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Sexual Differentiation in Tibetan Medical and Buddhist Perspectives

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Classical Tibetan medicine is closely related to Buddhist philosophy. This article describes how the study and meaning of sexual differentiation in Tibetan medicine is deeply rooted in Buddhist texts and philosophy. The article pays particular attention to the Buddhist theory of mutual dependence of birth and death and on the medical ways of explaining the determining of sex. While Tibetan medicine approaches sexual differentiation by examining its various determinant factors, thus aiming to improve understanding of the human body and diseases, which manifest differently in men and women, in Buddhist philosophy sexual differentiation is perceived as a fundamental, natural phenomenon of human life that forms a key in Tantric practices to comprehend the nature of mind and thence attaining the highest state of mind. The article consists of a translation of the first chapter of a Tibetan medical book on obstetrics, including a newly written introduction to the Buddhist interpretive frame employed in the chapter.
Keywords: Sexual differentiation, Tibetan medicine, Buddhist philosophy, determinant factors for sex


What follows is largely a translation of the first chapter of a monograph on the treatment of obstetric conditions in Tibetan medicine, which I published in Tibet in 2010. This earlier work aimed at filling a gap—there being at that time only very limited obstetrics texts available in the Tibetan medical literature, a situation that had come to my attention while preparing a Tibetan medical gynecological textbook for undergraduate students in university-based Tibetan medical courses in Tibet and China. I would argue that this lack in textual resources is linked to gender, and due to both the fact that, at least historically, the majority of physicians were men (mostly monks), as well as the point that Tibetan women tend to be reluctant to talk about health problems, especially when related to more intimate parts of the body. As obstetric conditions are health problems that occur mostly during or around the period of conception or delivery of a child, I therefore dedicated the first chapter of my book to Tibetan philosophical interpretations of gestation, the nature of birth and sexual differentiation, which all relate to the themes of this current special issue and are thus offered in English for a wider audience.
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Sexual difference is crucial to the maintenance of the life cycle. In Tibetan Buddhist philosophy, the male and the female are also respectively referred to with the metaphors of ‘method’ (thabs) and ‘wisdom’ (shes rab). As such ‘method’ and ‘wisdom’ lie at the centre of Buddhist practices aimed at discovering the fundamental nature of the mind (sems nyi kyi gdod ma’i rang bzhin), which goes beyond concepts of sex and gender altogether. Such practices have as their goal to reach the highest state of mind, which is the state of enlightenment (sangs rgyas pa). There is a whole body of theory in Tibetan Buddhism that characterizes the two distinct energies that the two sexes manifest through the body, for example in terms of spirit, psychology and physique. Such factors in turn influence a person’s social role and their performance of gender. It is impossible to discuss all these issues in a single paper. My intention here is to present an analysis of the interdependent relationship of birth and death in Tibetan Buddhism and point to its relevance for sexual divisions in Tibetan medicine.

In order to analyze and interpret ideas surrounding the division of the sexes described in the Four Tantras or Gyushi (rgyud bzhi), I wish to use Buddhist logic (tshad ma rig pa), and particularly the theory of the four conditions (rkyen bzhi), as found for instance the ‘Treasure of the Abhidharmaliterature (Skt. Abhidharmakośa, Tib. mNgon pa mdzod).

1 Different determining factors of the sexes are given in the Gyushi ’s Explanatory Tantra.* There, sexual differentiation is interpreted in relation to the specific moment of conception, as well as hereditary conditions from the parents (lhan skyes). In contrast, in the section on gynecology (mo nad) in the Oral Instructions Tantra*, sexual differentiation is examined more from the perspective of the emotional forces of the individual. Few explanations have so far been provided in any of the previous commentaries for the internal relationships between these factors, which in turn led to confusion or doubt about which of these factors (i.e. the hereditary conditions of the parents, the specific timing of conception, or an individual’s karmic merit) were more important in determining sex. In the medical literature production, there are examples of the use of the four conditions of Buddhist logic (tshad ma) to explain medical issues. One important example is the commentary on the Four Tantras by fifteenth century physician ]]Kyempa Tshewang’\\s (]]sKyem-pa Tshe-dbang]]), which used the four conditions of Buddhist logic (tshad ma) to explain the relationships between the three major etiologies of disease (rkyen gsum)2 (sKyem-pa Tshe-dbang, 2001). His interpretation has come to be seen as a comprehensive explanation to understand which one of the three etiologies of disease should be considered in which context.

