Tibetan Medicine

Kate Bidwell

Keywords: Tibet, holistic medicine, Ayurveda, Buddhism, Dharma, The Four Tantras (Gyu-zhi), Medicine Buddha, the diamond healing, Elder Yuthog Yontan Gonpo, humors, cosmic energies.

I. Abstract

Tibetan medicine developed more than 2300 years ago as a form of holistic health-care and it continues to remain a vital part of the Tibetan culture today. It is an ancient medical practice that struggles to survive in a world dominated by modern, Western medicine. The philosophical aspects of Tibetan medicine are rooted in the Buddhist faith, while its practical aspects derive from the Indian Ayurvedic system of medicine. Tibetan medicine focuses on the balance between the mind and body as well as the balance of the entire organism with the universe. Balance leads to health, and illness readily results when a disruption of this balance occurs. The main cause of disease is ignorance of the mind, which leads to a disruption of the three humors. The only way to overcome this ignorance and illness is through Dharma, the teachings of the Buddha. The system of Tibetan medicine is based on the teachings of the Gyu-zhi, or The Four Tantras. These Tantras contain the information that is necessary for the correct diagnosis and treatment of all diseases that result when the body is no longer in equilibrium. Tibetan medicine combines the holistic health care of Indian Ayurveda with the philosophical beliefs of the Buddha in an attempt to maintain a sense of balance between the mind and body.

II. Scope and Purpose of the System

Tibetan medicine is a form of ancient medicine that combines practical, holistic health care with psychological and spiritual healing. Health relies on the relationship within the organism, between mind and body, as well as the relationship between the organism and the universe. When disruption of this relationship occurs, Tibetan medicine attempts to restore cosmic equilibrium to the organism and the universe through the use of preventative and curative efforts.

According to Tibetan Buddhist tradition, ignorance is the major cause of disease. It is ignorance that leads to the three poisons of desire, hatred and aversion (Khangkar, 21). Each of these three poisons can stimulate one of the three humors, which are the wind humor, the bile humor and the phlegm humor (please see section III-A). A disruption of one of these humors leads to imbalance and illness within the body. Some believe that the teachings of the Buddha can overcome the ignorance of the mind, and in turn restore balance to the three humors. The practice of Tibetan medicine contains different levels, which consist of Dharma, Tantric and somatic medicine. Dharma or religious medicine heals through psychological and spiritual practices. Tantric or yogic medicine covers the level between the mind and body. Somatic medicine deals with the practices of Indian Ayurveda (Clifford, 9). These three levels of Tibetan medicine combine to form a practice that works to restore overall health through a balanced mind and body.

III. Authority Structure

A. Sources and Criteria of Valid Knowledge

The heart of Tibetan medicine lies within the philosophical principles and beliefs of the Buddhist faith. Tibetan Buddhism is a psychological religion that has a strong connection to healing (Clifford, 5). Buddhism seeks to understand the nature of the mind while also nurturing the development of awareness and compassion (Clifford, 5). Since the mind is the central connection, it becomes the basis for all phenomenons, including health and disease. Therefore, the principle teachings of the Buddha, known as Dharma, are aimed towards the prevention of suffering and disease (Clifford, 5).

Tibetan Buddhism is a combination of Indian Buddhism and yoga that derives from the Mahayana and Vajrayana schools of Buddhism (Tibetan Buddhism website). Karma is thought of as “the working out of the law of cause and effect”, and its concept and relation to reincarnation are central theories in Buddhism as well as the practice of Tibetan medicine (Clifford, 8). The texts from these schools of Buddhism often contain charms and Tantras used in rituals that serve as magical forms of healing (Zysk, 50). These Tantras describe how one could acquire magical powers and use them to prevent disease and death through the manipulation of karma (Zysk, 51). According to the Buddha, the presence of kleshas, or afflictive, negative emotions prevents perfection of the mind, which is essential for balance and health. The kleshas combine to form the three poisons (Clifford, 6) of desire, hatred, and aversion (Khangkar, 21). The presence of these three poisons can lead to imbalance and disease by triggering one of the three humors. Karma, from the past and present, can also influence the three humors (Clifford, 8). It is believed that the spiritual teachings of the Buddha can overcome these poisons and help restore balance within the individual. It is on this level that spiritual and physical worlds collide, as the poisons of the mind lead to illness within the body.

