Health and Sanitation

Its importance to nuns and their practice

Sónia Gomes

ABSTRACT

In recent times, advances in female daily-use healthcare items are fundamental

in having brought wide sweeping changes to the lives of millions of women
around the world. Prior to this ongoing sanitary and healthcare revolution, in
many parts of the developing world, issues of taboos around female cycles and
sanitation, were rampant, causing stress to women as also playing a role in
perpetuating patriarchy. In this dialogue, we focus on the health concerns and
Vinaya rules for the Tibetan Female monastic community, but these views and
trends, apply throughout the whole collective conscious of monastic
communities. There cannot be a clear radiant mind without a healthy and
hygienic body, and his view is supported by the concept of Vajra Kaya,
developed thousands of years ago in this Nalanda vicinity. The paper is also a
clarion call to Sangha leaders and scholar - practitioners for action covered in
the final summary so that women with different biology can equally excel on the
path of Dharma.

Keywords: Bhikkhunī Pāṭimokkha, cervical cancer, Kalacakra, hygiene, menstruation

taboo, Naldjorma Project, Pharping, vajra deha, Yoga.

INTRODUCTION

When considering health & sanitation, a focus on gender differences is of particular

importance, highlighting the inequalities and chronic disparities. This offers resolve and
a clear view of the work required in order to bring the affected women forward to
achieve 21st-century living standards.

Inadequate access to sanitation and hygiene disproportionally affects poor women,

girls, and nuns, especially those in developing countries with a very basic socio-
economic status. These affected groups are often faced with conditions that are not
only seriously adverse for health, with negative health outcomes but are fundamentally
suffered in silence, due to the codes of conduct, surrounding cultural reference and
tradition.

To ignore their natural female bodily functions out of fear, causes not only discomfort
but also increase the risk of being affected by serious health problems such as urinary
tract infections, gynaecological diseases, chronic constipation and mental stress, with
additional serious challenges related to menstrual hygiene and other related health
issues.

_________________________________________________________

*Sonia Gomes is the founder of Naldjorma Project working on the health issues of
Women and Buddhist nuns in the Himalayas. Email: smmsgomes@gmail.com
Without proper sanitation and hygiene, one’s health is at risk, and most crucially, so is
the maintenance of a good spiritual practice.

Having identified a clear health-poverty correlation within the female monastic

community, limitations of beliefs and previous societal values, poor access to basic
resources & a chronic shortage or adequate wash/latrine facilities, one can fathom the
severe obstacles, impeding severely overall quality of life.

RATIONALE & OBJECTIVES

In recent times, advances in female daily-use healthcare items are fundamental in

having brought wide sweeping changes to the lives of millions of women around the
world. Prior to this ongoing sanitary and healthcare revolution, in many parts of the
developing world, issues of taboos around female cycles and sanitation, were rampant,
causing stress to women as also playing a role in perpetuating patriarchy.

With a systemic crisis, such as that identified within the Buddhist monastic community
right now, immediate resolution and action must be applied to these matters without
delay. The systemic beliefs and habits that are at the root of these severe health
imbalances ought to be a matter of grave concern. These demand that a system of re-
education and massive awareness campaign must now be a priority action.

The rules that govern the actions and habits of nuns have led to a quiet denial and a
gross volume of suffering to most of them. Being stuck in the far distant past, these
must be reviewed by the Sangha's heads at the highest levels.

The aim of these desired changes are not to dilute any Dharma elements, but to apply
the wisdom held in modern healthcare practices with a balance that has been seen in
monastic communities of other faiths.

These matters must not be seen as either unspeakable and/or embarrassing to

address. The paths of so many rely upon immediate action with wisdom and resolute
decision.

The 21st century is witnessing the return of mankind to the root heart- based nature of
life. In order for this to be called in at the most subtle and the highest levels, we are
required to view from the perspective of the western world. Our civilization ought not to
carry the weight of old and worn out system that no longer serves humanity with
comfort, care, and equity.

Women are leading these changes, and not in reflection of the male dominant past or
ego- based narcissistic culture of the 20th century, but in giving the balance that is
seen in the wisdom and method. Heart -based change, is like a mother’s unconditional
love that keeps its children safe and fed as a matter of nature.
Women have quietly carried on the work of this root giving of life since primordial time.
As the world we live in calls for change; so must we reflect at the root natures that give
us the glorious life that we have.

