We are limited in the pursuit of both our physical and mental health, and the health of our communities and planet, by our science that teaches us to see everything from a mechanistic viewpoint. We are taught to think of our bodies as likened to a machine, our mind to a computer, and of ourselves as individuals divided from one another. The 'ecological' science of Tibetan medicine provides an alternative view. It describes the macrocosm of the world we live in and the microcosm of our body and mind and gives us a means to understand how they are directly interrelated. Tibetan medicine teaches that any case of illness needs to be understood through an appreciation of the inherent relationship between an individual's physical health, and factors of psychology, behaviour, diet, environment and our spiritual existence. It then provides the set of diagnostic tools a doctor needs to find the causes of the imbalance resulting in illness.

Tibetan medicine is a rich repository of knowledge drawing direct influences from the major medical systems of the ancient world. According to traditional sources, proceeding from the 4th century the Tibetans synthesised the medical knowledge of the pre-Buddhist Tibetan shamanistic religion Boen with the medical practices of India, China, Persia, and Greece. By the 11th century Tibetan medicine was codified and began its own evolution as a unique system of medicine. Fortunately, the relative geopolitical isolation of Tibet until the late 1950's allowed this knowledge to grow with an unbroken lineage of doctors.

As with most aspects of Tibetan culture, Tibetan medicine is rooted in the Buddhist understanding of the mind and the processes of life. The Buddhist teaching that existence is inherently fraught with suffering and frustrations is the primary consideration. That the cessation of suffering comes from spiritual development is the ultimate consideration. Tibetan medicine functions between these two. It describes the exact process of how we come to be born in this life, and the specific stages of physical, cognitive and psychological development beginning in the womb. Once born, we are prone to the ignorant viewpoint that who we are essentially is that mortal physical being driven by the information we gain from our senses. This misunderstanding of the nature of reality is what Tibetan medicine views as the ultimate cause of all illness.

From our conception we are defined by the physical laws of nature. In the ancient physics depicted in Tibetan medicine all matter is made up of 5 basic elements termed earth, water, fire, wind and space. The characteristics and therefore the nature of all matter then result from the qualities of these elements. During the aforementioned stages of development in the womb the aspect of mind interacting with the five physical elements gives rise to the three principle systems which control all functions of our body.

The mind expressed as attachment, desire or a materialist view is manifested as the system termed Wind which is most related to functions such as circulation. That is, circulation of our blood, of the nervous system's impulses, of thoughts in our minds and of food through our digestive tract and eliminative organs. The mind expressed as aggression, hatred, anger or the like is manifested as the system termed Bile which controls such functions as metabolism, Liver function and vision. The mind as expressed as ignorance or incomprehension is manifested as the system termed Phlegm which creates the basis whereby energy can create function, provides our body's lubrication and creates the will among many others.

A disturbance in one or more of these three principle energies result in a systemic change in our bodily functions and if untreated can lead to illness. The sources of illness are karma and/or our life experiences. Examples of karmic illness can be seen in genetic illness, illness due to a persons innate characteristics or any other such untreatable conditions. Illnesses due to our life experiences make up the vast majority of illnesses and may result from disturbing influences such as climate, behaviour, diet and/or spiritual and environmental factors.

To put theory into practice we have specific diagnostic tools. A doctor first speaks to the patient and find out their medical history as well as pertinent aspects of their personal history. We then look at a urine sample observing the colour and the odour, the size, colour, amount, and persistence of bubbles, and any deposits. From this information we can begin to confirm the nature of the illness, the presence of infection, the localisation of the illness among other factors. Next we feel the twelve pulses. They are felt at the radial artery of each wrist at a specific placement using three fingers on each wrist, each finger taking two distinct pulses on each side of the finger. 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. To further confirm the diagnosis we can look at the colour, shape and coatings of the tongue and the sclera of the eye.

The first level of treatment should consist of behaviour and lifestyle changes, and the adoption of an appropriate diet. Activities and foods which have qualities similar in nature to the physical imbalance are eliminated and replaced by those which can reverse the problem. For example if a person has a circulatory, nervous system or psychological (Wind) illness we should recommend they stop overworking, eating and sleeping irregularly and consuming stimulants, like coffee and sugar. A recommendation would be made for such a patient to adopt regular habits, get proper rest and eat a very nutritious diet consisting of certain beneficial foods. If behaviour and lifestyle changes are not sufficient, herbal compounds are given based on the vast Tibetan herbal pharmacopoeia. Herbs are chosen for each compound based on their qualities - such as their taste - to co-ordinate with the qualities of the system (Wind, Bile, Phlegm) which is imbalanced. If this is not sufficient to return the patient to good health, physical therapies such as acupuncture, and massage are employed.

