May-June 2000
By Susan C. Maresco
If you could imagine your family physician as herbalist, botanist, alchemist, gemologist, mystic, psychologist and medical practitioner, that would begin to encompass the knowledge of today’s Tibetan medical doctors. Stretching far back into the shamanistic Bon religion, Tibetan medicine’s historical roots also reach into Greece (via Persia), India and China, the closest ties being to Indian Ayurvedic medicine.
However, it is Buddhism that lies at the core of the practice and outlook of Tibetan medicine – Buddha’s teachings being the ultimate medicine for the suffering of all human beings. When you speak of Tibetan medicine, you are really referring to Tibetan Buddhist medicine. “It is precisely this spiritual and philosophical core that makes Tibetan medicine so unique,” says Terry Clifford.
“To understand this basic relationship, one need only recognize that the Buddha himself spoke of ultimate truth in terms of a medical analogy. It has been said that the entire teaching of the Buddha is how to prevent suffering. According to the Buddha, we suffer from the inherent frustration of conditioned existence, and our suffering is caused by the fact of impermanence of all entities and by the endless craving that arises from the basic delusion of ego’s self-existence. The medicine the Buddha prescribed to overcome our suffering and delusion is his teaching, the Dharma. And the essence of this teaching is to tame the mind and transmute the negative emotions. The Buddha taught that mind is the basis of all phenomena. Mind creates matter and mind creates illness and wellness. And herein lies the fundamental psychosomatic assumption of Buddhist medicine.”1
Dharma is the operative strength of both Buddhism and Tibetan medicine, and each of us has the responsibility to transform our own minds.
The training to become a doctor begins with right motivation and right intent, good character, politeness. Treatment must never be based on an individual’s ability to pay – all potential patients are welcome.
Inevitably, our sufferings often bring illness and disease and a variety of health problems for which Tibetan medicines offers “highly defined and relevant models with which we can enrich our modern views of healing. These include a model of holistic medicine, a model of psychosomatic medicine, a model of mental and psychic healing, an ethical model of the healer, and a model for using illness to develop wisdom.”2
The Tibetan doctor’s job is to relieve as much suffering as possible for all his patients, combining affectionate care with medicines, recipes for altered diet and behavior, and possibly, spiritual practices. The training to become a doctor begins with right motivation and right intent, good character, politeness. Treatment must never be based on an individual’s ability to pay – all potential patients are welcome. Ideally, the doctor and patient should share some heartfelt connectedness that is acknowledged by both.
Tibetan medicine’s holistic approach to healing has been attracting increasing interest in the West, especially in the last decade. Medical insurance plans now help pay for acupuncture treatments, and it is hoped that they may eventually acknowledge other forms of treatment for reimbursement as well. It is reassuring to see that, even as pharmaceutical companies are aggressively advertising prescription products on TV, more and more people are opting for the kind of holistic treatment that Tibetan medicine offers. Tibetan medicine works for both minor and major ailments and is able to cure cases of even the worst diseases, like AIDS and cancer.
Tibetan medicine was influenced by Greek and Chinese medicine, but is primarily derived from Ayurveda, which means literally “the science of long life” and is the traditional medical system of India. Before the arrival of Buddhism in Tibet and Ayurveda’s great influence, the Bon shamanic culture of Tibet had a medical tradition that utilized their great knowledge, both magical and medical, of the local abundance of herbs. “The marvelous quality of Tibetan healing herbs was known in ancient China, and mention of them found its way into early Chinese pharmacological texts,” Terry Clifford offers. Although pre-Buddhist Bon medicine was not really systematized, the Bon medical texts written after Buddhism’s arrival demonstrate the influence of Ayurveda.
From Chinese medicine, Tibetan medicine adopted pulse diagnosis, measurement and inspection of the tongue, and acupuncture. From the Persians’ advanced medical system, which the Persians themselves had derived from ancient Greek medicine, Tibetans also extracted teachings. “The Tibetans took the best of these teachings and added them to Ayurvedic, Buddhist, and tantric medicine adopted from India. They also added urine analysis, their major indigenous contribution to Ayurvedic medical science; a good Tibetan doctor could diagnose and prescribe a cure simply by urine analysis.”3
Tibet did not have a written language when, in about the 5th century, both Buddhism’s and Ayurveda’s influence arrived and began to be felt. Other healing teachings had arrived from foreign lands and been variously absorbed into the existing Tibetan practices, so keen interest in Ayurvedic practices would not seem unusual. Dr. Yeshi Dhonden, a Tibetan doctor and a personal physician to His Holiness the Dalai Lama, describes its arrival in Tibet during the reign of King Thothori Nyentsen, the 28th king of Tibet, in the 4th century CE: “What we now call Tibetan medicine was first introduced into Tibet during the reign of that same king, when two doctors, Biji Gadje and his female companion Bihla Gadzey, came to Tibet from India and practiced in the court of King Thothori Nyentsen. In Bodhgaya, Tara, the feminine embodiment of enlightened compassion, had previously appeared to them in a vision and told them they should go to Tibet to practice and teach medicine there. For many generations thereafter, this medical system was transmitted from teacher to disciple solely as an oral lineage, without any textual basis.”4
An accomplished siddha who could perform psychic feats of miraculous power, Yuthog Yontan Gonpo, Tibet’s first great doctor-saint, lived to be 125 years old. He is believed by Tibetans to be an emanation of the speech of the Medicine Buddha.