The concept of the five cosmic energies and their relationship to the three humors was adopted from Indian Ayurveda prior to the establishment of a medical system in Tibet. The three humors are the biological representation of the five cosmic energies of earth, fire, air, water, and space (Khangkar, 23). The cosmic energies are responsible for the maintenance of bodily functions, and disruption of these energies can lead to dysfunctions within the body (Khangkar, 23). The wind humor, rLung, is influenced by desire, the bile humor, mKhrispa, is stimulated by hatred, and the phlegm humor, Bad-kan, is stimulated by closed-mindedness (Khangkar, 21). There are seven physical energies that make up the basic bodily elements, and there are three excrements that rid the body of waste products so that the maintenance of health occurs (Khangkar, 23). The basic tissue elements are nutritional essence, blood, flesh, fat, bone, marrow and sperm, while the three excretions are feces, urine and sweat (Khangkar, 23). Improper diet, incorrect behavior patterns, and negative forces can all contribute to disease by disruption of the three humors, the seven basic elements, or the three forms of excretion (Khangkar, 23).

B. Methods of Inquiry

Tibetan medicine provides many sources as to how one can use the knowledge pertaining to the three humors in the diagnosis and treatment of disease. Unlike Western medicine, Tibetan medicine regards diagnosis as more than just the identification of a type of disease or illness. Rather, diagnosis is the identification of the disruption in the cosmic equilibrium that has lead to a certain state of illness (Khangkar, 39). A Tibetan doctor uses three methods of diagnosis. These are visual diagnosis, diagnosis by touch, and diagnosis by interrogation (Khangkar, 39).

Visual diagnosis involves the examination of the patient’s five sense organs, sputum, feces, tongue and urine (Khangkar, 39). The tongue is important in the examination because its color and appearance correspond to the three humors and possible problems with them (Dummer, 76). A urine analysis can also provide valuable information regarding the state of the humors (Dummer, 76). The urine analysis is considered to be one of the most important methods of diagnosis, and it is regarded as one of the medical techniques that Tibetan medicine is best known for (Khangkar, 39).

Diagnosis by touch involves the examination of the pulse by a Tibetan doctor. This technique takes many years for a physician to master, and if done correctly, a reading of the pulse tones can determine the health of each organ as well as the overall condition of the individual, both present and future (Sachs, 37). The physician uses three fingers to measure the pulse at both of the radial arteries, focusing specifically on the “strength, speed, nature, depth, and firmness” of the beat through the arteries (Khangkar, 40). The reading of a pulse can also be used for divination purposes in which the tone, rate and quality of the pulse are used to determine the life span, possible future disease, and even death in some cases (Sachs, 37).

Diagnosis by interrogation consists of a series of twenty-nine questions (Dummer, 81), and it is considered to be the most important form of diagnosis since it gives an overall picture of the patient’s status (Khangkar, 41). These questions cover “dietary and lifestyle factors, economic conditions, one’s profession, and social status or family background” in order to gain a complete and overall understanding of the patient’s condition (Khangkar, 41). The more honest and complete the patient’s answers are, the more accurate a physician’s diagnosis is likely to be (Khangkar, 41).

Classification and identification of the illness can occur once the three methods of diagnosis are complete. The key to diagnosis of an illness for a Tibetan physician is to determine which of the three humors is in a state of imbalance as a result of its close association with the five cosmic energies. All diseases are classified as hot and cold according to which humor the illness affects. The mKhrispa (bile) is hot, the Bad-kan (phlegm) is cold, and the rLung (wind) is neutral (Khangkar, 41). These humoral classifications lead to four main patterns of harmony that group the external symptoms with the internal nature of the illness (Khangkar, 42). These patterns of disharmony are a key element in understanding the nature of the illness.

While some of these methods of diagnosis used in Tibetan medicine may hold slight similarities to those methods used in Western medicine, a divide still remains between these forms of healing. Tibetan medicine attempts to understand the underlying causes of disease as they relate to the balance of the three humors. These methods allow a Tibetan physician to examine the presence of this balance or imbalance.

C. Institutions and Professional Structure

There are six causes a person must possess if he wishes to practice Tibetan medicine. These causes are “intelligence and understanding, a virtuous motivation, keeping one’s pledges, having a thorough knowledge of medicine, dedication to healing, and conduct appropriate to the society in which one is practicing medicine” (Dhonden, 109). Also, a person must practice medicine in relation to spiritual healing, or he runs the risk of suffering (Dhonden, 117).

