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RELIGION, MEDICINE AND THE
HUMAN EMBRYO IN TIBET

This book explores the fascinating history of embryology in Tibet, in culture,
religion, art and literature. It reveals the prevalence of descriptions of the development of the human body – from conception to birth – found in all forms of
Tibetan religious literature, as well as in medical texts and in art. By analyzing
stories of embryology, Frances Garrett explores questions of cultural transmission and adaptation: how did Tibetan writers adapt ideas inherited from India
and China for their own purposes? What original views did they develop on the
body, on gender, on creation, and on life itself?
The transformations of embryological narratives over several centuries illuminate key turning points in Tibetan medical history, and its relationship with
religious doctrine and practice. Embryology was a site for both religious and
medical theorists to contemplate profound questions of being and becoming,
where topics such as pharmacology and nosology were left to shape secular
medicine. The author argues that stories of human development comment on
embodiment, gender, socio-political hierarchy, religious ontology, and spiritual
progress. Through the lens of embryology, this book examines how these concerns shift as Tibetan history moves through the formative period of the twelfth
to seventeenth centuries.
Frances Garrett is Assistant Professor of Buddhist Studies at the University of
Toronto. She is a historian whose research addresses doctrinal, ritual and textual
practice in Tibetan Cultures.

ROUTLEDGE CRITICAL STUDIES
IN BUDDHISM
Founding Editors:
Charles S. Prebish and Damien Keown

Routledge Critical Studies in Buddhism is a comprehensive study of the Buddhist tradition. The Series explores this complex and extensive tradition from a
variety of perspectives, using a range of different methodologies.
The Series is diverse in its focus, including historical studies, textual translations and commentaries, sociological investigations, bibliographic studies, and
considerations of religious practice as an expression of Buddhism’s integral religiosity. It also presents materials on modern intellectual historical studies,
including the role of Buddhist thought and scholarship in a contemporary, critical context and in the light of current social issues. The Series is expansive and
imaginative in scope, spanning more than two and a half millennia of Buddhist
history. It is receptive to all research works that inform and advance our knowledge and understanding of the Buddhist tradition.
A SURVEY OF VINAYA
LITERATURE
Charles S. Prebish

AMERICAN BUDDHISM
Edited by Duncan Ryuken Williams
and Christopher Queen

THE REFLEXIVE NATURE OF
AWARENESS
Paul Williams

IMAGING WISDOM
Jacob N. Kinnard

ALTRUISM AND REALITY
Paul Williams
BUDDHISM AND HUMAN
RIGHTS
Edited by Damien Keown, Charles
Prebish and Wayne Husted
WOMEN IN THE FOOTSTEPS OF
THE BUDDHA
Kathryn R. Blackstone
THE RESONANCE OF EMPTINESS
Gay Watson

PAIN AND ITS ENDING
Carol S. Anderson
EMPTINESS APPRAISED
David F. Burton
THE SOUND OF LIBERATING
TRUTH
Edited by Sallie B. King and Paul O.
Ingram
BUDDHIST THEOLOGY
Edited by Roger R. Jackson and John
J. Makransky

THE GLORIOUS DEEDS OF
PURNA
Joel Tatelman

ACTION DHARMA
Edited by Christopher Queen, Charles
Prebish and Damien Keown

EARLY BUDDHISM – A NEW
APPROACH
Sue Hamilton

TIBETAN AND ZEN BUDDHISM
IN BRITAIN
David N. Kay

CONTEMPORARY BUDDHIST
ETHICS
Edited by Damien Keown

THE CONCEPT OF THE BUDDHA
Guang Xing

INNOVATIVE BUDDHIST
WOMEN
Edited by Karma Lekshe Tsomo
TEACHING BUDDHISM IN THE
WEST
Edited by V. S. Hori, R. P. Hayes and
J. M. Shields
EMPTY VISION
David L. McMahan
SELF, REALITY AND REASON IN
TIBETAN PHILOSOPHY
Thupten Jinpa
IN DEFENSE OF DHARMA
Tessa J. Bartholomeusz
BUDDHIST PHENOMENOLOGY
Dan Lusthaus
RELIGIOUS MOTIVATION AND
THE ORIGINS OF BUDDHISM
Torkel Brekke
DEVELOPMENTS IN
AUSTRALIAN BUDDHISM
Michelle Spuler

THE PHILOSOPHY OF DESIRE IN
THE BUDDHIST PALI CANON
David Webster
THE NOTION OF DITTHI IN
THERAVADA BUDDHISM
Paul Fuller
THE BUDDHIST THEORY OF
SELF-COGNITION
Zhihua Yao
MORAL THEORY IN
SANTIDEVA’S
SIKSAMUCCAYA
Barbra R. Clayton
BUDDHIST STUDIES FROM
INDIA TO AMERICA
Edited by Damien Keown
DISCOURSE AND IDEOLOGY IN
MEDIEVAL JAPANESE
BUDDHISM
Edited by Richard K. Payne and
Taigen Dan Leighton

ZEN WAR STORIES
Brian Victoria

BUDDHIST THOUGHT AND
APPLIED PSYCHOLOGICAL
RESEARCH
Edited by D. K. Nauriyal, Michael S.
Drummond and Y. B. Lal

THE BUDDHIST UNCONSCIOUS
William S. Waldron

BUDDHISM IN CANADA
Edited by Bruce Matthews

INDIAN BUDDHIST THEORIES OF
PERSONS
James Duerlinger

BUDDHISM, CONFLICT AND
VIOLENCE IN MODERN
SRI LANKA
Edited by Mahinda Deegalle
THERAVADA BUDDHISM AND
THE BRITISH ENCOUNTER
Religious, missionary and colonial
experience in nineteenth century
Sri Lanka
Elizabeth Harris
BEYOND ENLIGHTENMENT
Buddhism, religion, modernity
Richard Cohen
BUDDHISM IN THE PUBLIC
SPHERE
Reorienting global interdependence
Peter D. Hershock
BRITISH BUDDHISM
Teachings, practice and development
Robert Bluck
BUDDHIST NUNS IN TAIWAN
AND SRI LANKA
A critique of the feminist perspective
Wei-Yi Cheng
NEW BUDDHIST MOVEMENTS IN
THAILAND
Toward an understanding of Wat Phra
Dhammakåya and Santi Asoke
Rory Mackenzie

BUDDHIST RITUALS OF DEATH
AND REBIRTH
Contemporary Sri Lankan practice
and its origins
Rita Langer
BUDDHISM, POWER AND
POLITICAL ORDER
Edited by Ian Harris
ENVIRONMENTAL ETHICS IN
BUDDHISM
A virtues approach
Pragati Sahni
THE CULTURAL PRACTICES OF
MODERN CHINESE
BUDDHISM
Attuning the Dharma
Francesca Tarocco
MINDFULNESS IN EARLY
BUDDHISM
New approaches through psychology
and textual analysis of Pali,
Chinese and Sanskrit sources
Tse-fu Kuan
RELIGION, MEDICINE AND THE
HUMAN EMBRYO IN TIBET
Frances Garrett

The following titles are published in association with the Oxford Centre for
Buddhist Studies
The Oxford Centre for Buddhist Studies conducts and promotes rigorous
teaching and research into all forms of the Buddhist tradition.
EARLY BUDDHIST METAPHYSICS
Noa Ronkin
MIPHAM’S DIALECTICS AND THE DEBATES ON EMPTINESS
Karma Phuntsho
HOW BUDDHISM BEGAN
The conditioned genesis of the early teachings
Richard F. Gombrich
BUDDHIST MEDITATION
An anthology of texts from the Pali Canon
Sarah Shaw
REMAKING BUDDHISM FOR MEDIEVAL NEPAL
The fifteenth-century reformation of Newar Buddhism
Will Tuladhar-Douglas
METAPHOR AND LITERALISM IN BUDDHISM
The doctrinal history of Nirvana
Soonil Hwang
THE BIOGRAPHIES OF RECHUNGPA
The evolution of a Tibetan hagiography
Peter Alan Roberts
THE ORIGIN OF BUDDHIST MEDITATION
Alexander Wynne

RELIGION, MEDICINE
AND THE HUMAN
EMBRYO IN TIBET

Frances Garrett

First published 2008
by Routledge
2 Park Square, Milton Park, Abingdon, Oxon OX14 4RN
Simultaneously published in the USA and Canada
by Routledge
270 Madison Ave, New York, NY 10016
Routledge is an imprint of the Taylor & Francis Group, an informa business
© 2008 Frances Garrett
This edition published in the Taylor & Francis e-Library, 2008.
“To purchase your own copy of this or any of Taylor & Francis or Routledge’s
collection of thousands of eBooks please go to www.eBookstore.tandf.co.uk.”

All rights reserved. No part of this book may be reprinted or reproduced or
utilized in any form or by any electronic, mechanical, or other means, now
known or hereafter invented, including photocopying and recording, or in
any information storage or retrieval system, without permission in writing
from the publishers.
British Library Cataloguing in Publication Data
A catalogue record for this book is available from the British Library
Library of Congress Cataloging in Publication Data
Garrett, Frances Mary.
Religion, Medicine and the Human Embryo in Tibet/Frances Garrett.
p. cm. – (Routledge critical studies in Buddhism)
Includes bibliographical references and index.
1. Medicine–Religious aspects–Buddhism. 2. Embryology,
Human–Religious aspects–Buddhism. 3. Embryology,
Human–China–Tibet. 4. Buddhism–China–Tibet. I. Title.
BQ4570.M7G37 2008
294.3 661–dc22
2007046155
ISBN10: 0-415-44115-3 (hbk)
ISBN10: 0-203-92742-7 (ebk)
ISBN13: 978-0-415-44115-5 (hbk)
ISBN13: 978-0-203-92742-7 (ebk)
ISBN 0-203-92742-7 Master e-book ISBN

FOR MY PARENTS

CONTENTS

List of figures
List of tables
Acknowledgments
1

xiii
xiv
xv

Becoming human in Tibetan literature

1

Medicine, science and religion in European thought 2
Models of comparison: science and religion, science and
Buddhism 4
Narratives of embryology 8
Caveats and approaches 12
Medical epistemology and the embryological narrative 13
Narrative, identity and history 17
2

Theories of human development

20

Indian medical sources for human development 23
Early human development in Indian Nikaya and Mahayana
Buddhism 26
Practicing gestation in Indian Vajrayana Buddhism 31
Chinese traditions of “nurturing the fetus” 33
Cultural inheritance and adaptation 35
3

Interactions between medicine and religion in Tibet
Eurasian cosmopolitanism versus Indian Buddhism: a
historiographical conflict 37
Linking medical history with Buddhism 41
Striking the path: organizing the influx of Indian culture 42
The heyday of medical scholasticism 47

xi

37

CONTENTS

Locating human development in the narrative of Tibetan
history 53
4

The fetal body, gender and the normal

57

Functional physiologies: humoral and digestive systems 60
The circulatory system 64
Characterizing embodiment: gendered, defective and “normal”
bodies 71
Female physiology 76
Encountering the narrative’s central subject 84
5

Gestation and the religious path

85

Conception and debates over the sequence of fetal
development 88
Fetal development in tantric sources 96
The fetal experience of conception, gestation and birth 102
Practicing the exoteric path 106
Esoteric practices for closing the womb’s door 109
Purifying death, the intermediate state and rebirth 112
The embryologic vision of reality 117
Inconsistency, ignorance, or innovation? 121
6

Growth, change and continuity

127

Karma and the Buddhist problem of causality 128
Causality, the individual, and the cosmos 130
The power of karma in the context of conception and
development 136
The shaky foundations of karma’s role in becoming human 140
The role of the elements in causing growth 142
Attributing causality to winds 146
Growth caused by the power of gnosis 148
The forces of creation 150
Epilogue: historiography recapitulates embryology
Notes
Appendix
Bibliography
Index

