Complementary medicine has become a ubiquitous term in current discussions of alternative medicine. Whereas the active co-operation of various systems of medicine is an important goal, a hasty integration will limit us to a “Disneyworld” version of these vast and varied medical approaches. That is, we may find ourselves using only some of the form and some of the substance of complex traditional systems of natural medicine squeezed into easily marketable and saleable forms.
Before a system of truly complementary medicine can exist in
the United States, the essence of traditional natural medical practices
needs to be properly understood by allopathic health professionals and
more fully incorporated into American sensibilities. Simply creating a
field of complementary medicine as a new industrial category to modify
the term “alternative medicine” underestimates the needs and insults the
intelligence of the American people. That intelligence has been well expressed
during the past three decades through their investigation and use of alternatives
in healthcare.
To begin establishing a complementary approach to medicine,
we must create a common language through which traditional doctors and
allopathic doctors can communicate clearly about their disciplines. For
example, traditional Asian medicine is not about acupuncture points, herbal
remedies, or other therapeutic devices. Rather, it is about the scientific,
cultural, and spiritual knowledge which gave rise to those applications.
Creating such a language is a complex but essential task which at worst
is overlooked and at best is attempted in an intellectually and scientifically
inadequate fashion.
The following example is offered as an illustration. A meeting was recently held at Columbia University with two Ayurvedic physicians and a group of Western health professionals. In the question and answer session one Western practitioner, who was working at a hospital unit which utilises complementary medicine, asked the Vaidyas if and how they treat multiple sclerosis (MS). They answered that they did treat MS and then attempted to explain their approach to treatment. As they spoke, the American practitioner posed numerous additional queries regarding the details of MS. As this happened, the discussion became progressively obtuse and frustrating.
Based on my experience in traditional Asian medicine, I (Tokar) offered the comment that the Vaidyas were actually not diagnosing or treating MS because it does not exist as a diagnostic category in Ayurvedic medicine. I recommended that we share some case studies of their own patients with a Western diagnosis of MS and discuss in detail the condition they had diagnosed and the results of their treatment. The discussion immediately became a more organised and clear dialogue. It ceased to have the tone of an inquisition or the strain of a person struggling to fit the wrong size shoes onto the opposite foot. After the meeting the Indian doctors told me, “This often happens to us at meetings of this kind where we are asked about Western diagnosis. To accommodate the Western doctors we answer, but it is never adequate.”
Western diagnoses such as irritable bowel syndrome, cancer, and diabetes are not in fact illnesses; rather, they are conceptual descriptions of the aetiology of illness with related treatment protocols. When we appreciate this point, the concepts of Tibetan medicine or any other system of medicine can be considered on equal terms with the concepts of the Western model. Only then can we create a language that enables meaningful dialogue among different medical systems. The development of such a language is an often ignored prerequisite which is crucial for an effective integrative analysis.
The following article attempts to contribute to this language
of discourse with the long-term objective of creating such an analysis.
As a starting point in building this language, the condition defined by
Western medicine as irritable bowel syndrome provides an example of a useful
model for comparative analysis with the same condition as defined by Tibetan
medicine.
IRRITABLE BOWEL SYNDROME:
DIAGNOSIS AND TREATMENT IN WESTERN
MEDICINE
According to Harrison’s Textbook of Internal Medicine, irritable bowel syndrome (IBS) is the most common gastrointestinal disease in Western clinical practice (1998). Its aetiology is not clearly understood by Western medicine, and it has no organic disease as its basis (Mosby, 1989). It is thought to be triggered by psychological conditions ranging from stress to deeper disturbances. This condition seems to be generally accompanied by emotional stress and anxiety. In some cases more severe emotional disturbances can be seen in IBS patients, such as depression and obsessive-compulsive disorder can be seen in IBS patients.
Symptomatically, IBS is experienced as either spastic colitis causing pain and constipation, intermittent diarrhoea without pain, or alternating constipation and diarrhoea. Additional symptoms include but are not limited to stool urgency, a sense of incomplete evacuation, abdominal distension, a non-apparent sensation of bloating, and excess flatulence. Intestinal motility is either increased or decreased, especially in the colon.
