Overview ofTibetan Medicine

Anne Hendren Coulter, Ph.D.

EDITOR'S NOTE: While this article pro-vides an overview of Tibetan medicine ingeneral, the accompanying article onTibetan treatment of IBS by Eliot Tokarprovides a practical application of thisancient art.

In Buddhism, Tibetan or otherwise,the practice of medicine is a supremespiritual path. In their daily work,

physicians can accomplish simultaneous-ly the six perfections—giving, ethics,patience, effort, concentration, and wis-dom—integral to a good Buddhist prac-tice. This Buddhist equivalent of aHippocratic Oath requires practitioners togive their attention to patients and toshare their wisdom with them, to maintainmedicines in a proper ethical environment,to exercise patience while gathering andcollecting medicinal herbs, to engage ingreat effort while compounding themedicines, and to concentrate on the ritualassociated with their preparation.1 Physi-cians, in practicing their art, establishwhat Geshe Kalsang Damdul, monk fromthe Institute of Buddhist Dialectics inDharamsala, India, says is a "personalrelationship in which the doctor tries tounderstand the patient as a person, notjust as a machine to deal with." KevinErgil, L.Ac., dean of studies, Pacific Col-lege of Medicine (New York, New York),explains further: "If Tibetan medicine hasan essence, it is the practice of compas-sion on the part of the practitioner andthat vision for providing care to thepatient." The growing demand bypatients for improved patient-physicianrelations, as witnessed by a turn to alter-338

native healing forms, suggests that thissystem may have much to offer the West.Moreover, a recent spate of mass mediafilms and a medical documentary havealerted Westerners to the potential of thissimple, efficient system.Use of the system in Western culture,

however, is fraught with problems. Sub-huti Dharmananda, Ph.D., director of theInstitute for Traditional Medicine (ITM)in Portland, Oregon, summarizes oneaspect of a larger question—Western rightto the medicines. "One thing to keep inmind," he says, "before harvesting theTibetan herbs and remedies [for our use]is that there is a very limited supply ofthem. Do we have the right to them or

should they be saved for the Tibetan peo-ples?" Echoing this primary objection andpointing out a further one—our ability tobenefit from the medicine—Dr. Ergilnotes: "The model of our engagementwith almost anything is so relentlesslyexploitative that we will be prohibited byour own state of mind from understand-ing anything in Tibetan medicine." Fur-ther, he argues: "Unless we address thefundamental world-view that is connect-ed to Tibetan medicine—we'll miss itentirely." The implication that we mustbe Buddhists or at least understand itsfundamentals is forever present in thissystem, but in the practical world—theworld of doctor and patient—this maynot be the case."Most of my patients are not Bud-

dhists," says Eliot Tokar, Tibetanmedicine practitioner at the ChakporiInstitute in Howard Beach, New York(see accompanying article), "I treat Chris-tians and Orthodox Jews. What is impor-tant about the doctor-patientrelationship, the compassion in this sys-tem, is that the practitioner learns to

relate to the mind of the patient." WithChristian patients, for example, Mr. Tokarmight ask them to visualize qualities ofChrist that will aid them in healing. It isimportant, he says, that the practitionerbe able to "reach into patients," under-stand their pain, and provide them withtools—behavioral altitudes, diet, or actualphysical medicines—to treat their disease."The patient is relieved," says GesheDamdul, "when he encounters this inter-est from the doctor." The major motiva-tion, the primary intention of goodBuddhist works, then, comes from thephysician. Noting the importance of Bud-dhism to the practitioner, Dr. Yeshi Don-den, a Tibetan monk physician who hasdedicated many of his recent years toexplaining and teaching the system tomedical students worldwide, writes thatit is best to study both the medicine andthe religion at the same time. "The medi-cal system is," he writes, "intimatelyinvolved with Buddhism. It is a Buddhistscience, part of the Secret Mantra teach-ing."1

Historical RootsThe collected medical wisdom of this

small country encompasses four lengthyvolumes, hundreds of pages long, thattake aspiring medical doctors years tolearn. In the old days, these students wererequired to recite from memory any pas-sage from this impressive body of knowl-edge that a master would begin and leavefor them to finish, during the lengthy doc-toral examination. Tibetan medicine isone of the oldest in the world but it hashovered near extinction until recently,because of the Chinese occupation of theland since 1959. The original medical sys-tem draws on knowledge of systems from

ALTERNATIVE & COMPLEMENTARY THERAPIES—OCTOBER 1998 339

Tibetan medicine is still relatively poorlyunderstood in its totality by Western practitioners.

