Journal of Traditional Chinese Medical Sciences 8 (2021) S27eS31

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Journal of Traditional Chinese Medical Sciences

journal homepage: www.elsevier.com/locate/jtcms

History, current situation, and prospects of traditional Tibetan

medicine
Qing Jia Ren a, *, Junjie Bai b, *, Ni Ma Ci Ren a
a
University of Tibetan Medicine, Lhasa, The Tibetan Autonomous region, 850000, China
b
Beijing University of Chinese Medicine, Beijing, 100029, China

a r t i c l e i n f o a b s t r a c t

Article history: Traditional Tibetan medicine (TTM) is major component of traditional Chinese medicine (TCM). Over
Available online 17 December 2020 thousands of years, the Tibetan people have gradually established a comprehensive theoretical system
for Tibetan medicine and obtained rich clinical experience in the snow-covered plateau. The history of
Keywords: TTM has developed rapidly, especially since the establishment of the People's Republic of China, and
Traditional Tibetan medicine remarkable achievements have been made with the great support for ethnic medicines from the
History
Communist Party of China and the central government. In this paper, we give an overview of the history,
Prospects
theoretical system, common treatment methods, current development, and prospects for the future
development of TTM.
© 2021 Beijing University of Chinese Medicine. Production and hosting by Elsevier B.V. This is an open
access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

History
Traditional Tibetan medicine (TTM) is considered to be a miracle
within the treasury of traditional Chinese medicine (TCM) and has a
history of more than 3900 years, according to the periods covered
in the literature of the Tibetan Ben Religion.1 In ancient times, the
ancestors of the Tibetan people living on the snow-covered plateau
gradually learned the properties of plants and minerals and their
applications in treatment as they engaged in production and
struggled with the nature. From hunting, they learned the effects of
some animals; according to a legend from the third century BC,
there was a saying that “toxicity means medicine,” which suggests
the principle of “counteracting one toxin with another” or “toxin
makes medicine,” and TTM developed based on this idea.2
People increasingly advocate that the origin of TTM lies in the
Ben Religion, which was an early belief system originally developed
by the Tibetan people on the Qinghai-Tibet Plateau. Historians of
the Ben Religion have mentioned its nine medical collections,
including the Four Volumes of Medical Treatment (Yi Liao Si Bu Lun)
found in Tanjur, which is wide-ranging in its topics, a complete
theoretical system, and rich clinical practice. It is also believed that
* Corresponding authors.
E-mail addresses: renchen2109@qq.com (Q.J. Ren), 13910117028@163.com
(J. Bai).
Peer review under responsibility of Beijing University of Chinese Medicine.
during the period of the Tibetan King Nyatri Tsenpo, there was a pill
called “Tu Jiong Wang Ri” taken from the skull of an animal, which
was recorded in the Poison Therapy (Du Yao Liao Fa) edited by the
Tibetan medical physicist Dimagexi Danzengpingcuo and written
by Jiebu Chisi,3 the apprentice of Shenrao Miozzi, the founder of the
Yongzhong Ben Religion.
In the fourth century AD, Bichi Gechi and Bichi Lazi, two Indian
physicians, went to Tibet and passed on the knowledge of five
medical canons, including the Classic of Pulse (Mai Jing), Classic of
Medicinals (Yao Wu Jing), and Classic of Trauma (Zhi Shang Jing),
which promoted the development of TMM. In the seventh century
AD, Srongtsen Gampo, the Tibetan ruler, invited three physicians
representing three ancient medical schools of thought from ancient
India, inland China, and the Caliphate to translate five books into
Tibetan: the Big and Small Sand (Da Xiao Sha Li) and How to Prepare
Butter (Su You Zhi Bei Fa) by Bharadevaja, an ancient Indian physi-
cian; On Trauma Healing (Shang Shu Lun) by Hanwen Hangde, a
physician of Han nationality; and Collected Works of Art of Healing
(Yi Shu Wen Ji) and Treatment of Chicken, Peacock, and Psittacosis
Disorders (Ji Kongque Yinwu Bing Zhi Fa) by Galinu, a physician of
Caliphate. Afterwards, they worked together and compiled the
Fearless Weapons (Wu Wei De Wu Qi) and Complete Medical Works
(Men Jie Qin Mo) after Princess Wen Cheng married the King of
Tibet, bringing many medical classics with her.
