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Tibetan Medicine

Tibetan Medicine is a highly evolved system of medicine that developed as a synthesis of medical knowledge and wisdom from Indian Ayurveda, Chinese medicine, Greek medicine and Unani Tibb. Its origins can be traced back to at least the 7th century. It also incorporated Buddhist philosophy that was introduced to Tibet over two thousand years ago. Being deeply rooted in Buddhist philosophy, its perspective is that physical illness is inextricably bound with mental, social and spiritual illness.

Tibetan medicine has developed into a sophisticated and complex medical science with intricate theories about causes of disease, diagnosis and therapeutics, and has existed in its present form for over one thousand years. Sangye Menla, the “medicine Buddha”, is respected as the source of medical teachings and the inspiration for correct practice as a physician. The essential aspects of this teaching are summarised in the rGyud-Bzhi (pronunciation giu shi) or the Four Medical Tantras, the twelfth century text in four volumes, which is still taught today. The Tibetan system of healing, known as sowa rigpa, or the knowledge of healing, is still practiced in Tibet, India, Nepal, Bhutan, Sikkim, Ladakh, Siberia, China, Russia and Mongolia, as well as in parts of Europe and North America.

The Three Humours

Like other Asian systems of medicine, Tibetan medicine is based on the principle that everything in the cosmos, including human life, is composed of five elements: earth, water, fire, wind and space. These are symbols for matter, cohesion, energy, movement and space that affect the mind as well as the body. The universe and the body are a result of the interplay of these five elements, which manifest themselves in the form of energy into three humours or energies:

1. Wind (rLung, pronunciation loong) is vital for movement, responsible for breathing, circulation of bodily fluids including blood and lymph, mental activity like thinking, speech, energy, and transmission of nerve impulses. There are five subcategories of rLung each with different locations and functions: Srog-'Dzin rLung, Gyen-rGyu rLung, Khyab-Byed rLung, Me-mNyam rLung, Thur-Sel rLung.

2. Bile (mKhrispa, pronunciation Tripa) is heating energy, which regulates digestion and metabolism, liver function and maintains body temperature and the discriminating mind. The five subcategories of mKhris-pa are Ju-Byed mKhris-pa, sGrub-Byed mKhris-pa, mDangs-sGyur mKhris-pa, mThong-Byed, mKhris-pa, mDog-Sel mKhris-pa.

3. Phlegm (Badkan, pronunciation Beken) governs the structure of the physical body such as bone and muscle as well as mucous membranes. It is responsible for some aspects of digestion, the maintenance of our physical structure, joint health and mental stability. The five subcategories of Bad-kan are: rTen-Byed Bad-kan, Myag-byed Bad-kan, Myong-Byed Bad-kan, Tsim-Byed Bad-kan, Byor-Byed Bad-kan.

Health depends on the equilibrium of the humours, so disease is caused when they are out of balance. The three energies are present in different proportions in each person and determine their constitution including their body shape, temperament, and susceptibility to specific health problems.

Thangka painting on fabric, depicting the medicine Buddha Sangye Menia.

Balancing the Humours

Another important concept in Tibetan medicine is the dichotomy between warm and cold. Diseases, as well as remedies and food, are distinguished as warm and cold or as warming and cooling respectively. mKhrispa is warm and badkan is cool. rLung is a special case and is basically neutral, it can aggravate “warm” and “cold”, much like wind is able to boost a fire as well as cool down the body. A rLung imbalance is at the root of most diseases.

The understanding of physiology is governed by the dynamic interaction of three humours (rLung, mKhrispa and badkan). Health is a dynamic equilibrium and is therefore relative because all three humours must be in a corresponding balance for each individual. The aim of Tibetan therapy is thus to restore this equilibrium in the patient.

Diagnosis and Treatment

As in Ayurveda and Unani medicine, the balance of the humours determines the constitution of each individual. This balance is influenced by our external and internal environment, including diet, lifestyle, relationships and emotional, mental and spiritual influences. The dynamic equilibrium of the humours also changes with the climate, the seasons and the ageing process. In Buddhist thought, all physical and mental suffering, and hence all illness, is caused by the three mental poisons: attachment, anger and ignorance, as well as the effect of past karma. Tibetan medicine stresses the importance of compassion in healing.

Diagnosis of imbalance and disease involves observation and an in-depth interview of the patient, taking the pulse, and examining urine and faeces as well as the tongue. Once the imbalance of the humours has been ascertained, treatment specific to the individual is recommended, designed to re-establish mental harmony and equilibrium of the three humours. This can include advice on lifestyle, exercise, conduct and behaviour, healing of the mind through mantras and meditation, yoga, moxibustion (burning of the herb mugwort), the use of herbs, vegetable and mineral supplements, massage and inhalations with specially formulated herbal oils, bathing, cupping and occasionally acupuncture. Foods and herbs all consist of their own individual balance of the five elements and three humours. Foods and diets appropriate to each patient and the balance of the humours are recommended, and this includes quantities of food, and when they are eaten.

Herbal Medicines

If dietary and behavioural changes are not sufficient to remedy the condition, herbs are prescribed. The Tibetan Materia Medica consists largely of medicinal herbs, as well as minerals and, to a lesser extent, animal substances. As in Ayurveda, medicinal substances are grouped according to their properties, their taste (sweet, sour, salty, bitter, pungent and astringent), their potency (heavy/light, oily/rough, hot/cold and blunt/sharp) and the effect of these on the humours. Tibetan medicines are frequently composed of 20 or more different ingredients, and include one major group of ingredients and two minor ones aimed at supporting the major group and preventing unwanted side effects. Herbs that are used in the Tibetan tradition include amalaki, roses, calendula, nettles, coriander, cinnamon, cardamom, ginger, garlic, rhodiola, gentian and liquorice. Medicines are considered to be offerings to the Medicine Buddha and other medicine deities and are prepared with spiritual rituals by traditional methods of drying, grinding, mixing and pressing the plants to make pills, powders or decoctions.

The annexation of Tibet by the People's Republic of China (PRC) in the 1950s had a great impact on Tibetan medicine. During the Cultural Revolution in particular, practitioners suffered great persecution, and clinical practice, study and research largely censored by the repressive Chinese. Nevertheless, Tibetan medicine has survived almost intact. His Holiness the 14th Dalai Lama lives in exile in Dharamasala and has been a powerful influence in Tibetan medicine. In 1961 he founded the Men-Tsee-Khang (the Tibetan Medical and Astrological Institute – TMAI) which has a college of Tibetan medicine, a clinic, a pharmacy that produces and dispenses medicines, and carries out research and publication of medical and astrological texts. There are other schools and clinics in Tibet, India and Nepal and recently huge pharmaceutical factories have started making traditional Tibetan formulas in China.

HERBS COMMONLY USED IN TIBETAN MEDICINE

Allium sativum (see page 102)

Calendula officinalis (see page 132)

Cinnamomum zeylanicum (see page 142)

Coriandrum sativum (see page 148)

Elettaria cardamomum (see page 159)

Emblica officinalis (see page 161)

Gentiana lutea (see page 175)

Glycyrrhiza glabra (see page 178)

Myristica fragrans (see page 204)

Rhodiola rosea (see page 224)

Rosa spp (see page 225)

Urtica dioica (see page 257)

Zingiber officinale (see page 274)

Many herbs used in Tibetan medicine, for example garlic and ginger, are already part of our daily lives.