A diagnosis of IBS is supported by symptomatology of a chronic
and intermittent nature, an absence of physical signs of deterioration
and emotional stress. The rest of the diagnosis is established based on
the exclusion of other conditions, such as infection, neoplasia, thyrotoxicosis,
and lactase deficiency.
IBS is considered treatable but not curable. The most common
treatments include bulk-producing agents such as psyllium, anti-cholinergic
drugs such as dicyclomine to relieve abdominal cramping, and anti-diarrhoea
medications such as loperamide (Harrison’s, 1998). Mild tranquillisers
or anti-depressants can be given to help with stress and anxiety. Since
IBS is thought to be incurable, patients are advised to adapt to the symptoms.
COMPARATIVE DIAGNOSIS
Figure one illustrates a basic difference in the diagnostic
approaches of the Tibetan and Western systems. Consider two pyramids,
one inverted and the other upright. Western diagnosis can be graphically
represented by the inverted pyramid. In the process of performing a Western
diagnosis, the physician begins by considering the broad spectrum of a
patient’s chief complaints, history of present illness, past medical history,
and social history. The Western physician then progressively narrows
the differential, eliminating what is regarded as extraneous or secondary.
Finally, a singular definition of disease is reached, such as IBS. Once
this diagnosis is established, information about treatment options and
expected prognosis can be accessed from statistical and experimental research
tested in study populations. However, in this approach very little
is understood about the difference between one individual with IBS and
another individual with the same diagnosis. Beyond the subjective observation
of the Western physician, no satisfying explanation is available regarding
why individual patients experience the disease differently, with varying
symptoms, course, prognosis, and quality of life.
Tibetan diagnosis can be graphically represented by the upright pyramid. At the apex of the pyramid is the individual. The Tibetan physician places a particular emphasis on individuality because all illnesses are rooted in each patient’s unique background and situation. This concept of the individual is then expanded to include the chief complaint, accompanying symptoms, and relevant medical, personal, dietary, and spiritual history. Through this process, the physician perceives the broader complex which characterises the illness. Once the illness is diagnosed on such terms, the root cause of the entire complex of symptoms and conditions can be understood. It is this root cause of illness in addition to the acute symptoms that Tibetan physicians diagnose and treat. In this approach, each patient’s diagnosis, treatment plan, and prognosis are determined on an individual basis. Therefore, what might be perceived as one disease in Western medicine is actually perceived as a range of conditions in Tibetan medicine.
DIAGNOSIS OF THE CONDITION IN TIBETAN MEDICINE
It follows that the aetiologies and manifestations of illness can be understood within several diagnostic categories in Tibetan medicine. These categories relate to three principle systems which give rise to and regulate all functions of the body and mind: Lung (Wind), Tripa (Bile), and Bekan (Phlegm). Below is a rudimentary description of the three systems and a brief discussion of their relation to the diagnosis of IBS.
The three principle systems which create and sustain all the body’s functions (Lung, Tripa, Bekan) are created at various stages of development in the womb by an interaction of our mind’s developmental process and the five physical elements (discussed later in the section on DIET). Embryologically, the mind acts as the basis for the creation of each individual’s three principle physical systems. A materialist view of the world, based on ignorance of a spiritual perspective, is inherently related to Lung.
In Buddhism, stress can be defined at its most basic level as the conflict created between the pursuit of worldly desires and our limitations in fulfilling these desires. Therefore, stress is a reaction rather than a response to given circumstances. This reaction results in psychological and physical reactions which disturb Lung. The results of stress can include improper diet, harmful lifestyle (e.g. erratic sleep habits), and poor adaptation to one’s physical environment (e.g. overexposure to cold in winter or to heat in summer).
IBS has as its major component an emotional stress reaction resulting in symptoms such as diarrhoea and/or constipation. Therefore, a characteristic aetiology of this condition is the disturbance of what in Tibetan medicine is called Lung (Wind). Lung gives rise to all circulation in the body. As the basis of circulation, it is associated with processes of the human organism characterised by movement, from the intangible (e.g. thoughts), to the physical (e.g. nerve impulse, blood and lymphatic circulation and movement of chyme through the digestive and excretory systems).
