Introduction:

Challenges of Translating
Tibetan Medical Texts and Medical Histories
Barbara Gerke

Language is a process of free creation; its laws and principles are fixed,
but the manner in which the principles of generation
are used is free and infinitely varied.
Noam Chomsky

This publication is a German translation of the first two of the Four Tantras,1 in Tibetan
called Gyüschi (rgyud bzhi). This bi-lingual presentation (Tibetan-German) comprises
an important step towards a complete translation of all Four Tantras, which to date
has not appeared in any European language, which is surprising.2 After all, Tibetan
medicine is recognised along with Ayurveda and Chinese medicine as one of the semi-
nal Asian medical systems with vast amounts of medical literature drawing scholarly
interest around the world. Why is the standard work of Tibetan medicine appearing
in English and German only at the turn of the twenty-first century, despite Westerners
having studied Tibetan medicine since the early nineteenth century (Körös 1835)? In
this brief introduction,3 I want to provide some answers to this question by highlight-
ing some of the issues that make its translation a task so daunting that most scholars
in the past have avoided it. A few have limited themselves to the translation of the first
two tantras or a few chapters.4 I hope that by providing this introduction the reader
will be able to engage adequately with this seminal Tibetan medical treatise, including
all its intricacies and at times apparently strange use of language.

1 Gyüschi is also translated as Four Treatises, which avoids misunderstandings on the ‘tantric’ nature
of this medical texts among non-Tibetan readers. Here, in accordance with the rest of the book the
translation Four Tantras has been used.
2 The earliest translation of the Four Tantras into Russian by Pyotr Badmaev (Badmaev 1903) does not
include the Third Tantra, which Badmaev apparently translated but never published (Aschoff 1996:
30–31). The first complete translation of the Four Tantras was into Chinese (Li Yongnian 李永年 et al.
1983).
3 I want to thank Olaf Czaja, Jude Carroll, Afia Joy Adu-Sanyah, and Dr. Sonam Dolma for their helpful
comments.
4 To date, only parts of the Four Tantras have actually been translated into English or German. In the
following list, the Roman numeral refers to the four parts of the Four Tantras and the Arabic numeral
to the chapter. For example, [III: 49] refers to the 49th chapter of the third Tantra. If no chapter is
mentioned, the entire part has been translated: Badaraev et al. 1981 [III: 49]; Clark 1995 [I; II]; Clifford
1984 [III: 77–79]; Donden 1977 [I, II: 1–15]; Donden and Hopkins 1986 [IV: 1–8] (This is not a literal
translation, but is based on lectures and translations of various chapters of the Four Tantras, Donden
and Hopkins 1986: 9); Dorje and Richards 1981 [I: 1–2]; Emmerick 1975 [I: 3], 1990 [III: 90]; Jäger
1999 [III: 71–72]; Kelsang 1977 [I; II: 1–15]; Meyer 1990 [IV,1]; MTK 2008 [I; II], MTK 2011 [IV];
Seitelberger 2010 [I]. Vaidya Bhagwan Dash reconstructed a Sanskrit version of the Four Tantras, from
which he translated and annotated parts I, II and III 1–11 in English (Dash VB. 1994–2001).

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Introduction by Dr. Barbara Gerke (Englisch)

Characteristic ways of learning in Tibet (as in many parts of Asia) included and still
include the memorisation of large amounts of texts. Memorisation and the recitation
of a ‘root text’ were then elaborated on through oral instructions, as well as through
written commentaries. Even today, Tibetan medical students typically spend several
years memorising at least three of the Four Tantras, reciting them during oral exams
and writing them down from memory along with explanations during written exams. In
early Tibet, often only the teacher had a hand-written or printed copy of the text, and
the students learnt by memorising the orally transmitted text. Tibetan works have been
printed since at least the mid-twelfth century CE (Schaeffer 2009: 9), but the popular
technique of wooden block-prints was introduced from China only in the fifteenth
century and was expensive. Therefore, along with hand-written copies that were much
in use, memorisation was not only a key feature of oral literacy, but also a practical
way to carry one’s library in one’s head at all times. Modern Tibetan education and
the availability of Tibetan medical texts in print and electronic forms have so far not
replaced the oral traditions of memorising the ‘root text’ (see Millard 2002).

The very design of the Four Tantras facilitates their memorisation in several ways, of
which I want to point out two.