India—Ayurvedic—China, Persia, andGreece, which have been mixed togetherwith basic knowledge of native healers,but the major influence on the practice isBuddhism. Its original practitioners wereBuddhist monks, trained first in the pre-cepts of the religion that was transmutedto their remote land from India, and sec-ond in the basic tenets of medicine. Todayfewer students are monks, but they are,for the most part, Buddhists.Vestiges of Tibetan medicine have,

since the country's Chinese occupation,scattered to various locations in the West-ern world. The main medical school usedsince the 17th century in Lhasa wasdestroyed and another small one has beenestablished nearby that graduates newdoctors. An exile medical school has beenset up in Dharamsala in North Indiawhere the elders are attempting to trainnew doctors.1 There are remnants of themedical tradition in Mongolia and Russia,and it has been alluded to by variouspractitioners in the United States andelsewhere as an excellent system for treat-ment of mental illness. Its integration ofactive and thoughtful participation on thepart of the patient and interested compas-sion on the part of the physician makes itparticularly useful to healing from illnesswhere the patient's state of mind is inquestion. Whatever its potential, Tibetanmedicine is still relatively poorly under-stood in its totality by Western practition-ers.

Tibetan Medicine Core Texts andApplications

The reason for the lack of knowledgelies not only in the Western "ways of see-ing," but also in the complexity of themedicine itself. The core of the medical

system is a lengthy tome, the medicalteachings of the Buddha, brought into thecountry from India, and that was translat-ed from the Sanskrit into Tibetan in the8th century.The work was written as a question-

and-answer dialogue between a physicianand a student. It contains 156 chapters,and 5900 verses, and deals with 8 branch-es of medicine, namely, general anatomyand physiology, pediatrics, gynecology,disorders associated with harmful influ-ences, disorders of wounds from missiles(weapons), toxicology, geriatrics, and fer-tility and reproduction.2 The work isdivided into four esoteric texts, the FourTantras. The first, or Root Tantra, is ashort outline of the entire medical teach-ing; the second, Explanatory Tantra,describes the basic tenets of the system—the function of the three systems (wind,bile, and phlegm), how they relate to dis-ease and some treatments, and how tomaintain health through diet, behavior,and seasonal adjustment. The third text,the Oral Tradition Tantra, is a large tech-

Left: Precious Tibetan medicines. Right:Tibetan medicines.

nical book that discusses causes, nature,and therapies for major disorders individ-ually. The fourth book, the Last Tantra,introduces uniquely Tibetan methods ofdiagnosis, urine analysis, and pulse tak-ing, together with the manufacture ofsome medicines.1Tibetan cosmology holds that the

physical world, including its inhabi-tants, is composed of the five energies—earth, water, fire, wind, and space—thatconnect to the energies of the body byway of three humors. These threehumors are rooted in the so-called poi-sons—obscuration (ignorance), hatred,and attachment—which, in Buddhistbelief, ultimately cause illness. Thehumors are more (or less) predominantin individuals at certain ages or of cer-tain constitutions and signify the natureof the disease. Phlegm is thought to bethe predominant humor of childhood,bile the predominant one of mid-life,and wind the predominant humor of oldage (see box entitled Disease Manifesta-tion by Humor and Age). According to

340 ALTERNATIVE & COMPLEMENTARY THERAPIES—OCTOBER 1998

Arthritis is a really treatabledisease using Tibetan medicine.

Disease Manifestation by Humor and AgeHumor

Phlegm

BileWind

Disease LocationFlesh, fat marrow, nose and tongue, feces and urine, lungs,stomach, and spleen and kidneys, urinary bladderBlood, perspiration, eyes, gallbladder, and small intestineBone, ears, perspiration, heart, large and small intestines

Child

Mid-lifeOld age

Adapted from Ref. 1.