TTM developed rapidly during the reign of the Tibetan ruler
Trisong Deutsn. The King of Tibet invited medical scientists of high
repute from neighboring countries including India, Nepal, the Tang

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2095-7548/© 2021 Beijing University of Chinese Medicine. Production and hosting by Elsevier B.V. This is an open access article under the CC BY-NC-ND license (http://
creativecommons.org/licenses/by-nc-nd/4.0/).
Q.J. Ren, J. Bai and N.M.C. Ren
Dynasty, and the Turks, and he worked with them to translate
works of traditional medicine from other ethnic groups, ultimately
compiling the most complete existing Tibetan medical works,
including the Somaratsa (i.e., the Yue Wang Yao Zhen). At this time,
nine distinguished physicians appeared on the scene in Tibetan
medical history, of whom Yutuo Nyingma Yundeng Gongbu (AD
708e833) was the most famous. He served Tsenpo as royal physi-
cian during the Tubo Dynasty and was the founder of the theo-
retical system of Tibetan medicine. He traveled throughout Tibet
collecting folk remedies and summarizing the folk medical expe-
rience. He also visited Mount Wutai (Xinzhou City, China), India,
and Nepal and officially acknowledged famous physicians as his
masters to study medical theories and absorb the essence of
different medical cultures. He eventually wrote the Four Medical
Tantras (Si Bu Yi Dian), the world-famous Tibetan Medical Canon
(Fig. 1, Jinzhi edition); its publication marks the formation of TTM
with unique characteristics.
In 765, to further develop TTM, Yutuo Nyingma Yundeng
Gongbu headed a delegation of his disciples, including Dewabai,
and went to Miling County (currently Nan Yigou Township, Miling
County), Nyingchi Prefecture, and built the first school of TTM to
train medical professionals. The school was named “Sudarsa-
nadgood to see the city” or TTM City. He personally chaired the
school, which was funded by his savings and donations from Rubu
Sanbu. The school, with a three-to five-year program, used the Four
Medical Tantras as its textbook. It also formulated a complete
teaching system, including teaching materials, academic degrees,
and academic examinations. It established for the first time the
TTM academic degree system and cultivated thousands of gradu-
ates with academic degrees, which were divided into four types
based on academic performance: Benranba, Ranjunba, Gajuba, and
Dizaba. Strict assessment content and systems were available for
these four degrees. According to records, the school issued Ben-
ranba and Ranjunba degrees to 50 qualified students each and
Gajuba and Dizhaba degrees to 100 students. No record has been
found, however, for when and why the school closed. From the
existing site of the school, however, we can image its unprece-
dented scale and educational development model, as well as its
great contribution to the development of TTM.
During the several hundred years after the first TTM school, no
new TTM education institution and base of cultivation was built, so
TTM professionals were primarily trained based on a master-
apprentice system. In the fourteenth century, two TTM schools
appeared, the Jiampa School and the Suka School, both of which
Fig. 1. The Four Medical Tantras in the Jinzhi edition.
28
Journal of Traditional Chinese Medical Sciences 8 (2021) S27eS31
made further studies into medical theories, therapies, and identi-
fication of medicinal herbs based on the Four Medical Tantras,
opening a period of “letting a hundred flowers bloom and a hun-
dred schools of thought contend,” which forcefully promoted the
development of TTM theories. Physicians wrote books and devel-
oped theories one after another, producing outstanding canons of
medicine, as well as notes and commentaries on the Four Medical
Tantras.
In the seventeenth century, the fifth Dalai Lama advocated
training more medical professionals with the aim to develop TTM
and thus spurred a new upsurge in the development of TTM. In
1643, in the west hall of Drepung Monastery, the Dalai Lama set up
a medical academy headed by Nitangzhonggan Luosangjiacuo and
managed by Qiange Nangsuo Dajie. In Shigatse he established the
Changsong Duibailang, known as the “Immortal Assembly,” which
was managed by Charongba Cidanduojie. The fifth Dalai Lama
wrote the roughly 10 000-word regulations on teaching and
management himself. This precious document is now kept in the
archives center of the Tibet Autonomous Region (TAR). Afterwards,
Rosan Jiachu, a famous physician, set up another medical school in
Sampni Matang. A new medical school was also set up in Law-
angjue, the eastern turret of the Potala Palace, and headed by
Qiange Nangsuo Dajie and managed by Damo Manran Baluosang
Qiezha (Fig. 2). The school provided living allowances and neces-
sary facilities to the students. Because the fifth Dalai Lama attached
great importance to training TTM professionals, most students
passed examination on the Four Medical Tantras. Although TTM
flourished during his lifetime, it is a pity that in 1682, several years
after his death, all of the medical schools were closed because of
improper management or shortage of funds.
