In Exile From the Land of Snows (29 page)

The state of the three humors in the body is now explored. Each humor, as well as its combinations, possesses a characteristic pulse type. When it has been identified, the individual pulse of one of a huge number of conditions is sought. If the patient is pregnant, the “pregnancy pulse” will reveal it, as well as, after the sixth week, the sex of the child. If worms are present, the pulse is “flat” and seems to knot as it beats; if bacteria, it is incomplete, with “sudden, irregular and unpredictable cessation in the rhythm of the beat.” In leprosy, the pulsebeat is “quivering,” and contracting at its conclusion “like a person who limps.” Wounds manifest a “bulky, hard and quick” pulse. A bullet lodged in the body produces a “limping and double” pulse as if there were two arteries, not one, being read. After describing tests to distinguish pulse types, the tantra instructs the physician to investigate the individual organs through the twelve positions on the fingertips. His exam complete, over a period of roughly one hundred breaths, the doctor knows what the humoral imbalance is, its severity, which organs are affected and in what manner.

As Yeshi Dhonden and his classmates discovered, however, the topic of pulse diagnosis was far from exhausted. In the remaining sections numerous exceptions to the rules were cited as well as the uses of the pulse in determining lifespan, spirit possession and, in an extremely complex section known as the “Seven Amazing Pulses,” the future course of an illness. In the eleventh section, those pulses which reveal that a disease will be terminal are described, showing how vivid the tantra’s descriptions can be.

The “changing” death pulse is said to “flutter like a flag in the wind”; while the “irregular” death pulse appears “like a vulture attacking a bird, who stops, plunges, beats its wings quickly, stops again and then resumes flight.” In a combined wind-bile disorder, the patient’s pulse will resemble “a fish leaping out of water to catch a fly, who quickly shimmers back.” Accumulation of phlegm and wind producing death are like “the pecking of a hen eating grain”; that of a triple humoral imbalance, like “the saliva of a drooling cow, moving in the wind.” The text then enumerates death pulses unrelated to the humors. If a healthy person who has had an accident has a thin pulse, he will die shortly. If in a person who has been sick for some time the pulse suddenly turns strong or violent, death is imminent. The amount of time left to live, within a period of eight days, is shown by the absence of pulse. Death will occur in three days if the liver or gallbladder pulse is missing; in two if the lung or large intestine pulse is absent; in one if the tongue is black, the eyes are in a fixed stare and the pulse of either the heart or the small intestine is gone.

Dr. Dhonden’s true education in pulse diagnosis came only after his studies were completed. At the age of eighteen he was sent by Kenrab Norbu, Mendzekhang’s principal, to undertake a four-year internship with a master physician practicing in Lhoka, who was already surrounded by many disciples. During this second stage in his training, Dr. Dhonden rose before dawn each day to take pulse, analyze urine and present his diagnosis of patients’ ailments to his new teacher. While his understanding of the myriad pulse types grew, he came to have a profound regard for the efficacy of the entire medical system. Although patients in advanced states of illness could not be cured, others, afflicted by a number of usually fatal degenerative diseases, such as cancer and diabetes, responded with complete remission. In the case of diabetes, seen in one out of every two to three hundred patients, he witnessed many cures occurring within six to nine months. When medicine proved ineffective, he and his teacher used accessory treatments: emetics, purgatives, moxabustion, cauterization, bloodletting and acupuncture or “Golden Needle” therapy, which, according to Tibetan medical histories, originated in Tibet and spread to China via Mongolia. Among the most successful treatments Yeshi Dhonden found were those for senility (employing memory pills), those included in the divisions covering women’s and children’s diseases as well as those in the eight branches of infertility, itself an entire category of medical practice. Although rarely prescribed, due to Buddhist ethics, two types of birth-control pill existed. One had to be taken for a few consecutive days, whereafter its effect lasted for a year; the other eliminated fertility for life.

A related specialty known as
chu-len
or “Extracting the Essence” dealt with rejuvenation. By using its medicines, religious practitioners on three-, nine- or twelve-year retreats were able to survive, it was believed, on a single seed or flower a day. For lay people
chu-len
could restore hair and teeth while increasing lifespan by many decades. As Dr. Dhonden explained, “Each of us breathes 21,000 times a day; 500 of these breaths are associated with lifespan.
Chu-len
medicines, taken in conjunction with the correct meditation practices, increase the number of these breaths. From my own experience I can definitely say they work. I’ve known people in their hundreds who have undergone the full course of treatment, beginning at the age of fifty, and been restored to a state of middle age. I met one lama when he was 170 years old. He had gray hair but the face of a forty-year-old.”

