A Brief History of the Development of Tibetan Medicine

　　China is home to 55 ethnic minority groups, distributed across various provinces and regions including Northeast China, North China, Northwest China, South China, and Southwest China. Although these groups differ in historical and geographical conditions as well as in customs, habits, and cultural development, each ethnic group has its own unique medical system. Throughout the course of historical development, these medical systems have played a positive role in ensuring the survival and prosperity of their respective peoples, making them an integral and indispensable part of China’s medical heritage. Among the four major ethnic medical systems in China—those of the Tibetan, Mongolian, Uyghur, and Dai peoples—Tibetan medicine holds the leading position. While drawing upon the accumulated experience of its own ethnic medical traditions, Tibetan medicine has also absorbed theoretical insights from Chinese medicine, as well as from Indian (present-day India and Palestine) and Persian (present-day Iran, Iraq, Egypt, and Palestine) medical systems, gradually developing into a comprehensive Tibetan medical system characterized by a rich theoretical framework and distinct ethnic features.

　　In the early days, Tibetan medicine and Tibetan pharmacology were closely intertwined and not distinguished as separate disciplines. The seminal works from the 7th to 8th centuries—such as "The Moon King’s Medical Diagnosis" and "The Four Medical Tantras"—serve as prime examples of this integration. Starting from the 10th century, specialized treatises on Tibetan pharmacology began to appear; by the 18th century, there were approximately 120 such works, among which "Jingzhu Bencao" stands out as a particularly influential masterpiece.

　　According to historical records available in the literature, Tibetan medicine has a history of more than 1,300 years, yet its full historical span extends far beyond this. For the sake of research convenience, we now divide its history into the following periods and introduce them accordingly.

　　The Enlightenment Period (from ancient times to the 6th century AD): As early as several centuries BC, the Tibetan people, in their struggle against disease, had already recognized that certain parts of animals, plants, and minerals possessed medicinal properties capable of alleviating human ailments. They held the belief that “where there is poison, there is also medicine” (from the woodblock print edition of “The Minister’s Admonitions,” page 7). Later on, they began using butterfat to stop bleeding, treat burns and scalds; employed barley wine to regulate menstruation, invigorate the body’s meridians, and dispel blood stasis; and utilized juniper branches and mugwort for fumigation to prevent and control epidemic diseases. All these experiences were passed down orally from generation to generation, preserved within folk traditions. This was a long period—the Enlightenment Era of Tibetan medicine.

　　The Founding Period (A.D. 629–846): In the early 7th century, Nangri Lönchen initiated the grand vision of unifying Tibet. His son, Songtsen Gampo, inherited his father’s legacy and successfully completed the great undertaking of unifying Tibet, bringing an end to the fragmented state in which various tribes were independent of one another. Thus, the Tubo Dynasty was established in A.D. 629, with its capital at Rasa (present-day Lhasa). After establishing the dynasty, a series of measures were adopted to strengthen political power, develop the economy, and revitalize culture. At the same time, Tang Taizong sent emissaries such as Tumi Sangbuza to India to study Sanskrit, using it as a model to create the Tibetan script consisting of the 30 characters still in use today. During this period, in order to foster closer relations between the Han and Tibetan peoples, Emperor Taizong of the Tang Dynasty arranged for Princess Wencheng, a member of the imperial clan, to marry the Tibetan king Songtsen Gampo. In A.D. 641, Princess Wencheng entered Tibet, bringing with her a large number of books and skilled artisans from various trades—including 100 different medical prescriptions, five diagnostic methods, and four medical treatises (as recorded on pages 50–54 of the woodblock edition of “The Chronicle of Tibetan Kings”). These medical texts were translated into Tibetan by Han Chinese Buddhist physicians such as Mahadeva and Maguo Ga, and were given the title “Comprehensive Medical Treatise.” This work represents the earliest extant Tibetan medical text (though it has since been lost).

