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The Tanaduk Clinic of Tibetan Medicine

The Tibetan Medical Model
of Diagnosis and Treatment

HISTORY ~ A Summary of the Evolution of Tibetan Medicine

By synthesizing knowledge from various medical systems, Tibetan medicine evolved and created an approach to medical science drawn from thousands of years of accumulated empirical knowledge and research into the nature of health and illness. Centuries ago, before Buddhism entered Tibet, Tibetans had a significant degree of medical knowledge. According to traditional sources, in the beginning of the 4th century many new ideas regarding medicine began to enter the country. At first influences came from India in the form of what is now called Ayurvedic medicine, as well as more spiritual and psychologically based systems from Buddhism and other sources.

It was between the 7th and 8th centuries that the Tibetan government began sponsoring conferences where doctors skilled in the medical systems of China, Persia, India and Greece presented and debated their ideas regarding health and the treatment of illness. Those with superior abilities in the diagnosis, treatment and understanding of illness were invited to stay and contribute to the country's medical knowledge base.

In the 11th century, this knowledge was codified into a unique system containing a synthesis of the principles of physical and psychological medicine imbued with a Buddhist spiritual understanding. This understanding formed a foundation for Tibetan medicine and benefited patients and doctors alike. It acknowledged how health and illness both resulted from the relationship between the mind and the body and one's connectedness to the natural world and a sense of spirituality.

The Tibetan Medical Diagnostic Model

The physician inquires into the patient's current medical condition as well as how the patient feels personally. It may be useful to investigate the patient's medical history, health relative to the seasons, dietary patterns, etc. In addition, there is engagement in a more detailed discussion of personal or spiritual issues. It is useful to ask female patients about their gynecological health and history and their experience with childbirth. Each of these items provides a quantity of health information as well as a basis in understanding the nature of the patient's condition in reference to the five elements and the three humours.

The patient's dietary history can be especially revealing for two reasons. First, behavior and diet are a primary determinant of health. Second, there is a great amount in the Tibetan medical literature about the meaning and significance of foods and the six tastes (salty, pungent, sour, bitter, astringent, sweet) with respect to the theory of the five basic elements. Understanding a person's dietary habits and reactions to different foods can reveal the basis of their condition as well as the circumstances leading to illness.

Once the full range of symptoms in the context of the patient's history is discovered, the root cause of the illness can begin to be understood. Within the one disease (defined by allopathic medicine) the Tibetan physician might in fact define ten different sets of symptoms, ten different etiologies, and therefore ten different illnesses. The root cause of the patient's entire complex of symptoms is ultimately diagnosed and treated.

The physician arrives at an individualized, complex diagnosis explaining the systemic imbalances that have manifested as illness. A three phase therapeutic approach is created to treat imbalances (and significant acute symptoms) in order to achieve a truly curative effect.

Diagnostic Methods

Interview

First, we speak to the patient and find out their medical history as well as pertinent aspects of their personal history, diet and lifestyle.

Urine

In the urinalysis we observe such things as the color of the specimen, its odor, and then (after vigorous stirring) the size, color, amount, and persistence of bubbles, viscosity and deposits. This information supports pulse and tongue information to confirm the nature of the illness, the presence of infection, and the localization of the illness.   

Pulse

Next we feel the twelve pulses. There are six distinct pulses at the radial artery of each wrist. We feel for such things as the width, depth, strength, speed and quality of the pulse. Each of those factors when understood properly allow us to clearly define the illness, its location, hidden complications and its etiology.    

Tongue

To further confirm the diagnosis we can look at the color, shape and coatings of the tongue, the sclera of the eye and we may look for sensitivity at certain pressure points on the body.

Treatment

Treatment is specific to each of the four diagnostic categories. The first consideration in treatment is the principle that all illness ultimately originates in the mind. This does not mean that all illness is psychological or psychosomatic. Rather, it means that due to ignorance we misperceive the nature of reality and may act in ways which create suffering, such as illness. Given this basic principle, when treating an illness physicians first begin by recommending specific behavioral and lifestyle modifications. If this is not sufficient, then physicians work at the level of dietary therapy. If these are not enough to cure the problem, herbal medicines are employed. Acupuncture may also be recommended.S

The treatment ultimately must fit the patient. What this means is:  treatment must be formulated in a manner which can and will be effective for that individual.

Behavioral Modification

Behavioral modification can include meditation instruction, spiritual advice, counseling, exercise, or the reorganization of habitual patterns such as sleep habits and eating schedules.

