Traditional Tibetan Medicine

Traditional Tibetan Medicine – An Overview
Traditional Tibetan Medicine (TTM) is a natural and holistic medical science, which addresses the individual’s needs of body, mind and spirit, in an integrated way. Dating back to antiquity, TTM has a genesis, history and development of its own, rooted in the Tibetan landscape, the indigenous culture and the spirit of the Tibetan people.
Traditional Tibetan Medicine contains a comprehensive philosophy, cosmology and system of subtle anatomy with associated spiritual practices.
The study of TTM contains a wealth of knowledge on anatomy and physiology, embryology, pathology, diagnostics and therapeutics, including a huge herbal pharmacopoeia and a large variety of external therapies which are little-known in the Western world.
Despite being one of the world’s most ancient healing systems, Traditional Tibetan Medicine continues to be effectively practised in contemporary society. Modern research is now confirming the extraordinary benefits of this ancient knowledge.
The aims of TTM are two-fold:

Preventive aspects,
Prevention of illness through correct lifestyle and diet are fundamental to TTM. In this modern age, most chronic diseases arise as a result of imbalance of mental attitude, incorrect lifestyle and incorrect diet. Diabetes and cardiovascular disease are well-known examples of this.
Curative aspects.
Once imbalance arises, overt disease becomes manifest. It then becomes necessary to re-create balance through working on the underlying causes and effects. This means, in the first instance, attending to dietary and lifestyle factors, and then secondly making use of herbal therapies and external therapies.

What is meant by Balance and Imbalance? Balance refers to harmony between body, energy and mind. Of these, energy is the most important, as it is the vital link between body and mind. When this vitalising energy becomes imbalanced, the physical body and the mind also lose their balance resulting in ill-health.
Good balance results in a healthy body, a clear calm mind, and abundant energy.
Imbalance arises as the effect of negative causes. In TTM, negative causes are classified as primary or secondary. Primary causes always arise from negative or destructive mental attitudes such as anger or aggression; lust, unhealthy attachment or desire, and ignorance. Secondary causes are the perpetuating factors such as incorrect diet and life style, or acute precipitating factors.
What is Energy? In TTM, the term ‘energy’ refers to the dynamic power which is the source of all existence, including both microcosm and macrocosm. In the physical body it is the psycho-physical vitalising principle. This energy arises out of the Five Elements, namely: space, wind, fire, water and earth. The quality of space is emptiness or potentiality, out of which all phenomena arise; wind has the quality of movement, growth and development; fire has the qualities of speed and heat which create ripening; water has the qualities of fluidity as well as cohesiveness; earth has the quality of solidity and stability.
These 5 elements may be condensed into three specific qualities known as the Three Humors. The Three Humors are Bile, Phlegm and Wind, which have the essential qualities of heat, cold and neutral, respectively.

Tibetan	Humor	Element	Quality	Main Functions in the body
Lung	Wind	Space Air	Movement	Activities of the Mind: thought and reasoning Functions of the Nervous System -the interface between body and mind Respiration Excretion
Tripa	Bile	Fire	Heat	Regulation of body heat Digestion and assimilation of nutrients Catabolic functions Awareness of hunger and thirst Courage, motivation, Vision
Badkan	Phlegm	Earth Water	Solidity Cohesiveness Fluidity	Structural foundation of the body Body fluids Anabolic functions Sleep Patience, tolerance

Diagnosis in Traditional Tibetan Medicine
This ancient, natural and gentle medical system comprises three diagnostic methods:

Inspection (Tib. lTa ba) - which means to watch, to observe.
Palpation (Tib. Reg pa) - which means to touch.
Case History (Tib. Dri ba) - which means to ask questions.

Inspection (Tib. lTa ba)
Focussed inspection includes evaluating the form and contour of the patient’s body as well as the patient’s complexion; critical observation of the sense organs, in particular the characteristics of the tongue; and detailed inspection of the urine, which is considered to be the most important factor in diagnosis.

Urine Analysis According to Traditional Tibetan Medicine
In TTM there are nine important aspects to note when analysing the urine. The first four elements should be noted while the urine is still warm, namely, the colour of the urine as soon as it is passed, the vapour, the odour and the nature of any bubbles.
Two aspects should be observed during the cooling phase – these are the formation of sediment, and any oil on the surface of the urine.
As the urine cools, it changes colour. The time it takes for the change of colour between hot and cold urine should be noted, as well as the way in which the colour changes, and the final colour of the urine once it is completely cold.
Each of these characteristics of the urine, and the way that the urine changes over time, gives information as to how the three Humors are affecting the body and its metabolism.

Palpation (Tib. Reg pa)
In TTM, the art of palpation (touching) comprises two fields:

Pulse Diagnosis Pulse reading is a very important and complex method of diagnosis. It is extensively practised in most of the oriental traditional medicines, however it must be noted that the art of Tibetan pulse reading is different from that of other medicines. There are two major aspects to Pulse Diagnosis:
Pulse reading in order to establish the individual’s underlying typology and pulse reading to ascertain pathology.
Tender Points
Reg Pa also refers to checking specific points in order to identify the painful areas, which indicate where the illness is located. Palpating each painful point establishes a connection with the related organs; in particular the points along the vertebrae and on the head.

Case History or Interview (Tib. Dri Ba) This is the process of collecting information: how to question and listen to the patient in order to identify signs and symptoms; knowing about diet and behaviour in order to understand what the possible causes of the disturbance or illness may be.
There are three main points which need to be clarified during the interview: the patient’s current symptoms; the patients view of the cause of the symptoms; and how the patient responds when presented with certain foods and circumstances.
Treatment Methods in Traditional Tibetan Medicine There are four main methods of treatment in Traditional Tibetan Medicine, namely: Diet, Life-style, Medicine and External Therapies.

Diet: According to Tibetan Medicine, individuals should be aware of their typology, in order to partake of a diet which helps to maintain balance.
Diet can be adjusted for different types of imbalances according to whether the affliction is hot or cold in nature, or pathology according to the three Humors.
There are certain important guidelines that lead to greater well-being and vitality: a nutritionally balanced, natural diet, low in fats and taking meat in moderation, with no extremes of taste such as highly sweetened or highly salted meals. Alcohol is advised in moderation.
In modern life, fast-foods high in fats, pickled and preserved foods and drinks should be avoided, particularly in early years in order to prevent the onset of disease.
Life-Style
Tibetan Medicine considers a healthy lifestyle to consist of an awareness of every moment of our lives – waking, sleeping, eating, sitting, walking, working – (not just the participation in regular exercise!).
The environment should be suitable to each person’s typology – in particular, living in harmonious balance with nature. It is most essential to breathe fresh air, to have good light and to avoid extremes of temperature.
It is important for the individual to allow time for activities such as meditation, breathing exercises and gentle yoga, in order to reduce physical and mental stress - which form the underlying cause for disease.
Medicine
In the Tibetan pharmacopea, natural herbs, plants and wild-flowers are employed for their therapuetic effect. A variety of mineral substances, and a small number of animal-derived substances are also used. Many of these substances can be found all over Asia, however some specific and particularly-powerful herbs and minerals are found only on the Tibetan high plateau. Due to the pristine nature of this environment, the ingredients of theTibetan Materia Medica is particularly pure.
Tibetan medicines are formulated according to two guiding principles – according to Taste and according to Potency. Doctors examine the different tastes of the substances and make a combination of medicines – this is known as medicinal compounding according to Taste. Each substance of the Materia Medica has a natural potency which is independent of the taste, and serves to guide the compounding of medicines according to Potency. According to ancient texts and generations of Tibetan medical recipes, Tibetan doctors are still producing both of these types of medicines.
Typical of Tibetan medicines is that they contain many components – these are known as multi-component formulae. A simple remedy might contain 10 substances, whereas a more complex formula might contain as many as 70 ingredients. Remedies may be found in the form of pills, powders, decoctions, concentrates, creams or lotions.
There are approximately 500 medicinal formulae that are currently in common usage. These formulae or remedies have the function of restoring the balance of the three Humors. Recent scientific studies are now able to demonstrate the efficacy of these Tibetan formulae (Link to Padma research page).
External Therapies
TTM describes physical health as a balance between the Three Humors. Specific External Therapies can be used to restore balance in each of the Three Humors. Traditional Tibetan Medicine incorporates a wealth of External Therapies, each of which can be used individually, or can be used in combination with other types of treatment.

Massage - Kunye (Tib, bsKu mNye) Ku Nye is the traditional Tibetan Medical massage, which can be used both in prevention of disease as well as treating disease. Specific acupressure points and meridians are used, as well as the use of specific therapeutic herbal oils.

Acupuncture - Thurche (Tib, Thur dPyad) The knowledge of Tibetan acupuncture was lost for many years; however due to the research of Dr Nida Chenagtsang, a revival of this healing art has begun. IATTM is proud to present teachings on traditional Tibetan acupuncture. Tibetan acupuncture differs from the Chinese acupuncture predominantly in the use of different points and meridians.