The question of whether the hereditary condition of the parents or the time of the conception have a stronger influence in determining the sex of a child is a much discussed matter, and it also appear frequently in examinations at Tibetan medical colleges. The varying views in the Four Tantras show that the differentiation of the sexes during conception is not based on a single cause, such as the condition of the parentsreproductive fluids (khu ba). This paper also considers the four major vessel systems of the body, as described in the Four Tantras, the so-called ‘generating, sustaining, connecting and life vessels’. It includes also those vessels pertaining to reproduction, as this part of the bodily system is where the different sexual functions are found according to Tibetan medical theory. The aim of adding a discussion of the different vessel-based circulation systems (rtsa ’khor), how they are interconnected, and specifically how the reproductive system relates to the other bodily systems, is to give a broader context to issues of birth, sexual differentiation and obstetrics in Tibetan medicine. The article concludes with a discussion of the nature of birth and its conceptual limitations according to various viewpoints in Buddhist philosophy.

We now turn to the translation of the first chapter of my publication, Clinical Experience in Treating Obstetric Diseases (2009), which is entitled ‘Analysing the Natural Pattern of Birth’ (sKye ba’i khams kyi chos nyid la dpyad pa).3

Mutual dependence between arising (birth) and disintegration (death)

When the original nature of primordial purity is realised as it is, one attains peace and the precious state of the trikāya*,4 but as long as it is not realised one wanders, endlessly following the patterns of birth (skye ba), existence and disintegration or death (’jig pa),5 in the various states of samsāra corresponding to one’s own karmic imprints*.

These ‘facts’ show the conventional* and the definitive* approach to the ultimatetrue nature of things’ without contradicting the authentic meanings of the two truths: absolute and relative truths*. The various branches of knowledge in Tibetan Buddhism represent the different kinds of explanations suited to the mentality of the countries of individuals to be trained. Thus one of the five major branches of knowledge* is medicine, the science of healing (gso ba rig pa) which takes care of others. It can be defined in this way: to relieve the pains, both physical and mental, of an unlimited number of sick people, and to prolong the lifespan of human beings.

As for arising, existence and disintegration, these have to be discussed according to the particularities of each specific context. In this particular instance, let us examine birth: if we reason in terms of birth and disintegration, these occur through their mutual dependence. Considering any body, there would be no cause for its disintegration if it had not been born in the first place, and if anything ever born knew no disintegration and could live on forever, there could be no such thing as being born. Because of disintegration there is birth, and this is how the very word “universe”—’jig rten (‘the destructible basis’)—was formed.

The phenomenon of birth or arising has six types of causes* and when these are complete in all their aspects, there is a human body. As part of the possibility of existence of such a body in this universe, it can become born when all its physical constituents have been fully formed, but it will show disintegration once these physical constituents have degenerated.

As all the processes related to birth and disintegration depend on the circulation of the seven physical constituents*, the continuity of this circulation is called ‘existence’ or ‘life’. The various tissues of the body are matured through the circulation of all these in their own network of vessels.

The determinant factors of sex in Tibetan medicine

Although all beings in the realm of existence, be they superior or inferior* and differ in the origin of their gate of birth* (skye gnas), they are born from the union of ‘method’ and ‘wisdom’*. As for the mode of activity of beings that are born, they are mostly divided into masculine or feminine, and this depends on a very definite set of causes and conditions. To give an example, here is a quote from the Oral Instructions Tantra* of the Gyushi, found in the chapters on women’s diseases: ‘the body produced by the three poisons and the four elements* appears as male or female through former deeds and by the power of desire. With weaker merit, one will get a woman’s body.’6

Mind has been free from conceptual fabrications since beginningless time, yet incidentally, apparent impurities with a natural energy of their own, cause dualistic perception and apparent motivations of attachment, aversion, dullness and so forth. These create actions of a similar nature, which turn into all sorts of karmic manifestations. Among these are the three ‘dynamics’7 or nyes pa gsum, which are generated by the three negative emotional forces—desire, hatred and ignorance. Through the typical action of these three ‘harm-doers’, the womb-born body is made up of four elements—if we consider that space pervades them all.8 And, depending on its former karma still to be experienced,9 it will appear as male or female through the power of desire, part of the three poisons, and the cause of the dualistic split between perceiver and perception.

