U. iz,, i/ceeiiuier COMMENTARY TIBETAN MEDICINE AND DERMATOLOGY IN THE FIFTEENTH CENTURY ROBERT JACKSON, M.D., FRCPC The legend of the onset of Tibetan medicine was, ac- cording to Rechung, as follows: In the golden age, human beings lived in samddhi (the bliss of deep ab- sorption) and required nothing. One day, a man ate some bitumen and developed painful indigestion. Brah- ma heard about it and, remembering the teachings of the great Buddha Sha-kya, he taught the man to drink boiling water and the man was cured. "Therefore they say that the first disease was indigestion, and the first sick being was human, and the first medicine was boil- ing water, and the first doctor was Brahma. "^ The practice of twentieth century Tibetan medicine has many features in common with that described in the Blue Tantra.^ For hundreds of years there has been a highly civi- lized society in Tibet. The cornerstone was the teach- ings of Buddha with considerable foreign influences, particularly from China and India. An accompanying civilized system of medicine was the sowa rigpa or "science of healing." Akin to early Creek medicine, Tibetan medicine re- garding the body as a complex and diversified aggre- gate of the five elements—earth, water, fire, wind, and space. There were seven bodily tissues: chyle, blood, flesh, fat, bone, marrow, reproductive fluid and their residues—feces, urine, sweat. There were three humur- al fluids—wind (penuma), bile, and phlegm. As long as the three humors were in a reciprocal equilibrium, there was well life and good health. Things that could upset the equilibrium were climate, environment, con- duct, nutrition, trauma, and demons. The book entitled Tantra of Secret Instruction on the Eight Branches of the Essence of the Elixir of Im- mortality, or The Glorious Four Tantras of Medical Science, is one of the fundamental texts of Tibetan medicine.* An illustrated commentary on this text has been published recently in a beautiful two-volume set entitled Tibetan Medical Paintings^ with the subtitle 'Illustration to the Blue Beryl Treatise of Sangye Gyamtso (1653-705).' The commentary is accompanied by From the Department of Dermatology, Ottawa Civic Hospital, Ottawa, Ontario, Canada. Address for correspondence: Professor Robert Jackson, M.D., FRCPC, 1081 Carling Avenue, Suite 508, Ottawa, Ontario, KlY 4G2, Canada. Figure 1. Plate 1: Palace of the Buddha, Bhaisajyaguru, Master of Remedies. many small paintings or cameos illustrating the various stages of disease, types of treatment, and aphorisms of medical practice as would be appropriate to the Ti- betan physicians or healers of the 15th century. As "by tradition, the most concise expositions are valued above all others," this Blue Beryl is said to be suitable "for medical students of superior, mediocre, inferior, and dullest intelligence, respectively." The root tantra (Fig. 1) illustrates the Sakyamuni Buddha, manifesting as Bhaisajyaguru, the master of remedies, sitting in the center of a square celestial palace with gates. Surrounding this place there are cities and forests of medicine. Along the top is the lin- eage of medical teaching, starting with the Dalai Lama V (1617-1682) along with lesser Buddhas. The root tantra (Fig. 2) of diagnosis ("the three stems of inquiry that constitute [the technique of] diag- *Tantra - any of a class of Buddhist mystical and magical writings. 834