The Administration of Tibetan Precious Pills

Asian Med (Lieden). Author manuscript; available in PMC 2016 December 13.

Published in final edited form as:
Asian Med (Lieden). 2015 ; 10(1-2): 36–89. doi:10.1163/15734218-12341350.

The Administration of Tibetan Precious Pills: Efficacy in Historical and Ritual Contexts

Olaf Czaja

University of Westminster, London

Abstract

Precious pills represent a special kind of Tibetan drug that once was, and still is, highly sought after by Tibetan, Chinese, and Mongolian patients. Such pills are generally taken as a potent prophylactic remedy, and can be used to cure various diseases. The present study seeks to discuss the dispensation and efficacy of precious pills according to the presentations of historical Tibetan medical scholars. Several treatises dealing with these instructions will be analysed, thereby revealing their underlying concepts, and highlighting their points of both general consensus and disagreement. The analysis of these detailed instructions will reveal the fact that these precious pills were not merely given to a patient but, in order to ensure their full efficacy, involved an elaborate regimen concerning three chronological periods: (1) the time of preparation, (2) the time of dispensation, and (3) the time after dispensation. Thus the present study surveys not only the ritual empowerment of drugs in Tibetan medicine, but also the importance of social relationships between doctors and patients in Tibetan medical history.

Keywords

Tibetan medicine; Tibetan medical history; efficacy; precious pills

Introduction

oczaja@yahoo.de.

So-called ‘precious pills’, also known as ‘jewel pills’ (rin chen ril bu), constitute an important remedy for a variety of diseases and ailments.1 They are generally called precious pills or jewel pills because they consist of many precious ingredients, including the famous processed ‘mercury sulfide ash’ (btso thal).2 Some consider precious pills to be the most potent drug Tibetan medicine has to offer.3 This can be seen in the statement made by Dr Lobsang Dolma Khangkar for the English-reading public:

All of these ingredients are considered to be blessed by an enlightened being, by a Buddha, and then they are prepared and made into one pill. The attitude which the doctor must have toward this medicine is that, since the ingredients of this medicine have been blessed by Buddha, the medicines will not only cure the patient from the

2On the ingredients and use, see Aschoff and Tashigang 2001, 2004, 2009; Sachs 2001, pp. 86ff.; Bradley 2013, pp. 183ff. On btso thal, see Gerke 2013.
3See, for instance, Craig and Adams 2008.

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three diseases of rlung, mkhris-pa and bad-kan but will also extend the patient’s life and finally become the seed for the patient to realise the importance of obtaining enlightenment for the benefit of others and to reach the supreme state of Buddhahood. This medicine is like a blessing which enters into the stream of the patient’s being. In Tibet, where the distances are vast and there is no means of easy communication with a person who lives in a place where there is no doctor, taking just one such pill as a blessing from the Buddha is done in the case of serious illness or before death.4

Such appreciation for the precious nature of these pills has a profound impact on their usage and, most likely, also their efficacy. In the case of the Tibet Autonomous Region (TAR) in China, as observed by Theresia Hofer, they ‘are now also sold on a large scale as over-the- counter (OTC) drugs through various pharmacies and shops all over town, with buyers often not having had a prior clinical consultation’.5 The demand for these pills is high, which also results in a high price. This is also influenced by the fact that some of the ingredients are rare, come from endangered species, or are today regarded as toxic and need to be substituted because of the introduction of Good Manufacturing Practice (GMP) in 2003.6 They are of immense importance for the Tibetan community in India and elsewhere throughout the world.7 In Tibetan communities both inside and outside Tibet, precious pills are regarded as the true essence of Tibetan medical culture.8

While some studies have described various aspects of precious pills from an anthropological perspective, none of them have yet presented the writings of Tibetan scholar-physicians from the past—both recent and distant—even though some of the most important scholars and practioners in the history of Tibetan medicine have written on the subject. To fill this gap, the present paper explores the ways in which these special pills have been administered to ensure maximum efficacy. As will be presented in more detail below, the steps of dispensation generally include: (1) certain preliminary practices for the patient, (2) a complex ritual performed by the doctor to ensure the purity and the efficacy of the precious pills, (3) the highly ritualised administration of the pills involving both patient and doctor, and (4) the period after the administration when the patient has to follow specific lifestyle and dietary regulations that are necessary to ensure the long-term efficacy of the pills. The paper concludes with the general benefits of the jewel pills that, for instance, can also be worn as amulets. This study is based on an analysis of seven works written by famous scholar-physicians. They are the only known treatises that specifically deal with the administration of precious pills:

(1) A Note on How to Administer Precious Pills: The Special Teaching of Zurkharwa (Rin chen ril bu gtong tshul gyi zin bris zur mkhar ba’i khyad chos) by Chökyi Drakpa (Chos kyi grags pa, 1595–1659)9

8Kloos 2010, p. 80; Kloos 2012, p. 200; Saxer 2013, pp. 71ff.
9Zur mkhar khyad chos. For a brief account of his life, see Jampa Trinlé 2000, pp. 367ff. For some remarks on his medical expertise, see Czaja 2007, p. 349, n. 1, p. 358, n. 43. Many of his medical writings can be found in modern compilations containing the medical

4Lobsang Dolma Khangkar 1998, p. 59. For the same statement, see also Lobsang Dolma Khangkar 1990, p. 39; Tsewang
Dolkar Khangkar 1998, p. 65.
5Hofer 2008, p. 175.
6Hofer 2008, p. 176; Craig 2011a, p. 342; Craig 2012, pp. 150f.; Gerke 2013, pp. 133ff.; Saxer 2013, pp. 71ff. Cf. also Blaikie 2015. 7Prost 2008, pp. 77ff.; Kloos 2012, p. 200; Gerke 2012, p. 82; Gerke 2013, p. 142; Blaikie 2013, pp. 434f.

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(2) The Practice of Administering Jewel Pills: The Definite and Profound Heart Essence (Rin chen ril bu gtong thabs lag len nges zab snying thig) by Tendzin Püntsok (Bstan ’dzin phun tshogs, b. 1672)
(3) The 60th chapter in The Heart-beloved Jewel Instruction from the Precious Collection: The Jewel Garland of Immortality (Gces bsdus ’chi med nor phreng las man ngag snying gi nor bu) by Karma Ngedön Tendzin Trinlé Rapgyé, alias Karma Ratna (Karma nges don bstan ’dzin ’phrin las rab rgyas, Karma ratna, b. 1770)10
(4) On How to Administer Precious Pills (Rin chen ril bu gtong ba’i tshul) by Yeshé Gyatso (Ye shes rgya mtsho, 1789–1856)11
(5) On How to Administer Precious Pills (Rin chen ril bu gtong ba’i tshul) by Khyentsé Wangpo (Mkhyen brtse’i dbang po, 1820–92)12
(6) The 19th chapter in The Beautiful Ornament for the Compendium: A Treasury of Medicinal Elixirs (Zin tig mdzes rgyan bdud rtsi’i sman mdzod) by Orgyen Tekchok, alias Orgyen Tendzin (O rgyan Theg mchog, O rgyan Bstan ’dzin, b. 19th cent.)13
(7) On How to Administer Precious Pills (Rin chen ril bu gtong ba’i tshul) by Khyenrap Norbu (Mkhyen rab nor bu, 1883–1962)14

The starting point for the present analysis is the work written by Tendzin Püntsok, which will be presented in detail in the next section. It represents an early treatise that already shows features encountered in later works on this subject. It appears to have been the basis for some of the compositions by later doctors. A table of contents for the Practice of Administering Jewel Pills has also been added as an appendix to this article for the convenience of the reader. Its main points will be compared to the writings of the other scholar-physicians.

The Treatise of Tendzin Püntsok

The treatise written by Tendzin Püntsok is entitled The Practice of Administering Jewel Pills: The Definite and Profound Heart Essence (Rin chen ril bu gtong thabs lag len nges zab snying thig). The colophon does not provide a date for the composition of the text, but mentions only the persons who entreated him to write the work—namely the Dharma King

treatises of the Drigung school that are available in different editions, see ’Bri gung gso rig gces bsdus I; ’Bri gung gso rig gces bsdus II; and ’Bri gung gso rig gces bsdus III.
His important interlinear commentary on the Rgyud bzhi was recently published, Them spang ma. For his autobiography, see Chos kyi grags pa rnam thar. For his religious and political life as throne-holder of the Drigung school, see ’Bri gung gdan rabs, 257/7–286/23. 10For a brief account of his life, see Jampa Trinlé 2000, pp. 390ff. He is mainly known today for his medical writings that are available in modern editions; see Gces bsdus ’chi med nor phreng and Karma ratna’i sman yig gces btus.

11For a biographical sketch, see Drakpa Jungné and Lozang Khedrup 1992, p. 744f., and Döndor and Tendzin Chödrak 1993, p. 875f. He is not known to have studied medicine. Other medical works authored by him are unknown.
12For a brief account of his life, see Jampa Trinlé 2000, pp. 393ff.; Gardner 1866 [sic]. See the bibliography of the latter author for Tibetan- and English-language biographies of Khyentsé Wangpo, and further biographical entries of Tibetan lexicons. For his medical writings, see Mkhyen brtse’i dbang po’i sman yig I and Mkhyen brtse’i dbang po’i sman yig II.

13There exists no biographical account on him. According to the editors of the Zin tig mdzes rgyan bdud rtsi’i sman mdzod used for this study, he was born in Drida Damogang (’Bri zla zla mo sgang) in eastern Tibet. It is said that he was a follower of a Kagyü school. 14For a brief account of his life, see Jampa Trinlé 2000, pp. 453ff. His works are available in various editions; see, for instance, Mkhyen rab nor bu’i sman yig.

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of Nangchen (Nang chen chos rgyal) and his personal physician (bla sman).15 These figures also appear in the colophons of other works by Tendzin Püntsok, where their names are explicitly given: the Dharma King of Nangchen, Tsewang Dorjé (Nang chen chos kyi rgyal po Rdo rje tshe dbang), and the royal physician Lhamokyap (Bla sman Lha mo skyabs).16 Because the latter works that mention the Dharma King and his personal physician all primarily deal with poisoning, one might conclude that it was of major concern for the Nangchen King and the medical doctor responsible for his well-being.17 One of them, The Mantra Ritual of Binding the Hair of Sage Puri Entitled The Universal King who Annihilates Poison: A Practical Edition (Pu ri skra bcing gi sngags chog dug ’joms spyi’i rgyal po zhes bya ba ltas chog tu bkod pa), is also of direct importance for Tendzin Püntsok’s work on the administration of precious pills, as it outlines a ritual that is performed as part of the preliminary practices for giving precious pills. Fortunately, this ritual text provides the information that it was composed in the year 1727 at the royal capital or royal encampment (sgar chen) of Nangchen known as Khyilke Trashi Khyilwa (’Khyil ke [=Mchil ske] Bkra shis ’khyil ba) in eastern Tibet.18 As two of these works give the same place, one could be inclined to assume that perhaps Tendzin Püntsok wrote all these works at the same time when he stayed at the royal encampment of the Nangchen ruler, Tsewang Dorjé (r. 1680–1734).19 Based on this assumption, one could regard all these treatises as an example of medical expertise and scholarship at the first half of the eighteenth century.

Needless to say, Tendzin Püntsok did not create his treatise ex nihilo, but relied on medical knowledge handed down to him over previous generations. He stresses this fact at the beginning of his Practice of Administering Jewel Pills by pointing out that it represents an oral tradition that he had written down for the first time.20 He divides his work into four main parts—namely, (1) the preliminary practices, (2) the main practices, (3) the concluding practices, and (4) the benefits and blessings.

15Nges zab snying thig 858/1.
16Dug srung rim pa 472/18; Dug nad zin tig 481/2; Pu ri skra bcing sngags chog 498/14; Bi ṣa bcos pa 505/1. These four treatises are: (1) The Most Profound Steps for Guarding against Poison: The Indestructable Life-force Fortress (Dug srung gi rim pa yang zab rdo rje’i srog rdzong), (2) Remedies of Curing Poisoning: The Condensed Essence (Dug nad gso ba’i zin tig snying por dril ba), (3) The Mantra Ritual of Binding the Hair of Sage Puri Entitled the The Universal King who Annihilates Poison: A Practical Edition (Pu ri skra bcing gi sngags chog dug ’joms spyi’i rgyal po zhes bya ba ltas chog tu bkod pa) and (4) Instructions for Curing Poison: A Wish- fulfilling Jewel (Bi ṣa bcos pa’i man ngag tsitta ma ṇi).
17There was widespread unrest in eastern Tibet in the first half of the eighteenth century. The revolt led by the Mongol Lubsangdanjin (Blo bzang bstan ’dzin) in 1723 and 1724 that was eventually quelled by Qing forces was the beginning of a new political and administrative system introduced in this region. For more information, see Perdue 2005, pp. 310f.; Schwieger 2015, pp. 132ff. Tsewang Dorjé too had to become part of this new political regime, receiving the title of the ‘Head of One-Thousand Households’ (Tib. stong dpon; Chin. qianhu 千户) by the Qing court in 1726; Liu Guo-wei 2014, p. 94; Turek (forthcoming), p. 9. Probably the wish to be prepared for any case of poisoning resulted from the difficult political climate at that time.
18Pu ri skra bcing sngags chog 498/18. The Nangchen encampment (Nang chen sgar) was permanently established at Namtsang Chilkenyak (Rnam tshang ’chil sked nyag) in Nangchen. According to Denma Jamyang Tsültrim, the site for the permanent encampment was chosen by Tsewang Dorjé in 1724, Denma Jamyang Tsültrim 1995–7, vol. 2, p. 74. For the geographical locality and historical extension of the Nangchen kingdom, see Gruschke 2004, pp. 103ff.; Ryavec 2015, Map 42.
19For a brief biographical account on Tendzin Püntsok, see Jampa Trinlé 2000, pp. 381ff. For some information on Tsewang Dorjé, see Denma Jamyang Tsültrim 1995–7, vol. 2, pp. 74ff.; Turek (forthcoming), p. 9.
20It is presently unknown who were the teachers and students that were transmitting these instructions. Tendzin Püntsok gives no names in his treatise. In his record of the teachings he received, a teaching on the administration of precious pills is not listed;
Bstan ’dzin phun tshogs Thob yig.

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The Preliminary Practices

The first section, the preliminary practices, concerns all preparations that are to be done prior to the actual administration of the precious pills. Tendzin Püntsok writes that the doctor should choose a dwelling place such as a house or a hut in a quiet, auspicious spot that is blessed by buddhas or previous teachers. The dwelling place should be orientated towards the east, and it should be swept clean. The preliminary practice should be performed on an auspicious date. The person who actually gives the precious pills is of some importance—he notes that it would be best if the pills are administered by one who is expert in the compounding of such precious pills. If such an expert is not available, however, the option of medium quality refers to a fully ordained monk who has kept his vows and abstained from meat, beer, and onions prior to administering the pills. If this too is impossible, the lesser option refers to a male nurse, or someone trained in giving drugs, administering the precious pills. If all of these three options are not possible, a girl born in a tiger year who is untainted by sex and is pious should give the drugs. After these more general considerations, Tendzin Püntsok explains that a set of rituals should be performed, starting with the special teaching of the sage Puri, briefly known as ‘Binding the Hair’.21 This ritual primarily aims to neutralise the strength of any poison; it is said to draw out the poison through the pathways of the ‘channels’ (rtsa)—the same pathways that the formula, the precious pills, will enter. Thus, it is said that the pernicious and poisonous substances in the body are seized and brought to light. Moreover, one should perform rituals that scare obstacle-creating demons, visualise a protection circle, and secure the outer boundaries. Finally, three days prior to these events, one should follow the instructions regarding the gathering of poison and one should ask for healing rituals (rim gro), virtuous practices (dkar chos), empowerments, and blessings.

The next step is to establish a ritual ground and erect a small altar. At night one should spread out a white mat or cushion on a raised platform and create five swastikas with white grain in each of the four directions and the centre of the mat. One should then also place the pills, or whatever one intends to administer, on the mat. Then one should arrange blessed and exceptional shrine objects (rten gsum) in a hollow.22 Having done this, one has to arrange the water that is needed for the pills, food, and drinks; it is recommended to fetch water that possesses the 37 qualities from a fountain or a spring facing to the east.23 Then one should arrange the implements for making the offerings: one should conduct a fumigation offering, pray, praise, and make other offerings to the guardians of medicine. Then, that very night as well as the next morning and noon, the doctors should give three well-compounded Seru-4 pills (Bse ru bzhi tshad ldan ril bu) to each of the patients. This drug will ensure that the disease is brought together, made apparent, and that the ‘channels’ remain open.

21For the entire ritual, see Pu ri skra bcing sngags chog.
22The ‘three supports’ (rten gsum) refer to statues, scriptures, and stupas—representations of body, speech, and mind of the Buddha, respectively.
23It is unclear which qualities are meant.

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The Main Practices

The main practices begin the very same night as the preliminary preparations. After the last step of the preliminaries and the patient has received his first batch of Seru-4 pills, all of the participants—the doctor, patient, and assistants—should wash, put on new clothes, and stay pure and orderly. It is important that all three participants are dharma brothers with whom one has had pure connections in the past. Then one’s attention is to be directed to the altar once again. One should put a full measure of grain on top of the five swastikas and then place a mat or cushion of white silk on top of it. Then one is to create the symbol of a double thunderbolt (Skt. vajra; Tib. rdo rje) in the centre and one vajra in each of the four directions with white rice. One should cover these designs with a piece of yellow silk and place an alms bowl filled with rice on top of them. Then one should put a porcelain cup or a goblet made of gold, silver, or bronze in this alms bowl. One is to fill this cup with a mouthful of good tea made from the pure decoction of little sprouts of tea leaves. Then one should put the jewel pills in the tea, making sure that they are not exposed to the sky. Next one is to lift the cup up with four golden-coloured myrobalan fruits (a ru gser mdog), each placed in the four directions under the cup. One should cover the cup with a piece of red silk, as well as the religious robes of a fully ordained monk. Finally, one should put blessed and exceptional images of Bhaiṣajyarāja or Buddha Śākyamuni on the cup and erect a baldachin or a parasol of blue silk with three folds above it.