First, most of the text is written in a poetic meter, largely consisting of lines of nine
mono-syllables each. The 5,900 verses are partly encrypted and cannot be understood
without explanation by a qualified teacher, who ideally has received oral instructions—
some of which are considered secret and never written down. It is also considered ideal
for the teacher to embody to a certain extent the medical-religious qualities that are
described in the text, such as the compassionate attitude of a physician.5 Moreover, in
order to keep with the poetic meter, words are often omitted, or entire medical terms
are at times represented by only one syllable. Detailed commentaries and directly re-
ceived oral instructions from a lama (spiritual teacher) or a qualified medical teacher
are regarded as critical in the understanding of the root text. Even Tibetans with a good
knowledge of literary Tibetan have difficulty accessing the full meaning of the Four
Tantras independently, despite understanding the literal meaning of each word in the
root text. Any reader having seen biomedical literature filled with Latin technical terms
can empathise with the students of Tibetan medicine, even more so if Latin terms were
to be sometimes presented in one syllable to fit the poetic meter of a sentence.

Second, memorisation is enhanced through having six main organisational frameworks

along which the chapters of the Four Tantras are structured. These six frameworks are:
‘four tantras,’ ‘eight branches,’ ‘eleven sections,’ ‘fifteen categories,’ ‘four compendia,’
and ‘156 chapters’ (see Table 1). These frameworks give the text a very clear structure,
which helps the students memorise, recite, and understand its content.

5 One entire chapter in the second of the Four Tantras is dedicated to the spiritual qualities a physician
should develop, such as love, compassion, joy, and equanimity.

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 Introduction by Dr. Barbara Gerke (Englisch)

One can easily imagine that the poetic feature of the Four Tantras makes a translation
into a European language a challenging task. Further, the translator has to deal with
classical Tibetan—which is quite different from spoken colloquial Tibetan—with tex-
tual styles dating as far back as the twelfth century.6 Moreover, the translator also has
to make decisions on how to translate the numerous technical terms that, over time,
have acquired a technical meaning in Tibetan medical contexts. These terms were often
originally taken from colloquial Tibetan, and their literal translations would make no
sense to the reader.

To understand this transformation from colloquial to technical meanings, we have to

look at how medical terms were (and still are) created in the Tibetan language. Tibetans
have a history of adopting and creating technical terms from different languages and
cultural backgrounds (Gaffney 2000). The Tibetan language is mono-syllabic in nature,
and meaning is basically syllabic. Most of the syllables “have meaning independent of
the compound word (morpheme) in which they are found. […] This syllabic structure
affords tremendous flexibility with respect to both expression of new ideas and con-
cepts and the expression of old ones in new and original ways” (Goldstein 1984: xi).
This language characteristic enabled Tibetan and Indian translators to use loan trans-
lation words from the Sanskrit. This happened chiefly during the two main historical
translation periods (approx. 9th to 10th and 11th to 12th centuries CE), during which it
was mainly Buddhist texts that were translated from Sanskrit into Tibetan by teams of
translators, editors, and redactors. Soon, dictionaries of uniform Sanskrit and Tibetan
terms were created. Such high translation accuracy was achieved that “within 200 years
of its creation, the Tibetan language had become the medium for translating some of the
most refined and complex concepts and ideas of Indian Buddhism” (Gaffney 2000: 5).
This was done by creating a specialised form of Tibetan language, quite different from
colloquial Tibetan. According to Gaffney, the methods used were “creating calques,
or loan translation words, to convey the precise meaning of the original Indian term
without importing any presuppositions or connotations from the Tibetan language”
(Gaffney 2000: 11); only for similes and metaphors was some kind of paraphrasing
employed. The aim of this method was “to present as accurate and faithful a transla-
tion of the original source text as possible” (Gaffney 2000: 11). Tibetans implicitly
assumed that “the literal translation of a text will ipso facto be a faithful representa-
tion of the original text” (Gaffney 2000: 11). For the most part, their translations were
done so accurately that lost Sanskrit versions can be re-constructed from their Tibetan
versions. The methods used to translate Sanskrit Indian Buddhist texts were also used
to translate medical texts. The Indian Āyurvedic physician Bhagwan Dash spent many
years reconstructing what he believes is the ‘lost’ Sanskrit version of the Tibetan Four
Tantras (Dash 1994–2001); this re-translation, however, does not prove the historical

6 It is still debated whether the early version of the Four Tantras was compiled in the eighth or twelfth
century (e.g. Karmay 1989; Emmerick 1977; Yang Ga 2010, forthcoming) or whether it is even based
on a lost Sanskrit original (Dash 1994–2001). The text definitely went through later editions and re-
prints; the translation presented in this book is based on a revised edition of 1892 from the Chakpori
Medical College in Lhasa.

