Tibetan Medicine is a Tibetan originated traditional system of medicine which has at least a 4,000-year history based on documented and established medical systems. It is the major medical system practiced throughout Tibetan regions and the only health care system for the Tibetan population for thousands of years. Moreover, it has been practiced in other Himalayan nations including northern India, Nepal, and Bhutan, as well as many areas of P.R. China, and Inner Mongolia, Mongolia, and Buryat Republic of Russia.
Tibetan Medicine is classified as one of the five major Tibetan sciences, and it is called gSoba Rig-pa in Tibetan, meaning “science or wisdom of healing.” It has a well-developed theoretical foundation and sophisticated diagnosis methods, as well as complex therapeutic treatment methods. One of the treatments uses a variety of ingredients such as herbs, trees, rocks, soils, precious metals, and so on. If the physician is able to make the right diagnosis and administer the right medicine, then Tibetan Medicine is able to cure many types of illness. Compared to biomedicine, Tibetan Medicine has been particularly successful in its treatment of chronic diseases such as chronic digestive disorders and nervous system problems.
The concept of health involves a complex philosophy and theory of integration of mind and body, but to make it very simple, we could claim that the basic theory of Tibetan Medicine is to keep four elements in balance: rLung (air), mKhris-pa (fire), and Bad-kan (earth and water). The fundamental causes of the imbalance of these four elements are the three poisons of Dod-chag (attachment), Zhe-sDang (hatred) and gTi-mug (delusion). This indicates that Tibetan Medicine and Buddhist philosophy are integrated to form the unique notion of interdependence of mind, body and spirit as a holistic theory.
The following introduction will explain five topics. Firstly, a brief description of the rLung, mKhris-pa, and Bad-kan is provided with their locations and functions within the human body. Secondly, an explanation about the three imbalances of rLung, mKhris-pa, and Bad-kan, and their resulting disorders or diseases. Thirdly, the diagnosis of these diseases will be outlined. Fourthly, treatments will be discussed; and lastly, a brief highlight of the qualifications of physicians.
Imbalanced rLung, mKhris-pa, and Bad-kan:
According to rGyud-bzhi (The Four Medical Tantras), each human being is composed of mind and body. The body consists of rLung, mKhris-pa, and Bad-kan, the seven basic body constituents, and the three excretory substances.
rLung, mKhris-pa, and Bad-kan
Each of the rLung, mKhri-pa, and Bad-kan is further divided into five subdivisions to be discussed.
Firstly, what is rLung? What is mKhris-pa? What is Bad-kan? The nature of rLung (air or wind) is rough, light, cool, thin, hard, and movable. The general function of rLung is to help growth, movement of the body, exhalation and inhalation and to aid the function of body, speech, and mind. rLung helps to separate what we eat into nutrients and waste products. Its most important function is to move body, speech, and mind. The rLung can be associated with both hot and cold.
1. rLung (Air or Wind)
The five types of rLung are Life-sustaining rLung, Ascending rLung, Pervasive rLung, Fire-like rLung, and Downward cleansing rLung. Each of them has its own location, pathway, and function.
(1) Life-sustaining rLung (Srog ’dzin rlung) is located in the brain. It travels to the throat and chest cavity. It assists the swallowing of food and the spitting of saliva. This wind also assists in breathing, sneezing, and belching. It also gives a special clarity to the mind and sense organ and binds the mind and body together.
(2) Ascending rLung (Gyen rgyu’i rlung) resides in the chest cavity. It travels to the nose, tongue, and gullet. It assists speech and is the source of strength, perseverance, and good memory. This wind provides brightness and colorfulness of the body.
(3) Pervasive rLung (Khab byed rlung) is mainly found in the heart, but it travels to all parts of the body. It is responsible for most bodily movement, such as the movements of limbs, and the closing and opening of eyes, mouth, etc.
(4) Fire-like rLung (Me mnyam rlung) is located in the stomach and travels to all inner organs. It assists the digestion of food, extracts nutrition from food and transforms it into blood, enriching the seven constituents.
(5) Downward cleansing rLung (Thur sel rlung) resides in the rectum, but it travels to the large intestine, urinary bladder, sexual organ and inner thighs. The function of this wind is to regulate the passing of stool, urine, sperm, menstrual blood, and fetus.
There are five types of mKhris-pa: Digestive mKhris-pa, Color regulating mKhris-pa, Determining mKhris-pa, Sight mKhris-pa, and Complexion clearing mKhris-pa. Each of them has their own location and function.
(1) Digestive mKhris-pa (Mkhris pa ’ju byed) is located between the stomach and the intestine. It digests food, separates the nutrition and waste products, and provides body heat. This bile also supports and increases the rest of bile.
(2) Complexion clearing mKhris-pa (Mkhris pa mdog gsal) is found in the liver. Its function is to supply color for the seven basic body constituents, such as red color for blood and flesh.
(3) Determining mKhris-pa (Mkhris pa sgrub bye) resides in the heart. It gives confidence, pride, and wisdom to people. It also encourages people to achieve their desire.
(4) Sight mKhris-pa (Mkhris pa mthong bye) is located in the eye and it is responsible for vision.
