Medical System

15 Pages·2013·0.12 MB·English

EastAsianScience,TechnologyandSociety:AnInternationalJournal(2013)7:381–395
DOI10.1215/18752160-2333653
How Tibetan Medicine in Exile Became a “Medical System”
StephanKloos
Received:26September2011/Accepted:29November2012
qNationalScienceCouncil,Taiwan2013
Abstract TibetanmedicineorSowaRigpawaslargelyignoredinclassicpublications
on“Asianmedicalsystems.”Thisarticlecontendsthatoneimportantreasonforthis
oversight was that Tibetan medicine had not yet managed to establish itself as a
recognizablemedicalsystematthattime.Thishaschangedonlyrecentlywithongoing
politicalandeconomicprocessesthroughwhichTibetanmedicineinexilehasbeen
transformed,sincethe1990s,fromaregionalhealthtraditionintoagloballyrecog-
nizableandclearlydefinedanddelimitedmedicalsystem.Aftersomereflectiononthe
notionofmedicalsystems,thisarticlefocusesontheeventsandintereststhatledtothe
establishmentoftheCentralCouncilofTibetanMedicineinearly2004,whichcanbe
regarded astheofficialestablishmentofSowa Rigpa asamedical system.Thedis-
cussionthenmovesontotheconsequencesofthisdevelopmentforTibetanmedicine
in exile at large, and for its most powerful institution, the Men-Tsee-Khang, in
particular. The outcome of wider exile Tibetan political aspirations, Sowa Rigpa’s
“embodiment”asamedicalsystemalsohasdirectmedicalandpharmaceuticaldimen-
sions,manifestingmostimportantlyineffortstoregulateandstandardizeitssyllabi,
clinicalpractice,andpharmaceuticalproduction.Thearticlegivesin-depthinsights
intosomeofthemostimportantrecentdevelopmentsinTibetanmedicineinexile,its
economicandpoliticalorganization,andtheroleofitsmaininstitutions.
Keywords Tibetanmedicine(cid:1)SowaRigpa(cid:1)Tibetanexile(cid:1)Asianmedicalsystems
Acknowledgments Theresearchandwritingofthisarticlewasfunded,atdifferentstages,byaWenner
Grendissertationfieldworkgrant,theAustrianScienceFund(FWFprojectP20589-G15),andaMarieCurie
InternationalIncomingFellowship(PIIF-GA-2010-275832).IamgratefultotheBody,HealthandReligion
ResearchGroup(BAHAR)forenablingmetoparticipateonitsinternationalworkshoponTibetanmedicine
inCardiff.SpecialthanksareduetoGeoffreySamuel,ElisabethHsu,MonaSchrempf,BarbaraGerke,Colin
Millard, and the other workshop participants, as well as Me´lanie Vandenhelsken and two anonymous
reviewers,fortheirinsightfulcommentsandsuggestions.Finally,IamindebtedtotheCCTM,itsexecutive
members,andstafffortheircollaborationandsupportovertheyears,withoutwhichthisresearchwouldnot
havebeenpossible.
S.Kloos(*)
Institute for Social Anthropology, Austrian Academy of Sciences, Apostelgasse 23, A-1030, Vienna,
Austria
e-mail:[email protected]
382 S.Kloos
ThepublicationofAsianMedicalSystems(Leslie1976)wassomethingofafounding
event for the anthropology of Asian medicines. Identifying Ayurveda, Unani, and
Chinese medicine as intellectually coherent, rational, and professionally organized
“systemsofmedicine,”CharlesLeslieandhiscolleaguesshapedthethennascentfield
ofmedical anthropologyfor decadesto come.In their work, they defined “medical
systems”ascharacterizedbyahighdegreeofcomplexityandprofessionalization,a
longhistoryofsystematicempiricismandtheorization,internalcoherencemanifested
incoreclassicaltexts,andadistinctidentityresultingfromclearexternalboundaries
vis-a`-vis other medical systems. While not denying the existence of syncretism,
internal heterogeneity, or exchange between plural medical systems, Leslie’s focus
onsystems ofmedicinesoonforegroundedthese phenomena asmedicalanthropol-
ogy’scoreproblems,whichcanbetracedthroughmuchofmedicalanthropological
literatureduringthe1980sand1990s.