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Introduction by Dr. Barbara Gerke (Englisch)

existence of an early Sanskrit version of the Four Tantras, which has so far not been
found (see Yang Ga, forthcoming).

However, with this general focus on Sanskrit translations we should not forget that in
the history of Tibetan medicine, medical texts were apparently also translated from
Greco-Arabic, Central Asian, and Chinese sources—albeit none of them survived (see
Beckwith 1979; Garrett 2009; Taube 1980, 1981). However, there might be further
discoveries from the Dunhuang texts in the future that might help to understand the
methods used in early translations.7

What is certain is that the mono-syllabic character of the Tibetan language itself has
facilitated both the translation and creation of medical terms. This was the case not
only in the past, when Tibetan medicine was enriched by medical knowledge, practices,
and texts from neighbouring countries, but it has also been the case recently, facilitating
the creation of contemporary medical terms. Since Tibetans have been in contact with
Western science and biomedicine, the mono-syllabic language character has offered
Tibetan doctors the opportunity to create an array of new scientific and medical terms
in modern Tibetan and thus incorporate biomedical concepts into their pool of medical
knowledge.8 This mono-syllabic language feature that makes it so easy to create new
terms in Tibetan, is also one of the main reasons why translating classical Tibetan medi-
cal texts into modern languages is extremely difficult, as the examples below will show.

How exactly were medical words created by compounding monosyllables in Tibe-

tan? Let us look at some examples. Me drod, the technical term for ‘digestive heat’
is compounded of the monosyllables me meaning ‘fire’ and drod meaning ‘warmth’
However, the literal translation ‘fire-warmth’ would make little sense in a sentence on
the digestive process or a kidney disease involving the digestive heat. In compounding
words, Tibetans often used simple colloquial expressions that became technical terms
to describe complex therapeutic processes: for example, ‘to press something against’
(dugs pa) became a technical term for a therapeutic method of applying hot compresses;
and ‘mild fluid’ (’jam rtsi) received the medical meaning of a purgative.

This problem was already described by Eugène Obermiller in the 1930s. He argued that
the underlying epistemologies on which the meaning of Tibetan medical terms are based
might get lost in a literal translation process, particularly since a strictly philological
approach often fails to include living oral traditions (1989 [1935]: 15). In fact, literal
translation efforts have at times resulted in the adoption of terms that make the mean-
ing of the original medical Tibetan terms ambiguous (Obermiller 1989 [1935]: 16–17).

7 Tibetan medicine in the Dunhuang manuscripts and links between Tibetan medicine and the Arab world
are currently studied by Yoeli-Tlalim (2010, 2011, forthcoming); see also Yoeli-Tlalim et al. 2011.
8 Modern anatomical charts with Tibetan terms for anatomical details previously unknown in Tibetan
medicine is an example of this process (Wangdu 1982). For debates on the creation of such new medical
terms see, for example, Adams 2007; Czaja 2011; Gerke 2011; Prost 2006.

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 Introduction by Dr. Barbara Gerke (Englisch)

This ambiguity is mostly found in complex medical terms. Literal translations of basic
medical terms, such as mchin pa for liver, are common and accurate, even though the
understanding of the physiology and function of an organ might differ significantly
between biomedicine and Tibetan medicine.

Moreover, it is a characteristic of Asian scholarly medical systems that technical terms

often have a polysemous nature, i.e. have many meanings. Hsu shows in a Chinese
context that the meaning of one and the same medical term can differ in institutional
and private clinical settings. She argues that “the meaning of the technical terms that
evolved in those scholarly medical traditions9 is notoriously polysemous and dependent
on the context in which they occur” (Hsu 2000: 219). A relevant example from Tibetan
medicine is the term rtsa. In the context of anatomy, rtsa refers to all kinds of ‘chan-
nels’ transporting blood (khrag), wind/respiration (rlung), and water (chu; chu’i rtsa
are often translated as ‘nerves’), but also the mind (sems), nutrients, and waste products
(Gerke, in press); in pharmacology rtsa refers to the root of a plant; in a diagnostic
context rtsa refers to the ‘pulse’ that is being felt at the radial artery. Its meaning also
changed during history. The first documented mention of rtsa in a medical context is
in the eighth to tenth century Tibetan medical texts from Dunhuang, where rtsa relates
mainly to the practice of blood-letting (Yan 2007: 302). Depending on the context, rtsa
has to be translated accordingly.