Furthermore, four conditions* apply, one of which is the causal condition, which is what makes one appear as male or female, as is stated in the Explanatory Tantra*: ‘If semen (khu ba) is more abundant, one will be born a boy, but if menstruation (bzla mtshan)10 is more abundant, one will be born a girl.’11 Now, to explain how they appear differently through the determining condition, the same source says: ‘on the first, third, fifth, seventh, ninth [day], it will be a boy. On the second, fourth, sixth and eighth [day], it will be a girl.’12

The immediate condition causes a male or female manifestation, as appropriate, and the object-condition is the subtle base of focus for the motivation of the foetus in that very moment resulting from the karmic imprints of a being, life after life. To sum up, when such a body is acquired, compounded from a cause, the six-fold consciousness*, and from four conditions, it appears as either male or female.

If we wish to examine the characteristics of the four conditions in brief, the Treasury of Abhidharma* indicates:

    For results to be generated, there have to be conditions distinct from the results, and these are said to be four … What generates a result is a germinative seed: the cause of the visual consciousness present in the ālāya*, the ground consciousness, is like its seed or causal condition. Whatever it focuses on, the object generated as a representation of mind and its accompanying mental events*, this is the object-condition. The immediate condition is what makes way for a result as soon as a cause ceases. In the case of something distinct from these three conditions, the determining [factor] capable of producing it is a condition that can support a result similar to the previous.

    (sLob-dpon dByig-gnyen 2010 p. 163)

Like this statement, any scripture or work of Tibetan Buddhist logic corroborates the four conditions as identified above. If one considers what the Four Tantras teaches in its different sections about the male and female way of bodily manifestation, it does indeed speak of these as well. Yet by looking at the Four Tantras carefully none of what it says contradicts the logic of the six causes and the four conditions of Buddhist logic. For instance, the Explanatory Tantra is the part of the work that expounds the main points of medical theory. When it comments on the formation of the body, on its anatomy and so forth, it does so in terms of the determining conditions and the immediate conditions relative to the mode of manifestation of males and females.

In each of its sections or ‘Eight branches’* of healing, the Oral Instructions Tantra teaches extensively both from a conventional and a definitive* standpoint. In the section on ‘female illnesses’, those diseases are deliberately dealt with as a medical specialty. Everything there is discussed in terms of the causal condition: first, the karma and merit of women, then the way in which women appear as different from men and, the biological features of woman and the classification of various gynecological diseases and the detail of each. This shows that different styles of explanations are used according to each specific context of the Four Tantras.

Examining the pattern of birth, life and death based on the nature of vessels, ‘the connectors’13

As is described in the Four Tantras: ‘Generating, sustaining, connecting and life*: [these are the] four vessel systems’.14 Regarding the nature of the vessels*, they are defined as roots that sustain the body and life of human beings.15 It is taught how, while they are generating the body, various vessel ramifications branch out to form the body complex*: in the middle, while they are sustaining (life), these generative vessels are shown to be of different kinds, with their characteristics and function; at the end, when they disintegrate, the life-propelling energy is exhausted.16

Thus vessels are shown to be of three types determined by these three stages. Although the actual vessel network is one and the same at first, in the middle and at the end,17 it is necessary to divide it into these three stages; the concept of birth, life and disintegration is closely linked to the actual physical body of beings.

Examining the limits of the notion of birth (arising) from the viewpoint of Buddhist philosophy

This section offers three different perspectives on the limits of the notion of ‘birth’, first, as famously expressed by Nāgārjuna 18 in the Mūlamadhyamaka-kārikā: ‘Not from itself or from other, neither from both nor from no cause at all, whatever thing it is, nothing whatever, ever arises.’19 This quote, to me, expresses four essential ideas, which I now discuss.

First, there is no arising from oneself. If a self already exists, it does not need to arise. When a cause has stopped, it is invisible though its result is seen. Even common minds who have not investigated [the matter] will not mistake these for a single substance. Second, there is no arising from others. At the time of the cause, the “result” entity dependent on it has not arisen and does not exist. Therefore, there can be no dependent “other”. If we consider terminology, saying “I have procreated a son” when one has simply sown the seed of a son (the cause) amounts to the same misunderstanding as saying “I planted a flower” whereas one has merely sown the seed of a flower (its cause).

