Imbibing the Text, Transforming the Body, Perceiving the Patient: Cultivating Embodied Knowledge for Tibetan Medical Diagnosis Open Access
Tidwell, Tawni (Fall 2017)
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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