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Home > Historical, Cultural, and Comparative Studies > Tibetan Astrology and Medicine > Introduction to Tibetan Medicine

Introduction to Tibetan Medicine

Alexander Berzin
Mexico City, Mexico, August 30, 1993
Lightly edited course transcript

Introduction and History

I must mention before we begin that I am not a doctor, so please don't ask me about your various sicknesses. I have studied a little bit about Tibetan medicine and have taken Tibetan medicine for years, so I can only explain something about the theory.

Tibetan medicine has a long history. There was a native tradition of medicine in Tibet. With the formation of the Tibetan empire in the seventh century of the modern era, the emperors invited doctors from India and China, as well as from the Persian and Roman areas of Central Asia. Later, toward the end of the eighth century, they invited more doctors from these regions. Also at that time, the Buddha's teachings on medicine were brought from India to Tibet. This coincided with the arrival of Padmasambhava and the Nyingma teachings.

At that time, there was a big debate about what sort of Buddhism and what sort of medicine would be adopted for Tibet. The Indian Buddhist systems won on both counts for reasons that we won't go into. There was a great Tibetan physician at that time who combined a few aspects of Chinese and Greek medicine, which had been in Central Asia, into the basic Indian Buddhist teachings on medicine. Just as many Buddhist texts were hidden at that time due of difficulties, so were these medical texts. They were rediscovered in the twelfth century and were slightly reworked and modernized. It is from this revision that the present Tibetan medical system derives.

Tibetan medicine spread from Tibet to Mongolia, northern China, Siberia and many areas of Central Asia, going all the way over to the Caspian Sea. Tibetan medicine, as well as many other aspects of Tibetan culture, formed what would be analogous to Latin culture in Medieval Europe. Its influence spread all the way from the Caspian Sea to the Pacific, and from Siberia to the Himalayas. It was a major civilization. Let's look at the Tibetan medical system itself.

Classifications of Sicknesses

We find that diseases are classified into three groups. The first is thoroughly established diseases. Examples include genetic disorders, birth defects and so on. Diseases and defects that are thoroughly established come from past lives. They are very difficult to treat from the point of view of Tibetan medicine. One can only try to make the person comfortable. For example, if we have had a disease like asthma since we were babies, it will be very difficult to cure.

The second class is sicknesses that arise from other conditions. This includes imbalances in the body that develop due to various circumstances: the environment, pollution, germs and various conditions. They are the usual type of sicknesses and so this is the primary focus of Tibetan medicine. An example would be asthma that comes later in life due to living in a polluted city and experiencing a lot of stress.

The third category is literally called imaginary diseases. This refers to psychosomatic illnesses and to sicknesses that Tibetans generally view as having been caused by harmful forces. This category includes shellshock and nervous breakdowns that occur during a war. These diseases are primarily treated with various rituals. That might seem a bit preposterous to us, but if we look at an example from Africa, perhaps we can understand it. If someone is very sick, his or her attitude very much affects the immune system. This has been described and researched by modern medicine. If one's entire community is staying up all night, dancing and doing rituals, it gives one a feeling that everyone is really supporting them and it very much improves one's spirits, which can in turn affect the immune system. The same could occur when we have a group of monks and or nuns doing a ritual for us. It strengthens the immune system so that one can get better more quickly.

Sicknesses that Arise from Other Conditions: The Five Elements and Three Humors

Let us look at the second class of sicknesses. First, we will look at the nature of diseases. The body is examined in terms of a balance of either five elements or of three humors. The five elements are earth, water, fire, wind, and space. These are not abstract, weird things, unrelated to the body. Earth refers to the solid aspect of the body, water is the liquid, fire is the heat (including digestive heat and acidity), and wind refers not only to the gases within the body but also to the energy in the body, which includes the electrical energy of the nervous system. Space refers to the spatial aspects within the body – the position of the various organs, and the various hollow organs like the stomach and so on. Sicknesses are seen as being imbalances of these. There is something wrong with the system of these five elements.

Tibetan medicine's viewing disease in terms of an imbalance of the three humors is taken from the Greeks, but the actual word in both Sanskrit and Tibetan is literally "things that can go wrong." The humors are three systems in the body, each having five parts. It is not obvious to me why five constituents are lumped together as one system. The three major systems are called wind, bile and phlegm. Let's look at what is involved with these systems.

