Tibetan medicine is a unique combination of pre-Buddhist Bon shamanism, Buddhist, Chinese, Indian, Greek and Persian medicine. This is because it is at a crossroads between all of these regions. The basic theoretical framework is that Ayurveda with a number of Buddhist and Bon spirits, deities, and rituals added. From China, Greece, and Persia mainly techniques and medicinals have be added and fitted into this unique theoretical framework. However, the main Ideological Justification for the whole system is Buddhist.

     The Tibetans had their own medical system before the arrival of Buddhism. It used herbal remedies, poultices and Bon shamanic practices and rituals to cure people. King Songtsen Gampo took two Buddhist wives and introduced the religion into his country in the year 641 C.E. and he welcomed many masters and scholars of Buddhism from India and China. These masters did not dismiss the native traditions and deities but integrated them into Buddhism.  The same process occurred with the native medical system and those of India and Tibet. The next King, Trisong Deutsen organized and international medical college. He invited doctors from Nepal, Greece, China, Persia, and India. From this sharing of knowledge, the Tibetan doctor Yutok Yonten Gonpo created the Four Tantras.

    The historical Buddha, Siddhartha Gautama, often talked about his role in medical terms. He is known as the supreme physician. His teachings are intended to cure suffering. His first teaching, known as the four noble truths, is given in a traditional format of Indian medical diagnosis. This format is to first state the problem or disease, then state the cause of the disease, then state if the disease can be cured or treated, then finally state the cure or treatment of the disease. Thus, the Tibetan doctor is imitating the Buddha’s path and being a doctor is considered a spiritual path in itself. The traditional Tibetan doctor starts out his day with a specific meditation. He visualizes himself as the Medicine Buddha, “…seeing before him, with their particular suffering and all of the innumerable diseases they may have. The Medicine Buddha feels anguish for them and wishes them freedom from suffering. Through the power of his realized mind, this Medicine Buddha diagnoses the illness as symptomatic of fundamental spiritual disharmony caused by ignorance. This ignorance is a lack of understanding of the basic nature of reality, as understood from the Buddhist perspective…By visualizing themselves as Medicine Buddha, doctors of Tibetan medicine pursue an aspiration to develop the same capacity for compassion, awareness, and skillfulness. This process is the root from which diagnostic skill develops. It is established even before the first patient walks in the door.”

     The core texts of this medical tradition are known as the four Tantras. The first Tantra also known as the Root Tantra. It contains six chapters and is outline of the other six texts. Using the metaphor of a tree they categorize the Root Tantra categorizes into three roots, which divide into nine stems, which divide into 47 branches, the forty-seven branches hold 224 leaves. The second Tantra diagnosis techniques, including pulse diagnosis, tongue diagnosis, and urine analysis. The third tantra contains information on treatments, diet and behavior modification. The fourth Tantra contains 27 chapters and contains more information on diagnosis, information how to make and use medicinal pills, information purgatives and other treatments that are used as a last resort. 

   The basic understanding of human physiology in Tibetan medicine is based on the Ayurveda.  The roots of Ayurveda are in the Artharva Veda and even in those ancient times contained advanced medical knowledge. The famous physicians the Ashvins were known for surgery, treating paralysis blindness and even replaced the lost limb of a soldier with an iron one. In the beginning, Ayurveda was inseparable from religion and magic. “It is the Atharava Veda however which is the earliest source of therapeutic prescriptions that began the Ayurvedic tradition. Basically, the Atharva Veda equates disease with the influence of demons. It prescribes magical and herbal medicine, a variety of plants, charms and incantations-to ward off the evil spells of demons and enemies and to improve health and sexual vigor.” (Clifford p.35)  