Besides this immediate impact on the discipline,the work of Leslie and his col-
leaguesalsohadlargertheoreticalandpoliticalconsequencesforthestudyofmedical
traditions around the world. Rather than collecting bits of apparently incoherent or
irrationallocalbeliefsandknowledgeforthepotentialuseofpublichealthspecialists
eagertoovercome“culturalobstacles”tomoderndevelopment(seeLeslieandYoung
1992:7),ashadbeenthepervasiveapproach,medicalanthropologistsbegantofollow
LeslieinrecognizingAsianmedicinesascivilizationalprocessesandepistemicsys-
temsthatneededtobeplacedinthecontextofhistoryandpolitics.Inshort,Leslie
articulated an analytic framework that saw Asia’s “great medical traditions” (see
Redfield1956)asimportantmarkersof“civilization,”thatis,asmanifestationsofa
people’santiquity,scientificgenius,andculturalindependence.1
InallthesestudiesofAsia’sgreatmedicaltraditions,however,Tibetanmedicine
wasconspicuousbyitsabsence.NeitherAsianMedicalSystemsnorits1992sequel,
PathstoAsianMedicalKnowledge(LeslieandYoung1992),andlatervolumesonthe
topic (e.g., Bates 1995) so much as mentioned it in passing,2 let alone devoted a
chapteroranentiresectiontoit(seePordie´2008b:3).ItisnotthatTibetanmedicine
does not meet Leslie’s criteria for “medical systems” outlined above, as a growing
numberofrecentscholarlyandlaypublicationsdocument(e.g.,Meyer1981;Donden
1986;Janes1995;Adams2002;Schrempf2007;Pordie´ 2008a;Adamsetal.2011).
Tibetan medicine notonly possesses morethan fourteen hundred years ofrecorded
history and a classical textual core (the rgyud bzhi) displaying a high degree of
complexity and intellectual coherence, but it also has clear external boundaries
distinguishing it from Ayurveda, Unani, or Chinese medicine, not to mention a
well-established institutional apparatus in contemporary Tibet and the Tibetan
exile.Sowhatarethereasonsforthis—inretrospectquitemonumental—oversight?
One important reason is to be found in Asia’s colonial history: while Western
scholarlyattentionhaslongfocusedonIndiaandChinainconnectionwithEuropean
(and later also American) political and economic interests there, Tibet remained
1 ThisframeworkreflectsthediscoursesofnationalistmovementsinIndia,China,andelsewheresincethe
nineteenthcentury,whichusedmedicaltraditionsasameanstolegitimatetheirpoliticalclaimsforinde-
pendence(seePrakash1999;Chatterjee1993;Langford2002;Kloos2010).
2 TheonlyindirectreferencetoTibetinLeslie1976occursonpage3,intheintroductiontoAsianmedical
systems,whereLesliementionsAyurveda’s“markedinfluenceinTibet”andotherareas.
HowTibetanMedicineinExileBecamea“MedicalSystem” 383
largely inaccessible—a situation that was only reinforced with China’s annexation
and subsequent isolation of Tibet in the 1950s. Thus, when Tibetan medicine first
begantoattractseriousscholarlyinterestintheWestinthelate1960sand1970s—at
thattimelimitedtoafewhistoricalandtextualstudies(e.g.,Rechung1973;Finckh
1975; Dash 1976; Norbu 1976; Donden and Kelsang 1977; Meyer 1977; Beckwith
1979)—it was from the Tibetan exiles in India and Nepal. In the Indian town of
Dharamsala, the Central Tibetan Administration (CTA) had founded, upon the
Dalai Lama’s advice, a small Tibetan medical center in 1961, which in 1967 was
officiallynamed“DrophenMen-Tsee-Khang”(’grophansmanrtsiskhang:institute
formedicineandastrologyforthebenefitofallbeings).Whiletheexplicitpurposeof
thiscenterwas,fromthebeginning,to“preserveTibetanculture,”itsdailyworkcon-
sistedincompoundingmedicines,treatingpatients,andtrainingstudentsinTibetan
medicine andastrology.Lacking everythingfromhumanandfinancial resourcesto
specializedmedicaltextsandeventhelanguageskillsnecessarytooperateinIndia,it
tooktheMen-Tsee-Khanguntiltheearly1980stogainsomesortofstability,anduntil
the mid-1990s to achieve its present status as the most prestigious, profitable, and
successfulsecularinstitutionintheTibetanexile(Kloos2008).Foralongtime,the
Men-Tsee-Khang—whichpracticallywasTibetanmedicineinexileuntilthe1990s—
remained occupied with internal problems and was thus barely visible outside the
Tibetanexilecommunity.Similarly,theTibetanmedicalestablishmentinsideTibet,
whichstruggledwithproblemsofitsown(Janes1995),remainedclosedtotheinter-
nationalcommunityuntilthe1990s.Inshort,Tibetanmedicinehadnotmanagedto
attractthesamescholarlyattentionasotherAsianmedicinesbythetimeAsianMedi-
calSystemsandPathstoAsianMedicalKnowledgewerewritten.Atleastasfarasthe
academicrealmwasconcerned,Tibetanmedicinehadnotyetestablisheditselfasa
“medicalsystem”initsownright.