In 1696, to fulfill the grant of the fifth Dalai Lama, his disciple
Disi Sangjie Jiacuo set up a medical college on the Mount of King of
Medicine (Yaowang Mountain, Lhasa, China), just at the right front
of the Potala Palace. The college was named the Medical College of
Mount of King of Medicine and was the biggest medical college in
the history of modern Tibet (Fig. 3). Besides learning the Four
Medical Tantras, other textbooks at the college also included the
Annotation to the Four Medical Tantras, Addendum to Secrets (Mi Jue
Bu Yi), Jingzhu Materia Medica (Jing Zhu Ben Cao), and Yutuo's Secret
Documents (Yu Tuo Xin Yao Mi Han). Students also learned Bud-
dhism and took part in religious activities. Students had regular
classes and received face-to-face guidance from teachers, while
taking part in practice as well as other detailed course contents and
daily activities, including the identification of herbs in the field,
practical operation training, and memorization exams. On Mon-
days, Tuesdays, Thursdays, and Saturdays, students spent their time
learning the Four Medical Tantras; on Wednesdays and Fridays they
engaged in medical practice. Every week (or for a certain period of
Fig. 2. Lawangjue traditional Tibetan medicine school.
Q.J. Ren, J. Bai and N.M.C. Ren
Fig. 3. Frescoes in the medical college of Mount of King of Medicine.
Fig. 4. Diploma from the medical college of Mount of King of Medicine in 1696.
time), each student was required to go to the principal in charge
and recite the Four Medical Tantras one by one, a practice carried
forward to this day. Upon graduation, the system of awarding the
Geshe degree by three temples in Tibet was strictly exercised. Those
who passed all four examinations on the Four Medical Tantras were
awarded the Kanbu degree (Fig. 4). Students who failed to pass the
examination after nine years of study in the school were expelled
and new students recruited. In this way, many eminent physicians
Fig. 5. Former site of the Lhasa Menzikang (traditional Tibetan medicine hospital).
29
Journal of Traditional Chinese Medical Sciences 8 (2021) S27eS31
Fig. 6. Diploma from the Lhasa Menzikang.
were trained.
In 1745, Beijing's Lama Temple also established a TTM school,
and the notable temples in Hali Hage Xihuoer, Inner Mongolia,
established TTM schools to cultivate Tibetan medical professionals
from different ethnic groups (mainly Mongolian).
In 1916, on the site of the former Medical College of the Mount of
King of Medicine a new college was established, known as Menzi-
kang, or the College of Medicine and Astronomical Study (Fig. 5),
with Qinrao Luobu as the president.4 Qinrao Luobu widely
recruited disciples and spread medical theories. He set up two
majorsdmedicine and astronomydand graduates were divided
into three levels, lower, middle, and higher (Fig. 6). Initially, the
medical program required three years; the astronomy program,
two years; and the combined program, five years. Later, the medical
program was changed to five years, astronomy to three years, and
the combined program to eight years.
After the peaceful liberation of the Tibet in 1951, TTM has
entered a brand-new era and has made great achievements.
Basic theories of TTM
The basic theories of TTM consist of the doctrines of five sources
and three causes. These two doctrines were first raised by Yutuo
Nyingma Yundeng Gongbu in the classic work, Four Medical Tantras.
Both are used to elucidate human physiological and pathological
activities, as well as pharmacology, diagnosis, treatment, and
health preservation thus forming the key Tibetan medical theory.
The doctrine of five sources refers to earth, water, fire, wind, and
vacancy, while the three causes are Long, Chiba, and Peigen.5
Long is similar to the concepts of qi and wind in TCM, but with a
broader function and meaning. Physiologically, Long governs
breathing, physical activity, sensory thinking, and excretion; it is
the driving force that promotes the normal physiology of the hu-
man body. Pathologically, due to the influence of internal and
external factors, each organ has its Long (i.e., head Long, heart Long,
etc.) resulting in many complications such as Chilong, Peilong, and
blood Long.