Initial stages of meditation generally include simple breathing practice and working with one's thoughts in a manner which calms the mind. Meditation then evolves beyond that point to include specific contemplations and visualizations which begin a process leading to a new understanding and perception of the world.   This aspect of the treatment may vary slightly with the diagnosis. For example, in the case of Lhüng disorders, meditation may be specifically directed toward understanding the impermanent nature of physical phenomena as a cure for materialism and attachment. In the case of Tippa disorders, emphasis may be placed on generating  a deep feeling of love and compassion as a cure for aggression and anger. In Bheygan disorders, meditation will focus more on developing wisdom as a cure for ignorance.

Physical activity, lifestyle, exercise and habits are also considered. For example, patients with Lhüng disorders are told to pay special attention to regularity of lifestyle, eg. eating, sleeping and excretory function. They are counseled to find time for calm activities, socializing, and exercising in ways that promote good overall circulation, using techniques such as yoga. Individuals suffering from a Tippa disorders should avoid situations causing conflict. They should avoid direct, excessive exposure to the sun and engage in physical activities which relax them. Patients with Bheygan disorders should keep warm and perform vigorous exercise such as running or dancing. Swimming is not appropriate if it involves immersion in cold water. Combined disorders are looked at as well.  

The Three Humours

As with any medical system, understanding the various functions of the body is important in Tibetan medicine. However, the underlying physiological principles that create and maintain those functions are of primary importance. Tibetan medicine defines three main systems which control all the body's functions. These three systems of the body (the three humours in Tibetan) are created at various stages of development in the womb by an interaction of the mind's developmental process and the five physical elements.

The first, Lhung (Wind), creates an enormous number of functions. The best example of these functions is circulation. Lhung gives rise to and regulates the movement of blood, nerve impulses, thoughts in the mind, and food through the digestive tract and eliminative organs. The mind expresses itself through attachment, desire, or a materialist world view.

The second, Tippa (Bile), gives rise to and controls such functions as metabolism, liver function, and vision, allowing one's mind to function with discriminating intellect. The mind expresses itself through aggression, hatred, or anger.

Finally, Bheygan (Phlegm), creates the physical principle by which energy can be used to produce a function. It provides the body's lubrication, breaks down food at the initial stages of digestion, creates the will, and facilitates memory. The mind expresses itself through ignorance or incomprehension.

A disturbance in one or a combination of these three principle systems results in illness. The disturbance can come from diet, behavior or environmental factors.These qualities (based on their constituent elements) act to disturb the qualities of any of the three energies. The manner in which these factors can result in illness will be more or less complex depending on the acute or chronic nature of the problem. All illnesses must be seen as individual and based on the situation of the particular patient's background.

The Humours and Their Dance With The Elements

All of the material which makes up our universe is based on the qualities of 5 basic elements. Like all traditional people, Tibetans lived in direct contact with the natural environment. They understood through experience and study that their natural environmental forces directly correlated with and influenced the functioning of the human organism. Tibetans define the qualities of the basic forces which exist in nature in the theory of the five elements.

These forces are named for their most identifiable manifestations: earth, water, fire, wind, and space. Their characteristics express the nature of all matter and are a result of these elements individually or in combination.

Earth has qualities of firmness and stability and therefore provides the basis of physical existence and development. Water creates moisture, giving rise to all fluids. Wind creates movement and so enables all aspects of circulation and movement. Fire creates transformation, metabolic functions, and activity. Space provides the potential for existence to be created in the first place. Combinations of these qualities make up the physical aspect of our bodies as well as the body's distinct physiological energies.

Diet

In recommending an appropriate diet, Tibetan physicians consider which types of food are harmful and which might be beneficial, the amount of food to be eaten, the number of meals per day and the proper meal times. Food is analyzed based on its qualities and nature as defined by a five element theory. Specific arrangements of the five elements, which occur during embryological development, form the three basic principles of physical function (Wind, Bile, Phlegm). This is important because the taste of different foods, their resulting natures, and therefore their effects on the human organism are also dictated by the specific arrangements of elements which make up the food. This principle enables practitioners to think intelligently about diet and health relative to each individual patient's lifestyle, environment and health condition.  

Herbal Medicines

In Tibetan medicine, herbal treatments range from simple to very complex, using a range of herbs; anywhere from 3 to 150 herbs per formula. Each formula or set of formulas is prescribed to fit the manifestation of the disease and the evolving condition of the individual patient. As a result, herbal medicines often need to be modified at each visit.

Typically, two to four formulas are prescribed, to be taken each day at specific times. Morning remedies commonly include those for Bheygan disorders. Afternoon remedies are typically used to treat Tippa disorders. Remedies given in the late afternoon or evening are usually given to treat Lhüng disorders. Ultimately, the organization of the prescription is based on both the doctor's judgment and the patient's lifestyle.