Ofcourse,givenmorerecentcritiquesof“medicalsystems”asananalyticconcept,
thequestionarises:whyshouldit?AsJeanLangford(2002)andJosephAlterpoint
out,“ThereareseriousproblemsinlookingattraditionslikeAyurveda—oranyother
formofmedicine—asanintrinsicallyunified,organicallycoherent‘system’ofknowl-
edge and practice” (Alter 2008: 1167). Volker Scheid (2002: 9) makes a similar
observationinthecontextofChinesemedicine,whileLawrenceCohen(1995:320)
arguesmoregenerallythat“theformalism,coherence,andsynchronicityofasystem
donotseemtomapwellontomedicalknowledgeandpracticeinsitu.”Tobefair,
muchofthiswascleartoLesliefromthebeginning,causinghimtodistinguishamong
classicaltextual,syncretic,contemporaryprofessional,andfolkvariantsofmedicine
inIndia(1976:358–61).Still,thenotionofthe“system”thatLesliehadintroduced
required,inCohen’swords,“isolat[ing]thatwhichappearsmoststructuredandcoher-
ent as the epistemology of the thing and trace it backwards and forwards to give
ourselves back time” (1995: 358). Indeed, we find a strong focus on epistemology
andknowledgeinmostmedicalanthropologicalworkonAsianmedicinesduringthe
1980s and 1990s (e.g., Leslie and Young 1992; Bates 1995). However, this Bour-
dieuianattempttocombinestructuralistandhistoricalanalysisrequiredarrestingthe
historicity of medical knowledge in a classical past, thus separating it analytically
fromitscontinuallychangingpracticeandpolitics.Theresultwas—againstLeslie’s
ownethnographicinsights—aproblematicdualismbetweenknowledgeandpractice,
384 S.Kloos
between an inner (coherent, stable, etc.) essence of a medical system and its outer
historicalmanifestations(seeLatour1999;Adams2005).
Yet,evenwhiletheconceptofmedicalsystemshasoutliveditsanalyticusefulness,
it continues to be seen as an effective political strategy. Thus, the essentializing
function of systematization, especially in the realm of “traditional medicine,” was
successfullydeployedbyAsiannationaliststryingtoreclaimtheir“culturalessence”
inordertoimagineandlegitimizetheirnation(Langford2002;Spivak1988).More
recently and under (geo)political circumstances vastly different from Asia’s anti-
colonial movements in the early twentieth century, the Tibetan exile community
has lookedtoIndian nationalism—as the closest exampleathand—forguidance in
their own nationalist struggle for a “Free Tibet.” Thus, from the 1990s onward, it
becamecleartoTibetanmedicinepractitioners(calledamchi)inexilethattheconcept
of“medicalsystems”waswellestablishedinIndia’shealthpolicies,whichofficially
recognize,promote, and subsidize“Indian systems ofmedicine” (ISM).In order to
receive government funds, political representation, and regular access to the tra-
ditional health market, therefore, Tibetan medicine needed to be recognized by the
government of India as a “medical system.” What is more, the notion of a medical
system was attractive to the exile Tibetans for the same reasons as it was for other
Asiannationalistsbeforethem:throughitsstrongconnectiontotherelatednotionof
“civilization,”itconnotesculturalgreatness,historicalantiquity,intellectualgenius,
andpoliticalself-determination.3
Itisinthispoliticalrationale(againstChina’sopposingclaims)ratherthaninmore
superficial—thoughalsoimportant—financialconsiderationsthattheexileTibetans’
realinterestinremakingTibetanmedicineintoa“medicalsystem”lies.Theethical
andpoliticalimperativeforTibetanmedicineinexileto“preserve”Tibetanculture
neatlycoincideswiththeideathathavingone’sownmedicalsystemsignifiesone’s
statusasa“culture,”asa“civilization,”andconsequentlyasanation.Indeed,forexile
Tibetans,therecognitionofTibetanmedicineasamedicalsystemdoublesasarec-
ognitionofTibetasanation.Basedontwentymonthsofmultisitedfieldworkinthe
SouthAsianTibetandiasporabetween2005and2012,thisarticleexploreshowand
whyTibetanmedicineinexilecametobeconceptualizedasa“medicalsystem”and
tracestheearlieststagesofthedevelopmentthatfinallyledtoitsofficialrecognitionby
thegovernmentofIndiaasan“Indiansystemofmedicine”in2010.Whiletheevents
moredirectlyconnectedtothiswatershedeventwillbethesubjectofanotherarticle,
the following pages provide a more general study of Tibetan medicine’s “embodi-
ment” as a medical system that in turn embodies the nation, and of the interplay
betweenpoliticsandmedicineintheTibetanexile.
