Tibetan medicine places its primary focus on the interdependence of the body and mind, an ecological view of health, a holistic approach to diagnosing and treating illness, and the spiritual aspect of our existence.
OBSERVATION AND INTERVIEW
As taught by my teacher Dr. Trogawa Rinpoche, we should first observe the patient, taking into account their personal and physical attributes. We then speak to the patient and enquire about their condition, its symptoms and development, as well as about their medical history and pertinent aspects of their personal history. Many Asian doctors do not speak very much to their patients, but rather try to imbue them with confidence based solely on other diagnostic skills. Dr. Trogawa, however, felt that directly relating to a patient allows a doctor to better understand an individuals’ experience of their condition, and therefore to arrive at a deeper quality of diagnosis.
We then look at a urine sample. In the urinalysis we observe such things as the color of the specimen, its odor, viscosity and after vigorous stirring the size, color, amount, and persistence of bubbles, as well as any deposits occurring within or on the surface of the sample, etc. From this we can begin to confirm things such as the nature of the illness, the presence of infection and the localization of the illness, among many other diagnostic factors.
Next we feel the twelve pulses. Three fingers of the doctor’s hand are applied to the radial artery of each of the patient’s wrists. A Tibetan medicine doctor feels six pulses on each wrist. Each of the doctor’s fingers are divided in half, the left and right side feeling the pulse of a distinct organ system (i.e., heart, small intestine, liver, gall bladder, left kidney, reproductive organs, lungs, large intestine, spleen, stomach, right kidney, bladder). We feel for many qualities of the pulse, such as, its width, depth, strength, speed, persistence, etc. Each of those factors when understood properly allow us to clearly define the illness’ etiology, i.e., its relation to the Three Principles of Function (Lüng, Tripa, Bädkën, or combinations of these factors), its location, chronicity, hidden complications, etc.
ADDITIONAL DIAGNOSTIC TECHNIQUES
To further confirm the diagnosis, we can look at the color, shape and coatings of the tongue, specific signs appearing in the sclera (white) of the eye, and we may also test for sensitivity at certain pressure points on the body.
A patient’s treatment must be specifically tailored to fit their individual condition(s).
When treating an illness, Tibetan medicine doctors traditionally first begin by recommending specific behavioral and lifestyle modifications.
If this is not sufficient, then Tibetan medicine additionally utilizes dietary therapy.
If these are not enough to remedy the problem, Tibetan medicine employs herbal medicines.
If these are not adequate to the presenting problem then physical therapies such as massage, moxibustion (the heating of specific treatment points on the body), cupping, acupuncture, herbal bath therapies, etc. can be utilized.
Behavior/lifestyle modification is a broad category. It can include the reorganization of habitual patterns such as sleep and eating habits. Attention to one’s environment is important so, for example, sensitivity to hot or cold temperatures are considered. Physical activities such as exercise are evaluated. When appropriate to the individual situation, personal practices such as a person’s social life, meditation practice, spiritual perspective, and the applicability of counseling or therapy may also be addressed.
Regarding meditation or mindfulness practices, they initially may include simple breathing practice, working with one’s thoughts in a manner which calms the mind, or simple visualizations.
For those who are Buddhists, meditation may evolve beyond that point to include specific practices and visualizations. This aspect of treatment may vary slightly with a diagnosis. For example, in the case of Lüng disorders, meditation may be directed toward understanding the impermanent nature of physical phenomena in order to address one’s materialism/ attachment. In the case of Tripa disorders, emphasis may be placed on generating a deep feeling of love and compassion as a remedy for aggression and anger. In Bädkën disorders, meditation will focus more on developing (spiritual) awareness as a cure for ignorance.
Physical activity, lifestyle, exercise and habits are also considered. For example, patients with Lüng disorders are told to pay special attention to regularity of lifestyle (eg. eating, sleeping and elimination), find time for calm activities and socializing, and exercise in ways that promote good overall circulation using techniques such as yoga. Individuals suffering from a Tripa disorder should avoid situations causing conflict. They should also avoid prolonged excessive exposure to the sun and hot environments, and engage in physical activities which are relaxing and calming in nature. Patients with Bädkën disorders should keep warm and may perform vigorous aerobic exercise such as walking, running or dancing. In the case disorder resulting from a combination of imbalances of the Three Principles of Function, behavioral modification is tailored to those forms of illness.
Tibetan medicine doctors must think analytically about diet and health relative to each individual patient’s lifestyle, environment and health condition. In recommending an appropriate diet, Tibetan medicine considers details such as which types of food are detrimental and which might be beneficial for a given condition, the amount of food to be eaten, the proper number of meals per day and meal times, the amount of cooked vs raw foods, etc. Food is analyzed based on their qualities and nature as defined by the Theory of the Five Elements. The characteristics and therefore the nature of all things – including their taste – result from the qualities of these elements individually or in combination. The arrangements of the five elements which occur during embryological development also form the Three Principles of Function (Lüng , Tripa , Bädkën). This is important because the taste of different foods, their other qualities, and their resulting effects on health are due to the arrangements of elements which make up a given food.
If the above approaches are not sufficient in relieving a patient’s condition, herbal medicines are prescribed. In Tibetan medicine, herbal treatments range from simple to very complex. They utilize from 3 to 150 herbs per formula. Each formula or set of formulas is prescribed to fit the current manifestation of the illness as well as the individual patient’s prognosis. As a result, herbal medicines often need to be modified at each visit with a Tibetan medicine doctor.
Typically, two to four formulas are prescribed, to be taken each day at specific times. Morning remedies commonly include those for Bädkën disorders or digestive disorders. Afternoon remedies are often used to treat Tripa disorders. Remedies given in the late afternoon or evening are can be given to treat Lüng disorders.
Ultimately, the organization of the prescription is based on both the doctor’s judgment and the patient’s lifestyle.
If the above treatments are not sufficient to cure the illness, physicians may employ therapies such as acupuncture, moxabustion (the heating of specific treatment points on the body), cupping, massage, inhalation therapy, and herbal bath therapies.
Despite even the best use of medical treatment we cannot attain good health simply by being physically healthy. We need to have a healthy mind as well.
Based on the centuries-old Buddhist study of the mind, Tibetan medicine gives priority to factors of psychological and spiritual development in its definition of health. It seeks to understand and explain the nature and reason for the suffering we experience in our lives.
Buddhist philosophy teaches acceptance of the ultimate impermanence of all physical phenomena and gives meaning to the cycle of birth, sickness, old age, and death that we all encounter. Common experiences such as not getting what we want, not wanting what we get, being separated from whomever or whatever is dear to us, and being joined with people and things we dislike becomes a basis of spiritual understanding and growth.
Tibetan medicine explains how hatred, anger and aggression, ignorance and incomprehension and a materialist view of the world result in states of mind which are at the root of our suffering, and how our habitual patterns of thinking and behaving are a primary cause of illness. Finally, it asserts that through study and spiritual practice understanding and awareness can gradually be achieved which allow us to transcend such suffering.
In Tibetan medicine we attempt to become aware of the process of our physiological, spiritual and psychological evolution as it originates from what we do what we say and what we think. Every action sows its seed in the mind and will eventually ripen in accordance with its nature. No experience is seen as causeless. The transient, ever-changing nature of all things is embraced. The conclusion which is reached from this view is the interdependent nature of all things. The highest value is placed on the attainment of compassion and what is termed loving kindness.