Furthermore, oral traditions change over time. Even for Tibetan doctors themselves,
certain aspects of the Four Tantras might not make sense today, since they are not
practised anymore, or—in the case of materia medica—are known under a different
name and are used differently than they were in early Tibet.

How can translators of Tibetan medical texts deal with these issues effectively and
sensitively? Apart from the issue of the polysemy of many medical terms, in order to
preserve the living oral traditions that might easily be ignored in a literal translation,
it is advantageous if the translators are either trained in Tibetan medicine themselves
(which is the case with all Tibetan doctors who worked on the translation of this Men-
Tsee-Khang publication), or are in constant communication with practising Tibetan
doctors (which is the case with the editor and translator of this German edition). To
be trained in classical Tibetan and philology as well as in Tibetan medicine is albeit
rare, and interdisciplinary team work is necessary, as it was during the centuries of
Tibet’s peak translation activities, when the translation team consisted of the Indian
panditas (scholars) and ācāryas (teachers) and Tibetan translators (lo tsa ba), editors,
and redactors.

9 Here, with ‘scholarly medical traditions’ Hsu refers to Bates 1995. The main Asian medical traditions,
including Tibetan medicine, can be considered ‘scholarly medical traditions,’ since they all constitute
a literate tradition of medical theory and practice, are mostly taught in institutions, and evolved in
highly stratified societies. It is a characteristic of scholarly medical traditions that there are different
interpretations of medical terms in texts and in practice (Hsu 2000: 217).

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Introduction by Dr. Barbara Gerke (Englisch)

A simple and common example of how medical meaning can easily get lost in a literal
translation are the three nyepa (nyes pa), which have been rendered in Tibetan as loong
(rlung = ‘wind’), tripa (mkhris pa = ‘bile’), baekan (bad kan = ‘phlegm’). Their English
translations—wind, bile, and phlegm—while apt, cannot be taken literally. The three
nyepa are broad concepts that cannot be pinned down by any single word in a Euro-
pean language. Phlegm, for example is not the ‘phlegm’ coughed up from the lungs, but
a term to denote all aspects of the body that are governed by the elements water and
earth, thus having a nature of cooling stickiness, giving the body firmness, as well as
moisture. Literal translations of the three nyepa tend to be eurocentric since they miss
the polysemous nature of the Tibetan terms and would make readers associate the terms
with their own cultural-related medical perceptions and bodily associations that would
limit their understanding of the Tibetan meaning. We find that many translators and
scholars writing on Tibetan medicine have started developing more nuanced solutions
and choose to use the untranslated Tibetan words for technical medical terms and
describe their meaning, rather than translate them literally.

A translator of Tibetan medical texts is then confronted with a constant decision-

making process, balancing between literally accurate translations and sentences that
include some form of commentary (to fill in for missing syllables or words) and thus
make sense to the common reader.

Could translations of Tibetan medical texts potentially meet with a similar fate as tech-
nical Buddhist texts did over the past few decades? While translating Tibetan Buddhist
texts into English, translators employed “an almost artificial use of the English language
and newly-created English terminology” (Gaffney 2000: 12). Despite creating good
literal translations, the reader has to basically first learn the English Buddhist terminol-
ogy to understand the often odd-looking texts. This method, while literally accurate,
clearly excludes non-specialist readers. Here, the translators have opted to keep the
common reader in mind while at the same time aiming at a correct translation of the
meaning—admittedly often at the expense of literal accuracy. This makes this text more
readable than what it would be with complete philological and grammatical exactness.