155
164
188
191
205

xii

FIGURES

1.1
4.1
4.2

4.3
5.1
5.2
6.1
6.2

The seventeenth-century painting depicts the moment of
conception
The medical painting explains that conception on odd days will
bring about a boy, and conception on even days, a girl
The Four Tantras tradition also states that the child will be a boy
if the woman’s belly is heavy on the right side and a girl if she is
heavy on the left side
A woman gives birth
In the twenty-second week of gestation, the nine orifices open
During the thirty-sixth week, the fetus feels unhappy
The painting shows the influence of the natural elements on the
growth of the fetus
A series of images depict male and female reproductive substances
with various sorts of defects

xiii

8
72

74
81
88
103
135
141

TABLES

5.1
5.2
5.3
5.4
5.5
6.1

The use of terminology in early gestation
Development of the gross body
Development of circulatory channels
Comparison of tantric stages of gestation
Development of the mind/mental sensations over the course
of gestation
The names of the winds responsible for fetal development
during each week of gestation

xiv

93
94
95
101
105
145

ACKNOWLEDGMENTS

For generously sharing their scholarly expertise in the course of writing this
book, I am grateful to Ngawang Jinpa and Jampa in Darjeeling, Dorjé Dramdül
in Sarnath, and Yangga Trarong, Dawa, and Jampa Trinlé in Lhasa. In the U.S.,
I deeply appreciate the substantial advice of Paul Groner, Jeffrey Hopkins, Anne
Kinney, Karen Lang, Anne Monius and Ann Gill Taylor. I am especially grateful to David Germano for many years of support and kindness. This book has
benefitted also from suggestions by Janet Gyatso, Dan Martin, Robert Kritzer,
Dominik Wujastyk, Charles Burnett, Jonathan Silk, John Kloppenborg, Amy
Langenberg and several anonymous reviewers. The largest debts of gratitude are
owed to my parents, for their unfailing generosity, to Travis, for his affection,
and to Sivert, for getting me interested in embryos in the first place.
I would also like to acknowledge Fulbright-Hays, the U.S. National Institutes
for Health, the U.S. Department of Education, and the Weedon Foundation for
supporting me in my research and writing, as well as the University of Virginia’s Center for South Asian Studies, its Center for the Study of Complementary and Alternative Therapies, and its Tibetan and Himalayan Digital Library.
The assistance of the Tibetan Academy of Social Sciences faciliated productive
research time in Tibet.
The following editors and publishers have allowed me to use extracts of my
writing from their publications in this book:
“Embodiment and Embryology in Tibetan Literature,” in Soundings in Tibetan
Medicine: Historical and Anthropological Perspectives, ed. Mona Schrempf,
Leiden: Brill Publishers, 2007, 411–426.
“The Three Channels in Tibetan Medical and Religious Texts, including a translation of Tsultrim Gyaltsen’s ‘Treatise on the Three Channels in Tibetan Medicine’,” with Vincanne Adams, in Traditional South Asian Medicine,
forthcoming in 2008.
“Ordering human growth in Tibetan medical and religious embryologies,” in
Textual Healing: Essays on Medieval and Early Modern Medicine, ed. Elizabeth
Furdell, Leiden: Brill Publishers, 2005, 31–52.

xv

ACKNOWLEDGMENTS

Illustrations of the Tibetan medical paintings on embryology are printed here
from images held by the Tibetan and Himalayan Digital Library, made available
under the THDL Public License. These photographs reproduce the collection of
paintings held at the Museum of Medical History at the Traditional Medicine
Factory on Nyangré Road in Lhasa. An entire set of medical paintings (slightly
different in detail than those presented here) are beautifully reproduced in
Gyurme Dorje and Fernand Meyer, eds. Tibetan Medical Paintings: Illustrations
to the “Blue Beryl” Treatise of Sangye Gyamtso (1653–1705), 2 vols, New
York: Harry N. Abrams, Inc. Publishers, 1992.

Tibetan transcription and transliteration
This book uses the system of phonetic transcription of Tibetan words that is
described at the Tibetan and Himalayan Digital Library’s “THDL Simplified
Phonetic Transcription of Standard Tibetan,” by David Germano and Nicolas
Tournadre (2003), available at http://www.thdl.org/xml/showEssay.php?
xml=/collections/langling/THDL_phonetics.xml. At the end of this book, a
guide to transliteration of Tibetan provides the exact spelling for each phoneticized term. In the body of the book, when Tibetan and Sanskrit terms are provided in parentheses, the Tibetan term will always be provided first, followed by
the Sanskrit term; Sanskrit terms are preceded by the abbreviation “Skt.”

xvi

1
BECOMING HUMAN IN TIBETAN
LITERATURE

In 1479, the Tibetan physician Kyempa Tsewang suggested that during the early
stages of a woman’s pregnancy, a doctor should recommend certain procedures
to ensure that the fetus will be a boy. On the astrologically auspicious day when
the Victory star and the moon are aligned, he explains, a blacksmith should
create the form of a male child out of three, five or seven types of metal. The
form should be heated in a coal fire until it glows red, and then soaked in the
milk of an animal who has given birth to male offspring, measuring an amount
of milk that corresponds to however many types of metal were used. Two handfuls of cooled milk should be given to the woman. Alternatively, he continues,
to achieve the same effect a medicinal concoction, a mixture of Seaberry, grape
and molasses, could be administered to the pregnant woman. Finally, if these
procedures are ineffective or impractical, the woman could try wearing an
amulet. “Make three strands of thread with wool from the right shoulder of a
breeding male sheep,” Kyempa Tsewang explains, “and tie it around her waist
with the tip hanging down.”1
Kyempa Tsewang’s text is a commentary on the Four Tantras, a work that
came to be known in Tibetan medical circles in the thirteenth century and which
is still the most influential textual authority on Tibetan medicine. Kyempa
Tsewang’s treatise is widely respected and studied in the halls of medical learning today, and yet some contemporary readers, Tibetan and non-Tibetan alike,
are inclined to disregard recommendations such as those above. For many, these
prescriptions are artifices now considered unscientific, arcane remnants of a
foreign past. In the fifteenth century, however, Kyempa Tsewang was a leader
among physicians, part of a community who saw these techniques as critical to
medical practice and scholarship. If these intellectuals agreed, during the heyday
of Tibet’s scholarly renaissance, that such therapies were important to medical
practice and knowledge, should we not take them seriously? What was medicine
in the history of Tibet, if its recommendations included magical acts and
amulets?
Roughly a hundred years earlier, an influential religious thinker known as
Longchen Rabjampa composed a long treatise on Buddhist tantric practice.
Early in that work, he discusses pregnancy and gestation. He explains how the
1

BECOMING HUMAN IN TIBETAN LITERATURE

embryo begins to form in the first few days after conception. During the first
days immediately after conception, the embryonic constituents are gathered
together, dispersed, and reintegrated repeatedly by the actions of the natural elements, water, earth, fire, and so forth. On the very first day after conception, he
writes, “an extremely subtle water-element circulatory channel originates by
stretching straight out toward the right side of the woman, roughly the size of
one-hundredth of a horse tail’s hair. During this time, the woman feels cold.” On
the second day, another circulatory channel develops, and the woman feels of
dizzy and sluggish. On the third day after conception, yet another channel
emerges and the newly pregnant woman perspires and feels hot.2
Longchen Rabjampa was a prominent Buddhist scholar not known to have
any training in medicine. His work covers what we may easily agree to be religious topics, such as contemplative and yogic practices and enlightened
experience, and yet we also find a sizable portion of this text devoted to a
detailed discussion of human gestation. Is it surprising to find data on embryology in an esoteric religious treatise? What was religion in the history of Tibet, if
its treatises addressed conception, pregnancy and fetal growth?
This book reflects on these questions, considering a period of history when
Tibetans themselves were negotiating similar matters. With the wide-scale dominance of “Western biomedicine” today, most of us assume we know what medicine is, and what it is that one must know to practice medicine. Topics such as
anatomy and physiology, for instance, are unquestioned as the foundations of
medicine in our day. In this book, however, we will recognize the fact that the
categories of religion, medicine and science are products of particular times and
places. In the past, in the history of Tibet just as in the history of European
thought and practice, the disciplinary boundaries of knowledge were fluid or
fixed in different ways than they are now. All of these terms, and the bodies of
knowledge and action that surround them, have histories, their meanings changing often quite radically over time.

Medicine, science and religion in European thought
The history of disciplinary boundaries in Europe is intricate, and this has been a
matter of interest for thinkers in all times. By the fourth century B.C.E., the Hippocratic school was pondering the role of philosophy in medicine. The writings
of Plato and Aristotle had a strong shaping influence on the formulation of
Greek medicine, and it was an influence that lasted: the discipline of biology in
Europe was largely based on Aristotle until the eighteenth century.3 While the
close relationship of medicine to philosophy has been tolerable for most, medicine’s connections to “religion” have been more problematic. For most historians, ancient Greek medicine was prized as a rational tradition that went beyond
“superstitious” beliefs, which were seen to be part of religion. Until the 1970s,
historians saw in the rationality of Greek medicine a precursor to modern scientific medicine: calling it rational was to say that, like contemporary scientific
2

BECOMING HUMAN IN TIBETAN LITERATURE

medicine, it rejected a superstitious view of demons and gods as agents of harm
and healing, and it fought disease by natural means, such as diet, drugs or
surgery.4 In recent decades, however, with a recognition of the cultural specificity of the very notion of rationality, the history of Greek medicine has been
slowly revised. A distinction between “natural” and “supernatural” is no longer
considered appropriate for the early Greek world. While its influence was
lasting, the elite scholarly tradition of Greek medical texts is seen as but one tradition of knowledge in the Roman Empire and beyond. Temple medicine, for
instance, with its emphasis on prayers and magical healing, is recognized as a
key part of ordinary life for the Greeks.5 Historians now realize that in the
context of healing illness, religion, philosophy, astrology, alchemy, botany,
magic and medicine all intermixed in the thoughts, practices and writings of
various peoples around Europe.
Articulating the connections between the disciplines of religion, philosophy,
medicine and science has been contentious for centuries.6 By the thirteenth
century, these subjects were formally investigated in the universities of Western
Europe. Bringing students from all over Europe to towns such as Paris, Oxford
and Bologna, medieval universities focused learning on four faculties, an arts
degree forming a preliminary stage for professional degrees in theology, medicine or law. All university students were therefore similarly trained in the disciplines of the arts, which included a natural philosophy largely based on
Aristotle.7 While university educated Europeans received a comparable core
schooling, defining the differences and interactions between these subdisciplines remained problematic, particularly when it came to the relationship
between theology and science.8
While much has been written about cross-disciplinary scholarly exchange in
Europe, less is known of such interactions in Asia. As in medieval Europe, large
monastic universities in Tibet united students from around Central, East and
South Asia to master a complex corpus of scholarly learning on topics as wideranging as logic, grammar, religious practice and medicine. This book will consider how portions of that vast body of literature came to be defined and
differentiated during this formative period in Tibetan history.
The study of Asian medical traditions and their connections to religion has
been troubled by a heritage of learning that divided disciplines of knowledge in
particular ways. In European scholarship, Asian religions were initially defined
under the cloak of an Enlightenment concept of religion that placed emphasis on
the cognitive, intellectual and doctrinal elements of religious traditions. With the
nineteenth-century emphasis on rationality, and with the increasing availability
of information about non-European religions from missionaries, cognitive
accounts of religious belief, akin to a scientific description, served to objectify
religion. The idealization of rationality used to define philosophical and other
forms of scholarly thinking affected early Indologists such as Frauwaller, who
attempted to prove Indian thought to be unconcerned with soteriology, for
example, or Matilal, who tried to show Indian thought to be purely “scientific.”9
3

BECOMING HUMAN IN TIBETAN LITERATURE

Today, many scholars have noted that the epistemological frameworks that
shape our conception of Asia and Asian religions are themselves shaped by the
polemics and ideological concerns of our scholarly forebears. This is a cloak we
have yet to shed. To this day, texts classified as medical or scientific are rarely
consulted in the study of Indian religion. The study of Indian medicine largely
consists of non-analytical descriptions aimed at identifying effective medical
healing techniques. Some presentations of Ayurveda are still colored by the
desire to prove it a “secular” and “empirically objective” science, and many
translations from Sanskrit of seminal Ayurvedic treatises are purged of
“magical” or “superstitious” elements that might lend doubt to the scientific
authority of the system as a whole.
For historians studying the relationship between science and religion generally, such a reading of present concerns into the past is known as “presentism.”
Today, however, influenced by the work of feminist and other theorists, this
strategy has been largely dismissed in favor of “contextualism,” a model that
attempts to look at ideas or events on their own terms or in their own contexts,
to the extent possible. Within this framework, rather than define the boundaries
of Tibetan medicine and Tibetan religion by our own standards, we should
instead try to think about how these lines were drawn by particular Tibetan
thinkers at particular points in history. How did fifteenth-century Tibetan scholars themselves characterize the categories of “religion” and “medicine”? What
sorts of topics did these disciplines contain? How can we describe the interactions between religion and medicine in Tibet at that point in history?