   During its second stage, approximately 800 B.C. to the first few centuries A.D., Ayurveda began becoming more rational and scientific. This stage of Ayurveda was divided into eight branches. These were surgery, disorders of the head and neck, general medicine, psychiatry, pediatrics, toxicology, rejuvenation, vilification. The rational view of disease that developed was based on the three humors. “The three humors are air, bile, and phlegm. They are simply understood as the underlying constituents of the body, but as Heinrich Zimmer has explained, they are in fact “not just airy, bilious and mucous matter found in the body but three principles of life energy” (Clifford p37.) Ayurvedic knowledge spread to Tibet around the fifth century along with Buddhism. By the 13th century Moslems had conquered or raided most of India and destroyed what every trances of Buddhism they could along the way. At this point, Tibetans could no longer go to India for medical teachings or text. The Tibetans connected the Indian theory of the three humors and the five elements to the Buddhist idea of the three poisons that are consider to be the root of all suffering. The three emotional poisons, so central to Buddhist theory of suffering and liberation, are considered the root cause of all diseases. These poisons are ignorance, desire, and hatred or aversion. These poisons effect the health of the body through the wind element. This is the not wind as we normally think of it, though that is one of its manifestations, rather it is the subtle energy in India, known as prana, which connects the mind with body. 

   In Indian mythology, this medicine is first discovered by the god Brahman and then passed to the Ashwin twins who the pass it to the king of the gods Indra, and Indra taught it to a human named Atreya. Atreya taught medicine at the city of Taxila. The theory of the humors all starts with the void or Dharmakaya, what Hindus would call Brahman. This void mysteriously becomes two creating duality. This duality takes the form of the mind or consciousness and the five elements, because for Buddhist and Hindus alike, the mind is considered to be the base of all existence, it is the creator of all phenomena both internal and external. The mind combines the five elements into various forms and relations, these relations create energy. In this way, the mind and the five elements divide the energy and gross material they have created into three categories body, energy, and mind. In the human body these become Wind, Bile, and Phlegm respectively. The human body is seen as composed of five elements that combine to form the humors. These humors relation to each other are responsible for all bodily functions and when they get out of balance is when illness occurs. The three humors are Lung or Wind, Tripa or Bile, and Phlegm. Wind is responsible for all the movements in our body, blood circulation, nerve impulses, and our thoughts. Bile is responsible for our metabolism, liver function, vision, and discriminating intellect. Phlegm is responsible for the initial stages of breaking down food, the bodies lubrication, fluids, our will, and memory. In addition to balancing the humors themselves, there are other aspects of the body that must be balanced along with them to maintain health. The Gyu-zhi says that it is the balance or imbalance of three classifications of 1) humors, 2) constituents, and 3) excretions that cause the body to thrive or to be overcome. There are three types of excretions; urine, feces, and perspiration. There are seven types of constituents, also known as the supports of life; food, blood, flesh, fat, bone, marrow, and semen.

   Buddhism was intertwined with medicine from the very beginning. The Buddha knew Ayurveda very well and gave his first teaching, the four noble truths, in the form of a traditional medical diagnoses. He even gave medical prescription to be given to ailing monks. “In the medicine section of the Vinaya he noted that certain foods, such as honey and butter, should be taken as medicines by the monks; in fact, he prescribed many different vegetable, animal, and mineral substances as remedies for ill monks.” (Clifford p.39), from this base it can be seen how the development of Buddhism into three main vehicles and their yogic and meditation practices influenced the development of medicine. 

    The Hinayan tradition contains advanced anatomical knowledge. This knowledge probable arose from the practice of meditation in cremation and charnel ground. More specifically it arose from examining and meditating on dead bodies as a form of meditation on impermanence and interdependent origination. he meditation was also used to incite disgust with the human body in the meditator as a way of reducing his sexual desire. In the Vajrayana, the highly developed external cosmology of Mahayana Buddhism became internalized as the human body came to be seen as a microcosm of the universe. From the psycho-physical practices of these tantric yogis arose a separate category of healing know as Tantric medicine. 

    Indian alchemy is related to both tantra and medicine. From it arose another medical tradition known as siddha medicine. “The goal of this form of medicine is to transmute the body and make it “immortal by the use of medicinal and magical herbs and substances. These are applied in conjunction with religious techniques like mantra and incantation. In this way, the elements in the body become purified and transformed into their subtle counterparts.”  The main substance for this form of medicine was mercury. Much of the effort of the siddhas was in transforming mercury from its toxic liquid form to it healing solid or fixed form. “For it was said of mercury that it was like the mind: by nature, unsteady; but when stabilized, then there was nothing in the world that could not be accomplished. The alchemical formulas became a regular part of Tibetan medicine. The Tibetan system of elixirs and essence pills relied on the purified or fixed for of mercury that the siddhas developed.