Negotiating the differences between accuracy and readability is not an easy task. The
translators working on this project have contributed the best of their abilities. I visited
the team at the Translation Department at the Men-Tsee-Khang in Dharamsala several
times while they were working on this project. Sometimes, their collective translation
erupted into heated debates and discussions over a single word or phrase; whether to
keep the Tibetan term as it is or to translate it into English, or even find a biomedical
equivalent for it; whether to opt for a literal translation of the term or rather of its
medical meaning. It made me aware of the difficulties involved in translation and the
necessity of doing this as a team. The result can never be perfect, for it is negotiable; a
compromise. Likewise, the rendering of the text into German was not simply an act of
translating it from the English, but also required going back to the Tibetan ‘root text’
and comparing and re-translating it with great care, keeping the readers in mind, who

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 Introduction by Dr. Barbara Gerke (Englisch)

will largely be from outside the Tibetan cultural area. A translation of the Four Tantras
for such a readership is therefore also a translation of medical meanings across different
medical epistemologies, different chronological time, and cultures.

In the past, Tibetans have opted for several methods to bridge these epistemological
gaps. One recent method has been to find, or even create, biomedical equivalents for
Tibetan medical terms. This has been done at times in an effort to show that Tibetan
medicine is ‘scientific’ (Adams 2007; Prost 2006). Another move has been to keep
Tibetan medical terms in the Tibetan language and even to render English biomedical
terms phonetically, transcribing them into the Tibetan script using Sanskritic letters
(Men-Tsee-Khang 1998).10 These efforts and debates are different in Tibetan areas in
China and in exile, which I describe in another article (Gerke 2011), where I discuss
how translations of Tibetan medical texts are not only a matter of vagueness versus
accuracy but are also embedded in larger political and economic structures. The issues
at stake raise questions of conformity as well as self-confidence: should Tibetan doctors
in their translations conform to the requirements of standard biomedical terminology
used in clinical trials or should they retain Tibetan terms and express confidence in
their own medical system? (Gerke 2011; Prost 2006)

The current translation of the Four Tantras show that there is no single answer when
it comes to Tibetan medical translation methodology, and that translation methods
fluctuate and are negotiable, even within one translation project. While translating
challenging texts, such as the Four Tantras, into modern languages for a Western audi-
ence, we might like to consider recent insights from Translation Studies. For example,
the term ‘translation’ can also be defined as “a dynamic term of cultural encounter, as a
negotiation of differences as well as a difficult process of transformation” (Bachmann-
Medick 2006: 33). Perhaps at the cost of some philological accuracy, such negotiations
of differences are at the core of this work in an attempt to bring its medical wealth and
meaning to a wider audience. It is up to the reader to decide whether this has been a
risk worth taking.

The preface to the first English edition, translated here into German, offers a sum-
mary of key Tibetan medical historical narratives from the perspective of a Tibetan
medical historian (Tsomdrig Yuyon Lhankhang 1990). Along with quotations from
other sources (for example, Sangye Gyatso 1994), Lhankhang’s text was translated and
summarised by the translation department team at the Men-Tsee-Khang in Dharamsla
(MTK 2008). This preface is an example of cultural encounters in translation. Academic
scholarship of Tibetan medical history continues to develop from its relatively recent
beginnings and is not yet at a stage to verify the historic accuracy of most of what Ti-
betans accept as their authentic medical history, described in the preface of this book.
The sources used in writing the Four Tantras and its commentaries are just beginning

10 I describe this in detail in another paper using the example of diabetes, transcribed as D’a ya sbe T’is,
which is linked to the Tibetan term gcin snyi’i nad (lit. “the disease of urinating profusely”), and cancer,
transcribed as kan sar, which is related to the Tibetan term ’bras nad (Gerke 2011: 137).

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Introduction by Dr. Barbara Gerke (Englisch)

to be critically analysed (Czaja 2007; Emmerick 1977; Gyatso 2004; Karmay 1989;
Yang Ga 2010, forthcoming). We know little about the importance held by the Four
Tantras throughout Tibetan history in its various regions of practice.

Contrary to the common assumption that the Four Tantras have been the most repre-
sentative key medical compendium since the twelfth century, we know, for example,
that the eleventh century Tibetan translation of the Aṣṭāṅgahṛidayasaṃhitā was the
most influential medical text until the Four Tantras took prominence during the course
of the thirteenth century (Martin 2007: 312). The Tibetan physician and scholar Yan
Ga, in fact, convincingly argues that the Four Tantras were written only after the
Aṣṭāṅgahṛidayasaṃhitā was translated into Tibetan in the eleventh century, but that
approximately only fifteen percent of the Explanatory Tantra, seven percent of the
Oral Instruction Tantra, and three percent of the Subsequent Tantra are based on
this āyurvedic compendium (Yang Ga, forthcoming). Western scholars in the past have
assumed that this āyurvedic work had a much greater influence on the compilation of
the Four Tantras (Emmerick 1977).