With the digital genesis, this century has allowed much more to access teaching and
planted the seeds in many mind streams. Sangha, as instructed by the Buddha
Shakyamuni, are taught to question many elements as they learn the noble and wise
ways of this gift giving lotus of wisdom.
These issues around the treatment of female monastics, slow changes in the question
of parity of ordination and looking at many situations of health and sanitation as well as
poverty, has posed a great deal of cognitive dissonance within the expanding Sangha.

It is not a matter of blind faith, but a matter of what causes this question to stay in the
collective mind of the expanding Sangha:

The teaching of the root view of no separation, that we are all sentient beings, all father
–brother- mother, this wisdom shows us the heart away from ego- based chains that
have held humanity in ignorance and suffering. With that view, there can be no
possibility of female monastics being not venerated and their lives brought forward at a
great pace in this time.

The wider female Sangha members, reflecting this heart-based change in this time,
have so much to give to the monastic community. Seeing the monastics not only as
one’s father –brother- mother but as the root of the preservation of dharma and
expansion of heart -based practices.

Like a mother, wise in her nature gives life and preserves the unconditional yet skillful
ways, so the female Sangha members are fundamental and elemental in the changes
required within the female monastic community.

To base a system of re-education simply on the existing monastic order and make slow
changes, would not serve the best outcome. Western females Sangha members have
attained a level of wisdom and method in this area of re-education and this resource
must be deployed for realizing change. Leaders within the female monastic
communities must have a parity of re-education in order that the younger nuns may be
given the fundamental right to curtail eventual health problems before they take root.
Modalities such as yoga, so fundamental for health, now widely practiced within the
Sangha, and at dharma centers worldwide, must be brought in.

The aversion to one’s own body due to cultural reasons, to see oneself as inferior, to
create imbalances for practices, can be the only result of the restrictions currently
placed on nuns by rules and vows that were set 2.555 years ago. High cultural
reference and tradition are also important factors here that lead to ignorance.

A simple infection is enough to create widespread ill health, the liberation sought in
practice is severely hindered, when a solution is simply at hand.

The overall healthcare needs of female monastics has fallen way short of the baseline,
that is being prescribed as the norm in the wider world, creating a void in healthcare,
education, and resources. This has directly impacted the long-term health outcomes of
this community.

Moreover, there is a lack of connection with the basic female body principles of daily
healthcare. A culture of aversion to discuss the matter of female hygiene, further
impacts the issue. The questions that surround these matters are often of great
embarrassment to the very community it affects, and remain deeply ingrained.

Here below, we focus on the Tibetan Female monastic community, but these views
and trends, apply throughout the whole collective conscious of monastic communities,
therefore one should extrapolate the need for the wider view and the clear call to action
covered in the final summary.
WELL-BEING AND HEALTH

Buddha was interested in the well-being of all men and women in every aspect of life.
One of the life’s most central concerns is good health. Buddha’s instruction concerning
health is scattered throughout the ancient Buddhist texts, especially, in The Vinaya
Pitaka and The Sutta-Pitaka. In The Mahavagga, there is a whole chapter on
clinical/medical instructions called Bhesajja khandha and another called Bhojana
khandha (section on food) for monks. There is need for modern-day physicians and
scholars interested in ancient herbal medications to conduct studies and
experimentation guided by these texts and commentaries. There is, then, this rich
corpus of psychological material, to research the Buddhist texts, especially the
Abhidhamma Pitaka.

Dr. Sunanda Putuwar describes in details in the work “The Clinical and Hygienic
Concerns of Lord Buddha,” 1 how Buddha himself was never reluctant to address such
mundane issues of proper sanitation for better health. In The Mahavagga,
Vatthakkhandaka it says that one should dry bed sheets and clothes everyday. Monks
should sweep and clean their dwelling places. Therefore it is a violation of a Sangha
rule to keep an untidy residence. The Buddha said that one should live in a suitable
location or environment (patirupadesa vasa) for good health and peace of mind. To
preserve good health one should take a moderate amount of (nutrition) food at regular
times. Moderate meals are soon digested, making one feel comfortable, and this
protects the life-span (ayupalayamti). To cure many diseases, good diet, medicine, and
loving care are important.