3 RobertRedfield,fromwhosewritingsLeslieetal.borrow,usesthetermcivilizationasasynonymfor
“greattraditions,”inordertopointtothecomplexity,historicity,andlargerconnectionsbetweenwhatwas
previouslystudiedasboundedlocalculturesor“smalltraditions.”Inlightofitsmodernconnotationasthe
oppositeofbarbarism(theexistenceofoneassumingandnecessitatingtheother),itsuseasanideological
justificationofcolonialismandSamuelHuntington’s(1996)thesisofa“clashofcivilizations,”thetermis
deeplyproblematic(hencetheuseofquotationmarksinthisarticle).IntheexileTibetancase,however,both
meaningsoftheterm—assynonymouswithcultureandastheoppositeofbarbarism—convenientlycon-
vergeinthefightforculturalsurvival,politicalsovereignty,andresistancetocommonChineseclaimsthat
Tibetanswere“barbaric.”
HowTibetanMedicineinExileBecamea“MedicalSystem” 385
1 ABodyforTibetanMedicine
Nationalism’scentralthemeistobringintobeingaclearlydemarcated,unifiednation,
forwhichitrelied,inthe(post)colonialcontextsofAsia,oncultureandspiritualityas
itssovereigndomainthatborethecommunity’sessentialmarkersofdifferencevis-a`-
vis the colonial power (Nandy 1983; Norbu 1992; Chatterjee 1993; Prakash 1999).
Giventheirlonghistoriesas“nativesciences”andtheirundeniableeffectivenessin
clinicalpractice,suchmedicaltraditionsasAyurveda,Chinesemedicine,andTibetan
medicineemergedasidealmanifestationsofanotherwiseintangiblecultureor“civi-
lization.” But in order to do so, they needed a “body,” so to speak, that could be
preserved,defended,andsovereignlygoverned,onethatwasimmediatelyrecogniz-
ableandmarketableas“Tibetan”(or“Indian”or“Chinese”).Theconceptofa“medi-
calsystem”—withitsinternalcoherenceandclearboundaries,itsdistinctidentityand
self-governing, self-policing institutional structure—provided exactly the body that
bothnationalistsandmedicalpractitionerswerelookingfor.Inotherwords,totrans-
formarangeofmoreorlessheterogeneousmedicaltraditionsthatfollowedsimilar
epistemologicalprinciplesintoaunitary“medicalsystem”was,andcontinuestobe,a
politicalactofnationalism.
IntheexileTibetancase,whereTibetanmedicineiswidelybelievedtosymbolize
thegreatnessoftheTibetan“civilization”andthusmanifestTibet’snationalidentity,
the“preservation”ofTibetancultureisdirectlylinkedtothetransformationofTibetan
medicineintoamedicalsystem.InordertogiveTibetanmedicineanewbodypro-
videdbytheconceptofamedicalsystem,exactlythecriteriaoutlinedbyLeslieandhis
colleaguesandusedbyIndianofficials—uniquehistoricalorigins,aclassicaltextual
core, internal homogeneity, and clear external boundaries—needed to be demon-
strated, highlighted, and, if necessary, created. But before going into the details of
theseeffortsandaskinghow,exactly,Tibetanamchiinexiletransformedtheir—until
recently relatively obscure—medical tradition into a clearly defined “system,” it is
worth considering their timing. Why, in other words, did exile Tibetan medicine’s
preservationandsurvivalbecomesuchanurgentissueduringthelate1990sandearly
2000s—a time when it was actually thriving and its survival seemed, at long last,
secured?
For all practical purposes, Tibetan medicine was consubstantial with the Men-
Tsee-Khang’sinstitutionalbodyduringthefirstdecadesinexile,forthesimplereason
thatnootherinstitutions—orasignificantnumberofprivatepractitioners—ofTibetan
medicineexistedinexile.However,bytheearly1990s,thisequationbecameprob-
lematic as Tibetan medicine gradually grew larger, healthier, and stronger; other
Tibetanmedicalinstitutionswerefounded;andincreasingnumbersofamchiestab-
lished their private, independent clinics and pharmacies or traveled and practiced
abroad.OnecouldsaythattheboundariesofTibetanmedicineinexileincreasingly
outgrewthoseoftheMen-Tsee-Khang’sinstitutionalbody.Thissituationwasaggra-
vated bygrowingtensionsbetweenthe Men-Tsee-Khangandprivateamchi, which
hadalreadybeguninthe1960sand1970swiththeresignationofseveralsenioramchi
from the Men-Tsee-Khang and the dismissal of the popular chief physician at that
time, Dr. Lobsang Dolma, amid allegations of unethical conduct (Josayma and
Dhondup1990: 5;Tsering 2005:183; Kloos 2008: 23–24).Inthe 1980s, theMen-
Tsee-Khang decided to stop selling its medicines to private amchi in an attempt to
386 S.Kloos
discourage the establishment of private clinics, which was widely perceived as a
hostilegestureagainstthem.Duringthe1990s,astheeconomicpotentialofTibetan
medicinebecameincreasinglyapparent,thesheernumberofnewlyestablishedpri-
vatedoctors(mostofthemoriginallyfromtheMen-Tsee-Khang)begantochallenge
not only the Men-Tsee-Khang’s market dominance but also its political power to
representTibetanmedicine.
