A Conversation on the Causes of Covid-19 with a Senior Tibetan Doctor Living in Lockdown in Milan

From the Series: Responding to an Unfolding Pandemic: Asian Medicines and Covid-19

This piece, presented as a contextualized question-answer interview (conducted March 6, updated March 29, 2020), outlines how a senior practitioner, scholar, and teacher of Tibetan medicine is affected by, perceives, and responds to the on-going Covid-19 outbreak. From his home in the outskirts of Milan, Dr. Pasang Arya elaborates on the causes, prevention, and treatment of epidemics from the perspective of key Tibetan medical and Buddhist texts.

The demon Rāhula, king of planets, was enraged up above
The mother demon Mamo from the nether realm agitated
Helkhyi, the earth lords, eight classes of spirits, and so forth disturbed
[Their] malicious fumes appeared and spread
Forming clouds of disease breath
Showering illness, war, and famine like rain
[Provoking] leprosy, edema, and aggressive infectious disease (nyen né)
Leprosy conceives black bone disorder
Blood disease accumulates edema like a lake
Flesh and vital organs are consumed by nyen
—Dütsi Bumchen ("Great Nectar Vase," third chapter), eleventh-century (?) spiritual treasure text revealed by Dobum Chökyi Drakpa and attributed to Guru Padmasambhava (eighth century)1

How has life been in Milan since the outbreak of the coronavirus?

At first, the Italians found it difficult to grasp. They did not expect it would become such a severe attack on their lives so suddenly. But soon the population reacted strongly to the media, initially by avoiding Chinese restaurants,2 shopping less, and feeling fearful on the metro. At the time of writing, the impact on all aspects of life and economy is great. We are living in the region which was the first epicenter of coronavirus in Europe. For one and a half months now, we have been in lockdown at home. In some way, it is not that bad because we can still obtain daily essentials, yet there is negativity in the air which saddens the heart and makes life less serene. All my face-to-face teachings, workshops, and other activities this spring have been cancelled.

As a senior scholar and Tibetan medical practitioner living in Italy, how do you interpret the sudden rise and spread of this pandemic?

I remember telling my students that, according to the twelve-year Tibetan astrological cycle, these coming years people will suffer from strong diseases because the Earth and our bodies have become vulnerable as the heat of two consecutive fire element years (2016 and 2017) lingers on unextinguished. Correspondingly, we are now also facing the consequences of global warming, with increasing droughts and forest fires. The Pig and Mouse years (2019 and 2020) are generally not too bad for business, but terrible for health, as stated in our almanac. I could not predict the coronavirus pandemic, but the transition from winter to early spring is generally a conflict season of internal cold/humidity and external heat, which can act as an open door for disease. The virus in fact surfaced close to the Chinese New Year, which is associated with the start of spring following the lunar calendar. Connections with the zodiac and the seasons notwithstanding, our collective actions as humans also impact the appearance of natural calamities from a karmic perspective.3 Our cruelty toward other beings and destruction of the environment thus potentially contribute to a plethora of extreme events such as floods, cyclones, and plagues as indicated in various Tibetan medical and Buddhist texts. Traditionally, the eight classes of gods and demons are protectors responsible for maintaining cosmic balance; they too are disturbed by our selfish exploitation of sky and earth.4 In this respect, it is notable that SARS-CoV-2 likely spread initially to humans from cave-dwelling and burrowing animals such as bats or pangolins,5 which Tibetan Buddhists consider embodiments of the underworld. These notions might come across as archaic to some, coming from “ancient people” who were supposedly uneducated and unable to make full use of their natural resources. But we have to face the fact that it is modern science and technology, together with the idea that we can rule the world (also pointed out by Charles Eisenstein),6 which have brought us this thoroughly polluted, disturbed ecology. We are a tiny part in an enormously complex cycle which largely remains “mystical,” beyond our limited knowledge. Coronavirus is just one single product of this universal machinery that continues to baffle scientists.

In classical Tibetan medical texts, infectious diseases are said to be caused by what has been translated as “evil spirits.” How can we understand this today?

This is the case, and I subscribe to this perspective. It is a matter of language, of how you choose to understand things. The Tibetan term jungpö dön can be translated as “wandering spirits.” In Sowa Rigpa, these invisible nonhuman beings are one of the four illness-causing factors—together with unwholesome diet, behavior, and environmental influences—of which the pathogenesis goes beyond strictly “medical” knowing, especially in times before the invention of microscopy and other modern diagnostic instruments.7 Nevertheless, the enlightened Buddhist master Padmasambhava—also known as Guru Rinpoché—expounded in detail on the origins, etiology, and treatment of contagious diseases already in the eight century, discussing the role of tiny beings called sinbu in the transmission of disease. The status of viruses as living organisms has long been debated in modern biology. In Tibetan sources, sinbu have been described as entering human bodies through mouth, nose, and skin, and being nourished by blood and interstitial fluid.8 Their shapes have been likened to lizard heads, snakes, and the countless legs of centipedes.9 This notwithstanding, it is unlikely that biomedical experts will reach an understanding of reality comparable to Padmasambhava any time soon.