The descendants of King Thothori included at least seven generations of royal physicians in the court. Tibetan doctors would travel back and forth to India to receive teachings. It was not until the 7th century that a written Tibetan language was created in order to translate Buddhist texts written in Sanskrit into Tibetan. Men from the court of King Songtsen Gampo were sent to India for this express purpose. “Thonmi Samhota formulated a Tibetan alphabet and grammar based on Sanskrit. This made it a fairly straightforward process to translate from Sanskrit into Tibetan…. However, it should be noted that Sanskrit grammar is far more complex than Tibetan, which does present problems when trying to reconstruct Sanskrit texts from the Tibetan. But on the whole, Tibetan translations from Sanskrit are highly accurate.”5
In the 8th century, under the reign of King Trisong Detsen (742-797), Tibet’s most enlightened ruler, Tibet’s medical system began to blossom and spread throughout Tibet, and the Dharma prospered. Samye, the first Buddhist monastery, was founded during his reign. Created in the form of a mandala, it was presided over by the Indian saint Padmasambhava, Guru Rinpoche.6 It was there that many Sanskrit manuscripts covering a wide range of topics on Buddhism were first translated into Tibetan.
“In 749 Padmasambhava accepted the king’s invitation, went to Tibet, subdued the negative forces, and so firmly established the Dharma there…. From that time on, Vajrayana Buddhism and all the sciences it included became the one and only consuming interest, life-focus, and belief of the Tibetan people. From that time on Tibetan Buddhism and Tibetan culture were inseparable.”7
“Padmasambhava … initiated the king and others into his lineage of esoteric Buddhism, and prophesized that in future times, after centuries of unbroken lineage in Tibet, the Dharma would go to the West.”8
The greater a person’s heart-realization of true Dharma, the greater a doctor he can be, rendering him more capable of understanding the depths of the medical science and serving the needs of his patients.
Religious and medical teachings were one and the same, all part of the Dharma. Vairochana, who was Tibet’s first great translator of important religious texts, had been educated by both Abbot Shantarakshita, a distinguished Bengali monk and scholar who was responsible for sending Padmasambhava to Tibetoriginally, and by Padmasambhava himself. Vairochana was sent to India. “So in addition to the important religious texts which Vairochana procured, translated and mastered, there was also the medical work that became the most crucial in Tibetan medical literature, the Gyu-zhi.”9
The Gyu-zhi, or Four Tantras, is still the most important medical text; its herbal and other remedies and psychiatric cures are still being practiced today. When Vairochana returned to Tibet from India, he met Tibet’s first great doctor saint, Yuthog Yontan Gonpo, and gave him the Gyu-zhi teaching.
King Trisong Detsen was so enthusiastic about the Tibetan medical system that he held a convention, a debate actually, inviting Asia’s greatest doctors from India, China, Kashmir, Persia, Nepal, Mongolia, Sinkiang and Afghanistan. Naturally, Yuthog Yontan Gonpo represented Tibet, and he won the debate! Although it is difficult to imagine how they approached the language and translation problem, apparently they did manage it. “All translated texts from their own systems and presented them to the king. The doctor from China became the king’s court physician and started his own family medical lineage in Tibet, which was called Foreign Doctors.”10
Yuthog Yontan Gonpo bore the nickname “Turquoise Roof Physician” and was an ordained monk until the age of 80, at which time he disrobed and married to have children and thus continue his lineage. He was considered a genius as a doctor, an extraordinary, respected and accomplished healer, “a prime example of the lama-doctors and physician-saints of Tibet, an exalted and holy model of the healer drawn from the example of the Medicine Buddha himself,” Terry Clifford says. “An accomplished siddha who could perform psychic feats of miraculous power, Yuthog lived to be 125 years old. He is believed by Tibetans to be an emanation of the speech of the Medicine Buddha.”11
Yuthog’s death was as bright and extraordinary as his life had been. He “accomplished the ultimate Dharma by transmuting his physical body into rainbow light at the time of his death.”12 The Gyu-zhi, which he had mastered and taught so extensively, became an object of intrigue. It was hidden by Padmasambhava at Samye Monastery in the 8th century and remained there until the middle of the 11th century, when it exchanged several hands before finding its way into those of the second Yuthog. He worked on it and presumably edited some of the texts, though the degree of his work is not known. Today’s text also includes ideas and information that was not probably in the Indian version originally as there is “mention of uniquely Tibetan foods, plants unknown in India, Mongolian cauterization, Chinese pulse theory, etc. The original eighth century Tibetan translation, having been replaced in a pillar of Samye Monastery by its discoverer, was supposedly still there as recently as 20 years ago.”13
Buddhist culture in India came under fierce attack by Muslims from Turkey during the 13th century, wiping out monks, texts and monasteries. Although Tibetans could no longer go to India for teachings, the Tibetan medical system survived because “they had already brought almost all the spiritual and scientific lineages back to Tibet as living initiated lineages.”14 Important texts lost or destroyed by this Muslim attack in India were preserved in Sanskrit inTibet.