After the altar is finished the doctor—together with the patient and the assistants—should make prostrations and offerings, with knees down and palms together. A spiritual master should then conduct the ensuing ritual. It starts with a praise of the real condition of existence (dharmatā, chos nyid) and is followed with contemplation on a special meditative experience—namely, the state of the inherent absence of a self-entity in the individual person as well as in all phenomena. Next a meditative visualisation begins. One should visualise that, out of the sphere of emptiness, one’s self appears in a moment as the beautiful Goddess of Medicine, White Ambrosia (Sman gyi lha mo Bdud rtsi ma dkar mo), who is adorned with the sambhogakāya ornaments and the major and minor marks. She holds a vajra in her right hand that destroys the demons that cause interruptions and obstacles. In her left hand, she holds a medicine vase of ambrosia with a myrobalan branch with leaves, flowers, and fruits, and a vase ornamented with a peacock feather that annihilates poison.24 By means of the light radiating from the three seed syllables25 of the three abodes,26 the Three Jewels27 of the infinite buddhafield of the ten directions and the three ‘roots’ (rtsa gsum)28 are to be invited together with the guardians, and remain in the sky in front of oneself like a dense mass of clouds. One then is to make a smoke offering and a sevenfold offering before them:

24The visualisation of this goddess is probably based on the Yuthok Heart Essence (G.yu thog snying thig) and its oral textual transmissions (lung) as obtained by Tendzin Püntsok. In his record of teachings he received, he gives the complete transmission lines for the empowerment and the oral textual transmissions, including the Goddess of Medicine (Sman gyi lha mo), of the G.yu thog snying thig, Bstan ’dzin phun tshogs Thob yig 133/20, 134/11. This Goddess of Medicine is most probably Dütsima (Bdud rtsi ma), but a goddess with this iconography cannot be traced in modern editions of the G.yu thog snying thig.
25The three seed syllables are oṃ āḥ hūṃ.
26The three abodes are located at the head, throat, and heart.
27The Three Jewels are Buddha, the dharma, and the saṅgha.
28The three roots are the guru, yidam, and ḍākinī.

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I faithfully salute and praise
The infinite ocean, worthwhile to praise,
Rejoicing at the marvels,
While recalling [your] deeds, virtues, and life-stories of liberation, May we be blessed, here and now, with the ambrosia of immortality! oṃ ā hūṃ kaya vakka citta jñānasya /
vajra samaya dzaḥ siddhi phala hūṃ!

Because one recites it many times, body, speech, and mind will be blessed. Then one should contemplate the nature of ambrosia. One should rely on the ambrosia of the Sanskrit vowels and consonants (dbyangs gsal) when reciting the ‘Essence of Causation’ (rten snying) mantra and praising it. This should be followed by a recitation of the mantra, Oṃ auṣadhī idaṃ vajra amṛta supratiṣṭha vajraye svāhā, along with a scattering of flowers. All three participants—the doctor, patient, and assistants—should then look to the east. The patient should sleep on his right side with his head towards the place where the pills will be given and one should imagine that the field of refuge and the guardians stand like a baldachin or parasol.

At midnight, the patient should eat a restricted diet. As the first half of the night falls the patient should take a full cup of a boiled potion made from three spoons of pepper (g.yer ma).29 Then the patient should rinse his mouth with cold water and sleep like before. Early in the morning before dawn (tho rangs), the physician should take refuge and cultivate the resolve to attain enlightenment out of compassion for all sentient beings, and ask the spiritual master for fumigation and libation rituals. Then when the assistant takes out the pills in the alms bowl, the spiritual master should recite the following praise poem:

Oṃ āḥ hūṃ
With the power of the blessings of the Three Jewels and the objects of refuge Resembling an ocean, and the truthfully speaking gods and sages,
May I today truly realise this praise poem
That originates from the Veda of former times!
May Brahmā, Dakṣa, the Aśvinī brothers,

29In modern botanical works, the term g.yer ma refers to different kinds of peppers growing in Tibet and its adjacent regions. G.yer ma can variously refer to: (i) Zanthoxylum tibetanum Huang (Börang Kyongjong Sarjé Uyön Lhenkhanggi Trötenü 1973, p. 330; Gurmet Namgyal and Phuntsog 1990, p. 319; Parfionovitch et al. 1992, p. 215), (ii) Zanthoxylum bungeanum Maxim. (Yang Jingsheng and Chucheng Jiangcuo 1987, p. 212; Zhongguo kexue yuan xibei gaoyuan shengwu yanjiusuo (Northwest Institute of Plateau Biology, Chinese Academy of Sciences) (ed.) 1991, p. 332; Gawé Dorjé 1995, p. 154; Pasang Yonten Arya 1998, p. 237; Bönjong Mentsikhang Sorik Zhinjukkhang 2007, p. 413), (iii) Zanthoxylum (Clark 1995, p. 165), (iv) Zanthoxylum nepalense Babu, (Dawa 1999, p. 346), (v) Zanthoxylum armatum DC. (Tsering Dorjee Dekhang 2008, p. 202), (vi) Zanthoxylum sp. (Thinley Gyatso and Hakim 2010, p. 281), (vii) Zanthoxylum schinifolium Sieb et Zucc, Zanthoxylum bungeanum Maxim. (Karma Chömpel 1993, p. 63), (viii) Zanthoxylura bungeamum Maxim., Zanthoxylura armatum DC. (Luo Dashang 1997, p. 147), (ix) Zanthoxylum schinifolium Sieb. et Zucc., Zanthoxylum bungeanum Maxim. (Xizang deng weishengju [Health Offices of Tibetan Autonomous Region, Qinghai, Sichuan, Gansu, Yunnan and Xinjiang] 1979, p. 52), and (x) Zanthoxylura bungeamum Maxim., Zanthoxylura schinifolium Sieb. et Zucc., Zanthoxylura armatum DC. (Qinghaisheng yaopin jianyan suo [Qinghai Institute for Drug Control] 1996, vol. 2, p. 240).

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Rudra, Indra, the earth, the fire, the sun, the moon, the wind,
And the sages, together with a multitude of medicinal herbs and
The multitude of living beings, protect you!
When, by the command issued by Buddha Kanakamuni,
The grandfather of the worlds [that is, Brahmā] uttered hūṃ,
The neutraliser of ‘mobile’ and ‘immobile’ poison, they vanished in the sun. May all poisons be neutralised accordingly!
When the vase of ambrosia that arose from the churning of the ocean
Was exposed to the moon,
The concentrated essence of the ten directions vanished in the moonlight, And the vapour of the ambrosia annihilated all diseases.
May auspices arise from this truth!
May this medicine be for you
Like ambrosia for all gods—
The medicine of the sages, the concentrated essence, and
And the jewel of the supreme serpent-like spirits!30

Then the master should recite the mantra: Oṃ namo bhagavate bhaiṣajyaguru vaiḍūryaprabharājāya tathāgatāya arhate samyaksaṃbuddhāya tadyathā / oṃ bhaiṣajye bhaiṣajye mahābhaiṣajye rājā samudgate svāhā three times. The mantra should be followed by the recitation of Sanskrit vowels and consonants, the Essence of Causation mantra (rten snying), and praises for and the invocation of the truth (shis brjod bden bdar).

Next the doctor should mix a full spoon of grinded copper powder with butter and rub it

firmly on the body of the patient. This should be done because, if copper powder is not

applied, sweat will not appear on the body. Then the doctor should give the patient a dose of

bear’s bile along with clarified butter, which is to be drunk quickly like a cup of tea. In doing

so, the ‘channels’ will be closed and made firm. After a period of time that lasts as long as it

would take to drink a cup of tea, the patient should take a dose (thun) of broth made from

fine meat. As Tendzin Püntsok adds, there is also a tradition of giving the patient a little

good beer both before and after the broth. He remarks that beer should be given if the patient

is physically weakened by the disease, and it resembles giving a bribe to the ‘wind default’. 31

31This simile is used in medical thinking to express the notion that a physician can alleviate the symptoms of a disease caused by one of the three ‘defaults’ (nyes pa) by giving food to a patient. This is usually exemplified by a ‘wind’ disease mixed with ‘heat’. If the

30This praise poem appears to have been influenced by Vāgbhaṭa’s Aṣṭāñgahṛdayasaṁhitā, especially in the second and the fifth verses, which are more or less identical to verses found in the Aṣṭāñgahṛdaya, cf. Srikantha Murthy 2004–5 [1992–7], vol. 1, pp. 227f. A praise poem that ends with the mantra of Bhaiṣajyaguru is also recommended when an emetic drug is given in the Āyurvedic Aṣṭāñgahṛdaya. The fifth verse translated above was also used by Yutok Yönten Gönpo in the thirty-first chapter of the Explanatory Tantra (Bshad rgyud), the second part of his Four Tantras (Rgyud bzhi). It is part of a prayer to consecrate drugs, Rgyud bzhi 97/6, Clark 1995, p. 225.

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The Concluding Practices

This final instruction passes into the third larger section that deals with the concluding practices, giving information about the diet and lifestyle of the patient. firstly, Tendzin Püntsok writes that a patient should consume food gradually and constantly, but there are also numerous restrictions. One should avoid bitter, salty, rotten, and putrid foods, aromatic fruits and vegetables, fish, pork and eggs, wheat, peas and sour beer, common sea-buckthorn (star bu), peaches and apricots, walnuts, onions and garlic.32 The patient should also try to avoid cheese, the meat between the ribs, the membrane covering the ribs (rtsib shun), and the shoulder cartilage of any animal.

Similarly, the patient should observe certain lifestyle modifications. He should abstain from work or any behaviour that is very strenuous and makes one sweat. He should also refrain from horse racing, sleeping with women, or sleeping upside down. Furthermore the patient should take heed of specific admonitions against defilement or physical danger—such as stepping over the lower part of a drain pipe on a roof, the lower part of a ladder, a woman, a rat, or a dog. One also must not cross a fire or a big river, walk with bare feet, or sleep during the day. The patient should be careful to avoid shivering, lepers, the corpses of murder victims (gri ro), and persons born from incestual relations. Furthermore, the patient should not be treated with purgative therapy, emetic therapy, bloodletting, or intoxicating drugs.

As Tendzin Püntsok admits, some of the rules concerning diet and lifestyle are not very practical and, therefore, not so important. He stresses that one should definitely abstain from eating onions, garlic, pork, and cheese, and guard against defilement caused by the lower part of a drain pipe on a roof, the lower part of a ladder, a dog, a rat, a fire, and a big river for one month. Similiarly, one should not apply any purgative therapy, emetic therapy, nor bloodletting for up to three months. Regarding the remaining dietary, behavioural, and therapeutic rules, the patient should follow them forever—which would be best—for three years—the medium choice—or at least for one year—the lesser option.

physician does not give food, the wind may blow on the heat, causing it to increase. Therefore, if one gives a bribe in form of food, it helps to diminish and suppress the ‘wind’. Tendzin Püntsok probably uses this simile in regard to the poison that is present in the body of the patient. Therefore, a doctor should give beer to a poisoned patient who is already very weak in order to lessen the strength and the impact of the poison.

32There is a broad consensus that star bu has to be identified with common sea-buckthorn. Some authors also include regional subspecies, (i) Hippophae rhamnoidese Linn. (Börang Kyongjong Sarjé Uyön Lhenkhanggi Trötenü 1973, p. 484; Xizang deng weishengju [Health Offices of Tibetan Autonomous Region, Qinghai, Sichuan, Gansu, Yunnan and Xinjiang] 1979, p. 47; Gurmet Namgyal and Phuntsog 1990, p. 316; Parfionovitch et al. 1992, pp. 219, 235; Karma Chömpel 1993, p. 52; Clark 1995, p. 144; Pasang Yonten Arya 1998, p. 86; Dawa 1999, p. 192; Institute of Traditional Medicine Services 1999, p. 27; Tenzin Dakpa 2007, p. 88; Berling 2008, p. 74), (ii) Hippophae spp. (Yang Jingsheng and Chucheng Jiangcuo 1987, p. 159), (iii) Hippophae rhamnoides L. subsp. gyantsensis Rousi, Hippophae neurocarpa S. W. Liu and T. N. He, Hippophae thibetana Schlecht (Zhongguo kexue yuan xibei gaoyuan shengwu yanjiusuo [Northwest Institute of Plateau Biology, Chinese Academy of Sciences], ed. 1991, p. 133), (iv) Hippophae tibetana (Tsarong 1994, p. 88), Hippophae thibetana Schlecht (Chen Jiahui and Yang Yong 2010, p. 97), (v) Hippophae rhamnoides L., Hippophae thibetana Schlecht (Luo Dashang 1997, p. 162), (vi) Hippophae rhamnoides L. subsp. gyantsensis Rousi (Bönjong Mentsikhang Sorik Zhinjukkhang 2007, p. 435), (vii) Hippophae rhamnoides L. ssp. sinensis Rousi (Qinghaisheng yaopin jianyan suo [Qinghai Institute for Drug Control] 1996, vol. 2, p. 89), and (viii) Gawé Dorjé distinguishes between three types of star bu: namely celestial star bu (gnam star)—Hippophae rhamnoides L.—medium star bu (bar star)—Hippophae neurocarpa S. W. Liu and T. N. He—and terrestrial star bu (sa star)—Hippophae tibetana Schlecht (Gawé Dorjé 1995, pp. 131f.).

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The Benefits and Blessings

As is common in such treatises, especially those dealing with precious pills, the final section discusses the benefits and blessings of this extraordinary drug. The benefits for those who rely on these jewel pills while keeping the rules is immense: this therapy cures disorders of ‘wind’, ‘bile’, and ‘phlegm’, and their combinations, ‘swellings’ (skran), ‘sin-disease affecting the teeth’ (so srin), ‘different kinds of dropsy’ (dmu ’or skya rbab), ‘leprosy’ (mdze), ‘ulcers’ (’bras ), ‘a certain kind of skin disease’ (surya), ‘infectious diseases’ (gnyan), ‘sinus infection’ (ya ma), ‘abdominal cramps’ (glang thabs), ‘chronic heat’ (tshad rnying), ‘gastrointestinal disease’ (smug po), ‘indigestion’ (ma zhu), and ‘poisoning’ (dug thabs). Especially, it also fully cures all kinds of poisoning, such as ‘black aconite poisoning’ (btsan dug), ‘compounded poisoning’ (sbyar dug), ‘non-poisonous substances that turned poisonous’ (gyur dug), ‘naturally occuring poison’ (rang bzhin dug), ‘poisoning transmitted through sunbeam and moonbeam’ (nyi zla’i zer dug), ‘poisoning caused by peacock eggs’ (rma bya’i sgong dug), ‘precious substance poisoning’ (dbyig dug), ‘mineral and metal poisoning’ (rdo dug), ‘meat poisoning’ (sha dug), ‘consistent fluid poisoning’ (rtsi yi dug), ‘thin hair poisoning’ (spu dug), ‘herbal poisoning’ (sngo dug), ‘natural poisoning’ (dngos dug), ‘poisoning transmitted through touch’ (reg bya’i dug), ‘poisoning transmitted through vision’ (mthong dug), ‘poisoning transmitted through smell’ (dri dug), and ‘poisoning transmitted through vapor and teeth’ (kha rlangs so yi dug).

Furthermore, Tendzin Püntsok explains that, if a patient has followed the rules explained above and achieved all favourable circumstances (rten ’brel), the jewel pills will remain in his body for one year. If the circumstances are of medium quality, they will remain for half a year. If they are of low quality, they will only last for four months. If there are no favourable circumstances, however, the pills will not remain active for longer than one month. Even worse, if the patient does not succeed in abstaining from that which should be rejected, he will vomit or become exhausted. Therefore it is essential to heed the instructions given by the doctor. Tendzin Püntsok also emphasises the importance of the quality of the water that is to be used. He stresses that if the drinking water is weak, the healing potential of the drug will be weak, but if spring water with the eight qualities is used, it will increase the strength of a formula. Indeed, he explains, quality water is of major importance for a healthy life.

Then Tendzin Püntsok presents another important aspect of precious pills: they can be used as amulets. One should wrap the jewel pills in five-coloured silk and insert them into an amulet container made of gold, silver, or copper. Thus spirits of all kinds will not harm the bearer—be they ‘mischievous spirits’ (rgyal ’gong), ‘violent spirits’ (btsan), ‘mother goddesses’ (ma mo), ‘lords of the grounds’ (sa bdag), ‘serpent-like spirits’ (klu), ‘planets’ (gza’), ‘evil spirits’ (gnyan), ‘gods and demons’ (lha bdud), ‘lords of the death’ (gshin rje), ‘harm bringer’ (gnod sbyin), ‘human-eating demons’ (srin po), ‘starving spirits’ (yi dwags), ‘smell eaters’ (dri za), ‘spirits with human bodies and animal heads’ (grul bum), or ‘elemental spirits’ (’byung po). Likewise, such amulets will protect the bearer against, and even repel, ‘sorcery using baleful objects that are buried’ (mnan gtad), ‘cursing spirits’ (rbad ’dre), ‘sorcery setting a demon or guardian on an enemy’ (rbod gtong), ‘evil spells’ recited to harm others (ngan sngags), ‘hail and thunderbolts’ (thog ser), ‘poisonous weapons’ (dug mtshon), ‘defilement’ (grib), and ‘demons’ (gdon). finally, if one has jewel

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pills in one’s stomach, they will seal the gates to a bad rebirth, and one will obtain a vajra body as well as some ordinary accomplishments by gradually proceeding along the stages of the path. Although Tendzin Püntsok’s treatise was of some influence for later generations of medical doctors and scholars—such as Orgyen Tekchok—there are also some differences in later works that will be discussed in the following section.

Time of Administration

Tendzin Püntsok’s initial explanation regarding the time and place for the dispensation of jewel pills is similar to that of many preliminaries proceeding Tibetan rituals which is not surprising.33 Therefore later authors, such as Chökyi Drakpa, do not elaborate this point but just remark that the ritual should be done on an auspicious date.34 Similarly, Khyentsé Wangpo just speaks of an auspicious date and a quiet and blessed place.35 Other authors, however, are slightly more specific. Karma Ngedön Tendzin Trinlé Rapgyé writes that it is important to give the medicine when the waning moon is over, but in general it is fine on any auspicious day.36 Interestingly, the remaining authors introduce a notion that is not addressed by Tendzin Püntsok, one that concerns the distinction between ill and healthy persons to whom the precious pills can be given. Yeshé Gyatso states that if a person has a strong disease and the situation is dire, the physician should still administer jewel pills on that occasion.37 Otherwise, in the case of a healthy person, the physician should administer the pills in accordance with the rise of an auspicious time in conjunction with an auspicious date, especially in the first two weeks of the three winter months and, in general, early in the morning before dawn (tho rengs). Khyenrap Norbu holds a similar view.38 In the case of ill persons, the physician should act in accordance with the circumstances of the illness. For healthy persons and ‘rejuvenation practices’ (bcud len), the physician should perform the preparations on an auspicious day, such as the day when the star Sage Agastya appears,39 any day of any of the three winter months, any day of the waxing phase of the moon, or on the 21st and 22nd day of the waning phase of the moon.

The physician Orgyen Tekchok does not just state that the dispensation of jewel pills should take place on an auspicious date, but he also sets out basic temporal rules according to astrological principles.40 He explains that there are good, less good, and bad days of the week. The good days are Sunday, Monday, Thursday, and Friday, while Wednesday and Saturday are less good, and Tuesday is a bad day. According to another tradition, the physician should give the drugs at an auspicious time on Thursday, Wednesday, or Monday during daybreak. He also states that the physician should pay attention to the lunar mansions

33On the relationshop between medicine and astrology, see, for instance Yoeli-Tlalim 2008; Gerke 2012, pp. 92ff. 34Zur mkhar khyad chos 117/16.
35Mkhyen brtse’i dbang po Gtong tshul 120/3.
36Man ngag snying gi nor bu 139/4.