How have Tibetan medicine practitioners and Tibetan society in general reacted to epidemics in the past? What kind of prevention and treatments were used? Are these still useful today?

In reading Tibetan histories and hagiographies, infectious diseases are much discussed, often in relation to journeys to more tropical areas. The concept of contagion was understood through the action of spirit provocateurs, which spread aggressive pathogens (nyen sin parpata) with their toxic breath, leading to outbreaks of pox, measles, and fevers. Preventative measures akin to quarantine were taken, for instance blocking the road with thorny barberry bushes and stones to warn and bar travelers—including spirits and their byproducts—from entering a village. Alongside, specifically prepared amulets would be worn, medicines prepared (Gerke 2020), and rituals conducted. Our root medical text (the Four Tantras, established twelfth to fourteenth century), its commentaries, and revealed treasure texts called terma10 discuss numerous types of aggressive infectious fevers (nyenrim), listing specific antidote medicines to kill the disease in an antibiotic manner whilst strengthening organs and the digestive fire. Religious protective and healing methods also vary, including tantric practices involving the Medicine Buddha, the wrathful dharma protector Vajrapāṇi, and Garuḍa (the winged conqueror of nāga serpent spirits).11

According to my understanding, Covid-19 could be identified as nyenrim lotsé as it first attacks the respiratory system and eventually often manifests as viral pneumonia.12 Coronavirus is bad, but it does not seem to be as severe as the killer diseases predicted by Guru Rinpoché to eradicate one fourth of the global population in the degenerate age (Sanskrit: kaliyuga). I believe that Sowa Rigpa and the tantric medical sources mentioned here still provide highly valuable material for contemplation as well as experimental research. A vast arsenal of Tibetan herbal formulas and other time-tested treatments are at our disposal, and I am confident that both single and compounded medicines will prove their worth once again (see Tidwell, this series). May the Earth Lords soon find peace, and may we humans learn from our mistakes.

A key issue remains, however, to what extent potent Tibetan medical ingredients and formulas (as well as qualified practitioners) are (il)legalized, available, and integrated into the biomedically dominated public health sectors of the EU and beyond. In this respect, a focus on “complementary” prevention and ritual protection—not full-on medical treatment—is to be expected even though Sowa Rigpa deems these difficult infectious diseases to be treatable.


The writing of this essay was supported by the FWF Austrian Science Fund (grant 30804) through the University of Vienna.


1. Translated by the authors from the Tibetan (Dobum Chökyi Drakpa 1995, 52).

2. The contribution in this series by Christos Lynteris unravels the epidemic manifestation of Sinophobia in relation to Covid-19.

3. Whereas the emergence of epidemics is related to immorality, the tantric medical text Dütsi Bumchen also repeatedly makes clear that the law of karma cannot be individually applied once the negative force is unleashed, stealing life indiscriminately and leading to premature sudden death.

4. This spiritual ecology, and its entanglement with climate change and conservation (Salick, Byg, and Bauer 2012), is dynamic and strongly politicized in the context of statist development and ethnic conflict (e.g., Tsering Bum 2016; Yeh and Coggins 2014).

5. Rhinolophus affinis bats have so far been identified as the most likely original host of SARS-CoV-2 based on comparisons of viral strains, but intermediate animal hosts such as pangolins (Manis spp.) and/or other traded species are suspected (Ye et al. 2020).

6. See Eisenstein’s essay The Coronation, which highlights the dangers and limitations of modern civilization’s obsession with control in the context of Covid-19.

7. Demonology and other “shamanistic” elements of Tibetan religious expression have long captivated the Western imagination as exemplified by the foundational work by René de Nebesky-Wojkowitz (1975 [1956]), while also playing a central role in the psychiatric branch of Sowa Rigpa. Terry Clifford (1984) elaborates on the latter and shows how spirits or demons are approached on multiple levels: as external forces that are pernicious karmic coagulations, mental projections of profound inner emotional disturbance, and ultimately as “empty” of intrinsic existence.