In the 14th century two famous doctors, Jangpa and Zurkarpa, headed rival medical systems that continued to exist into the 17th century. These rival systems engendered some confusion on both theoretical and practical matters of Tibetan medicine. Thus the Fifth Dalai Lama’s Regent, Sangye Gyatso (1653-1705), established Tibet’s first medical school, which was initially at Drepung Monastery. Soon thereafter a building site was chosen, probably by utilizing astrology and divination, and a school/hospital/monastery complex was erected on an exceedingly rocky hill. The complex was named the Iron Mountain or Chagpori, which refers to the almost vertical aspect of the hill itself. Chagpori became both the spiritual center for medicine in Tibetas well as an important center of “medical learning and secret herbal cures made by the lama-doctors.”15 The tradition of having a lama-doctor in residence at every main monastery was instituted at Chagpori.
The Regent, meanwhile, added various literary and artistic activities to his already considerable political duties. He revised the Four Tantras, wrote a famous commentary, and then created a series of 79 paintings illustrating the contents of his commentary. Embryology, anatomy, physiology, materia medica, methods of diagnosis, therapy, etc. were just a few of the topics he covered. His assiduousness and desire for precision of depiction ranged from the indigenous medicinal plants to exotic ones and even led him to send an artist to funeral sites so as to sketch the visceral contents of corpses for his anatomical descriptions. Corpses were often cut up as food for vultures in keeping with Buddhist tradition. Ultimately, the Regent’s vast body of work with its wide range of topics is considered to be “one of the great achievements in medical iconography.”16
Chagpori became a magnet for medical students from far and wide throughout Asia, reminiscent of Tibet’s Golden Age between the 8th and 12th centuries. Kublai Khan’s conversion to the Dharma caused Mongolians to become so enthusiastic over Tibetan Ayurveda that they adopted the entire system, translating the major works into Mongolian. This wholesale adoption of the Tibetan Buddhist medical system survives today in Mongolia.
The greatest doctors in Tibet were also great lamas. A physician represents the Medicine Buddha: “The greater a person’s heart-realization of true Dharma, the greater a doctor he can be, for he will have two-fold Buddha-nature aspects of wisdom and compassion, rendering him more capable of understanding the depths of the medical science and serving the physical, emotional, and spiritual needs of his patients.”17
This tradition of great lamas and saints applying themselves to Tibetan medicine has continued to the present. Scholars and saints wrote commentaries and treatises on a variety of subjects, thus ever increasing the existing body of knowledge. Lama Mipham, in the late 19th and early 20th century, wrote 32 volumes of works on music, logic, astrology, alchemy and medicine as well as organizing the sutras and philosophical tantras. Also important were his writings about the healing properties of gems, the healing uses of five Tibetan grasses and his commentary on the Gyu-zhi.
In the early 20th century, during the years of the Thirteenth Dalai Lama, a new medical college in Lhasa named the House of Medicine and Astronomy was built through the efforts of the outstanding physician-lama Khyenrab Norbu (1883-1962). His phenomenal memory and intellectual acuity allowed him to memorize the entire Gyu-zhi by the age of 16 and four years later he passed his medical exams with a perfect score. He was the personal physician to the Thirteenth and Fourteenth Dalai Lamas in Tibet, and he was the teacher of Dr. Yeshi Dhonden.
Ironically, since the Chinese Communist invasion of Tibet in 1959 and the subsequent exodus by many Tibetans to India and countries in the West, we in the West have learned more about Tibetan medicine and have had greater access to Tibetan doctors than ever before. Although the Chinese respected Tibetan medicine and used it themselves, they prohibited prayer in the preparation of medicines. However, over a period of time, they came to realize that the medicines were more efficacious when prayer was offered according to Tibetan Buddhist tradition; thus the practice of prayer was allowed to be resumed, and hopefully, continues to this day.
The Body in Balance
Of the Four Tantras that comprise the Tibetan medical system, the Root Tantra is the primary one that describes an overview of the whole field: “The six chapters of this tantra correspond to the central metaphor for the whole of Tibetan medicine, namely the tree of medicine, with its three roots, nine trunks, 47 branches, 224 leaves, two flowers, and three fruits, each corresponding to specific topics within this medical system. The topics corresponding to the two flowers and three fruits are the professional and spiritual qualities achieved by a totally proficient physician in this tradition.”18
This “tree” in its branched and leafed out state represents both the natural state of the body and the bodily processes that produce a body in good health. The Root Tantra looks and reads like a series of categories and lists, but in reality it is infinitely complex, requiring elucidation in the form of the many commentaries that have been written over the centuries, which contribute to the vast body of knowledge concerning the science and art of Tibetan healing.