37Ye shes rgya mtsho Gtong tshul 437/4.
38Gsal ba’i me long 200/17.
39The sage Agastya, in Tibetan Ri shi or Ri byi, is based on Indian astrological lore that was also transmitted in Indian Ayurvedic treatises, such as Vāgbhaṭa’s Aṣṭāṅgahṛdayasaṃhitā, that were translated into Tibetan; see, for instance, Vogel 1965, pp. 164f. Agastya is the bright southern star Canopus. In medical texts, as well as in classical poetry, it is said that the waters are cleaned with the rise of this star Agastya, ibid.; Mythrey et al. 2012, p. 770. Its rise occurs on the seventh day of the second half of the Bhādra month in Indian astrology, and on the seventh day of middle autumn month Mon gru in Tibetan astrology, respectively. Rain that falls on that day is said to be endowed with the eight qualities.
40Bdud rtsi’i sman mdzod 285/6.

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—there are good, bad, and neutral lunar mansions.41 He also categorises the zodiacal signs in such a tripartite fashion.42 Accordingly, the physician also has to make sure which day of a lunar month it is—the days associated with the ‘bird’ (bya) and ‘dog’ (khyi) are good, whereas the days of the ‘tiger’ (stag), ‘snake’ (sbrul), and ‘sheep’ (lug) are bad. The others are neither good nor bad.43 Moreover, the physician should pay attention to particular days of the month—days when the ‘serpent-like spirits’ (klu) and the ‘eight classes of spirits’ (sde brgyad) gather are good, but one should avoid days when they repel.44

Orgyen Tekchok is also the only author beside Tendzin Püntsok who comments on the quality of the water and its effect on the quality of pills. In this regard, he repeats the views of Tendzin Püntsok.45 Unlike Tendzin Püntsok, however, and more like the other authors, he explicitely discusses the distinct approaches to giving precious pills to sick and healthy persons. Sick persons, especially in case of poisoning, should first be given Seru-4 pills. He stresses that, in the case of disorders of three ‘defaults’ (nyes pa)—namely ‘wind’ (rlung), ‘bile’ (mkhris pa), and ‘phlegm’ (bad kan)—‘alone or in combination of two or of all three’ (rkyang ldan ’dus gsum), the physician should abstain from prescribing sour ‘potions that would gather the illness’ (sdud thang), for such potions would be difficult to neutralise, and instead should give potions like the Norbu Düntang (Nor bu bdun thang, ‘Potion of Seven Jewels’), Trindrel Dazer (Sprin bral zla zer, ‘Beams of a Cloudless Moon’), Tangchen-25 (Thang chen nyer lnga, ‘Great Plain-25’), and so on, for up to eight days.46 If a doctor intends to administer jewel pills to a person who has no illness, he has to clean the patient’s stomach first by prescribing a mild laxative. He also should give drugs that prevent the emission of semen and avoid prescribing anything that might cause perspiration. The healthy patient should rely on a diet of nutritious foods and medicinal herbs.

Opening the ‘Channels’ of the Patient

The process of opening the ‘channels’ (rtsa) of the patient refers to the medical preparations that are to be done prior to the actual administration of the precious pills. As mentioned in the description above, Tendzin Püntsok gives two instructions that, according to him, bring the illness or the poison together, make it rise, and open the ‘channels’—these consist of the special ritual briefly known as Binding the Hair and the administration of Seru-4 pills. Orgyen Tekchok, who used Tendzin Püntsok’s treatise extensively in composing his own treatise, omits this ritual but, as mentioned above, he also supports the administration of

41The good lunar mansions are: Kṛttikā (Smin drug), Rohiṇī (Snar ma), Mṛgaśirāḥ (Mgo), Puṣyaḥ (Rgyal), Hastā (Me bzhi), Citrā (Nag pa), Svātī (Sa ri), Śravaṇā (Gro bzhin), Pūrvabhadrapadā (Khrums stod), Uttarabhadrapadā (Khrums smad), Śatabhiṣā (Mon gre), Dhaniṣṭhā (Mon gru), Uttarāṣāḍhā (Chu smad), and Revatī (Nam gru). The bad lunar mansions are: Anurādhā (Lha mtshams), Abhijit (Byi ’bring), Bharaṇī (Bra nye), Aśleṣā (Skag), Jyeṣṭhā (Snron), Pūrvaphalgunī (Gre ba), and Aśvinī (Tha skar). The remaining lunar mansions are neutral.

42The four good zodiacal signs are: Virgo (Kanyā, Bu mo), Gemini (Mithuna, ’Khrig), Sagittarius (Dhanu, Gzhu), and Pisces (Mīna, Nya). The three bad zodiacal signs are: Capricorn (Makara, Chu srin), Scorpio (Vṛścika, Sdig pa), and Cancer (Karka, Kar ka ṭa). 43The statement of Orgyen Tekchok is not fully clear in this passage. He just speaks of day(s) (nyi ma). It could also be possible that he means a specific time of day, which can also be associated with zodiacal signs.

44Certain spirits are associated with certain days, based on their activities such as gathering and repelling. For more information, see Schuh 2011, pp. 153f. See also Schuh 2012a.
45Bdud rtsi’i sman mdzod 285/21.
46Bdud rtsi’i sman mdzod 285/1. On these formulas in accordance with the compounding tradition of Orgyen Tekchok, see his work Bdud rtsi’i sman mdzod: Nor bu bdun thang, ibid., 177/6; Sprin bral zla zer, ibid., 177/9; Thang chen nyer lnga, ibid., 145/19.

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Seru-4 pills.47 These are the only two authors who recommend the use of these pills; all others do not recommend the use of Seru-4 pills.

It is very likely that Tendzin Püntsok relies on the medical expertise of Nyamnyi Dorjé (Mnyam nyid rdo rje, 1439–75), who wrote a brief work entitled Oral Instructions for Seru-4 (Bse ru bzhi ba’i zhal gdams) that is contained in his opus Ten Million Instructions: Relics (Bye ba ring bsrel).48 Seru-4 pills consist of four ingredients—namely ‘white rhino horn’ (bse ru dkar po), a type of corydalis (su mi) from the Mön region (Mon yul),49 myrobalan of the all-victorious type (rnam rgyal), and musk (gla rtsi).50 Seru-4 pills must be prepared accurately, especially with regard to the proportion of their ingredients. Nyamnyi Dorjé explains that the night before taking the pills, the patient has to drink a cupful of a ‘pepper potion’ (g.yer chu) to open the ‘channels’. Then he should take the pills in the early morning before dawn and drink melted butter with bear’s bile at dawn; the latter being given to make sure the ‘channels’ will close. This regimen should be repeated daily for up to a fortnight. Side-effects may include vomiting, diarrhoea, and abdominal pain and, depending on which viscera (heart, liver, or kidneys) is affected by the poison, the physician may need to add other ingredients to the Seru-4 pills during the therapy. Nyamnyi Dorjé states that this remedy is especially beneficial for poisoning, and it can indeed be employed to diagnose whether or not one is poisoned. If regimen is given and the patient experiences vomiting and diarrhoea, the patient has been poisoned. If the regimen is digested without any difficulties, there is no doubt that the illness has been caused some disease other than poisoning.

There are a number of points deserving commentary on these instructions for Seru-4 pills. Firstly, unlike Nyamnyi Dorjé, Tendzin Püntsok does not recommend other remedies to be given before and after the administration of the Seru-4 pills; he even mentions that the physician should give them at night, the next morning, and at noon the following day. He also does not mention anything regarding potential side-effects, such as vomiting and diarrhoea. Secondly, the basic scheme of opening and closing the ‘channels’ can be found in the instructions for the dispensation of precious pills as well. Prior to the administration of precious pills, the pathways of the ‘channels’ need to be opened so that the pills can move to where the poison is and, after the drug has been taken, the pathways need to be closed again. According to Tendzin Püntsok, the opening of the ‘channels’ is to be achieved by means of a potion of boiled pepper, as is instructed by Nyamnyi Dorjé for Seru-4 pills. Like Nyamnyi Dorjé, Tendzin Püntsok also recommends clarified butter with bear’s bile to be given after the precious pills have been taken. This same basic method of giving pepper potion to open the ‘channels’ and bear bile butter to close them is recommended by all other doctors whose treatises are examined in this article. These instructions only differ regarding how much pepper should be used for the potion, and when the patient should start to drink it. Chökyi Drakpa speaks of 21 peppercorns for a potion that is to be taken the night before the

47Bdud rtsi’i sman mdzod 284/20.
48Bse ru bzhi ba’i zhal gdams.
49The designation Mönpa (Mon pa) generally denotes populations living in the south of Tibet, in an area known as Mönyül (Mon yul) and in adjacent areas of the Eastern Himalayas.
50It is especially the yellow type of su mi (su mi ser po) that is of interest for botanists (even though there exist also other types according to Tibetan medicine). This yellow su mi is described as being Corydalis yanhusuo W. T. Wang (Karma Chömpel 1993, p. 266; Gawé Dorjé 1995, pp. 302f.; Qinghaisheng yaopin jianyan suo [Qinghai Institute for Drug Control] 1996, vol. 3, p. 346; Pasang Yonten Arya 1998, p. 276; and Bönjong Mentsikhang Sorik Zhinjukkhang 2007, p. 368).

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precious pills are administered.51 Tendzin Püntsok recommends three spoonfuls for a potion that is to be taken at night. Karma Ngedön Tendzin Trinlé Rapgyé writes that a potion of seven peppercorns should be taken for three days.52 Yeshé Gyatso agrees with Karma Ngedön Tendzin Trinlé Rapgyé on the number of peppercorns, but prescribes that the potion should be taken for only one night.53 Khyentsé Wangpo agrees that the potion should be taken only once, but is of the opinion that it should be made from 21 peppercorns.54 Orgyen Tekchok agrees with Khyentsé Wangpo.55 Khyenrap Norbu writes that the potion should consist of six peppercorns and the patient should drink it in six full gulps.56 Thus, despite general agreement regarding the use of a pepper potion for opening the ‘channels’ of the patient prior to the administration of the precious pill, it is evident that Tibetan doctors disagreed regarding the timing and quantity of pepper to be used in the potion, which is not insignificant, for the effectiveness of the opening of ‘channels’ also determines the effectiveness of the precious pills entering the body.

Closing the ‘Channels’

Although all authors agree that, after the patient has taken the precious pills, the closing of the ‘channels’ is to be achieved by giving a portion of bear’s bile together with strained butter, some authors add additional details. For example, Chökyi Drakpa notes that the butter should be the butter of the female yak (’bri).57 Yeshé Gyatso notes that the physician should combine a piece of bear’s bile that is the size of a grain of barley with a slice of white butter that is the size of a wet bean, roll them into a pill, and give it to the patient.58 Khyentsé Wangpo writes that the physician should combine bear’s bile and one portion of saffron (gur kum alias gur gum) together with strained fresh melted butter.59 Khyenrap Norbu is of the same opinion.60

Causing Perspiration

Another important aspect of the jewel pill regimen—warming or perspiration—takes place after the pills have been given, but before the ‘channels’ have been closed. As stated above,

51Zur mkhar khyad chos 117/7.
52Man ngag snying gi nor bu 139/6.
53Ye shes rgya mtsho Gtong tshul 438/3.
54Mkhyen brtse’i dbang po Gtong tshul 120/17.
55Bdud rtsi’i sman mdzod 286/22.
56Gsal ba’i me long 203/13.
57Zur mkhar khyad chos 117/10.
58Ye shes rgya mtsho Gtong tshul 440/6.
59Mkhyen brtse’i dbang po Gtong tshul 121/24. The plant gur kum or gur gum consists of two types. The so-called Kashmiri gur kum refers to saffron crocus (Crocus sativus), while the non-Kashmiri type from Tibet or Nepal refers to safflower (Carthamus tinctorius). In medical writings it is often not clear which type is meant unless a geographical region is mentioned—both saffron and safflower were regarded as variations of the same plant in Tibetan medicine. In botanical publications, this distinction is not always clear: Carthamus tinctorius L. (Börang Kyongjong Sarjé Uyön Lhenkhanggi Trötenü 1973, p. 470; Xizang deng weishengju [Health Offices of Tibetan Autonomous Region, Qinghai, Sichuan, Gansu, Yunnan, and Xinjiang] 1979, p. 44; Dawa 1999, p. 102; Bönjong Mentsikhang Sorik Zhinjukkhang 2007, p. 522; Berling 2008, p. 40; Tsering Dorjee Dekhang 2008, p. 39; Thinley Gyatso and Hakim 2010, p. 246), (ii) Crocus sativus L. (Parfionovitch et al. 1992, pp. 219, 235, 261; Pasang Yonten Arya 1998, p. 34), (iii) Crocus sativus Linn., Carthamus tinctorius L. (Yang Jingsheng and Chucheng Jiangcuo 1987, pp. 252, 272; Gurmet Namgyal and Phuntsog 1990, p. 315; Zhongguo kexue yuan xibei gaoyuan shengwu yanjiusuo [Northwest Institute of Plateau Biology, Chinese Academy of Sciences] 1991, p. 44; Karma Chömpel 1993, pp. 14, 16; Clark 1995, p. 141; Gawé Dorjé 1995, p. 100; Qinghaisheng yaopin jianyan suo [Qinghai Institute for Drug Control] 1996, vol. 1, p. 380, vol. 3, p. 31), and (iv) Carthamus tinctorius L., Crocus sativus L. (Luo Dashang 1997, pp. 247, 286).
60Gsal ba’i me long 204/8.

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Tendzin Püntsok recommends that the physician rubs the patient with a mixture of butter and copper powder in order to induce sweating, but he is the only doctor to recommend this method. Others, like Karma Ngedön Tendzin Trinlé Rapgyé, Yeshé Gyatso, Khyentsé Wangpo, and Orgyen Tekchok, prefer to wrap the patient in very warm clothes.61 Sometimes, if the wrapping shows no results, a cup of warm tea with butter and salt, or a cup of tea with impure soda can be given to drink. Orgyen Tekchok even states that the physician should bind a clay water vessel filled with warm tea below the breast of the patient before he is wrapped in warm clothes. He also writes that all this should be done to make sure that the patient sweats profusely. After the patient begins to sweat, the physician should repeatedly wipe it away with a piece of cotton or wool, and once it has stopped, the physician should scrape the dirt from the patient’s skin with pale parched barley flour.

Despite general agreement regarding this threefold therapy—the opening of the ‘channels’ so that the drug can effectively enter the body, making sure they remain open by warming the body, and finally closing the ‘channels’—details regarding the issue of gathering the poison or illness can be found in the writings of the other doctors but not in those of Tendzin Püntsok. On this point, Tendzin Püntsok just notes that three days prior to the night when the pills will be administered, the physician should follow the instructions for gathering the poison, and then gives no further details. Orgyen Tekchok, who used Tendzin Püntsok’s treatise as an important source for his own work, prescribes the potions mentioned above, such as the Norbu Düntang, Trindrel Dazer, Tangchen-25, and so on.62 He notes that they should be administered for up to eight days. It is possible that he was influenced by the writings of Karma Ngedön Tendzin Trinlé Rapgyé, in which he recommends that a suitable medicinal potion that gathers the illness or poison should be taken for eight days.63 Khyentsé Wangpo also recommends the potion Tangchen-25, stating that it is suitable for the majority of diseases, but he notes that the physician should only give it for three or four days prior to the actual administration of the precious pills.64 The famous doctor Khyenrap Norbu also prescribes Tangchen-25, but is equally supportive of Omatang-15 (’O ma thang bco lnga, ‘Milk Plain-15’), Segö-3 (Se rgod gsum pa, ‘Wild Rose-3’), Segö-7 (Se rgod gsum pa, ‘Wild Rose-7’), Tangchen-10 (Thang chen bcu pa, ‘Great Plain-10’) and others.65

61Man ngag snying gi nor bu 139/22, Ye shes rgya mtsho Gtong tshul 440/6, Mkhyen brtse’i dbang po Gtong tshul 121/20, Bdud rtsi’i sman mdzod 287/6.
62Bdud rtsi’i sman mdzod 285/1. On these drugs, see above.
63Man ngag snying gi nor bu 139/5.

64Mkhyen brtse’i dbang po Gtong tshul 120/15.
65Gsal ba’i me long 205/2. In modern publications the name se rgod can be identified as a type of currant, a type of wild rose, or both: (i) Ribes emodense Rehder (Börang Kyongjong Sarjé Uyön Lhenkhanggi Trötenü 1973, p. 244; Karma Chömpel 1993, p. 116), Ribeshimalense Royle (Chen Jiahui and Yang Yong 2010, p. 74), (ii) Rosa sericea (Parfionovitch et al. 1992, p. 223), (iii) Rosasweginzowii Koehne. (Qinghaisheng yaopin jianyan suo [Qinghai Institute for Drug Control] 1996, vol. 3, p. 356; Luo Dashang 1997, p. 124; Bönjong Mentsikhang Sorik Zhinjukkhang 2007, p. 752), (iv) Rosa omeiensis Rolfe (Tian Shuqin 1997, p. 279), (v) Rosa macrophylla Lindley (Dawa 2005, p. 146), (vi) Rosa webbiana Wallich ex. Royle (Tsering Dorjee Dekhang 2008, p. 163), (vii) Rosa webbiana, Ribes orientale (Tenzin Dakpa 2007, pp. 252, 253), (viii) Rosa sertata Rolfe, Rosa rubus H. Léveillé et Vaniot (Yang Jingsheng and Chucheng Jiangcuo 1987, p. 219; Gawé Dorjé 1995, p. 159; Pasang Yonten Arya 1998, p. 277), (ix) Rosa avicularis, Rosa sericea, Rosa laevigate (Clark 1995, p. 154), and (x) Ribes himalense Royle ex Decne, Rosa sweginzowii Koehne (Zhongguo kexue yuan xibei gaoyuan shengwu yanjiusuo [Northwest Institute of Plateau Biology, Chinese Academy of Sciences] 1991, p. 404).

