Peter Fenton explores the medicine of Tibet, in which the physical, psychological, magical and spiritual are combined in a single system of healing.
From the moment I first read the ad I was hooked: “The Tibetan Medical and Astrological Institute of H.H. the Dalai Lama presents a one week special retreat.” What could I do but pay the fees, book a flight and buy new batteries for the tape recorder?
Tibetan medicine is above all a vast tradition. It embraces medical ideas from many countries of the ancient world, including those of Greece, India, China and the shamanic practices indigenous to the Himalayan region. Its pharmacopoeia alone has earned Tibet the nickname, “Land of Medicine Plants.” But as I was to find out, Tibetan medicine is much more than its plant lore.
In the modern world of healing, Tibetan medicine is unique in this special sense: under the guidance of its spiritual leaders, Tibetan medicine has been organized into a single framework, bringing together physical, magical, psychological and spiritual practices. It is an interesting feature of Tibetan history that the authorities in matters of both spirit and state are the same group of people, the lamas.
Khensur Rinpoche is the abbot and senior resident teacher at Namgyal Monastery in Ithaca, New York, where the medicine retreat was held. He has received teachings and initiations from all four traditions of Tibetan Buddhism and is a renowned scholar and lecturer. During the retreat, he led the proceedings with lectures and instruction on the Medicine Buddha practice.
Each morning, the abbot took his seat— a modest throne several feet above the audience, and after prayers he explained Medicine Buddha, the practice of Tibetan healing. Rinpoche opened with a maxim: “We should not blindly follow the teachings of the Medicine Buddha. We must consider. We have to acquire everything by ourselves and not depend on others.”
So began the instruction—with this injunction to use our own analytical abilities to discover the truth of things. Over the next eight days, he, together with members of the Institute, outlined a massive system of ideas related to mind, the nature of reality, and disease.
For a system of such great antiquity—at least 1300 years—Tibetan medicine is surprisingly contemporary in its assumptions. Take, for example, its primary assumption—that all disease results from imperfect states of mind.
Ignorance is said to be the root cause of all disorders. This poisonous state of mind gives rise to delusions about ourselves, our relationships and our interpretations of world experiences. As a result, we suffer. The two lesser poisons, attachment and hatred, stem from ignorance. Together, these three negative states of mind are thought of as the remote causes of disease, whether mental or physical.
Compare this idea, in existence 500 years before the Christian era, to modern medicine’s “discovery” of a direct relationship between unfavorable mental attitudes and any number of medical problems, including nervous disorders, insomnia and heart problems. Currently popular techniques to modify unhealthy states of mind include stress management programs, hypnotherapy, exercise routines, meditation, sound and art therapies, and visualization practices. Interestingly, all of these tools and more are found in the traditional Tibetan medical kit.
Consider the following excerpt from a practice presented during the workshop. We were instructed to recite a mantra and visualize as follows:
Granting my request, from the heart and holy body of the King of Medicine, infinite rays of white light pour down, completely filling my body from head to toe. They purify all my diseases and afflictions due to spirits and their causes, all my negative karma and mental obscurations. In the nature of light, my body becomes as clean and clear as crystal.
The idea of balance is a recurring theme in Tibetan medical theory. Dr. Dakpa is a lecturer at the Institute. With an associate, he presented a detailed explanation of the physical aspects of Tibetan medicine in a series of ten lectures.
Dr. Dakpa began, “The proximate causes of disease are four: actions from past lives, seasonal changes, wrong behavior and unwholesome diet.” In this sentence, the heart of the practice can be found. Through balance, harmony is achieved. Without harmony, illness will result. Curing disease requires the restoration of balance, the essence of good health.
When the internal organs and processes are in harmony, they cooperate with each other and also with the external world. When balance is lost, by ignoring seasonal changes, for example, or by improper actions, health suffers. On another, more fundamental level, the internal microcosm of the body must be in accord with the external macrocosm of the universe. What exactly constitutes balance is determined first by an analysis of the five universal elements —earth, water, fire, wind and space—in relation to the body.
Chinese practitioners have taken this discussion to its apparent limits, relating each of the five elements to both macrocosmic and microcosmic conditions. In the version used by many Tibetan medical practitioners, we see a slightly different configuration of the elements, which includes wood and metal while omitting wind and space.
