Commentary

To practice Tibetan medicine effectively a doctor must draw upon all aspects of human cognition as well as spiritual understanding and a sense of compassion. Our responsibility is not only to provide for our patients. We must also serve as an example, teaching others that living with a sense of compassion – derived from ecological and spiritual awareness – is the most practical way to reduce suffering in our bodies, minds, and in the world in which we live.

CURRENT ISSUES
Having begun my study of Tibetan medicine (Sowa Rigpa) in 1983 and my clinical practice in 1993, I have developed a broad view of the ways in which our discipline has progressed as well as the challenges that we currently face.

As we focus on Tibetan medicine as a healing science, it is essential that we do not loose sight of the context in which students and doctors study and practice, and patients avail themselves of Tibetan medicine’s healing remedies. To embody holism, it is necessary that we do not “miss the forest for the trees.”

ANCIENT WISDOM
This is especially important in fields of traditional medicine where we must work to preserve ancient traditions as fully as possible, while at the same time engendering the progress that is required for any healthcare system to remain useful and relevant.

Many of the senior teachers that I have known displayed a very sophisticated understanding of the challenges that Tibetan medicine faces in the context of globalization as it increasingly encounters the broader world. Like many of his generational colleagues — e.g., Tenzin Choedrak, Yeshi Dhonden and Tsoru Tsenam — my teacher, Dr. Trogawa Rinpoche, saw the manner in which factors outside of his medical or Dharma practice, such as geopolitics and ecological degradation, could have a profound effect on the survival and the progress of Tibetan medicine.

TRADITION VS EMERGING METHODS
The fact is that despite it being an ancient system of medicine, Tibetan medicine is an ‘emerging’ healthcare discipline in the West. In Asia, it is being affected by various economic, ecological, political and cultural forces. In this context several new approaches to Tibetan medicine have been developing.

One current approach greatly emphasizes the religious and ritualistic aspect of healing in Tibetan culture. Whereas these are a significant component of the Tibetan Buddhist healing tradition, this movement does not necessarily acknowledge the important traditional understanding about the differentiation (and relationship) between Buddhist practice and Tibetan medicine. As Dr. Trogawa Rinpoche eloquently described this interrelation, “my external activity is the practice of medicine, and in my inner thoughts I meditate on the Buddha of Medicine.”

There has also been an effort to emphasize the physical therapy aspect of Tibetan medicine. Since those physical treatments can be effective when applied properly, this could be a boon to patients seeking healing. But, reordering the treatment protocols of a medical discipline to react to market forces or other factors also has its costs. The traditional approach to Tibetan medical diagnosis and treatment has a purpose and a basis in centuries of clinical practice.

CHALLENGES OF MODERN APPROACHES
Yet another current movement is emphasizing making Tibetan medicine a largely quantitative system that adopts many of the parameters, methods, language, and industrialization, etc., of biomedicine. This has the potential to significantly alter our tradition. This approach [incorrectly] implies that tools like modern research techniques can only be applied to traditional Asian medicine if those disciplines inexorably alter themselves in terms of biomedicine.

Many allied with this approach also promote the idea that standardization is necessary for the advance of Tibetan medicine in the global marketplace. However, one of the strengths of traditional natural medical systems is the diversity of approaches [e.g., lineages] that exist in both training and practice.

Biomedicine has shown us the perils of developing medicine as a commodity or in an overly industrial fashion. In the West the alternative medicine movement’s interest in traditional and natural healthcare approaches grew in part as a direct response to the negative impact such developments had on the quality and cost of biomedical care.

BENEFITS OF MODERN APPROACHES
There are modern approaches that can certainly benefit Tibetan medicine. First and foremost is developing techniques to insure the safety and purity of herbal medicines. Since a great deal of Tibetan medicine is produced in traditional settings such solutions need to be low cost and relatively low tech. Requiring the use of only high tech industrial solutions has already created an inflation in the cost of herbal medicines in parts of Asia, making traditional medicine less accessible to the native population. Unnecessary inflation in costs will eventually affect access to these medicines worldwide.