Uptothatpoint,Tibetanmedicineinexilepracticallyfunctionedwithoutanykind
of regulation or control whatsoever. The CTA did not have a single law regarding
Tibetanmedicine,oranyinstitutionalstructurestooverseeitspracticeanddevelop-
mentbesidesthelargelyautonomousMen-Tsee-Khang.Similarly,althoughthegov-
ernmentofIndiahadtoleratedthepracticeofTibetanmedicineonitssoilsince1964
(ChoeloThar2000:52;Kloos2008:18–19),itwasnotofficiallyrecognizedandthus
remained outside Indian legal regulatory purview. Until the 1990s, this was not a
problem, since Tibetan medicine in exile was largely consubstantial with the Men-
Tsee-Khang,andthefewpractitionersthatpracticedindependentlywereallserious
senior doctors. But during the 1990s, three other Tibetan medical institutions were
founded(Kloos2008:30–33),andthenumbersofprivateamchiincreaseddramati-
cally. Consequently, concerns arose at the Men-Tsee-Khang about these doctors’
ability and motivation to practice and represent Tibetan medicine in a proper way.
The clandestine spread of counterfeit precious pills (rinchen rilbu) and impostors
pretending to be fully qualified amchi in the West—both widely discussed in exile
Tibetanmedia—onlyservedtojustifytheMen-Tsee-Khang’sconcernsinthepublic
andingovernmentcircles.Tibetanmedicinegrew—quiteliterally—outofcontrol.
TheabsenceofanyregulationwasathreatnotonlytotheMen-Tsee-Khangand
Tibetan medicine but also to exile Tibetan ethical and political aspirations. One of
themostcommonstatementsIencounteredamongexileTibetanamchiwasthateven
asrefugees,throughTibetanmedicinetheycouldhelptheworld.Inordertodoso,
however,theyneededtoensureTibetanmedicine’sefficacyandthepatients’trustin
it, both of which seemed endangered by unqualified or unscrupulous medical prac-
titioners.Inotherwords,Tibetanmedicineneededtobe“preserved”—thatis,regu-
latedandcontrolled—forthebenefitofitspatients.Whilethismedicalmanifestation
ofaTibetanethicsofaltruismandcompassionisagenuinesentimentandshouldbyno
means be interpreted as mere “self-marketing” (Huber 2001: 367), it does have an
importantpoliticalaspect,insofarasexileTibetanstodaylocatemuchoftheircultural
andpoliticalidentityinexactlythisMahayanaBuddhistethics(Kloos2010,2011).
Byvirtueoftheclassical—butnewlyreformulated—Tibetandefinitionofmedical
practiceinethicaltermsanditsrecentgrowthinpopularity,Tibetanmedicinehad,by
the1990s,becomeanincreasinglypowerfulvehicletotransportacertainculturaland
politicalidentitybothamongthediasporapopulationandtheworld.Thus,theabsence
ofanyregulationforTibetanmedicineinexilewasproblematicnotonlyintermsof
theprofession’sclinicalandethicalresponsibilitytowarditspatientsbutalsointerms
oftheCTA’spoliticalagenda,inwhichtheMen-Tsee-Khangplayedanunofficialand
indirect, but nevertheless central, role (Kloos 2012). Indeed, it was the Men-Tsee-
Khang’sambiguousstatusbothasamedicalinstitutionwithhegemonicambitionsand
asaquasi-governmentalentitywithjustifiedethicalandpoliticalconcernsthatlayat
therootofvirtuallyalltensionssurroundingit.Whenthemillenniumdrewtoaclose
withaninternaluproarabouttheCongressonTibetanMedicineinWashington,DC
HowTibetanMedicineinExileBecamea“MedicalSystem” 387
(wheretheMen-Tsee-Khangfeltslightedinitsself-perceivedroleasthesolelegiti-
mate representative of Tibetan medicine outside China); negative press in Europe
regarding toxic Tibetan pills (for which the Men-Tsee-Khang blamed unqualified
privatedoctors);andincreasinglywidespreadconcernsamongexileTibetandoctors
andofficialsaboutthedeteriorationofTibetanmedicineduetocommercialexploi-
tation,atippingpointwasreached.
2 ConflictingInterests
Inearly2000,theMen-Tsee-Khang’sdirectoratthetime,PemaDamdulArya,sub-
mitted a draft law to be passed by the Assembly of Tibetan People’s Deputies (the
Tibetanparliamentinexile,oftensimplycalledtheAssembly).Thislawwasintended
to regulate Tibetan medical practice and pharmaceutical production by bringing
Tibetan medicine in exile under the Men-Tsee-Khang’s official control—or, in
other words, of expanding the Men-Tsee-Khang’s institutional body and power.