Physical Therapies

Physicians may also employ therapies such as acupuncture, moxabustion, cupping, massage, exercise, saunas, swimming, yoga and inhalation therapy.  

Spiritual Considerations

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 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.

It teaches acceptance of 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, become 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. Habitual patterns of thinking and behaving can be the primary cause of illness. Finally, it asserts that through study and spiritual practice an understanding and awareness can gradually be achieved which transcends this form of 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.

Tibetan Medicine as a Spiritual Science

Buddhist practitioners have been administering their religious healing practices of Tibetan medicine since the 4th century and it is regarded as the oldest holistic science of healing known. It is important to remember that Tibetan medicine is, at its core, a spiritual science. Therefore it should not be subject to AMA, state, or federal regulations. But rather it should be registered nationally as a spiritual, holistic science.

Conclusion

A clear understanding of and personal experience with the principles of health and illness are necessary to develop the capacity to make a discriminating diagnosis. When the doctor achieves this capacity, treatment will be appropriate to the condition. It will be based on the use of spiritual, behavioral, psychological, botanical and dietary approaches to affect the root cause of the condition. Then, if it is relevant to the individual case, precious herbal medicines and other physical treatments can be employed. This procedure allows the doctor and the patient to avoid over dependence on therapeutic techniques or devices.

Tibetan medicine reminds us what traditional people know. Illness needs to be understood on the basis of the inherent relationship between physical health, psychology, behavior, diet, environment, and our spiritual existence. 

A short Biography of Dr. Bradley Dobos, (Amchi Thubten Lekshe); Founder and Director of Tanaduk Institute

 

Interest in the areas of Sutra, Tantra, indigenous and alternative healing practices and botanical medicine led Dobos to an audience with His Holiness the Dalai Lama in 1972.  It was arranged for him to begin a four year study of Tibetan medicine and a twelve year internship with many great teachers of Tibetan tantra, philosophy and medicine. These include:  His Holiness the Dalai Lama, Dr. Amala Lobsang Dolma, Dr.Yeshe Donden, the great elder Dr. Tenzing Choedrak, Venerable Geshe Rapten. His Holiness Zong Rinpoche, Venerable Thubten Yeshe, Venerable Thubten Zopa Rinpoche, His Holiness Chagdud Tulku Rinpoche, Venerable Kalu Rinpoche, and His Holiness Dudjom Rinpoche. Over the past 33 years, Dobos has received further teachings, instruction and initiations with many other kind and compassionate wisdom holders in the Tibetan tradition.

Bradley Dobos is known among his peers and in the Tibetan world community as Amchi (Doctor) Thubten Lekshe. In 1976, Amchi Thubten Lekshe began his trials and clinical research of Tibetan formulation in the West at Tenzing Momo Clinic of Tibetan Medicine in Seattle, Washington, U.S.A. Working side by side with visiting elder Tibetan physicians for over thirty years and administering Tibetan healing methods and practices to over 25,000 patients, Amchi Thubten Lekshe was able to refine and perfect Tibetan formulations for use with Western patients and for use in Western countries. He uses a full range of traditional treatment modalities beginning with educating his patients regarding the nature of their condition. He then employs counseling, behavior and lifestyle modification, spiritual practices, dietary therapy, herbal remedies, acupressure massage, cupping and moxabustion.

Amchi Thubten Lekshe created the Tanaduk Botanical Research Institute of Tibetan Medicine ~ The Tibetan Medical Research Clinic and The Tibetan Medicinal Plant Cultivation Program to further preserve the integrity of Tibetan medicine through research and education. He has worked as the clinical director and liaison between Western scientists and physicians assessing the efficacy of Tibetan Medicine in a variety of treatments for over twenty five years. He volunteered his services for nine years as the clinical director of botanical medicine at The Savatthi Ayurvedic Hospital in Washington.

DEDICATION

I offer this jewel understanding of Tibetan Medicine in the tradition of all those great physicians who have come before me.  May whoever sees, reads, remembers, talks or thinks about these teachings never be reborn in unfortunate circumstances. May they receive only rebirths in situations conducive to the perfect practice of Dharma, meet only perfectly qualified spiritual guides, quickly develop bodhicitta and immediately attain enlightenment for the sake of all sentient beings.  ~Amchi Thubten Lekshe

ACKNOWLEDGMENTS

I am indebted to my teachers for their shower of blessings and rare, priceless Jewels of shared Wisdom. Their kindness and patience are immeasurable. ~Amchi Thubten Lekshe

RESOURCES  ~ The Northwest Territories: The Tanaduk Botanical Research Institute of Tibetan Medicine, Home of The Medicine Buddha ~ Menla's Healing Botanical Medicines and The Teachings of The Four Medical Tantras.

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