|Early 18th Century Tangka ("scroll") painting of Lama Yutog Yontan Gonpo (1127–1203), the second physician king of Tibet, and one of the founders of the Tibetan medical system. His right hand expresses the mudra (gesture) of generosity. In front of him is a bowl of myrobalan fruit, a medicinal plant. He is surrounded by images of the Buddha, medicine Goddesses, and tutelary deities. Image copyright Shelley & Donald Rubin, courtesy of www.tibetart.org. |
Tibetan medicine is one of the world's oldest medical systems. It has survived political upheaval, warfare and exile. Can it survive in America?
Tibetan healing practices are nearly inseparable from Tibetan Buddhist spiritual practices. While Tibetan physicians make use of herbs, manipulation techniques, and other physical modalities, Tibetan medical doctrine holds that physical disorders—especially chronic diseases—have their roots in psychological, emotional, and lifestyle imbalances.
Despite, or perhaps because of its inherently spiritual nature, Tibetan medicine is attracting a growing number of Westerners, including some physicians. But as a system, it defies easy integration with American medicine.
"The entities and causes of all illness derive from ignorance," writes Dr. Yeshi Donden, formerly the Dalai Lama's physician for several decades. In his seminal book, Health Through Balance, Dr. Donden explains that, "From ignorance there is obscuration, due to which we do not recognize unsalutory states of mind as faulty, and instead generate desire that leads to many ill-deeds and the accumulation of bad karma." This in turn drives unhealthy lifestyles and disease processes.
In a sense, Tibetan medicine represents a summation of the entire medical wisdom of the "ancient" world. In the 7th century, physicians from India, China, Nepal, Persia, and Byzantium were invited to Tibet under the aegis of the Buddhist King Songsten Gampo, to exchange medical wisdom and translate their knowledge into Tibetan.
This material became the bedrock for the Tibetan system, which is based on an understanding of three humors in the body: wind, bile, and phlegm. These three forces have a highly complex relationship within an individual. When they are out of balance, disorders and disease processes develop. According to Dr. Donden, these imbalances can arise from specific states of mind.
"In brief, the three basic afflictive emotions, called the three poisons, are desire, hatred and obscuration. From obscuration, which is heavy, dull, and cloudy, phlegm disorders increase, phlegm being heavy and viscous. From desire, which has a nature of captivation of the mind, all types of wind disorders arise—wind having a nature of being light and moving. Hatred is like fire; from it, bile disorders as well as blood–bile disorders arise."
The Tibetan system does not conceptualize diseases as finite states. Tibetan doctors consider that each person has a specific condition based on his or her own outer and inner circumstances. They work with their own senses rather than lab tests to determine the nature of the imbalance presenting as disease.
There is no practical way to learn Tibetan medicine outside of a long and dedicated relationship with a master practitioner. Knowledge and skill are transmitted through an apprenticeship in which the student's character development is as important as his mastery of information. Presently, the centers of the Tibetan medicine in exile are in Northern India.
Eliot Tokar is one of a very few Americans who have undertaken such training, completing an apprenticeship with Trogawa Rinpoche and Shakya Dorje, at the Chagpori Tibetan Medical Institute in Darjeeling, as well as private study with Dr. Donden. He now practices Tibetan medicine in New York City.
"Tibetan medicine has not been de-contextualized; it has no set 'curriculum,' and few translated texts," said Dr. Tokar of the difficulties facing interested Westerners. Since it evolved entirely independent of the European scientific and industrial revolutions, its intrinsic concepts are virtually impossible to translate into Western scientific terms. And where allopathic medicine looks to the mechanics of the physical world, Tibetan practice emphasizes psychospiritual forces.
Describing his teacher Trogawa Rinpoche, Dr. Tokar said, "his external activity is the practice of medicine, and his inner thoughts are those of a meditative spiritual practitioner." A physician's concern for his patient extends into all parts of the patient's life. The healing relationship is deep and intimate, with the expectation that the patient's lifestyle changes contribute to healing as much as the medicinal herbs.
A "work-up" in Tibetan medicine includes an in-depth interview followed by visual examination of the patient's standing urine sample, the eyes and the tongue. It also includes determination of whether there is sensitivity in selected pressure points.
The last step, said Dr. Tokar, is taking the pulses. As in traditional Chinese medicine (TCM), pulse-taking is key to understanding a patient, and goes far beyond simple measurement of heart rate. Tibetan theory holds that each person has a constitutional pulse—the pulse of their nature in a healthy state. In addition, each of the three humors have pulse manifestations. Energetic imbalances and disease processes also have specific pulse patterns.
This sort of diagnostic approach does not lend itself to the "10-minute visit" realities of American medicine. Dr. Tokar fears for the system's ability to survive as a living tradition in a market-driven environment. And he is concerned that arranged marriages between traditional systems, like Tibetan medicine, and western medical science tends to reduce the traditional systems to a set of superficial techniques bolstered by patent medicines.
Despite the difficulties, there is a dialogue emerging between the two systems. The first International Conference on Tibetan Medicine was held in Washington DC in 1998. The program brought together practitioners from many disciplines, to explore everything from the role of astrology in Tibetan medicine, to the biochemical effects of Tibetan medicinal plants. Grand rounds sessions focused on diagnostic techniques and mind/body approaches to a wide range of disorders including diabetes, cancer, HIV disease and arthritis.