Notsurprisingly,giventhetenseclimateofmutualsuspicionsandaccusations,this
decisionwasmetwithvigorousoppositionfromotherquartersinthefieldofTibetan
medicine,notablytheprivatepractitioners,andsetinmotionanearlyfour-year-long
showdown, with political battlesandheatedconfrontations betweenthe Men-Tsee-
Khangandprivateamchi.TheAssemblyrejectedtheMen-Tsee-Khang’sproposal—
notleastbecauseofnumerousspellingmistakesintheTibetanoriginal(anindication
ofthehasteinwhichitwaswritten)—butinsteadpassedaresolutionon27September
2000callingfortheestablishmentofaCentralCouncilofTibetanMedicine(CCTM).
Both the idea and the CCTM’s name indicate an important reference point for
Tibetan medicine outside the exile community. It was not only Tibetan medicine’s
dramaticexpansionandeconomicsuccess—coupledwiththeeventsjustdescribed—
thatledtoagrowingconsensusamongexileTibetansabouttheneedofsomesortof
regulation, but also the developments in the Indian health care context. In 1970,
thegovernmentofIndiahadestablishedtheCentralCouncilofIndianMedicinesto
recognize the so-called Indian systems of medicine (ISM): Ayurveda, Unani, and
Siddha.4 In 1979, it amended the Indian Drugs and Cosmetics Act toinclude regu-
lationsforthecommercialproductionof“Indian”medicines,andin1995itbrought
ISM-H under the Indian Ministry of Health and Family Welfare in the form of a
separate Department of ISM-H, which was renamed the Department of AYUSH in
2003.5EspeciallythelatterdevelopmentconstitutedamajorboostforISM,providing
themwithahighlevelofpoliticalrepresentationandaccesstobillionsofrupeesof
governmentfunding.AlthoughtheexileTibetanamchitendtoregardespeciallythe
developmentofAyurvedaverycritically,allofthisconstitutedapowerfulexamplefor
“embodying”Tibetanmedicineintheformofa“system.”
AsafirststepintheestablishmentoftheCCTM,acommitteeconsistingofmem-
bers from the CTA Health Department and the Men-Tsee-Khang was formed in
November 2000. This committee met in December to draft a legal code for the
4 Later,yogaandnaturopathywereadded,aswellashomeopathy(thelatterindicatedbythe“H”inISM-H).
5 AYUSHstandsforAyurveda,YogaandNaturopathy,Unani,Siddha,andHomeopathy.InSanskrit,a¯yus
(commonlypronounced“ayush”)means“health”or“longlife.”
388 S.Kloos
CCTM,whichwasthenpresentedtothehealthdepartment.Consideringthemakeup
ofthecommittee(withthehealthdepartmentatthattimeclearlysidingwiththeMen-
Tsee-Khang), it is hardly surprising that the result was, in its main ideas, not very
differentfromPemaDamdulArya’soriginalproposal.Itcontainedtwosetsofrules
andregulations,oneforTibetandoctorsandoneforTibetanpharmacistsinexile.Each
setwastobeoverseenandimplementedbyacouncilheavilydominatedbyMen-Tsee-
Khang representatives and members of the health department. Most important, the
rulesstipulatedthatanyTibetanmedicalinstitute,privatepractitioner,orpharmacist
mustberegisteredunder—andcontrolledby—theMen-Tsee-Khangandmustfollow
thelatter’srules,ranks,normsofpromotion,andexamspecifications.
Forexample,Article18stated:“SincetheMen-Tsee-Khangisrecognizedasthe
standard center for the study of Tibetan medicine, the institute is endowed with
the responsibility and authority to regulate registration, conduct training programs
andexaminations,andissuecertificates.”Regardingpharmaceuticalproduction,the
CCTM’sabove-mentionedcommitteewastoinvestigateanyoneproducingmedicines
and“take anappropriatedecisionandimmediately reportthe matter tothegovern-
ment.” Furthermore, “Any Tibetan lineage doctor planning to start pharmaceutical
practicemustobtainpriorpermission[fromtheMen-Tsee-Khang]andgetregistered
under the Tibetan government in exile. No Tibetan doctor can engage in Tibetan
pharmaceuticalpractices[forcommercialpurposes]withoutpriorregistration.”The
documentcontinuedwithacallforagovernmentpharmaceuticalinvestigator—again
explicitly from the Men-Tsee-Khang—to check whether any private amchi’s phar-
maceuticalproductionwas“atvariancewiththeTibetanmedicalsystem,whetherthe
ingredientsareinstandardproportion,”whetherhygienicconditionswerekept,andif
there were any signs of adulteration. Finally, in order to keep medicine prices af-
fordableforthepoor,Article30concluded:“Thegovernmenthasthepowertocontrol
andfixpricesforsaleaswellasexportofthemedicinestakingintoconsiderationthe
costprice.Thegovernmentalsoreservesthepowertoreducethepricesorrepealthe
registrationcertificateincaseofmedicinesalessolelyforpersonalgains.”