Wind refers primarily to the wind in the body. There are winds that deal with the upper part of the body: the energy coming in and out of the upper part of the body as when we are swallowing, talking and so on. And winds that deal with the lower part of the body: the energy coming in and out of the lower part of the body, such as with holding in or releasing excretion, menstruation, and orgasm. One aspect of the energy deals with the circulation in the body and the blood pressure. We also have actual physical energy related to motion, and various types of energy associated with the heart.

Bile deals with certain aspects of digestion, like bile from the liver. It deals with different aspects of pigmentation, as when we get sunburned, with the hemoglobin, the red blood cells, and with things related to the eyes.

Phlegm deals with the mucus systems and the lymph systems in the body. It relates to colds, sinus problems and these types of things, as well as the liquid aspect for the movement of the joints – I am not sure of the technical Western medical term here. I think it's called synovial fluid. For instance, rheumatism and arthritis are phlegm disorders. Digestion is a complex process in which certain aspects of wind, bile and phlegm are associated with different stages. These are all very complex systems. As I say, it is not so easy to see how the five categories of each of the three humors fit together in one humor.

Sicknesses are seen as imbalances of these three humors, which could mean either that one of them is too strong or one of them is too weak. There can be simple disorders and there can be disorders of several of systems at once. Tibetan medicine is a holistic system, treating the entire body, since all the systems of the body are interrelated.

There are various ways of classifying sicknesses. Sometimes blood is taken as a fourth system, which includes muscles in the body. Within that division, we can divide the systems of bile, blood and heat disorders as one category and wind, phlegm and cold disorders as another. Tibetans often analyze sicknesses in terms of their being hot or cold sicknesses, but I am not quite sure what exactly is meant by hot or cold. It is certainly not related to temperature.

The Causes of Sickness

In general, sicknesses could be due to diet: eating food that disagrees with us or is too greasy. They could be due to problems with our behavior, like going out in the cold without sufficient clothing. Sitting out on the cold ground or on a cold wet rock is a sure cause for kidney problems. Sicknesses may be caused by small organisms, germs or microbes. This is similar to what Western medicine says. However, what Tibetan medicine says beyond this is that we can look at a deeper level of the causes of sicknesses. I think that probably the most interesting and useful way of looking at Tibetan medicine in terms of our ways of thinking is the whole idea that the basic underlying cause of physical imbalance is emotional and mental imbalance.

If we want to overcome disease completely we have to become balanced on all levels, particularly on the emotional/mental level. There are three primary disturbing emotions or attitudes. The first is longing desire and attachment. It is the neurotic desire that feels I've got to get this and if I don't get it I'll go crazy. The second is anger. Third is naive closed-mindedness and stubbornness. These are correlated to the disorders of the three humors. From desire comes wind disorders; from anger, bile disorders; from closed-mindedness, phlegm disorders. This is very interesting. Let us look at it a little closer.

Wind disorders are very often characterized by becoming very nervous. They are related to high blood pressure. We also get a very tight feeling in the chest. We get what we describe as a broken heart; we feel terribly depressed. These are very common wind disorders associated with longing desire. For instance, if we are very attached to making a lot of money, we work and work, we get high blood pressure and we are nervous all the time. If we are very attached to someone and they die or leave us, we get the whole broken heart syndrome. People who meditate incorrectly and push themselves too hard also develop wind disorders. When we push ourselves too hard in anything, it squeezes the energies in the body and that causes the uptightness in the chest, nervousness, paranoia and so on. Nervous bowels or a nervous stomach are also a wind disorder. The underlying psychological cause for these problems is too much attachment or desire.

Bile disorders come from anger. An ulcer, where there is too much bile in the stomach, is associated with being very angry. When we get angry we turn red. The bile affects the pigmentation. We turn yellow with jaundice and red with anger. There are also bile headaches, which often come with anger: the eyes burn, the head burns.

Phlegm is related to being naive and closed-minded. We hold onto ideas very stubbornly and don't want to listen to anybody else. Or our hearts are closed to certain people because we don't want to deal with them. Just as our mind and heart are closed, our sinuses close and we have sinus problems or we get problems with our chest, like pneumonia, or asthma, or the body becomes closed and stiff with arthritis or rheumatism. The body reflects the mind's inflexibility.

Although it may not be totally accurate, we can play with this type of thinking in terms of other diseases as well. Often with cancer, we find that people have very self-destructive attitudes. After my aunt died, my uncle had no desire to continue living. His lifestyle started to become self-destructive and quite quickly he developed cancer in which the body destroyed itself. He died within a year. One can think that the state of mind is reflected by the self-destruction of cancer. This is obviously not true with every case of cancer but it gives us something interesting to think about.