A physician must necessarily be skillful and expert in a chosen field of work, knowing
why and how any disease incurs, how it makes a patient, feel pain etc, and why it
vanishes. In other words, a physician must know the cause and origin of disease, its
existence and duration, severity and its positive and negative reactions. This aids in
determining what treatment will be profitable (beneficial) or what will lead to inertia (or
worse). A physician must be patient and kind and treat the patient well.

SANITATION AND HYGIENE

Statistically, one person in three lacks access to adequate sanitation. 2 The UN Report
on sanitation mentions that the lack of access result is widespread death and disease –
especially among children – and social marginalization. Women are particularly
vulnerable. Poor sanitation exposes females to the risk of assault, and when schools
cannot provide clean, safe toilets girls’ attendance drops.

Since our project is starting to do some work among women and Buddhist Nuns in
Nepal, an eyeview of conditions of Nepalese women is necessary.
NEPAL

In Nepal, women and girls are disproportionately affected by the lack of access to safe
water, sanitation, and hygiene. Access to safe water and sanitation is a fundamental
right, but unless health and hygiene practices are changed for the better, no amount of
investment will improve living conditions. In Nepal, women have the responsibility of
managing health and hygiene at home, including the preparation of food as well as the
general cleanliness.

As a developing country, Nepal faces a multitude of serious problems at a community

level, with the literacy rate of women around 40% and the quality of education in public
schools being extremely poor for various reasons. One of the most serious problems
faced by local communities in Nepal is the lack of awareness among wider community
members regarding health and sanitation requirements and protocols. As the majority
of them are illiterate, they have not been able to adopt modern hygiene standards into
their daily practices. Some of the communities do not have toilet facilities in their
houses and as such, they use open spaces nearby for defecation. These problems
obviously constitute a major threat to the health of the people in the community, as well
as to the surrounding environment. Thus, there is a great need to improve the quality of
life within such communities.

But the problem appears to be accentuated among Buddhist nuns due to several
restrictions aggravated by the cultural aspects, beliefs, and practices. Naldjorma
Project intends to address this aspect of female Sangha lives so that their dharmic
practices do not suffer due to poor health and sanitation.

NALDJORMA PROJECT3

Our team, from Naldjorma Project, visited Kyabje Chatral Rinpoche Gonpa in Pharping,
Bhagang Monastery, Sindhupalchok - now in temporary shelter at Baisiparty and
Kopan Nunnery in Nepal. Pharping is known for the cave where Great Guru
Padmasambhava practiced the Generation stage of Vajrakilaya. Asura Cave, where
he practiced the completion Stage of Yangdak Heruka.

The most common health problems we found were:

1. Gastritis, indigestion

2. Stomach pain

3. Urinary Infections / Gynaecological problems

4. Arthritic- type joint pain

5. High blood pressure

6. Eye problems. Reading glasses needed for those over 40 years old.
7. Cataracts among older people.
8. Headaches.
9. Diarrhoea.
The most serious health problems were related to lack of medicines, proper sanitation
and information/education in Female Hygiene. We also noticed that sometimes nuns
are absent for one or two days per month for the “monthly disease” (menstruation), “but
they don’t speak about it”. This is alarming & highlights systemic issues that require
change. Why do they do so? Simply, because Vinayas for monastic women is stricter
without a clear understanding of their exceptional biology.

VINAYAS FOR THE BUDDHIST NUNS

Those who join the Buddhist monastic order submit to an ethical code, Vinaya, that is
intended to drive out or remove the lust, ill will, infatuation and other obstacles to
liberation that characterize a secluded life. The Vinaya code is vigilant in ensuring that
the ethical conduct of monks and nuns remains beyond the reproach of the laity,
whose own behavior conforms to a lower ethical standard.