　　After the publication of the "Comprehensive Medical Treatise," the Tibetan king again invited Han Chinese physician Han Wenhai, Indian physician Bajeda Zha, and Persian physician Galingna to jointly compile a comprehensive seven-volume medical text. This book incorporated elements from Chinese medicine, Indian medicine, and Persian medicine, and was titled "The Fearless Weapon." Unfortunately, it has since been lost. Songtsen Gampo ordered all Tibetan physicians to master this work thoroughly and issued twelve special decrees to that effect. These measures greatly facilitated the development of medical science.

　　In 710 AD, Emperor Zhongzong of the Tang Dynasty dispatched Princess Jincheng, a member of the imperial clan, to Tibet, bringing with her once again a large number of medical texts. Among these, the most renowned translation and commentary is undoubtedly "The Moon King’s Medical Diagnosis." Translated by the Han Chinese Buddhist physician Mahayana and the Tibetan translator Bie Ruo Zhan, this work was compiled around 720 AD, drawing upon both clinical experience from Tibetan medicine and the original text itself. The book comprises a total of 113 chapters. It is one of the earliest extant classical works on Tibetan medicine preserved in China today. This text holds immense significance for the study of the early history of Tibetan medicine as well as its connections with traditional Chinese medicine, Indian medicine, and the medical traditions of the Abbasid Caliphate. The book lists 329 medicinal substances, including 212 plant-based remedies, 67 animal-derived remedies, and 50 mineral-based remedies. The medicinal substances featured in the book are distinctly adapted to the high-altitude environment of the Tibetan Plateau, and the vast majority of them remain in use to this day.

　　As for the origin of “The Moon King’s Medical Diagnosis,” some say it was composed by the Indian master Nāgārjuna and transmitted to Tibet after being translated from Sanskrit into Tibetan; others claim it was a treatise delivered by Manjushri’s incarnate child, Manjushri, on Mount Wutai in China, thus suggesting that the original work originated from Mount Wutai. Yet another view holds that the text first made its way from Mount Wutai to India and then from India to Tibet. In short, there are many different opinions, and no consensus has been reached. However, judging from the content of the entire book, it is a comprehensive medical work that integrates Tibetan, Chinese, and Indian medical traditions.

　　In the mid-9th century AD, the renowned Tibetan physician Yutok Yontan Gonpo (729–832 AD) and others, while summarizing the accumulated experience of Tibetan medicine, also drew upon the essence of the aforementioned works. Over a period of roughly 20 years (from 768 to 790 AD), they compiled the "Four Medical Tantras," which contains 313 prescriptions and 406 individual medicinal substances. Based on differences in the origin, quality, habitat, and part of the plant used for medicinal purposes, these substances are categorized into eight major groups: precious medicines, gemstones, earth-derived substances, wood-based substances, essence substances, common terrestrial products (crop-based substances), herbaceous plants, and animal-derived medicines.

　　The period from the 6th to the mid-9th century AD was a pivotal era in the history of Tibetan medicine. Although the works from this period were collaborative efforts in medical science, they laid a solid foundation for the subsequent development of Tibetan medicine and Tibetan pharmacology.

　　The Formative Period (A.D. 846–1271): Following the collapse of the Tubo Dynasty (A.D. 629–846) and subsequent political turmoil triggered by Langdarma’s reforms, the region fell into a state of fragmentation and regional autonomy. During this period, specialized treatises on Tibetan medicine gradually began to emerge, marking the inception of Tibetan pharmacology as an independent discipline. A defining characteristic of this period is that, in its early phase (during the Tubo Dynasty), medicine and pharmacology were closely intertwined, with medicine taking center stage and pharmacology playing a supporting role. Although the “Four Medical Tantras” classified medicinal substances and discussed their properties and the Five Elements, these topics were still treated as supplementary sections within the text and occupied only a small portion of its content. However, during this period, medicine and pharmacology each developed their own dedicated treatises, and pharmacological works began to appear more frequently, gradually giving rise to the distinct field of Tibetan pharmacology. Representative works from this period include “Ganlu Jingyi,” “Ganlu Babu,” “Ganlu Jingyi Bazi Mijue,” “Yaozhen Zhuzhong Caoben Yaojue,” “Zanmuyang Bencao,” “Yao Wu Daquan,” “Yi Yao Fangji Jiyao,” “Caoyao Daquan,” and over twenty other pharmacological treatises. These works systematically documented various aspects of medicinal substances, including their types, distribution habitats, properties, flavors, therapeutic effects, and processing methods. Some of these works took specific sections from the “Four Medical Tantras” and subjected them to detailed examination or added supplementary information to certain medicinal substances—for example, “Caoyao Daquan.” This work retained the classification system and species categories used in the “Four Medical Tantras,” but expanded upon them by adding detailed information on species identification, habitat distribution, and morphological characteristics.