With AIDS, the body does not have any ability to fight things off. Some people with AIDS were not able to fight off addictions to drugs or to promiscuous sex. Just as they can't control themselves against their desires, the body can't defend itself from anything. This is the aspect of Tibetan medicine that I find most stimulating – aside from the practical use of the medicine.

Diagnosis of Sicknesses

Let us go on with the actual medical system. To diagnose sicknesses, we have questioning, visual examination and examination of the pulse. Tibetans don't put very much emphasis on asking what is wrong. More emphasis is on the second two. The visual examination includes the tongue, but the main thing is the visual examination of the urine. The doctor looks at the first urine of the morning. This is taken to the doctor in a clear or a white container and then he or she whips it with a stick. The doctor looks for many variables. First, they look at the color. Then they look at what type of bubbles form when it is whisked, how large they are, and how long do they last. When they disperse, how do they disperse, and is there a certain oiliness there? Is the urine thin or thick? Are there any precipitants? They also examine the odor. If they get it immediately in the morning, they can also observe how its color changes as it cools down. With all these variables, one can make a very precise diagnosis of the sickness.

Examining the urine is actually a very excellent system for diagnosis because, as when examining the pulse, the doctor has to take into consideration the age of the person, their sex, and the time of year. When they examine the urine, they also take into consideration how old it is. This allows the doctor to examine urine that is a week or two old. That was helpful in Tibet where a family member might have had to carry a urine sample by yak for a week or two to get to a doctor. In modern times, we might have to send it by airmail to India.

The pulse is also examined. This is also very sophisticated. The doctor usually examines the pulse on the wrist, a little above the thumb, using three fingers. With each finger, he or she presses down with a different amount of force. The index finger feels just the surface pulse. The middle finger presses down a little bit more and then the ring finger presses down as deeply as is possible. Each finger rolls slightly from one side and to the other. This is done on both wrists. In this way, each side of the finger reads the diagnosis for a different organ in the body.

The rate of pulse is measured by comparing it to the breath of the doctor. There were no wristwatches in ancient Tibet, so a doctor would count the number of pulses to, say, ten of his breaths. In addition, one examines what happens to the pulse when one presses down. Does it disappear? Does it bounce back strongly? One looks at the way the pulse travels in the artery by feeling how it flows past the three fingers. The "shape" of the pulse is noted. Is it rolling? Does it come in sharp peaks? Does it twist from side to side? There are many possibilities. This obviously requires that the doctor have very sensitive fingers. While there are pulse examinations in the Indian Ayurvedic system, which is of Hindu origin, as well as in Chinese medicine, it is done differently in each system. Urine examination seems to be unique to the Tibetan system.

Treatment

By examining these various things, the doctor can arrive at a diagnosis. Then we need treatment. Treatment involves regulating the diet, regulating the behavior and taking medicine, but there are other ways of treating various conditions, including acupuncture and moxabustion, which is burning parts of the body.

Diet

If we have a wind disorder, then certain foods will be very harmful. For instance caffeine, as in coffee, will aggravate a wind disorder. We are very nervous and our blood pressure is high. Lentils, like beans, produce wind – passing gas is an indication of this. For bile disorders, eggs and greasy or fried foods are very bad. For phlegm disorders, we avoid dairy products and rice, since they produce a lot of mucus. We note this in the West as well. Other types of food might be very helpful for these disorders. For instance, drinking hot water is very good for phlegm because it washes out the mucus.

Behavior Modification

As for modifying the behavior, if we have a wind disorder it is important to keep warm and to be with affectionate friends. Laughter is a great thing for wind disorders. If we are very upset and nervous, laughter releases it. Looking out at a long distance vista is very helpful. Also, we can avoid things like standing in front of a fan or outside in a strong wind. Often people find very high-powered machines that make noise, like power lawnmowers or air conditioners, will make them even more nervous. For bile disorders, it is very helpful to keep cool and stay out of the sun. For phlegm, exercise and keeping warm are very good. That will put more flexibility in the joints and help with clearing out the mucus.