This kind of discussion of the primal elements is by no means new. It was old in the middle of the third century B.C., when Aristotle challenged the preeminent philosopher Plato about the nature of the these elements and how they came into being. In the centuries of debate and discussion that followed, it was generally decided that the qualities of the elements enable the relationships among living tissues: earth provides a foundation, water enables cohesion, fire permits things to mature and ripen, wind enables growth, and space ensures room.
By investigating these cosmic constants, both inside the body and as they manifest in the world, the physician is able to bring irregularities into balance and help patients harmonize with the natural order. Tibetan medicines are created from the planetary counterparts of these universal elements; in this way, a bridge can be built reconnecting the individual to the rest of creation.
Exactly how to diagnose which elements are missing in a person and how to replace them is what takes the Tibetan doctor ten years or longer to learn. As a diagnostic system, the Tibetan physician relies on ayurveda, the medical science indigenous to India. Its roots extend far into the Vedic period of Indian history, perhaps 7,000 years back, but it was during the Buddhist period in India, roughly between 500 bce and 500ce., that ayurveda reached its peak of development.
At that time, ayurvedic physicians practiced surgery and dentistry, set bones, and compiled a rich index of healing herbs. This tradition continued until Moslem invasions from the north interrupted its development. Fortunately the system was preserved in Tibet, where wandering monks had taken many of the medical texts and translated them into Tibetan from the original Sanskrit.
The theory of the three basic bodily humors—wind, bile and phlegm—is a central idea passed on from ayurveda to the Tibetan system. When in balance, the theory states, the humors work harmoniously and maintain a healthy body. But aberrant patterns of thought caused by the three mental poisons lead to the disintegration of this natural balance in the humours.
The humor of phlegm appears in the body as a heavy, dull substance. It is the subtle principle of matter and when functioning properly, it provides the body with moisture and also aids in digestion. Phlegm governs our tastes and it is responsible for bringing a sense of satisfaction to our minds. As well, it enables movement. Phlegm disorders stem from ignorance, the first poison.
By wind, a Tibetan doctor refers to the life sustaining force seated at the crown of the head. It is similar to wind in the world around us, and its subtle principle is mind. Among other things, wind lends clarity to thought, memory and the senses. It enables speech, enhances physical strength, and improves the overall tonal quality of the body. Wind in the body is related to the second poison, desire.
Bile is related to fire and its subtle principle is energy. When functioning properly, it regulates digestion and is responsible for our coloration and complexion. It is the source of determination and decisiveness, and actually enables us to see. The third poison, hatred, lies at the root of bile disorders.
Each of the three humors can be divided into five further categories. These subdivisions enable the physician to make sophisticated assessments of the patient’s health.
The humors do not operate exclusively in the physical body; they are also present in its invisible counterpart, the subtle body. Tibetan practice maintains that the subtle body is comprised of vibrations, energy currents and centers which, although largely undetectable, are nevertheless very real. Ultimately, these forces control the humours.
According to tradition, there are roughly 84,000 channels, known as nadis, which direct the flow of energy, blood and other fluids, including the humors, in the body. As it turns out, this is a significant number for other reasons. Buddhism postulates 84,000 different afflictive emotions. These in turn are supposed to give rise to 84,000 unique disorders. To deal with this vast array of problems, the Tibetan physician relies heavily on the restorative effects of herbal preparations.
Dr. Dawa is the deputy director of the Materia Medica department of the Tibetan Medical and Astrological Institute, and the author of A Clear Mirror of Tibetan Medical Paintings, Vol. 1, an illustrated manual of 150 medicinal plants. He conducted the research himself high in the Himalayan mountains. He plans to write eight more volumes; this gives some idea of the number of regional plants already known to have medicinal value.
One of his first observations engaged my attention: “All that we see,” he said, “has medicinal value. But in the future, precious gemstones and animal products will become rare and very expensive. Therefore, medicinal plants should be used because they are found everywhere and are easy to grow.”
Tibetans use many hundreds of prepared medicines which can be organized into several general categories, including those made from jewels or precious substances; those made from earth, from stone, from wood and from roots, and finally, those made from leaves, flowers, fruits, bark, sap, and even from animal parts.
In the West, medicine is made by workers wearing full body suits who prepare capsules in hermetically sealed rooms equipped with special air filters. In making Tibetan medicines, an equal yet very different kind of care is taken.
In one lecture, Dr. Dawa presented an overview of the many factors that must be considered for the final preparation to be effective. Habitat, season, removal of impurities, drying, duration and compounding are all relevant considerations. But, in the final analysis, what makes the medicine so special is the blessing bestowed upon it by the lama.