8. As stated in Dütsi Bumchen (Dobum Chökyi Drakpa 1995, 118).

9. As described in Dési Sangyé Gyatso’s (2005, 162–69) seventeenth-century Manual of Pith Instructions.

10. Carmen Simioli (2019) explores the impact of Buddhist tantras of the Old School on Tibetan conceptions of epidemics. She estimates Dütsi Bumchen as not older than the thirteenth century based on circumstantial textual data, but this seems unlikely to the first author (Pasang Yonten Arya) since it appears that the twelfth-century composer of the Four Tantras, Yutok Yönten Gönpo, drew from this work (see Yutok Yönten Gönpo 2011).

11. On March 29, Dr. Pasang Arya convened a special online session (attended by ninety-five students) on the causes and prevention of Covid-19, in which he also gave instructions on a concise Black Garuḍa practice for (self-)protection and transformation. See Jan M. A. van der Valk (2019) for an anthropological analysis of the potency of the Tibetan medical formula “Garuḍa 5,” which was also advised for preventive use during high-risk situations in this session. See Michael Slouber (2017) on the importance of the Garuḍa in early Indian medicine and religion.

12. This identification draws on Dütsi Bumchen, which the first author (Pasang Yonten Arya) considers the definitive reference on contagious disease. According to this text, every disease has its hidden spirit owner (nédak). The pulse diagnosis chapter of the Four Tantras further states that acute pulmonary inflammations are inflicted by tsen, , and lu or nāga spirits, whereas infectious (rim) and bile disorders are provoked by wrathful mother spirits (mamo).


Clifford, Terry. 1984. Tibetan Buddhist Medicine and Psychiatry: The Diamond Healing. York Beach, Maine: Samuel Weiser.

Dési Sangyé Gyatso (Sde srid sangs rgyas rgya mtsho). 2005. Man ngag lhan thabs [Manual of Pith Instructions]. Dharamsala: Men-Tsee-Khang.

Dobum Chökyi Drakpa (Rdo ’bum chos kyi grags pa). 1995. “Bdud rtsi bum chen” [Great Nectar Vase]. In Rin gter sman yig gces btus, 49–239. Chengdu: Sichuan People’s Publishing House.

Gerke, Barbara. 2020. “Thinking through Complex Webs of Potency: Early Tibetan Medical Responses to the Emerging Coronavirus Epidemic: Notes from a Field Visit to Dharamsala, India.” Medical Anthropology Theory 7, no. 1: 188–209.

Nebesky-Wojkowitz, René de. 1975. Oracles and Demons of Tibet: The Cult and Iconography of the Tibetan Protective Deities. Graz: Adademische Druck und Verlagsanstalt. Originally published in 1956.

Salick, Jan, Anja Byg, and Kenneth Bauer. 2012. “Contemporary Tibetan Cosmology of Climate Change.” Journal for the Study of Religion, Nature and Culture 6, no. 4: 447–76.

Simioli, Carmen. 2019. “Knowledge, Imagery, and the Treatment of Communicable Disease in the Vase of the Amṛta of Immortality: A Preliminary Analysis of a Nyingma Medical Corpus.” In Tibetan Medicine in Context, PIATS 2016, Tibetan Studies: Proceedings of the Fourteenth Seminar of the International Association for Tibetan Studies, Bergen, 2016, edited by William McGrath, 218–60. Leiden: Brill.

Slouber, Michael. 2017. Early Tantric Medicine: Snakebite, Mantras, and Healing in the Gāruḍa Tantras. Oxford: Oxford University Press.

Tsering Bum. 2016. “The Changing Roles of Tibetan Mountain Deities in the Context of Emerging Environmental Issues: Dkar po Lha bsham in Yul Shul.” Asian Highland Perspectives no. 40: 1–33.

van der Valk, Jan M. A. 2019 “Garuda 5 (khyung lnga): Ecologies of Potency and the Poison-Medicine Spectrum of Sowa Rigpa’s Renowned ‘Black Aconite’ Formula.” HIMALAYA 39, no. 1: 111–28.

Yeh, Emily T., and Chris Coggins, eds. 2014. Mapping Shangrila: Contested Landscapes in the Sino-Tibetan Borderlands. Seattle: University of Washington Press.

Ye, Zi-Wei, Shuofeng Yuan, Kit-San Yuen, Sin-Yee Fung, Chi-Ping Chan, and Dong-Yan Jin. 2020. “Zoonotic Origins of Human Coronaviruses.” International Journal of Biological Sciences 16, no. 10: 1686–97.

Yutok Yönten Gönpo (G.yu thog yon tan mgon po). 2011. Bdud rtsi snying po yan lag brgyad pa gsang ba man ngag gi rgyud [Gyüzhi, the Four Tantras]. Dharamsala: Men-Tsee-Khang.