More recently, the University of California San Francisco's Breast Cancer Care Center undertook a 1-year study with Dr. Donden, assessing the impact of his diagnostic and therapeutic approaches in 30 women with advanced breast cancer. Dr. Donden will examine each patient, and then prescribe one of a number of herbal formulas he commonly uses to treat breast cancers. All of the formulas have been granted investigational new drug (IND) permits by the FDA. Efficacy will be assessed in terms of reduction in tumor size.
Tibetan botanical medicine is the aspect of the system most likely to "catch on" with American physicians. A number of MDs are already finding they can help their patients with a commercially-produced herbal formula called Padma Basic, derived from a "classical" Tibetan formula called Gabur ("camphor formula"). Though traditional Tibetan practice does not utilize commercial preparations (specific formulas are prescribed and freshly-made for the patient by the doctor), this product is giving some patients a first taste of the potential offered by the Tibetan system.
Basic is the first US-distributed product from Padma AG, a Swiss company that markets other Tibetan-influenced herbal supplements and medicinal teas in Europe. It is prepared from 19 dried, ground herbs, and is rich in bioflavinoids, polyphenols and other antioxidants. The Padma tablets must be chewed and swallowed with water to facilitate absorption. The flavor can be described as similar to chewing on a piece of incense.
Padma promotes its product as an antioxidant, immune system stimulant, and promoter of healthy circulation. There is clinical evidence that it improves intermittent claudication, chronic occlusive arterial disease, and angina pectoris. All the published studies so far have been done in Europe and Israel.
But recently, Michael K. Hoffman, MD, of New York Medical College's Department of Microbiology and Immunology conducted tissue culture assays to determine if Padma Basic has immunomodulatory effects. He found that it is able to stimulate macrophages, the cells that orchestrate cellular immune response. Dr. Hoffman plans to publish his findings later this year in an American journal.
Asked how this multi-herb formula can be effective in seemingly diverse conditions, he replied, "The principle of 'one substance–one effect' is no longer active. We are beginning to look at synergistic effects."
Ronald Lynch, MD, who practices integrative medicine in Orlando, is struck by the difference between Western and Tibetan approaches to botanical medicine. "We try to do things with one targeted drug; they combine 20 plants into a formula that is based on the theory of homeodynamics," the way the body regulates itself. He recommends the Padma product to his diabetic patients with poor circulation as well as for patients with hepatitis, peri-menopausal complaints, and obesity.
John Foster, MD, directs a complementary and alternative medical clinic in Philadelphia. He takes a multi-disciplinary approach to treating a number of chronic disorders, but specializes in multiple sclerosis and amyotrophic lateral sclerosis. "Typically, patients come to see me after their neurologist has told them that not much can be done. I clean up their diet, introduce them to supplements, and give them the Padma Basic formula. They get better."
Because these neurologically compromised patients are using a number of different medications and modalities, Dr. Foster is not certain how much of the observed improvement to attribute to the Padma supplement. But he is certain that it has helped his patients with claudication.
The Tibetan emphasis on restoring balance is, "a very reasonable way to heal," said Dr. Foster. But he recognized that this involves more than simply recommending herbs. A fuller study of Tibetan medicine, "would require a lifetime of devotion to a spiritual discipline and would best be practiced in an environment where there is no concept such as malpractice," he told Holistic Primary Care.
Dr. Tokar pointed out that people who have the deepest understanding of Tibetan medicine face major obstacles to practicing in the US—unless they also happen to be MDs, DOs, or other licensed professionals. Under most state licensure laws, Tibetan doctors trained in Buddhist monasteries, are considered lay people and thus prohibited from practicing medicine.
But as was the case with traditional Chinese medicine 20 years ago, public interest in Tibetan medicine could influence public policy.
Dr. Foster believes growing patient acceptance of natural therapies, including Tibetan approaches, reflects a major change in how people see themselves. "Twenty years ago a patient's self- image was apt to be mechanistic, and they could only accept treatments that matched that perception. Today, people have a greater sense of awe about themselves as human beings and they are open to working with that."
Richly illustrated site maintained by Eliot Tokar, with overviews and commentaries on Tibetan clinical practice and links to traditional medicine resources.
Site maintained by Dr. Nyima Youdon Namseling, a Tibetan physician now living in the US, who is the first woman in Tibetan medical history to hold a lectureship at the Men-Tsee-Khang, the Tibetan Medical and Astrological Institute.
An astonishing online museum of Tibetan sacred art, including a number of Tangka paintings and diagrams related to the practice of medicine.
A non-profit organization founded by Marsha Woolf, and committed to providing free health care to Tibetan refugee communities in the US and abroad, as well as facilitating the evolution of Tibetan medicine in America. This is the online home of Dr. Yeshi Donden.
To obtain more information about Padma Basic, contact:
Padma Health Products, Inc.
215 River Vale Rd.
River Vale, NJ 07675
Proceedings of the First International Congress on Tibetan Medicine: