9th CENTURY: There was period of violent reaction to the new wave of Buddhist and foreign culture introduced by King Khri-Srong, under his successor King Langdarma and his animist priests and ministers. Most vestiges of the Buddhist religion were destroyed. During and after his reign, the empire crumbled, there was considerable anarchy and a low period in Tibetan history. Some medical historians say that although Buddhism suffered terribly, the medical tradition continued unaffected. This is very doubtful. It probably continued but in a diminished form, as many of the best physicians had been based in the Buddhist monasteries destroyed and the whole ethos of modernising Tibetan knowledge had suffered through reactionaries trying to restore the old order. Although so much was translated, very few manuscripts remain from this early period.

It was in the latter half of the 10th century that Tibetan medicine took its the next significant step forward. A wave of diligent and heroic people of both lands plied between India and Tibet, working hard to restore culture in Tibet and bring it the best that India had to offer. They were known as lotsawa, which literally means translators. These were not mere linguists but great scholars end enlightened beings in their own right, 'translating' in the very broadest sense the jewels of one culture into another. From the 10th-12th century, they not merely restore Buddhism and medicine in Tibet but considerably augmented them, broadening their bases and firmly implanting a culture which was to last until the late 20th century. Among other things, they translated one of the most important early medical texts, the yan-lag brgyad-pa'i snying-po bsdus-pa ("Quintessence of the Eight Branches of Medicine), in 120 chapters, and its commentary, bZl.ba'i 'od.Zer ("Moonbeams").

11th CENTURY: Probably the most influential of the translators was Rin.chen bZang.po (958-1055). He studied in general under 75 great masters of India and spent much time mastering the medical teachings of Janadarna, especially the Quintessence of the Eight Branches text and its commentary. He taught, established and spread these medical teachings in Tibet. The lineages arising from his students gave a major uplift to, and considerably increased, the practice of TTM. In all, 158 texts were translated and edited under his guidance.

During this century, profound notions of the psychosomatic nature of the human being and his/her interdependence with the immediate and more distant universe in which s/he lives were adopted, through the teachings of the Kalachakra tantra. These study, among many other things, the influence of time of day, season of the year etc. on human biology and temperament: as Professor Meyer puts it: inherited ... Indian concepts pertaining to the structure of the body, conception, physiopathology and therapy.

History makes particular mention of nine master physicians of Rin.chen bZang.po's lineage towards the end of the 11th century. Two of them brought new developments. Shang-ston gZi Brjid-'bar went to India and studied the Eightfold Quitessence extensively in Nalanda under the great doctor Chadravi. He returned to Tibet with many teachings, which he translated. sTod-ston dKonchog Skyabs also went to India and studied these same works under Master Shintipa. sTod ston is best known for instructing the Later Yuthog (see below) in the Moonbeams commentary on the Eightfold Quintessence. During the last half of the century, gTer-ston Gra-pa mNon-shes (1012-1090), is believed to have revealed the Fourfold Treatise hidden three centuries previously in the pillar of Samye monastery by Vairocana (see first part of history). Some Tibetans see him as the reincarnation of Vairocana because of this.

12th CENTURY: This brings us to the most famous of Tibetan physicans - the 2nd Yuthog (1112-1203) - and the most famous medical work - the Fourfold Treatise. The latter work draws together in a masterly way all the elements that had entered Tibetan medicine up to that time. About its origins, Professor Meyer says, in "Oriental Medicine":

This is a reasonable exoteric explanation. The view of one of (if not the) greatest contemporary TTM physician, Professor Khenpo Troru Tsenam, resolves any controversy by pointing out the way the Buddha is envisaged in Northern Buddhism, i.e. not just as an historical Indian figure but also as a constant inspirational presence (sambhogakaya) to this world during the five millennia following his enlightenment and, more generally, as the guiding presence of the absolute, anywhere and in anyone. If this 'pure mind' had appeared to Yuthog and guided his brilliant work of the Four Tantras, then the text becomes at one and the same time the authentic teaching of the Buddha and a contemporary edition. This does not preclude the possibility of it being also a revision and update of an ancient text - authentically from the Buddha - made suitable to its times by the Buddha's own, later, influence on Yuthog.

Whatever the origins of the Fourfold Treatise, it is certainly the text of TTM and a brilliant one at that. So much of TTM literature is composed of commentaries to the Fourfold Treatise and, like many great works, it always seems to stand above and beyond its commentaries in a pristine and commanding position. For more information on the content of this work please consult the Fourfold Treatise section.

Yuthog himself is surrounded by legend and was doubtless an extraordinary figure, who visited India many times and whose clear and all-encompassing mind was able to possess and present an overview of all the various components present in the medical science of Tibet at the time. His work is not merely the fruit of a clear mind but also that of a wide-ranging medical experience and considerable travel.

12th - 15th CENTURIES:     the main recorded medical tradition over this period was that of Yuthog, in Central Tibet. Other similar traditions flourished in Western Tibet and the Sakya area and all over Tibet medicine continued in a simple and domestic way as father-to-son transmission.