Accessory TherapiesGolden Needle Acupuncture

Cole Thompson, L.Ac., a recent graduate of Oregon College of Oriental Medicine andstudent of Tibetan medicine, has worked with Tibetan doctors in Nepal and has recollectionsof several of the accessory treatments.

In the clinic, I saw the physician see a patient twice and not give her any medicines. Hetreated her with the "Golden Needle" therapy. In this treatment, he takes a 24-carat gold needlewhich is very thick and will bend, he goes into GV 20 (point on the top of the head). First hepierces the skin, then takes a drop or so of blood out, with another kind of needle, then he putsthe Golden Needle into that hole. He takes a big piece of moxa (mugwort) and puts it on the topand burns it. So the heat goes into the needle and into the hole, then into the top of the head.The woman didn't even feel it. She was an older Tibetan lady. It could be that she didn't want himto know that he was hurting her because she wanted to get the best treatment possible, that'salso part of their culture. She came back and said the headaches were much better; she'd only hadthem a couple of times that week, instead of all the time. He did the same thing again and she saidshe felt it. She came back again and said she didn't have any more headaches and he said she wasdone and I didn't see her anymore.

The other treatment I have seen the Golden Needle for is arthritis. They do the points nearthe bone. Arthritis is a really treatable disease using Tibetan medicine. It's a very cold climate.

the information in the Root Tantra, thetargets of the diseases are typicallyexcretions, branch-humors, or physicalconstituents. An illness will occurbecause of a dietary imbalance, behav-ioral factors, seasonal maladjustment, orspirit problems. Spirit problems rangefrom karmic problems involvingdemons to disorders that may havecome to the patient from a behavior in a

previous incarnation. The disease willenter the body through several meansincluding skin, flesh, bones, and organs.

At length one of these regions becomesthe afflicted area.1,3To define disease, the Tibetan physician

makes use of specific diagnostic tools—pulse taking, urinalysis, and extensivequestioning. The pulse, like the rest ofTibetan medicine, is a composite of tech-niques from other systems. Says ColeThompson, L.Ac., a student of Tibetanmedicine: "It's a mix of Chinese andAyurvedic and it's very complex." Thephysician first determines the patient'sconstitution—phlegm, bile, or wind—

then analyzes the patient's various organsas in Chinese medicine. Then the doctorchecks the health of each of the manyorgans, a health that can be determinedduring the pulse taking. Urinalysis isdone visually. The color, vapor, odor, andfroth are analyzed for traces of disease.For example, Dr. Donden notes that redurine indicates a blood disorder, rust-col-ored urine suggests a disorder of lymph,brown urine suggests a complex disorderof three humors.1 These elementary toolscombined with a visual diagnosis of thetongue are combined with interesteddirected questions. The questions aredirected, says Mr. Tokar, at "understand-ing the patient. I attempt to understandsomething about [patients' lives] and theway they live. I try to understand some-thing about their basic constitutionalqualities." Mr. Tokar's questions attempt,ultimately, to determine what in theirway of living could cause the problemsthey currently manifest.

Typical TreatmentOnce physicians have identified the

disease type, they have a large selectionof Tibetan-based treatments to choosefrom, different accessory treatments,including "Golden Needle acupuncture"(see box entitled Accessory Therapies:Golden Needle Acupuncture), and today,if the need is great, the physician willsend the patient to a surgeon or other spe-cialist who can address special problems.Diet and behavior are two very impor-

tant areas treated first by the physicians.Notes Geshe Damdul, "If a patient hasheart disease, the first thing the doctor willdo is ask him to change his diet and hisbehavior. If he is drinking too much he hasto change his behavior, or if he is eating

ALTERNATIVE & COMPLEMENTARY THERAPIES—OCTOBER 1998 341

Killing any living being, stealing, and impureacts may cause suffering that leads to illness.