The Vinaya code differs for nuns, reflecting the patriarchal era in which the rules were
first promulgated and then interpreted. Shakyamuni Buddha initially hesitated to
establish an order for nuns but eventually set out Eight Important Rules 4 for them,
what Pali text describes as Bhikkhunī Pāṭimokkha, in that did not apply to the order of
monks, such as requiring a nun to show deference to all monks, even those with less
monastic tenure than the nun (monks show deference only to other monks with longer
tenure). Nuns also have extra pravajika rules on sexual behavior beyond the
prohibition of sexual intercourse that apply equally to monks. These extend to
physical contact with a man or making preparations for such physical contact out of
sexual desire, which would be lesser offenses if committed by a monk.

THUS QUESTION IS RAISED: IS ADJUSTMENT NEEDED IN VINAYA FOR

BHIKKHUNIS FOR A HEALTHY LIFE?

The biggest problem is not the root text, but the way this has been interpreted and
applied. There is no doubt that the policy in many Buddhist traditions has been quite
unacceptable. Very little is said, too, about how the ordinary body might theoretically
serve as a bridge to a Buddha’s enlightened form. Even the Vinaya literature, which
depends on n fundamental ways on bodily discipline, has little to say overtly about how
the body itself exists, or how it acts as an instrument for spiritual or ethical
transformation. Lama Yeshe and Lama Zopa Rinpoche, two of modernizing Buddhist
leaders, describe the predicament in following ways:

“Remember that Vinaya rules can change with the times. As our culture
changes, the Vinaya rules themselves can also change. Lord Buddha himself
said this. Study the Vinaya in detail. This doesn't mean that these days you can
kill– it doesn't mean that. For example, Western women's use of perfume is
commonplace; it's nothing special, no big deal. But in Tibet and other Third
World countries, when a woman puts on perfume, it is something special–
people think there's something going in her mind. In the West, it's nothing: both
men and women use perfume. It's almost obligatory! So you have to take into
account such cultural differences, too.”

Lama Yeshe and Lama Zopa Rinpoche 5

Is it not the right time to amend certain Vinaya rules for the Buddhist nuns who are
suffering quietly when their different biology already torments them? Though, the Yoga
of drops whereby red drop(menstrual blood) and white drop( semen) is practiced
among the Himalayan Buddhists when it comes to a menstruating women, the
principles of prajna and Karuna goes for a spin.

IMPORTANCE OF HEALTH AND THE SUBTLE BODY

“To find balance, we need to pay more attention to the body, especially the
subtle body.”

Given the close relationship between subtle physiology and the gross flesh-and-blood
body, it is not surprising that in contemporary Himalayan (or Tibetan) Buddhist practice,
the subtle body (vajra deha) acts as a kind of bridge between the body and mind. Vajra
deha is an interface between body and mind. It has elements of the physical, such as
form, colors, and structure. But it has elements of the mental as well; like thought and
emotions. The vajradeha can be reconditioned with focus, training, and intent, and
even permanently altered to support a more enlightened state of being.

The vajradeha inhabits an "in-between” mode of embodiment, mediating between body

and mind. Gyalwa YangOnpa(1213-1258), a great Dzogchen master has mapped the
subtle body in his seminal work, “Hidden description of the Vajra Body”. The same is
available in translation now. 6

Yangonpa outlines how vajra deha accommodates body and mind both as an
integrated whole. This whole is the field of somatic experience, as it occurs at the
present moment. While the body may not be in our control, the quality of our attention
to our experience is, and this is where we begin to enter the world of the subtle body.

Yangonpa, and his predecessor Naropa, who was a Nalanda Master and great
exponent of the Kalacakra Tantra focused on the inseparability of the energy winds
and mind. If we can bring mind into a radical union with energy winds, the theory goes,
that alone liberates. Willa Blythe Miller, in her dissertation, Secrets of the Vajra Body,
examines Gyalwa Yangonpa’s work on Tibetan views on the subtle body.7 Willa Miller’s
dissertation focuses on Yang dgon pa Rgyal mtshan dpal’s Explanation of the Hidden
Vajra Body (Rdo rje lus kyi sbas bshad), and provides Buddhist and Tibetan studies
scholars a rare portrait of a tantric soteriology that positions the human body from its
coarse to subtle levels as the basis, path, and fruit of Buddhist enlightenment. Buddhist
doctrine normally places the mind as the primary basis for cultivation, but in an
important move, Miller focuses on the extraordinary and unique emphasis on the body,
and its radical inseparability from the mind and speech in Yang dgon pa’s work. To do
this, Miller explores the pivotal and multivalent term, dngos po’i gnas lugs, broadly
meaning in Yang dgon pa’s conceptualisation “the entire situation of human
embodiment.”
Vesna Wallace, who has translated portions of the Kālacakra Tantra(chapter 2 &
chapter 4 and now translating chapter 5) and its commentary, the Vimalaprabhā, has
focused on materials that especially concern Kalachakra tantric notions of
understanding the inner human body.8