Third, there cannot be arising from both (self and other): If self and other individually had a generative capacity, there could be generation through the coming together of these two. But if, as explained above, neither self nor other have a procreative capacity it is logically impossible that even their coming together could create something, just as there can be no sesame oil in sand grains.20

Fourth, there can be no arising from an absence of cause: Buddhapālita demonstrated that thus, ‘it is a logical impossibility for things to arise in the absence of a continuous line21 because all things always come from all things.’22 Thus, as stated above, ‘things’ are beyond the ‘four extremes of arising’*.

The second perspective on the limits of birth derives from the Explanatory Tantra of the Four Tantras: ‘First, faultless sperm and blood* of father and mother, a consciousness stimulated by karma and defilements, the five elements* all gathered together—[such are] the causes of conception in the womb.’23

The third perspective is that of Sakya Gyaltsen Palsang, as found in his Secret Explanations of the Vajra Body:

    Looking at this in connection with the five awakenings* of the followers of the Mahāyoga Tantra: first the father’s essence* emerges through the anal passage, then it stays in the vajra pathway below the navel and comes out when it is expelled. This is the awakening by means of the moon, the mirror-like wisdom. When this enters the procreative organ of the mother, the quintessential part of rakta is covered from the outside: this is the awakening to the sun, the wisdom of identity.24 Suffused with innate joy, the bardo consciousness* remains between these two, the sun and the moon; this is the awakening to the seed—the discerning wisdom. The three mingle in the form of blissful prana-mind,25 and become a mer mer po, a nur nur po and a tar tar po.26 This is the awakening to the activity wisdom. When these solidify, a physical form is produced from which the body will gradually become complete, as a creation of the previous life—this is the awakening to complete perfection, the dharmadhātu wisdom.27

From the causes of conception of a child in the womb, as explained in these various perspectives, one can gain additional understanding of Nāgārjuna’s quotation at the beginning of this section (‘neither from itself nor from others / neither from both nor without cause’). Thereby one can be certain that birth and disintegration are ultimately only delusions due to ignorance. This certainty will make clear the reason why Tibetan medicine rejects ignorance, as the prime the cause of illness.


The study and meaning of sexual difference according to Tibetan medicine is deeply rooted in Tibetan Buddhist texts and philosophy. Sexual differentiation is perceived as a fundamental, natural phenomenon of human life and is seen as a key in Tantric practices to comprehend the nature of mind and thence attaining the highest state of mind. By contrast, as shown above, Tibetan medicine approaches sexual differentiation by examining its various determinant factors, thus aiming to improve understanding of the human body and diseases, which manifest differently in men and women.


    the Yogacara school added two aspects to the six consciousnesses model (q.v). The seventh, is the tainted mind, nyon yid. While the eighth, Ālāyavijñāna (Sanskrit), kun gzhi rnam shes in Tibetan, defines the universal basis or ground consciousness, a sort of virtual repository where thoughts and feelings leave mental imprints, habitual tendencies and conditioning, which are the seeds of later experiences.

Arising, existence and disintegration (skye ba, srid pa,’jig pa)

    concepts used by Nāgārjuna (the great Middle Way exponent) to demonstrate that nothing has any independent, ultimate reality. Tibetan medicine shares this view and sees human life as a compound of many elements which, due to various causes and conditions, come together at a certain point through birth, endure for a certain period of life or existence, but necessarily come apart and disintegrate at some point—death—when causes and conditions have changed.

Bardo consciousness

    Tibetan medicine follows the Buddhist view that when a person dies, the elements forming the body disintegrate but as long as the consciousness is fueled by karma (the propelling energy of previous deeds), it goes on seeking another life. The bardo (“between two”) is the intermediary state between two lives during which the consciousness undergoes various experiences, at the end of which it seeks a birth corresponding to its particular karma. Conception happens when this so-called bardo consciousness meets with the father’s sperm and the mother’s ovum, and literally “takes flesh” or incarnates.

Branches of knowledge

    Tibetan knowledge is categorised into ten branches, out of which five are known as the five major branches of knowledge or ‘the five major sciences’ (see below), and others as ‘five minor sciences’.

Conventional and definitive approach (drangnges tshul)

    Two ways to approach the Ultimate, the true nature of things, looking at it in the ordinary, conventional way or in absolute terms. The conventional or expedient approach addresses what pertains to the relative truth, things as they appear to be; the definitive or absolute approach relates to the absolute truth, things as they really are. Not only are these two approaches of the Ultimate compatible but they are inseparably linked within the authentic meaning of the Two Truths—simultaneity of the absolute and the relative.

