Introduction to Tibetan Medicin
from Dr. Tamdin Sither Bradley
Tibetan medicine is a traditional system of medicine which has been practiced for over 2500 years and is still practiced today although Tibetans are now in exile.
The headquarters of the Tibetan Medical and Astrological Institute are now based in Dharamsala, North India. It is here that ail the Tibetan doctors now receive all their training, and it is also where the medicines are manufactured. The period of training before one qualifies as a Tibetan doctor is for a minimum of seven years. For the student to understand the medical texts a knowledge of Tibetan linguistics, grammar and poetry is required. The first four years of training are taken up with studying the four main medical tantras, or rGyud-bzhi; they are the root tantra, the exegetical tantra, the oral tradition tantra containing methods and instructions, and finally the subsequent tantra. In the fifth year students take exams both oral and written on these four tantras. For the sixth and seventh years students are sent for practical training under a senior and experienced doctor at one of the branches of the Tibetan Medical and Astrological institute. At present there are now over 30 branches in India and Nepal, and in addition to this there are a number of private clinics. Tibetan medicine still survives in Tibet where the Chinese have destroyed so much of the Tibetan tradition and culture. It has survived because it is of great practical help for them.
Tibetan medicine is one of the five major sciences, and it is called gSoba Rig-pa, the science of healing. It uses different kinds of ingredients such as herbs, trees, rocks, resins, soils, precious metals, saps etc. However, 95% of Tibetan medicine is based on herbs, and precious metals are used for the seven kinds of precious pill known as Rinchesen rilpo. If the physician is able to make the right diagnosis and administer the right medicine, then Tibetan medicine is good for all kinds of illness. However, it has been particularly successful in its treatment of chronic diseases such as rheumatism, arthritis, ulcers, chronic digestive problems, asthma, hepatitis, eczema, liver problems, sinus problems, anxiety and problems connected with the nervous system.
The basic theory of Tibetan medicine is to keep in balance the Nyipa sum - they are rLung (pronounced loong), mKhris-pa and Bad-kan. The long-term causative factors of Nyipa sum are the three poisons of desire, hatred and delusion which show how closely connected Tibetan medicine is with Buddhist philosophy.
So this introduction will now be divided into four parts. Firstly I will give a brief description of the Nyipa sum - their type, location and function within the human body. Secondly I will describe what happens when the Nyipa sum are imbalanced. Thirdly I will talk about the diagnosis of these Nyipa sum when they are imbalanced. Finally after diagnosis, I will talk about their treatment
Brief Description of the Nyipa sum
Firstly, what is rLung? What is mKhris-pa? what is Bad-kan? Before these terms can be explained it must be pointed out that there is no equivalent translation of them except into Sanskrit; therefore the original names are used.
The general description of rLung is that it is a subtle flow of energy and out of the five elements (air, fire, water, earth and space) it is most closely connected with air. However it is not simply the air which we breathe or the wind in our stomachs, it goes much deeper than that. rLung is like a horse and tile mind is the rider, if there is something wrong with the horse the rider will not be able to ride properly. Its description is that it is rough, light, cool, thin, hard, movable. The general function of rLung is to help growth, movement of the body, exhalation and inhalation and to aid the function of mind, speech and body. rLung helps to separate in our stomachs what we eat into nutrients and waste products. However its most important function is to carry the movements of mind, speech and body. The nature of rLung is both hot and cold.
Now I will explain the type, location and function of rLung. There are five types of rLung.
The first is called Srog-'dzin (life-grasping rLung). Its location is in the brain and its functions are the swallowing of food, inhalation and spitting, eructation and sneezing, clearing the senses and intellect, and steadying of the mind.
The second type of rLung is Gyen-rgyu (upward moving rLung). Its location is in the chest and its functions are responsible for speech, the increase of bodily vigour and health, the giving of lustre to the skin and the promotion of mental endeavour and diligence.
The third type of rLung is Khyab-byed (all pervading rLung). Its location is in the heart. Its locations is responsible for lifting, walking, stretching, grasping of limbs, the opening and closing of the mouth, eyelids, anus etc.
The fourth type of rLung is Me-mnyam (fire accompanying rLung). Its location is in the stomach and its function is to promote digestion and the metabolism, and ripen the seven bodily sustainers known as lus-zung dhun.
The fifth type of rLung is Thur-sel (downward cleansing rLung). Its location is in the rectum and its function is to expel faeces, urine, semen, menstruation and the foetus.
This is a brief explanation of rLung
Secondly I will explain the type, location and function of mKhris-pa. It is the hot nature within our body and not simply the bile which comes from our gall bladder. From out of the five elements mKhris-pa is related to fire. The description of mKhris-pa is oily, sharp, hot, light, pungent and moist. The most important function of mKhris-pa is to keep in balance the bodily temperature. It helps with the digestion of food and it is what makes us feel hungry and thirsty at the right times. It also gives lustre to the skin and helps to keep the pores clear. The nature of mKhris-pa is hot like fire or the sun.