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The Fluid Used for the Pill’s Vessel

The instructions for the arrangement of the altar are basically the same across the different texts; there are just a few minor differences that are of no real importance in this context. A detail that is not unimportant and differs across the texts, however, is the use of either beer or tea to fill the cup in the jewel pill preparations. As outlined above, Tendzin Püntsok uses good tea made from the decoction of the little sprouts of tea leaves. Khyentsé Wangpo provides similar instructions.66 In contrast, however, Karma Ngedön Tendzin Trinlé Rapgyé writes that the physician should not use good tea, but very good beer, in the preparation of the jewel pills.67 Yeshé Gyatso also mentions methods involving the use of beer, but he considers them to be highly offensive for monks, and therefore recommends that the physician only use boiled water instead.68 Orgyen Tekchok mentions the use of both tea and beer, but does not make a decision in favour of either; instead, he thinks that the use of tea or beer should depend on the nature of the illness—if the main base of an illness is ‘heat’ (nad gzhi tsha can), the physician should use clean water that has been boiled down to two-thirds of its original volume and is free from dust. In case of diseases that are of either ‘a hot or cold disorder and in association with wind’ (cha [=tsha] dang grang rlung ldan), the physician should either use a cupful of good beer or of a decoction of the little sprouts of tea leaves in preparation of the jewel pills.69 Khyenrap Norbu describes the fluid used in the preparation of the jewel pills as a type of vehicle for the pills (sman rta).70 Thus it would appear that he regards it not just as the fluid in which the pills are placed, but also as the fluid with which the pills are to be ingested. Thus, despite Khyenrap Norbu’s conflation of these two fluids, the initial fluid is not necessarily the same as the final concoction. Khyenrap Norbu states that one should use strong beer in the case of a healthy person who is performing rejuvenation practices, but in the case of a sick person, it depends on the disease. If the patient is ill with ‘gastrointestinal disease’ (smug po), ‘chronic heat’ (tshad rnying), and so on, then the physician should prescribe a decoction of fine tea without trona residue (bul tshwa).71 If the patient is ill with cold disorders—such as diseases of the ‘serous fluids’ (chu ser), ‘arthritis’ (grum bu), ‘a kind of dropsy’ (skya rbab), and so on—the physician should use good beer, or a decoction of good pomegranate with a measure of specially prepared calcite ash (cong zhi ’phrul thal). The physician should use boiled water to apply the methods of ‘slipping poison’ (’dred)72 or ‘general annihilating poison’ (spyi ’joms). If the patient is ill with ‘liver disease’ (mchin nad), the physician should give the patient saffron water. Whatever the case may be, Khyenrap Norbu continues, the physician should

66Mkhyen brtse’i dbang po Gtong tshul 120/8. 67Man ngag snying gi nor bu 139/9.
68Ye shes rgya mtsho Gtong tshul 438/1. 69Bdud rtsi’i sman mdzod 286/9.

70Gsal ba’i me long 200/17, 204/4, 204/7.
71Most modern authors agree that bul tog is the evaporite mineral trona. Others identify it with natron, an alkali salt, or sodium carbonate: (i) trona (Yang Jingsheng and Chucheng Jiangcuo 1987, p. 28; Zhongguo kexue yuan xibei gaoyuan shengwu yanjiusuo [Northwest Institute of Plateau Biology, Chinese Academy of Sciences] 1991, p. 569; Karma Chömpel 1993, p. 590; Gawé Dorjé 1995, p. 90; Tian Shuqin 1997, p. 283; Bönjong Mentsikhang Sorik Zhinjukkhang 2007, p. 82; Kenden Nyima 2010, p. 159), (ii) alcali sodae (Xizang deng weishengju [Health Offices of Tibetan Autonomous Region, Qinghai, Sichuan, Gansu, Yunnan and Xinjiang] 1979, p. 100), (iii) natron (Parfionovitch et al. 1992, p. 219; Pasang Yonten Arya 1998, p. 151), and (iv) sal soda (Clark 1995, p. 138). 72The so-called ‘slipping poison’ (dug ’dred) is a special therapeutic method to eliminate poison. It is said that if poison gets on difficult grounds it can slip, which can be achieved by taking certain drugs. In most cases the patient vomits out the poison, which comes to smell like musk.

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either pour a cupful of the preferred fluid, or he should pour it until the precious pills have been completely covered.

The Ritual of Empowerment

Distinct instructions are given for the ritual of empowering the precious pills and how this needs to be set up. Most authors indicate that this ritual needs to be performed both times, after the altar has been erected and later when the pills are being administered.73 Regarding the first ritual, Karma Ngedön Tendzin Trinlé Rapgyé states that after the altar is completed one should recite the aspiration prayer (smon lam cho ga) of the Seven Medicine Buddhas based on the Sūtra tradition, and perform an extensive ritual based on the Yuthok Heart Essence (G.yu thog snying thig) from the Tantra tradition.74 If the physician wants to only perform a brief ritual, he should conduct a ritual from the Treasury of Evocation Ritual Accomplishments (Sgrub thabs dngos grub bang mdzod).75 With special visualisation, devotion, and an attitude and behaviour of compassion, the physician should recite many dhāraṇīs, mantras, and verses of praise. He should then restrict the movement of people and demons by establishing retreat markers and offering sacrifical cakes for ransom (glud gtor) or other ritual objects to scare obstacle-creating demons (bgegs bskrad). With the completion of the religious side of the jewel pill ritual, the doctor can then give the precious pills to his patient. In order to do so, the physician just has to choose an auspicious time, wash his hands, crush the pills with his ring finger, then pulverise the rest in the mortar and administer the powder with words of aspiration (smon lam). After doing so, the doctor should clean the mortar with a sip of boiled water and also give this to the patient to drink. Such are the ritual instructions provided by Karma Ngedön Tendzin Trinlé Rapgyé but, as stated above, the instructions provided by other authors are slightly more detailed.

Yeshé Gyatso explains that, after the altar has been erected, the physician should arrange the five offerings of the five senses in front of it.76 The next step depends on whether the physician has a ritual assistant or not—if he has one, this is perfect, but if he does not, the doctor should perform the entire ritual by himself, following instructions based on either the extensive or the short Medicine Buddha ritual, visualising the cleansing of the flow of ambrosia, and so on. Then, before everyone falls sleep, the physician should do prostrations before the Medicine Buddha, make a seven-fold offering, generate bodhicitta, and so on. The next day, he should get up before dawn and wash carefully. As an auspicious omen

(rten ’brel) to achieve an increased lifespan and religious merit, the physician should put on a new garment. The doctor should then spread out a new mat or cushion and create swastikas out of white grain that turn to the right. He should make three prostrations to an image of

73Karma Ngedön Tendzin Trinlé Rapgyé provides instructions only for the time after the shrine has been erected, Man ngag snying gi nor bu 139/7.
74Man ngag snying gi nor bu 139/13. Karma Ngedön Tendzin Trinlé Rapgyé gives the title Snying thig sdum mun sel. This is probably identical with The Empowering Flow of Accomplishing the Master from the Yutok Heart Essence—The Cycle of Dharma- Teachings: The Sunlight of Compassionate Energy Clarifying the Darkness of Suffering (G.yu thog snying thig las byin rlabs bla ma sgrub pa’i chos skor sdug bsngal mun sel thugs rje’i nyi ’od). On the Yutok Heart Essence, see Ehrhard 2007; Garrett 2009.

75This sādhana and the ritual are said to have been handed down from Nyamnyi Dorjé. Chökyi Drakpa edited the text in 1613 in order to supplement the ritual side of jewel pill preparation; see Dngos grub bang mdzod. His treatise was used as the main source for a subsequent edition made by Lodrö Tayé (Blo gros mtha’ yas, 1813–1899/1890), together with explanations by his teacher, Khyentsé Wangpo: Dngos grub bang mdzod kha ’phangs.

76Ye shes rgya mtsho Gtong tshul 438/2.
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Buddha and then put the image on the mat as well. In order to empower the precious pills, the physician should first take refuge, then arouse bodhicitta, and perform a detailed meditative realisation based on the blue Medicine Buddha, Bhaiṣajyarāja. The doctor should then grind the pills in a porcelain cup with the ring finger of his left hand, thinking,

Anyone who enjoys this supreme medicinal ambrosia will have a fully cleansed heart all day and night; he will not meaninglessly waste this very receptacle that he has had the fortune to gain—the precious human body that is difficult to obtain— before too long he will obtain the rank of a buddha in order to help all sentient beings, our own old mothers!77

The physician should offer the first portion (phud) of the pills with the thumb and ring finger of his left hand, throwing it in the air, dedicating it to the root teachers, the ‘meditational personal deity’ (yi dam), buddhas, bodhisattvas, śrāvakas, and pratyekabuddhas. He should offer the second portion to the ḍākas, ḍākinīs, dharmapālas, and pālas, and the third portion to the local ‘territorial deities’ (yul lha) and ‘lords of the ground’ (gzhi bdag). Then the doctor himself should take the first gulp of the pill and tea solution, imagining that it pervades the entire interior of his body. Moreover, he should imagine that it will cleanse the general sins and defilements accumulated from beginningless time—especially all the sins and defilements that cause misfortune and obstructions, as well as the spirits that cause diseases, and ‘karmic propensities’ (bag chags). Because these sins and defilements have the appearance of ‘moisture in smoke’ (dud khu) and ‘liquid charcoal’ (sol khu), they emerge as a blackish liquid from all the sense doors and pores of the thin hairs on the skin. After this process, he will become as stainless as a pearl. During the second gulp, the physician should imagine that his life and body become a body of immortality that is free from change and transformation—indestructible and imperishable like an adamantine vajra, an everlasting swastika, and a Victory Banner that Does Not Wane. Finally, taking the third gulp, the physician should imagine that he has become a fortunate one who visibly possesses the four bodies (sku bzhi)—one who has generated kindness, compassion, and the aspiration to attain enlightenment in one’s mind-continuum. Then he should pour some boiled water into the porcelain cup once more, drink the remanants of the pills, and swallow all that is inside his mouth. Then he should again pour some water into the cup, offering it to the spirits that

77Ye shes rgya mtsho Gtong tshul 438/6. The physician should first purify appearances of self-existence through meditative dissolution into voidness, by means of the recitation of the svabhāva mantra. Then, from this state of emptiness, in the sky in front of oneself he should imagine an entity that is one’s own root teacher in the appearance of Buddha Bhaiṣajyarāja. He should have a blue complexion, one face, and two hands—in his right hand he should hold a myrobalan fruit, and in his left hand should rest an almsbowl filled with ambrosia. Wearing a religious garment, he should sit in the vajrāsana posture on both a lotus and a moon seat. Because beams of light emit from the syllable oṃ at his forehead, āḥ at his throat, and hūṃ at his heart, a Wisdom Being (ye shes pa) resembling the physician’s own visualised form can then be invited from the self-existing, spontaneous realm, surrounded by a multitude of buddhas and bodhisattvas. The syllables dzaḥ hūṃ baṃ hoḥ should be generated in front of, and vanish into, the body of the spiritual practitioner. He should then imagine that he himself has become an embodiment of that which assembles all sources of refuge. After he recites the mantra, Tadyathā / Oṃ bhaiṣajye bhaiṣajye / Mahābhaiṣajye rājā samudgate svāhā, rays of light should emit from the hūṃ in the heart of Bhaiṣajyarāja. All blessings of the body, speech, and mind of all buddhas—together with their sons—of the ten directions should be invited in the form of light rays of ambrosia, and then vanish in the seed of the heart of Bhaiṣajyarāja. A constant stream of ambrosia emits from the heart seed and the other parts of Bhaiṣajyarāja’s body, vanishing into the precious pills and transforming them into a supreme medicine that removes all 404 diseases. Then the physician should recite a dhāraṇī many times, with the thought that the pills have become ambrosia— endowed with the power to increase the limitless qualities of lifespan and religious merit, prosperity and wealth, and perception and learning. Finally, after Bhaiṣajyarāja melts into light, he too vanishes into the ambrosia. Thus, the physician should imagine the pills as having become indivisible (dbyer med) and of one taste (ro gcig). This last statement made by Yeshé Gyatso points to the Buddhist concept of absolute reality.

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desire remains and leftovers. Eventually, he should recite auspicious verses (rten ’brel), such as those of praise, dedication, aspiration, and so on.

Khyentsé Wangpo writes that the physician should visualise the Medicine Buddha based on an authorative text, but does not specify what that text might be.78 Afterward the physician should recite the so-called Golden Dhāraṇī (Gser gzungs) twenty-one or one hundred times. 79 These should be supplemented by many recitations of the Sanskrit vowels and consonants (dbyangs gsal), as well as the Essence of Causation mantra (rten snying). The final step consists of several concluding rituals.80 After all of this the actual administration of the pills to the patient should then be performed. When an auspicious time arises, the doctor should take the jewel pills and go to the pillow where the patient is laying. The doctor should then recite the lineage supplication that begins with the line, ‘Limitless merit …’ (dpag yas bsod nams).81 When he reaches the line, ‘I pray to multitude of proud guardians of the teachings’, (bka’ srung dregs byed tshogs la gsol ba ’debs), he should crush the pills with his ring finger. He should recite the dhāraṇīs and mantras seven times before making the first portion offering of the crushed pills (phud mchod). Khyentsé Wangpo points out that according to his experience the physician should perform a ransom rite (blud) while reciting the Golden Dhāraṇī. This should be followed by a recitation of the Sanskrit vowels and consonants, the Essence of Causation mantra, the solemn asseveration (bden tshig), and verses of praise associated with the goddess Mahāsāhasrapramardinī. After scattering some flowers, the physician can take a seat, make some customary prayers, and receive the accomplishment of the gaṇacakra feast.

The ritual aspects of the dispensation of jewel pills are also addressed by Orgyen Tekchok.82 He seems to reproduce instructions from both Tendzin Püntsok and Karma Ngedön Tendzin Trinlé Rapgyé, combining them in innovative ways and also omitting several details. After the altar has been erected he simply writes that the physician should arrange suitable offerings according to both the Sūtra and Tantra traditions. He also recommends that the physician draw out the poison from the pathways of the ‘channels’ where the drug enters the body of the patient, but strangely enough he does not mention the teaching, Binding the Hair, attributed to the sage Puri. As is the case in other treatises, these steps should be followed by a ransom offering, the scaring away of the obstacle-creating demons, the visualisation of a protection circle, and the securing of the outer boundaries. For the main ritual practice, he speaks in general terms of taking refuge, arousing bodhicitta, reciting

79The Golden Dhāraṇī (Gser gzungs) is a tradition transmitted by Nyamnyi Dorjé and is contained in his famous Ten Million Instructions: Relics (Bye ba ring bsrel). In particular, it protects against all kinds of poison.
80The physician should make offerings, recite verses of praise, and make prayers. Then he should offer sacrifical cakes (gtor ma) to the deity Zhanglön (Zhang blon) and the nine types of spirits (zhang blon sde dgu). The next step is to perform a gaṇacakra feast, starting with the confession known as the Ineffable Confession of the Ultimate (Brjod med don gyi bshags pa), and cleansing and purifying the implements of the tantric feast offering. Then the physician should offer the gaṇacakra and make confession (bskang bshags)—the offering is made to the deities and protectors so that they fulfull their vows, and a confession is made for transgressions and errors.

78This is preceded by the performance of the preliminaries, taking refuge, and the cultivation of the thought of enlightenment for all. After this the physician should offer sacrifical cakes (gtor ma) to the crowd that protect the good and the virtuous and to the ‘elemental spirits’ (’byung po). Moreover, one should vehemently dispel obstructing forces. The physician should bind the latter with a wheel of protection.

81The line of ‘limitless merit’ refers to the lineage supplication provided in Chökyi Drakpa’s work, the Treasury of Accomplishments; Dngos grub bang mdzod 108/7.
82Bdud rtsi’i sman mdzod 286/14.

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mantras, and so on. He insists that one should perform rituals with a pure and clear motivation, compassion, devotion, and clarity in visualisation. Early in the morning before dawn, the physician should again peform the preliminaries—such as taking refuge and arousing bodhicitta—and ask a spiritual master for help with rituals of fumigation, libation, offerings and praise to the dharma protectors. At an auspicious time, the physician should take the pills with clean hands and wash them with his ring finger. He should recite verses of praise for the Vedas—as Orgyen Tekchok calls it, in reference to the verses of praise included in Tendzin Püntsok’s instructions—and recite a mantra. The physician should also clean the vessel in which the pills are given with a sip of boiled water and drink this water too. These steps should be concluded with the recitation of the Sanskrit vowels and consonants, the Essence of Causation mantra, and a consecration ritual. The latter instruction is clearly different from those of Tendzin Püntsok, who recommends verses of praise and an ‘invocation of the truth’ (bden bdar). Thus it seems that Orgyen Tekchok merely gives a brief description of the ritual aspects associated wth the dispensation of jewel pills.

Khyenrap Norbu explains that after the altar has been erected, the physician should arrange the five kinds of offerings and perform whatever is suitable—either the Bhaiṣajyaguru Sūtra Ritual (Sman bla’i mdo chog) or the Empowering Flow of Accomplishing the Master (Byin rlabs bla ma sgrub kyi cho ga, from the Yutok Heart Essence).83 This performance should be followed by the offering of blessings and of the first portion of the pills (byin rlabs phud mchod).84 Then the physician should conduct a detailed ritual in order to empower the precious pills. It starts with taking refuge and arousing bodhicitta. Imagining the statue or painting of the Medicine Buddha on the altar as real, the physician should prostrate and praise him seven times, saying ‘I pay homage to the Blessed One, the One Gone Thus, the Worthy One, the Teacher of Medicine, the King of Lapis Lazuli Light! I make offerings! I take refuge!’ Then the physician should take a seat, perform the seven-fold offering, and make a mandala offering. He should imagine that the beams of light issuing from the heart of the Medicine Buddha collect all of the ambrosia in both nirvāṇa and saṃsāra and, vanishing into the pills, transform them into the ambrosia of immortality. The physician should recite the dhāraṇī of the Medicine Buddha many times, followed by particular verses of praise.85 Finally, Khyenrap Norbu describes the actual administration of the pills as follows: first the physician should consider the position of the planets (dus sbyor)—any signs of the zodiac associated with wrathful planets should be avoided. The time of the administration should coincide with the zodiacal signs of Virgo (Kanyā, Bu mo), Gemini (Mithuna, ’Khrig), Sagittarius (Dhanu, Gzhu), or Pisces (Mīna, Nya). In general, the pills should be administered during an auspicious period of the day—such as between midnight

83Gsal ba’i me long 201/2.
84For detailed instructions on these offerings, see Khyenrap Norbu’s treatise, Phud mchod nyung ngu.
85The dhāraṇī reads: Oṃ namo bhagavate / bhaiṣajyaguru vaiḍuryaprabharājāya tathāgatāya arhate samyaksaṃbuddhāya tadyathā / Oṃ bhaiṣajye bhaiṣajye / mahābhaiṣajye bhaiṣajye rājā samudgate svāhā. These verses of praise consist of five stanzas, partly similar to the verses of praise outlined by Tendzin Püntsok. The first stanza in the instructions of Khyenrap Norbu reads: ‘I bow down to the sublime Light of Beryl, the Buddha, the Medicine teacher, the dispeller of the three poisons and the diseases, who has impartial compassion for all beings. Even hearing his name, the suffering of those in the miserable states is eliminated’ (thugs rje kun la snyoms pa’i bcom ldan ’das / mtshan tsam thos pas ngan ’gro’i sdug bsngal sel / dug gsum nad sel sangs rgyas sman gyi bla / baidurya yi ’od la phyag ’tshal lo). This first verse appears to have been taken from the Aṣṭatathāgatastotra (De bzhin gshegs pa brgyad la bstod pa) written by Śāntarakṣita and contained in the Bstan ’gyur. The second, fourth, and fifth stanzas are identical to stanzas of the Explanatory Tantra (Bshad rgyud), the second part of the Four Tantras (Rgyud bzhi), by Yutok Yönten Gönpo. The third stanza derives from the Aṣṭāñgahṛdayasaṁhitā (Yan lag brgyad pa’i snying po bsdus pa) by Vāgbhaṭa.