(See Two Truths)

Eight branches of healing (yan lag brgyad pa)

    a mode of presentation of the third treatise which covers the same material as the 15 sections but follows the traditional eight-fold classification of Ayurveda:

1. The body (anatomy, physiology),
2. Infantile diseases (paediatrics),
3. Women’s diseases (gynaecology)
4. Spirits (psychiatry)
6. Poisons,
7. Ageing (gerontology),
8. Treatment of impotence and infertility, rejuvenation.

Explanatory Tantra (bShad rgyud )

    the second volume of The Four Tantras, q.v.

Father’s essence (Tib. thig le, Sanskrit bindu)

    the male energy in its purest form, also called the ‘white element’. The procreative seed (sperm) is its physical counterpart, semen is its residue.

Four conditions

1. the causal condition, rgyu’i rkyen;
2. the determining condition, bdag rkyen;
3. the immediate condition, de ma thag pa’i rkyen;
4. the object-condition, dmigs pa’i rkyen.

Five elements

    the four elements (q.v.) plus space.

Five major branches of knowledge (rig pa’i gnas lnga)

    Tibetan knowledge is categorised into ten branches, out of which five are known as the five major branches or sciences: grammar, dialectics, medicine, arts and crafts, and philosophy.

Five awakenings —(Tib.: mngon par byang chub, Skt.: abhisambodhi)

    the main premise of tantra is that everything is already totally pure and perfect (as shown by the terms Vajra body and five primordial wisdoms). The point is to realize this innate, original purity, presently unrecognized.

Four elements

    ’byung ba bzhi, according to the traditional Indian classification: earth, water, fire, wind/air.

Four extremes or limits (mtha’ bzhi) of arising

    the four propositions on arising refuted by Nāgārjuna are extreme or limiting statements, in the sense that none of them correspond to what is actually there. The Middle Way of Nāgārjuna avoids all such extremes.

Four Tantras or Gyushi (rGyud bzhi)

    Short title of the fundamental textbook of Tibetan Medicine in four volumes. It is comprised of

1. the Root Tantra,
2. the Explanatory Tantra,
3. the Oral Instructions Tantra and
4. the Subsequent Tantra.

Gates of birth, four (skye sgo bzhi)

    the four modes of birth or the four ways in which something can arise in samsāra: from a womb, from an egg, from moisture and heat, and in a “spontaneous” or miraculous fashion.

Generating, sustaining, connecting and life

    “Generating” corresponds to the stage of formation of the nervous and vascular systems. As the names indicate, “Life-sustaining” shows the function of these systems in terms of sustaining life, “Connecting” evidences their linking role. “Life” is short for “support of the life-force”—this informs on the potential longevity of a body.

Individuals to be trained ( gdul bya)

    a set phrase in Buddhism to designate beings as those who need to be trained in order to reach liberation. It applies more loosely in the sense of students, disciples, trainees.
Karmic imprints
    traces left in the mind by any of thought or action. See also Ālāya, q.v.

Mental events (sems byung) (Mind and its accompanying mental events)

    the Abhidharma analyses what is conventionally called a “person” in terms of five aggregates, or five collections of various elements which make up a seeming individual whole. The fourth aggregate, ’du byed kyi phung po, represents what is called mental factors (57), out of which 51 are “mental events”. Most of these colour the workings of mind by their positive, negative or neutral quality; some are mere mental processes.

Nur nur po (“thickened”), ltar ltar po (“alike”) and mer mer po (“malleable”)

    the names of the embryo in the early stages of its development (second, third and fourth week of pregnancy respectively, according to the Explanatory Tantra, Point II on the Body, Part 1, Formation of the body, chap. 2).

Oral Instructions Tantra (Man ngag rgyud )
    the third volume of the Four Tantras, q.v. The third treatise is divided into 15 Sections—the tenth of which addresses ‘Women’s diseases’.

Precious human life

    literally precious human body (mi lus rin chen). Precious because of the six sorts of beings in samsara, humans alone are capable of seeking liberation.