It is thought to take thirty years to master the art of Tibetan medicine (Khangkar, 13). In the early 20th century, a fourteen year course of study as well as qualifying medical school exams were required before a person could take up the study of medicine in Tibet (Khangkar, 13). Once a person entered one of Tibet’s medical colleges, they followed a difficult schedule that combined religious and spiritual studies with art, science, medicine and astronomy (Khangkar, 13). A Tibetan physician also had to have knowledge of herbs and other medicinal plants, and this required daily outings to collect and study the plants (Clifford, 63). At this time, it took six years to complete the courses required to become a practitioner of Tibetan medicine.

The Gyu-zhi or The Four Medical Tantras is the text that contains the medical teachings of Tibetan medicine (Khangkar, 15). Tibetan physicians were expected to memorize the information in each of these four Tantras before they began practicing medicine (Clifford, 63). The first volume is The Root Treatise and it “explains the importance of studying medical science, how to differentiate between a healthy and a diseased body, the principle methods of diagnosis to be used and the basic categories of treatment” (Khangkar, 15). The second volume is The Explanatory Text and it discusses the details of physical illness along with diet, medications and maintenance of a healthy lifestyle (Khangkar, 17). The third volume is the Practice Instruction Text which discusses the causes and treatments of every possible disease that can afflict any one person (Khangkar, 17). The final volume is the Last Text which describes the procedures that pertain to pulse and urine analysis (Khangkar, 17). These four volumes are meant to be read together to provide a thorough understanding of the practice of Tibetan medicine.

In modern Tibet, the Tibetan Medical and Astro-Institute is where the training of Tibetan physicians now takes place. Students study for five years, during which they memorize the information contained within The Four Tantras. After successfully completing their five years of study, the students receive a Bachelor of Traditional Tibetan Medicine and Surgery (Men-Tsee-Khang Online).

IV. History

The origin of Tibetan medicine as a system of healing consists of three stages of development. The first stage involves the mythological world, the second stage involves the pre-Tibetan era in India with Ayurveda, and the final stage involves the actual practice of medicine in Tibet (Dummer, 7). The latter stage covers the beginnings of medicine in Tibet in the seventh century and continues on to the medical practices in present-day Tibet.

According to tradition, the sacred origin of Tibetan medicine originated when the Buddha Kashyapa, from a previous time cycle, taught medicine to Brahma, the creator of life (Clifford, 47). A period of time then passed where everyone was in a state of deep meditation, including Brahma. After an event where Brahma was able to cure a man through his medical knowledge, he was prompted to remember the medical teachings of the Buddha Kashyapa (Clifford, 47). When this occurred, it was said that the medical practices of our current time cycle began (Clifford, 47). This medical knowledge was passed on to the Ashwin twins and to a famous teacher of Ayurveda on earth named Atreya (Clifford, 48). These teachings were then passed on to the Buddha’s personal physician Kumara Jivaka, who taught this knowledge to others and eventually became the saint of Tibetan medicine (Clifford, 48).

In India, the Buddha Shakyamuni spread the knowledge of Tibetan medicine in the current time cycle just as Buddha Kashyapa had taught it in the previous time cycle (Clifford, 48). The Buddha Shakyamuni then took the form of the BuddhaVaidurya and spoke of the medical teachings, which were recorded in the form of the Gyu-zhi, or The Four Tantras (Clifford, 48). Tibetan culture still considers this text to be the most important text in the practice of Tibetan (Clifford, 48).

At the beginning of the fifth century, the influence of Buddhism slowly made its way into Tibet from India. In the seventh century, the concept of Buddhism was formally introduced into Tibet during the reign of King Srongtsan Gampo (Clifford, 53). It was also at this time that the practice of Ayurveda made its way to Tibet from India. The King frequently sent messengers to India to collect texts and other information on Buddhism and Ayurvedic medicine (Clifford, 53). A new language was developed in Tibet at this time so that the Sanskrit medical texts could be translated and used for medical purposes in Tibet (Clifford, 53). It was also during the reign of King Srongtsan Gampo that an international medical conference was held in Tibet that included doctors from India, China and Persia (Clifford, 53).

In the eighth century, King Trison Detsen held another international medical conference that included a debate between doctors from India, China, Persia, and Nepal (Clifford, 56). The Elder Yuthog Yontan Gonpo represented Tibet during this debate, and became known as an emanation of the speech of the Medicine Buddha (Clifford, 57). It was during the lifetime of the Elder Yuthog and his descendent, the Younger Yuthog, that Tibet experienced its “golden age” of medicine, as the knowledge and practice of medicine continued to expand (Clifford, 57).