A disturbance of Lung can occur alone or in combination with dysfunctions of one or both of the two other principal systems. When it occurs alone, this disturbance is termed a Lung disorder. Typical symptoms of such a disorder include erratic and diffuse pain, lower back and hip pain, dry skin, abdominal distension, constipation, diarrhoea, anxiety, anorexia, depression, mood swings, insomnia, psychosomatic disorders, irregular blood pressure and metastasis of tumours.
The second principle system is Tripa (Bile). Tripa is associated with thermo-regulation, metabolism, vision, liver and gallbladder function, and blood production. It allows the mind to function with discriminating intelligence. A disturbance of this system can include such conditions as anger, hypertension, vomiting, gastric acidity, hepatic dysfunction and the development of fast growing tumours.
Cases of IBS defined by the basic Lung disorder in combination with a Tripa, disorder are called Lung/Tripa disorders. They can include symptoms such as erratic episodes of hypertension, sharp pains which move around the body, fluctuating fevers, reflux, regurgitation, and a combination of symptoms of both Lung and Tripa disorders.
Bekan (Phlegm) is the third principle of physical and psychological
function. It is associated with the proper breakdown of food in the initial
stages of digestion, the maintenance of the body’s internal fluids, and
the proper functions of the senses overall. Typical manifestations
of Bekan disorders can include a sensation of physical or mental heaviness,
kidney disorders, hypotension, slow metabolism, hypersensitivity to cold,
weakness, diarrhoea, the development of soft cysts, and slow tumour growth
progression.
If the case of IBS is characterised by a Lung disturbance
combining with the principle system of Bekan (Phlegm), it is called a Lung
/Bekan disorder and is characterised by an inability to properly break
down foods at the initial stages of digestion. In this case, the IBS is
accompanied by symptoms such as hypersensitivity to cold, mucus or undigested
food in the stool, excessive urination and a combination of Lung and Bekan
derived pathology.
Finally, if the condition derives from a complex dysfunction of all three main principle systems mentioned above (Lung, Tripa, and Bekan), it is termed a Bekan Mukpo (lit. Brown Phlegm) disorder and reflects a combination of liver and stomach dysfunction that chronically undermines digestive and assimilative processes. This results in a variety of symptoms, including intestinal pain, sour vomiting, indigestion, nausea, lack of appetite, blood in the stool, and constipation. In more severe cases, or if left untreated , this condition may lead to tumorigenesis.
Appropriate diagnosis of the condition is determined through an interview and physical examination, in which the patient’s history and presenting symptoms are elicited. Next the physician analyses a urine sample, feels the twelve distinct pulses on the radial artery of each wrist, observes the tongue and the sclera of the eyes, and if necessary, applies pressure to appropriate points on the body. Treatment is then tailored to address the specific aetiology of the individual’s condition.
TREATMENT IN TIBETAN MEDICINE
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 act in ways which create suffering such as illness. Given this basic principle, when treating an illness physicians first begin by recommending specific behavioural 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, physicians employ herbal medicines or, if needed, physical therapies such as acupuncture. As stated by Dr. Trogawa Rinpoche, the treatment ultimately must fit the patient; that is, treatment must be formulated in a manner which can and will be effective for that individual.
B e h a v i o u r a l M o d i f i c a t i o n
Behavioural modification can include meditation instruction,
spiritual advice, counselling, exercise, or the reorganisation 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 visualisations 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 Lung 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 Tripa disorders, emphasis may be placed on generating a
deep feeling of love and compassion as a cure for aggression and anger.
In Bekan disorders, meditation will focus more on developing wisdom as
a cure for ignorance.