Modern forms of research can also be helpful for Tibetan medicine. But only when 1) research protocols are designed that specifically address the unique approaches of traditional Asian medicine and 2) that, as with biomedicine, research is designed to assist clinicians to answer key questions to improve practice, outcomes and herbal pharmacology.

ECOLOGY AND MEDICAL HERBOLOGY
One of the greatest challenges to Tibetan medicine is ecological degradation both locally and in terms of global climate change. The improper harvesting of wildcrafted medicinal herbs, the market dominance of one nation or company in obtaining such herbs, and pollution of groundwater affecting herbal purity are just a few of the issues that need to be addressed. It is important that those who wish to benefit from traditional systems of herbal medicine become familiar with these and other challenges, and support positive solutions. Mere consumerism regarding herbal medicine is a recipe for more problems ahead.

WORKING TOGETHER
My teacher Dr. Trogawa Rinpoche, taught that Tibetan medicine can learn something useful from biomedicine regarding professionalism and collegiality. He explained that in the modern context it is urgent for Tibetan doctors to improve their professional culture and begin to emphasize the importance of mutual aid and respect for one’s colleagues. He felt that for Tibetan medicine doctors to build greater collegiality they needed to abandon traditional sectarianism and divisions based on things such as region, culture, ethnicity, language, institution or lineage.

CULTURE OR PROPERTY
Finally, another current issue facing Tibetan medicine revolves around concern about the competition between China and India at UNESCO to lay claim to Tibetan medicine as being part of their nation’s “intangible cultural heritage.” Some who are critical of this process say that Tibetan medicine is the property of Tibetans. Of course, the problem with all of these positions is that only with the recent advent of global Intellectual Property Laws (IPR) has culture (along with plants, organisms and even genes) after millennia been deemed as ‘property.’ Previously, throughout history, world culture including medicine, was built on reciprocal sharing of heritage, not on the rules of sole ownership. If IPR existed in the ancient world then there would likely be no Tibetan medicine since Sowa Rigpa is an integration of Tibetan, Indian, Persian, Greek and Chinese ideas. Tibetan medicine is a key part of Tibetan culture, and Tibetans are the stewards of that culture, its knowledge and disciplines. But to place ownership of Tibetan medicine on one group is to accept the ideology that is the basis for the current UNESCO competition between China and India.

SHARING VS OWNERSHIP MODELS
A focus on IPR also makes it harder for people to be collegial and share ideas — even those based fully on traditional culture — since ‘ownership’ and copyright are suddenly uniquely at stake. A focus on ownership of Sowa Rigpa, also makes it more likely that proprietary claims on [traditional] herbal medicine formulas will continue to increase. This further challenges the sharing of medical knowledge that made Tibetan medicine viable, and also has the potential to drive up cost of care.

CODA
If people want to encourage the survival of the full tradition of Tibetan medicine and see it spread globally, there are certain steps to take. First, it is worthwhile to support those institutions and individual lineage holders who are teaching and practicing Tibetan medicine. It is important that senior Tibetan physicians in Tibet, India, Nepal, Bhutan, etc. fully transfer their knowledge to a new generation. Great attention to the aforementioned ecological issues is also vital.
To allow a true flowering of Tibetan medical practice in the West the small group of clinicians here who are serious long-term students of Tibetan medicine need backing from those who are supporters and/or patients of our system of natural healthcare. As people in the West succeed in their attempts to study and faithfully practice this tradition, we can begin to build the infrastructure required for the proper practice of Tibetan medicine here. The key to Tibetan medicine’s success is native practitioners and Western practitioners working to help individual patients suffering from illness.
For a person to practice Tibetan medicine effectively they must draw upon many aspects of human cognition as well as spiritual understanding and a sense of compassion. In practice our responsibility is not only to provide for our patients. We must also serve as an example. Teaching our fellow citizens that living with a sense of compassion — derived from ecological and spiritual awareness — is the most practical way to reduce suffering in our bodies, minds, and in the world in which we live. For those who would like to see such an approach to healthcare survive and proliferate in the West, now is the time to make it possible through thoughtful action.

Best of health in Body and Mind,
Eliot Tokar
Traditional Tibetan Medicine Doctor

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