Tibetan medicine went directly to Indian Ayurvedic medicine for its theory of the afflictive humoral elements of the body – wind, bile and phlegm – on which diagnosis of illness is based. The terms “wind, bile and phlegm” have both literal and figurative meanings, referring to both qualities within the body as well as systems of energetic movement. There are five winds, five biles and five phlegms underlying the humors. All inanimate things and all animate beings also contain five elements: earth (solidity), water (fluidity), fire (heat), air (motility) and space.19
As earth, water, fire, air and space are necessary to life on this planet, so too are the three humors’ functions of these elements, and each humor has its own particular characteristics, qualities, essences. Dr. Dhonden describes it briefly: “Phlegm has the potency of the earth and the water elements; bile has the potency of the fire element; and wind gives rise to the motion of the blood and breath within the body.”20
All bodies are born with characteristics, elements that can be/become afflicted and thus bring illness or harm to a person. Dr. Dhonden lists ten afflicted elements, within which are seven body constituents and three waste products. These are as follows:21 (1) nutriment; (2) blood; (3) flesh; (4) fat; (5) bone; (6) bone marrow; (7) regenerative substances (sperm and uterine blood, or ovum); (8) excrement; (9) urine; (10) sweat.
These ten characteristics intertwine with the afflictive three humoral elements of wind, bile and phlegm, making life possible until death arrives. Within the entire digestive process is the key to good or afflicted health. The complex digestive system provides the body with nutriment, warmth, flesh, blood, fat, bone and bone marrow – all interdependent. Digestive warmth is the key to the success of the entire process of keeping three humors in balance. Each humor plays a part in the process, and often the humors overlap to keep the body tuned harmoniously.
Wind’s characteristics are light, cool, rough, subtle, firm or mobile and may be located in the lower regions of the body. It has the general functions of “inhalation and exhalation, moving the limbs, and expelling and retaining waste products … also moves all the seven bodily constituents … is responsible for participating in all types of mental, verbal and bodily activities … bring clarity to all the five senses, and enables one to identify with one’s body….”22
Wind, being wind, moves around through the bones, skin, organs, and large intestine.
Tibetan medicine went directly to Indian Ayurvedic medicine for its theory of the afflictive humoral elements of the body – wind, bile, phlegm – on which diagnosis of illness is based.
Bile is oily, sharp, warm, light, fetid, purgative, moistening and is located mostly in the liver and gallbladder. Bile “… moves in the blood, sweat, eyes, liver, gallbladder, and intestines … is of the nature of fire, is responsible for hunger and thirst and has the function of ingesting and digesting food … of producing all the warmth throughout the entire body and giving one a clear complexion. Bile gives one a sense of courage, determination and fortitude … also leads to aggression and resentment … enables one to exert effort and have ambitions … acts as the basis for the four kinds of intelligence – deep, fast, sharp, and subtle – and it enables one to think ahead.”23
Phlegm is cool, dull, heavy, soft, stable, sticky and is located in the upper part of the body, especially the brain. It has the nature of earth and water. Phlegm functions by lending “strength to all of the constituents of the body, especially the brain. It has the nature of earth and water. Phlegm functions by lending “… strength to all of the constituents of the body, and it gives stability to one’s intelligence and awareness as well … acts as the basis for memory … has the general function of connecting and lubricating the joints, and it produces the softness, oiliness, and pliancy of the body … has the general function of mental stability, as well as drowsiness and sleep.”24
Although this is only the briefest of descriptions of these humor functions and interactions, to put it simply, a person may be dominant in or deficient in one or more of these humors, influencing individual characteristics in both negative and positive fashion. This is known as one’s humoral constitution, which is formed during the formation of the fetus and, according to Tibetan medicine, remains that way for the rest of one’s life.25 The balance or imbalance of one’s humoral constitution creates a context for good health or illness for one’s life.
The Primary Causes of Disease
One of the beauties of the Root Tantra is that the tree metaphor is a perfect framework of instruction, that is, a visual tool from which the categories and lists can be hung cleverly and with artistry into many subclasses. The tree is heavy in single words but sparse in descriptions, those having been provided over the centuries by the many commentaries that learned lama doctors and scholars have contributed.
The delusions of attachment, hatred and ignorance are the fundamental causes of all disorders and diseases. “Attachment is the primary cause of wind disorders; hatred is the primary cause of bile disorders; and delusion [ignorance] is the primary cause of phlegm disorders. These three are called poisons because they kill our progress along the path to spiritual liberation.”26
The causes of illness are both internal and external and relate to our countless previous lifetimes, in which we have inhabited a variety of bodies in different realms, and in which we were also both subject and object of ignorance, or self-grasping, repeatedly.27 In our present human existence, the instances of this ignorance, and the delusions it gives rise to, from those past lives follow us like a shadow.