Relation of Four Cosmological Forces to Humors and "Poisons"

Earth and Water->Fire—>Air—>

Humors

PhlegmBileWind

Poisons<—Obscuration

^Hatred<—Attachment

Adapted from Refs. 3 and 4.

too much salt he must reduce it." Behaviorin the Tibetan model also includes spiritu-al behavior. Killing any living being, steal-ing, and impure acts may cause sufferingthat leads to illness; lying, senseless talk,and harmful speech are also harmful spiri-tual behaviors. Helping others, as thephysician is helping patients, is a goodbehavior that may stem the course of dis-ease for it will further the patient on theroad to enlightenment.1If the physician determines that

medicines are necessary to treat the ill-ness, a vast pharmacopoeia of more than2000 herbs and other materials can be pre-scribed, including gems, minerals, andplant substances, some of which aremass-produced and others that are rela-tively rare. The means to detoxify the pre-cious minerals to make them into usefulmedicines has been passed on from gen-eration to generation mainly by word ofmouth. Piecing together ancient recordsand elder physician memories, Tibetanshave gradually reinstituted this practice.The precious medicines are used for vari-ous diseases, many whose roots are spiri-tual.Both the mineral and the herbal medi-

cation preparation reiterate the single uni-fying quality of the medicine—itsspiritual dimension. Dr. Barry Clark, aNew Zealand-born practitioner of Tibetanmedicine, writes that the plants are to be

gathered in certain seasons by childrenrobed in white clothes, on auspiciousdays.1'3 Says Dr. Dharmananda: "Theherbs are gathered in the correct phase ofthe moon and using the correct mantras.What matters is the ceremony of the pill.The making of it, the delivery of it, andtime of day it is consumed are all part ofthe ceremony." Many of the gems andplants are said to have celestial origins.The prayers and ceremony that surroundtheir preparation and the simple butimportant spiritual beliefs that are at theroot of these are part of the solid imma-nent nature of Tibetan medicine.The seven precious medicines are

composed of many different ingredientsthought to be useful in a wide variety ofillnesses. They are used for specific ail-ments and do not provide a panacea forWellness if taken indiscriminately.However, their varied content revealsthe vast array of traditions and medici-nal types that the Tibetan medicinesuse. The combined ingredients in eachof them include numerous detoxifiedminerals; herbs (like clove and nutmegin the "Wish Fulfilling Jewel"medicine), and even homeopathic reme-dies like "nux vómica" in the "PurifiedMoon Crystal" pill are among the con-stituents. Most of the preciousmedicines are useful for serious oruncomfortable diseases, although some

Cole and Yeshi Thompson. Cole is a recentgraduate of Oregon College of OrientalMedicine.

are taken during times of year whenTibetans feel especially vulnerable. InJune, for example, says Dr. Thompson,"a number of mal-intentioned spirits areout," so Tibetans save the preciousmedicines to take then.The Wish Fulfilling Jewel medicine

can be used as an antidote to combatfood and other poisons; it is also usefulin caring for nerve disorders, heart ail-ments, and cancer. According to Dr.Dharmananda, the dosages are verylow, but the ceremony—most pills areprepared carefully by the patient andthe patient is asked to relax and refrainfrom eating certain foods—starts thepatient on the road to recovery. The tan-gible integration of ritual, prayer, andmedication fuses the body-mind-spirit

342 ALTERNATIVE & COMPLEMENTARY THERAPIES—OCTOBER 1998

"Medicine, he says, does not requirea subculture; it has to be understandable."

OrganizationsShang Shung Institute ofAmerica, Inc.P.O. Box 27718 Schoolhouse RoadConway, MA 01341(413)369-4928Fax:(413)369-4165e-mail: ssiusa@compuserve.comFounded to foster the knowledge and

development of Tibetan cultural traditions,encouraging cooperation among interestedgroups and individuals, thus keeping alive theessential values of these traditions. Offerscourses in Tibetan visual art, literature, andmedicine.Tibet House22 West 15th StreetNew York, NY 10011e-mail: mail@tibethouse.orgNot-for-profit organization dedicated to

preserving Tibetan culture. Has gallery ofTibetan art, shrines, and lectures.BooksTibetan Buddhist Medicine and PsychiatryBy Terry CliffordYork Beach, ME: Samuel Weiser, 1984Useful basic concepts; information needs

rces

supplementation with more recent texts.Health Through Balance: An Introduction toTibetan MedicineBy Yeshi DondenIthaca, NY: Snow Lion Publications, 1986Detailed informative study of the Tantras.