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(nam phyed) and dawn (nam langs)—but not at a period of the day when the female deity Sepungjé Nakmo (Sa’i ’phung byed nag mo) is active.86 The person who administers the pills should dress in new clothes, sit on a white mat or cushion and, looking to the Buddha field of the Medicine Buddha in the east, pay homage. Then the physician should recite the verses of praise that begin with the line ‘Who has impartial compassion for all beings …’ (thugs rje kun la snyoms pa’i).87 This should be followed by many recitations of the long or the short dhāraṇī—Tadyathā / Oṃ bhaiṣajye bhaiṣajye / Mahābhaiṣajye rājā samudgate svāhā. The physician should then make a prayer, imagining ambrosia appears in the almsbowl of Bhaiṣajyaguru, who clearly resides in the sky in front of him, and comes to remain on his own tongue. This ambrosia should purify and clear away all diseases causing demons like the sun dispels darkness. With this wish in mind, the physician should finely crush the pills with an iron spoon or his clean ring finger. Without rubbing it, he should then clean the vessel a few times with the solvent—tea, beer, and so on—and drink it.

The Vehicle of the Precious Pills

Khyenrap Norbu gives a comprehensive description. As already outlined above, he goes into great detail regarding which liquid should be given together with the pills. As is usually the case in Tibetan medicine, he refers to the substance as the ‘horse’—that is, vehicle or carrier —of the medicine (sman rta). In other cases the vehicle could be sugar, honey, water, or any other suitable substance, but in the case of jewel pills, Khyenrap Norbu instructs that the vehicle should be the same as the liquid used during the ritual. He also goes on to instruct that the liquid should vary with respect to the health of the patient and the nature of the disease.88 Most of the other authors examined here are not so explicit in this regard. It seems that Karma Ngedön Tendzin Trinlé Rapgyé, Orgyen Tekchok, and Yeshé Gyatso recommend the use of boiled water as the vehicle.89 Tendzin Püntsok and Khyentsé Wangpo do not explicitly reference the substance used for the vehicle, but one might assume that it should be the same as the liquid used for filling up the cup. Chökyi Drakpa, however, is an important and notable exception; he provides a very detailed list of potential vehicles that should be given together with the precious pills.90 If the patient suffers from either a ‘combination of all three defaults’ (’dus gsum) or from a ‘gastrointestinal disease’ (smug po), the physician should give the jewel pills with Manu-4 (Ma nu bzhi, ‘Inula-4’).91 In case

86Sepungjé Nakmo is the wife of Rāhu and a goddess of the ground (sa bdag)—see Schuh 2011, p. 131; and Schuh 2012a. She is usually depicted as being black and naked, holding a sickle in her right hand and a bag in her left. She appears on each day at different times, and these different periods are exactly described for all thirty days of the month, ibid.
87See above for these verses of praise.
88Gsal ba’i me long 200/17.
89Man ngag snying gi nor bu 139/21, Ye shes rgya mtsho Gtong tshul 438/1, Bdud rtsi’i sman mdzod 287/5.
90Zur mkhar khyad chos 117/13.
91Ma nu refers to a type of inula, and the majority of botanists consider it to be Inula racemosa Hook. f., while some other propose Inula helenium L. In two publications, both identifications are seen as valid, while Clark is an exception, offering three differing identifications. (i) Inula racemosa Hook. f. (Börang Kyongjong Sarjé Uyön Lhenkhanggi Trötenü 1973, p. 421; Xizang deng weishengju [Health Offices of Tibetan Autonomous Region, Qinghai, Sichuan, Gansu, Yunnan and Xinjiang] 1979, p. 103; Yang Jingsheng and Chucheng Jiangcuo 1987, p. 479; Gurmet Namgyal and Phuntsog 1990, p. 318; Karma Chömpel 1993, p. 145; Tsarong 1994, p. 58; Gawé Dorjé 1995, p. 260; Pasang Yonten Arya 1998, p. 176; Dawa 2005, p. 98; Tenzin Dakpa 2007, p. 176; Berling 2008, p. 78), (ii) Inula helenium L. (Zhongguo kexue yuan xibei gaoyuan shengwu yanjiusuo [Northwest Institute of Plateau Biology, Chinese Academy of Sciences] 1991, p. 260), Inula helenium, p. elecompane (Parfionovitch et al. 1992, pp. 221, 235; Bönjong Mentsikhang Sorik Zhinjukkhang 2007, p. 102; Thinley Gyatso and Hakim 2010, p. 227), (iii) Inula racemosa Hook. f., Inula helenium L. (Qinghaisheng yaopin jianyan suo [Qinghai Institute for Drug Control] 1996, vol. 2, p. 173; Luo Dashang 1997, p. 254), and (iv) Iris germanica Linn., Aristolochia sp., Inula racemosa (Clark 1995, p. 150).

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of ‘chronic heat’ (tshad rnying), the physician should first give Gabur-25 (Ga bur nyer lnga, ‘Camphor-25’) and then the jewel pills with boiled water—or if the physician seeks to cleanse the ‘channels’, he should give beer first and then the pills. If the patient has severe ‘black aconite poisoning’ (btsan dug), the physician should use the urine of a seven-year-old boy as the vehicle.92 If the illness is severe, the patient should take the ‘essence of ambrosia’ (bdud rtsi’i dwangs ma).93 When a doctor gives precious pills to a patient afflicted with ‘rabies’ (khyi dug), he should use either the urine of a stallion, a ‘concentrated decoction’ (gdus khu) of ‘dung beetles’ (sbur nag),94 or a ‘decoction of a Corydalis species’ (stong ri). 95 A patient injured by ‘poisoned arrows’ (mda’ dug) should take the urine of a seven-year- old boy but, if the poisoning is severe, he should consume the so-called ‘four equals’ (bzhi mnyam)96 and then use a ‘male horse’ that corresponds to the age of the patient as vehicle for the pills. A patient suffering from ‘meat poisoning’ (sha dug) should drink beer but, if it is severe, he should take a concentrated decoction of either common salt (lan tshwa) or dried turnip (nyung skam). A patient suffering from ‘egg poisoning’ (sgong dug) should eat otter meat or a broth made from the exterior coating of blue bamboo (mthing shun).97 For ‘thin hair poisoning’ (spu dug), the physician should give either warm blood or bear’s fat, and then add further medicinal substances. If the patient is suffering from ‘rust poisoning’ (g.ya’ dug), the physician should administer the jewel pills together with a ‘broth of processed

92The plant designation ga bur includes various herbs, deciduous shrubs, or small trees. It generally refers to Cinnamomum camphora, but also can refer to a number of other species with the addition of descriptors to the Tibetan name—such as shel ga bur, stag zil ga bur, and mang ga bur. The identifications offered in modern botanical works are as follows: (i) Cinnamomum camphora Nees Karpura & Eberm. (Gurmet Namgyal and Phuntsog 1990, p. 314), Camphor (Clark 1995, p. 139), Camphora sp. (Tenzin Dakpa 2007, p. 27), Cinnamomum camphora L. Presl. (Luo Dashang 1997, p. 91; Berling 2008, p. 46), Cinnamomun camphora (Thinley Gyatso and Hakim 2010, p. 178), (ii) Dryobalanops aromatica Gaertn. f. (Qinghaisheng yaopin jianyan suo [Qinghai Institute for Drug Control] 1996, vol. 3, p. 44; Bönjong Mentsikhang Sorik Zhinjukkhang 2007, p. 391), (iii) Dryobalanops aromatica Gaertn. f. Blume balsamifera L. DC. (Zhongguo kexue yuan xibei gaoyuan shengwu yanjiusuo [Northwest Institute of Plateau Biology, Chinese Academy of Sciences] 1991, p. 36), (iv) sngo ga bur: Vitex canescens Kurz, shing ga bur: Litsea rubescens H. Lec. (Börang Kyongjong Sarjé Uyön Lhenkhanggi Trötenü 1973, pp. 77, 332), (v) ga bur (ga bur, shel ga bur, stag zil ga bur, mang ga bur): Dryobalanops aromatica Gaertn. f., Borneo camphora, Blume balsamifera L. DC., Nagi camphora, Cinnamomum camphor L. Presl. (Yang Jingsheng and Chucheng Jiangcuo 1987, p. 136), (vi) ga bur: Cinnamomum camphora, mang ga bur: Cinnamomum camphor, shel ga bur: Blume balsamifera L. DC. (Parfionovitch et al. 1992, p. 219), (vii) mang ga bur: Cinnamomum camphor L. Presl., stag zil: Blume balsamifera L. DC., shel ga bur: Dryobalanops aromatica Gaertn. f. (Karma Chömpel 1993, p. 3), (viii) ga bur (mang): Borneo camphora Dryobalanops aromatica Gaertn., stag zil ga bur: Nagi, Camphora Blumea blasmifera L., shel ga bur: Cinnamomum camphora L. Presl. (Gawé Dorjé 1995, p. 97f.), and (ix) ga bur: Cinnamomum camphor Linn. Sieb., stag zil ga bur: Nagi, Camphora Blumea blasmifera L., ga bur (mang): Borneo cam-phora Dryobalanops aromatica Gaertn. (Pasang Yonten Arya 1998, p. 29).

93It is unclear what exactly Chökyi Drakpa had in mind here, and it is therefore open to interpretation.
94According to modern dictionaries, the term sbur nag (which literally means ‘black insect’) is a dung beetle: Goldstein 2001, 778c; Le ’dod mos 2009, 2019b. Notably, the animal known as sbur nag is not discussed in Tibetan treatises on materia medica, even though one might encounter it in some medical works such as two nineteenth-century treatises on materia medica written by the Mongol Jampel Dorjé (’Jam dpal rdo rje) alias Yeshé Döndrup Tenpé Gyentsen (Ye shes don grub bstan pa’i rgyal mtshan, 1792–1855), Gso byed Mdzes mtshar mig rgyan 255, Shel phreng Mdzes mtshar mig rgyan I 19; Shel phreng Mdzes mtshar mig rgyan II 25b; Shel phreng Mdzes mtshar mig rgyan III 25b. It leads to the conclusion that sbur nag and bying bying thu lu could be synonymus terms and that, indeed, both designations stand for a dung beetle. (A full discussion will be published elsewhere.)
95Stong ri is usually identified as a type of Corydalis: (i) Corydalis boweri Hemsl (Karma Chömpel 1993, p. 282), (ii) Corydalis conspera Maxim (Gawé Dorjé 1995, p. 212; Pasang Yonten 1998, p. 86f.), (iii) Corydalis gerdae Fedde (Institute of Traditional Medicine Services, Health Dept., Ministry of Health & Education 1999, p. 1), (iv) Corydalis (Kletter and Kriechbaum 2001, p. 68; Bönjong Mentsikhang Sorik Zhinjukkhang 2007, p. 651), (v) Corydalis mucronifera Maxim (Chen Jiahui and Yang Yong 2010, p. 60), and (vi) Corydalis alpigena C. Y. Wu et H. Chuang (Qinghaisheng yaopin jianyan suo [Qinghai Institute for Drug Control] 1996, vol. 1, p. 176).
96How Chökyi Drakpa understands this term is not totally clear to me. Usually the “‘our equals’ refer to excretions from the stomach, gall bladder, large, and small intestine.
97Usually, the term mthing shun refers to the colour, azurite blue—it literally means ‘azurite skin, peel, hide, bark’. Das equates the word be tur with mthing shun, meaning ‘sulphate of copper’ (Das 1902, p. 875), but in this context it probably means something else. It possibly is a synonym for bamboo resin (smyug ma’i rtsi); Pasang Yonten Arya 1998, p. 93. This view should be qualified by an explanation made by Penden Gyentsen (Dpal ldan rgyal mtshan) in a treatise on making pills based on mercury: according to him, the term mthing shun should be understood as ‘the exterior coating of the bluish bamboo’ (mthing shun ces pa / smyug ma sngon po’i phyi rtsi ste); Sman nag sbyor ba 147/15.

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borax’ (tsha la btul ma)98 and ‘golden-coloured sulphur’ (mu zi gser ’dra),99 or a ‘broth of white nettles’ (zwa dkar). If the patient has been ‘poisoned by the liver of a poisoned animal’ (dug gis shi ba’i mchin dug), the doctor should prescribe rotten fish and nettle soup, and afterward he should cleanse the rest of the poison with a purgative. If the patient has been ‘poisoned by non-poisonous substances that turned poisonous’ (gyur dug), regardless of what it might be, the physician should give the pills together with a vegetable broth. Furthermore, as explained by Chökyi Drakpa, all types of poison—‘mobile’ and ‘immobile’ —can completely be annihilated by precious pills in combination with further appropriate drugs, which are found in the Four Tantras (Rgyud bzhi). Thus, from these examples we can see that Chökyi Drakpa offers extensive instructions regarding the proper use of precious pills in the treatment of different diseases and different kinds of poisoning.

Instructions for the Patient

As outlined in the discussion of Tendzin Püntsok’s treatise above, there are a number of dietary and lifestyle restrictions for a patient taking jewel pills. As Tendzin Püntsok explains, some of these instructions are less important than others, so he briefly describes the most significant dietary and lifestyle restrictions that a patient must follow. The other authors examined here also give lists of restrictions that are comparable to Tendzin Püntsok’s treatise, with varying degrees of detail. The instructions given by Khyentsé Wangpo, Orgyen Tekchok, and Khyenrap Norbu seem to be derived from Tendzin Püntsok’s treatise directly, although there also are important differences. For example, Tendzin Püntsok writes that the best regimen would last forever, the medium regimen lasts for three years, and the lesser regimen lasts for at least one year. Orgyen Tekchok, however, is less strict in this regard.100 He sees the best regimen as lasting three years, the medium regimen as lasting one year, and the minimum length being a regimen of six months. Khyenrap Norbu provides further specifications regarding medical therapies; according to him, it would be acceptable if a physician gives a purgative after three or four days in the case of ‘chronic heat’ (tshad rnying), ‘wounds and sores’ (rma lhog), ‘diseases of the serous fluid’ (chu ser), and so on. 101 Regarding ‘slipping poison’ (’dred), he states that the patient should abstain from sour foods and beverages (such as beer, common sea-buckthorn [star bu], stems of rhubarb [phyur (chu) rkang],102 and so on), strenuous activities (such as horse racing, sexual intercourse, and so on), and walking with bare feet or crossing a big river, because these all neutralise the healing potentials of the pills. If the patient follows these instructions, the jewel pills should

98There is a general consensus in the modern literature that tsha la refers to borax—only one publication suggests that it refers to Tincalconit (in English, but then gives the Chinese term for borax, pengsha 硼砂, as an equivalent): (i) borax (Yang Jingsheng and Chucheng Jiangcuo 1987, p. 32; Parfionovitch et al. 1992, p. 221; Karma Chömpel 1993, p. 593; Clark 1995, p. 147; Gawé Dorjé 1995, p. 92; Qinghaisheng yaopin jianyan suo [Qinghai Institute for Drug Control] 1996, vol. 2, p. 212; Tian Shuqin 1997, p. 268; Pasang Yonten Arya 1998, p. 203; Bönjong Mentsikhang Sorik Zhinjukkhang 2007, p. 78; Kenden Nyima 2010, p. 154; Thinley Gyatso and Hakim 2010, p. 175) and (ii) Tincalconit (Zhongguo kexue yuan xibei gaoyuan shengwu yanjiusuo [Northwest Institute of Plateau Biology, Chinese Academy of Sciences] 1991, p. 576).

99Most of the authors agree that mu zi refers to sulphur—only one publication considers further identifications: (i) sulphur (Xizang deng weishengju [Health Offices of Tibetan Autonomous Region, Qinghai, Sichuan, Gansu, Yunnan and Xinjiang] 1979, p. 68; Yang Jingsheng and Chucheng Jiangcuo 1987, p. 30; Parfionovitch et al. 1992, p. 219, 273; Karma Chömpel 1993, p. 579; Clark 1995, p. 138; Gawé Dorjé 1995, p. 72; Qinghaisheng yaopin jianyan suo [Qinghai Institute for Drug Control] 1996, vol. 2, p. 178; Pasang Yonten Arya 1998,p. 182; Bönjong Mentsikhang Sorik Zhinjukkhang 2007, p. 63; Kenden Nyima 2010, p. 141) and (ii) sulphur, pyrite, quartz (Zhongguo kexue yuan xibei gaoyuan shengwu yanjiusuo [Northwest Institute of Plateau Biology, Chinese Academy of Sciences] 1991, p. 574).

100Bdud rtsi’i sman mdzod 288/4. 101Gsal ba’i me long 204/11.

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remain in the body. When the poison emerges, the patient will begin to show certain symptoms—such as diarrhoea, vomiting, stomach rumble, belching, and the pleasant smell of musk. When such symptoms show, the doctor should immediately give a ‘purgative against poisoning’ (dug sbyong)—such as the purgative known as the ‘Cleansed Gold of Myrobalan’ (a ru’i gser bshal),103 which is beneficial for all kinds of poisoning and ‘gastrointestinal disease’ (smug po).

The instructions provided by Karma Ngedön Tendzin Trinlé Rapgyé and Yeshé Gyatso are both more flexible and more practical. Karma Ngedön writes that it would be good if the patient abstains from walking, travelling, and also from certain types of food for about seven days.104 He emphasises that it is very important that the patient abstains from garlic, onion, turnip, foods that are bitter, salty or rotten, aromatic vegetables or fruits, and especially from substances that ‘overcome’ mercury (dngul chu bshig pa), sour beer, sexual intercourse, and so on. Yeshé Gyatso also prescribes a regimen of moderate length—the best regimen should last for a period of one month, a middle regimen for three weeks, and a lesser regimen for two weeks. According to him a patient may not eat the cartilage of a shoulder blade, the meat between the ribs, all kinds of entrails, fish, eggs, goat meat, pork, garlic, onion, radish, all kinds of fruits, cold tea, cold soup, sour beer, yogurt, buttermilk, cooked vegetables, and all kinds of bitter, salty, and rotten food.105 Moreover, lifestyle and medical therapies should also be restricted accordingly: the patient should avoid strong craving, sexual intercourse, freezing, sweating, bloodletting, and moxibustion. Chökyi Drakpa is equally pragmatic.106 He writes that, as long as the precious pills are in the body of a patient, he must not consume any food or drink that is too sour—such as nettle, common sea-buckthorn, or chukang (chu rkang). The latter can probably be understood as rhubarb stem (chu rtsa’i rkang).107 Another possibility is that it denotes the stalks of the leaves of chutsi (chu rtsi).108 Moreover, one should not consume sour water, sour beer, peach, apricot, apple, curd, spoiled

103This purgative is usually given for bile disorders. 104Man ngag snying gi nor bu 140/1.
105Ye shes rgya mtsho Gtong tshul 440/7.
106Zur mkhar khyad chos 120/7.