There is little doubt that the Four Tantras have remained the most influential medi-
cal text among contemporary Tibetans to date, but there are regional variations. For
example, Garrett’s study (forthcoming) of the Situ Panchen (1700–1774) tradition of
medicine in eastern Tibet in the eighteenth century questions the dominant role of the
Four Tantras. Garrett emphasises “the need to understand Tibetan medical knowledge
and practice as being as widely diverse as we know religious traditions in Tibet to be”
(Garrett, forthcoming), which points to the heterogeneous nature of Tibetan medicine.
This heterogeneity of Tibetan medical histories and practices is only slowly emerging
(see also Gerke 2012: 89 and Hofer 2012).

To contextualise existing Tibetan medical histories written in Tibetan and/or by Tibe-

tans, it is important to understand the background from which many Tibetans write and
understand history.11 Apart from conveying specialised knowledge, Tibetan histories
often acquire additional meanings involving ideas of authority, which influence their
contemporary use and interpretations. Writing Tibetan histories involves certain ideas
of authority and texts, often linked to Buddhism. Large compendia, such as the Four
Tantras, were compiled in an attempt to structure, codify, and standardise medical
knowledge of that time. The result is often a unified and authoritative system, which
is anchored so deeply in tradition that it becomes difficult to introduce innovations.
In Tibet, historical questioning has often been met with resentment, since “innovation
if not actual deviation from the authoritative was always a risky business in Tibetan
literary culture” (Gyatso 2004: 86). The way innovations were introduced into existing
texts was often by simply copying and inserting entire sections from older texts.

11 One of these medical histories has recently been translated into English and provides accessible mate-
rial for further analysis (Kilty 2009). See Czaja 2005/2006 for an analysis of a Tibetan perspective on
medical history.

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 Introduction by Dr. Barbara Gerke (Englisch)

Both in Āyurvedic and Tibetan medical texts we find quotations or passages from older
works, often without any source mentioned. This was done quite often “to introduce
innovations not as something new but as part of the already existing” (Das 1993: 67).
Quite contrary to contemporary understanding, Tibetan authors had no intention to
take the work of others without sufficient acknowledgment, an act which currently is
called plagiarism, but were only “passing on existing knowledge” following Tibetan
“traditional literary norms” (Mayer 2010).

It does not come as a surprise then that we find two ways of writing history, especially
in the context of Tibetan Buddhist literature:

[…] the ‘objective’ histories of the archaeologist and secular historian on

one hand; and the interpretative histories of Buddhist self-representation
on the other. Generally, these two are seen as at odds, with the former
acting to progressively deconstruct and disprove the pious and post hoc
reconstructions of the latter, unearthing the ‘true’ history of Buddhism to
its (presumably conservative and indignant, but ultimately ‘enlightened’)
proponents (Mills 2003: 7).

These two approaches to history are also found in Tibetan medical contexts. We should
keep in mind here that medicine is not free from religious interpretation. Since from
its beginning literacy in Tibet was associated with ideas of spiritual enlightenment,
these notions pervaded other areas of textual scholarship, including medicine (Schaef-
fer 2003). Several Tibetan medical histories are found to “display an explicit concern
to show medicine to be part of Buddhist history” (Garrett 2006: 204; see also Czaja
2005/2006).

Rather than outright condemning ‘interpretive’ histories of Tibetan medicine, we might

like to look at medical histories oscillating between ‘secular’ and ‘interpretive’ ap-
proaches as examples of varied cultural translation processes—as acts of “negotiating
differences.” We could learn to appreciate the ‘interpretive’ histories for what they
are: conscious attempts to set a medical tradition within specific political and religious
contexts of their time, communicating how medical historians viewed Tibetan medical
identities in relation to their imperial past and fragmented present. The often-occurring
lists of physicians in Tibetan medical histories, the narratives of their greatness in terms
of Buddhist and medical ethics and achievements, the importance of a continuing line-
age, can all be seen—and here I agree with Garrett—as attempts by Tibetan medical
historians to portray a certain image of Tibetan medicine that they considered authori-
tative and representative (Garrett 2007).