For example, the following is a basic meditation for people experiencing anxiety and depression, which are fundamentally Lung disorders. Because it calms Lung, this meditation can be helpful in some aetiologies of IBS. After awakening in the morning patients are asked to sit with their back to the sun in a place where they can look at the clear blue sky. If this is not possible, they can simply visualise the clear blue sky in their minds. Patients are then taught some simple breathing practice. When thoughts arise, they must not try to suppress them or to become involved with them; rather, they should allow them to arise in the mind and pass away. Such relaxing practices allow patients to focus and calm their minds. Patients are then asked to look at the sky, taking particular notice of its expanse into infinity. Next, they are told to focus on their mind and locate their consciousness. Then, on the exhalation, they are taught to project their consciousness out of their body and into the sky where it diffuses into an infinite blue expanse. Although it is very basic, this meditation begins to train patients gripped with mental turmoil to let go of their thoughts. In Tibetan medicine, this grasping to thoughts is considered an exacerbating factor of anxiety and depression.
Physical activity, lifestyle, exercise and habits are also considered. For example, patients with Lung disorders are told to pay special attention to regularity of lifestyle (e.g. eating, sleeping and excretory function), find time for calm activities and socialising, 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 avoid direct, excessive exposure to the sun and engage in physical activities which relax them. Patients with Bekan disorders should keep warm and perform vigorous exercise such as running or dancing. Swimming is not appropriate if it involves immersion in cold water. In the case of a combined disorder such as Mukpo, behavioural modification is tailored to the particular form the illness takes.
D i e t
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 analysed based on its qualities and nature as defined by a five element theory. All of the material which makes up our universe is based on the qualities of five basic elements which are described in the ancient texts of Tibetan medicine. Ancient Tibetans lived in direct contact with the natural environment. They understood through experience and study that the forces manifest in nature directly correlate with and influence the functioning of the human organism. In the theory of the five elements, we see an effort to define the qualities of the basic forces which exist in nature. Once defined they are named for their most identifiable manifestations: earth, water, fire, wind and space. The characteristics and therefore the nature of all matter then result from the qualities of these elements individually or in combination.
Specific arrangements of the five elements which occur during embryological development form the three basic principles of physical function (Lung, Tripa, Bekan). 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.
The recommended diet for IBS varies significantly depending on the specific aetiology experienced by the individual patient. Because stress is a significant trigger in IBS, Lung is usually a contributing factor. Therefore, a proper therapeutic diet must routinely treat Lung imbalances. Depending on the presence of imbalances of Tripa and/or Bekan additional foods must be added to or removed from the diet.
Lung Diet
Patients benefit from a diet of heavy nutritious foods, such as meat, cheese, butter, and soups made with bones (e.g. chicken soup). In the case of a Lung /Tripa disorder, or some Bekan Mukpo disorders, or if the patient is a vegetarian, animal-based foods can be replaced with other foods. Substitutes include avocados, vegetable, legume or in nature should be avoided, because they would impede or distort the movement and circulation which is essential for the function of Lung. These include foods that are burned in cooking or processing (e.g., grilled meat, over-toasted bread, coffee, chocolate) because they induce stagnation of the circulatory energy; sugar, molasses and artificial sweeteners; puffed grains such as rice cakes; monosodium glutamate, improperly processed foods (e.g. distilled vinegar, low-grade soy sauce); and green tea. These foods, which might otherwise be benign or useful, are contraindicated in this situation for two reasons: (1) because they are irritants causing an exacerbation of stress related symptoms, or (2) because they impede proper circulation in the body.
Tripa Diet
These patients observe the Lung dietary guidelines while incorporating additional principles that are tailored to the Tripa condition. In this case a simple vegetarian diet is suitable, including legumes, potatoes, cumin, coriander, fenugreek, artichoke, bitter vegetables (e.g. dandelion), and turnips. Foods that are heating in nature should be avoided. These include peanut butter, mustard, spices, garlic, ginger, onion, alcohol, meats [esp. lamb], oily and greasy foods, and soups made with bones.
Bekan Diet
These patients adopt a heating diet with respect to both the nature and the temperature of the food. For example, they consume hot water, cooked foods, pomegranates, sheep cheese, yoghurt, ginger radish, honey, ginger, and garlic. They avoid cold drinks and foods, potatoes, tomatoes, eggplant, bell peppers, and sugar, and raw foods such as salads.