(5) Color regulating mKhris-pa (Mkhris pa mdangs sgyur) is situated in the skin and it is responsible for skin color.
3. Bad-kan (Earth/Water)
There are five types of Bad-kan, which are Supporting Bad-kan, Decomposing Bad-kan, Experiencing Bad-kan, Satisfying Bad-kan and Connecting Bad-kan. Each of them has its own location and function.
(1) Supporting Bad-kan (Bad kan rten byed) is located in the chest. Its function is to support the other four types of phlegm and regulate bodily fluids.
(2) Decomposing Bad-kan (Bad kan myag byed) is situated in the upper part of abdomen. It breaks down solid foodstuffs into a semi-liquid state.
(3) Experiencing Bad-kan (Bad kan myong byed) resides in the tongue. It tastes and experiences the six types of taste in the food.
(4) Satisfying Bad-kan (Bad kan tsim byed) is located in the head. It is responsible for the satisfaction of the sense organs.
(5) Connecting Bad-kan (Bad kan ’byor byed) is found in between the joints all over the body. Its function is to maintain the connections of all the joints and to move the four limbs.
When rLung, mKhris-pa and Bad-kan are balanced, then what are called the seven body constituents are also balanced.
The Seven Body Constituents
The seven body constituents are: 1) Essential nutrients, 2) Blood, 3) Muscle tissues, 4) Fat, 5) Bone, 6) Marrow, and 7) Regenerative fluid.
In order to show how this process works, we can explain by looking at the consumption of food. For example, when we eat or drink anything, it goes to the stomach, where the Bad-kan will help to mix it, the mKhris-pa will help to digest it and the rLung will help to separate the essential nutrients from the waste products. The essence of the nutrients will then form blood, the essence of blood forms muscle tissue, the essence of muscle tissue forms fat, the essence of fat forms bones, the essence of bones forms marrow, and the essence of bone marrow forms the regenerative fluid. With the waste products there are three excretory substances: 1) bowel excreta (feces), 2) urine, and 3) sweat. This process shows how important it is for rLung, mKhris-pa, and Bad-kan to be kept in balance.
Imbalanced rLung, mKhris-pa, and Bad-kan:
Imbalanced rLung, mKhris-pa, and Bad-kan is called Nges-pa-gSum, meaning the three crimes of health. As mentioned, the fundamental causes of the imbalance of normal rLung, mKhris-pa, and Bad-kan are the three poisons, Dod-chag (attachment), Zhe-sDang (hatred) and gTi-mug (delusion). The immediate causes of imbalance are time and season, the influence of spirits, improper diet, and improper behavior.
With regard to the time and season, rLung arises at dawn and in the evening and summer. mKhris-pa arises at midday, midnight and in autumn. Bad-kan arises in the morning, dusk, and in the spring. The harmful influence of spirits depends upon a variety of material and emotional conditions. As for improper diet, if someone eats excessive amounts of light foods such as pork, goat’s meat, goat’s milk and yogurt, strong tea, strong coffee, and vegetables they will suffer from rLung problems. If someone drinks lots of cow’s milk and alcohol, and eats lots of meat, fatty cheese, nuts, sugar, ice cream, butter, chocolate, and cooks with lots of oil – these cause mKhris-pa problems. When someone eats lots of raw food such as uncooked meat, salad, raw fish, as well as cold water and milk, they will suffer from problems related to Bad-kan.
With regard to improper behavior for rLung, if a person does a lot of fasting and meditation, does not sleep much, takes meats at improper times, has too much sex, strains or over controls his bowel and urinary functions, has lots of mental pressure and tension, and talks too much, then rLung will arise. mKhris-pa arises through straining the body, for instance through carrying heavy loads, digging hard soil, running in hot weather, and through causing sudden shocks to the body, such as from falling or other accidents. Bad-kan is affected by behavior such as doing no physical exercise, sleeping for most of the day after eating a heavy meal, taking cold showers every day, exposing your body through inadequate clothing, and working in damp and cold places.
There are three methods of diagnosis in Tibetan medicine: 1) Observation, 2) Palpation, and 3) Questioning.
Observation is done by urine analysis and looking at the tongue. For the urine sample, the patient should refrain from eating spicy foods, drinking alcohol, or having sexual intercourse the night before, and then, the sample itself should be taken first thing in the morning. In Tibetan Medicine urine analysis is divided into eight sections; the physician examines the color, vapour, odour, bubbles, and sediments of the urine. The color of the urine is determined by the intake of food and drink, the seasons, and by diseases.
If there is excessive rLung, the patient’s urine is very clear, like water, and it has big bubbles. If there is excessive mKhris-pa, the patient’s urine is a reddish-yellow color, there is a lot of vapor and a very strong odour. If there is excessive Bad-kan, the patient’s urine is white in color and there is little odour and vapour. Generally a reddish color indicates a hot disorder while transparency indicates a cold disorder.
When observing the tongue, the patient with excessive rLung has a very red, dry and rough tongue. The patient with excessive mKhris-pa has a tongue which is yellow with a thick coating. The tongue of a patient with excessive Bad-kan is white, smooth and wet.