Janet Gyatso and Frances Garrett, both of whom take Tibetan medical works as their
primary subject, are also trying to understand outer human body in Tibetan medical
system from a modern perspective. Frances Garrett’s recent book is a detailed
comparative study of Tibetan versions of embryology, looking at both medical and
religious works. 9 In this study, we see a remarkable indication of the enduring
connection between the pervading wind, the mind, and the channels that convey the
wind-mind all over the human body.

KAYA AND VAJRADEHA- INTERRELATIONALITY OF HYGIENE AND

ENLIGHTENMENT

If one doesn’t have a healthy physical body, with hygiene and proper sanitation, how
would one’s subtle body react to that? How is it possible for nuns and female to have
an effective practice in Vajrayana if their health is not well? How are their winds and
channels going to move in right places at a right time when they have gynecological
problems?

Here we have a deep and powerful connection with the importance of health and
sanitation for the effectiveness of practice according to Tantrayana Is there a cost-
effective way to address the health concern of nuns in the Himalayan belt?

Apart from improved nutrition, separate and clean toilets, supply of sanitary napkins or
(maybe in a near future, the mooncup? 10 ), arrangement of proper drinking water;
introduction of Indian Yoga into nunneries can help the distressed nuns from several
chronic problems. Many studies have tried to determine the effectiveness of yoga as a
complementary intervention for chronic back pain, depression, diabetes, menopause,
asthma, obesity, heart disease and stress management. 11 On December 1, 2016,
Yoga has now been listed as UNESCO’s Intangible cultural heritage.

MENSTRUATION AND BUDDHIST TEXTS

Buddhism is engrained in Tibetan society and reflects a schism between attitudes

around the subject of the female cycle and menstruation. There is little information
concerning menstruation presented in Buddhist texts, yet Tibetan Buddhist myths and
practices regard menstruation are both powerful and sinful.

Kara Spafford 12 conducted a study with Men Tsee Khang in MacLeodGanj, Himachal
Pradesh among Buddhist women to understand their health practices. The majority of
respondents were not familiar with the perception of menstruation in Buddhist texts and
practices, yet demonstrated avoidance of religious places due to the fear of committing
sin and impurity.
The findings mention astonishing results. Out of 32 Tibetan women, 56.3% reported
that they do not enter monasteries while they are menstruating. An additional 12.5%
reported only entering a monastery under special circumstances or requirement. The
majority of this group explained that they avoid entering religious places when they are
alone, but they will go if they have work to do at the monastery or if a relative is
accompanying them. A total of 6 out of 32 women (18.7%) said that they do enter a
monastery while menstruating. It is important to note that 5 out of these 6 women were
Buddhist nuns who live in the monastery and are required to attend rituals while they
are menstruating.13 The report mentions how one nun explained that this experience
can be particularly distressing and conflicts with her religious beliefs: “Especially when
there is ritual practice and I have to attend, I feel very uncomfortable. I feel impure.”
Several of the nuns mentioned that if they have severely painful menstruation, then
they are able to obtain a leave. Out of the 18 women who did not enter religious places
while menstruating under any circumstances, 11 stated that doing so would be
considered impure or sinful. Another woman said entering a religious place “would de-
sanctify the gods.”

Spafford writes that in Tibet, the bodily functions of women were seen as dangerous to
the effectiveness of rituals, and therefore menstruating women had the power to
“endanger entire communities” by their presence at monasteries.14

There are also positive representations of menstruation in Tibetan medical texts and
practices, in which menstrual blood is both natural and powerful. But this perspective is
not taught to the Buddhist nuns.