“To repeat this point, in reality the self does not exist as an independent, inherent entity; but under the influence of ignorance, we compulsively reify ourselves as being inherently existent, and that is the root cause of illness…. In brief, as long as one is subject to ignorance, it is impossible to be invulnerable to illness.”28
Methods for overcoming this self-grasping are to be founding the four noble truths: these are (1) the truth of suffering, (2) the causes of suffering, (3) the cessation of suffering, and (4) the path to the cessation of suffering. Within this last truth – the path to the cessation of suffering – is found the way to eliminate suffering. The Dharma path begins with morality; then, through meditation comes the wisdom that realizes the emptiness of this self and all phenomena, that they lack inherent existence. This leads to enlightenment.
Controlling one’s mind and overcoming negative emotions also leads to the cessation of illness, but in the meantime, illnesses that arise need to be dealt with. To be human is to be vulnerable to illness.
“Under the influences of one’s diet, conduct, environment and the seasons, wind, bile and phlegm gradually increase in their own locations, and disorders are thereby accumulated. Due to those contributing conditions, the bodily constituents are disturbed and agitated, and one then craves food and drink having qualities opposite to those of the disturbed humors.”29
Controlling one’s mind and overcoming negative emotions also leads to the cessation of illness, but in the meantime, illnesses that arise need to be dealt with. To be human is to be vulnerable to illness.
Humoral imbalances derive from a state of excess, efficiency or disturbance and are applied to the seven bodily constituents and the three waste products that comprise the 10 afflicted elements. When humoral disorders arise and lead to discomfort, this is known as accumulation, which will manifest in the pulse and urine. This result, then, is known as arousal. Specific conditions contribute to disorders of each humor. Some examples are:
“… Disorders of the wind humor include ingesting medication, food or drink that taste bitter and light and that have rough, motile, hard, thin, dry (that is, non-oily), or cold potencies…. Conditions that contribute to bile disorders include ingesting food that is spicy, hot, sharp or oily, experiencing strong hatred or anger, sleeping excessively during the daytime, and immediately thereafter engaging in vigorous activity… Conditions that contribute to phlegm disorders include ingesting too much sweet, bitter, heavy, oily and cool food and drink, and then lounging around or falling asleep.”30
The influence of the seasons mingled with the foods we eat are of essential importance in Tibetan medical theory. The seasons may bring heat, cold, rain, dryness, wind, oiliness, heaviness and will intermingle with the essential qualities of the foods we eat, which can be bitter, salty, hot, astringent, sweet or sour, and thus produce an accumulation of humoral disorders. Furthermore, humoral disorders can be overlapping and, therefore, difficult to diagnose.
When accumulation results in arousal, reversing the condition requires a process known as pacification, which means following a healthy diet, proper conduct, living in as healthy an environment as possible, and receiving the appropriate medical treatment. It is extremely important to have a correct diagnosis followed by the correct medical treatment to avoid further illness that might lead to worsening disease.
Conditions Contributing to Illness
It has already been stated that illnesses arise from the three poisons of the mind – attachment, hatred and ignorance. Illnesses can be divided into three types of causes: (1) those in this lifetime; (2) karma from previous lifetimes; (3) factors in this lifetime in conjunction with karma acquired from previous lifetimes.31
Causes in this lifetime may be from either or both internal and external origins. Internal types of causes refer to an imbalance in the three humors, which has already been discussed. External types of causes are threefold: (a) poisons, (b) weapons, such as spears, swords, stones … chemical, biological and nuclear weapons and (c) demonic influences [harm from spirits].”32
KARMA: Karma ripens from either positive or negative deeds committed in a past life: positive or virtuous karma gives rise to happiness, and negative or non-virtuous to suffering. The negative deeds accumulated from previous lives constitute the second of the three causes listed above. There are ten non-virtues: killing, stealing and sexual misconduct are the three that pertain to the body; lying, slander, abuse and idle gossip are the four pertaining to speech; and avarice, malice and holding false views pertain to the mind.33
The third cause also entails karma, or the ripening of non-virtues from a previous life dovetailing with present humoral imbalance.
Negative karma ripens in four ways: (1) as an experience similar to the cause; (2) as an action similar to the cause; (3) environmental results; (4) as rebirth in the lower realms.
Illnesses can be divided into three types of causes: (1) those in this lifetime; (2) karma from previous lifetimes; (3) factors in this lifetime in conjunction with karma acquired from previous lifetimes.
Examples of an experience similar to the cause (1) may be as follows: for killing in a past life you will either be killed, become sick or have your life cut short; for stealing in a past life you will lack possessions in this life; for sexual misconduct in a past life you will be unable to keep your spouse; for lying in a past life people will not believe you now.
Actions similar to the cause (2): because of killing in the past, you are born with the habit to keep killing; by stealing in the past, you will have the habit to keep stealing; a child who can make other children steal does so as a result of her/his own enjoyment. Furthermore, “The actions congruent with the causes of covetousness, harmful intent and wrong views are an increase in attachment, hostility and benightedness.”34
Examples of (3) environmental results may be that due to killing in a previous life, food and medicine may be of poor quality or polluted; due to taking things not offered in a previous life, you experience poverty in this life; or you will be cheated in this life due to having lied in a past life; or “[from divisive speech] you will have to live in places where the ground is uneven; [from insulting words] you will be born in a place where there are many tree stumps and brambles; …[due to covetousness] all your pleasures will be overshadowed; [due to harmful intent] there will be much war, sickness and famine; [due to wrong views] your sources of water and precious things will dry up.”35
Examples of (4) are a rebirth in hell for killing in a past life, or rebirth as a hungry ghost or animal.