The second method of diagnosis is by reading the pulse. In Tibetan Medicine pulse reading is divided into thirteen sections. For the Tibetan physician, the art of pulse reading provides an invaluable source of information – the pulse is like a messenger between the doctor and the patient. To read the pulse, it is very important for the patient to be as rested as possible. The physician places the index, middle and third fingers on the radial arteries. The space between each of the three fingers is the width of a grain of rice, and the fingers are placed half an inch from the crease of the wrist. The physician will use both hands to examine the pulse; the left wrist of a male patient is read first, while for the female patient it is the right wrist which is read first.
The third and final method of diagnosis is by questioning— asking the patient how and when the problem started, its location and which foods harm or help them.
The fourth and final dimension is about the treatment of the patient. There are four methods of treatment: 1) Advice regarding diet, 2) Advice regarding behavior, 3) Prescribing medicine, and 4) Performing physical therapy.
If the illness is not so serious we need only give advice as to the diet and behavior. Generally the patient with excessive rLung must try to eat foods which are heavy with nutritional potency, such as lamb, butter, alcohol, milk, soups, chicken, garlic and onions. The patient with excessive mKhris-pa should eat beef, vegetables, fresh butter, fresh low fat cheese, cow’s yogurt and buttermilk, drink weak tea, spring water and have less greasy food. The patient with excessive Bad-kan should have honey, mutton, fish, barley, wine and plenty of hot water and cooked vegetables.
For behavior, the rLung patient should stay in dark and warm places; the surroundings should be very quiet, and there should be beautiful scenery. He or she should have good company, such as lovers and close friends. The patient should also rest both physically and mentally without any worries. For excessive mKhris-pa, the patient should have cold baths and showers, sit in shaded places, walk by the sea and use a cool perfume such as sandalwood. The Bad-kan patient should have lots of sun, warm fires in their home, also they should do lots of exercise such as prostrations, walking and running.
The third and fourth methods of treatment are the prescribing of medicine and external therapeutic techniques. The prescribing of medicine consists of ten different forms: liquid, powder, pill, medicinal paste, medicinal butter, medicinal ash, concentrated liquid, medicinal wine, gem medicine, and herbal compounds. External therapeutic techniques include purgatives, forced vomiting, nasal medication, suppository, enema, and vessel cleansing techniques. Medicine is identified with its taste and functions. There are six tastes: sweet, sour, salty, bitter, pungent and astringent. There are eight functions, namely, heavy, oily, cool, blunt, light, coarse, hot and sharp. In general, patients with rLung disorder should be treated by sweet, sour, and salty tastes; mKhris-pa disorders are treated by medicines which have sweet, bitter or astringent tastes; Bad-kan patients should be treated with medicines which have bitter, sour, or astringent tastes. Patients who have rLung problems should be treated by medicines which contain oily and heavy functions; mKhris-pa disorders should take medicines which have blunt functions; Bad-kan patients should be treated by medicines which have sharp and coarse and light functions. Patients who have rLung problems should be treated by medicinal butter and a mild suppository; mKhris-pa disorders should take liquid, powered medicine and purgatives; Bad-kan patients should be treated with pills, powdered medicine and emetics.
The final method of treatment is performing physical therapy, which is divided into smooth and rough. Smooth physical therapy for the rLung patient includes massage with year-old butter and oily compresses. Rough physical therapy for the rLung patient is placing hot moxibustion on the selected points for rLung (these are on the crown of the head, the first, fifth and sixth vertebrae of the spinal cord, the sternum, etc.). For the mKhris-pa patient, smooth physical therapy consists in sweating and sitting beneath waterfalls. Rough surgery for the mKhris-pa patient is bloodletting. For the Bad-kan patient, smooth physical therapy is hot fermentations; rough physical therapy is moxibustion.
Qualifications of Physicians:
According to the Tibetan medical tradition, the physician must have the following qualities:
Intelligence: One who wishes to become a doctor must have a certain level of intellectual accomplishment. People who are intelligent, having a deep comprehension and quick understanding can be trained as doctors.
One who wishes to be a doctor has to practice The Four Immeasurable Thoughts of love, compassion, joy and equanimity towards their patients.
Vows: The person who wishes to be doctor has to pay great respect to his or her master, the subject of the teaching, medical science and his/her colleagues. The doctor also must have sympathy towards patients. The doctor must not consider blood and pus as contaminated. The doctor must regard medical experts as the guardians of medicine, medical instruments as holy objects, and medicine as a precious nectar and an offering to the medicine Buddha.
We can say in conclusion that there are many different types of diseases and illnesses, but they all can be categorized within the rLung, mKhris-pa, and Bad-kan. All diseases are located in the seven body constituents and the three excretory substances. The diseases can be diagnosed through observation, palpation and questioning. Pulse reading and urine analysis are very important ways to diagnose the diseases in Tibetan Medicine. The diseases can be treated by diet, proper behavior, medicine, and physical therapy. The physician plays an important role in a patient’s life, diagnosis and treatment of disease; this requires that physicians not only have good knowledge about medicine, but also that they pay great attention to medical ethics. They must be qualified.