Having administered rejuvenation treatment for two millennia, Tibetan physicians considered it a normal component of their medical practice. However, one group of drugs, as venerable as those of
chu-len
, excited particular interest—
rinchen ribus
or “Precious Pills.” Whenever Dr. Dhonden returned to Mendzekhang to replenish his professor’s medicines, he made sure to inquire which Precious Pills had most recently been manufactured in the college’s pharmacy. Seven types existed, the weakest composed of eighteen ingredients, the strongest, known as the King of Medicines, of one hundred sixty-five. Wrapped in colored cotton, tied with rainbow-hued thread and sealed with wax, the Precious Pills received their name for two reasons: for their contents—gold, silver, mercury, pearl, ruby, sapphire and diamond, specially treated and then mixed with various medicinal plants—and for their function—as panaceas for the entire body. Precious Pills, it was believed, could cure the most intractable ailments. As their manufacture sometimes took up to three months of around-the-clock labor by a team of twenty druggists, they were extremely potent and administered only under strict conditions. The stronger ones often incapacitated the patient for a day, while toxins were eliminated and imbalances in the body corrected. Though Yeshi Dhonden was familiar with their ingredients, his internship was primarily geared toward expanding his knowledge of Tibetan medicine’s vast pharmacopoeia. To check his progress, Kenrab Norbu required Dr. Dhonden to accompany the college each year on its annual outing to pick herbs in the mountains.

The journey commenced at the start of July and was attended by those who had completed memorization, generally 300 students and faculty in all. As a rule, each traveler brought three changes of clothing, the Buddha having stressed the importance of cleanliness while collecting medicinal substances. With one pack animal and a groom serving every two students,
the caravan left Mendzekhang and, skirting Lhasa, proceeded a day north to Dhakyaba, a region of peaks and alpine meadows considered ideal for herb gathering. A large tent camp provided by the government, staffed with cooks and fully provisioned, already awaited the college. For seven weeks, changing location every three days, small groups of students and teachers set off at eight o’clock each morning to collect herbs just below the snow line. While harvesting, they recited prayers to the Medicine Buddha, intent on keeping the mind as well as the body pure. Thirty classes of plants, subdivided into fifty-nine categories, with each plant having nine divisions, were initially sought. Hundreds of herbs with less universal value were also taken. With the waxing of vegetative processes and the onset of pollination, barks and plant secretions received less attention; flowers, fruits, seeds and leaves, more.

Halfway through the summer, large wooden crates began arriving from Lhasa. Ordered from district governors months in advance, the crates contained dozens of medicinal plants that were unavailable in Central Tibet. They had been carefully picked with earth still around their roots and immediately packed in snow and ice. By the end of August, when all had arrived, the students had completed their own collections and were ready to take the year-end test on the identification of plants.

The exam took place inside a large tent surrounded by a high cloth wall. Within, stacks of wood covered with white cotton lined the enclosure, two hundred selected plants laid out haphazardly on top. With Kenrab Norbu presiding from a high seat at the far end, three faculty members, each assisted by a secretary, escorted students past the tables. While the secretaries recorded their replies, the students were asked to describe each specimen by type, species and the medicinal power of the active part. Guided out the tent’s rear, they were separated from those yet to be examined, and the next group of three took their places. While they did, the scores were tabulated and given to the Master, who had them announced to the whole gathering—a procedure guaranteed to increase the tremendous tension the students already felt. The test completed, students once more were taken around, this time to have their mistakes pointed out.

Most of Mendzekhang’s aspiring physicians took up to five exams before they could correctly identify a majority of each year’s plants. In his first and second attempts, Yeshi Dhonden placed sixty-second, then forty-fifth in the ranking. By the age of twenty, though, with his internship completed, he captured third place. By coincidence his old roommates took first and second, giving the three friends a clean sweep of the top positions. Because their scores were so close, Kenrab Norbu ordered a
retest. This time the young men were taken around the tables blindfolded. One by one their examiners held up plants, requesting that they be identified by odor and taste alone. As Yeshi Dhonden recalled, “This was very difficult, but fortunately all of us were able to answer correctly. When the test was over, it was announced that I had come in number one. Later, though,” he added, laughing, “I found out there had been a catch. Because I was graduating, my friends had pretended to make little mistakes. In reality I was number three, but thanks to their trick I was chosen as the best student in the college.”