Medicines

The taking of medicines is the primary treatment in Tibetan medicine. The medicine is made primarily of herbs. It also includes various mineral substances and so on. Each medicine can have fifty or more ingredients mixed together. Usually they are mixed and pulverized into a pill form. These pills are to be chewed and taken with hot water. If we don't chew them and just swallow them, they will probably just go right through us without dissolving. They are very hard. Tibetans have very strong teeth. If we find them difficult to chew, we can always wrap them in something like a handkerchief and smash them with a hammer.

The medicines are taken either a half-hour before or a half-hour after a meal. Occasionally, a fourth pill will be prescribed for around four in the afternoon, since lunchtime for Tibetans means noon. Here in Mexico and other Latin countries, if you have been prescribed four different medicines, you need to take the one that says lunch at noon and the one that says four o'clock after your afternoon meal.

One of the great advantages of Tibetan medicine is that in almost all instances – although there are exceptions – there are no side effects. However, it is a little bit like homeopathic medicine, not in the sense of being micro-doses but in the sense that the medicine will first gather the sickness together so that it is concentrated. Then, it will destroy it. Because of this, in many cases, though not always, the sickness gets a little bit worse at first. That is simply a sign that the medicine is drawing the sickness together so it can get rid of it. One has to be patient and pass through the initial stage.

In taking the medicine, it is important to chew it not only so that we can digest it properly, but also so that we can taste it. The taste is usually quite horrible. They can have tastes that one never imagined existed. The taste is important because it will stimulate various secretions in the mouth and in the digestive tract. Part of how the medicine works is through stimulating the body to give off various enzymes and so on. One has to have some patience with the taste of the medicine.

It is quite interesting that the foods and various ingredients of Tibetan medicine are classified according to taste, not the Chinese classification of the five elements or yin and yang, nor the Ayurvedic classification of the three qualities of rajas, sattva and tamas. Tibetan doctors classify them according to primary tastes and aftertastes. Certain tastes are appropriate for different types of disorders.

There is also a system of about eighteen qualities of foods as well as of herbs. What is interesting here is that where the food or herbs grow will affect their quality. Something that grows in a windy place will take on a certain quality different from something that grows in a dry place. It becomes quite a problem in terms of growing medicinal plants, because they have to grow in their natural habitat.

Massage and Acupuncture

In Tibetan medicine, there is not too much emphasis on massage. There is a little bit of rubbing on of medicinal oils for certain sicknesses, but it is rubbed on without doing a manipulative type of massage. Tibetan medicine does not manipulate the aura as the Japanese Reiki system does. There is a form of acupuncture, which is different from Chinese acupuncture. The points are different and the descriptions of the channels in which the energies move through the body are different. The types of needles used are also different. Tibetans use needles of various substances. The gold needle is one of the most common. It is put into the soft part of the top of the head to stimulate various nerves. This is used for things like epilepsy.

Burning

Moxa is the application of heat or burning on different parts of the body. These are done on the same points at which you would do acupuncture. In high altitude, cold places, moxa is more effective; in hotter, lower altitude places, the needles are more effective on the same points. For specific diseases, however, moxabustion is recommended.

The theory of this is that there is a blockage of the flow of the energy through the main channels and so, by either burning or stimulating these points with needles, the blockage is removed. The burning can be done with various degrees of heat. The mildest form is with a certain type of stone, which is mounted in a wooden handle. It is a white stone with black stripes called a zi stone, a very special stone found in Tibet. It is heated by friction on a wooden board and then applied on specific points of the body. This is very effective. I have had it done to myself probably a hundred times for several disorders. Let me describe it to you.

I had the early signs of arthritic rheumatism, and so I was getting painful lumps in the shoulders and hips. The doctor gave me medicine that drew what Tibetans call "lymph" into these painful points and then he burned them. He did this over a course of three or four years. The burn is not that bad, it is about like a cigarette burn and does not hurt that much, although it looks very medieval. I don't know how you would describe it from a Western medical point of view but my own interpretation of what was going on was that there was some sort of swelling within the lymph nodes on the joints or perhaps it was a problem with the synovial fluid around the joints. In any case, when the doctor burned on those points, the liquid that was inside causing the painful pressure went into forming a blister, because the pain was immediately finished when he burned. Another way I looked at it was that if the body is burnt at certain points it sends an alarm; an enormous amount of white blood cells come to that place and they will then help to heal whatever disorder is occurring at that place besides the burn. I found this treatment very helpful and I was cured.