Moxibustion - Metsa (Tib, Me bTsa) Moxibustion is a heating therapy which utilises the herb leontopodium which is dried, crushed and formed into a cone that is burned - applied over specific points in order to provide heat. This is one of the most important external therapies used for cold conditions – eg. Digestive problems, poor circulation, dull pain. Specific points are used for different conditions. There are 20 different types of moxibustion, each using different materials, making the art of Tibetan medical moxibustion quite unique in its diversity.

Cupping – Mebum (Tib, Me Bum) Tibetan medicine traditionally employs copper cups applied to painful areas in order to relieve the pain and energetic blockage.

In addition, Traditional Tibetan Medicine employs unique and lesser-known External Therapies, such as:

Herbal Bath therapy - Lum (Tib. Lums)
Blood-letting - Tarka (Tib, gTarga)
Compresses - Dug (Tib, Dugs)
Stick therapy - Yuk Cho (Tib. dByug bChos)
"Mongolian" Moxibustion - Hor Me
The Fundamental Treatise rgyud-bzhi The fundamental medical treatise, the rgyud-bzhi, is comprised of four sections, usually known as the Four Tantras:

1. the RCTA Tantra
2. the Explanatory Tantra
3. the Oral Tradition Tantra and
4. the Last Tantra.

The Fundamental Treatise rgyud-bzhi
The complete test encompasses 5900 verses which are grouped in 156 chapters.
The following is a short description of the contents of this treatise, which lists the different topics treated in Tibetan medicine and illustrates the lucid and systematic presentation of the teachings. The RCTA Tantra The first section, the RCTA Tantra, is comprised of six chapters giving a brief outline of the whole text and comparing the medical system with a tree. Three rCTAs sprout into nine stems, which branch out into 47 branches bearing 224 leaves. The nine stems represent the nine sections of medical science, the branches stand for general information and the leaves illustrate the details.
The First RCTA (Figure-I) The first rCTA explains the human organism and its functioning and encompasses two stems, which stand for the healthy and the sick body. The healthy body is represented by three branches and 25 leaves, the sick body by nine branches and 63 leaves. The first stem, the healthy body, bears three branches. One of the branches represents the three humours, another the - bodily constituents (nutritional essence, blood, muscle tissue, fat or fatty tissue, bones, marrow and regenerative fluid) and the third branch the three excretions of the body (feces, urine and perspiration).
Furthermore, the first stem bears two flowers standing for health and long life and three fruits representing religion, wealth and happiness.
The second stem represents the sick organism. This section deals with the causes and the conditions of diseases, the six - doorteays by which diseases may enter the body, the locations of the humoral diseases and the pathways where they circulate. Information is provided about the promotion of humoral diseases by the patient's age, the season, time of day and the dwelling place. Furthermore, incurable diseases, side effects due to inappropriate treatment and the classification of all diseases as either cold or hot disorders are discussed.
Figure - I: The RCTA of Physiology and Pathology This picture describes the Tibetan concepts of health and disease illustrated as a tree with two stems. The first stem deals with the healthy body. It has three branches, 25 leaves, two flowers and three fruits. The first branch bears 15 leaves representing the three humours and their five types. These are depicted in the three different colours blue, yellow and white signify-ing the humours riung, mkhris pa and bad kan, respec-tively.
The second branch has seven leaves representing the seven bodily constituents.
The third branch bears three leaves, which stand for the three bodily excre-tions. The two flowers stand for a healthy and long life and ultimately serve as the basis for attaining the three fruits: spiritual accomplishment, wealth and happiness.
The second stem deals with the diseased body. It com-prises nine branches and 63 leaves. The first branch has three leaves, which stand for the three specific distant causes of disorder: attactment, hatred and closed - mindedness. The second branch bears four leaves de-picting the four conditions that trigger disorders: sea-sonal changes, demons, diet and behaviour. The third branch has six leaves representing the six areas of in-ception of diseases. The fourth branch possesses three leaves showing the main locations of the three hu-mours. The fifth branch has 15 leaves, which illustrate the pathways of the humours. The sixth branch has nine leaves representinq the humoral diseases in rela-tion to age, places of occurrence, maturation period and seasonal changes. The seventh branch has nine leaves signifying the nine incurable cases. The eighth branch shows 12 leaves depicting the side effects of in-appropriate treatment. The ninth and last branch has two leaves, which illustrates the fact that all diseases can be either hot or cold disorders.
In the upper left corner one can see the picture of the Medicine Buddha. According to the main Tibetan med-ical text, i.e. tgyud bzhi, drang srong rig pa'iye shes emanated from the heart of the Medi-cine Buddha as the expounder of rgyud bzhi, and drang srong yid las skyes emanated as the recipient of rgyud bzhi. Thus,the main Tibetan text is written in the form of questions and answers between these two emanations, which are portrayed in the upper left corner. It is also stated that when the Medicine Buddha unfolded this medical system, he was surrounded by various disciples, gods, sages, Buddhists and non-Buddhists. Some of whom are portyed in the uppermost part of the picture.