Models of comparison: science and religion, science and
Buddhism
Characterizing the nature of the relationship between religion and science or
medicine has been important to the historians of Europe. These thinkers have
focused on models of conflict, mutual support, complementarity or total separation.10 Recent scholars have criticized the long held dominance of the “conflict
thesis,” which claims conflict to be the defining mode of interaction between
science and religion.11 Richard Olson notes that in the early modern period,
science, religion, law and history all used common language, methods, and concepts; he also observes that publishing scientists and religious thinkers were
often the same individual. Science and religion were linked institutionally as
well as conceptually or biographically, sharing or competing for resources, personnel, authority and prestige. Olson suggests that in general, projects of science
and theology are driven by such differing concerns that a model of conflict is a
misguided stereotype.
Colin Russell traces the expansion of this stereotype over nearly a century of
writings on the relationship of science and religion, suggesting that while certainly there have been conflicts in the history of science and religion, a thesis of
conflict as the defining characteristic in the relationship is inadequate for the
4

BECOMING HUMAN IN TIBETAN LITERATURE

“sensitive and realistic” historiography of science and religion.12 He explains
that the conflict thesis (1) occludes an understanding of any other sort of relationship between science and religion, (2) discounts many instances of a close
alliance between science and religion, (3) emphasizes a Whiggish view of
history as aiming at “victory”, (4) ignores the richness of diversity of ideas in
science and religion, and (5) exaggerates what were historically minor debates to
the status of major conflicts.13 James Moore, likewise, criticizes the conflict
thesis’ “military metaphor” for promoting false dichotomies between science
and religion, scientists and theologians, or scientific and religious institutions.14
While some historians and scientists still accept the conflict thesis, most
historians of science have rejected it as misleadingly presentist, now focusing
instead on a “complexity thesis” that became the dominant methodology in the
1980s and 1990s.15 With the complexity thesis, new studies of science and religion acknowledge a changing and multifaceted relationship between the two,
and also recognize that specific and pervasive definitions for science and religion are unattainable, given that the terms have so many meanings in so many
contexts. In this book I will agree with this position, seeing that in Tibetan
history as in European history, the definitions of science and religion and the
relationships between them are in flux and inherently contextual.
The study of science and religion in European history is well developed.
More recently, scholars have been considering the relationship between science
and Buddhism specifically. In Buddhism and Science: Breaking New Ground, B.
Alan Wallace surveys attitudes on the relationship between religion and science
that emphasize either conflict or connection. At the outset he questions the
applicability of the term “religion” to Buddhism, pointing out that definitions of
religion are based on Judeo-Christian models of religion. Pressing Buddhism
into these molds results in a distorting neglect of many key features of practice
and thought that could, with a broader definition in action, be reasonably considered part of a continuous tradition; classifying Buddhism as religion encourages one to overlook aspects of that tradition that many may consider
philosophy, psychology or science, for example.
For Wallace, science is a method more than a geographically and historically
situated discipline: it is an “organized, systematic enterprise that gathers knowledge about the world and condenses the knowledge into testable laws and principles.”16 With this definition, he reasons that elements of Buddhism are strongly
scientific: “Buddhism, like science, presents itself as a body of systematic knowledge about the natural world, and it posits a wide array of testable hypotheses
and theories concerning the nature of the mind and its relation to the physical
environment.”17 Recognizing the strict disjuncture between religion and science
in both popular and scholarly attitudes, Wallace aims to capture Buddhism from
the scientist’s ghettoization of religion and demonstrate that Buddhism as a
whole spans the Euro-American boundaries of science and religion. By defining
science very broadly as method, moreover, he argues that Buddhism is science.
Taking another tack, but arguing similarly for an expansion beyond the
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BECOMING HUMAN IN TIBETAN LITERATURE

particular limits of science and religion as defined by most Euro-Americans
today, José Cabezón’s essay in Buddhism and Science aims to categorize the
relationship between Buddhism and science in “structural and typological, rather
than in historical, terms.”18 He points out that while in fact the nature of this
relationship has been largely one-sided, such that Buddhism is an object of
scientific inquiry not the reverse, we can nevertheless speak of three modes of
interaction between Buddhism and science: conflict/ambivalence,
similarity/identity, and complementarity. Until the recent scientific interest in
limited aspects of Buddhism, he reports, the relationship has been one of
ambivalence, not conflict, largely because Buddhism was simply “absent as a
serious intellectual option” for scientists.19 More recently, a similarity/identity
model has operated, some writers considering Buddhism to be like science,
others seeing Buddhism to be science. In the last model, that of complementarity, Buddhism and science offer either complementary objects of analysis, on the
one hand, or complementary methods of analysis, on the other. In other words,
Buddhism’s focus on the mind complements science’s expertise with the material world; or, Buddhism offers an ethical or embodied corrective to an ethically
insensitive or disembodied scientific approach. Cabezón is critical of taking
these metaphors too far, however, pointing out importantly that,
Where the metaphor of Buddhism as an inner science is reified, it precludes a dialogue between Buddhism and science on the nature of
matter; it prevents a serious engagement between Tibetan and Western
medicine on the on the physical causes of illness. In short, it acts to
silence Buddhism when it attempts to address any issue related to the
material world.20
Cabezón highlights here a real risk of much contemporary work on Buddhism
and science. If Buddhism is successfully captured as a “science of the mind,” are
the many volumes of Buddhist writing on the material world simply to be
ignored because they are not scientific? And if they are not scientific, does this
mean that they are not “systematic,” not “objective,” and somehow not “true”?
And what about traditions of knowledge and practice that are commonly
referred to as “Buddhist medicine,” such as Tibetan medicine? If Tibetan medicine is considered “Buddhist,” as it often is labeled, is it religion or science? If it
is to be valued by the globalized world of contemporary researchers, it must be
considered science. But what happens, then, to those aspects of Tibetan medicine that do not fall within the contemporary boundaries of science?
Such questions are not merely academic, as these issues have real and powerful effects on human lives and societies. The answers to these questions are
matters of ideology and politics, today as much as in the past. The polemics of
the Buddhism-as-science position, for example, have succeeded in publicizing
the contemporary relevance of Tibetan Buddhism in particular, an important aim
of the current Dalai Lama and others who recognize that for many, “religion”
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points to a static and outdated mode of knowing or practice. One effect of this
position, however, involves the dismissal of the “religious” from Tibetan medicine in the twentieth century. For Tibetan doctors to gain the sort of prestige
accorded to the popular Buddhism–science discussions, they must ally themselves with the science side of the equation, since Buddhism, in the complexities
of that scheme, can be prized only for its expertise with the mind. “Science” in
this dialogue means Euro-American science, moreover, and therefore Tibetan
medicine must be fashioned after that model.
The elimination of Buddhism from Tibetan medicine has, therefore, occurred
not only for Euro-American scholars, as discussed above, but it is also happening for many Tibetans, as has been documented by medical anthropologists.
Vincanne Adams’ work has examined the contemporary preoccupation among
Tibetan doctors with defining what “science” and “religion” are and whether, or
how, Tibetan medicine is science. This discussion has taken on new meanings in
the last fifty years in Tibet, “brought about by recent political and social conditions that have made science a politically safe term at the same time that they
have made religion politically unsafe.”21 Tibet has seen the gradual excising of
content deemed “religious” from the curriculum of large state-sponsored
medical schools, with the “religious” largely defined by guidelines set forth
during the Cultural Revolution; the religious, including superstition and magic,
is politically dangerous, primitive and nonscientific.22 As elsewhere in China,
medical doctors in mid-twentieth-century Tibet were asked to use MarxistLeninist principles of health care that distinguished between “the
religious/superstitious and the materialist/scientific bases of their knowledge,”23
and a generation of doctors was thus trained in a highly simplified version of
Tibetan medicine. In a sense, this worked to the benefit of Tibetan medical institutions, which suffered far fewer deprivations over the ensuing decades than
religious institutions. Ironically, this move also brings Tibetan medicine onto the
world stage as a recognized tradition of medicine that may one day, with adequate research-based publications documenting its efficacy, stand alongside biomedicine.
As is proposed by the science historians’ “complexity thesis,” the relationships between medical and religious traditions are changing and multifaceted,
determined in part by how the boundaries of those disciplines are articulated at
different times, in different places, in different contexts, or for difference purposes. This is not only a phenomenon of modernity, or of European scholarship;
it is also characteristic of the history of Buddhism and medical traditions in
Asia. It is sometimes said that the practice of medicine is fully integrated with
religious concerns in Tibet historically. But it is clear the two have been, in
some way, individual disciplines and genres of literature for centuries. Although
we must certainly be aware that the boundaries of these disciplines are not what
they may be in Europe or North America, still it is the case that these were, and
are, considered distinct disciplines in some sense. Obtaining a clearer understanding of just how these disciplines were understood at different points in
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history in Tibet is one important aim of this book, and we will do this by looking
at embryology, a topic that for many Asian cultures spans the boundaries of
medicine and religion. Tibetans in medical and religious communities alike were
intrigued by the topic of human development, and as we study their perspectives
on how life is created, we will also learn something about how they shaped the
disciplines of knowledge that contextualized those perspectives.

Narratives of embryology
In 1688, Sanggyé Gyatso, the politically powerful regent of the Fifth Dalai
Lama and a prolific scholar in his own right, completed the Blue Beryl. Like the
work by Kyempa Tsewang cited above, this lengthy treatise is also a commentary on the Four Tantras. To accompany his commentary, Sanggyé Gyatso commissioned a series of eighty paintings. Corresponding directly to the chapters of
his text, these paintings illustrate aspects of Tibetan medicine, including detailed
drawings of anatomy and physiology, disease states, medicinal substances, diagnostic techniques and so on. One of these paintings illustrates human conception
and the growth of the embryo.
The story of the embryo depicted in that painting begins with the soon-to-be
mother and father lying in bed, and the mind, or “consciousness,” of a transmigrating being entering the union of their reproductive substances. This is the moment of
conception, an event that requires the confluence of three factors: reproductive substances emitted by a man and woman and a transmigrating consciousness, which is
impelled by its own karma to that particular copulating couple. The text explains
that if the reproductive substances of either the father or mother are faulty – if they
are deficient in one of nine ways – conception will not occur. It also tells us when a
woman is fertile and, moreover, that conception on odd days after the end of menstruation will result in a male child and on even days, a female child. It explains
which aspects of the embryo’s body are formed by which contributing factor (the
reproductive substances of the parents or the consciousness), and how the body is
formed also by the five natural elements (earth, water, fire, air and space).

Figure 1.1 The seventeenth-century painting depicts the moment of conception.