I had another sickness. Sometimes when you do a lot of walking up and down in the mountains, a tendon starts to rub against the bone on the knee. It is quite painful. I went to a Western doctor who said, "Just wear an elastic bandage around it whenever you walk." Thank you very much. I had Chinese acupuncture done and it did not help at all. Finally, I got back to India and saw my Tibetan doctor. He did a burning right on the knee and another place on the upper part of the leg and I was completely cured. So, from my personal experience, I have found moxa burning to be a very effective type of treatment.

A more forceful type of burning is done with an iron or silver poker made red-hot in coals. I have seen this method used for problems with the spine where there is something wrong with a disc or the spine is somehow out of alignment. They burn on specific spots next to the spine and that causes such an incredible shock to the body that the body automatically corrects itself. Again, it looks very medieval, but it works.

The even more severe type of burning is burning a little cone of a certain type of paste. It burns slowly. That type of burning is used for very severe arthritis and rheumatism when you cannot move your joints.

Other Types of Treatment

There are some types of ointments, made of oil or butter mixed with various herbs used for skin disorders. There are even herbal enemas, which are helpful for disorders of the lower bowels. There are also certain types of powders that are inhaled like snuff for sinus problems. Also, the Tibetans very much make use of hot mineral springs.

Training

The Tibetan medicine system requires a very long period of training. Doctors usually train for seven years and they learn not only how to heal people, but also to treat animals; and not only medicine, but pharmacology as well. They learn to identify the medicinal plants, how to gather them and how to make the medicines.

Astrology

The Tibetan system also involves some study of astrology. In Tibetan astrology, one aspect is the animal of the year one was born in. For each animal, specific days of the week are life supporting or deadly. If the doctors are going to do some sort of strong manipulation like a burning, then if there is time, they will consult astrology to determine the most appropriate day of the week. That is not always possible, as when there is an emergency or there is not enough time.

Surgery

Tibetan medicine in ancient times did have a form of surgery. We have pictures in the texts of the surgical instruments. But once a doctor performed heart surgery on a queen and it was unsuccessful. After that, operations and surgery were forbidden. Tibetan medicine can treat many things with herbs that would require an operation in the West, like appendicitis. If we were in a car accident Tibetan medicine can help with setting bones, there is very good medicine for shock and for speeding up the mending process, but if we really need some sort of operation we are better off going to Western doctors.

The point is that we should not place all of our hopes on just one medical system. Various medical systems from around the world are useful for specific types of things. There are certain things that Tibetan medicine has never been able to treat, like smallpox or tuberculosis. But it has excellent cures other things which we don't have treatments for in the West, like arthritis and hepatitis. Certain – not all – types of cancer respond quite well to Tibetan medicine. Even if it does not cure the cancer, it can make reduce pain and improve the quality of a dying person's life.

Modern Adaptations

It is also quite interesting that the ancient texts predicted the development of new diseases in the future. Now we have things like AIDS and pollution-related diseases. The formulas for making these medicines are in the texts, but are a bit obscure. Dr. Tenzin Choedak, in addition to being the senior doctor to His Holiness the Dalai Lama, was the one who was able to decode these formulas and make new medicines.

A lot of these medicines are made from detoxified mercury. It is cooked with other ingredients for several months at a time in a very slow detoxification process. This type of medicine has been very helpful for pollution-related diseases – and an awful lot of our modern diseases are related to pollution. This type of medicine was quite successful in treating the people who were contaminated by the Bhopal chemical disaster in India. I had the honor to travel with Dr. Tenzin Choedak in Russia a few years ago in which he was testing this medicine for radiation victims from Chernobyl at the invitation of the Russian Ministry of Health. The initial results were very encouraging. So, although the Tibetan medical system is old and complex, it can adapt to modern diseases as well and can be very useful for many types of disorders.

A Realistic Attitude toward Treatment

We should not expect miracles from taking Tibetan medicine. We also have to take karma into consideration. We can have two people with the exact same sickness taking the exact same medicine and it will work with one and not with the other. There are many factors involved. One is the karmic connection from past lives with a particular type of medical treatment and a particular doctor. If one has not built up the karmic forces to be cured of a sickness, it does not matter what type of medicine or what type of doctor we have, nothing is going to help. We have to be realistic when we approach any medical system, including the Tibetan. We also need to try to have a positive attitude, since that certainly affects the immune system. But, we must not expect miracles and then sue the doctor if the medicine does not work as we wished.

Questions and Answers

Question: Can you speak a little bit about healing rituals?

