Imbibing the Text, Transforming the Body, Perceiving the Patient: Cultivating Embodied Knowledge for Tibetan Medical Diagnosis Open Access

Tidwell, Tawni (Fall 2017)

Permanent URL: https://etd.library.emory.edu/concern/etds/kp78gg36g?locale=en
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Abstract

Tibetan medical diagnostics provide a powerful lens for understanding embodied expertise among Tibetan physicians. This investigation probes the transmission and practice of Tibetan medical diagnosis as a gateway to understanding the epistemic grounds for Tibetan conceptions of illness and healing. Participatory research as a student at two major sites for Tibetan medical training, Men-Tsee-Khang in north India and at Sorig Loling in Amdo, focused on the role of embodied knowledge in diagnosis along two analytic dimensions, namely physician as embodied diagnostic instrument, and patient as embodying disease processes. Training of physicians as diagnostic instrument is elucidated using biocultural methods, Mauss’s notion of habitus, and understandings of enacted cognition, memory, metaphor, and visualization from cognitive neuroscience. Disease processes embodied in the patient are tracked through a bioecocultural model of development and logics of biomarkers. Grounded theory from seventh century Buddhist logician Dharmakīrti’s approach to valid cognition—pramāṇa theory–acts as interlocutor with Western scholarship on these dimensions.

This work challenges common assumptions about “rote memorization” and pedagogical values in Western education. It suggests that memorization, recitation, metaphor, and learning through praxis generate a conceptual-perceptual dialectic that drives processes cultivating embodied knowledge transmission. For the Tibetan physician, “methods of becoming” are “methods of diagnosis” by developing the senses, training the mind, and sculpting the physician’s skilled body as vessel and instrument for diagnosis and healing. Rigorous practice and associated self cultivation form the grounds for acquisition of expertise. This project documents a distinctive approach to medical education that simultaneously fosters rigorous medical knowledge and humanistic skills with distinctive diagnostic and therapeutic value.

Table of Contents

List of Figures, Diagrams, and Tables

Notes on Translation and Technical Terms

 

Introduction…………………………………………………………………………………1

   Part I. Modes of Inquiry………..…………………………………………..………………………8

Participant Observation

Auto-Ethnography

Grounded Theory

   Part II. Methodological Approach……..…………………………………………………………12

Text as Key Informant

   Part III. Mechanics and Context……..……………………………………………………………19

Methodology……..……………………………………………………………..……19

Participant-observation

Textual analysis

Clinical patient diagnostics data

Surveys and interviews

Study Group

Coding

Daily Schedule at Men-Tsee-Khang…………………………………………………33

Daily Schedule at Sorig Loling………………………………………………………34

Curricular Progression at Men-Tsee-Khang and Sorig Loling………………………36

Focal questions………………………………………………………………………36

Hypotheses………………………………………………………..…………….……38

Chapter summaries………………………………………………..…………….……40

 

Chapter I. Anthropology of Embodiment: Theoretical Foundations……………………46

Historical Roots for the Anthropology of Embodiment………………..…………….47

Body & Embodiment: A Brief History of Ideas………………………..…………….49

Multiple Bodies, Multiple Biologies……………………………..……..……54

Mind-Body-Culture Nexus……………………………..……..……….…….55

Cultural Affordances, Cultural Kindling……………..……..……..…..……..57

Biological Anthropological Approaches…..……..……..….………..……….63

Approaches in Cognitive Neuroscience……..….…..……..……….….….….64

Psychocultural Approaches & Integration…..……..……..……….…..….….75

Embodiment Defined…..……..……..……….….….….….….….….….….….….….79

Oral Literate Traditions and Embodiment…..……….….….……….….….….….….88

Chapter conclusion…...….….….….….….….….….….….…..….….….….….….….94

 

Chapter II. Diagnostics that Matter: 

   Embodied knowledge at work, a case study………………….……………………..….96

Entering the Scene……………..……………..……………..……………...96

Encountering Tibetan medicine……….……..……………..………………102

Meeting a doctor, meeting my teacher..…………………..……………..….109

Beginning studies, experiencing treatment………………..………….…….113

Introducing the tools of embodied knowledge…..………………..………………116

New developments in my studies………………………..………….…….118

What can embodied knowledge do in diagnosis?.………….……..………….……121

Chapter conclusion.………………..………………………………………..….….140

 

Chapter III. Education Grounds: 

   Pedagogical foundations for cultivating embodied knowledge……………………..142

Tutorials Transform: Proper Study Preparations…………………..………………142

Preparing for the entrance exam……………………………………………………148

Entrance Exam………………………………………………………..………….…152

Preliminary Year & Introduction to Memorization……………………..………….159

Initial class experiences…………………………………………………………..167

The Four Medical Transmissions as a Text

Teaching Styles & Class Experience at Men-Tsee-Khang

Transitioning to Xining

Teaching Styles & Class Experience at Sorig Loling

Curricular Progression………………………………………….…………………..181

Examinations……………………………………………………………..…………184

Contemporary times and new approaches…….………………………..…………..186

Searching for the historical locus of medical education tradition……….…..……..187

Chapter conclusion.………………..………………………….…………………….191

 

Chapter IV. Memory, Metaphor & Visualization: 

   Shaping the brain, priming the body, imbibing the pedagogy…………..…….193

Memory and Memorization……………………………………………………..….196

Semantic & Episodic Memory…………………………………………..….201

Working Memory…………………………………………………..………203

Implicit Memory & Priming…….……………….……………..…..………205

Conditioning Response………….…………………………………..…..….217

Spatial Memory……………….…………………………………….…..….219

Visual Memory & Encoding the World…….…………………..……….….225

Brain Development, Neuroplasticity and Memory Capacity……….…..….228

Cognitive Efficiency……………..………………………………..……….232

Summary of Memory Processes and Tibetan Medical Pedagogy………….233

Limitations of current research on memory……………….….………..…..233

Metaphor……………………..…………………..……………….……………..….235

Grounded cognition and simulation…………….……….………………..……..….248

Applications in memory, metaphor, grounded cognition & simulation: 

Encoding memory into space………….…………………………….…..….254

Memory palaces, maṇḍalas and metaphorical loci…………….………..….254

Memorization generating creativity…….………………………..……..….262

Synesthesia and memory capacity: re-defining the norm……………….….263

Memorization and recitation in orally transmitted literate traditions.…..….266

Chapter conclusion……………………………………………………………..…267

 

Chapter V. Epistemological Grounds: 

   Pramāṇic bases for embodied knowledge in Tibetan medical diagnosis ………..….269

Laying epistemological grounds at Men-Tsee-Khang ………..….……..……..….270

Debate Class at Men-Tsee-Khang ………………………….….….…….….277

Laying epistemological grounds at Sorig Loling…..……………….…….….….….282

Ontology of the body in Tibetan medicine………………………….…….….…….291

Buddhist model of cognition: Pramāṇa Theory………………….………….….….305

Dharmakīrti’s model of cognition….…………………………….….….….307

Dharmakīrti’s ontology………….……………………………….….….….311

Dharmakīrti’s epistemology……………..……………………….….….….325

Conceptual-perceptual dialectic: generating embodied knowledge….……….……331

Teleology and purpose: why know?…………………………..……………………337

Causality……………………………………………………………………………342

Chapter conclusion……………………………………………………..…….….….347

 

Chapter VI. Working Grounds in Producing Embodied Knowledge: 

   Diagnostic Theory & Praxis….…………..…………………………….…………….…350

Theoretical foundations for diagnostics………………………………..……….….350

View of the body and pathology………………………..………..…..….….355

Diagnostic theory chapters………………………………….….…..……….364

Preparing physician body, perceptual cuing: pulse & urine chapters……….376

Metaphor as complex data organizer…………………………..….………..378

Classifying illness: levels of categorization…………..………..….…….….378

Diagnostic theory in action……………………………..…..……….……..….….382

Case #1. Uncovering the root in illnesses with hot-cold conflict..…..….….382

Case #2. Tripa constitution with cold symptoms……..…..…..…..….……..395

Case #3. Seeing cancer through pulse and urine…………..…..………..…..399

Chapter conclusion: Dialectic reflections..…….……………………………..……410

 

 

Chapter VII. Embodied Knowledge Manifest: 

   Expertise in methods of becoming as methods of diagnosis……………………..……412

     Part I. Expertise in Tibetan Medicine………..………….………………..…………………412

Expertise as understood by the Tibetan medical tradition: defining an expert……415

Theoretical basis for expertise in the Four Medical Transmissions

Clear vessel: refining body as means of refining diagnostic skill

Expertise articulated by the great Tibetan medical scholars historically

The role of extraordinary ideal models………………………………………….….438

Legendary expertise exemplar: Yuthok Yonten Gonpo

Yeshe Tsogyal, legendary expert in female form

Compassion versus empathy…….…………..…………………….………………459

Compassion as directing attention

Frameworks for transformation…………..……………………………….………462

Models for cleaning the vessel, honing the instrument

Embodiment through emulation

Exemplars and lineage formation

Persistent modes of transmission and conferring nüpa

     Part II. Expertise in cognitive neuroscience………..…………………..……………………472

Expertise in memory………….…..……..……..……..……..………………..……474

Expertise in perceptual skill…………..……..……..……..……..………..…..……475

Expertise in auditory discernment: pitch, scale, tone, structure

Expertise in gustatory and olfaction senses

Tactile expertise: developed haptic skill

Expertise in reading (and reciting)…..….…..………..…………..…………………490

Expertise in performance (chess, dance, synchronizing the senses)……..……..…..491

Expertise in compassion, expertise in perception…………………………..………494

     Part III. Expertise in for Dharmakīrti………..…………………..…………………….………496

     Part IV. Buddhist practice as cultivating medical expertise…………………………………502

The role of ritual…..…………………..……………………………………………510

‘Common’ and ‘uncommon’: medical versus Buddhist aims & techniques……..…511

     Chapter conclusion………………………………………………………………………515

 

Conclusion…………………………………..…….………………………………………517

Diagnosis without embodiment…………………….……………………..….……524

Processes in cultivating embodiment for diagnostic application…………………..525

Reflections……………………………………………….……….………..………526

Potential contributions……………………………………………………..………529

 

Appendices……………………………………….………………………………………532

Appendix 1. Four Medical Transmissions Contents & Structure………….…..…533

Appendix 2. Relevant chapters from the Four Medical Transmissions….…….…536

Appendix 3. Historical Figures, Dates & Works related to TM Education…….…537

Appendix 4. Daily and Annual Schedules: Men-Tsee-Khang and Sorig Loling.…541

Appendix 5. Curricular Progression at Men-Tsee-Khang and Sorig Loling………546

Appendix 6. Rlung-tsab case field notes………………………………………..…553

 

Bibliography……………………………………….…………………….…………………………558

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