Thesedraftrules—andthestrongrepresentationoftheMen-Tsee-Khangandthe
CTAontheCCTM—demonstratetheconcernsofallthreepartiesinvolved.Theexile
government’s interest in controlling one of its most valuable cultural and political
assetswouldbeensured,andthewell-knownanti-commercializationstanceofSam-
dhongRinpoche(whowouldbeelectedprimeministerthenextyear)isclearlyvisible
inthelastrule.TheMen-Tsee-Khangwouldhavefinallyobtainedtheofficialpower
tocarryoutwhatitsawasitsmainresponsibility,thatis,toprotectand“preserve”
Tibetanmedicinebyensuringthequalityofitseducation,clinicalpractice,andphar-
maceuticalproducts.Atthesametime,theseplansonlyconfirmedtheprivatedoctors’
worstsuspicions,namely,thattheMen-Tsee-Khangwanted tomonopolize Tibetan
medicine,marginalizeprivatepractitionersasmuchaspossible,anduseitspolitical
powertodistortthemarketofTibetanmedicinetoitsownadvantage.LiketheMen-
Tsee-Khang’sownconcerns,thesesuspicionswerepartlyjustifiedandpartlyaprod-
uctoftheescalatingtensionswithinTibetanmedicineinexile.
UnfortunatelyfortheMen-Tsee-Khang,itsdreamsofalmostabsolutepowerand
controlwerenottocometrue.Therewasanothermeetingtodiscussandamendthis
draft code in March 2001, where both Men-Tsee-Khang and private amchi were
invited. While private physicians were up in arms against the proposed regulations
HowTibetanMedicineinExileBecamea“MedicalSystem” 389
andturnedoutinlargenumbers,mostMen-Tsee-Khangdoctorsatthattimeshowed
littleinterestinsuchpoliticalissues,whichallowedtheprivatedoctorstochangethe
proposalintheirfavor.Whenthechangedproposalwaspresentedtothehealthmin-
isterandtoPemaDamdulArya,theMen-Tsee-Khangdirectorstronglyopposedthe
newversionbutultimatelyhadtoagreetosubmitittotheAssembly.However,this
was in July 2001, and the entire exile government was in transition after the first
general election, so it was not presented to the new parliament before January
2002. Again, however, the code did not pass the parliamentary vote, this time due
toobjectionsbyaBonpodeputy,whoinsistedonastrongeremphasisonBoninflu-
ences in Tibetan medicine.6 Yet another committee was formed, and changes were
madetothedraft,including,mostsignificantly,strongreferencestothe’bumbzhi(the
Bonversionofthergyudbzhi)andaBonpomemberontheCCTM’sgoverningboard.
Theresult—Document13,alsoknownastheExileTibetanDoctor’sAssociationAct,
orsimplytheCCTMAct—wasthenreadbythehealthministerduringthefifthsession
ofthethirteenthAssembly,passedunanimouslyinMarch2003,andapprovedbythe
DalaiLamaalittlelater.Onthebasisofthisact,theCCTM(btsanbyolbodmi’ibod
kyigsobarigpa’ichesmtho’ismanpa’ilhantshogs,orChe-thoeMen-paeLhen-tsog)
wasofficiallyestablishedasan“apexbody”undertheCTAon5January2004,during
theFirstConferenceofSorigPractitionersinDharamsala.
3 TheCentralCouncilofTibetanMedicine
After more than forty years in exile, Tibetan medicine was thus finally born as
a “medical system.” That is, for the first time in its history, there existed a legal
body—separate from any particular medical institution—with the sole purpose to
regulate,standardize,andcontrolTibetanmedicineinordertomakeitintoaclearly
demarcated“system”ofmedicalandpharmaceuticalknowledgeandpractice,which
could in turn define the larger contours of an exile Tibetan cultural and political
subjectivity. This body—no doubt weak and dependent for now, but also full of
promise—was the CCTM. As it turned out, however, its shape—the result of four
years of intense political battles—was hardly what had been envisioned at its con-
ceptionin2000.