Answer: The discussion of healing rituals is similar to what we discussed with respect to karma. Imaginary or psychosomatic diseases, which are caused by harmful forces, are usually treated with rituals and prayers. Often Tibetans will have pujas or prayers done as a supplement to medical treatment. One does not just have the puja done without taking medicine. To do so would be like the following joke.

A man was praying to God to help him. God finally said, "What do you want?" The man said, "I would like to win the lottery." "Okay." So the man waited and waited and nothing happened. Then the fellow started praying again: "God, why have you abandoned me?" God answered, "Idiot, buy a lottery ticket!"

The rituals are not going to be effective until we buy the lottery ticket, until we take the medicine. Then they can be of some help, but they are not going to bring about miracles. They will only help if we have the karmic potential to be helped by this type of ritual. One needs to approach these rituals in a realistic fashion. They can help boost our confidence but they are really only to be done as a supplement to medical treatment. They are not magical or miraculous.

Question: Can you talk a little bit about medicines made with precious gems?

Answer: Tibetan medicine has what are called "precious pills," which are usually made with detoxified mercury and some precious gems and metals. I know that they use diamond dust, gold and silver. Certain minerals are used, though I do not know the specifics. These precious pills are used for detoxification and so on. They usually come wrapped in colored silk with a wax seal because they are light sensitive. We need to try to not expose them to light. Sometimes, we have to soak them in water, so we get a porcelain cup and put a top on it. Or we just cut the silk off and pop it into our mouth right away.

Question: When you were being cured of wind disorders, did the doctors tell you to bathe in hot or cold water?

Answer: No, they did not say anything specific about bathing. Some wind disorders are classified as hot and some as cold. For some, keeping warm is helpful, so a hot bath may be helpful, but not a sauna. We can see that if we go to a sauna, for instance, it is not very good for wind and increases the blood pressure. Heat is quite harmful for bile disorders. For phlegm disorders it is very helpful to sweat because it gets the excess phlegm out, so a sauna would be very good for that.

Question: Is it possible to detect sicknesses that have not yet been manifest as symptoms?

Answer: Tibetans certainly can treat diseases that are just in a potential form. I am taking Tibetan medicine now for that reason for my eyes, which are getting weaker. I am noticing that I have not had any trouble with my eyes. But that type of treatment is usually long-term.

Question: If we do not have the opportunity to see a Tibetan doctor, what is available in our culture that is most similar, especially if we are taking Tibetan medicine and it runs out?

Answer: It is hard to say which system in the West is most similar. Outside of Western treatments, however, probably either Chinese or Ayurvedic medicine is the closest. Sometimes in the Tibetan tradition, we are given a powder that is made into a type of tea, but it is not like the teas in the Chinese system. In the Chinese system, they do not mix the ingredients; they just give four or five loose ingredients and then we have to make the tea ourselves. In modern times, the Chinese have made pills, but traditionally they did not.

If we find that the Tibetan medicine is effective, we can get more. If we have a prescription, we can send a photocopy and a urine sample of the first urine of the day in a little unbreakable plastic bottle. For customs officials we can just write "urine sample."

Question: What sanitary measures are taken in the fabrication of these medicines?

Answer: The medicinal plants are washed and dried in the sun, but I don't think they would stand up to Western standards of sanitation. However, I have not heard of anyone getting stomach problems from them. I only know of one example of an old man in the West with advanced cancer who got diarrhea from the medicine.

Question: Wouldn't the urine be contaminated in the little plastic bottle?

Answer: Well, hopefully we would wash out the shampoo first! Plastic does not react very much to urine.

Question: Can one combine treatment by Tibetan medicine with Western medicine?

Answer: That is done sometimes. It is recommended that we do not take the medicines at the same time, but that there be a couple of hours between them. Sometimes strong vitamin pills color our urine, so it is best not to take vitamins the day before we see a Tibetan doctor, particularly vitamin B.

Question: If the patient that is not curable, does the Tibetan doctor ever perform euthanasia?

Answer: No, they don't. They try to minimize the pain and make the patient as comfortable as possible. The Buddhist attitude is to let the karma finish itself out naturally. And, of course, they did not have machines that would artificially extend life.

Question: For example, dogs are often put to sleep in the West. Would they do that?