Good overview of entire medical practice.The Quintessence Tantras of Tibetan MedicineBy Barry ClarkIthaca, NY: Snow Lion Publications, 1995Helpful information about practical use ofmedical system.

Useful Web SitesSee Wootton, J.C. WebWatch: TibetanMedicine ALTERNATIVE & COMPLEMEN-TARY THERAPIES, 4(3) 218-219, 1998 fora list of useful Web sites for Tibetanmedicine information.

Additional useful sites include:http://www.europa.com/~itm/tibet.htmITM Online, Resources for the Study ofTibetan Medicine, by Subhuti Dharmanan-da, Ph.D., director, Institute for Tradition-al Medicine (ITM), Portland, Oregon.

http://omni.cc.purdue.edu/~wtv/tibet/medicine.htmlTibetan medicine.

and encourages healing.Can This Tradition Be Exported?Whether or not this healing modality can

be useful in a setting outside Tibet is at theroot of fears of some of its strongest advo-cates. Says Dr. Ergil: "If you get a bunch ofpills and you give them to patients, youcan be using Tibetan medicine." Themedicine itself is complex enough to dis-courage many from pursuing its study forpure amusement. The effects and capabili-ties of all the pills and precious medicinesare not only unknown to Westerners butalso largely undocumented. There are,however, practitioners like Eliot Tokar,who will take what they know of the tradi-tions, combine that with common sense,and dispense it in a way that maintains thesystem's integrity. In his Tibetan medicinework, Mr. Tokar observes that educationand talking with patients will make the

biggest difference in continued goodhealth. "When you see a lama, a rabbi, or apriest, you see that they are trying to teachyou something about the nature of life andthe nature of how to deal with it. This per-mits healing or prevents the problems fromhappening in the first place." Clothing thetradition in mystery is not something thatwill help it either, he believes. "Medicine,"he says, "does not require a subculture; ithas to be understandable."In addition to the practitioners like Mr.

Tokar, it will take dedicated young studentssuch as Cole Thompson, a recent graduateof Oregon College of Oriental Medicine, tomove the tradition into Western culture.Remarking about the mystery enshroudingthe "Precious Medicines," he notes that"they are mixed in a certain order, preparedin a certain way, and prayed over by some-one empowered with a certain deity." But tounderstand what this means, or all the

applications of a much used medicine suchas "Rinchen Yu Nying 25," he says, "I mustwait until I go back to Nepal and sit with theTibetan doctor and say, 'Here are thesemedicines, what do they do?'"Addressing fears of exploitation, Dr.

Thompson says: "Some of the othermedicines are even better [than the previousmedicines]. They are mass-produced, butwe need to know how to prescribe themand what illnesses to use them for." His willbe the first phase in a gradual and carefulintroduction of this medicine into the West-ern world. The second, of course, would bean intention to understand what in themedicines it is that makes them work.Sounding yet another negative siren, FrediKronenberg, M.D., of the Richard andHinda Rosenthal Center for Complemen-tary & Alternative Medicine Research inWomen's Health, Columbia University,New York, New York, says: "There is theimportant consideration that once we dis-cover that these medicines work, we willstill have to go through the arduous processof having them approved for use in thiscountry."If the understanding of medications takes

some time and the reading and understand-ing of the Four Tantras takes students manyyears, perhaps the single most valuablecontribution of this medicine—compassionfor those who suffer, a lifetime understand-ing and development on the part of thepractitioner—could begin at once, withoutflourish or research. D

References1. Donden, Y. Health Through Balance: An Intro-duction to Tibetan Medicine. Ithaca, NY: SnowLion Publications, 1986, pp. 214-215.2. Subhuti Dharmananda, Ph.D. "Resources forthe Study of Tibetan Medicine"(http://www.europe.com/~itm/tibet.htm):ITM Online, September 1996).3. Clark, B. The Quintessence Tantras of TibetanMedicine. Ithaca, NY: Snow Lion Publications,1995, p. 12.

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