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During the first month after conception, the embryo is transformed from a
substance that resembles curdled milk in week one, to a lengthened and thickened substance in week two, and by week three it resembles the semi-solid consistency of yogurt. After week three, rituals can be performed to transform the
still undetermined sex of the embryo into that of a male. In the fourth week the
embryo will take on a rounded, oval or elongated shape according to whether it
will become male, female or indeterminate in sex. According to Sanggyé
Gyatso’s commentary and the associated images, these first nine weeks of development are known as the “fish stage.”
The next period of gestation, weeks ten through seventeen, is the “tortoise
stage”: text and image describe precisely which aspects of the fetus’ body develops during each of these weeks. In the fifth week of gestation the navel forms,
and a week later the body’s main circulatory channel extends from the navel. A
preliminary form of the eyes develops in the seventh week around which the
head grows the following week. In the ninth week the upper and lower torso
form, followed by the shoulders and hips in the tenth week, the nine orifices of
the body in the eleventh week, the five “solid organs” (heart, liver, kidney,
spleen and lungs) in the twelfth week and the six “hollow organs” (stomach,
small intestine, large intestine, urinary bladder, gall bladder and reproductive
organs) in the thirteenth week. The third phase of development is the “pig
stage,” covering the eighteenth through thirty-fifth weeks. Following that period,
the fetus begins to feel a sense of revulsion at being in the womb, additional
signs of whether the fetus will be male or female are provided and, finally, the
child is born.24
As clear and explicit as this text on early human development and its accompanying images may seem, in fact these details were controversial during the
several hundred years of writing on human development preceding this text.
Examining this controversy will tell us a great deal about intellectual history in
Tibet, much as debates over embryology are a mirror into our own history. In
Europe, embryological theories had a profound impact on the history of ideas,
an influence that was felt in circles far beyond that of biologists and medical
researchers. In the seventeenth and eighteenth centuries, for instance, the question of how the fetus developed was a contentious issue. Some embryologists
favored a theory called epigenesis; others propounded a theory of preformation.
In epigenesis, development of the human form within the womb was sequential,
or cumulative. Conceptual difficulties in this view were centered around the
problem of differentiation: what could be the stimulus that would convert
nothing into something? This question caused many European embryologists of
the late seventeenth and early eighteenth centuries to reject epigenesis in favor
of preformation. In preformation, a tiny form of the human body was believed to
exist from the very beginning of development; some preformationists even
claimed they could see tiny human forms in ova or sperm. Conceptual troubles
with this hypothesis, however, led to two schools of thought: the ovists, who
placed the homunculus in ova, and the spermists who placed it in sperm.
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Problems did not end there – if the homunculus was contained in the egg, then
each homunculus must have another homunculus in an infinite regression, suggesting, in fact, that the entire human race was included in the ovaries of Eve.25
This debate cast its influence widely across European intellectual thought, art
theory and literature. Eighteenth-century Europe saw a radically new orientation
of thought, for instance, that brought about a change from a mimetic theory of
art to an organic theory of art. Critics who searched widely for the origins of this
transformation were led to focus on the importance of embryological research of
a century earlier. Parallels had begun to be drawn between the production of a
work of art and the conception and development of a living organism, such that
organic imagery described the artist’s creativity. Metaphors that drew on the
processes of conception and fetal development were linked conceptually to that
which is naturally conceived and developed. Rather than being manufactured
from artificially conjoined substances and by means of strenuous effort in a fight
against nature, the fruit borne by a means modeled after human conception and
development bears quite different implications.26
In fact, the influence of embryology on intellectual life in Europe stretches
back many centuries. In twelfth-century Europe, theologians used the anatomy
and physiology of the body as proofs for divine perfection and intelligence. Theories of generation and embryology in particular were used in scholastic debates
on a range of theological topics.27 Earlier still, embryology proved an influential,
though controversial, topic for the philosophers of ancient Greece. Plato considered the embryo to be an animal, Hippocrates called it a plant, and Aristotle
explained that in the process of gestation it began as a plant and later grew into
an animal. Emerging Christian thinkers subsequently rejected the thought that
the embryo could be a plant since, of course, plants have no souls. Throughout
the history of European and Islamic intellectual history, the study of the embryo
has been intertwined with religion, ethics and natural science.28
In this book, it is my contention that the history of embryology and its role in
Tibetan scholarly traditions is similarly influential. Discussion of the embryo in
Tibetan literature was not restricted to an isolated group of medical traditions;
rather, the power of embryological symbolism held sway far beyond Tibet,
across the Buddhist world. Tibetan embryological literature provides us with an
array of controversial topics. All Tibetan traditions known today agree that conception occurs upon the confluence of three conditions, as described in the
account above: the two types of healthy reproductive substance from a copulating man and woman, and a consciousness in the postmortem state awaiting
rebirth. When the consciousness finds an appropriate womb, some traditions
claim that it takes hold there by means of the three “destructive emotions” (nyon
mongs; Skt. klesa), attachment, anger, and delusion. Other texts contend that the
transmigrating consciousness experiences attraction to one parent and anger
toward the other, and that it is due to these emotions that the postmortem period
ceases and a new being is conceived. At the moment of conception, some traditions claim that an ordinary transmigrating being loses awareness as it merges
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into the mixture of reproductive substances. Following conception, full embryological descriptions detail thirty-seven to forty weeks of development, with
daily, weekly or monthly records of the process of the psycho-physical body’s
growth. But the details are debated. How precisely does the consciousness enter
the mother’s womb? What exactly is the role of the transmigrating being’s
karma throughout the process of gestation? Which are the primary forces
responsible for directing fetal growth? What is the exact sequence of development of the fetus in the womb? Many of these issues are rooted in complex
philosophical problems that can also be found debated in other contexts in Buddhist religious and philosophical texts. In chapters to come, I will address some
of the contested issues found in Tibetan literature on embryology and consider
their place in the wider context of Tibetan religious, philosophical and medical
thinking and writing.
This book focuses on stories of human development as they begin to appear
in Tibetan texts from the eleventh and twelfth centuries. This includes works
authored by Tibetans from this period onwards, works translated into Tibetan
from other languages, and earlier works that continued to hold great importance.
The centuries preceding these witnessed the break-up of a Tibetan empire that
spanned Central Asia over a period of several centuries, the persecution of
certain forms of Buddhist culture and scholasticism, and a dramatic range of
other social, political and economic transformations across Tibet and surrounding regions. Following these upheavals, a new transmission of Buddhist texts
and other forms of intellectual culture arrived in Tibet from India and neighboring regions, and Tibetans themselves began anew to produce a wide variety of
literary materials. Over the next several centuries, major monastic sites were
transformed into centers for the production, circulation and transmission of
scholastic knowledge of various types, including medical knowledge. The concentration of physicians in monastic and other religious centers and the prominent political position of physicians in those centuries points to an important
relationship between the politico-religious hierarchy and medical scholars and
practitioners of various types. What impact did this relationship have on medical
and religious intellectual histories?
Embryology was an important theoretical topic throughout the history of
Indian literature, and many shared and conflicting views found there were known
to Tibetans of the eleventh and twelfth centuries. During this period, vast
amounts of literature poured across the borders of Tibet. As this transmission of
intellectual culture arrived from neighboring regions, how did Tibetans evaluate
such an eclectic mix of foreign ideas, and how did they adapt these materials to
meet their own concerns? As I assess the significance of embryology across religious and medical literature in the chapters to follow, general questions of cultural transmission and adaptation will also surface. As they wrote, how did
Tibetans determine when originality was acceptable, and when adherence to tradition was required? Intellectual controversy in twelfth-century Tibet was characterized by a concern to uphold India as the ideal authorizing source. Tibetan
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scholars at this time possessed numerous sources with which they could easily
have maintained connection to India, and yet in embryology this link was broken,
as certain embryological concerns – vitally important issues for Indian scholars of
all types – were rendered invisible, and other concerns emerged as significant.
During this tremendously formative period in intellectual history, Tibetans categorized objects of scholarship: some topics required an external legitimating
authority, but for other topics Tibetans themselves could exercise individual discretion. During this process, Tibetan disciplines of knowledge were shaped and
reshaped.

Caveats and approaches
Before going any further, I must pause to make a few comments about what this
book will not be. First and foremost, this is not a comprehensive presentation of
all instances of, and uses of, Tibetan embryology. It will soon become clear that
such a goal would be unattainable, so widely spread are Tibetan embryologies
across the vast expanse of Tibetan literature and practice, and so few are the
sources that have survived for our examination today. Because it is methodologically more my aim to demonstrate “a style of reading” than to present a comprehensive analysis of the entire range of medical or religious attitudes toward
embryology, my sources are selective.29 The results of this examination, therefore, are not intended to be – and indeed cannot be – a definitive history of
Tibetan embryology that attempts to gain a complete vision of the past.
Although my conclusions will have social and historical ramifications, this is
mainly a study of the development and exchange of scholarly rhetoric within
certain literate traditions. As such, I am more concerned with the historicity of
narratives than the historicity of “reality.” As Leslie Kurke expresses it in her
work on ancient Greek coinage and games, the discursive structures of the texts
are themselves the central “facts” under consideration.30
Second, because embryology is written about in the context of many of Buddhism’s most esoteric yogic and ritual practices, a detailed analysis of those religious practices might be expected in this book. In the introduction to his Indian
Esoteric Buddhism: A Social History of the Tantric Movement, Ronald Davidson
similarly anticipates his readers’ desire for discussion of esoteric Buddhist practice in his book, and he refers such readers to the many excellent ritual and
textual studies and translations that address Buddhist ritual, yogic and doctrinal
systems in detail.31 I will refer my readers to these same works, and others as relevant, noting that because this is above all a study of literary expressions of
human development, my treatment of Buddhist contemplative or ritual practices
themselves is necessarily brief.
Third, I would be remiss in not stating at the outcome that there is properly
no such thing as “Tibetan embryology.” Embryology, along with physiology and
anatomy, are sub-branches of the discipline of biology with specific definitions
and histories in Euro-American thought, and they have no direct terminological
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or conceptual correlative in Tibetan. What I am calling “embryology” in this
book is, in fact, referred to in Tibetan literature simply as “how the body is
formed” (lus kyi chags tshul), a topic that typically begins with a discussion of
conception and typically ends with the moment of birth. There is, likewise, no
such thing as a dedicated “Tibetan embryologist,” although I may use this designation to refer to Tibetan authors who write about the formation of the body in
the womb. Indeed, in Tibetan literature there is properly no single, unambiguous
term for “embryo”: that which we call in English both the “embryo” and the
“fetus” is, in Tibetan literature, variously referred to as the “body (lus) forming
in the womb,” as “that which resides in the womb” (mngal gnas), as the “womb”
itself (conflating the term for womb, mngal, with the embryo), or simply as the
“child” (phru gu).
A brief comment about what I mean by “literature” is also required here. In
this book, I ask that our notion of literature go beyond the everyday, but narrow,
sense of its association with fiction alone. Oral narratives aside, the widest, most
neutral and value-free sense of the term literature may encompass a full range of
written material: philosophical or scientific, fictional or non-fictional, academic
or common.32 This expanded definition may go some way toward acknowledging Cabezón and Jackson’s reminder that literature is a Euro-American analytical category that should not be uncritically applied to the Tibetan context, and
that, indeed, until the twentieth century there was not a term in Tibetan that
clearly correlated to the English term “literature.”33 In this book, however, using
the term to refer simply to the wide range of written material available in
Tibetan, I need not grapple with this problem.
Finally, while this is in some sense a history of Tibetan medicine, in this
work I will not engage in significant description or analysis of Tibetan medicine
as a whole, nor will I comprehensively address the content of its sub-disciplines,
such as pharmacology (the study of materia medica, toxicology, and therapeutics), nosology (the study of the classification of diseases), or etiology (the study
of the causes and origins of diseases). As subsequent chapters will show, one
central aim of this book is to demonstrate that Tibetan embryology should not be
viewed solely within the domain of “medicine” (whatever we may mean by
that). We will see, over the course of this work, that embryology defies our
expectations in various ways. Where we might anticipate essential connections
with gynecology, obstetrics or the experience of pregnancy, for example,
Tibetan embryologists will leave us wondering, what are we really talking about
here? The key to answering this question will lie, I believe, in the interpretive
decisions we make while reading.