Mukpo Diet
Mukpo is the combined dysfunction of all three energies. This is a complex chronic condition in which each of the imbalances ultimately affects the digestive and metabolic functions. The diet includes fresh, cooked foods to facilitate the severely compromised digestion that is typical of this condition. Recommended foods include fresh meat, dairy products, vegetables, fruits, and whole grains. This condition is exacerbated by garlic, tomatoes eggplant, bell peppers, and foods that are aged, fermented, cured, smoked, sour, chilled, oily, or processed.
H e r b a l M e d i c i n e s
If the above approaches are not sufficient in relieving the condition, herbal medicines are prescribed. In Tibetan medicine, herbal treatments range from simple to very complex, in a using approx. 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 Bekan disorders or digestive disorders. Afternoon remedies are typically used to treat Tripa disorders. Remedies given in the late afternoon or evening are usually given to treat Lung disorders. Ultimately, the organisation of the prescription is based on both the doctor’s judgement and the patient’s lifestyle.
Although prescriptions are specifically tailored to each case, some herbs are more frequently found in formulas applicable to cases defined as IBS by Western medicine. For example, a set of three herbs (Terminalia chebula, Terminalia belerica, and Emblica officinalis) are often given together as a mixture or included as ingredients of a complex formula.
Additional herbs are typically prescribed for each individual’s condition. Herbs such as Aquilaria agollocha (Eaglewood), Asafoetida, Saussurea lappa, Areca catechu, cardamon, nutmeg, and clove are often found in Lung disorder medications. Swertia chirata, Saussurea lappa, and berberis are commonly used in Tripa disorder formulas. Bekan disorders are commonly treated with pomegranate seeds, Piper longum, black salt, cardamom, and cinnamon. Commonly used ingredients for relevant Mukpo disorders are Saussurea lappa, Emblica officinalis, pomegranate seeds, cardamom, Piper longum, Veronica ciliata, and calcite.
P h y s i c a l
T h e r a p i e s
Other therapies may also be used if the above approaches are
not sufficient. They include:
MASSAGE
Massage is calming and promotes good circulation. For cold
conditions such as Lung and Bekan disorders, massage oils should be heating
in nature, such as sesame oil or mustard oil.
TIBETAN ACCUPUNCTURE
Tibetan medicine has its own acupuncture system. In addition to the application of needles Tibetan physicians also use moxibustion, which may be used in conditions such as Bekan and Lung.
INHALATION THERAPY
This modality is best illustrated by the medicinal use of incense
formulated specifically to treat Lung conditions. When indicated, patients
are prescribed such incense and asked to inhale the smoke as it diffuses
into the air during times of the day when the Lung predominates such as
in the late afternoon and before bedtime.
CONCLUSION
A very highly regarded Tibetan physician in West Bengal, India recently expressed that he was wary of the negative effects when younger Tibetan doctors feel they must address Western medical diagnoses. He said that such information does not help the doctor to make an accurate Tibetan medical diagnoses and instead spreads the hegemony of Western medicine.
This is a persuasive argument. The most important issue regarding traditional medical systems is their complete preservation. The economy of time and commerce and the influence of Western medical approaches are endangering the more classical, holistic approach to Tibetan medicine. Already Tibetan medicine is becoming a hot new commodity in the new alternative medicine industry. The use of the classical treatment protocol described above is giving way to the use of Tibetan herbal pills as an oversimplification of Tibetan medical treatment. This creates a scenario easily exploitable by the growing nutriceutical industry which is always looking for potential new products.