AccordingtotheofficialtenoratthatFirstConferenceofSorigPractitioners,the
CCTM’smissionseemedtobeclear:tocontrolandgovernTibetanmedicineinexile
inordertopreventitscommercialexploitationanddegradation.Buttherealitybehind
thepoliticians’loftyspeechesspokeadifferentlanguage.Whilethefirstdraftcodefor
theCCTMin2001stillcontainedanexplicitstatementthatTibetanmedicinehadto
remainaffordabletothepoor,andgavetheexilegovernmentthepowertoregulatethe
pricesofTibetanmedicinesaccordingly,thereremainednotraceofsuchrulesinthe
finalCCTMact.Notonlythat,butinsteadofestablishinggovernmentaloversightover
6 Bonisusuallyconsideredtorefertopre-BuddhistreligioustraditionsofTibet,whicharestillpracticedby
apartoftheTibetanpopulationandrecognizedbythefourteenthDalaiLamaasoneofsixTibetanreligious
schools(Kvaerne1995).ThehistoriccompetitionbetweenBonandBuddhismextendstocontemporary
Tibetanmedicineintheformofdebatesoveritsorigins,whicharelocatedeitherintheBuddha’steachings
orintheBontradition.SeealsoColinMillard’scontributiontothisissue.
390 S.Kloos
Tibetanmedicine’spreservationanddevelopment,theCCTM’sgoverningboardnow
consistedofonlyonegovernmentappointee(abiomedicaldoctor,notapolitician),
three Men-Tsee-Khang representatives, and four private amchi. In other words, the
exilegovernmentwasleftwithnodirectpoliticalcontroloverTibetanmedicineatall,
andtheMen-Tsee-KhangonlyhadaminorityofvotesintheCCTM’sdecisions.Both
PemaDamdulArya’sandthecabinet’s(andpartsoftheAssembly’s)initialplanto
countertheperceivedthreatofprivatepractitionersandbringTibetanmedicineunder
thegovernment’sandtheMen-Tsee-Khang’scontrolhadthusbackfireddramatically.
TheMen-Tsee-KhangwasdemotedtoanequalstatusasanyotherTibetanmedical
institutionorprivatedoctorsregisteredundertheCCTM,whilethefledglingCCTM
itselfwascharged,intheMen-Tsee-Khang’sstead,withthegovernmentalresponsi-
bilityofpreserving,regulating,andrepresentingTibetanmedicineinexile.
TheCCTM’slegalcode, as itstandstoday,explicitly states asits objectives the
registration,regulation,standardization,andcontrolofTibetanmedicalcolleges,phar-
maceuticalunits,clinics,doctors,andnewlydevelopedpharmaceuticalformulations.
Itsjurisdictionappliesto“alltraditionalTibetanphysiciansundertheexileTibetan
government,andtothosepractitionersofTibetanmedicinewhovoluntarilyrespect
andacceptitslegalcode”(CTAHealthDepartment2003).Inotherwords,whilenon-
Tibetan, Himalayanamchi—for example,Ladakhi,Sherpa,orMonpa—can choose
whethertheywishtocomeundertheCCTM’sjurisdictionornot,Tibetannationals
havetoacceptitsrulesaspartoftheirgovernment’slaws.EspeciallytheMen-Tsee-
KhangdoctorsbutalsosomeofthemoreestablishedindependentTibetanamchiwere
lessthanamusedbythisturnofeventsandprivatelygrumbledaboutthisimposednew
authority. Most Himalayan amchi, on the other hand, were attracted by the status
conferredbytheCCTM’sregistrationcertificates,aswellastheregularconferences,
workshops,andhigh-profileempowermentsorganizedbytheCCTM.Thus,atpresent
425 practitioners of Tibetan medicine in South Asia, Europe, North America, Aus-
tralia,andIsraelareregisteredundertheCCTM(CentralCouncilofTibetanMedicine
2013),7whichrepresentsthevastmajorityofTibetanmedicinepractitionerstrained
andpracticingoutsideTibet,Bhutan,andMongolia.
While the CCTM’s most visible activities since 2004 consisted of registering
doctorsandaccreditingthefourmainTibetanmedicalcollegesinIndia,standardizing
syllabi,compilinglistsofrecognizedclassicaltexts,andorganizingthejust-mentioned
conferences and workshops—thus establishing a hitherto nonexistent platform of
communicationandexchangeamongmostactorsinthefieldofTibetanmedicinein
exile—this is not its main objective. As Dr. Dorjee Rabten, CCTM chairman from
2007to2010, repeatedlystressed both inpublic speeches andinprivateinterviews
with me, the CCTM’s real mission is to control, regulate, and represent Tibetan
medicine in exile as its sole legitimate authority and thereby claim “the authority
andownershipoftheTibetans”(Chukora2007:16)overTibetanmedicine.AsTibet-
an medicine is growing into a multimillion dollar market on a global scale, exile
TibetanauthoritiesareclearlyconcernedtoreasserttheircontrolnotonlyoverTibetan
7 TheCCTMdistinguishesbetweentwokindsofregistration:“qualifiedmedicalpractitioners,”whopos-
sessgraduationcertificatesfromTibetanmedicalcollegesrecognizedbytheCCTM;and“registeredmedi-
calpractitioners,”whoaremostlyHimalayanamchitrainedinthetraditionalteacher-apprenticesystem(and
thuslackinganyofficialcertificates).