Medical epistemology and the embryological narrative
With these caveats in mind, I will suggest now that as we examine Tibetan
accounts of human development, we will find that they may be most fruitfully
understood through a form of narrative epistemology, rather than what we
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typically understand to be a scientific epistemology. The term epistemology is
sometimes understood in an exclusively scientistic sense; that is, it often
describes the belief that the foundation of knowledge rests on facts disclosed
through observation and argument governed by rules of logical inference. The
term is also more widely understood to refer simply to how things are known,
focusing on methodological issues involved in the question of what facts are; it
is this wider sense of the term that I mean here. As we considered earlier, conventional epistemology has traditionally been, for most contemporary EuroAmericans, grounded in what is characterized as logico-scientific rationality.34
Logico-scientific discourse functions to demonstrate or prove a statement by
linking it to other statements following the principles of formal logic. Such discourse is founded on logical empiricism, the dominant Euro-American philosophy of science until the 1970s and a model of belief about science that still
persists in many circles today. According to this view, “reality” exists prior to,
and independent of, the effort to understand it or manipulate it, and it is science
that most closely approaches the accurate representation of reality. As Charles
Leslie and Allen Young note in Paths to Asian Medical Knowledge, “This correspondence between reality and the way science represents reality, a match guaranteed by science’s epistemology, makes scientific representations not merely
useful, but also true.”35 The privileging of the epistemology of modern EuroAmerican science affects the study of non-modern, non-Euro-American knowledge systems, however, as it is thereby believed that these systems alone
“culturalize” reality and are thus “untrue.” As discussed above, this attitude is
manifest in many Euro-American writings on Asian medical systems.
Narrative epistemology is an alternative to this sort of logico-scientific rationality. The commonplace impression of narrative is conditioned by the prominent
role of the novel in literary criticism and also, therefore, by the novel’s fictional
truth-status. In the last quarter of the twentieth century, however, many theorists
in the humanities and social sciences have come to view narrative not as “just an
impressionistic substitute for reliable statistics,” but as a valuable way of understanding and explanation in itself.36 Like the historians described above, philosophers of science have challenged logical empiricism, its ontological
privileging of scientific knowledge, and the adequacy of logico-scientific rationality. In its place, some have embraced an understanding of the social and historical contingency of all types of knowledge, including scientific knowledge.
Questioning the validity of logico-scientific discourse, many have accepted
“narrative rationality.” In narrative, principles such as phonetics, rhyme and
metaphoric connection can replace rules of formal logic in producing meaningful truths. In Narrative Knowing and the Human Sciences, Donald Polkinghorne
explains further that narrative is particularly attuned to individual experiences
and their meaning by relating them as parts to a whole, and, by noting sequence
of action, narrative is sensitive to temporal dimensions of human experience.37
Rather than relying on general laws, narrative knowing is called for in realms
where knowledge is particular and rules emerge from individual instances of
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action, as in engineering, navigation, common law, meteorology, moral conduct
and clinical medicine.38 As such, narrative knowing is essential to practical
reason, the means by which individuals and groups make sense of events and
situations and make decisions about how best to act under those conditions.
Prominent theorists like Hauerwas, MacIntyre and Nussbaum have also called
narrative knowing and expression essential to moral knowing.39
What I will focus on in this book is the idea that Tibetan embryology is not
most productively approached as “science” or “medicine” in the way that these
topics have traditionally been understood in Euro-American thought. Rather, I
want to say that embryology – that is, those discussions in Tibetan texts that
focus on the development of the human body from conception to birth – may be
more fruitfully read as narrative. To call embryology narrative is not to call it
fictional, for the narrative form may be used to express information in ways that
are fictional or nonfictional, literary or nonliterary. Over the course of this book
we will see that Tibetan embryologies are narrativized to a greater or lesser
extent, and we will consider why this is so, and what this adds to our understanding of Tibetan writing and interpretation during the centuries in question.
We will also see how these embryologies take advantage of narrative’s qualities
of situated subjectivity and entanglement with time, and its role in practical
reason and moral knowing.
In calling embryology narrative, I am suggesting that it partakes of many of
the attributes we normally ascribe to a story. Hayden White summarizes five
such attributes, most of which can be seen to varying degrees in Tibetan
accounts of human development: a central subject; a well-marked beginning,
middle, and end; peripeteia; an identifiable narrative voice; and the suggestion of
a necessary connection between one event and another.40 In most Tibetan
embryologies, the central subject is the developing embryo; in cases where symbolism is explicit, the subject may alternatively be the contemplative who is
meant to undergo the spiritual transformation described embryologically.
Accounts of fetal development certainly have a well-marked beginning, middle
and end: they invariably begin with a description of conception, always present
some information about the process of development throughout gestation, and
commonly end with the occurrence of birth. The more narrativized embryologies may even possess peripeteia, a sudden or unexpected reversal of circumstances or situation, a common feature in literary works. Many embryologies
have an identifiable narrative voice, commonly that of a religious teacher
(rarely, as we will see, that of a medical clinician); more rarely, the embryo itself
may narrate its experience of conception, gestation or birth. Finally, the details
of conception and development are explicitly about the necessary connections
between one event and another, an essential feature in the narrative form.
Embryology is a particularly interesting object for study as narrative because,
as Daniel Punday has pointed out in “A Corporeal Narratology?”, the human
body is often forgotten in narratology. Punday explains that narratology has
traditionally been interested more in discourse, that is, the manner in which the
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narrative is expressed, than in focusing on the elements that make up the story –
the actual events, actors and places.41 Looking at these elements involves considering how the objects represented in the story shape the narrative that represents
them. Punday does not mean that writers have ignored the human body in individual narratives, but rather that when writers do address the body’s role in narratives – for example, to investigate narrative’s role in defining gender – they do
not generally take the next step and raise fundamentally narratological issues
that may affect and be affected by the body itself. Feminist narratology that links
gender and narratological concepts, for instance, focuses primarily on women’s
social position or subjective experience, and not directly on the bodies that the
narratives represent. Punday defines the central question of a true corporeal narratology, “How do certain ways of thinking about the body shape the plot, characterization, setting, and other aspects of narrative?”42
Hayden White argues that historiography is an especially fruitful ground to
think about the nature of narrativity because it is where the imaginative intersects with the real.43 Like history, embryology is explicitly describing events that
are identified as “real,” rather than those overtly described as “imaginary.” The
“real” and the “imaginary” are, of course, complicated concepts in Buddhism,
but my claim here suggests loosely that, even in Tibetan literature, both history
and embryology are written to express series of events that have actually happened, as opposed to explicitly fictional literature, for example, for which there
is no such explicit or implicit claim made. Still the question remains what the
events described are really meant to indicate. One aim of this book will be to
understand what that reality is for Tibetan embryological narratives. We will
quickly see that this reality may not be the physical reality of the embryo’s
development, as is the case in modern biomedical embryology. It may become
productive, furthermore, to think of embryology as a kind of historical narrative,
an attempt to describe historical events – historical events both at the personal
level and at the cosmological level. Another important part of the historical
narrative, Hayden agrees with Hegel, are themes of law, legitimacy or, more
generally, authority – we will see this to varying degrees in embryology too,
drawing the parallel between embryology and historiography even more finely.
Also part of most historical narratives is the latent or manifest desire to moralize
the events it addresses,44 again a central feature of many Tibetan embryological
narratives.
Certainly, not all histories are narratives. White points to annals, which are
simply a list of events in chronological sequence, or chronicles, which begin to
tell a story but then do not finish it, as examples of historical literature in which
the impulse to narrativize events is ignored. Similarly, Tibetan texts narrativize
embryology to a greater or lesser extent. The earliest Tibetan-authored medical
accounts of human development from the twelfth century follow very closely
the Four Tantras’ spartan account of embryology and have little to add of their
own. By contrast, by the fourteenth or fifteenth centuries, embryologies such as
those by Longchen Rabjampa, Tsong Khapa or Zurkhar Lodrö Gyelpo are
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elaborately embellished and take on a variety of narratological features. There
are also differences in what is narrativized: some writers spend time embellishing the experiences of the embryo in the womb, filling out the embryo’s character. In other texts, it is made explicit that gestation is a metaphor for spiritual
development, and embryology is thus used to narrativize the experience of spiritual development for the contemplative.
There are two interpretive issues that intertwine throughout this book: one,
that of how I am understanding traditions of Tibetan embryology, and two, that
of how early Tibetans understood Indian embryology and developed their own
traditions of writing on the topic. On each of these fronts, I am interested in both
mimesis, the understanding of how an intellectual model or account of an event
is meant to correspond to reality, and hermeneutic, the interpretation of details
and their integration into a coherent story. As I consider whether embryological
knowing can be more fruitfully viewed as a form of narrative knowing than a
form of logico-scientific knowing, embryology appears as a method for truthtelling that expresses religious taxonomies, moral or political reflections, and a
variety of other aims. These are true stories, shaped and articulated by physiological concepts. Far from trivial, they use the human body to address some of
the most fundamental questions of life: who we are, why we are here, and how
we should lead our lives.

Narrative, identity and history
In the next chapter, I will survey the traditions of early human development
found in Indian sources that formed the basis for Tibetan writing on the topic.
Although embryology was discussed in a wide range of Indian sources for a millennium before reaching Tibet, only a small number of those texts were available to Tibetans by the eleventh century. Those that did make it across the
Himalayas represented a fairly disparate range of traditions, however, and
Tibetans were thus introduced to Indic embryologies through Ayurvedic
medical, Buddhist sutric, and Buddhist tantric texts. Chinese sources were presumably available to Tibetans as well, and although I will make note of some
early Chinese accounts of gestation, I have identified no concrete evidence that
these traditions played a role in the development of Tibetan embryological
knowledge.
From these origins, Tibetans themselves began composing a wide range of
literature that contained discussion of early human development. Chapter three
will consider the role of writing on embryology and, more generally, of descriptive presentations of the human body in Tibetan medical literature, beginning
with a look at the historiography of medicine in Tibet. This chapter asks how
historians grappled with the relationship between medicine and Buddhism prior
to the seventeenth century, and how the complex interaction between the two
worlds of thought and practice may be seen in how their boundaries are defined.
What topics were included in the field of “medicine,” and how historically
17

BECOMING HUMAN IN TIBETAN LITERATURE

contingent is this issue? This discussion begins to problematize the role of
knowledge about human development in medical literature, questioning how this
may change over time as Buddhist intellectual frameworks pervade Tibetan
scholasticism more and more thoroughly.
Chapters four, five and six will illustrate connections between embryology
and issues of fundamental importance in Buddhist religious thought and practice, and the ways in which embryology is used as a forum for debating these
issues. In chapter four, I will consider how embryology is used to speak about
human identity, examining descriptions of the human body in different types of
Tibetan literature. Who is the main character in an embryological narrative?
Most basically, of course, the embryo is a body. But what is it that embryological narratives in particular allowed Tibetan narrators to say about the body?
How did Tibetan understandings of the body shape accounts of early human
development? While medical literature focuses on the body’s systemic or
humoral organization and digestive physiology, these are areas of little concern
to religious authors; the body’s circulatory system, on the other hand, is a topic
of great concern to all. Over several centuries of writing on human development
in Tibet, Buddhist models of physiology pervade medical writings, such that
knowing about embryology meant knowing about religion. One effect of this is
the loss of the pregnant woman as a character in narratives of embryology.
Tibetan accounts of human development can be interpreted on various levels.
While on one level the main character is clearly the developing fetus, in some
narratives the fetus is a double for the Buddhist practitioner. Who is signified by
the character of the fetus, if not the physical body itself? In some texts, the fetus
refers to a religious contemplative who wishes to be “spiritually reborn” and
who will, therefore, enact the process of embryogenesis through meditation.
Chapter five’s close examination of the details of gestation will demonstrate that
the composition of embryology in early Tibetan literature was far from straightforward. Despite the twelfth-century Tibetan author’s impulse to form intellectual alliances with India, certain issues within embryology were clearly left to
the discretion of the individual author. Embryological stories depict Buddhist
practitioners of morality and meditation who undertake a soteriological process
of gestation and rebirth. The stories about these characters are various, however:
some tell of the suffering of gestation and agony of birth, and others describe
gestation and rebirth positively as opportunities to reach higher spiritual attainments. This chapter will suggest that embryological narratives are related in
structure and purpose to literature on the Buddhist path. In examining the relationship between Tibetan narratives of gestation and models of the religious
path, I will explore discursive tools used to promote specific religious practices.
This chapter tells stories of transformation that situate the seeds of change in the
origins of the human body.
There is still more to say about how these stories are composed and what they
communicate. In chapter six, I will examine the connections between events in
embryological narratives. What causal elements drive those events? Is it solely
18