   Of these three types, tantric medicine is the bridge between the rituals and spiritual practices of dharmic medicine and that of medicinals and acupuncture of somatic medicine “The expression of absolute truth as the three-fold Buddha body is the doctrinal foundation of tantric practice and tantric medicine. It is also the template of our actual embodied existence with its three aspects-mental subtle, vital, and physical and for the three kinds of Tibetan medicine-Dharmic, tantric and somatic. “(Clifford p.66). Tantric medicine deals with the winds channels and essences. It manipulates them through mantra and visualizations to heal the physical body. These winds and channels are the subtle body which manifest out of the voidness of the Dhamakaya and is a support for the physical body. Illness occurs when there is a blockage in the flow of this subtle energy system. “The overall picture of Tibetan Medicine is similarly complex in this way, an interwoven expression of non-linear, triadic relationships linking the spiritual, psychic and physical life of the individual and the universe. In Buddhist Tantric medicine, the entire universe is seen to be within the individual. Tantric medicine the vital psycho-physical energies of the internalized universe as a means to transforming the outer universe.”(Clifford p.66) This is the inverse of the use of mercury in siddha medicine. In siddha medicine the external elements are used to transform mercury which is then applied to the body as a way to effect the winds and the mind and therefore transform the body and improve health and concentration.

   A number of treatments and modalities are used to manipulate the subtle energy in tantric medicine. Mantras are prescribed by the doctor and said by the patient to adjust the vibration of the subtle body and undo blockages to allow one to tune into their inherent Buddha nature. Another technique is to visualize various colors of light emanating from a deity and entering the ailing part of your body and purifying it. Jewels are also used to adjust the frequency of the subtle body. Seen as physical embodiment of the seven color rays in a rainbow they connect the pure lands of the Buddha directly with physical reality. Massage and acupuncture also use the channels and winds to effect healing in the physical body through the subtle body. Also common are breathing exercises used to strengthen the subtle body and clear blockages from the channels. As it says in Tibetan Buddhist Medicine and Psychiatry, “Tantric mystic physiology of the subtle body is directly related to the somatic physiology of regular medicine and the tantric practices of manipulating it bear directly on tantric healing. For example, the system of subtle veins and pathways are the channels used and manipulated in Tibetan acupuncture and moxibustion.” (Clifford p72).

   That which connects the microcosm and the macrocosm are the five elements. This is because the both the internal subtle body and the external world of gross material world are made of the five elements. This links the subtle energy practices of tantric medicine to the more physical practice like herbal medicines. Both diagnoses and medicines are classified according to the three humors and the fire elements. The gentlest effective form of treatment is used. It starts out with inhaling incense as means of delivery and work its way up through herbal baths, medicinal oils, and the ingestion of various herbal preparation. Moxa, blood, letting and acupuncture are generally seen as extreme forms of treatment and are therefore a last resort and not used and frequently as they are in the Chinese medical system.

    Every aspect of living can throw the three humors out of balance. The environment and weather can throw them out of balance. Too much or too little of anything can do the same, such as too little food, too much physical labor, or too much thinking. The factors that can throw one out of balance are divided into two main types, these are called primary causes and secondary causes. The primary causes are the negative emotions, such as anger, aggression, lust, desire, and ignorance. The secondary causes repetitive patterns in lifestyle, behavior and diet, changes in the weather and d the seasons, and other outside provocations such as spirits. This model is similar to Chinese medicine and the primary and secondary factors can be seen as the what Chinese medicine refers to as the root and branch causes of disease respectively.

    The methods of diagnosis are divided into three categories. They are Inspection, Palpation, Anamnesis. Observation includes all aspects of a patient’s behavior and appearance including things like analysis of the urine. Palpation refers specifically to pulse diagnosis Anamnesis is the case history and includes the answer from all question asked of the patient about such things as diet, lifestyle, and emotional states. Healing methods are divided into four categories. These are therapeutic diet, modifications in lifestyle, medication, application of external therapies, these are cupping, bloodletting, compresses, and stick therapy. There is also a fifth category according to the terms or treasure tradition. This fifth category is mantra healing. Mantras can be used with of the other modalities of healing or they can be used example independently. When used in conjunction with another healing modality it enhances the effects of the treatment method being employed. For example, “During the compounding traditional of Tibetan medicines many healing mantras are recited, incorporating the energy of sound into these complex combinations of herbs and minerals.” (p.14 The Tibetan art of good karma). 