In this historical portrait sketched by Garrett, the emphasis on international exchange

that influenced the development of Tibetan medicine stands out. Garrett argues that
“the possession of medical knowledge from surrounding regions during the imperial
period became an important aspect of the identity of Tibetan medicine” (Garrett 2007:

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Introduction by Dr. Barbara Gerke (Englisch)

382). Today, contemporary Tibetan physicians often point out this early ‘imperial inter-
nationalism’ when introducing Tibetan medicine to a global audience at international
conferences. The often-claimed isolation of Tibet on the ‘Roof of the World’ has defini-
tely not been characteristic of the development and spread of Tibetan medicine, which
benefitted from international relations and exchange since the early Tibetan empire. It
is the growing popularity of Tibetan medicine that has sparked this current translation
process in the twenty-first century, this time not to bring medical knowledge to Tibet,
but to make existing Tibetan medical knowledge available to the wider world.

Dr. Barbara Gerke

Humboldt University of Berlin
Department of Asian and African Studies
Central Asian Seminar
Unter den Linden 6
10099 Berlin

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 Table 1: The six organisational frameworks of the Four Tantras
The lists should be read vertically along the separate columns.
Note that the ‘8 Branches’ (see second column) are explained further in the 92 chapters
of the Oral Instruction Tantra (see fourth column).

The 4 Tantras The 8 Branches The 11 Sections The 15 Categories The 4 Compendia The 156 Chapters
(rgyud bzhi) (yan lag brgyad) (gnas bcu gcig) (skabs bco lnga) (mdo bzhi) (le’u ༡༥༦)
Discussed mainly in discussed in discussed in discussed in
the Oral Instruction 31 chapters of the 92 chapters of the 25 chapters1 of the
Tantra Explanatory Tantra Oral Instruction Tantra Subsequent Tantra
6 chapters 70 chapters 1 chapter (1) 1 chapter (1) 2 chapters (1–2) 6 chapters
Root Tantra Diseases of the Body Basic Summary Requesting the Examination of Pulse Covering the Principles
Teachings and Urine of the Root Tantra
31 chapters 3 chapters 6 chapters (2–7) 4 chapters (2–5) 10 chapters (3–12) 31 chapters
Explanatory Tantra Children’s Diseases Formation of the Body Healing the Three Pacifying Medications Covering the
nyes pa ‘11 Sections’
92 chapters 3 chapters 5 chapters (8–12) 6 chapters (6–11) 7 chapters (13–19) 92 chapters
Oral Instruction Tantra Women’s Diseases Diseases Healing Internal Evacuative Therapy Covering the
Disorders ‘15 Categories’
25 + 2 chapters 5 chapters 3 chapters (13–15) 16 chapters (12–27) 6 chapters (20–25) 25+2 chapters
Subsequent Tantra Spirit Diseases Behavioral Regimens Healing Hot Disorders External Therapies Covering the
‘4 Compendia’
5 chapters 3 chapters (16–18) 6 chapters (28–33) 1 chapter (26)
Injuries Caused by Diet Healing Diseases of the Concluding Chapter
Weapons Upper Part of the Body
3 chapters 3 chapters (19–21) 8 chapters (34–41) 1 chapter (27)
Disorders Caused by Pharmacology Healing Diseases in Vital Chapter on the Student
Toxic Substances and Vessel Organs to whom Teachings may
be Entrusted
1 chapter 1 chapter (22) 2 chapters (42–43)
Healing the Aged with Surgical Instruments Healing Disorders of the
Elixirs and Rejuvenation Genitals
2 chapters 1 chapter (23) 19 chapters (44–62)
Restoring Virility and Maintenance of Health Healing Miscellaneous
Healing Infertility Disorders
3 chapters (24–26) 8 chapters (63–70)
Diagnostic Approaches Healing Simultaneously
Arising Wounds
4 chapters (27–30) 3 chapters (71–73)
Methods of Healing Healing Children’s
Diseases
1 chapter (31) 3 chapters (74–76)
Qualities of the Healing Women’s
Physician Diseases
5 chapters (77–81)
Healing Spirit Diseases
5 chapters (82–86)
Healing Injuries Caused
by Weapons
3 chapters (87–89)
Healing Disorders
Caused by Toxic
Substances
1 chapter (90)
Healing the Aged with
Elixirs and Rejuvenation
2 chapters (91–92)
Restoring Virility and
Healing Infertility

1 Note that the Subsequent Tantra has an additional two chapters (26–27) that are not covered by the ‘4 Compendia’ but are included in the ‘156 Chapters.’