(Many lamas recommend various meditations, such as on compassion, as antidotes to the negative karma created against sentient beings in the past.)
HARM FROM SPIRITS: Having already mentioned that diet, conduct (karma) and the season influence health and may contribute to disease, another factor of considerable note is that of interference or harm from spirits. Spirits are invisible, non-human entities, who have the ability to bring harm to humans in the form of both physical and mental illness. Their disembodied consciousness uses negative force to gain entry into a human body. Some are known as devas, yakshas, bhutas, nagas, parthivas and ksamapatis, and specific qualities or characteristics may be associated with each of these names. For example, nagas and ksamapatis have been credited with contributing to the formation of various tumors.
If this seemed to be the case, special “propitiatory” rituals would be made to these beings before medication was prescribed or administered. Dr. Dhonden assures us that “the combination of these methods often effected a cure.” Dr. Dhonden goes on to say that “a skilled Tibetan doctor is able to identify specifically which type of non-human agency is responsible for a specific disorder based upon the conduct and other symptoms of the patient.”36
The importance of understanding spirit influences in Tibetan culture and medicine is such that the Third Tantra of the Gyu-zhi devotes five chapters to diseases caused by spirits, three of these being about spirits contributing to mental illness.
Dr. Dhonden offers that there are “360 types of entities which may possess an individual and thereby alter the mind and personality traits.” Because spirits are invisible, their presence is a more difficult concept for the patient to deal with than a tangible, visible problem. While it may or may not be possible to discover exactly what non-virtue one has committed in the past to cause the interference by the spirit, removing the spirit harm with practices of virtue, prayers and pujas is possible and may be prescribed by the physician. Many lamas also suggest meditation and prayer as the means for removing the spirit interference.
Diagnosis
On the illustrated medicine tree’s diagnosis root there are three trunks, which are (1) visual observation; (2) pulse feeling; (3) questioning. Visual observation means observing and examining both the tongue and urine with regard to wind, bile and phlegm systems. The pulse feeling trunk is divided into wind pulse, bile pulse and phlegm pulse with the beat of each type offering some significance. The questioning trunk has long branches referring to wind, bile and phlegm; and for each humoral aspect, there are lists of causal conditions, symptoms and remedies. The diagnostic tools and techniques used by Tibetan physicians are commonly known as pulse, urine and questioning.37
PULSE: According to Dr. Dhonden, knowledge of pulse is the supreme diagnostic tool, and there are many considerations associated with taking the pulse. The patient is required to observe certain rules laid out by the doctor on the day before the pulse is to be taken. Furthermore, the time of the pulse reading, the place on the body for the pulse reading, the amount of pressure to be applied, and how to read the pulse are all subjects in which a doctor must be expert. “The best place for reading the pulse is about half an inch from the crease at the wrist, on the radial artery. The index, middle and ring fingers are to be placed in a straight line on the radial artery, half an inch from the crease of the wrist. They should not touch each other but should also not be far apart – the distance between them being that of the width of a grain.”38
Categories of pulses include constitutional pulses, which represent temperament and constitution; seasonal pulses, driven by the five elements and the four seasons; and, in a healthy person, seven wondrous pulses, as follows: (1) family pulse; (2) guest pulse; (3) enemy pulse; (4) friend pulse; (5) evil spirit pulse; (6) substitutional pulse; (7) pregnancy pulse.39
Before a physician is able to distinguish between healthy and unhealthy pulses, he must first have information about the patient’s constitutional pulse, known as male, female, or bodhisattva, and this will always be the first order of business. From there onward, feeling pulses is somewhat comparable to understanding and appreciating music – the beats, rhythm, intensity, structure – all are part of a recognizable composition. In music, this might mean a minuet, canon, fugue, symphony, etc. In Tibetan medicine, this translates to a variety of pulses indicating certain conditions in the patient, some examples being a fever pulse, spirit pulse or death pulse. “Those who have full understanding of pulse will become famous physicians, able to serve their patients effectively,”40 concludes Dr. Dhonden.
URINALYSIS: A Tibetan physician can look at a patient’s urine and see any disorders by observing three aspects: color, vapor arising and albumin – a cloud-like substance.41 Urinalysis pertains to four classes of persons: normally healthy persons, those with disorders, those on the verge of death, and those affected by spirits.
Some of the rules for behavior preceding a morning urinalysis are as follows: avoid caffeine, yogurt or any alcohol the night before; take other liquids as desired; avoid sexual intercourse; neither too much nor too little activity; avoid mental and emotional tension; try to sleep well.
For collecting urine, a plain white porcelain cup is best for observing color and sediment.
