnyiné (‘the disease of urinating profusely’); and cancer
(transcribed as kan sar ), which is related to the Tibetan term dräné though
the latter is discussed quite controversially among different doctors of
Tibetan medicine (see Czaja, in this volume).
Yet, also in the case of diabetes, not everyone agrees to translate it with
cinnyiné . Amchi Lobzang Tenpa, in particular, argues that cinnyiné is based
on different physiological concepts (1998: 150–52; see figure 6.2).
According to Tibetan understanding, cinnyiné begins in the stomach where,due to lack of digestive heat in the stomach, the chyle remains undigested
and cannot be properly separated into nutrients and waste. This negatively
Figure 6.2: A sample page of the Men-Tsee-Khang conference proceedings where medicalterms are inserted in English into the Tibetan text (Amchi Lobsang Tenpa 1998: 150)
but rather they were engaged in a mutual interaction. In Kalimpong, this
interaction with biomedicine happened in the absence of a direct
communication and professional exchange with biomedical practitionersand so it was largely based on individual amchi’s terms. Apart from his
education at the Men-Tsee-Khang in Dharamsala and his private studies,
it was essentially through his patients who freely combined medical
systems, and through their medical records, that Amchi Jamyang was
exposed to biomedical practices.
One day, I asked Amchi Jamyang about the concept of ‘blood’, trag , inTibetan medicine. Trag is a Tibetan medical term with several meanings.
Generally, in the Gyüshi the three nyépa – lung, tripa and péken – appear in
their combination of three, but I found some instances where trag occurs
together with lung, tripa and péken giving the impression of a ‘fourth’ nyépa.
However, trag is generally not seen as a part of the three nyépa. It can be a
name of a disease, or a characteristic feature in pulse diagnosis. It is mainly
seen as an important part of Tibetan physiology, in particular the seven
bodily constituents, lüzung dün (see note 11). Amchi Jamyang explained
that ‘Trag is part of the lüzung dün. In Tibetan medicine we believe that the
blood is made in the liver (chinpa), not like in Western medicine, where it
is made in the bone marrow. For us, the liver is the most important organrelated to trag .’
Trag can also be a part of a name of a specific type of a disease that relates
to the characteristics of tripa, which is hot in nature. The relationship
between trag and the liver – also one of the main seats for the nyépa tripa– is reflected in the fact that trag frequently occurs in the Gyüshi together
with tripa.15 Drungtso and Drungtso translate trag and tripa as ‘Blood and
Bile. Diseases which are like fire and heat by nature’ (Drungtso and
Drungtso 2005: 49).I was interested in how Amchi Jamyang understood ‘blood’ and linked
it to ideas of longevity. Our discussions at that time took place in Tibetan.
In his response, he used two English terms, ‘haemoglobin’ and ‘oxygen’. He
said ‘There is no ‘haemoglobin’ as such in Tibetan medicine, and you won’t
find it in the Gyüshi. But amchi use the term frequently and also check the
efficacy of their medicines through blood reports.’
At the time, he was treating two patients in Kalimpong for low levels of
haemoglobin. Both of them reported a raise of 1.5 gm/dl in their
haemoglobin after one month of treatment with Tibetan medicine. Amchi
Jamyang showed me the blood reports, which he was able to read, interpret
and link up with his treatment scheme. I asked him if he could feel a low
Correlating Biomedical and Tibetan Medical Concepts in Amchi Medical Practice
143
haemoglobin level in the pulse or if he relied entirely on the blood reports.
He said ‘The pulse shows signs of high lung when the haemoglobin is low.
The pulse also feels weak and can show a combination of pé [kan] lung when the haemoglobin is low. And in the cases of ‘diseased blood’, nétrag ,I find a tripa and trag pulse.’
Here, trag describes a type of pulse that has specific qualities, again
similar to tripa, and indicates an increase of ‘diseased blood’. For Amchi
Jamyang the pulse diagnosis remained the major diagnostic tool. The blood
tests were secondary for his diagnosis, but primary for the communication
with the patient, who was used to blood test reports. As Amchi Jamyang
explained during one of our later discussions:
Tibetan medicine and medical reports are a good combination because without
the report the patients do not really believe or know that the medicine works.
When I feel the pulse I cannot say ‘your haemoglobin is 12.8’. I have no
measurement they can understand. The HB parameter is easier and more
accurate. The new patients, who come with a long history of often unsuccessful
biomedical treatment, want to know how our medicine works. I cannot tell them
the details about the pulse, but I can tell them the blood test result. They can see
that our medicine works. It is some kind of a proof. I do not need that proof
because I know our medicine works, but it helps. It also helps my confidence.