　　Period of Development (A.D. 1279–1642): After the collapse of the Tubo Dynasty, Tibet fell into a state of fragmentation and regional fragmentation, which in turn gave rise to a vibrant debate among different schools of Tibetan medicine. By the 13th century, a multiplicity of schools had already emerged. During the Phagmodru Dynasty (A.D. 1349–1436), the scholarly insights formed amid this intense academic rivalry prompted scholars to write extensively, thereby greatly advancing the development of Tibetan medicine.

　　The Southern School, led by Suchak Nyamnyidoji, includes Tibetan medical scholars from various periods, such as Garbu Bon Romigebu. This school is particularly adept at using warming herbs and pays close attention to the morphological characteristics and natural habitats of medicinal plants. They have created several illustrated charts of medicinal substances and put forward distinctive views on drug combinations and processing methods. The school’s works include nearly 20 publications, such as “Millions of Relics,” “Reply to the Northern School—Ginseng,” “Questions and Answers on Medicinal Substances,” and “The Ancestral Oral Teachings.” Among these, “The Ancestral Oral Teachings” was later praised by the Fifth Dalai Lama and Desi Sangye Gyatso as an outstanding work, and to this day, it remains a renowned classic.

　　The Northern School, led by Champa Namgyal Zhaxang, includes renowned medical scholars from various periods, such as Minima Tongwa Dondan, Hun Di Du Zi Jimei, and Namgyal Dorje. In terms of teaching, this school has developed a pedagogical approach known as the "Six Sides and Four Methods." In pharmacology, the school excels in the use of cold-natured herbs and has conducted extensive research on high-altitude illnesses as well as wind-cold-damp bi syndromes. The school’s works include more than ten texts, such as "Questions and Answers on Medicines," "Ganlu Changliu," and "Commentaries on the Four Medical Canons."

　　Due to the opposition between the Northern and Southern schools, scholarly debates flourished. Numerous pharmaceutical works—approximately 40 in number—were published, covering topics such as types of medicinal substances and their identification, illustrations, properties and flavors, processing and preparation methods, and compatibility and dosage forms, thereby promoting the in-depth development of Tibetan pharmacology.

　　The Period of Flourishing (A.D. 1642–1750): After the Fifth Dalai Lama seized power in 1642, he actively promoted the development of Tibetan medicine. Throughout the two-century period up to the Tenth Dalai Lama, Tibetan medicine continued to flourish unswervingly. Under the auspices of the local Tibetan authorities, renowned medical scholars from both the northern and southern schools were organized to compile and publish over 40 medical texts. For instance, in 1662, such landmark works as the "Four Medical Tantras," the "Eighteen Branches of Yutö Medical Diagnosis," and the "Ancestral Oral Teachings" were reprinted. During the reign of the Sixth Dalai Lama, all the prominent painters from across Tibet were convened to create, based on the "Blue Lapis Lazuli Edition of the Four Medical Tantras" and incorporating specimens of Tibetan medicinal herbs collected from throughout the region, a set of colorful illustrated pharmacopoeias in 1702. The sheer variety of species depicted, the harmonious use of colors, and the remarkable similarity in form represented a groundbreaking achievement in the history of Chinese pharmacology. At the same time, numerous other works were authored, including "Collection of Essential Medical Prescriptions," "Pharmaceutical Formulas," "Compendium of Medicines," "Notes on the Glorious Treasury of Nectar Medicines," "Identification of Medicinal Substances," "Three Methods of Pharmaceutical Preparation," "Powdered Medicines," "Nine Prescriptions for Preventing Infectious Diseases," and "Materia Medica." Particularly noteworthy are the monumental works "Blue Lapis Lazuli" and "Crystal Jewel Materia Medica," which stand as exemplary masterpieces reflecting the golden age of Tibetan medicine's flourishing development.