102Khyenrap Norbu uses the word phyur rkang, which consist of the word ‘cheese’ (phyur) and an ambiguous term that could refer to ‘marrow, pith, descent, extraction, origin, stuff, bundle, collection, foot, leg, or stalk’ (rkang). As written, this term remains difficult to understand; perhaps it signifies something related to cheese, or perhaps each syllable should be read separately—namely cheese and marrow. More likely, however, it is a mistake that should be amended to chu rkang, meaning the stems of rhubarb. See also Note note 105 below.

107This explanation is given by Lingmen Trashibum (Gling sman Bkra shis ’bum) and Lungrik Tendar (Lung rigs bstan dar); Gling sman Dka’ ’grel 262/6, 341/7, 620/8; Lung rigs bstan dar Brda bkrol 50/10. In modern botanical literature chu rtsa is generally identified as a type of Rheum, but it differs significantly which one: (i) Rheum spiciforme Royle (Xizang deng weishengju [Health Offices of Tibetan Autonomous Region, Qinghai, Sichuan, Gansu, Yunnan and Xinjiang] 1979, p. 34; Karma Chömpel 1993, p. 213; Gawé Dorjé 1995, p. 200; Pasang Yonten Arya 1998, p. 66), (ii) Rheum nobile Hook. f. et Thoms. (Yang Jingsheng and Chucheng Jiangcuo 1987, p. 328), (iii) Rheum emodi Wall. (Gurmet Namgyal and Phuntsog 1990, p. 315; Parfionovitch et al. 1992, p. 213), (iv) Rheum scaberrimum Lingelsh. (Zhongguo kexue yuan xibei gaoyuan shengwu yanjiusuo [Northwest Institute of Plateau Biology, Chinese Academy of Sciences] 1991, p. 89; Bönjong Mentsikhang Sorik Zhinjukkhang 2007, p. 340), (v) Rheum spiciforme, Rheum officinale (Clark 1995, p. 175), (vi) Rheum emodi Wall., Rheum acuminatum Hook. f. et Thoms., Rheum lhasaense A. J. Li et P. K. Hsiao, Rheum inopinatum Prain. (Luo Dashang 1997, p. 49), (vii) Rheum sp. (Dawa 1999, p. 286; Tenzin Dakpa 2007, p. 71), (viii) chu rtsa (mo rigs): Rheum acuminatum D. Don, chu rtsa (ma ning): Rheum spiciforme Royle (Dawa 2005, p. 51), (ix) Rheum australe D. Don. (Tsering Dorjee Dekhang 2008, p. 157), and (x) Rheum rhomboideuml A. Los., Rheum moorcroftianum Royle (Chen Jiahui and Yang Yong 2010, pp. 25, 26).

108This statement is made by Karma Ngedön Tendzin Trinlé Rapgyé (chu rkang ni chu rtsi’i lo ma’i rkang), Phan bde’i sgo ’byed lde mig 188/8. Perhaps chu rtsi should be amended to chu rtsa (rhubarb), but there also are various opinions about the botanical identification of a plant called chu ma rtsi. There is a strong tendency to identify this plant with a type within the taxonomic genus of Rheum—such as the Noble rhubarb or Sikkim rhubarb, for example—but there already were diverging views about this plant within the Tibetan traditions of centuries ago that would vary in accordance with medical school. For instance, there are differences in interpretation between the treatises of the Zur school (zur lugs) and those of Jarpa Penchen Dorjé Palam (Byar pa pan chen Rdo rje

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buttermilk, whey (dar ras pa), or any tsur minerals (mtshur).109 Furthermore, he also instructs the patient to avoid sweating too much by sitting in the sun. He should also avoid eating too much salt, encountering demons, becoming polluted due to defilements, and having sexual intercourse. Chökyi Drakpa warns that if the patient transgresses these rules, the jewel pills will have negative effects—including abdominal bloating, headaches, and nausea. In such a case, the doctor should first mix the spraint of an otter with fresh butter, rub it on the head and the belly of the patient, and then have him warm up by a fire or the sun. These steps should be repeated until such afflictions have been alleviated.110

Handling and Storage of Precious Pills

Importantly, in order to ensure the full efficacy of the precious pills, there are not just specific regulations for the patient regarding diet and lifestyle, but there also are instructions concerning the proper methods for handling and storing these pills. Indeed, this is an issue of high relevance, and its importance cannot be overstated. The authors all seem to agree that spoiling must be prevented and that the pills must be kept away from influences that might be regarded as inauspicious. Chökyi Drakpa emphasises that the doctor should always administer the pills while keeping them away from being exposed to the sky, women, or rats. 111 As seen above, Tendzin Püntsok just explains that the pills should not be exposed to the sky. Karma Ngedön Tendzin Trinlé Rapgyé reiterates Tendzin Püntsok’s instruction, but adds that even just hearing the sound of dogs or women could spoil the pills.112 He further

pha lam) regarding the identity of chu ma rtsi, resulting in the same term referring to a variety of medicinal plants that are not necessarily of the same genus. Thus, in modern botanical literature chu ma rtsi has been variously identified as: (i) Rheum nobile Hook f. and Thoms. (Gurmet Namgyal and Phuntsog 1990, p. 315; Tsarong 1994, p. 20; Bönjong Mentsikhang Sorik Zhinjukkhang 2007, p. 617), (ii) Rheum delavayi Franch. (Yang Jingsheng and Chucheng Jiangcuo 1987, p. 325), (iii) Rheum pumilum Maxim. (Pasang Yonten Arya 1998, p. 66), (iv) chu ma rtsi or lcum dkar: Rheum nobile Hook. et Thorns, chu ma tsi (rigs gzhan): Rheum sp. (Tenzin Dakpa 2007, pp. 69, 70), (v) Polygonum sibiricum Laxm. (Zhongguo kexue yuan xibei gaoyuan shengwu yanjiusuo [Northwest Institute of Plateau Biology, Chinese Academy of Sciences] 1991, p. 85), (vi) Polygonum polystachyum/sibiricum Laxm. (Parfionovitch et al. 1992, p. 225), (vii) Veronica anagallis-aquatica L. (Karma Chömpel 1993, p. 212), (viii) byar pan chu rtsi zhes pa’i sngo dug mo nyung: Epilobium palustre L. (Dawa 2005, p. 94; Chen Jiahui and Yang Yong 2010, p. 98), (ix) byar pan chu rtsi: Epilobium laxum Royle, chu rtsi nag po: Polygonum hydropiper L. (Tsering Dorjee Dekhang 2008, pp. 73, 142), (x) Rheum pumilum Maxim., Polygonum sibiricum Laxm. (Xizang deng weishengju [Health Offices of Tibetan Autonomous Region, Qinghai, Sichuan, Gansu, Yunnan and Xinjiang] 1979, p. 35), (xi) Rheum nobile Hook f. et Thoms, Oxyria digyna (mountain sorrel), Polygonum polystachyum (Clark 1995, p. 167), (xii) Rheum pumilum Maxim., Rheum globulosum Gage., Rheum delavagi Franch, Rheum nobile Hook. f. et Thoms., Polygonum sibiricum Laxm. (Luo Dashang 1997, p. 50) (xiii) chu rtsi nag po: Polygonum polystachyum Wall., byar pan chu rtsi: Epilobium angustifolium L., zur lugs chu rtsi: achyranthus bidentata Blume (Börang Kyongjong Sarjé Uyön Lhenkhanggi Trötenü 1973, pp. 188, 275, 342), and (xiv) the wild type (chu ma rtsi rgod pa): Rheum pumilum Maxim., the cultivated type (chu ma rtsi g.yung ba): Polygonum hookeri Meisn., and the so-called ḍākinī turnip (mkha’ ’gro la phug): Rheum sp. (Gawé Dorjé 1995, p. 199).
109The term mtshur, or more commonly spelled tshur, is a group of mineral substances used in Tibetan medicine that are traditionally classified by their colour. The white type (da tshur, dkar tshur) is often identified with alumen, the black (nag mtshur) with fibroferrite, melanterite, or vitriol (a sulfate), and the yellow (ser tshur) with fibroferrite: (i) dkar tshur, da tshur: alumen, nag tshur: melanterite (Yang Jingsheng and Chucheng Jiangcuo 1987, pp. 9, 24), (ii) da tshur: alum, pickeringite; nag mtshur and ser mtshur: halotrichite (quartz), halotrichite (pyrite), copiapite (Zhongguo kexue yuan xibei gaoyuan shengwu yanjiusuo [Northwest Institute of Plateau Biology, Chinese Academy of Sciences] 1991, pp. 562, 567), (iii) nag mtshur: black vitriol, ser tshur: yellow vitriol (Parfionovitch et al. 1992, p. 219), (iv) nag mtshur and ser mtshur: fibroferritum, dkar mtshur: alumen (Karma Chömpel 1993, pp. 587, 588, 591), (v) nag mtshur: black alunite, vitriol; ser mtshur: fibroferrite (Clark 1995, p. 138), (vi) da tshur: alum, tshur dkar: aluminium, rnag tshur and ser tshur: fibroferrite (Gawé Dorjé 1995, pp. 88f.), (vii) dkar tshur: alumen, nag tshur: jarosite (Qinghaisheng yaopin jianyan suo [Qinghai Institute for Drug Control] 1996, vol. 2, p. 1; vol. 3, p. 152), (viii) da tshur: alumen (Luo Dashang 1997, p. 7), (ix) tshur dkar: alumitum, tshur nag: fibroferritum, tshur ser: fibroferritum, tshur sngon: chalcanthitum (Pasang Yonten Arya 1998, p. 205), (x) da tshur: alumen, nag tshur and ser tshur: fibroferritum (Kenden Nyima 2010, p. 160, 161), and (xi) nag mtshur: melanteritum (Bönjong Mentsikhang Sorik Zhinjukkhang 2007, p. 58).
110Khyenrap Norbu also refers to this very same medical application, probably based on Chökyi Drakpa’s work; Gsal ba’i me long 204/19. In the colophon of this work, Khyenrap Norbu lists one of the works of Chökyi Drakpa called the Personal (Cold) Compound (alias) Jewel Black Pills (Phyag sbyor rin chen ril nag); ibid. 207/20. Chökyi Drakpa composed several works on Black Pills. It is not clear which text Khyenrap Norbu is referring to see Czaja 2013, p. 81, n. 32.
111Zur mkhar khyad chos 117/9.

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remarks that if the pills are administered to women, it is necessary that they are given by a man.

Naturally, such instructions beg the question of what to do if a transgression of these rules occurs. Both Khyentsé Wangpo and Orgyen Tekchok address this issue in some detail.113 The former—famous author, scholar, and religious hierarch—writes that precious pills will be defiled if they incidentally come into contact with a leper, a murderer, someone who has broken an oath, and so on, or if they are exposed to the sky, dogs, women, rats, and so on (see below for more detail).114 In cases where the physician has to cleanse the pills from exposure to defilement and restore their purity, Khyentsé Wangpo explains, during the full moon, on the fifteenth day of any lunar month, a moment before dusk, the physician should wrap the pills in red silk and put them in a precious vessel that is filled with various pure medical herbs, like myrobalan and so on. Then he should cover the opening of the vessel and, after surrounding it with offerings, he should perform the preliminaries—such as taking refuge and cultivating the thought of enlightenment for all. He should then give sacrifical cakes to the local protective deities (gzhi bdag), make offerings to avert dangers caused by evil spirits (bgegs gtor), burn incense, and recite the Four Hūṃ Mantra many times.115 Another method would be to address the obstacles caused by defilement after one has done a general ritual purification. Then the physician should visualise a protection circle, perform appropriate ‘ritual activities’ (las gzhung), and make recitations. Once the moon has begun to rise, the physician should remove the cover of the vessel and recite the Golden Dhāraṇī silently for as long as the moon is still in the sky. Once the moon has set, the physician should cover the vessel again and perform offerings, praises, prayers, feast offerings, and so on. The physician should also perform ceremonies for longevity (brtan bzhugs), consecrations (rab gnas), and recite eulogies. After these steps, the physician should take the pills out of the vessel, place each package of pills together with a row of offerings, and lay them up as provisions. It is very important that the time of ritually purifying the pills is a month without clouds, such as an autumn month, and it is equally important that the time of dispensation is an auspicious time.

Similarly, Orgyen Tekchok explains that precious pills should be directly exposed to neither the light of the sky nor sunlight.116 The pills must not been seen or be touched by anyone who has broken religious vows, committed murder, prepared poison, women, or even laypeople in general. One should therefore carry the jewel pills in a small vessel wrapped in silk brocade and saturated with perfume. If it is necessary to restore the purity of the jewel pills, one should conduct a ritual that is basically similar to that described by Khyentsé Wangpo, but also with some important differences. Orgyen Tekchok writes that firstly the physician should fill a precious vessel or a procelain cup with ‘six medicinal substances’ (bzang drug)—such as golden myrobalan and so forth—and place the jewel pills wrapped in red silk on top of them. Then on the fifteenth of the lunar month, just as the moon has begun

112Man ngag snying gi nor bu 140/6.
113Yeshé Gyatso and Khyenrap Norbu do not discuss such transgressions at all.
114Mkhyen brtse’i dbang po Gtong tshul 122/21.
115The so-called Four Hūṃ Mantra exists in all Buddhist schools with variation of its exact wording. It can read: Oṃ sumbha nisumbha huṃ huṃ phaṭ / Oṃ gṛhṇa gṛhṇa huṃ huṃ phaṭ / Oṃ gṛhṇāpaya gṛhṇāpaya huṃ huṃ phaṭ / Oṃ ānaya ho bhagavān vajra huṃ huṃ phaṭ. It is also employed in the Yuthok Heart Essence (G.yu thog snying thig).
116Bdud rtsi’i sman mdzod 284/11.

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to rise, the physician should recite mantras from authoritative texts, such the ritual for a dead person, known as the Light of the Moon (Bsil ba’i ’od gdung chog).117 Orgyen Tekchok notes that these mantras should be followed by other rituals, but gives no further instructions.

Who May Administer Precious Pills

One feature common to the ritual instructions of all these authors is the impurity of women; and, therefore, the fact that precious pills should strictly be kept away from them—already during their production, storage, and administration. Such restrictions even apply to the administration of pills to a female patient, which must be done by a male physician in order to protect the purity of the pills. Such views are explicitly expressed in the writings of Karma Ngedön Tendzin Trinlé Rapgyé and Orgyen Tekchok.118 Only some of the authors examined here explicitly comment upon these restrictions, but all of them were aware of such important ritual impurities; as discussed above, Tendzin Püntsok presents three or four types of persons who may administer precious pills to a patient in order of their graded quality. Notably, the instructions provided by Orgyen Tekchok on this issue differ from those provided by Tendzin Püntsok, including a different set of criteria for the administration of precious pills.119 According to Orgyen Tekchok, there are three categories of suitable professionals—namely a specialist regarding the rituals of the Eight Medicine Buddhas in the Sūtra tradition; a monk who has kept his vows and abstains from meat, beer, and onions; and a doctor who has received teachings regarding all ‘six tantras’ (rgyud drug), such as the Heart Essence: Dispelling the Darkness of Ignorance (Snying thig ma rig mun sel), and so on.120

Benefits of Precious Pills

As seen in the elaborate explanation provided by Tendzin Püntsok, the benefits of precious pills can be both significant and long lasting. These benefits do not only concern the physical body and its ailments, but also the spiritual development of the patient as well. The latter benefits can be understood in the distinction between ill and healthy patients as described by Tendzin Püntsok above. Such descriptions are essentially repeated in the instructions provided by Orgyen Tekchok,121 and although the phrasing and length of their descriptions might differ, the basic statements of the other authors are essentially the same. 122 For example, Khyentsé Wangpo states that the precious pills can cure the 404 diseases, pacify the 8000 types of pathogenic demons, and prevent the eight types of untimely death. 123 He goes on to describe that they will increase the lifespan and religious merit of the patient, as well as his welfare, riches, and bodily strength. Eventually, precious pills enable the patient to become an ‘awareness holder’ (vidyādhara, rig ’dzin) of the ḍākinīs. Thus, despite these further elaborations in the writings of other authors, Tendzin Püntsok’s

117I have been unable to identify this work.
118Man ngag snying gi nor bu 140/7, Bdud rtsi’i sman mdzod 285/21.
119Bdud rtsi’i sman mdzod 285/18.
120Bdud rtsi’i sman mdzod 285/18.
121Bdud rtsi’i sman mdzod 288/5.
122Zur mkhar khyad chos 118/21, Man ngag snying gi nor bu 140/8, Ye shes rgya mtsho Gtong tshul 441/2, Gsal ba’i me long 198/17. 123Mkhyen brtse’i dbang po Gtong tshul 122/15.

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descriptions provide the reader with a thorough understanding of the outstanding and extraordinary qualities attributed to precious pills by Tibetan doctors throughout history.

Concluding Remarks

Following these descriptions, it has been demonstrated that the historical administration of precious pills was a highly complex procedure. It was not a simple prescription of a drug; the doctor had to consider a wide range of issues, including medical, astrological, and ritual aspects. Firstly, the physician had to possess a profound knowledge of the processes of different diseases, with a particular focus on poisoning. Such knowledge is well demonstrated in the instructions for opening the ‘channels’ and their closing, and also causing perspiration. The physician also had to decide an appropriate carrier for the pills, which could be the result of highly sophisticated calculations, as seen in the detailed instructions provided by Chökyi Drakpa. The elaborate rituals required for the empowerment and the actual administration of the pills illustrates the fact that liturgical knowledge was an integral part of Tibetan medical practices regarding precious pills. That being said, it was not always necessary that the doctor performed all of these ritual procedures himself, for he could employ the assistance of a ritual expert if necessary. The specific rituals—including the making of offerings, the performance of meditations, and the recitation of mantras, dhāraṇīs, and verses of praise could differ according to the religious background of each doctor, but it is evident that these had to be performed to ensure that the pills would be truly efficacious. The ritual side of the administration of precious pills also manifests in the storage and handling of precious pills; the basic restriction that the pills must not be exposed to direct sunlight is probably one of the reasons that the ritual is to be conducted during the night, and the pills are to be given before sunrise. Further restrictions specify that all defilements must be prevented,124 and if defilement happens to occur, the purity of the pills should be restored by an appropriate ritual. In the views of the male doctors and religious dignitaries examined here, a constant potential source of defilement is women, revealing a socio-religious status of women in the intellectual history of Tibet that still has repercussions in the present.125 Women were not seen as the only hazard that could spoil the efficacy of the pills, however; the patient was also oblidged to follow certain dietary, behavioural, and medical instructions, which also reflect the socio-religious life of historical Tibet. The varying opinions on these instructions expressed by the authors indicate that they were too numerous and restrictive, however, and the more pragmatic regulations that were in harmony with the reality of daily life appear to have prevailed. The supreme status of jewel pills among other drugs in Tibetan medicine is underlined by their specific efficacy including long-term blessings they are said to provide; one can imagine that these pills were highly sought after. They were expected not just to cure an illness or to eliminate a poison, but also to strengthen the general health and elevate the spiritual accomplishments of a patient. Consequently they also came to be used as amulets.

