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.

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