BECOMING HUMAN IN TIBETAN LITERATURE

karma? Or are other causal forces at work during gestation? In this chapter, I
suggest that embryology allows Tibetan writers to temporalize doctrinal issues. The
“emplotment” of embryological narratives transforms the events of early human
development into stories with specific rhetorical functions, and it thereby imbues
doctrine with a sense of time. Embryological narratives define certain acceptable
paradigms for change and growth. Over the course of this chapter, by examining
competing models for causation and human growth, we will see that while karma
was vital to some models, others emphasized the power of different psychosomatic
forces to effect change. In this discussion we will observe once again that embryology is at the center of a fundamental Buddhist philosophical issue.
At the same time, I will begin to consider the emplotment of the narration of
Tibetan embryology itself. How did these narratives interact with each other and
with their literary environments during this period of Tibetan history? What
might embryology tell us about the historical transformations of medical and
religious forms of literature? I will propose that religious traditions did not
simply borrow embryology from medical traditions, as is most often assumed –
rather, embryology is most fruitfully a religious topic. For religious writers,
these narratives were a means of embedding doctrinal messages into human
identities: such embryologies are religious doctrines that are narrativized into
human lives. For medical writers too, at least by the fifteenth century, embryological narratives were a forum for religious theorizing – the topic provided a
special context for medical scholars to philosophize about issues of vital importance to Buddhist thought and practice.
If we continue the thought, we might shift focus from narratives of embryology to historical narratives, arguing that there exists an important parallel
between how embryological narratives construct identity and how historical narratives do so. Arguably, if embryology is a narrative that defines individual identity, history is the narrative that defines social or institutional identity. Can we
see any parallels between models expressing human identity and models
expressing social identity? What are the organizing themes of medical histories
in Tibet, for example, and how are their characters described? As is the case in
embryological narratives, in historical narratives we see an emphasis on geographic and geometric conceptualization, for instance. The cyclic “moraltemporal structure” that is based on the evolutionary narratives of Buddhist
embryology appears as the foundation for the plot of Tibetan historical narratives too. Notions of ethics, causality and identity shape the creative construction of social history through historical narratives just as they do the creative
construction of personal history through embryological narratives. Embryological and historical narratives alike appear to be concerned above all with explaining discontinuity as continuity, with making the discontinuous continuous. In the
epilogue, therefore, I will gesture toward a new direction of thought, suggesting
that just as it is of limited value to read embryological narratives only for
information on how embryos grow, there is likewise much more to be understood from a historical narrative than simply what events occurred.
19

2
THEORIES OF HUMAN
DEVELOPMENT

In the Ayurvedic Compendium by Caraka (Carakasamhita), the chief medical
theoretician, Punarvasu Atreya, advises an assembly of philosophers, “Do not let
yourselves become embroiled in complex arguments and counter-arguments nor
let yourselves pretend that truth is obvious and easy to attain if one adheres to a
single philosophical position.”1 Although Caraka’s Compendium is one of the
most influential medical treatises in South Asia, in this book we will see that
Punarvasu’s advice to eschew “complex arguments” was rarely heeded. The
Compendium is generally said to date from the third or second century B.C.E.,
although it went through several centuries of revision subsequently. During the
same period, many primary issues in Indian philosophy were also being debated,
including the problems of salvation, selfhood, rebirth and karma. One of these
contentious issues was the question of how the human being develops.
In early Indian literature, the development of the human body in the womb is
described as a progressive layering of material elements. According to Caraka’s
Compendium, in the first month of gestation the embryo is gelatinous in form,
described using the Sanskrit term kalala. In the second month, it becomes
thicker, or more solid, a state referred to as ghana. If it is a male, it is shaped
like a tight ball (pinda), if it is female, it appears more elliptical (pesi), and if its
sex is indeterminate or other than male or female, it is like half a sphere
(arbuda). In the third month the limbs begin to bud and the sense organs appear.
In the fourth month, the fetus becomes denser and more compact, and in the fifth
month it grows larger. The sixth month sees the fetus strengthen, and in the
seventh month it is complete. In the eighth month it begins to draw strength or
vitality (ojas) from the mother, and between the ninth and tenth months it is
delivered.2 Many South Asian embryological accounts are similarly structured,
recording primarily which parts of the embryo develop in what order, but Indian
writers disagreed about the exact sequence of development. Debates over the
embryo’s developmental sequence were not held among physicians only, but
were spread across the full range of Indian scholarship. With elaborate rationalization, some said the head appears first (because it is the seat of the senses),
while others prioritized the heart (as the seat of consciousness), the navel (as the
place where food is stored), the intestines (as the seat of air), or the hands and
20

THEORIES OF HUMAN DEVELOPMENT

feet (as the principal organs). Some argued – like the preformationists centuries
later in Europe – that all parts of the body are perfectly differentiated from the
moment of conception, and that they simply grow larger during gestation.3 In the
chapters to follow, we will see that for Tibetan writers, although the divergence
of opinion on the issue of sequence of development is less radical than for their
Indian predecessors, the question of how the body grows is still of intense
interest.
The question of when consciousness emerged was also disputed in Indian
literature. Classical Ayurvedic accounts, such as Caraka’s Compendium, imply
that it is active right from the moment of conception, while other traditions
suggest that it appears only later in fetal development: in the Garbha Upanisad,
a soul comes to the embryo after a gestation of seven months, and Puranic texts
locate the time of consciousness entering the fetus in the seventh to ninth
month.4 In many traditions of South Asian embryology and in some Tibetan traditions, as we will see, the fetus is said to have conscious experiences, at least
toward the end of its stay in the womb, experiencing feelings of suffering,
memories of past lives, and even sentiments of religious devotion.
Sequence of development was but one of many issues central to the study of
human development that were of concern not only to biologists, but to philosophers and religious thinkers too. In the context of embryology, philosophers
discussed the causes of the formation and development of the fetus, they questioned the precise roles of the natural elements, the soul (Skt. atman) and the
mind (Skt. manas), and they pondered how transmigration occurred and the role
of karma. In thinking about the process of transmigration, Indian scholars were
confronted with the problem of the subtle body: what exactly was it that transmigrated? Surendranath Dasgupta summarizes these debates in his History of
Indian Philosophy. For Samkhya philosophers, the subtle body, necessary as the
physical support of an individual’s mind during the interval between death and
rebirth, travels from life to life, becoming associated with the mind “like an odor
is attached to a cloth,” until the mind disassociates from it by attaining true
knowledge. Caraka’s Compendium refers to a non-physical factor that connects
the soul with the body; Susruta’s Compendium, another Ayurvedic classic, also
refers to a being that, urged by karma, enters the womb for rebirth. By contrast,
according to Vaisesika philosophers, who do not posit a subtle body, the influence of uterine heat works on the combination of parental substances, producing
successive degeneration and regeneration until a fetal body develops. The mind,
which requires a supporting body, enters the fetus only later in gestation. The
Nyaya discuss this issue as well, also rejecting the existence of a subtle body
and positing an “all-pervading” soul that takes its place in the new fetus.5
Inherent in debates over the mechanics of transmigration is also a question
about the role of karma – or other causal forces – in propelling a being to a
particular womb. Contemporary scholars theorize that early South Asian thinking understood karma mainly as an agent in the realm of sacrificial rituals, which
were themselves ultimately responsible for creating a new being.6 Only with a
21

THEORIES OF HUMAN DEVELOPMENT

later “ethicization” of karma, where the quality of a new life was directly determined by the quality of previous actions, did the doctrine of karma come to
encompass all actions. Steven Collins explains that, “If one’s entire life is a sacrificial performance, then every action will have the results which sacrificial
performance has – that is, every act will have its effect on the next life.”7 He
attributes much of the responsibility for this transformation, a radical move that
led to “the internalization of the sacrifice in the life of the renouncer,” to the
doctrine’s interaction with Buddhism.
According to Caraka’s Compendium, the union of male reproductive substance and female “blood” only produces a fetus when “the atman with its subtle
body, constituted of air, fire, water, and earth, and manas . . ., becomes connected
with it by means of its karma.”8 The early Indian Buddhist thinker Vasubhandu,
likewise, explains that the transmigrating gandhabba about to enter the womb is
impelled by karma to do so. We will see in the following chapters that in some
Buddhist texts karma empowers the energetic “winds” that create the embryo
during gestation and then expel the fetus from the womb. In Indian tantric texts,
karma is responsible for bringing together the first circulatory channels of the
embryo’s psycho-physical subtle body. Karma is said by some to determine the
sex of the child during gestation. At the same time, however, many texts prescribe rituals to be performed early in development that will overpower this
karmic action in the fetus, thereby ensuring the birth of a boy child. The presence of such rites confirms that for the Hindu and Buddhist medical traditions
stemming from Caraka, karma is not an immutable force, but rather something
that can be affected by human actions. I will return to this issue in Chapter 6.
In early Indian medicine, sequestering a patient in a womb-like cave was
prescribed in order to restore a lost equilibrium between the body and the universe. Ayurvedic theory claimed that in the womb the human being experienced
the perfect functioning of the three dosa – translated variously as “humors,”
“faults” or “systemic processes” – and exposure to the outside world and its
fluctuating climate of elements was said to throw this balance off, ill-health
requiring, therefore, a return to a figurative womb. This medical treatment was
applied also to spiritual imbalances: religious initiation practices (Skt. diksa)
called for sequestering the initiate in a closed hut, from which he or she is subsequently “reborn.”9 As David White points out eloquently, initiation into a religious order in this manner thus “biologically” links members of the order to
each other, as all are reborn of the same womb.10 Indeed, as far back as the
Vedic Brahmanas, sacrificial rites prescribe isolation in preparation for ritual
rebirth. We will see in Chapter 5 that detailed religious contemplative practices
modeled after the processes of human conception, development and birth are
also present in a wide range of Tibetan Buddhist tantric works, no doubt
derived from these older Indian traditions and yet articulated in ways that are
uniquely Tibetan. In tantric traditions, procreative metaphors are brought to the
fore. The study of early human development provides the tantric yogi with an
accurate description of the erroneous developmental path of an ordinary being,
22

THEORIES OF HUMAN DEVELOPMENT

and this knowledge is the key to learning to repeat this process without committing such error. The womb symbolizes an ultimate enlightened space in tantric
Buddhism, although, as we will see, this glorification of female anatomy and
physiology has little to do with real women.

Indian medical sources for human development
As Tibet was flooded with aspects of Indian culture in the eleventh and twelfth
centuries, it was not only Buddhist texts that captured their attention – a number
of Indian medical texts also crossed the Himalayas into Tibet to contribute to the
fervor of teaching and writing taking place at the time. In the context of this
increase of scholastic activity in Tibet, Indian Ayurveda was established with an
unmatched place of influence in the history of Tibetan medicine.
Classical Indian Ayurveda is closely related to a range of philosophical
systems, the Nyaya-Vaisesika and Samkhya schools playing perhaps the largest
roles. Ayurvedic theory is also influenced by yoga traditions concerned with
controlling the mind and senses and avoiding excess, and by early tantric principles emphasizing the body and the structural equivalence of macrocosm and
microcosm. The conceptual systemization of these philosophical systems into
medical theory owes much to medical treatises commonly attributed to three
scholars, Caraka, Susruta, and Vagbhata, known as the great trio of classical
Ayurveda, although the actual identity of these figures is contested.11 The
works ascribed to them are still considered the seminal literature of the
Ayurvedic tradition today. Caraka’s Compendium contains one hundred and
twenty chapters divided into eight main sections, or “books”: Sutrasthana, a
general synopsis (thirty chapters); Nidanasthana, on pathology (eight chapters);
Vimanasthana, on tastes, the systemic processes (Skt. dosa), and classifications
of patients, physicians, and textbooks (eight chapters); Sarirasthana, on the
human body, including anatomy, reproduction, and midwifery (eight chapters);
Indriyasthana, on prognostic technique (twelve chapters); Cikitasthana, on
treatment of disease (thirty chapters); Kalpasthana, pharmaceutical formulae
(twelve chapters); and Siddhisthana, on various therapeutic measures (twelve
chapters).12 We will see that the structure of Caraka’s Compendium is closely
followed by Vagbhata and, to a degree, by the Tibetan medical text, the Four
Tantras, as well.
The basic assumptions of classical Ayurvedic thought include the idea of the
material constitution of human nature (Skt. pañcabhuta) and the notion that
human behavior is based on the three “systemic processes” or “humors” (Skt.
dosa). The former is closely related theoretically to the Nyaya-Vaisesika philosophical system, and the latter to the Samkhya. The mechanics of transmigration
and early human development are discussed in the first chapter of Caraka’s
fourth major section, the Sarirasthana, with a cosmological bent that is clearly
Samkhyan in inspiration. The chapter begins by outlining the twenty-four
Samkhya principles (Skt. tattvas), and in his commentary on the Caraka verses,
23