15th - 17th CENTURIES: the two famous traditions of BYANG and ZUR    In the early to mid 15th century, these two important systems of TTM developed, in Northern and Southern Tibet respectively, each based upon the Fourfold Treatise but with a different view to its nature, some slight differences of interpretation and some variance in plant recognition. The latter is not surprising and evokes a problem we have often encountered in preparing our database of TTM materia medica here at Tara Rokpa. Whereas in the West botanical recognition is based primarily upon plant shape and colour, which define whole species and sub-species, in TTM the prime importance lies in the medicinal properties. Often several quite different plants bear the same name in TTM.
Not all plants grow in all countries. Even when the same species is found in different places, its medicinal properties can vary enormously depending upon the altitude, climate and geographical conditions of its situation. As medicine spread from other countries to Tibet and from one region of Tibet to another, local substitutes had sometimes to be found for the materia medica prescribed in the Fourfold Treatise and other authoritative texts but not found locally. These substitutes frequently took on the name of the original remedy. It happened that sometimes local substitutes even turned out to have properties surpassing those of the original.

The Byang and Zur systems developed independently in the 15th century, cross-fertilised each other in the 16th century and virtually merged into one during the late 17th century, under the powerful influence of Regent Desi Sangye.

The BYANG system originated with Jangdagpa (byang.bdag rnam.rgyal grags.bzang) (1395-1475). He and his followers composed many medical treatises, especially commentaries on the Fourfold Tantra. Their system flourished in the north of Tibet. They held the Fourfold Treatise to be a teaching given directly by the Buddha.

The ZUR system started some 50 years later, in Southern Tibet, through Zurkhapa (zur.mkar mnyam.nyid rdo.rje) (1439-1475). A child prodigy, he was strongly influenced by the Yuthog Nyintik esoteric medical tradition stemming from the Second Yuthog. In a powerful dream, he received instruction that the extant versions of the Fourfold Treatise and other related texts had become corrupted over the centuries, through additions and alterations, and that he should revise them. This he did meticulously, returning to Indian source documents and convening conferences of doctors from all parts of Tibet. His brief but important life gave a great renewal to TTM and launched one of its most famous traditions.

17th CENTURY: the influence of the Vth Dalai Lama and Regent Desi Sangye Gyamtso    The Vth Dalai Lama (1617-16820 gained power over many Tibetan areas and became a powerful monarch. He founded several medical schools, away from the new capital Lhasa. His main disciple and future Regent, Desi Sangye (sde.srid sangs.rgyas rgya.mtsho) (1563-1705) was a brilliant scholar. Under his direction, a team of doctors and scholars studied the various commentaries of the Byang and Zur traditions on the Fourfold Treatise and reported back to him on differences, discrepancies and moot points. From all this research, a major commentary, the 'Blue Vaidurya Treatise' was composed. It has many great qualities and is very highly respected today. The shortcoming of the work is that Desi Sangye was not a practising physician but a medical theoretician. He had a busy political, academic and religious life. It is for this reason that we have - for many years now at Tara - have used a wide range of commentaries, especially those based on deep practical experience, for our researches even though the Blue Vaiduya has received much attention in the West in recent years and is thought of by many as being the commentary on the Fourfold Treatise. This is not really at all the case.

The Vth Dalai Lama was not completely happy with his medical colleges and asked Desi Sangye to find a suitable location near Lhasa to found one. It was thus that (some years later, after the Dalai Lama's passing and during Desi Sangye's regency) the Iron Hill (lcags.po.ri) Medical College was established. It was ordained that each monastery, i.e. each district, would receive a doctor trained in the College and thus it represented the beginnings of a public health system in Tibet. The political power of Desi Sangye's tradition - the Gelugpa school - at the time meant that this medical movement soon came to dominate a great part of the Tibetan plateau. It effectively drew the Byang and Zur traditions into one (although it was more the case that the Byang was absorbed into the Zur) and launched a new wave of TTM.

18th CENTURY: The Iron Hill Medical school became a model that was copied in Eastern Tibet, at Kumbum in 1757, at Labrang in 1784, in Beijing at the Yonghegong around 1750 and also in Mongolia and Transbaikalia.

There was a flowering of TTM in Eastern Tibet during this century, under the influence of Dilmar Geshe, whose catalogue of materia medica became the widely accepted reference. Eastern Tibet is far less barren than Central Tibet and is one of the main sources for many of the herbs, plants and trees used in TTM. Dilmar Geshe's famous disciple was the 8th Situpa, Choji Jungnay (chos.kyi byung.gnas) (1700-1774) a religious figure, grammarian, poet, scientist and doctor of incomparable skills. He founded a medical school at Palpung, in the Tibetan kingdom of De-Ge in far Eastern Tibet, which also showed a great open mindedness to the great wealth of classical Chinese knowledge of art, medicine and science.