When I asked Amchi Jamyang if there was a Tibetan word for
‘haemoglobin’, he mentioned the term zungtrag , which means ‘vitalized
blood’. Zungtrag is seen in opposition to nétrag , which translates into ‘bad’
or ‘diseased blood’. He then used the English term ‘oxygen’ to explain the
difference between these two types of blood. According to him the ‘vitalized
blood’ has a lot of ‘oxygen’. Again, there is no concept of ‘oxygen’ in Tibetan
texts, but young Men-Tsee-Khang trained doctors seem to use the term very freely. According to Amchi Jamyang:
Zungtrag has a lot of oxygen and builds up ‘blood’ (trag ) and good health. It is the
type of blood that forms part of the ‘seven bodily constitutents’ ( lüzung dün).
Haemoglobin is synonymous with the trag of those lüzung dün. Oxygen is the
same than the sogdzin lung . Soglung (lit. ‘life-wind’) is actually the term for a
mental illness, but sogdzin lung (lit. ‘life-sustaining wind’) is one of the five types
of lung .
Logically it follows from here thatzungtrag has a lot of sogdzin lung , in the same
way that haemoglobin has more oxygen. Amchi Jamyang’s understanding was
clear and referred to the vitalizing power of the ‘good blood’, but what was his
underlying rationale to correlate ‘oxygen’ with soglung ? He explained:
Sogdzin lung you cannot see with your eyes, oxygen you also cannot see; sogdzin
lung is situated in the heart, oxygen is also pumped through the heart. Sog is life;
it is the pathway for lung . Without oxygen there is no life. Without soglung you
will die. Now, zungtrag is the important and good blood and has a lot of oxygen
and a lot of sogdzin lung . To build the body’s blood is most important. Zungtrag
has a great power (nüpa). If the zungtrag is strong, the ‘supreme essence’
dangchog 16 will be of good quality, which in turn produces long life.
Here, the amchi reveals some of the reasons behind his method of correlating the medical terms from two different medical systems.
Interestingly, perceptions of vitality and its topographic location in the body
are at the base of his comparison. I shall take up this point further in the
conclusion of this chapter.
In contrast to the vitality of the ‘good blood’, the nétrag is the ‘diseased
blood’ that forms through toxins and waste products. It is nétrag that is let
out during blood-letting. The main medicine that supports the cleansing of
nétrag from the body is a decoction of three myrobalan fruits, called DräbuSumtang (a combination of Chebulic myrobalan or Terminalia chebula(Arura), Beleric myrobalan or Terminalia belerica (Barura) and Indian
gooseberry or Phyllantus emblica (Kyurura), also known as Aru-Baru-
Kyuru, all three of which comprise the popular Ayurvedic drug known as
Triphala churna). Amchi Jamyang explained his course of treatment:
Only if Dräbu Sumtang thang is not available, I will choose medicines like
Gurgum 13, Tsenden 18, Yunying 25 and Ratna Samphel. The choices of
medication are based on each doctor’s individual experiences. Each amchi hashis laglen,17 and this is my choice of medicines. First we use Dräbusum. It
separates the good from the bad blood and expels the bad one.
To build up the ‘vitalized blood’, he used a drug called Dashel Dütsima. His
repeated experience was that it could raise the haemoglobin level by one
gm/dl over the course of a month. During the treatment, patients were
usually compliant in getting regular blood tests done. However, Amchi
Jamyang admitted that his patient records were incomplete, since once hispatients felt they were cured they did not want to spend additional money
on blood tests, endoscopies or expensive scans. He regretted the fact that
the patients’ subjective improvement and his pulse reading were the only
sustaining wind’). Since in India many patients come to the amchi and the
rather unknown system of Tibetan medicine with a biomedical-oriented
way of understanding illness, the measuring of ‘haemoglobin’ through ablood test is easier for the amchi because it links the Tibetan treatment to
the patients’ biomedical record. Moreover, by relating the Tibetan term for
‘vitalized blood’ to haemoglobin and monitoring the several month-long
Tibetan medical treatments with monthly blood tests, Amchi Jamyang
creates a diagnostic method that the patient is familiar with. While he feels
comfortable within his own medical system, Amchi Jamyang uses the blood
report as a kind of ‘proof’, primarily for the patients’ sake. Furthermore, he
himself gains confidence through the medical report, because he sees the
blood test as a measurable parameter that is easier to communicate with
than his own ‘invisible’ pulse diagnosis, and it provides him with a figure
he can note into his own medical records.