THEORIES OF HUMAN DEVELOPMENT

Cakrapani cites Samkhya texts, the Samkhyakarika in particular, as authoritative
sources. The root verses are explicit about their debt to Samkhya; an explanation
of the best way to attain salvation, for instance, concludes with the line, “This is
what the yogins, the virtuous ones, the followers of the Samkhya system, and the
liberated ones say.”13 Even a cursory examination of classical Ayurveda makes
clear the overt connections between medical and religio-philosophical traditions
in India.
The second author in the trio of classical Ayurvedic authors, Susruta, is also
responsible for a Compendium (Susrutasamhita), which is similar in structure to
Caraka’s treatise.14 Susruta’s Compendium is renowned among Ayurvedic texts
for its study of surgery, although it deals comprehensively with all branches of
Ayurveda. Despite their fundamental importance in the history of Indian medicine, however, the works of Caraka or Susruta are not cited in Tibetan literature
on early human development prior to modern times.
In Tibet, the most influential Indian medical text with a presentation of
early human development is the Heart of Medicine Compendium (Astangahrdayasamhita, Tib. Yan lag brgyad pa’i snying po bsdus pa) attributed to the
third great author of classical Ayurveda, Vagbhata. This work is considered the
“greatest synthesis of Indian medicine ever produced,” and formed the basis of
medical education across a wide expanse of South and Central Asia as it was
translated into Tibetan, Arabic and other languages.15 Little is known about the
identity of this text’s author, although most scholars attribute the text to a
seventh-century figure with Buddhist tendencies.16 His text and its Indian
commentaries, along with other medical texts that were not sources for early
human development but for other medical topics, were included in the Tibetan
Buddhist canon, and they form some of the primary sources for later Tibetan
studies of early human development.17
Similar in structure to the treatises of Caraka and Susruta, Vagbhata’s Heart
of Medicine has 120 chapters. The Sarirasthana, its section on the human body,
addresses conception and fetal development, disorders of pregnancy, parts of the
body (anatomy and physiology), classification of vital points, signs of death, and
dreams and omens. The first part of this section covers topics such as the formation of the embryo, determination of the embryo’s sex, menstruation, the features of healthy reproductive fluids, fertile periods, ceremonies for conception in
general and conception of a male child in particular, features of a pregnant
woman, the sequence of fetal development, practices of labor and delivery, and
postpartum care. As we will see, the structure of this section is loosely replicated
by the Tibetan Four Tantras and most medical texts on the body in Tibet subsequently. Despite this work being one of the most widely cited sources in Tibetan
medical literature, however, and is, in fact, the very basis of much of Tibetan
medicine, we will see in that in many respects its authority is disregarded in the
study of early human development.
The Heart of Medicine reached Tibet by the eleventh century and was translated by the prolific translator Rinchen Zangpo (957–1055). Two Indian
24

THEORIES OF HUMAN DEVELOPMENT

commentaries of this work were also quickly made available to Tibetans.18
Rinchen Zangpo studied and translated the works of Vagbhata and his commentator Dawa Ngönga, and he taught them to a scholar who carried on this tradition by passing it through a lineage of students.19 The famous Tibetan physician,
Yuthok Yönten Gönpo (1112–1203), is said to have relied on this text especially
as a guide in his medical practice for the first part of his life, until he received,
edited, and made public the Four Tantras.20
The Heart of Medicine chapter on conception and fetal development is short,
and much of its detail is reproduced in the Four Tantras, although we will
examine in later chapters some significant differences. In the Tibetan canonical
version of the Heart of Medicine’s account, as in the Four Tantras, conception
occurs when the transmigrating consciousness is impelled by its own karma into
the union of male and female reproductive substances (using the Tibetan terms
khu ba and khrag, respectively). Prefiguring one of several Four Tantras theories on sex determination, Vagbhata notes that when the male substance dominates in volume at the moment of conception, the embryo will be male, when the
female substance dominates, the embryo will be female, and when both are
equal, the embryo will become a child of indeterminate sex. Defects in the male
or female reproductive substances may result in an imperfect fetus or an inability to conceive; medicinal remedies for these problems are suggested, and the
characteristics of healthy reproductive substances are also described. The proper
time for conception is addressed with an explanation of when menstruation
occurs and when a woman is fertile, and the text notes that pregnancy for a
woman who is less than the age of sixteen will result in an ill or defective fetus.
Certain ceremonial methods of intercourse are also recommended for those who
wish to conceive a male child.
Once conception has occurred, the Heart of Medicine describes medicinal
concoctions to be taken during the first month of pregnancy to ensure the production of a male child, and certain behaviors and foods that are to be avoided
by the pregnant woman to ensure the growth of a healthy fetus. As pregnancy
progresses, the text details the effects the condition has on the woman, and how
she should be treated. Finally, methods for labor, delivery and postpartum care
are considered at some length.21 While there is some discussion of the development of the fetus’ body during gestation in the Heart of Medicine, the text is
more centrally focused on describing the conditions of pregnancy and care of the
pregnant woman. Although the Heart of Medicine forms the basis of Tibetan
medicine for several centuries after its arrival in Tibet, we will see in chapters to
come that its emphasis on pregnancy and the experience of the woman is all but
lost in later embryological accounts there. This omission becomes more striking
over time, as centuries of Buddhist cultural authority replace the concerns of
Indian medicine with those of a Buddhist literature in which women are marginalized at best, or, at worst, ostracized or even eliminated.

25

THEORIES OF HUMAN DEVELOPMENT

Early human development in Indian Nikaya and
Mahayana Buddhism
Discussion of these topics was not limited to Hindu philosophical and medical
schools of thought, and the mechanics of conception and the process of fetal
development were also of interest to a wide range of early Indian Buddhist
writers. Because these sources have been studied elsewhere, here I will only
mention a few such issues.22 It is well known that many Pali Buddhist works
include accounts of fetal development, but the details vary widely. The Samyutta
Nikaya, for instance, outlines five stages of development, using the traditional
terms kalala, abbuda, pesi, ghana and pasakha, each stage lasting a week; the
Visuddhimagga, by contrast, mentions only four stages. Asanga’s
Yogacharyabhumi offers yet another arrangement of the stages. While the
Samyutta Nikaya uses the term pasakha to describe the fifth stage of embryonic
development, accounts in the Vinaya use the same term to refer to the embryo’s
lower body.23 The question of whether the intermediate being has a body – and
what that might mean – was also a topic of contention for Buddhists. Among the
so-called Eighteen Schools of early Buddhism, O. Wijesekara comments that
Sammatiyas, Pubbaseliyas, Sarvastivadins and Vaibhasikas affirmed the necessity of a corporeal being, while Mahasamghikas, Ekavyavaharikas, Kukkutikas
and Lokottaravadins did not.24 Also debated was what exactly this being should
be called. For many Buddhists, terminology that might have derived from early
South Asian atman theories, implying a permanent and unchanging being or
“self,” was unacceptable. Some Indian Buddhists settled on the term vijnˇana,
most often translated as “consciousness,” to denote the transmigrating factor;
Wijesekara points to the use of this term in the Digha Nikaya’s account of
rebirth, for example.25 He also considers the possibility of another factor in conception, pointing out that the Mahatanhasankhaya Sutta of the Majjhima Nikaya
states that the presence of a being called gandhabba is required for conception
to take place; Buddhaghosa clearly states that this reference to gandhabba is to a
being about to enter the womb. As McDermott explains, this is not an
“intermediate-state being,” which exists in the state between death and rebirth,
for Theravadins were opposed to this position. Instead, Theravadins proposed a
“rebirth-linking consciousness” (Skt. patisandhi vijñana) that arises newly at the
moment of conception, linked causally to the previous lifetime “like a sound and
its echo,” according to Buddhaghosa.26 Most of these canonical Buddhist texts
were well known to Tibetans as they began their own traditions of writing on
early human development. How did they resolve these differences? Or did they?
If they did not, what may this tell us about embryology as a topic of intellectual
discussion?
Among the most influential treatments of human development from early
Indian Buddhism are those of Abhidharma literature, presented clearly in the
fifth-century work by Vasubhandu, the Commentary on the Treasury of the
Abhidharma (Abhidharmakosabhasyam). Abhidharma literature forms the foun26

THEORIES OF HUMAN DEVELOPMENT

dation of Buddhist philosophy throughout the Buddhist world, comprising many
volumes in Chinese and Tibetan translations of the Buddhist canon. So important is this body of literature that it forms an independent branch of the canon,
which is known as the “Three Baskets” (Tripitaka): the sutra basket is said to
record the words of the Buddha himself, comprising teachings often presented as
stories; the vinaya basket describes the code of monastic regulations for monks
and nuns; and the abhidharma basket consists of a later collection of scriptures
focused on systematizing Buddhist religious and philosophical doctrines.
The Commentary’s discussion of human conception and fetal development
occurs in its third chapter, “Exposition of the World” (Lokanirdesa), which is a
presentation of the physical world, including its various hells and heavens, and
its inhabitants. Citing liberally from various sutras (few of which are identified
by name), Vasubhandu’s text is a compilation of early Buddhist views from a
range of sources. The “Exposition of the World” begins by introducing the different types of beings and the various realms of rebirth. Here a Buddhist sutric
theory of four modes of birth is presented: beings may be born from eggs (sgong
skyes, Skt. andaja), from wombs (mngal skyes, Skt. jalabuja), from heat or
moisture (drod skyes, Skt. samsedaja), or from “space” (rdzus skyes, Skt. opapatika). Beings of this fourth category are also referred to as miraculous births or
as apparitional beings, and Vasubhandu defines them as “those beings who arise
all at once, with their organs neither lacking nor deficient, with all their major
and minor limbs.” These beings appear without conception and gestation, and
include supernormal entities such as gods, hell creatures and intermediate state
beings. Curiously, humans may be born in each of these four manners, and the
text cites examples of legendary men of each type.27
The next section of the text is a long discussion of the intermediate state, the
phase between death and rebirth. Here Vasubhandu defends the existence of the
intermediate state and discusses its nature, a contentious topic among early
Indian Buddhist schools that has been well studied.28 Following this topic, the
mechanics of reincarnation are addressed. Vasubhandu explains that the male
intermediate state being is attracted to the female member of a copulating
couple, and a female intermediate state being is attracted to the male member of
the couple. The moment of conception is described as follows:
When the mind is thus troubled by these two erroneous thoughts, it
attaches itself through the desire for sex to the place where the organs are
joined together, imagining that it is he with whom they unite. Then the
impurities of semen and blood are found in the womb; the intermediate
being, enjoying its pleasures, installs itself there. Then the skandhas
harden; the intermediate being perishes; and birth arises that is called
“reincarnation” (pratisamdhi). When the embryo is male, it remains to its
right in the womb, with its head leaning forward, crouching; female, to
the left of the womb, vagina forward; with no sex, in the attitude in
which one finds the intermediate being when it believes it is having sex.29
27