Habitat is the first concern. Like diseases, plants can be classified according to whether they are hot or cold—whether they are yin in nature or yang. Knowing this fundamental orientation of a plant is the first step to making medicine.
Season refers to the time a plant, or its constituent parts, can be gathered. Each part of a plant—the roots, the stems, the leaves and the fruits—has a special time when harvesting is most favorable. For example, the roots of a plant should be collected in cold weather in the fall, after the rest of the plant has matured and ripened. At this time, the energy of the plant has left the leaves and stems and has descended into the roots, making them stronger and more vital.
Once the plant is harvested coarser qualities must be removed. These elements are likened to poisons. If the plant is not thoroughly cleaned, the resulting medicine can adversely affect the wind energy, the overall strength of the body, and the body’s constituents. So when roots are collected, the external bark must be removed before processing. This makes the final preparation smooth and digestible.
Now the plant can be dried. Plants which warm the body are dried in the sun; those which cool the body are dried in the shade. Chopping plants into little pieces ensures thorough drying.
As with many products made from organic material, the duration of the product’s life must be known. Unlike minerals and precious stones, which are also commonly used in Tibetan medicinal preparations, plants lose their healing properties quickly. Medicines made from trunks, roots and fruits last between three and four years; medicines from leaves last only one year before their potency dissipates.
Once the ingredients have been properly prepared, they must be blended. Medicines which are made from several plants with similar qualities are soothing, smooth and easy to digest. Some medicines contain as many as thirty-five ingredients while others have only three.
In the final stage, the medicine is blessed. Through a series of recitations, visualizations and offerings, the gross, physical medicine is infused with divine qualities. This ritual is usually performed by a lama, although it can be performed by anyone who has received the Medicine Buddha initiation. Without this special spiritual attention, the Tibetan doctors and their now worldwide clientele believe that their medicine will lose its fundamental efficacy.
Here is a description of a small part of the blessing ceremony we were instructed to use with our own preparations.
We were instructed, “In a clean place, arrange the medicine. Cover a small table with a cloth and sprinkle some rice on it. Then place the medicine in a precious pot of some type, such as an alms bowl.” At this point we said a prayer and visualized ourselves as Medicine Buddha, the King of Medicine, invested with miraculous healing powers and surrounded by enlightened beings of all descriptions.
Here we began the process of transforming the medicinal substance into divine offerings. The first of the eight verses of recitation went:
“I offer this water of godly substance
to the Lord King of Medicine,
by relying on whom the miseries
of existence and Nirvana are eliminated.
Bestow upon me your Supreme Gift
in order to eliminate the illnesses and diseases
of the upper part of the body.”
Each passage ended with the recitation of a Sanskrit mantra, which was, for this verse, an offering of water for the mouth: “Om Sarva Tathagata Argham Praticca Svaha.”
Having learned the theory behind Tibetan medicine, I wanted to see how it was used in practice, so I signed myself up for an examination. This is what happened during my forty minute consultation with a Tibetan doctor.
Not everything a Tibetan medical practitioner does is foreign to the Western way of thinking. For example, the first thing I had to do was sign a release form, and I was asked to bring a urine sample.
After the preliminary greetings, Dr. Dawa examined the contents of my urine sample with care, checking its color, vapor, smell and bubbles. Analysis of the urine indicates the affected humor. Urine characteristic of a wind disorder is bluish and has big bubbles. If it is reddish-yellow with thick sediments and a foul smell, there is a problem with the bile. If it is white, has few sediments and is without smell, the condition is identified with phlegm.
As it turned out, my sample was quite normal. The doctor knew this because healthy urine is whitish-yellow and smells much like sheep dung. Putting the bottle down, Dr. Dawa placed the first three fingers of his right hand on my left wrist and “listened.” In Tibetan practice, pulse-taking is not a straightforward matter. Historically, pulse reading was conducted with the patient at rest, at dawn: “When the sun rises in the east,” the text reads, “but before the rays have touched the ground, is the time to read the pulse.” The meaning is clear: to read a pulse, a doctor requires light to work and the patient to be at rest.
Dr. Dawa then reversed hands, using his left to read the pulse on my right wrist. Only three fingers on each hand are used to read the various pulses (Tibetan doctors recognize many kinds of pulses), but each finger is considered to have two halves, making twelve sections in all. Each section is associated with an organ and an element. In this way, the doctor can study the internal landscape of his patient.