The color of the urine is determined after the long digestive process has divided the waste into two parts in the intestines, and the liquid part has gone to the bladder for excretion.
The stomach differentiates between more and less nutritious parts of the food, sending the more nutritious part to the liver, where further differentiation takes place. The liver determines that the more nutritious part will become blood while the lesser will go to the gallbladder. Now in the gallbladder, another differentiation occurs: the finer substance becomes lymph and the lesser substance or waste part becomes albumin. The albumin goes to the bladder and mixes with the urine before both are excreted. These separation and differentiation processes that occur during food digestion influence the color of the urine.
In general urinalysis, the three times for diagnosing the urine are when it is hot, or lukewarm, or cooled down.
“There are nine types of diagnosis that are broken down into three groups relative to the three times. First, when the urine is hot, one checks the color, the vapor, the odor, the type of bubbles or froth. When it is lukewarm, one checks the cloud-like albumin and the oily chyle that rises to the top. When the urine is cooled off completely, one checks the time of the variation of color, then how it changes, and finally postponed analysis. When patients are not able to come themselves, their urine is sent in Tibet by yak, in India by other means.
It is rather old by the time it arrives, and so the doctor checks everything, but with a different type of diagnosis, because the urine is older. This is called “postponed analysis.”42
Depending on the color of the urine, wind, bile and phlegm disorders may indicate either cold or heat disorders depending on the exact nature of the changes. Vapor, odor and froth or bubbles also play a part in determining these disorders. Analyzing the albumin and the oily chyle of a urine specimen (lukewarm) requires quite subtle observation and understanding. While the appearance of any albumin usually indicates a heat disorder, “as it basically arises from bile and heat,” according to Dr. Dhonden, the appearance of oily chyle could indicate a heat disorder if it is thick or a cold disorder if it is thin. Spirits or evil non-human beings can also be recognized “from this oily substance when it forms certain patterns or shapes on the surface of the urine.”43
Also on the observation trunk of the diagnosis root is the tongue. The tongue’s appearance in diagnosing disorders of wind, bile and phlegm is as follows: “… the tongue in a wind disorder is red and a little dry with many small bumps around the edge … in a bile disorder is covered with a yellow coating; the patient has a bitter taste in his mouth … in a phlegm disorder is covered with a gray and sticky coating.”44
Looking once more at the medicine tree, this brings us to the questioning trunk on the diagnosis root, on which there are three branches of questions about wind, bile and phlegm. The doctor will ask the patient about recent diet and behavior, physical conditions, etc, and all questions are designed to elicit as much information possible to determine any symptoms of the humoral disorders of wind, bile and phlegm. The physician will eventually determine from the patient’s answers just what conditions led to the symptoms observed and the current disorder. Then a remedy can be found, and most remedies will include instructions for both diet and behavior.
This brief discussion of pulse, urinalysis and tongue observation and questioning is meant to give only a very basic idea of how these skills are utilized in Tibetan medicine to diagnose illness or disease. The training a Tibetan doctor receives encompasses an enormous range of subtle knowledge, perception and attunement that expands the lists and categories of the medicine tree into a rich and deep understanding of the human body in both its healthy and unhealthy states.
Pharmacology
Although the Second Tantra of the Gyu-zhi deals with the qualities of Tibetan medicinal substances used in general medicine it is only one of numerous medical texts with information on the vast Tibetan pharmacopoeia, and few are available in English.
Nearly 700 medicinal substances derived from minerals, plants and animals are listed in The Illustrated Tibetan Mongolian Materia Medica of Ayurveda (in Tibetan, ed. By Prof. Dr. Lokesh Chandra). An English translation of the various categories is listed in the table of contents as follows:
I. Gems and Metals (a. precious substances which can’t be melted; b. precious substances which can be melted).
II. Substances derived from rocks and minerals (a. meltable; b. not meltable).
III. Medicinal earths (natural; manufactured; salts).
IV. Exudates and secretions.
V. Medicinal substances obtained from trees (fruits and nuts; blossoms; leaves, twigs, stalks, roots, saps).
VI. Medicinal substances obtained from boiled extracts of various parts of plants.
VII. Medicinal plants, herbs and grasses (roots; flowers; fruits; leaves; leaves-stalks-flowers-fruits together; entire plant; cultivated plants, i.e. bearded; leguminous and roots).
VIII. Medicines obtained from sentient creatures (birds; herbivores; wild animals; magical birds; domestic animals; those living in holes and burrows; those thriving in moisture.).45
(Chapter 90 of the Third Tantra is devoted to an extensive and detailed explanation of how to prepare “essences,” made up of complex combinations of various flowers, minerals, etc., mixed according to the appropriate constitution. Although they are to help rejuvenate and increase vitality, they are mainly used by meditators, who survive solely on these essences during retreat.)
The six tastes and eight potencies of therapeutic substances derive from the nature of the five elements – earth, water, fire, air and space – which produced them.