Seven physical constituents (lus zungs bdun)

    the seven components of the metabolic chain which goes from the digested food all the way to the “essence-element” which ensures the vitality of a person. These are: nutrients, blood, flesh, fat, bone, marrow, and “regenerative fluid”. The quintessence of this regenerative substance is understood to be the “white element” in men and the “red element” in women, which provide vitality. The sperm and the ovum are their material vehicles for procreation.

Six causes (rgyu drug)

    1. efficient cause (byed pa’i rgyu) e.g. empty space can accommodate objects and the earth can support life;
2. concurrent cause (mtshungs par ldan pa’i rgyu), e.g. three sticks together supporting something;
3. cause with a similar effect (skal pa mnyam pa’i rgyu), e.g. a good thought leads to a corresponding good action;
4. interactive cause (lhan cig ‘byung ba’i rgyu), e.g. mental functions interact with one another;
5. all-affecting cause (kun tu ‘gro ba’i rgyu), e.g. a wrong view affects all one’s actions;
6. ripening cause (rnam par smin pa’i rgyu), e.g. the karma of killing a sentient being brings the killer a requital, his rebirth in hell like a ripened fruit.

Six-fold consciousness or six consciousnesses

    Buddhism analyses consciousness as having six aspects: five connected to sensory perception (the visual, auditory, olfactory, gustatory and tactile consciousnesses), and the mental consciousness, which labels and conceptualises on the basis of sensory experience. Consciousness can also be analysed as eight-fold, as was done by the Yogācāra and Cittamatra schools. See ]]Ālāya\\, q.v.

Superior or inferior

    Buddhism distinguishes six types of beings in samsāra, existence conditioned by ignorance. Three of these are deemed inferior, because riddled with suffering (animals, spirits and hell-beings), three are said to be superior because they are more favourable (gods, semi-gods and human beings), but the best of all is the human condition which, alone, can serve as a basis for liberation. Birth in either of those states is determined by the quality of one’s own actions (karma).
Three poisons (dug gsum)
    The primary cause of illness is found in the Tibetan Buddhist theory of the three poisons: desire, hatred and ignorance.
Treasure of the Abhidharma (Skt. Abhidharmakośa, Tib. mNgon pa mdzod )
    written by Vasubandhu (sLob-dpon dByig-gnyen), a famous exponent of Buddhist logic and one of the founders of the Yogācāra school (circa fourth century CE).


    in Sanskrit, the three “bodies” of Buddha: dharmakāya, sambhogakāya, nirmānakāya. In Tibetan: chos sku, longs sku, sprul sku. Finding peace or attaining the trikāya means reaching the full and perfect enlightenment of a buddha.

Two truths (bden pa gnyis)

    the absolute and the relative truths. The absolute truth accounts for the ultimately real, and the relative or expedient truth accounts for the relatively real. Though these may seem to be of a very different nature, the Middle Way teachings show that they are actually indivisible and apply simultaneously. In the absolute sense, everything is already pure and perfect but, as long as this is unrecognized, things manifest on a relative level as a result of the interdependent play of causes and conditions driven by karma.

Union of means (Tib. thabs, Skt. upāya) and wisdom (Tib. shes rab; Skt. prajñā)

    “means” represents the male energy, “wisdom” the female energy. Everything is born through the union of male and female energy.

Vessels (rtsa)

    Generic term used for veins, arteries and nerves, seen as ducts or channels through which various circulations can take place in the body. There are channels for blood to circulate through the vascular system (along with carbon dioxide in veins, and with oxygen in arteries), and for nervous impulses to travel through nerves. Veins and arteries collectively are called ‘black vessels’, rtsa nag while nerves are known as ‘white vessels’ or ‘water vessels’, rtsa dkar or chu rtsa.


1See for instance mKhas-grub Sangs-rgyas rGya-mtsho 2010.

2Progressive condition (skye mched kyi rkyen), the accumulation manifesting condition ( gsog ldang gi rkyen) and the actual arousal condition (slong rkyen).

3Cuomu 2009, pp. 53–60. I would like to thank Katia Holmes for her assistance in translating this chapter and preparing the glossary appended to this article. Both have been further edited and amended by the author and the editors.

4All words followed by an asterisk are explained in the Glossary that follows this paper.

5sKye ba means arising, in general, and birth as a particular instance of this. Both meanings apply throughout the text. ’Jig pa means destruction, or disintegration, and can be understood as death when used in conjunction with “birth”.