The patient’s pulse is determined by reading it in the gap between the doctor’s inhalations and exhalations. If it is healthy, it will beat five times in this span of time. If the pulse is regular throughout the reading, the patient is considered healthy; otherwise, there is a problem. Faster or slower rates indicate hot and cold disorders respectively, and the specific frequency suggests how serious an illness is.
In all, a pulse is tested one hundred times. After what seemed an eternity, the doctor smiled a knowing smile and asked to look at my tongue. “I have found a heart disorder,” he announced a moment later.
Why I laughed, I’m not certain. During a previous lecture, he had explained about the tongue. “The tongue of someone with a wind disorder will be red, covered with small pimples, and will have a dry and coarse texture. The tongue has a close relation to the heart. Someone who has a heart disorder caused by ‘wind’ will have a crack in the center of their tongue.” After that lecture, I had studied my tongue in the mirror and suspected the worst. Now my suspicions had been confirmed.
“You,” said Dr. Dawa, “have too much heat. You have to bring this condition into balance. Be very careful about your diet. What sort of things are you eating now?” Here began the interrogation. As a result of his questioning, I told him about the oatmeal and toast, and about the eggs and pancakes. No meat, but when I mentioned the chicken and fish he interjected.
“Fish and chicken are good for you but not red meat. Cut back on chicken in summer. It produces too much heat. What do you drink?”
Up to this point, I had avoided telling him about the coffee and beer, but now he had left me no choice. “I have the occasional beer,” I mumbled. Then, with a sinking feeling, I confessed to the coffee, “and I drink quite a bit of coffee. I also drink plenty of water,” I added, hoping in some way for absolution.
No such luck. The doctor began, “Stay away from alcohol. And from coffee too. It is bitter and produces heat. And do not eat dairy products. Do you know about vegan diets?”
“Yes,” I said, the sinking feeling returning. I had heard of them. I knew that it would be highly unlikely for me to stick with any kind of diet, let alone one as strict as vegan.
He concluded by discussing my work habits. I told him about our country life, about shoveling the snow from the roofs, about cutting and stacking firewood, about building our house, and about life in the woods in general. Then I talked about writing and how I could become preoccupied with it, even to the point of obsession.
Dr. Dawa began his concluding statement. “Too much physical work is bad for your heart. Too much mental work makes you light headed. You must bring these two work habits into balance.”
Then he wrote out a prescription. “Try this,” he said, “and see if they help. You have nothing to lose.” He couldn’t fill the prescription until he returned to his office in India, which would be in six to eight weeks. Then there would be delivery time by mail. But not to worry, even though India was a long way away, the medication would arrive in due time.
“Yes,” I thought later, reflecting on the interview, “India is a long way from here.” Five hundred years ago in India, much of one of the world’s great medical traditions, ayurveda, was lost to the destructive effects of invasion. Fortunately, the ayurvedic system was preserved and nurtured in Tibet. There it became even more compelling and complete in the form of contemporary Tibetan medicine, until the tradition was once again threatened by invasion.
Much has already been lost, but fortunately, people around the world have welcomed Tibetan refugees. That has made it possible for the Tibetans to preserve at least something of their traditions, and now the lamas are repaying that kindness by sharing their wisdom and knowledge with those who care to listen and learn.
Clifford, Terry: Tibetan Buddhist Medicine and Psychiatry: The Diamond Healing. York Beach: Samuel Weiser, Inc., 1992.
Donden, Yeshe: Health Through Balance: An Introduction to Tibetan Medicine. Trans. Jerry Hopkins. Ithaca: Snow Lion Publications, 1986.
Dummer, Tom: Tibetan Medicine and Other Holistic Health-Care Systems. London: Routledge, 1988.
Khangkar, Lobsang D. : Lectures on Tibetan Medicine. K. Dhondup, ed. Dharamsala: The Library of Tibetan Works and Archive, 1991.
Rinpoche, Thubten Z. : The Healing Buddha: A Practice for the Prevention and Healing of Disease. Boston: Wisdom Publications, 1994.
Tiwari, Maya: Ayurveda: A Life of Balance. Rochester: Healing Arts Press, 1995.
“Medicine for the Mind and Body: Medicine Buddha and the Science of Tibetan Medicine,” lectures by The Tibetan Medical and Astrological Institute, Ithaca, NY, February 2-9, 1997.