During the twelfth century, the Younger Yuthog was able to extract the teachings of the Gyu-zhi, which had been rewritten earlier by the Elder Yuthog and hidden at the Samye Monastery (Khangkar, 8). The Younger Yuthog received medical knowledge from many foreign sources during this time, and he also traveled many times to India to learn more about their medical practice (Khangkar, 9). He was able to write a new version of the Four Tantras, The Eighteen Auxiliary Aids, which is still the standard version of the text in Tibet today (Khangkar, 10).

The Great Fifth Dalai Lama created the first medical school in Tibet during the late 17^th century (Khangkar, 10). During his reign, the Great Fifth Dalai Lama also appointed Desi Sangye Gyatso as the vice-chief of all doctors in Tibet, also known as the Regent to the Dalai Lama (Khangkar, 10). Sangye Gyatso established the Chagpori Medical School in the 17^th century, which became known as the spiritual center for Tibetan medicine (Khangkar, 13). A form of public health care was established in Tibet at the same time, when the Regent decided that each monastery in Tibet would have a lama-physician who had received his training at Chagpori (Khangkar, 13).

The second medical college, the House of Medicine and Astronomy, was built in Tibet at Lhasa during the early 20^th century by the lama-physician Khyenrab Norbu (Clifford, 62). During this time, medical students usually spent six years at these two colleges where they studied a combination of religion and medicine (Clifford, 63). Medicine in Tibet continued to thrive during the early 20^th century until the invasion of the Chinese in 1949. During the Chinese invasion, known as the Cultural Revolution, many monasteries, including the Chagpori Medical College, were destroyed (Clifford, 60). The struggle continues today in Tibet, as a nation of exile attempts to save their ancient culture and medical practice from destruction. Some physicians of Tibetan medicine have brought their knowledge to the United States and England in an attempt to educate the Western world on the benefits of Tibetan medicine. They also hope to save their culture and medical practice by moving out of their exiled nation and into countries where there are more opportunities for further growth and development.

V. Representative Examples of Argumentation

In the Western world, the art of Tibetan medicine is not always regarded as an equivalent treatment to the more modern, allopathic medical treatments. However, Dr. Yeshi Dhonden and other prominent Tibetan physicians indicate that the treatment of some chronic and long-term illnesses is more effective when Western medicine is combined with some of the philosophies of Tibetan medicine. Some of these chronic illnesses include Type II Diabetes, arthritis, Crohn’s Disease, and irritable bowl syndrome. Dr. Yeshi Dhonden considers Western medicine to be the best form of medical treatment when acute injury or illness occurs, such as an automobile accident (Dhonden, 187). On the other hand, Tibetan medicine is more effective in the treatment of long-term illnesses because the slow-healing nature of Tibetan medicine allows the physician to heal the problem from the source (Dhonden, 187). Tibetan medicine is also used to treat the conditions that remain after the acute injury has healed (Dhonden, 187). While some people prefer one form of medicine to another, Dr. Dhonden believes that the most effective treatment is with the use of both Western and Tibetan medical practices (Dhonden, 187).

Tibetan medicine may be more effective in the treatment of these chronic illnesses because it also emphasizes personal responsibility and self-care, whereas Western medicine focuses on “theoretical knowledge and empirical research” (Llewllyn, 2001). In Tibetan medicine, the ingestion of the wrong types of food or the ingestion of incorrect amounts of food can result in an imbalance of the three humors (Llewellyn, 2001). This imbalance usually results when certain energy accumulates as a result of the ingestion of a specific type of food (Llewellyn, 2001). It is thought that the maintenance of a correct and balanced diet will lead to balance within the body (Llewellyn, 2001). More importantly, a balanced diet can be used to prevent illness so that balance is constantly maintained (Llewellyn, 2001). Therefore, while it is difficult to completely incorporate all of the practices of Tibetan medicine into our daily lifestyle, modification of our diets is a simple step that can be taken to maintain balance within the body and prevent illness (Llewellyn, 2001).

VI. Suggested Position in Comparative Scales

A. tradition(1) --- experience (10): 4

The medical system of Tibet is deeply rooted in tradition, as it still follows some of the same standards that were set 2300 years ago when it was established. It closely follows the traditions of Buddhism, which remains a large part of Tibetan medicine. However, in the actual practice of Tibetan medicine, the physician relies heavily on experience when examining and diagnosing a patient. While Tibetan medicine is based largely on tradition, it does incorporate some form of personal experience.

B. centralized authority(1) --- decentralized authority (10): 3

Emphasis was placed on institutional schooling in established monasteries across Tibet. All perspective physicians attended the same style of program in which the same Tantras were taught. The practice of Tibetan medicine relies heavily on this institutional schooling and instruction.