There are five types of mKhris-pa
The first type of mKhris-pa is called 'Ju-byed (digesting mKhris-pa). Its location is between the stomach and intestine. Its function is to promote digestion and to break down essential nutrients from foodstuffs and fluids and then to separate essence and waste. It promotes bodily heat and helps to provide energy to the other four types of mKhris-pa.
The second type of mKhris-pa is called sGrub-byed (accomplishing mKhris-pa). Its location is the heart. Its function is that it anger, aggression and hatred. It provides the initial driving force behind the minds of desire, achievement and ambition.
The third type of mKhris-pa is called mdangs-sgyur (colour changing mKhris-pa). Its location is in the liver. Its function is to maintain and promote the red colouring of essential nutrients in the blood.
The fourth type of mKhris-pa is mThong-byed (seeing mKhris-pa). Its locations is in the eyes and it promotes vision.
The fifth mKhris-pa is mDog-sel (complexion clearing mKhris-pa). Its location is the skin and its function is to clear and promote skin lustre by giving it a healthy and wholesome colour.
This is a brief explanation of mKhris-pa
Thirdly I will now explain the type, location and function of Bad-kan. Bad-kan is not the phlegm which comes from the chest, it is all the diseases connected with the cold nature called Bad-kan. From out of the five elements it is related to both water and earth. The description of Bad-kan is oily, cool, heavy, blunt, smooth, steady and sticky. The main function of Bad-kan is to sustain the bodily liquids. It helps to mix food in the stomach, steady the mind, and it helps to keep our joints flexible. The nature of Bad-kan is cold, like water or the moon.
There are five types of Bad-kan
The first Bad-kan is called rTen-byed (supporting Bad-kan). Its location is the chest, and it's function is to support the remaining four Bad-kans.
The second Bad-kan is called Myag-byed (mixing Bad-kan). Its location is the upper region and, its function is the mixing of liquid and solid foodstuffs into a semi-liquid state.
The third Bad-kan is called Myong-byed (experiencing Bad-kan). Its location is the tongue, and its function is to sense and experience the six primary tastes.
The fourth Bad-kan is called Tsim-byed (satisfying Bad-kan). Its location is the head, and its function is to increase and satisfy the power of the five senses.
The fifth Bad-kan is called 'Byor-byed (joining Bad-kan). Its location is the joints and its function is responsibility for the flexibility of the joints.
This is a brief description of the type, location and function of the Nyipa sum When the Nyipa sum are balanced, then what are called the seven bodily sustainers are also balanced. The seven bodily sestinas are:
1) Essential nutrients
3) Muscle tissues
7) Regenerative fluid
To show how this process works, when we eat or drink something, 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 essential 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 eliminating functions of the wastes:
1) Elimination of faeces
2) Elimination of urine
3) Elimination of perspiration
This process shows how important it is for rLung, mKhris-pa and Bad-kan to be kept in balance.
Imbalance of Nyipa sum
We now move on to the second of the four categories - the imbalance of Nyipa sum. The long-term causes of the imbalance of Nyipa sum are the three poisons. The short-term causes of imbalance are the time and season, the influence of spirits, improper diet and improper behaviour.
With regard to the time and season, rLung asses at dawn and in the evening in summer. mhhris-pa arises during the autumn at midday and at midnight. Bad-kan arises in the spring, in the morning and at dusk. For the influence of spirits there are innumerable disorders brought about by certain contributory factors or conditions relating to harmful influences or spirits. The 360 female spirit influences are connected with desire and attachment and give rise to rLung. The 360 male spirit influences are connected with anger and hared and give rise to disorders from mKhris-pa. The 360 klu (Skt. Nagas or water dwelling spirits) and Sa-bdag (specific spirits that govern or haunt particular places) are connected with ignorance and give rise to Bad-kan disorders. If they happen to be disturbed, all these spirits can cause harm, and people would have to consult a lama or tantric practitioner for a divination. Through their help the spirits would be expelled through religious ritual and ceremony.
As for improper diet, if someone eats lots of light foods such as pork, goat's meat, milk and yogurt, strong tea, strong coffee, soya, vegetables, pulses, skimmed milk continuously, eating only these kinds of foods every day, they will suffer from rLung problems. If someone drinks lots of milk and alcohol, and eats lots of meat, full-fat cheese, nuts, sugar, ice cream, lard, butter, chocolate, cooks with lots of oil - these cause rKhri-pa problems. When someone eats lots of raw food such as uncooked meat, salad, raw fish, cold drinks, raw milk they will suffer from problems related to Bad-kan.
With regard to improper behaviour forrLung, 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. 'nKhris-pa arises through straining the body such as by crying heavy loads, digging hard dry soil, running in the middle of the day in the peak of summer, falling through sudden jerks to the body, such as falling off a horse or a roof and accidents. Bad-kan is caused by behaviour such as doing no physical exercise, sleeping for most of the day alter eating a heavy meal, taking cold showers every day, exposing your body through inadequate clothing, and working in damp and cold places.