Chiba is similar to the concept of fire in TCM, but it has more
functions. It can generate heat, regulate body temperature, and
promote digestion physiologically. In terms of pathology, symp-
toms including general fever; yellowish skin, sclera, and face;
brown urine; thirst; vomiting; diarrhea; abdominal fullness; and
preference for cold and aversion to heat are due to Chiba
dysregulation.
Q.J. Ren, J. Bai and N.M.C. Ren
Peigen is similar to the concepts of water and earth in TCM and
also has more functions. Its main physiological activities are to
transport food and regulate body fluids. If Peigen is in disorder,
digestive system diseases in the spleen and stomach, body fluid
disorders, and kidney failure may occur; if it interacts with Peilong
and Peichi, various complex diseases can develop.
Tree illustrations are a unique doctrine in TTM.6 The tree illus-
tration compares medical theory with a three-rooted, nine-trunked
tree, and it encompasses the philosophy of physiology and pa-
thology. Characterized as systematic and organized, a unity of op-
posites, and partial and whole, it embodies the complex and
abstract theories of TTM (Fig. 7).
Current development
After the peaceful liberation of Tibet, the Communist Party of
China and Chinese government attached great importance to the
development of TTM. Thanks to strong support from the Party
Committee of the Autonomic Region, more than 50 Tibetan medical
practitioners were trained from 1963 to 1973. The Lhasa Health
School set up a special class for TTM from 1974 to 1981 and trained
more than 140 Tibetan practitioners, and this marks the beginning
of modern Tibetan medical education. The Traditional Tibetan
Medical School established in 1983 trained about 130 talents up to
1989. In September 1989 the Traditional Tibetan Medical School of
the TAR and the Traditional Tibetan Medicine Department of Tibet
University (starting from 1985) were incorporated to form the
Traditional Tibetan Medicine College of Tibet University. After the
reform and opening-up in 1978, the Traditional Tibetan Medicine
Research Institute and Astronomical Study Institute were estab-
lished. In February 1993, with approval of the State Education
Commission, the Traditional Tibetan Medicine College was sepa-
rated from Tibet University and became the independent College of
Mount of King of Medicine (although the Ministry of Education
Fig. 7. Traditional teaching Thangka: Tree illustration.
30
Journal of Traditional Chinese Medical Sciences 8 (2021) S27eS31
approved its official name as the Tibet Traditional Tibetan Medicine
College in July 2001). On June 24, 2016, the TAR Government and
State Administration of Traditional Chinese Medicine signed an
agreement on the joint establishment of the Tibet Traditional Ti-
betan Medicine College, which in 2017, became the “2011” TTM
Regional Corporative Creation Center. In 2018, the College was
authorized to grant TTM doctoral and master's degrees. In the same
year, with the approval of the Ministry of Education, the College
was renamed Tibet University of Traditional Tibetan Medicine. Over
the past 30 years, it has cultivated more than 6000 professionals,
established two studios of TCM masters, 14 TTM inheritance stu-
dios, 9 grassroots-level expert inheritance studios, and 20 auton-
omous regionelevel famous expert inheritance studios. So far it has
cultivated 2 national TCM masters, 1 TCM specialist, 3 national
outstanding TCM masters, 1 national TCM and herbal master, and
36 celebrated TTM practitioners, thus making great contributions
to the development of TTM.
In 2014, the TTM Development Congress clearly stipulated the
guidelines, principles, and missions for the development of TTM.