　　“The Blue Lapis Lazuli Commentary on the Four Medical Tantras” was authored by Desi Sangye Gyatso (1653–1707). Drawing upon comparative reviews and collations of Yutö’s “Four Medical Tantras,” “Four Continuations and Detailed Examinations,” Su Ka’s “Four Medical Tantras,” as well as versions from Zongga, Ganmu Bao, Derge, and Zhadang, he meticulously corrected punctuation, rectified typographical errors, and provided annotations for obscure archaic terms. In 1687, he completed the revised and annotated edition known as “The Blue Lapis Lazuli Commentary on the Four Medical Tantras,” which became the universally accepted “standard” annotated edition throughout Tibet. The number of medicinal substances increased from the original 406 to over 700, and the six tastes, eight properties, and seventeen effects were further clarified. Moreover, he also authored specialized works on pharmacology such as “The Golden Key to the Eight Essential Secrets,” making tremendous contributions to the history of Tibetan medicine and pharmaceutical science.

　　“The Compendium of Crystal Gems” was compiled by Dimal Denzeng Pengcuo over a period of roughly 20 years, starting in 1743. It was based on field investigations and extensive research into more than 130 historical Tibetan medical texts. The book contains a total of 2,294 medicinal substances and represents the culmination of Tibetan pharmacology. According to their origins, physical characteristics, habitats, and parts used in medicine, the substances are categorized into 13 major groups: precious gems, gemstones, trees, wetland plants, xerophytic plants, crops, animals, sap-based substances, earth-based substances, water-based substances, processed substances, saline-alkaline substances, and fire-based substances. Among these, the tree category is further subdivided into seven subcategories: leaves, flowers, fruits, branches, trunks, bark, and resin. The xerophytic category consists of herbaceous plants and is divided into six types: roots, leaves, flowers, fruits, aerial parts, and whole plants. This classification method is highly scientific and continues to serve as an important reference for plant and medicinal substance classification today.

　　The "Jingzhu Bencao" has thoroughly examined and corrected the issues of homonyms with different species, different names for the same species, and multiple species bearing the same name in pharmacopeias throughout history. For instance, the term "Waxiaga" currently refers to nearly 20 species belonging to seven different plant families; among them, the authentic species is Adhatoda vasica. However, this species is rarely used in clinical practice. The "Jingzhu Bencao" provides a clear description: "Waxiaga" is a woody plant with articulated branches whose nodes are swollen; its leaves are opposite, leathery, and its flowers are yellowish-white with a bitter taste. In contrast, what is currently used is actually a herbaceous plant. According to the "Jingzhu Bencao," although "Waxiaga" is not native to Tibet, it can be substituted by "Dongladongchi" (Veronica). Thus, it is evident that the "Jingzhu Bencao's" research on Tibetan medicine remains an important reference even today.

　　Since the liberation, under the radiant guidance of the Party’s ethnic policies, Tibetan medicine has experienced a remarkable leap in development. Since 1960, Xiao Peigen and Xia Guangcheng from the Chinese Academy of Medical Sciences have conducted three field surveys in Tibet to investigate Tibetan medicinal resources. From 1968 to 1975, Pan Jintang and others from the Northwest Plateau Institute of Biology carried out similar surveys; from 1964 to 1985, Yang JingSheng from the Yunnan Institute for Drug Control did likewise; and from 1968 to 1988, Luo Dashang from the Tibetan Medicine Department of Gansu College of Traditional Chinese Medicine (now Gansu University of Traditional Chinese Medicine) also conducted on-site investigations into Tibetan medicinal resources on the Qinghai-Tibet Plateau. These efforts have provided a solid foundation for identifying the variety of Tibetan medicinal resources and for their effective development and utilization.

　　Due to varying historical and developmental conditions, the Tibetan medicine industry has advanced in a wave-like manner. There are numerous works on Tibetan pharmacology, each featuring unique theories and rich content. These represent the enduring achievements of Tibetan pharmacologists throughout history. Since the liberation, the accomplishments made by the Institute of Tibetan Medicine have been particularly inspiring.