C. Emphasis on the invisible realm (1) --- visible realitites (10): 4

While the theories of Tibetan medicine are heavily influenced by the philosophical principles of Buddhism, the diagnosis and treatment of disease and illness are based on a mixture of the spiritual realm and the visible realities.

D. Spiritual/moral goal (1) --- pragmatic objectives (10): 5

The ultimate objective of Tibetan medicine is to maintain physical health, but the basis of physical health lies within the spiritual realm. In order to achieve physical health, one must achieve spiritual health.

E. Primarily divine power (1) --- individual power (10): 2

In Tibetan medicine, the ultimate powers of health and wellness lie within Dharma, the teachings of Buddha. However, some power lies in the hands of the physician who is responsible for identifying disease or illness. The physician must be there to diagnose the problem, but ultimately, it is the power of the Buddha that controls Tibetan medicine.

Bibliography

Primary Sources:

Bradley, Tambdin Sither, Dr. Introduction to Tibetan Medicine.

www.tibet.com/Med_Astro/tibmed.html

Overall description on the methods of diagnosis and treatment in Tibetan medicine.

Dash, Bhagwan. Pharmacopoeia of Tibetan Medicine. Delhi, India:

Sri Satguru Publications. 1994.

Lists all of the drugs used for specific ailments. The only real commentary regards how to administer the herbs or drugs.

Dhonden, Yeshi, Dr. and B. Alan Wallace. Healing from the Source: the Science and Lore of

Tibetan Medicine. Ithaca, NY: Snow Lion Publications. 2002.

Useful in that it is directly from a Tibetan physician. Mostly contains information pertaining to the body in health and illness. It also has questions and answers that address many of the issues that involve Tibetan medicine in the modern world.

Khangkar, Tsewang Dolkar. Tibetan Medicine: the Buddhist Way of Healing.

New Delhi: Lustre Press. 1998.

Excellent overall source on Tibetan Medicine. Gives clear explanations on all of the important aspects of the medical practice, including history, the humors and their relation to the cosmos, The Four Tantras, and diagnosis.

Men-Tsee-Khang. Official Website for Tibetan Medical and Astro. Institute of H.H. The

Dalai Lama. http://www.mentseekhang.org/index.html

Provides information on the training of Tibetan physicians in the 20th century.

Rinpoche, Rechung. Tibetan Medicine: illustrated in original texts. Berkeley: University of

California Press. 1973.

It provides English translations of some of the most important medical texts of Tibetan medicine. Also provides some history of Tibetan medicine as well as information on the treatment of patients and the practice of Tibetan medicine.

Tibetan Buddhism. http://homepages.ihug.co.nz/~greg.c/tibet.html

Provides a brief summary of Tibetan Buddhism and its principles and practices.

Tokar, Eliot. Tibetan Medicine. www.tibetanmedicine.com

Provides information that pertains to the basics of Tibetan medicine such as the five cosmic energies, the three humors, and what results when these are not in equilibrium.

Wujastyk, Dominik. The Roots of Ayurveda: selections from Sanskrit medical writings.

New Delhi: Penguin Books India. 1998.

Provides useful information on Indian Ayurveda that ranges from the basic system of medicine to a variety of treatments for different ailments.

Secondary Sources:

Clifford, T. Tibetan Buddhist Medicine and Psychiatry. York Beach, ME:

Weiser. 1990.

This is an excellent source on Tibetan medicine that discusses the close connection between the physical and spiritual world. It also has one of the most organized historical sections that clearly discusses the origins of Tibetan medicine.

Dummer, Thomas G. Tibetan Medicine and Other Holistic Health-Care Systems.

London; New York: Routledge, 1988.

Useful in its description and explanation of Tibetan medicine as a holistic form of health care. Has a useful section regarding the techniques of diagnosis.

Llewellyn, Lisa. “Balancing Health - Tibetan Medicine” Positive Health Publications (2001?).

http://www.positivehealth.com/permit/Articles/Ayurveda/llewellyn67.htm

Useful article on the applications of Tibetan medicine in lifestyles dominated by the modern, Western culture. Highlights the treatment of certain chronic diseases through diet and behavioral modifications.

Sachs, Robert. Health for Life: Secrets of Tibetan Ayurveda. Santa Fe, NM:

Clear Light Publishers. 1995.

Useful information on the actual practice of Tibetan medicine.

Zysk, Kenneth G. Asceticism and healing in ancient India : medicine in the Buddhist monastery.

New York: Oxford University Press. 1991.

This book provides useful comparisons on Ayurvedic and Buddhist medicine throughout many different cultures.