The Outline for the TCM Development Strategy Planning of the Tibet
Autonomous Region (2016e2030) issued by the TAR in 2017 also
provided a favorable policy environment for the development of
TTM. Today, the TTM service system has been fully established with
the creation of 43 public TTM institutions with in-depth stan-
dardized management and unified construction, 5 country-level
clinical specialties, and 7 key specialties under the State Adminis-
tration of Traditional Chinese Medicine. A further 289 kinds of
hospital preparations have obtained 1031 registrations, and 352
kinds of Tibetan remedies and 128 kinds of Ka Cha have been listed
in the Catalogue of Basic Medicines and Traditional Tibetan Medi-
cines of the Tibet Autonomous Region. There are 2412 TTM beds in
the Region, with the number of patients reaching 3.29 million
annually; 89% of township hospitals and 38% of village clinics are
capable of providing TTM services. TTM has a variety of treatment
methods, including medicinal therapy, mechanical treatment,
bloodletting, fire moxibustion, medicated baths, diet therapy, and
external applications.7 This article considered the following:
Medicinal therapy. Tibetan prescriptions are generally
composed of various medicinal materials, including combinations
of over 100 kinds of material. Prescriptions composed of about 10
medicinal materials are the most common. Prescriptions for the
treatment of various diseases are formulated according to the
specific conditions of the disease, and fixed “prepared medicines”
are rarely used. In TTM, guiding drugs are preferred that direct the
remedy to the affected area (i.e., brown sugar cubes as primers to
treat cold-contracted diseases). Many diseases can be treated using
medicinal therapy, including cardiovascular and cerebrovascular
diseases, gynecological diseases, and gastrointestinal diseases.8
Tibetan medicated baths. Having advantages that include a
wide range of indications, safety, painlessness, and favorable ef-
fects, medicated baths are a common external treatment in TTM
and are popular among the Tibetan people. Wuwei Ganlu is the
basic formula for the Tibetan medicated bath. There are strict in-
dications and contraindications before bathing, which are recorded
in detail in the Four Medical Tantras. People with heart disease, high
blood pressure, trauma, tuberculosis, and pregnancy are not
allowed; medicated baths are also contraindicated shortly after
moxibustion, or while women are menstruating. Medicated bath
therapy is indicated for stiffness of the limbs, scrofula, and Long
dysregulation.
Fire moxibustion. The material used by Tibetan medicine for
moxibustion is mainly moxa. The points are divided into fixed and
Ashi points. Currently, fire moxibustion is mainly used for cold
diseases, such as dyspepsia, edema, and weakened stomach fire.
Smearing therapy. This therapy is simple and easy to perform
Q.J. Ren, J. Bai and N.M.C. Ren
and is commonly used in folk medicine. TTM believes that it has a
nourishing effect on the body, and its indications include poor
spirits, overwork, and insomnia due to deficiency of essence and
blood. The commonly used medicines are oils, followed by
ointments.
In recent years, TTM has made great progress, and academic
researchers have applied various methods such as neural networks
and information technology to ancient books, high-throughput
drug-screening technology, biotechnology, fingerprint analysis
technology, and serum pharmacology research for Tibetan
medicinals.8,9
Prospects
In the twenty-first century, both the development needs of
contemporary science and technology and the improvement of
China's higher education system require forward-looking per-
spectives to analyze and predict the future prospects for TTM. The
Outline of the National Medium- and Long-term Education Reform
and Development Plan (2010e2020) 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. A group of
internationally renowned, equipped, and high-level advanced ed-
ucation 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,
and higher education will optimize its structure and create unique
features. The Outline gives a clear direction for the development of
the higher education specialty system with Tibetan characteristics.
The lack of medicine in the TAR, especially in remote areas, has
always been an important difficulty affecting public health in the
region. TTM has played a supporting role, but has failed to funda-
mentally solve this problem. In Tibet, the development of Tibetan
medicine and lack of trained personnel are the core areas for
improvement. The rapid development of technical research has
played a vital role in promoting research on Tibetan medicine, but
there is still room for further research. 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 TAR will help improve the natural
environment, promote employment, and elevate local standards of
living and quality of life. The establishment of an integrated
industry-university-research model could effectively ease the
problem of lack of talent, insufficient resources for medicinal ma-
terials, inadequate jobs, and low levels of research and production.
31
Journal of Traditional Chinese Medical Sciences 8 (2021) S27eS31
TTM is a treasure within the field of China's national medicine, and
improving the development of TTM is the common aspiration of
our entire nation to ensure the happiness and health of all people.
CRediT authorship contribution statement
Qing Jia Ren: Conceptualization and writing e original draft.
Junjie Bai: Investigation and writing e original draft. Ni Ma Ci Ren:
Conceptualization, supervision, and writing e review & editing.
Transparency declaration
This article is published as part of a supplement entitled History
and Prospects of Traditional and Contemporary Medicines published
with support from the Beijing University of Chinese Medicine.
Declaration of competing interest
The opinions and description of traditional Tibetan medicine in
this paper are personal and do not represent the standpoints of our
journal or other institutions.
Acknowledgements
We would like to thank three undergraduates: Zha Xi Zhuo Ga,
Suo Lang Sang Mu, and Ga Ma Yu Zhen from Beijing University of
Chinese Medicine (Beijing, China) for their assistance.
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