Following the exam, a large celebration, equivalent to graduation day, was held. Hundreds of people came from Lhasa and the surrounding villages to watch as the students were publicly ranked. Those who took first and second places received long silk scarves embroidered with the words “Luck in the Day. Luck in the Night.” Those who came in last didn’t fare so well. The fifth from last was pronounced “Carrier of the Medicines”—a barb equivalent to “nurse”—and given a blue doctor’s bag to hold, of the kind used by every physician’s assistant. The fourth from last, called “The Doorman,” was dressed in the black robes of a government servant and placed at the entrance to the tent; the third from last, costumed as a muleteer, escorted the second from last and the last—banished not just from the race of physicians but that of men—known, respectively, as the “White” and “Black Donkeys.” With bells, reins and halters on their necks and medicines loaded across their backs, the “donkeys” were driven around the camp, bellowing and braying, to the great amusement of the crowd, after which a picnic was shared by all. The next day the college returned to Lhasa, where a ceremony at the Central Cathedral took place and the year ended for a week’s vacation.

After graduating, Dr. Dhonden served as Kenrab Norbu’s special assistant for three years. In the evenings he continued to debate with Mendzekhang’s senior students and faculty members. Once a month he went to the Lingkhor, Lhasa’s Holy Walk, to treat the hundreds of poor pilgrims and beggars who rarely came on their own for help. In conjunction with this, he paid special attention to cultivating the eleven vows of the physicians’ code which attempted to instill an altruistic motive as the basis of a doctor’s practice. As Yeshi Dhonden commented, concerning his own application of the ancient code, “I am just an ordinary person afflicted by desire, hatred and ignorance. But through contemplating the suffering I see in my work, I have tried to increase my compassion. As doctors we are expected to put kindness before all else.” Out of his own curiosity, Dr. Dhonden also went, two hours a day, to the British Legation, to acquaint himself with Western medicine. Finally, in 1951, Kenrab Norbu sent Yeshi
Dhonden’s diploma to the office of the Cabinet, where it was officially confirmed. The Kashag then dispatched letters to district officials in Lhoka, as well as the government transport center, from which Yeshi Dhonden received free passage home. Thirteen years after his education began, Dr. Dhonden left Lhasa, looking forward to taking up practice on his own.

He didn’t have long to wait. An epidemic had broken out along the Bhutanese border, imported—along with chocolate, batteries, silks and the beloved fedora hats—by traders returning from India. In Tibet’s high, germ-scarce environment, those who contracted the disease—a form of intestinal influenza—died quickly. Scores of doctors had already flocked to the area.

Traveling to a monastery called Sungroling Gonpa, Dr. Dhonden joined three physicians who had been attempting, unsuccessfully, to check the epidemic. Nine of the monastery’s 300 monks had already died, as well as many of the inhabitants of the village below its walls. Arriving just before nightfall, Dr. Dhonden was shown to a private room, where, after his regular evening meditation session, he went to sleep, expecting to see his first patients in the morning. During the night, however, he experienced an unusual dream, one which, though seemingly inexplicable by Western standards, demonstrated the close relationship of religion to science in Tibetan medicine. “In the night I dreamt that a naked woman came before me, a
khadroma
,” said Dr. Dhonden, referring to a spiritual being believed, in a manner similar to that of an angel, to aid practitioners in meditation. “In her right hand she held a tantric drum; in her left hand she held a skull. She carried a bag of medicine under her left arm. A white tin cup with a red design and a slight crack on its rim, filled with urine, appeared before her. Then the woman asked me, ‘After examining this urine can you tell me the disease of the patient? What is your diagnosis?’ In the dream I looked at the urine and replied, ‘This is today’s epidemic, one of sixty-five types of the eighteen new diseases predicted in the tantras for this era.’ ‘What is its cause?’ she asked. I responded that it was due, as the tantras state, to environmental pollution and that it was a hot disease. ‘You said that externally it is a fever, but are you sure that internally it’s not cold?’ she said. At that time, because my memory was fresh from constant study, I recalled that the thirteenth and fourteenth chapters of the third Tantra address the topic of cold and hot diseases together. I answered her in debate form, quoting the text as proof, stating that there was no hidden cold fever, but that the ailment was hot both inside and out. We debated back and forth for some time and finally she said, ‘What treatment will you give?’ I replied, ‘Because the bacteria causing the disease have
mixed the blood and bile, medicine should be given to separate them.’ Then she asked what the patient’s behavior and diet should be—two aspects of treatment that always accompany medicine. I answered and she said, ‘Tell me again. How will you cut the tail of this disease?’ Once more we debated vigorously and then she laughed and suddenly disappeared. There was complete silence and I woke up.”