In addition to medical training it is best if a practitioner of Tibetan medicine receives spiritual training so he or she can develop the necessary emotional stability, moral sense as well as the insight and intuition required to put this theory into practice. The traditional spiritual training consists of meditation, visualisation and mantra practices which allow us to identify ourselves as the idealised doctor/healer embodied by the Buddha of Medicine. Through this training we work to develop the capacity of compassion and equanimity through which we can view our patients as who they are essentially, not simply defining them by their presenting illness.

FUTURE?

Tibetan medicine first came to America in the late 1970's with the visit of Dr. Yeshi Dhonden. Dr. Dhonden has been followed by other senior Tibetan physicians, such as Dr. Trogawa Rinpoche and Dr. Tenzin Choedrak, who occasionally tour the U.S. lecturing and seeing patients, before returning to India. Despite a sustained interest in Tibetan medicine, however, no substantial effort has been made to create a means by which native Tibetan doctors can work consistently with American patients. Only Dr. Trogawa tried to address this issue, and in 1990, began providing follow-up care for his patients through a small group of his N. American students.

The promotion of Tibetan medicine as a new commodity is growing both within the growing American 'alternative' medicine industry and within the Tibetan community. Such market forces alone cannot act to present the true Tibetan medical tradition to the West. The Western medical tradition has already shown us the dangers of developing medicine as a commodity. In fact, the alternative medicine movement grew as a direct response by the American people to the negative impact such a development had on the quality of allopathic medical care.

From the perspective of the Tibetan community there are dangers as well. The Tibetan medical community in India has yet to develop a sophisticated understanding of the protocols and uses of Western medical research or of the workings of Western medicine or the American medical industry. If our goal is to preserve Tibetan medicine we must be conscious of the powerful hegemony of our culture and avoid to the greatest extent possible negatively affecting Tibetan culture as we attempt to encourage its preservation and perpetuation.

The economy of time and commerce and the influence of Western medical approaches puts the more classical, holistic, approach to Tibetan medicine at risk of being lost.

Another issue of great significance is ecological sustainability. The growing demand for medicinal herbs in the West creates the potential for an ecological crisis in the countries in which these herbs grow and/or are cultivated. 'Biopiracy', is already a term commonly used in India to describe the plunder by pharma-ceutical firms of the herbal knowledge of traditional people. Deforestation and over exploitation of land in the Himalayan region is a serious issue. There is a shortage in India of herbs required for the manufacture of Tibetan medicines required to serve the needs of existing doctors and clinics. To promote a sudden increase of demand for Tibetan medicine in the West without providing for its supply in a sustainable fashion is ill advised.

If people in N. America want to encourage the survival of the full tradition of Tibetan medicine and see it spread to the West there are certain steps they can take. First, we must support those institutions teaching Tibetan medicine in the East. There are very few senior Tibetan physicians working and practising in India, Nepal and Bhutan and we need to insure that they can transfer their knowledge fully to a new generation.

To allow a true flowering of Tibetan medical practice here the small group of us in North America who are serious long-term students of Tibetan medicine need assistance from our Tibetan colleagues and from those Westerners who are supporters and/or consumers of this system of natural health care. As we succeed in our attempts to study and faithfully practice this tradition we can begin to work with our Tibetan colleagues to build the practical and pedagogic infrastructure required for the proper practice of Tibetan medicine there. We must work together to develop a curriculum for the proper teaching of the tradition in the West. There needs to be sufficient translations of Tibetan medical texts into English. If experimental studies are to be done, research protocols must be specifically designed which are appropriate to investigate the theory and practice of Tibetan medicine. There is questionable value in investigating Tibetan herbal medicines as if they are simply a complement to allopathic treatment or an interchangeable with allopathic pharmaceuticals. As with Chinese medicine, the key to Tibetan medicine's success in the U.S. will be native practitioners working in concert with American practitioners consistently helping people suffering from illness.

For a person to practice Tibetan medicine effectively he or she must draw upon all 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 health and medical care survive and spread now is the time to take thoughtful action to help make it possible.
 

About The Author

ELIOT TOKAR is a NYC based practitioner of traditional Asian medicine. He has studied Tibetan medicine since 1983, and is one of the only people in North America to be receiving such training. From 1983-86 Eliot studied, at the American Institute of Buddhist Studies and privately, with Dr. Yeshi Dhonden. Since 1986 he has been an apprentice of the incarnate lama/physician Dr. Trogawa Rinpoche. Eliot has also trained in Chinese medicine and acupuncture, and Macrobiotics and its related traditional Japanese natural therapies.

In addition to his practice and studies Mr. Tokar has spoken on Tibetan medicine and alternative medicine at Princeton University, the New York Botanical Garden, New York's Asia Society, Columbia Presbyterian Hospital, Mount Sinai Medical School, the American Association of Medical Colleges and the New York Open Centre among others.
 

Eliot Tokar
151-31, 88th Street, Box 2D
Howard Beach NY 11414
USA

Phone: 001 - 718 - 641 73 23
E-mail: etokar at aol.com