6g.Yu-thog Yon-tan mGon-po, 1993, p. 375.

7According to Tibetan medicine, the three dynamics, or nyes pa gsum, are three major biological forces of all physiological functions of the human body. They are rlung (air), mkhris pa (fire) and bad kan (earth and water). According to Four Tantras, health is basically understood as the constituents of the four elements in the body as well as the ‘three dynamics’: being well-balanced and working together in harmony. For details, see Cuomu’s PhD dissertation (Cuomu 2010).

8The four element classification does not include space, which is considered to be omnipresent, pervading all of the other elements.

9Karma: the propelling energy of previous deeds; the quality of one’s own past actions.

10Although literally, the broad meaning of the Tibetan word zla mtshan can be understood as menstruation, in this context, it should be understood as ‘ovum’, or literally as the ‘red element’ (khams mar). There are many other reversible terms like this used in Four Tantras, such as ‘mngal’, which in some contexts can be understood as ‘foetus’, and in others as ‘uterus’.

11g.Yu-thog Yon-tan mGon-po, 1993, p. 17.

12Ibid. the Explanatory Tantra indicates a correspondence between the day of intercourse and sex determination: counting the day when the menstruation begins as day one, it is said that intercourse on days one, three, five, seven, nine will conceive a boy, and on days two, four, six, eight, a girl (g.Yu-thog Yon-tan mGon-po 1993, p. 17).

13‘Connectors’ or ‘connections’ (’brel ba) is a term used to qualify all vessels or channels in this is because they are responsible for all circulations in the body. “Connecting” is also used more specifically to describe one of the four functions of vessels.

14g.Yu-thog Yon-tan mGon-po 1993, p. 23.

15It may be interesting to note the semantic kinship between the word rtsa for vessel and rtsa ba for root.

16Literally, the propulsive force (’phen pa).

17The four categories should not be mistaken for different anatomical entities: they serve only to highlight the various functions of the vessels or channels in the body, particularly at the different stages of formation, life and disintegration.

18In Tibetan: sLob-dpon kLu-sgrub.

19Sangs-rgyas bsKyangs 1989, p. 3.

20rDza sPa’-sprul 1989, p. 473.

21Rgyud: continuum or lineage.

22Sangs-rgyas bsKyangs 1989, p. 134.

23g.Yu-thog Yon-tan mGon-po 1993, p. 16.

24Rakta, blood in Sanskrit, tends to replace the word blood in tantric texts, such as in the source quoted here. The “quintessence” (dvangs ma) of rakta designates the “red element”, the female essence in its purest form (the ‘ovum’ is its physical counterpart, menstrual blood its residue).

25Sanskit prāna,Tib rlung. In this tantric context, the merging of the physical quintessences of father and mother with the bardo consciousness, takes the form of mind united with rlung or prāna (pure energy, subtlest breath) and bliss, an intrinsic quality of pure mind.

26Nur nur po (“thickened”), ltar ltar po (“alike”) and mer mer po (“malleable”), are the respective names of the embryo in the second, third and fourth week of pregnancy. Explanatory Tantra, Point II on the Body, Part 1, Formation of the body (chap. 2), g.Yu-thog Yon-tan mGon-po 1993 p.23.

27Sa-skya-pa rGyal-mtshan dPal-bzang 1991, p. 13.
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    Cuomu Mingji. Social and Cultural Factors in Developing Tibetan Public Health System [PhD dissertation] Humboldt University zu Berlin; 2010.
    g.Yu-thog Yon-tan mGon-po . rGyud bzhi (Four Tantras) Bdud rtsi snying po yan lag brgyad pa gsang ba man ngag gi rgyud. 3rd edition Tibetan People’s Publishing House; Lhasa: 1993.
    rDza sPa’-sprul . sNying bsdus sngon ‘gro’i khrid yig kun bzang bla ma’i zhal lung. Sichuan Publishing House for Nationalities; Chengdu: 1989.
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    sKyem-pa Tshe-dbang . rGyud bzhi’ rnam bshad. Tibetan People’s Publishing Company; 2001.
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    sLob-dpon dByig-gnyen . MKhas-grub Sang-rgyas rGya-mtsho, Dam pa’i chos mngon pa mdzod kyi dgongs pa rab tu gsal bar byed pa’I gtan bcos lung rigs gter mdzod. 2010. Bkras lhun gsung rab dpar khang.