Jenny Bright in her work, "'Female Nectar': A Study of Hybridity and Gender in
Contemporary Tibetan Medical Literature on Menstruation”(2011) 15 writes how
menstrual blood is referred to as dazen in Tibetan medicine and is the most important
factor in conception. The whole process of formation of the blood and its periodic
oozing is described in Tibetan medicine much of which is based upon Buddha’s
teachings.

But, menstrual blood “is the main cause of gynecological problems.” Tibetan Medicine
describes how menstrual ailments occur when there is a disturbance of wind or bile
energy in the body. Disorders that result from disturbance of wind are known as rLung
disorders. A form of rLung called Downward Cleansing Wind (Thur-sel-rLung) is
generally responsible for controlling excretion, including the flow of menstrual blood.

Future studies using ethno-methodological tools for emic studies of Buddhist

nuns can explore the perception of menstruation among them in the interior
area. Their viewpoints are important and they are generally more knowledgeable about
Buddhist portrayals of menstruation than the general public is.
CONSEQUENCES OF UNHEALTHY MENSTRUAL PRACTICES AND WAY OUT

Poor menstrual hygiene can cause fungal infections, Reproductive Tract Infection and
Urinary Tract Infection which might lead to cervical cancer. Cervical cancer is the
cancer of the mouth of the uterus caused by a virus called Human Papillomavirus
(HPV) and can be caused due to the unclean generative organ. A study has found that
the hygiene-related practices of women during menstruation are considered important
because it can increase vulnerability to Reproductive Tract Infections (RTI's). Most
adolescent girls in villages, use rags and old clothes, instead of sanitary towels, during
the menstruation cycle, practices that directly increase susceptibility to RTI's. Poor
menstrual hygiene is one of the major reasons for the high prevalence of RTIs in the
country and contributes significantly to female morbidity. 16 These are deaths that can
be reduced through the implementation of very simple resources and protocols.

Education for nuns, girls and the wider community on the menstruation cycle, is crucial
to address discrimination and exclusion, and to create an environment where women
and girls can articulate their needs is a fundamental need — particularly in contexts
where there are significant taboos and restrictions, coupled with a lack of accurate
information on sexual and reproductive health. Educating girls and women about
feminine hygiene and biology helps to bust myths and cultural superstitions. Access to
correct information about hygiene and adequate sanitary materials enables women to
feel more confident and comfortable with their bodies.

Despite the importance of menstrual hygiene management (MHM), findings from a

recent study showed that menstrual hygiene is not a talked about topic and often a
discussion that must be kept hidden from males. This is even more apparent in the
monastic institutions.

Appropriate water and sanitation facilities for women and girls are another gap, and are
probably even more important. A consolidated program of extensive review and repair
of female monastic facilities must be a priority to get to the root of a very serious life
threatening cycle of sanitation & health poverty.

To break the silence and help understand better, presentations and images were
presented in Kopan Nunnery in Nepal by Naldjorma project. When these issues are
accepted as essential education & the previous aversions are addressed, great
obstacle will be removed.
 Image: Naldjorma Team with Buddhist Nuns in Kopan Nunnery – Nepal

It is not only menstruation-related problems that might lead to epidemic of cervical

cancer among Himalayan Buddhist nuns but also issues like diabetes, backache,
malnutrition and consequent chronic problems, which ought to be addressed before
pushing women on the path of lightning-bolt enlightenment.

WHAT NEXT?

The remedy is but a simple call to action backed by the clear instruction to proceed,
from the single pointed objective of the global monastic leaders assembled here.
Approving the need for urgent change, with one voice shows the wider community that
these mundane matters not only are truly important but require a voice and can be
spoken about.

The appointment of senior representatives, with clear mandate, to focus at the

healthcare resources and implementation of sanitary improvements and education over
the next weeks and months, into the short term, medium term & long term, is a matter
of great urgency. The project at hand to address these matters immediately, requires a
setting out of the “path to change objectives” during this momentous Nalanda Dialogue.

At the same time, with a formal sanction to move forward, as a matter of urgency
without prejudice, a clear signal will be given to the wider monastic community and
Sangha to prepare and embrace these changes. This will be truly most welcome.