124On the important role of defilement in Tibetan culture, see Lichter and Epstein 1983; Schicklgruber 1992; Sa mtsho skyid and Roche 2011.
125There is also a tradition that women should not be involved in the processing of mercury—the main ingredient for precious pills; see Gerke 2013, p. 140, and Blaikie et al. 2015, p. 190. For more information on women and Tibetan medicine, see, for instance, Fjeld and Hofer 2010.

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A significant portion of recent scholarship on Tibetan medicine has analysed both its efficacy and safety in the modern age. Such research has mostly been performed using ethnographic methods, investigating the present situation of Tibetan medicine in isolation from its history. In analysing the instructions provided by the leading pre-modern medical scholars of the Tibetan tradition, this article has demonstrated that these doctors were by and large in agreement regarding the complex administration of precious pills. This similarity also surely derives from the fact that their instructions were expressed in writing, as opposed to being expressed in an oral exposition or personal tutorial. Such literary instructions were presumably consulted by doctors of the same and subsequent generations, forming a kind of intellectual consensus among the elite medical scholars and physicians of the Tibetan tradition—all authors came from monastic backgrounds and tended to treat aristocratic patients. The high status of the authors’ texts analysed here can be inferred from their expertise in ritual and meditation practices, but one must assume that such a status was not shared by all doctors in the past. Presumably, some physicians had to employ ritual specialists to empower their pills correctly, or use simplified versions, in order to ensure their utmost efficacy. Seeing that the ritual and spiritual purity of the pills was a major concern for our authors, the administration of jewel pills appears to have involved strong socio-religious connotations—including prohibitive rules for the daily activities and social norms of both the physician and patient. Such prohibitions can be found not only in the ritual procedures of jewel pill administration, but also in its temporal procedures, and the medical theory describing the full healing potency of jewel pills in the body. The religious side of jewel pill administration is fully expressed in the benefits and blessings that a patient and a healthy person can expect to receive when following a jewel pill regimen. Importantly, the ritual processes of empowering and administering the jewel pills explicitly include the patient, illustrating the fact that the pills themselves are but ‘one element in the social construction of “health care” in Tibetan contexts’.126 The administration of jewel pills is neatly interwoven with other ‘proper’ medical treatments—such as the opening and closing of the ‘channels’—and all of these aspects interpenetrate to create the full efficacy of the precious pill regimen in the past.

Acknowledgments

I want to thank Calum Blaikie for sending me his article ‘Wish-fulfilling Jewel Pills’, Maria Turek for sending me her still unpublished paper on Nang chen, and Anne Burchardi and Bent Lerbæk Pedersen for pointing out to me Heissig’s catalogue on Mongolian textual sources in the Royal Library in Copenhagen. Special thanks go to William McGrath for his careful English editing of this essay. However, all mistakes that remain are my own. This research is part of the ‘Beyond Tradition’ project, funded by The Wellcome Trust.

Appendix

126Craig 2011b, p. 220.
Asian Med (Lieden). Author manuscript; available in PMC 2016 December 13.

The Practice of Administering Jewel Pills: The Definite and Profound Heart Essence (Rin chen ril bu gtong thabs lag len nges zab snying thig) by Tendzin Püntsok (Bstan ’dzin phun tshogs, b. 1672).

Table of Contents

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[subdivisions added]

1. Preliminary Practices

[1.1.] Date, place, and dispenser of the pills
[1.2.] Extraction of poison
[1.3.] Gathering of poison
[1.4.] Preparation platform, offerings, and so forth [night]
[1.5.] The administration of Seru-4 pills [night, next morning and noon]

2. Main Practice

[2.1.] Bathing, attire, and so forth
[2.2.] Erection of an altar
[2.3.] Worship
[2.4.] Visualisation, offering
[2.5.] Aspirational prayer
[2.6.] Mantra recitation
[2.7.] Contemplation
[2.8.] Recitation of Sanskrit vowels and consonants and the Essence of Causation mantra
[2.9.] Mantra recitation, scattering of flowers, and so forth
[2.10.] Sleep and dietary instructions [night]
[2.11.] Opening of the ‘channels’ [night]
[2.12.] Preliminaries, ritual performance, and so forth [dawn]
[2.13.] Spiritual master fumigation, libation ritual, and so forth
[2.14.] Removal of the pills from their container, recitation of praise verses, mantra, and so forth
[2.15.] Perspiration
[2.16.] Closing of the ‘channels’
[2.17.] Broth of pure meat

3. Patient’s Instructions

[3.1.] Dietary instructions
[3.2.] Diet and lifestyle modifications
[3.3.] Medical instructions

4. Benefits and Blessing

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[4.1.] Various kinds of diseases
[4.2.] Various kinds of poisoning
[4.3.] Preservation of the pills in the body
[4.4.] Importance of instructions
[4.5.] Importance of water quality
[4.6.] Amulets
[4.7.] Spiritual accomplishments

Bibliography Primary Sources

Baidurya sngon poSangyé Gyatso (Sangs rgyas rgya mtsho) 1994, Gso ba rig pa’i bstan bcos sman bla’i dgongs rgyan rgyud bzhi’i gsal byed baiḍūrya sngon po’i ma lli ka, Dharamsala: Tibetan Medical & Astro Institute.

Bdud rtsi’i sman mdzodOrgyen Tekchok (O rgyan Theg mchog) 2002, ‘Zin tig mdzes rgyan bdud rtsi’i sman mdzod’, in Yon tan rgya mtsho et al., Gso rig skor gyi rgyun mkho gal che ba bdam bsgrigs, Pe cin: Mi rigs dpe skrun khang, 106–259, (19th chapter Rin chen ril bu btang thabs), 252–7.

Bi ṣa bcos paTendzin Püntsok (Bstan ’dzin phun tshogs) 2006, ‘Bi ṣa bcos pa’i man ngag tsitta ma ṇi’, in Bstan ’dzin phun tshogs, De’u dmar gso rig gces btus, Pe cin: Mi rigs dpe skrun khang, 499–505.

’Bri gung gdan rabsTendzin Pemé Gyemtsen (Bstan ’dzin pad ma’i rgyal mtshan) 1989, Nges don bstan pa’i snying po mgon po ’bri gung pa chen po’i gdan rabs chos kyi byung tshul gser gyi phreng ba, Lha sa: Bod ljongs Bod yig dpe snying dpe skrun khang.

’Bri gung gso rig gces bsdus IDrigung Chödrak (’Bri gung Chos grags) et al. 1999, ’Bri gung gso rig gces bsdus, Pe cin: Mi rigs dpe skrun khang.

’Bri gung gso rig gces bsdus IIPöntsang Yeshé (Dpon tshang Ye shes) 2007, ’Bri gung gso rig gces bsdus, Dehradun, Uttarakhand: Srong btsan dpe mdzod khang, 2 vols.

’Bri gung gso rig gces bsdus IIIDrigung Chödrak (’Bri gung Chos grags) et al. 2008, ’Bri gung sman rtsis phyogs bsgrigs, Pe cin: Mi rigs dpe skrun khang.

Bse ru bzhi ba’i zhal gdamsNyamnyi Dorjé (Mnyam nyid rdo rje) 2005, ‘Bse ru bzhi ba’i zhal gdams’, in Mnyam nyid rdo rje, Man ngag bye ba ring bsrel pod chung rab byams gsal ba’i sgron me, Pe cin: Mi rigs dpe skrun khang, 265–6.

Bstan ’dzin phun tshogs Thob yigTendzin Püntsok (Bstan ’dzin phun tshogs) 2006, ‘Gso ba rig pa’i thob yig byin rlabs myu gu’, in Bstan ’dzin phun tshogs, De’u dmar gso rig gces btus, Pe cin: Mi rigs dpe skrun khang, 132–50.

Chos kyi grags pa rnam tharChökyi Drakpa (Chos kyi grags pa), ‘Rang gi tshul gyi rtogs pa brjod pa’i gtam rang bzhin brjod pa’i rgyan kho nas smras pa gsong po’i dga’ ston’, in ’Bri-gung-pa texts. Miscellaneous Writings by Eminent Master of the Drigung Kargyudpa Tradition. Reproduced from xylographic prints and manuscripts from the library of the Ven. Tokden Rompoche of Gangon. Leh: S. W. Tashigang, 1972, 2 vols, vol. 1, 1–304.

Dngos grub bang mdzodChökyi Drakpa (Chos kyi grags pa) 1999, ‘Sman bla longs spyod rdzogs sku’i gtso ’khor lnga’i sgrub thabs dngos grub bang mdzod’, in ’Bri gung Chos grags et al., ’Bri gung gso rig gces bsdus, Pe cin: Mi rigs dpe skrun khang, 103–16.

Dngos grub bang mdzod kha ’phangsLodrö Tayé (Blo gros mtha’ yas) 2007, ‘Sman bla longs sku gtso ’khor lnga’i sgrub thabs dngos grub kyi bang mdzod kha ’phangs zur mkhar ba mnyam nyid rdo rje nas brgyud pa’o,’,in Ston pa Shakya thub pa et al., Bdud rtsi sman gyi mdo chog, Pe cin: Mi rigs dpe skrun khang, 224–38.

Dug nad zin tigTendzin Püntsok (Bstan ’dzin phun tshogs) 2006, ‘Dug nad gso ba’i zin tig snying por dril ba’, in Bstan ’dzin phun tshogs, De’u dmar gso rig gces btus, Pe cin: Mi rigs dpe skrun khang, 473–81.

Asian Med (Lieden). Author manuscript; available in PMC 2016 December 13.

Europe PMC Funders Author Manuscripts Europe PMC Funders Author Manuscripts

Czaja

Page 32

Dug srung rim paTendzin Püntsok (Bstan ’dzin phun tshogs) 2006, ‘Dug srung gi rim pa yang zab rdo rje’i srog rdzong’, in Bstan ’dzin phun tshogs, De’u dmar gso rig gces btus, Pe cin: Mi rigs dpe skrun khang, 466–81.

Gces bsdus ’chi med nor phrengKarma Ngedön Tendzin Trinlé Rapgyé (Karma nges don
bstan ’dzin ’phrin las rab rgyas) 1973, ‘Gso rig yan lag brgyad ldan chu gter las gces bsdus ’chi med nor bu’i phreng ba’, in Ṅag-dbaṅ-dpal-bzaṅ-po, Man ṅag lhan thabs kyi lde mig, Leh: S. W. Tashigangpa, 305–539.

Gling sman Dka’ ’grelLingmen Trashibum (Gling sman Bkra shis ’bum) 2004, ‘Gso ba rig pa’i bstan bcos chen po dpal ldan rgyud bzhi’i dka’ ’grel mkhas pa’i zhal lung’, in Dam chos zla ba (ed.), Gso rig, Zi ling: Mtsho sngon mi rigs dpe skrun khang, 125–709.

Gsal ba’i me longKhyenrap Norbu (Mkhyen rab nor bu) 2007, ‘Rin chen ril bu’i phan yon dang bsten thabs gsal ba’i me long,’ in Mkhyen rab nor bu et al., Mkhyen rab nor bu’i sman yig gces btus. Mā yang sman yig gces btus, Pe cin: Mi rigs dpe skrun khang, 198–209.

Gso byed Mdzes mtshar mig rgyanYeshé Döndrup Tenpé Gyemtsen (Ye shes don grub bstan pa’i rgyal mtshan) 1971, ‘Gso byed bdud rtsi’i ’khrul med dngos ’dzin bzo rig me long rnam par shar pa mdzes mtshar mig rgyan’, in Jampel Dorjé (’Jam dpal rdo rje) 1971, An Illustrated Tibeto- Mongolian materia medica of Ayurveda of ‘Jam-dpal-rdo-rje of Mongolia, ed. by Lokesh Chandra from the collection of Z. D. Gomboev with a forew. by E. Gene Smith, New Delhi: Internat. Acad. of Indian Culture, 1–347.

Karma ratna’i sman yig gces btusKarma Ngedön Tendzin Trinlé Rapgyé (Karma nges don
bstan ’dzin ’phrin las rab rgyas) 2008, Karma ratna’i sman yig gces btus, Pe cin: Mi rigs dpe skrun khang.

Lung rigs bstan dar Brda bkrolBönjong Böluk Sorik Zhinjukkhang (Bod ljongs bod lugs gso rig
zhib ’jug khang) (ed.) 2008, Man ngag lhan thabs kyi brda bkrol rnam rgyal gser mdog gi phreng ba, Lha sa: Bod ljongs mi dmangs dpe skrun khang.

Man ngag snying gi nor buKarma Ngedön Tendzin Trinlé Rapgyé (Karma nges don bstan ’dzin ’phrin las rab rgyas) 2008, ‘Gces bsdus ’chi med nor phreng las man ngag snying gi nor bu’, in Karma nges don bstan ’dzin ’phrin las rab rgyas, Karma ratna’i sman yig gces btus, Pe cin: Mi rigs dpe skrun khang, 83–147.

Mkhyen brtse’i dbang po Gtong tshulKhyentsé Wangpo (Mkhyen brtse’i dbang po) 2008, ‘Rin chen ril bu gtong tshul’, in Mkhyen brtse’i dbang po and Stag bla nor bu, Mkhyen brtse’i dbang po’i sman yig. Stag bla nor bu’i sman yig, Pe cin: Mi rigs dpe skrun khang, 120–3.

Mkhyen brtse’i dbang po’i sman yig IKhyentsé Wangpo (Mkhyen brtse’i dbang po) 2003, ‘Mkhyen brtse’i dbang po’i sman yig’, in ’Jam dbyangs mkhyen brtse and Byang chub rdo rje, Mkhyen brtse’i dbang po’i sman yig dang bla ma zab don snying thig las ’gro ba’i srog ‘dzin bdud rtsi’i char rgyun, Khreng tu’u: Si khron mi rigs dpe skrun khang, 1–254.

Mkhyen brtse’i dbang po’i sman yig IIKhyentsé Wangpo (Mkhyen brtse’i dbang po) 2008, ‘Mkhyen brtse’i dbang po’i sman yig’, in Mkhyen brtse’i dbang po and Stag bla nor bu, Mkhyen brtse’i dbang po’i sman yig. Stag bla nor bu’i sman yig, Pe cin: Mi rigs dpe skrun khang, 3–245.

Mkhyen rab nor bu’i sman yigKhyenrap Norbu (Mkhyen rab nor bu) 2007, ‘Mkhyen rab nor bu’i sman yig gces btus’, in Mkhyen rab nor bu et al., Mkhyen rab nor bu’i sman yig gces btus. Mā yang sman yig gces btus, Pe cin: Mi rigs dpe skrun khang, 3–220.

Nges zab snying thigTendzin Püntsok (Bstan ’dzin phun tshogs) 2006, ‘Rin chen ril bu gtong thabs lag len nges zab snying thig’, in Bstan ’dzin phun tshogs, De’u dmar gso rig gces btus, Pe cin: Mi rigs dpe skrun khang, 853–8.

Phan bde’i sgo ’byed lde migKarma Ngedön Tendzin Trinlé Rapgyé (Karma nges don
bstan ’dzin ’phrin las rab rgyas) 2008, ‘’Dod ’byung man ngag yon tan nor bu’i bang mdzod gsal byed phan bde’i sgo ’byed lde mig’, in Karma nges don bstan ’dzin ’phrin las rab rgyas, Karma ratna’i sman yig gces btus, Pe cin: Mi rigs dpe skrun khang, 177–398.

Phud mchod nyung nguKhyenrap Norbu (Mkhyen rab nor bu) 2008, ‘Sman gyi byin rlabs phud mchod nyung ngu’, in Mkhyen rab nor bu et al., Mkhyen rab nor bu’i sman yig gces btus. Mā yang sman yig gces btus, Pe cin: Mi rigs dpe skrun khang, 210–14.

Pu ri skra bcing sngags chogTendzin Püntsok (Bstan ’dzin phun tshogs) 2006, ‘Pu ri skra bcing gi sngags chog dug ’joms spyi’i rgyal po zhes bya ba ltas chog tu bkod pa’, in Bstan ’dzin phun tshogs, De’u dmar gso rig gces btus, Pe cin: Mi rigs dpe skrun khang, 485–98.

Asian Med (Lieden). Author manuscript; available in PMC 2016 December 13.

Europe PMC Funders Author Manuscripts Europe PMC Funders Author Manuscripts

Czaja

Page 33

Rgyud bzhiYutok Yönten Gönpo (G.yu thog Yon tan mgon po) 2002, Bdud rtsi snying po yan lag brgyad pa gsang ba man ngag gi rgyud, Lha sa: Bod ljongs mi dmangs dpe skrun khang, 4th edition.

Shel gong shel phrengTendzin Püntsok (Bstan ’dzin phun tshogs) 2005, Bdud rtsi sman gyi rnam dbye nus ming rgyas par bshad pa shel gong shel phreng, Pe cin: Mi rigs dpe skrun khang.

Shel phreng Mdzes mtshar mig rgyan IYeshé Döndrup Tenpé Gyemtsen (Ye shes don grub bstan pa’i rgyal mtshan) 1971, ‘Dri med shel phreng nas bshad pa’i sman gyi ’khrungs dpe mdzes mtshar mig rgyan’, in Jampel Dorjé (’Jam dpal rdo rje) 1971, An Illustrated Tibeto-Mongolian materia medica of Ayurveda of ‘Jam-dpal-rdo-rje of Mongolia, ed. by Lokesh Chandra from the collection of Z. D. Gomboev with a forew. by E. Gene Smith, New Delhi: Internat. Acad. of Indian Culture, 1–24.

Shel phreng Mdzes mtshar mig rgyan IIYeshé Döndrup Tenpé Gyemtsen (Ye shes don grub bstan pa’i rgyal mtshan), Dri med shel phreng nas bshad pa’i sman gyi ’khrungs dpe mdzes mtshar mig rgyan, Bsod nams kun sdud gling gi par khang: Bsod nams kun sdud gling, Tibetan block print, 34 fols.

Shel phreng Mdzes mtshar mig rgyan IIIYeshé Döndrup Tenpé Gyemtsen (Ye shes don grub bstan pa’i rgyal mtshan), Dri med shel phreng nas bshad pa’i sman gyi ’khrungs dpe mdzes mtshar mig rgyan, n.p.: n.n. Tibetan block print, 30 fols. Bayerische Staatsbibliothek München, BSB-Hss Cod.tibet. 807 http://daten.digitale-sammlungen.de/~db/0005/bsb00058610/images/.

Sman nag sbyor baDrangti Penden Gyeltsen (Brang ti Dpal ldan rgyal mtshan), ‘O rgyan pa’i dngul chu’i sman nag sbyor ba rin chen phreng ba’, in Bod rang skyong ljongs sman rtsis khang (ed.), Brang ti lha rje’i rim brgyud kyi man ngag gser bre chen mo, Lha sa: Bod ljongs mi dmangs dpe skrun khang, 2005, 143–57.

Them spang maChökyi Drakpa (Chos kyi grags pa) 2009, Dpal ldan rgyud bzhi’i bka’ mchan them spang ma, Dehradun, Uttarakhand: Srong btsan dpe mdzod khang.