The Second RCTA (Figure-II) The second rCTA informs about the methods of diagnosis, the examination of the tongue and urine, the pulse diagnosis and the questioning of the patient regarding the symptoms of the disease, the way of living, etc.
Figure-II: The RCTA of Diagnosis This illustration displays three stems and depicts the three main diagnostic techniques used by Tibetan phy-sicians: pulse reading, urine analysis and interrogation. The first stem deals with visual observation methods. it is divided into two branches; the first branch stands for observation of the tongue and the other branch for ur-ine analysis.
These branches possess three leaves each, showing that each of the three humours has a differ-ent effect on the patient's tongue and urine, which can be visually detected by the physician.
The second stem depicts the pulse analysis in three branches. each comprised of a single leaf symbolising the different pulse nature of each of the three humours.
The third stem deals with the method of interrogation. It consists of three branches with 11 blue leaves relat-ing to rlung disorders, seven yellow leaves relating to mkhris pa disorders and 11 white leaves to bad kan dis-orders. These colours stand for the different ways of in-quiring used to identify the humoral diseases and their symptoms as well as to determine their remedies. Several sages and non-Buddhists are depicted In the uppermost part of the picture.
The Third RCTA (Figure-III) This rCTA deals with therapeutical methods, diet, behaviour, medical preparations and external treatments.
Figure-III: The RCTA of Treatment This picture shows the methods of treatment used in the Tibetan system of medicine. The rCTA of treatment develops into four stems symbolising diet, behaviour, medication and external therapy. These treatments are generally used in combination depending on the nat-ure of the person and the disease involved.
The first stem stands for diet treatment, which has six branches. The first two branches with ten and four blue leaves, respectively, show the diet and the drink best suited to treat rlung disorders. The third and fourth branches with seven and five yellow leaves, respectively, stand for the diet and drink suitable for mkhtis pa disorders and the fifth and sixth branches with six and three white leaves, respectively, stand for the diet and drink recommended for bad kan disor-ders.
The second stem illustrates behavioural treatment. It has three branches with two leaves each representing the behaviours beneficial for the three humours.
The third stem depicts the different medications. It has a total of 15 branches and 50 leaves. The first six branches each bear three leaves. These refer to the tastes and medicinal qualities favourable for treating rlung, inkliris pa and bad kan disorders, which are shown as blue, yellow and white leaves, respectively.
The seventh to the twelfth branches bear a total of 23 leaves representing different medicinal preparations: broth and medicinal butter, decoctions and powders, pills and specific medicinal powders. The type of pre-paration prescribed depends on the afflicted humour. In addition to the above medications, there are three different branches symbolising medicinal preparations with a cleansing effect: enemas, purgatives and eme-tics used respectively for rlung, mkhrispa and badkan disorders. They are represented by three blue leaves on the thirteenth branch, four yellow leaves on the four-teenth and two white leaves on the fifteenth branch. The fourth stein stands for external therapies, which are generally used as a list resort after all other treatments fail. It consists of three branches. The two blue leaves on the first branch portray the external therapy used to treat rlung disorders. The three yellow leaves on the second branch stand for external therapies used to f iqiit fight mkhris pa disorders and the two white leaves on the third branch signify external therapies used on bad kan disorders.
In the lower right corner one can see a picture of the Medicine Buddha. Some of Buddha's disciples, Buddhists and important scholars of Tibetan medicine are depicted in the uppermost part of the picture.
The Explanatory Tantra The second tantra, the Explanatory Tantra, en-compasses 31 chapters and is concerned with the life cycle (conception, childbirth, function-ing of the three humours and signs of death), causes, conditions and classification of the dis-eases. It specifies the properties of medicinal in-gredients and explain in detail diet, behaviour and the rules for maintaining health, etc. It also contains a code which the physician should up-hold in conducting his profession.
The Oral Tradition Tantra The third tantra, the Oral Tradition Tantra, consists of 92 chapters which mainly teach the 101 disorders of the three humours indicating their causes, conditions, symptoms and meth-ods of therapy.
The Last Tantra The fourth tantra, the Last Tantra, is comprised of 27 chapters, which deal with diagnosis (such as urine analysis and pulse reading), medicinal ingredients and their preparations (pills, powders, syrups, medicinal butters, etc.) pacifying medicaiton (purgatives and emetics) and additional treatments (moxibustion, golden-needle therapy) which are applied when all other medicinal preparations have failed to cure the patient.