The most glorious programs of education being revived and sanctioned at this time,
here, will provide a long term backing to such a program of overall re-education.
The most glorious wisdom that has been shared and reflected upon in the worlds of
science during the many years of sessions in Dharamsala, and the wider scholastic
links with Western science & its comparative discussions and studies, give the most
solid base and valuable resource at the cutting edge of healthcare and modern
systems of change. These offer invaluable sources of references from completed
studies and the basis for the proposed educational materials.

The ancient systems of Indian yoga, its adepts and wisdom, also compliment these
studies and form an immediate source of direct implementable seeds of change.

The process of change into expanded awareness and taking the above female
monastic issues forward is a great source of harmony, intrinsic in supporting women
further into the next part of this very global transition.

ENDNOTES
1.
Ven. Dr. Sunanda Putuwar (1988-89). “The Clinical and Hygienic Concerns of Lord
Buddha”, Buddhist Himalaya. Vol.1 (2). Available
at http://buddhism.lib.ntu.edu.tw/FULLTEXT/JR-BH/bh117481.htm
2
UNDESA(2015). International decade For Action “Water For Life”(2005-2015).
www.un.org/waterforlifedecade/sanitation.shtml
3
http://www.naldjormas.com/
4
https://en.wikipedia.org/wiki/The_Eight_Garudhammas. Also, see Thanissaro Bhikkhu
tr.(2007).Bhikkhunī Pāṭimokkha: The Bhikkhunīs' Code of Discipline.Translated from
the Pali. Available at http://www.accesstoinsight.org/tipitaka/vin/sv/bhikkhuni-pati.html
5
Lama Yeshe and Lama Zopa Rinpoche, Advice for monks and Nuns. Available at
http://buddhanet.net/ftp04.htm

6
Gyalwa Yangonpa (2017). Secret Map of the Body: Visions of the Human Energy
Structure. Translated from Tibetan by Elio Guarisco (Translator) Shang Shung
Publications.
7
Willa Blythe Miller( 2013). Secrets of the Vajra Body: Dngos po'i gnas lugs and the
Apotheosis of the Body in the Work of Rgyal ba Yang dgon pa. Ph.D Dissertation,
Harvard University. Available at https://dash.harvard.edu/handle/1/11125112
8
Vesna A. Wallace (2001). The Inner Kālacakratantra: A Buddhist Tantric View of the
Individual. (Oxford: Oxford University Press) and The Kālacakratantra: The Chapter on
the Individual Together with the Vimalaprabhā, Treasury of the Buddhist sciences (New
York: American Institute of Buddhist Studies at Columbia University, 2004).
9
Frances Mary Garrett (2008).Religion, Medicine and the Human Embryo in Tibet,
Routledge Critical Studies in Buddhism (London; New York: Routledge).
10
https://en.wikipedia.org/wiki/Menstrual_cup
11
Zorica Popovic & Predrag Nikie(2016).Traditional knowledge of benefits of Yoga
practice verified in modern scientific literature: An overview of journals indexed in
Integrative & Complementary Medicine, Indian Journal of Traditional Knowledge, Vol.
15(3):37-84.Available at
http://nopr.niscair.res.in/bitstream/123456789/34273/1/IJTK%2015(3)%20378-384.pdf
12
Kara Spafford(2015). "The Perception of Menstruation and Treatment Of Menstrual
Ailments among Tibetan Women in McleodGanj, Himachal Pradesh". India: Public
Health, Policy Advocacy, and Community. Paper 1. Available at
http://digitalcollections.sit.edu/inh/1

13
Ibid.
14
Ibid.
15
Spafford(2015). Also Jenny Bright(2011). 'Female Nectar': A Study of Hybridity and
Gender in Contemporary Tibetan Medical Literature on Menstruation, Asian Medicine
Vol.6.2 (2011), 403.

Also see an inside perspective, Tsering Thakchoe Drungsto(2007). Basic Concepts of

Tibetan Medicine: A Guide to Understanding Tibetan Medical Science, 1, p.79 (New
Delhi: Drungsto Publications).
16
Juneja A, Sehgal A, Mitra AB, Pandey A.(2003). A survey on risk factors associated
with cervical cancer Indian J Cancer. Jan-Mar; Vol.40 (1):15-22. Available at
https://www.ncbi.nlm.nih.gov/pubmed/14716127