THEORIES OF HUMAN DEVELOPMENT

This particular emotional impetus for conception is attributed to beings who are
born from wombs or eggs; beings born from moisture, by contrast, are attracted
to the odors of a new rebirth site, and apparitional beings are motivated by
desire for a particular sort of location.
Next, Vasubhandu explains that, according to sutric sources, there are four
ways to enter into, abide within, and depart from the womb, depending on the
level of merit achieved by the transmigrating being. Beings of least merit are
unaware of the entire process of conception, gestation and birth. Beings with
somewhat more merit are aware of the moment of conception, but are then
“unconscious” during gestation and birth; this type of being “has a great outflowing of merit and he is made resplendent through actions” and will become a
Cakravartin. The next type of being is aware of conception and gestation but not
birth; he or she has “knowledge obtained through instruction, reflection and
meditation” and will become a solitary realizer. The final type is aware of all
phases of the process, has “both action and knowledge” and will become a
Buddha.30 Robert Kritzer emphasizes this presentation as an important contribution by Vasubhandu. “Vasubandhu’s purpose in including the four
garbhavakrantis,” or modes of entering the womb, Kritzer writes, “is to complete the account that is left unfinished by the older abhidharma descriptions of
conception, which only deal with the ordinary, i.e., spiritually unaccomplished,
person.”31
Addressing the suggestion that a transmigrating being must necessarily be a
“self” (atman), a notion that is anathema to Buddhist doctrine, Vasubhandu then
describes the process of gestation in the context of the Buddhist theory of interdependent arising (pratityasamutpada). “Growth is gradual,” Vasubhandu comments simply, and he cites a scriptural source that lists the five stages of the
embryo:
There is first the kalala; the arbuda arises from the kalala; the pesin
arises from the arbuda; the ghana arises from the pesin; and from the
ghana there arises the prasakha, hair, body-hair, the nails, etc., and the
material organs with their supports.32
After this very brief nod to the issue of fetal development, the text moves to a
long and detailed recounting of debates between early Buddhist schools on interdependent arising. The remainder of the chapter addresses such topics as the
physical world and hells, the lifespan of different types of beings and the occasions for the appearance of Buddhas and other beings in the world.
Vasubhandu’s Commentary was a foundational text in Tibet, as in all Buddhist cultures, and Buddhist writers of all sectarian affiliations refer to abhidharma theories as authoritative in matters of embryology. The abhidharma
presentation on the topic is succinct, however, serving ultimately as a starting
point, or root text, for much more elaborate embryological narratives in Tibetan
literature. Vasubhandu’s text is a compilation of existing early Indian views on
28

THEORIES OF HUMAN DEVELOPMENT

the topics at hand. Its treatment of human conception and fetal development is
therefore neither the only, nor the earliest, such account in early Buddhist literature. On the contrary, embryology was of interest in a range of early Buddhist
texts, many of which made their way into the languages of China, Central Asia
and Tibet to form the basis of new writings on the topic in those regions.
A closely related set of Buddhist sutras, canonical texts cited as the speech of
the Buddha himself, stands out among these as the most widely-cited source in
Tibet for topics concerning early human development. This set of texts, now
extant only in Tibetan and Chinese, are found with the titles Sutra of Teaching
Nanda about Entering the Womb and Sutra of Teaching Nanda about Abiding in
the Womb. Although Sanskrit originals for these works are missing, there are
several extant Chinese and Tibetan translations, the earliest being a Chinese
version from the period of the Western Chin dynasty (CE 265–317).33 Tibetan
versions of the texts are included within the “Jewel Mound” (Dkon brtsegs, Skt.
Ratnakuta) classification of the Kangyur section of the Tibetan Buddhist canon,
and curiously a version of the text is also found as part of the Mulasarvastivada
Vinaya. A comparative study of the Tibetan versions by Lalou and several
detailed articles comparing Chinese versions by Kritzer address general differences between these works.34 Both Tibetan “Jewel Mound” texts appear to have
been translated into Tibetan from Chinese by the Dunhuang translator Chödrub
in the mid-ninth century. Lalou, when comparing the two, concludes that it is
unlikely that they derive from the same original,35 a suggestion that my examination supports as well; additional studies of the Chinese works may clarify this
issue. Despite the existence of several translations in the Tibetan canon, interestingly, in later Tibetan discussions of this sutric tradition, I have not seen
acknowledgement of those different versions: they are referred to as if they were
a single work. I will, in general, follow this convention myself, therefore, and
refer simply to the Entering the Womb sutra, leaving the text critical scholarship
of comparing translations to other studies.
In this Mahayana sutra, the Buddha is asked by his younger brother Nanda to
explain the factors necessary for conception and the entire developmental
process. The Buddha begins by explaining the suitable conditions for conception:
If a father and mother have intercourse with desirous intention, and the
mother’s womb is totally healthy and she menstruates regularly, and the
aggregates of the intermediate state being are present, at that time it is
possible [for the transmigrator] to enter the mother’s womb.36
The Buddha next describes what the intermediate being may look like, followed
by a discussion of what it means to menstruate regularly. Several reasons for
failure to conceive are outlined. The health of the mother’s womb is important to
successful conception, and this topic is elaborated upon at length: conception
will not occur if the mother’s uterus is afflicted by any of a long list of
29

THEORIES OF HUMAN DEVELOPMENT

conditions, such as possessing defects of wind, bile, phlegm, or blood; being
filled with fleshy growths or medicines; being shaped like an ant’s waist, the
mouth of a camel, the axel or hub of a chariot; and so forth.37 This discussion is
followed by a description of the moment of conception that is similar to that of
abhidharmic and other sutric traditions:
If the womb of the mother is totally healthy, if the intermediate state
being sees the act of intercourse, if the [disease] conditions described
above are absent, and if the father, mother and child have the karma to
come together, then the intermediate state being will enter the womb.
When that intermediate state being enters the womb, moreover, mental
distortions (sems phyin ci log) will arise [in that being]: if it is a male,
desire for the mother and anger toward the father will arise; if it is
female, it will desire the father and feel anger toward the mother.38
The sutra explains that intermediate state beings will experience the moment of
entering the womb in different ways according to their karmic inheritance, with
some feeling as if they are entering a splendorous mansion and others feeling as
if they are slipping through a hole in a wall. The Buddha then describes the
initial embryonic mixture of the male reproductive substance, the female reproductive substance and the transmigrating consciousness, as well as the importance and particular roles of the natural elements on the embryo. After a detailed
week-by-week account of fetal development, the Buddha discusses the physical
and mental suffering of the new child that begins right after birth and the importance of religious practice as the means to escape suffering. The sutra addresses
the length of life, the inevitability of disease, the basis of suffering and the
importance of renouncing mundane pleasures in favor of religious practice.
Again similar to Vasubhandu’s account, the experiences felt by four types of
beings when entering, abiding and exiting the womb are presented, followed by
a discussion of the superiority of a human life, the suffering of other life forms
and, again, the importance of religious practice. The Buddha’s discourse closes
with the instruction to seek liberation from rebirth by understanding the impermanence of human existence.
It is clear that the details of conception and gestation in this text are presented
in the context of a Buddhist soteriology. As in Vasubandhu’s account, but unlike
Ayurvedic presentations, the experience of the pregnant woman is all but
ignored here. While the sutric tradition of gestation is more densely descriptive
than the fairly terse abhidharmic version, still the framing context for these
accounts – or the purpose of these stories – is the presentation of a Buddhist
teaching on impermanence and suffering. As we will see in subsequent chapters,
the Entering the Womb sutra is extensively quoted by nearly every Tibetan
author who writes about early human development in both medical and religious
traditions. During debates on embryological topics, other sutras are referred to
as well as authorities on the process of transmigration, the nature of the transmi30

THEORIES OF HUMAN DEVELOPMENT

grating entity, the workings of karma and the four (or sometimes five) elements
of nature, the relationship between the mind and the body, and other topics relevant to human development. It is plain that while Indian medicine was the basis
for much early medical scholarship in Tibet, the works of Indian Nikaya Buddhism and Mahayana Buddhism that made it across the Himalayas formed the
basis of knowledge about early human development in later Tibetan medical and
non-medical literature.

Practicing gestation in Indian Vajrayana Buddhism
Another significant class of Indian texts utilized by Tibetan authors discussing
early human development is the tantras of Vajrayana Buddhism. Detailed contemplative practices overtly modeled after the processes of human conception,
development and birth – to be considered further in chapter five – are present in
a wide range of Indian Buddhist tantras, such as the Kalacakra, Vajrabhairava,
Guhyasamaja, Cakrasamvara, Samvarodaya and Hevajra tantras, as well as in
numerous exegetical works. Indeed, esoteric Buddhism is renowned as a site for
the prolific narration of human development, expressing a particular interest in
the soteriological capabilities of the human body.
For Tibetans, an especially important tantric source for human development
and knowledge of the body in general is the Kalacakra tantra. Classified within
the esoteric highest yoga tantra category of such texts, this work is dated to the
early decades of the eleventh century, making it possibly one of the last of the
major Buddhist tantras to be authored in India. The Kalacakra is well known for
its comprehensive presentation of human psycho-physiology and is thus the
basis for much writing on the close interactions of psycho-physiological
mechanics and esoteric religious practice. The text is also celebrated for its
complex yogic system and teachings on topics as wide ranging as medical therapeutics, botany, alchemy, astronomy and cosmology. The “most significant
goal” of the Kalacakra religious system, however, Vesna Wallace writes in a
comprehensive study of this work, “is the transformation of one’s own gross
physical body into a luminous form devoid of both gross matter and the subtle
body of pranas,”39 or energetic “winds.” Thus, the elaborate presentation of
human physiology found in the text is ultimately offered for the purpose of
advanced contemplative practices, a goal, we shall see, that is central to most
Tibetan tantric presentations of embryology and physiology as well.
The Kalacakra tantra is divided into five chapters addressing the world
system, the individual, initiation, religious practice and gnosis (ye shes, Skt.
jñana). Human psycho-physiology is included within the second of these divisions. The starting point of the Kalacakra world-view is the notion that the individual and its environment, i.e. the cosmos, both share the same material basis,
energetic nature, and manner of origination and destruction. This means that to
know fully the individual and understand its path to salvation, knowledge of the
cosmos is essential. Presentations of human origination are thus preceded, in the
31

THEORIES OF HUMAN DEVELOPMENT

Kalacakra and other tantras modeled similarly, by a description of the origination and destruction of the various Buddha-fields and world-systems of the
cosmos. These worlds arise, initially, on the basis of the collective karma of sentient beings – that is, the good and bad actions of sentient beings cause the creation and dissolution of the various world-systems in the Buddhist universe. The
tantra explains the role of the energetic karmic winds in activating this process,
an explanation that is then mirrored in the discussion of the winds in the creation
of an individual human in the womb.40 The other natural elements, water, fire
and earth, play specified roles in these creation stories as well.
In Kalacakra embryology, the newly conceived embryo develops due to the
actions of the energetic winds. The fetus is also said to consume substances with
six flavors (bitter, sour, salty, pungent, sweet and astringent) that are derived
from the six elements (earth, water, fire, wind, space and gnosis). This enables
the fetal body to develop in the same way as does the cosmos. The father’s
reproductive substance generates the fetus’ marrow, bones, channels and sinews,
and the mother’s reproductive substance generates its skin, blood and flesh.
Earth, water, fire, wind and space also play specific roles in the creation and
development of the fetus’ body. A month after conception, ten subtle channels
(nadi) emerge in the fetus’ heart, and seventy six channels emerge from its
navel, traveling throughout the body. Arms, legs and head begin to protrude
after the second month, and by the end of the third month they are clearly
developed. Subtle channels continue to proliferate and in the fifth month the
fetus has three hundred and sixty bones and joints. By the end of the sixth
month, it has flesh and blood and can feel pain and pleasure. The seventh month
sees the development of hair, the apertures of the body and more channels, and
by the end of the eighth month, joints, bones, marrow, the tongue, urine and
feces are fully formed. In the ninth month, “the fetus experiences pain as if it
were being baked in a potter’s oven” and when it is born at the end of that
month, it experiences pain as if “being crushed by an anvil and hammer.”41
Wallace points out that many of the details of Kalacakra embryology closely
mirror earlier Buddhist texts, and, indeed, we will see some of these similarities
in chapters to come. The Entering the Womb sutra, for instance, appears to be
the source for its explanation of the conditions required for conception and the
nature and development of the embryo. As in Vasubhandu’s Commentary, the
Kalacakra embeds human gestation in the context of the notion of interdependent arising (rten cing ‘brel bar ‘byung ba; Skt. pratityasamutpada). Other
aspects of its presentation, however, seem more closely linked to Indian medical
treatises.42
The Kalacakra’s account of gestation demonstrates explicitly the intricate
correspondences between human and cosmos, as Wallace’s study of the tantra
describes in detail. Knowledge of embryology is an essential part of the path to
liberation because it facilitates a full understanding of ordinary reality, which is
then the basis for understanding ultimate reality.43 Knowing the structure and
functions of the human body intricately is thus a key step on the path to escaping
32


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