Diagnosis of Nyipa sum when imbalanced
We will now briefly look at the methods of diagnosis in Tibetan medicine. When we see the patient there are three methods of diagnosis through:
Observation is done by urine analysis and looking at the tongue. A sample of urine must be the first early morning urine of the patient, and the night before she should refrain from eating spicy foods, drinking alcohol and having sexual intercourse. In Tibetan medicine urine analysis is divided into eight sections; the physician examines the colour, vapour, odour, bubbles, sediments and albumin's of the urine. The colour of the urine is determined by the intake of food and drink, seasons and diseases.
For the rLung patient the urine is very clear like water and it has big bubbles. For the mKhris-pa patient the urine is a reddish-yellow colour, there is much vapour and a very strong odour. For the Bad-kan patient the urine is white in colour and there is little odour and vapour. Generally a reddish colour indicates a hot disorder while transparency indicates a cold disorder.
When observing the tongue, the rLungg patient has a very red, dry and rough tongue. For the mKhris-pa patient the tongue is yellow with a thick coating. The tongue of a Bad-kan patient 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 arts of pulse reading provide an invaluable source of information because 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 inches 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, whilst 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 sort of food harms or helps them.
The fourth and final category is about the treatment of the patient. There are four methods of treatment, as follows:
1) Advice regarding diet
2) Advice regarding behaviour
3) Prescribing medicine
4) Performing surgery
If the illness is not so serious we need only give advice as to the diet and behaviour. Generally the rLung patient must try to eat food which has got heavy and nutritional potency, such as lamb, butter, molasses, alcohol, milk, soups, chicken, garlic, ginger and onions. The mKhris-pa patient 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 Bad-kan patient should have honey, mutton, fish, barley, wine, ginger decoction and plenty of hot water and cooked vegetables.
For behaviour the rLung patient should stay in dark and warm places, the surroundings should be very quiet, and there should be beautiful scenery. He should have good company such as lovers and close friends. The patient should also rest both physically and mentally without any worries. For the mKhris-pa patient's behaviour she should have cold baths and showers, sit in shaded places and walk by the sea and use a cool perfume such as sandalwood. For the behaviour of the Bad-kan patient, he should have lots of sun, warm fires in his home; he should do lots of exercise such as prostrations, walking and running.
The third method of treatment is the prescribing of medicine. It can be administered in various forms. In the form decoction, powder, pills etc. For the rLung patient various herbal ingredients are used such as aqullaria agollocha, allium sativum, myristica fragrans, asafoetida, santalum album etc. For the mKhris-pa patient's medicine we use swertia chirata, momordica charantia, holarrhena antidysenterica, aconitum naviculare, ixers gracilis, chrysosplenium nepalense, swertia hookeri and berberis asiatica etc. For the Bad-kan patient's medicine we use chaenomeles, inula helenium, coriandium sativum, meconopsis discigera, punica granatum, kaempferia galanga and phyllantus emblica etc.
The filial method of treatment is surgery - divided into mild and rough. Mild surgery for the rLung patient includes massage with year-old butter and oily compresses. Rough surgery for the rLung patient is placing moxa on the selected points of 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 mild surgery is sitting beneath waterfall and mild purgatives. Rough surgery for the mKhris-pa patient is blood letting and cupping. For the Bad-kan patient mild surgery is hot fermentations, saunas and mild emetics. Rough surgery for the Bad-kan patient is golden needle therapy and the application of heated surgical stylets.
We can say in conclusion that there are many different types of disease and illness, but they can all be categorised within the Nyipa sum - rLung, mKhris-pa and Bad-kan. Similarly, with all these different types of disease and illness there is no other location for them than the seven bodily sustiners and the three eliminating functions. For example just as a bird has the freedom of the skies, it cannot fly above the sky. In Tibetan or the science of healing, we always treat the cause or the root of the disease and illness and not the symptoms. In the medical texts there is the following example -without treating the root or the cause of the disease it is the - as having a poisonous tree and just cutting off the leaves and branches without pulling it up from it's roots. If you just cut the leaves and branches it will still continue to grow. The Medicine Buddha says that if the physician tats the patient according to the medical texts the treatment will be beneficial. If the method of treatment fills, it is not the fault of the physician but the fault of the Medicine Buddha himself. This shows us how confident and sure the Medicinc Buddha was about the medical texts. However, if a person is suffering from a chronic disease and expects a quick solution, then this will not be possible. He will have to be patient and take the medicine for a long period of time before its positive results will show.
So this is a brief introduction to Tibetan medicine and all that has been said is based on the Tibetan medical texts. Hopefully the reader will gain some understanding of Tibetan medicine, and it will help to relieve the sufferings of all sentient beings.
Dr. Tamdin Sither Bradley graduated from the Tibetan Medical and Astrological Institute in Dharamsala, India After graduating she worked at the Tibetan Medical and Astrological Institute's branch clinic in New Delhi, and later as Chief Medical Officer at Bhubneshwar, Orissa, India. Dr Tamdin has studied under the guidance of His holiness the Dalai Lama's senior personal physician, Dr Tenzin Chodak, and other prominent Tibetan doctors. She is the first Tibetan doctor resident in Great Britain and she lives in London.