Answer: From a Buddhist point of view, that is not advisable. Of course, it depends on the situation. We have to judge in each case. His Holiness the Dalai Lama has said the same. If we are in a situation where there are limited medicines and we have a choice of spending an enormous amount of resources to artificially prolong the life of someone who is going to die anyway, and there are others with the possibility of recovering who could benefit from those resources, then one has to make tough choices.

Question: Is there a time limit associated with the treatment of different diseases?

Answer: I don't know. Tibetans will often ask a lama for a divination either before they start treatment or if a treatment has been ineffective. The lama will then recommend that a certain ritual or puja be done to supplement the treatment. In India, they will often ask which medical system they should use, Western or Tibetan, and within the Tibetan system, which doctor would be best to consult. Certain people might have more of a karmic connection with one doctor than another, or one doctor might be better than another for a certain type of disease.

In the West, it is difficult to have that type of prognostication. Tibetan medicine does not give instant cures for most things. If we have an asthma attack, Tibetan medicine will not automatically open up our lungs like a spray. But once I had hepatitis in India and after a day and half of Tibetan medicine, I could get up out of bed, which would have been impossible in the West.

Question: Is there a mixture of Tibetan medicine and the shamanism of the Bon religion?

Answer: The whole system of prognostication to see what ritual would be appropriate or inappropriate and what spirits might be involved is the aspect that comes from Bon. Astrology was in the Bon system as well.

Question: How does Tibetan medicine deal with teeth?

Answer: As I said in the beginning, I am not a doctor so I cannot answer specific technical questions. I am sorry. I do know, however, that dental problems are usually looked at as being caused by microbes, which is how we would look at cavities as well. They don't have a sophisticated system of dentistry. I have never seen them do any sort of dental work. There is "removing the worm from the tooth," which I think means pulling out the nerve. Besides just pulling out a rotten tooth, I do not think dentistry is emphasized. As a race, Tibetans have remarkably excellent teeth. I think that could be attributed to dairy products being a primary element of their diets for so many generations.

Question: Dr. Choedak has said that certain sicknesses were caused by spirits. Could you talk more about that?

Answer: That is what I was referring to as the class of imaginary sicknesses. I think a lot of our understanding depends on how we understand spirits, whether that means a ghost wearing a white sheet and saying boo or whether we take it a little more metaphorically, as in the harmful forces of a war freaking somebody out. The circumstantial causes of a nervous breakdown or environmental factors could be looked at as harmful spirits. Often Tibetans speak of diseases caused by nagas. Nagas are a type of spirit associated with lakes, trees, and forests and when we pollute their territory, they cause problems. That is a way of viewing diseases that come from ecological devastation.

Question: How about diseases that are caused by black magic or witchcraft?

Answer: There are rituals that Tibetans use for overcoming such things. Tibetans take all of that very seriously. They would be in the category of the imaginary diseases. "Imaginary" is not the best way of translating the word but that is literally what it means.

Question: Are there specific meditations one can do for specific types of sicknesses?

Answer: I don't know of meditations for a cold as opposed to meditations for an upset stomach, but there are certainly healing meditations that can be used for any type of disease. They are usually done with visualizations of specific Buddha-figures like Tara, Medicine Buddha, or Amitayus. They are usually done in terms of the five elements that we discussed in the beginning, so they involve imagining each of the elements being healed in turn. We can also imagine that another person who is sick is in our hearts and we do the same type of healing visualizations. Then there is the healing meditation called "giving and taking" which, again, is done with the imagination. In Tibetan medicine or meditation, there is nothing like the laying on of hands. We become an absolute fool if it doesn't work – and in many cases it is not going to work, so it is dangerous to pretend that we can do it. Visualizations of taking on other people's sicknesses and giving them good health are common.

There are, of course, non-Tibetan systems, such as Reiki and so on, that involve curing with the hands. From the Tibetan Buddhist point of view, these types of healings are not accomplished simply by a physical manipulation, like a physical laying on of hands, but through a mental action of healing.

No matter what system we use, there will be cases where it does not work. It depends on how we present it. If we present something as a method that will work and it does not, we become fools. In any medical system, it is best to say that it may work; we will try it and see.

Question: Are exorcisms a part of Tibetan medicine?

Answer: Not in Tibetan medicine itself, but in the rituals that can be done to supplement the treatment.

Dedication

Let us end then with a dedication. May whatever positive energy or potential has been built up by this contribute to being able to overcome our sicknesses, shortcomings and problems. May everybody be able to realize good health and realize all of their positive potentials in order to be of best help to everyone else.