Ye shes rgya mtsho Gtong tshulYeshé Gyatso (Ye shes rgya mtsho) 1981, ‘Rin chen ril bu gtong tshul’, in Ye shes rgya mtsho, Gsung ’bum, The Collected Works of Chu-bzang bla-ma Ye-shes rgya- mtsho, New Delhi: Ngawang Gelek Demo, 437–41.

Zur mkhar khyad chosChökyi Drakpa (Chos kyi grags pa) 1999, ‘Rin chen ril bu gtong tshul gyi zin bris zur mkhar ba’i khyad chos’, in ’Bri gung Chos grags et al., ’Bri gung gso rig gces bsdus, Pe cin: Mi rigs dpe skrun khang, 117–20.

Secondary Sources

Aschoff, JC.; Tashigang, Tashi Y. Tibetan ‘Precious Pills’ The Rinchen Medicine A Tantric Healing System with Great Benefits, Some Problems, Many Secrets. Ulm: Fabri; 2001.

Aschoff, JC.; Tashigang, Tashi Y. Tibetan Jewel Pills. The Rinchen Medicine A Tantric Healing System with Great Benefits, Some Problems, Many Secrets. 2nd rev. and enl. edition. Ulm: Fabri– Verlag; 2004.

Aschoff, JC.; Tashigang, TY. Tibetan Jewel Pills With Some Remarks on Consecration (Byin rlabs) of the Medicine. Ulm: Fabri–Verlag; 2009. 3rd rev. edition

Berling, N. Heilpflanzen in der Tibetischen Medizin 61 ausgewählte Pflanzenmono-graphien. Essen: KVC-Verlag; 2008.

Blaikie C. Currents of Tradition in Sowa Rigpa Pharmacy. East Asian Science, Technology and Society An International Journal. 2013; 7(3):426–51.

Blaikie C. Wish–fulfilling Jewel Pills: Tibetan Medicines from Exclusivity to Ubiquity. Anthropology and Medicine. 2015; 22(1):7–22. [PubMed: 25633307]

Blaikie C, Craig S, Gerke B, Hofer Th. Co-Producing Efficacious Medicines: Collaborative Event Ethnography with Himalayan and Tibetan Sowa Rigpa Practitioners. Current Anthropology. 2015; 56(2):178–205.

Bönjong, Mentsikhang Sorik Zhinjukkhang, editor. Krung hva sngo ’bum bod lugs sman rdzas bod yig par ma. Xining: Krung go’i bod rig pa dpe skrun khang; 2007. (Bod ljongs sman rtsis khang gso rig zhib’jug khang)

Asian Med (Lieden). Author manuscript; available in PMC 2016 December 13.

Europe PMC Funders Author Manuscripts Europe PMC Funders Author Manuscripts

Czaja

Page 34

Börang, Kyongjong Sarjé Uyön Lhenkhanggi Trötenü. Bod ljongs rgyun spyod krung dbyi’i sman rigs. Lha sa: Bod ljongs mi dmangs dpe skrun khang; 1973. (Bod rang skyong ljongs gsar brje u yon lhan khang gi ’phrod bsten cus)

Bradley, TS. Principles of Tibetan Medicine. (rev. edition of 2000). London: Jessica Kingsley Publishers; 2013. Revised

Chen, Jiahui (陈家辉).; Yang, Yong (杨勇). Qiangtang caoyuan zhiwu shibie shouce 羌塘草原植物识别手册 (A field guide for the plants of the grassland in Northern Plateau (Byang thang)). Kunming: Yunnan keji chubanshe; 2010.

Clark, B. The Quintessence Tantras of Tibetan Medicine. Ithaca NY: Snow Lion Publications; 1995.

Craig S. “Good” Manufacturing by Whose Standards? Remaking Concepts of Quality, Safety, and Value in the Production of Tibetan Medicines. Anthropological Quarterly. 2011a; 84(2):331–78.

Craig, S. From Empowerments to Power Calculations: Notes on Efficacy, Value and Method. Medicine between Science and Religion Explorations on Tibetan Grounds. Adams, V.; Schrempf, M.; Craig, S., editors. New York: Berghahn; 2011b. p. 215-44.

Craig, S. Healing Elements Efficacy and the Social Ecologies of Tibetan Medicine. Berkeley: University of California Press; 2012.

Craig S, Adams V. Global Pharma in the Land of Snows: Tibetan Medicines, SARS, and Identity Politics across Nations. Asian Medicine. 2008; 4(1):1–28.

Czaja, O. The Making of the Blue Beryl. Some Remarks on the Textual Sources of the Famous Commentary of Sangye Gyatsho (1653–1705). Soundings in Tibetan Medicine Anthropological and Historical Perspectives. Schrempf, M., editor. Leiden: Brill; 2007. p. 345-71.

Czaja O. On the History of Refining Mercury in Tibetan Medicine. Asian Medicine. 2013; 8(1):75– 105.

Czaja O. Substitution of Materia Medica in Tibetan Medicine. forthcoming.

Das, SCh. A Tibetan-English Dictionary with Sanskrit Synonyms. Calcutta: Bengal Secretariat Book Depôt; 1902.

Dawa (Zla ba). Bod kyi gso ba rig pa’i sman rdzas dpe ris gsal ba’i me long blo gsar dgyes pa’i nyin byed. Vol. 1. Dharamsala: Bod gzhung dbus sman rtsis khang; 1993.

Dawa. A Clear Mirror of Tibetan Medicinal Plants. Rome; Tibet Domani: 1999.

Dawa (Zla ba). Bod kyi gso ba rig pa’i sman rdzas dpe ris gsal ba’i me long blo gsar dgyes pa’i nyin byed. Vol. 2. Dharamsala: Bod gzhung dbus sman rtsis khang; 2005.

Denma, Jamyang Tsültrim. Khams stod lo rgyus thor bsdus. Vol. 2. Lan kru’u: Kan su’u mi rigs dpe skrun khang; 1995–7. (Ldan ma ’Jam dbyangs tshul khrims)

Döndor (Don rdor); Chödrak, Tendzin, editors. Gangs ljongs lo rgyus thog gi grags can mi sna. Lha sa: Bod ljongs mi dmangs dpe skrun khang; 1993. (Bstan ‘dzin chos grags)

Drakpa, Jungné; Lozang, Khedrup (Blo bzang mkhas grub), editors. Gangs can mkhas grub rim byon ming mdzod. Lan kru’u: Kan su’u mi rigs dpe skrun khang; 1992. (Grags pa ‘byung gnas)

Ehrhard, F-K. A Short History of the g.Yu thog snying thig. Indica et Tibetica Festschrift für Michael Hahn zum 65 Geburtstag von Freunden und Schülern überreicht. Klaus, K.; Hartmann, J-U., editors. Wien: Arbeitskreis für Tibetische und Buddhistische Studien; 2007. p. 151-70.

Fjeld H, Hofer Th. Women and Gender in Tibetan Medicine. Asian Medicine Tradition and Modernity. 2010–2011; 6(2) (special issue).

Gardner, A. [last accessed 1 April 2016] Jamyang Khyentse Wangpo’ Treasury of Lives. 1866. URL: <http://www.treasuryoflives.org/biographies/view/Jamyang-Khyentse-Wangpo/4291>, [sic]

Garrett F. The Alchemy of Accomplishing Medicine (sman sgrub): Situating the Yuthok Heart Essence (G.yu thog snying thig) in Literature and History. Journal of Indian Philosophy. 2009; 37(3):207– 30.

Gawé, Dorjé. Khrungs dpe dri med shel gyi me long. Pe cin: Mi rigs dpe skrun khang; 1995. (Dga’ ba’i rdo rje)

Gerke, B. Long Lives and Untimely Deaths Life-span Concepts and Longevity Practices among Tibetans in the Darjeeling Hills, India. Leiden: Brill; 2012.

Asian Med (Lieden). Author manuscript; available in PMC 2016 December 13.

Europe PMC Funders Author Manuscripts Europe PMC Funders Author Manuscripts

Czaja

Page 35

Gerke, B. The Social Life of Tsotel: Processing Mercury in Contemporary Tibetan Medicine. Mercury in Ayurveda and Tibetan Medicine. Gerke, B., editor. Vol. 8. 2013. p. 120-52.special issue, Asian Medicine

Gerke B. Moving from Efficacy to Safety: A Changing Focus in the Study of Asian Medical Systems. Journal of the Anthropological Society of Oxford (JASO), special issue on Medical Anthropology at Oxford: The First Decade and Beyond. 2015; 7(3):370–84.

Goldstein, MC. The New Tibetan-English Dictionary of Modern Tibetan. Berkeley: University of California Press; 2001.

Gruschke, A. The Cultural Monuments of Tibet’s Outer Provinces Kham vol 2 The Qinghai part of Kham. Bangkok: White Lotus Press; 2004.

Gurmet, Namgyal; Phuntsog, ST. Gso rig sman sbyor phyogs bsgrigs phan bde bsil zer Amchi pharmaco-therapeutics. New Delhi: Central Council for Research in Ayurveda and Siddha, Ministry of Health and Family Welfare, (Govt. of India); 1990.

Heissig, W. Catalogue of Mongol Books, Manuscripts and Xylographs. Copenhagen: The Royal Library; 1971.

Heissig, W. Geser-Studien Untersuchungen zu den Erzählstoffen in den ‘Neuen’ Kapiteln des Mongolischen Geser-Zyklus. Wiesbaden: VS Verlag für Sozialwissenschaften; 1983.

Hofer, Th. Socio-Economic Dimensions of Tibetan Medicine in the Tibet Autonomous Region, China Part One. Asian Medicine. 2008; 4(1):174–200.

Institute of Traditional Medicine Services, Health Dept., Ministry of Health & Education. , editor. Sman ljongs rab mdzes sngo ldum sman gyi ’khrungs dpe baidurya’i phreng ba. Medicinal Flora of Bhutan. Thimphu: Institute of Traditional Medicine Services, Health Dept., Ministry of Health & Education; 1999.

Jampa, Trinlé. Gangs ljongs gso rig bstan pa’i nyin byed rim byon gyi rnam thar phyogs bsgrigs. Pe cin: Mi rigs dpe skrun khang; 2000. (Byams pa phrin las)

Karma, Chömpel. Bdud rtsi sman gyi ’khrungs dpe legs bshad nor bu’i phreng mdzes. Lha sa: Bod ljongs mi rigs dpe skrun khang; 1993. (Karma chos ’phel)

Kenden, Nyima. Bod gangs can gyi gso ba rig pa’i lugs kyi rin po che dang sa rdo’i sman gyi ngos ’dzin gsal ston me long. Pe cin: Mi rigs dpe skrun khang; 2010. (Skal ldan nyi ma)

Kletter, C.; Kriechbaum, M., editors. Tibetan Medicinal Plants. Stuttgart: Medpharm Scientific Publications; 2001.

Kloos, S. Tibetan Medicine in Exile: The Ethics, Politics and Science of Cultural Survival. PhD thesis submitted at the Graduate Division of the University of California; San Francisco and University of California, Berkeley: 2010.

Kloos S. Die Alchemie Exil-tibetischer Identität. Anmerkungen zur Pharmazeutischen und Politischen Wirksamkeit Tibetischer Pillen (Processing Exile-Tibetan Identity: The Alchemy of Tibetan Medicine’s Pharmaceutical and Political Efficacy). Curare. 2012; 35:197–207.

Le, ’dod mos; Li, duo mei 李多美. Bod kyi gso rig tshig mdzod rab gsal me long 简明藏医词典. Pe cin: Mi rigs dpe skrun khang; 2009.

Lichter, D.; Epstein, L. Irony in Tibetan Notions of the Good Life. Karma An Anthropological Inquiry. Keyes, CF.; Daniel, VE., editors. Berkeley: University of California Press; 1983. p. 223-60.

Liu, Guo-wei 劉國威. 青海省玉樹藏族自治州的噶舉派發展特色. (Characteristics of Kagyu Monasteries in Yushu Tibetan Autonomous Prefecture of Qinghai Province). 蒙藏季刊 Mengzang jikan [Mongolian and Tibetan Quarterly]. 2014; 23/3:88–123.

Lobsang, Dolma Khangkar. Journey into the Mystery of Tibetan Medicine. New Delhi: Yarlung Publications; 1990.

Lobsang, Dolma Khangkar. Lectures on Tibetan Medicine. 3rd rev. edition. Dharamsala: Library of Tibetan Works & Archives; 1998.

Luo, Dashang (罗达尚). Zhonghua zang bencao 中华藏本草 (Materia Medica of China’s Tibetan Medicine). Beijing: Minzu chubanshe; 1997.

Mills, MA. Living in Time’s Shadow: Pollution, Purification and Fractured Temporalities in Buddhist Ladakh. The Quality of Time Anthropological Approaches. James, W.; Mills, D., editors. Oxford: Berg; 2005. p. 349-66.

Asian Med (Lieden). Author manuscript; available in PMC 2016 December 13.

Europe PMC Funders Author Manuscripts Europe PMC Funders Author Manuscripts

Czaja

Page 36

Mythrey RC, Ramachandra Nisargi, Shreevathsa. Water: The Elixir of Life. International Journal of Research in Ayurveda and Pharmacy. 2012; 3(5):769–71.

Parfionovitch, Y.; Meyer, F.; Dorje, Gyurme, editors. Tibetan Medical Paintings: Illustrations to the Blue Beryl Treatise of Sangye Gyamtso (1653–1705). London: Serindia Publications; 1992.

Pasang, Yonten Arya. Dictionary of Tibetan Materia Medica. Delhi: Motilal Banarsidass Publ; 1998.

Perdue, PC. China Marches West The Qing Conquest of Central Eurasia. Cambridge, Mass.: Belknap Press of Harvard Univ. Press; 2005.

Prost, A. Precious Pills Medicine and Social Change among Tibetan Refugees in India. New York: Berghahn Books; 2008.

Qinghaisheng yaopin jianyan suo 青海省药品检验所 (Qinghai Institute for Drug Control). Zhongguo zang yao 中囯藏药 (Chinas Tibetan Medicine). Shanghai: Shanghai ke xue ji shu chu ban she; 1996.

Ryavec, KE. A Historical Atlas of Tibet. Chicago, Ill: University of Chicago Press; 2015.

Sa, mtsho skyid; Roche, G. Purity and Fortune in Phug sde Village Rituals. Asian Highlands Perspectives. 2011; 10:231–84.

Sabernig K. The Substitution of Rare Ingredients in Traditional Tibetan Medicine on the Basis of Classical Tibetan Texts, their Use in Modern Formularies, and a Case Study from Amdo/Qinghai. Curare. 2011; 34(1+2):83–96.

Sachs, R. Tibetan Ayurveda. Health Secrets from the Roof of the World. Rochester, Vt.: Healing Arts Press; 2001.

Saxer, M. Manufacturing Tibetan Medicine. The Creation of an Industry and the Moral Economy of Tibetanness. Oxford, New York: Berghahn Books; 2013.

Schicklgruber, C. Grib: On the Significance of the Term in a Socio-religious Context. Tibetan Studies, Proceedings of the 5th Seminar of the International Association of Tibetan Studies. Vol. 2. Narita 1989: 1992. p. 723-34.

Schuh D. Die sa-bdag (Erdherrengeister) und die Schwierigkeiten der Interpretation illuminierter Manuskripte. Zentralasiatische Studien. 2011; 40:7–163.

Schuh, D. [last accessed 27 October 2015] Erdherrengeister (sa-bdag). 2012a. URL: <http://www.tibet- encyclopaedia.de/erdherren-sa-bdag.html>

Schuh, D. Contributions to the History of Tibetan Mathematics, Tibetan Astronomy, Tibetan Time Calculation (Calendar) and Sino–Tibetan Divination. Vol. 4. Andiast: International Institute of Tibetan and Buddhist Studies; 2012b.

Schwieger, P. The Dalai Lama and the Emperor of China A Political History of the Tibetan Institution of Reincarnation. New York: Columbia University Press; 2015.

Srikantha Murthy, KR. Vāgbhaṭa’s Aṣṭāñgahṛdayam (Text, English Translation, Notes, Appendix and Indices). Vol. 3. Varanasi: Krishnadas Academy; 2004–5 [1992–7]. Reprint of 1992–7

Tenzin, Dakpa. Tibetan Medicinal Plants, An Illustrated Guide to Identification and Practical Use. New Delhi: Paljor Publications; 2007.

Thinley, Gyatso; Hakim, C. Essentials of Tibetan Traditional Medicine. Berkeley, Calif.: North Atlantic Books; 2010.

Tian, Shuqin (田淑琴). Changyong zangyao zhi 常用藏药志 (Manual of Common Tibetan Materia Medica). Chengdu: Sichuan kexue jizhu chubanshe; 1997.

Tsering, Dorjee Dekhang. A Handbook of Tibetan Medicinal Plants. 3rd edition. Dharamsala: Tibetan Medical & Astrological Institute; 2008.

Tsewang, Khangkar Dolkar. Tibetan Medicine The Buddhist Way of Healing. New Delhi: Lustre Press; 1998.

Tsarong, Tsewang J. Tibetan Medicinal Plants. Kalimpong: Tibetan Medical Publications; 1994.

Turek MM. Monastic Obligations, Hat Change and Lhasa Encroachment: Notes on the Economic System in the Historical Kingdom of Nang chen. (forthcoming).

Vogel, C. Vāgbhaṭa’s Aṣṭāṅgahṛdayasamhitā. The First Five Chapters of its Tibetan Version. Mainz: Dt. Morgenländ. Gesellschaft; 1965. Wiesbaden: F. Steiner in Komm

Asian Med (Lieden). Author manuscript; available in PMC 2016 December 13.

Europe PMC Funders Author Manuscripts Europe PMC Funders Author Manuscripts

Czaja

Page 37

Xizang, deng weishengju; 西藏等卫生局 (Health Offices of Tibetan Autonomous Region, Qinghai, Sichuan, Gansu, Yunnan and Xinjiang). , editor. Zangyao biaozhun 藏药标准 (Standard of Tibetan Drugs). Xining: Qinghai renmin chubanshe; 1979.

Jingsheng Yang, Jiangcuo Chucheng 杨竞生, 初称江措. , editor. Diqing zangyao 迪庆藏药 (Tibetan Materia Medica of Diqing / Bde chen). Vol. 2. Kunming: Yunnan minzu chubanshe; 1987.

Yoeli-Tlalim, R. Tibetan Medical Astrology. Astro-Medicine Astrology and Medicine, East and West. Akasoy, A.; Burnett, Ch; Yoeli-Tlalim, R., editors. Florence: Sismel; 2008. p. 223-36.

Zhongguo kexue yuan xibei gaoyuan shengwu yanjiusuo 中国科学院西北高原生物研究所 (Northwest Institute of Plateau Biology, Chinese Academy of Sciences). , editor. Zangyao zhi 藏药志 (Manual of Tibetan Materia Medica). Xining: Qinghai ren min chu ban she; 1991.

Asian Med (Lieden). Author manuscript; available in PMC 2016 December 13.

Europe PMC Funders Author Manuscripts Europe PMC Funders Author Manuscripts

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