The integration of biomedical and Tibetan medical concepts and
practices seen in this example is one that Amchi Jamyang describes not as
competitive, but rather ‘a good combination’. It allows him to make use of
both systems on a diagnostic level, while the treatment remains Tibetan. By
correlating medical terms from both systems, the amchi extends his medical
vocabulary into a world that most of his patients are more familiar with andcan therefore more easily relate to. The underlying process here seems
similar to what I described in the first part of the paper, referring to Adams
(2007) and her research in the TAR. At the Lhasa Mentsikhang the use of
biomedical measures is seen by many Tibetan doctors as better than Tibetan
methods for pinpointing diagnoses. One reason for this is that Tibetan
techniques are difficult to learn and appear vague when compared to
biomedical diagnostic categories that are measurable. While linking Tibetan
medicine to ideas of ‘science’ is primarily a political issue – and also a matterof protecting the medical system (Adams 2002a: 568–71) – Tibetan amchiin India integrate biomedical test results into their clinical practice, for
different but equally compelling reasons. In the case presented here, blood
pressure parameters and blood test results give amchi clearer quantitative
figures than the pulse diagnosis can and they enable them to communicate
more easily with their patients, who often have been exposed to biomedicine
but know little about Tibetan medicine. In our conversations, not once did
Amchi Jamyang use the word ‘scientific’ to explain why he uses biomedical
test procedures. Even though he has a keen interest in research and sends
copies of patients’ medical records to the research department in
Dharamsala, his main motivation is not to be more ‘scientific’. From his
Correlating Biomedical and Tibetan Medical Concepts in Amchi Medical Practice
147
statements we can conclude that the current anthropological focus on the
‘scientization’ of Tibetan medicine requires more nuanced and localized
perspectives, in particular in terms of medical practice, in order not tooverlook other local strategies that ‘appear’ to be part of the ‘scientization’
process, but are actually guided by different motives.
Amchi Jamyang’s correlations of biomedical and Tibetan medical terms
are based on characteristics that he considers to be similar in both systems.
In the case of ‘oxygen’ and sogdzin lung , both are invisible, related to the
heart and are vital to life. Haemoglobin and zungtrag are both related to
‘blood’ and especially to the vital aspects and strength of having ‘vitalized
blood’. These correlations have little to do with biochemical analysis, or a
Western ‘scientific approach’. In this case, they rather refer to similar ideas
of vitality and localization in the body.
Particularity and idiosyncratic, practitioner-specific methods are a
hallmark of Asian medical traditions. Thus, individual perceptions and
practices should receive a stronger focus in the anthropological gaze if we
want to trace the process of how these correlations are constituted and
employed in amchi medical practice. It is in these similarities that Amchi
Jamyang finds a basis for understanding another medical knowledge system
so different from his own. The similarities allow him to apply selectiveaspects of another medical system while confirming to his patients the
efficacy of his own knowledge system, about which he himself has no doubt.
Notes1. I am aware that the term ‘Tibetan medicine’ is itself problematic and gives the
impression of a unified system, which it is not. The definition of ‘Tibetan medicine’
or ‘amchi medical practice’ has been discussed in recent publications (Schrempf 2007, Pordié 2008) and is also critically approached by the editors in the
introduction of this volume. In this chapter, I am primarily concerned with doctors
trained at the Men-Tsee-Khang Tibetan medical institution in India.
2. Parts of an earlier unpublished paper on ‘Problems of Translating and Creating
Tibetan Medical Terminology’ have been included in this chapter (Gerke 1998).
3. So far, there have been no studies on medical terminology in Tibet before the
introduction of the Tibetan script in the seventh century. The most suitable text
for studying the principles according to which Indian scholars and Tibetan lotsawa
literally created Tibetan medical terms is the A ṣṭ āṅ gahṛ idayasahitā by Vāgbhata.This text was written in India sometime around the seventh century and reached
Tibet in the eleventh century (see Hilgenberg and Kirfel 1941 and Murthy 1996,
Correlating Biomedical and Tibetan Medical Concepts in Amchi Medical Practice
149
descriptions in the A ṣṭ āṅ gahṛ idayasahitā (compared with Hilgenberg and Kirfel
1941: 2ff, Murthy 1996: 9). According to the Gyüshi, the digestive process takes six
days and is as follows: the essence of food is refined through six stages from the organic
food sap, or chyle, into blood, flesh, fat, bone, bone marrow and semen.
12. khrag dang gcin nang mngar cha’i tshas cha.
13. For demographic details see the Tibetan Demographic Survey 1998 (Planning
Council 2000).
14. I have explained the effects of these rotation practices on the role of amchi in the
Darjeeling Hills in another article (Gerke, in press).
15. Tri (mkhris) , for example, ‘clears away trag tri’ (khrag mkhris sel byed ), ‘generates
trag tri’ (khrag mkhris skyed ), ‘balances trag and tri’ (khrag mkhris snyoms par
byed ), or ‘increases trag and tri’ (khrag mkhris rgyas par byed ).
16. The supreme essence ‘distilled’ from all stages of the seven bodily constituents is
known as dangchog (mdangs mchog ) which is located in the heart and makes up
the vital radiance of a person (Rgyud bzhi, II, 5: 72, see also note 10).
17. Laglen is the medical experience gained through an apprenticeship with a senior amchi.
18. Prost’s example on Tibetan medical students in Dharamsala preparing their own
tables of biomedical equivalents for Tibetan medical terms of diseases shows that
there is (not yet) a uniform method to introduce students at Men-Tsee-Khang to
biomedical terms (Prost 2006b: 134).
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