A medicinal fruit known as myrobalan, the “supreme medicine,”46 has been traditionally held in the highest esteem. Its fruit and stem especially were used for driving away a large array of diseases. Unfortunately, due most likely to environmental causes, it is not now easily available.
“Myrobalan is good for fevers and colds. The root is good for bone diseases, the trunk for flesh, the branch for nerve disorders and sinew, the bark for skin, the leaf for diseases of the “hollow organs,” the flower for sense organs, and the fruit for heart and the solid organs. Myrobalan has all the six tastes and all the eight powers of Tibetan medicine. Its perfume drives away all 404 diseases.”47
The six tastes and eight potencies of therapeutic substances derive from the nature of the five elements – earth, water, fire, air and space – which produced them. Each substance is also affected by the conditions of its growth and other factors, such as the season of its harvesting and/or the method of preservation. Substances also may have inherent powers, which are immutable, and secondary qualities, which are mutable. The six tastes are sweet, salty, bitter, sour, astringent, hot. The eight potencies are four pairs of opposites: heavy and light; unctuous and rough; hot and cold; dull and sharp. They are influenced by the tastes and the elements.
Conclusion
Tibetan medicine’s holistic approach to healing appears to include every living thing – whether animal, vegetable or mineral – in its effort to comprehend and demonstrate how the universe works. It defines, explains and arranges the external system and internal systems of our world and our bodies for human perusal and understanding. Its mixture of Indian Ayurveda, physiology, pathology and therapy make it an appealing and important resource for healing. It is infinitely complex and finely detailed.
The renowned and beloved blue figure of the Medicine Buddha constantly reminds us that the ultimate medicine is enlightenment.
If someone wants to study Tibetan medicine, the first recommendation is to learn the Tibetan language, thereby giving direct access to the literature and knowledge of the learned lamas.
A person interested in experiencing Tibetan medical treatment should consult a Tibetan Buddhist center for the name of a doctor locally. Or contact the Tibetan Medical and Astrological Institute in Dharamsala, requesting information about courses as well as names and addresses of Tibetan doctors in the various countries.
Notes
1. Clifford, Terry. Tibetan Buddhist Medicine and Psychiatry: The Diamond Healing. YorkBeach: Samuel Weiser, Inc., 1984. p. 5
4. Dhonden, Dr. Yeshi. Healing from the Source: The Science and Lore of Tibetan Medicine. Trans. and ed. B. Alan Wallace. Ithaca: Snow Lion Publications, 2000DD, p. 13
6. Shakyamuni Buddha is supposed to have prophesized Padmasambhava’s birth and life’s work as an important Dharma teacher.
16. Aris, A. and Van Alphen, J., Gen. Ed., Oriental Medicine: An Illustrated Guide to the Healing Arts, p. 117
35. Pabongka Rinpoche. Liberation in the Palm of Your Hand. Boston: Wisdom Publications, 1991. p. 453
37. Dhonden, Dr. Yeshi. Health through Balance: An Introduction to Tibetan Medicine. Ed. and trans. Jeffrey Hopkins. Ithaca: Snow Lion Publications, 1986. pp. 73-74. See the causal conditions, symptoms and remedies of the three humoral branches on the questioning trunk.
39. Ibid., p. 85. See further discussion of the role of these pulses.
Bibliography
Clifford, Terry. Tibetan Buddhist Medicine and Psychiatry: The Diamond Healing. YorkBeach: Samuel Weiser, Inc., 1984.
Dhonden, Dr. Yeshi. Health through Balance: An Introduction to Tibetan Medicine. Ed. and trans. Jeffrey Hopkins. Ithaca: Snow Lion Publications, 1986.
__________ Healing from the Source: The Science and Lore of Tibetan Medicine.Trans. and ed. B. Allan Wallace. Ithaca: Snow Lion Publications, 2000.
Johnson, Sandy, ed. The Book of Tibetan Elders. “Medicine and Astrology.” New York: Riverhead Books.
Pabongka Rinpoche. Liberation in the Palm of Your Hand. Boston: Wisdom Publications, 1991
Van Alphen, Jan and Aris, Anthony, general eds. Oriental Medicine: An Illustrate Guide to the Asian Arts of Healing. Ferdinand Meyer, “Theory and Practice of Tibetan Medicine.” Boston: Shambala Publications, 1997.
Other Reading
Arya, Pasang Yonten. Dictionary of Tibetan Materia Medica, New Delhi: Motilal Banarsidass, 1998.
Avedon, John, and Sither Bradley, Dr. Tamdin, et al. Buddha’s Art of Healing. Rizzoli, 1998.
Clark, Dr. Barry. Quintessence Tantras of Tibetan Medicine. Ithaca: Snow Lion, 1993.
Dhonden, Dr. Yeshi. Ambrosia Heart Tantra. Dharamsala: Library of Tibetan Works and Archives, 1989.
Dummer, Tom. Tibetan Medicine. Dharamsala: Library of Tibetan Works and Archives, 1989.
Tsarong, Tsewang. J. Tibetan Medicinal Plants. Tibetan Medical Publications, 1994.
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