However, adopting the isolationist perspective of the aforementioned Tibetan physician is not the only way to preserve Tibetan medicine. We must work to understand the system and teach its true meaning so that healthcare consumers can discern what is real and what is commercial. The first step in that process is developing a means of discourse so that lay people, allopathic physicians, and practitioners of traditional natural medicine can speak to and educate each other. This process of introducing new ideas regarding medicine and creating a new, integrative paradigm is already present in the history of Tibetan medicine. Centuries ago, before Buddhism entered Tibet, Tibetans like all ancient people had some 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 psychological systems from Buddhist and other sources. Around the 7th-8th century, government-sponsored conferences occurred in Tibet, where doctors skilled in the medical systems of China, Persia, India and Greece came to present and debate their ideas on health and the treatment of illness. Those with superior abilities were invited to stay and contribute to the country’s medical knowledge base. It was not until the 11th century that this knowledge was integrated into a unified system. This system contained a synergy of various principles of physical and psychological medicine imbued with a spiritual understanding.
For the past thirty years the American people have expressed that the medical system which has dominated this country for most of this century is not wholly adequate. The recent explosion of interest in alternatives in healthcare from allopathic doctors, researchers, the government and industry creates two possibilities. One is a renaissance atmosphere where doctors, researchers and independent practitioners of natural medicine meet on equal ground, freely exchanging ideas, experience and knowledge and thereby creating great benefit for patients. The other is expressed by the new presence of those in the healthcare industry who are seeking to co-opt and control this renaissance through professional, political, legal and commercial means.
People must learn to negotiate the landscape of alternative health modalities. However, Americans need a better understanding of the theory and practice of these disciplines before their efficacies can be truly understood. When understanding is achieved Americans can gain benefit from Tibetan medicine’s insights into how to maintain health and cure illness based on centuries of accumulated knowledge of the spiritual, ecological, psychological and physical aspects of health.
Given the speed of developments in the modern world, it will probably not take us seven centuries the Tibetans utilised to create a new paradigm of integrative medicine. However, we must not allow the agenda to be set by the rapid pace of economics and technology which has affected our American healthcare system. The above material is an illustrative example of how diagnoses can be understood across two disciplines. Additional dialogue is required to explain the meaning of basic concepts such as “blood quality”, “slow metabolism” or “sweet taste” in Tibetan medical terms. More work needs to be done to create a language which allows for clear and constructive dialogue between systems. Practitioners of natural medicine need to become more sophisticated in the language of allopathic medicine rather than using it as an inaccurate convenience or as a way to pass in the healthcare system. Allopathic physicians and researchers need to truly understand the approach of natural medicine rather than seeing it as a collection of therapeutic devices which can be cut and pasted into the existing paradigm. When this work is fully accomplished, we can reach a point where different systems of medicine can act independently or in a complementary fashion where appropriate for a patient’s condition. Once freed from the dangers of hegemony and dedicated to equality, “complementary medicine” will fulfil its promise in broadening American health care.
Ariana Vora was the 1997-1998 National Co-ordinator of the American Medical Student Association’s National Project on Complementary and Alternative Medicine. She is currently a student at Mount Sinai School of Medicine.
Eliot Tokar is a NYC based practitioner of traditional Asian medicine. He has studied Tibetan medicine since 1983, first under Dr. Yeshi Dhonden and since 1986 with Dr. Trogawa Rinpoche. He has also been trained in Chinese medicine, acupuncture, and macrobiotics and its related traditional Japanese natural therapies. He has lectured on Tibetan medicine, natural medicine and alternatives in healthcare at Princeton University, Mount Sinai School of Medicine, the Columbia Presbyterian Hospital, and the American Association of Medical Colleges. He currently serves as an advisor to the American Medical Student Association’s National Project on Complementary and Alternative Medicine.
Ariana Vora
Mt. Sinai Medical School
Aron Residence Hall
50 East 98th Street, Apt. 14B
New York NY 10029
USA
phone: 001 (212) 831-1652
e-mail: voraa01 at doc.mssm.edu
Eliot Tokar
151-31, 88th Street
Box 2D
Howard Beach
New York NY 11414
USAphone: 001 (718) 641 73 23
e-mail: etokar at aol.com
You can visit Eliot's Website on Tibetan Medicine
at:
http://www.tibetanmedicine.com
The article was first published
in the USA in “Alternative and Complementary Therapies”, Vol. 4 No. 5,
October 1998, p343-349.