   The Tibetans have a unique perspective on the process of death and dying. Every medical system must have perspective on and means of handling this process as it is an unavoidable part of life. The Tibet medical system gives advice about the process of dying from a subjective point of view as well as the state in between bodies before rebirth called the bardo. “According to the Tibetans, both in medical and religious theory, what happens during death is this. First, the five elements making up the physical body dissolve, and the consciousness is released into space. Second, one either recognizes the luminous nature of the mind and reality as voidness or if not, one experiences a variety of hallucinations and is directed by the force of karma into pleasant and unpleasant experiences (experienced with the mental body as being real-the way the mind experiences a dream) until in finally takes rebirth. In the womb, one has a variety of conscious experiences before birth.” (Clifford p108) 

   At the time of death first the five elements dissolve one after the other in the order first earth, then water, then wind, and finally the consciousness dissolves into space. Each of these stages are described in detail in the Tibetan book of the dead. It is considering important to know this so that one can easily recognize the stagers of death as they are occurring so as to remain unafraid. It is important not to be overcome by emotion, so as to avoid confusion while dying, so that one may recognize one is in the bardo and then guide one’s consciousness either to enlightenment or a better rebirth. For tantric practitioners, the exact time of consciousness dissolving into space is of highest importance. This is because at this moment space is revealed as the pure light of consciousness also known as the Dharmakaya reversing the process of creation. If one is able to remain conscious at the moment of death and recognize the Dharmakaya for what it is one achieves Buddhahood instantly. Tibetan medicine considers it important that the dying person not be under the influence of strong drugs or pain killers because it can interfere with the ability of a person’s consciousness to recognize the clear light at the moment of death. If one does not recognize the clear light one enters the bardo. 

   The Tibetan book of the Dead is read in the presence of the dead person’s body because it is believed that he can hear the recitation in his mental body. The book entail guides the person through a series of visions the person’s mind will have between death and rebirth. It continually reminds the practitioner to recognize that what he is experiencing are projections of his own mind for if he recognizes this fact his consciousness can become enlightened.   

    Eventually the consciousness merges with a body. The mental body sees various images of beings copulating, his karma attracts him to a particular couple and he enters a womb. At this point the process of being reborn in a physical body has begun and from the Tibetan medical perspective it is time to consider the relationship between the mother and the fetus. The diet and psychic/emotional relationship with the developing fetus is considered very important during pregnancy. The fetus is considering a conscious person and it is said “the consciousness of the fetus, grieved by the state of dirtiness, stench, darkness, and imprisonment, conceives the idea of escaping.” (Clifford p114) Birth is also said to be quite an ordeal. Gompopa describes it in this way, “At birth it feels like a cow that is flayed alive and as if stung by a wasp, and when it is bathed the touch of warm water gives it a feeling as if it was beaten.” (Clifford p.114) Every aspect of life is seen as filled with suffering. Tibetan medicine also has its own system for childbirth and pregnancy as well as form of birth control. 

   Tibetan medicine has an extensive pharmacology and these medicinal substances are divided into eight categories. These are gems and metals, substances derived from rocks and minerals, medicinal earths, exudates and secretions, medicinal substances obtained from trees, medicinal substances obtained from the boiled extracts of various plant parts, medicinal plants, herbs and grasses, medicinal substances obtained from sentient creatures. These substances are also categorized and arranged in a medicine mandala. Like any mandala, it contains a center and the four direction; east, south, west, and north. In each direction is a medicine mountain which contains medicines to treat a specific category of disease. “The four medicine mountains of the mandala provide treatment for hot disease; cold diseases; all diseases; and maintenance of the six vital functions and organs. These four divisions of medicine, which can be further reduced to two, preventative and curative, are a miniature model of the larger medical system.’ (Clifford p.118) The mountains of every direction are said to be planted with medicinal herbs by the medicine goddess Nectar Mother or Yitogma. 

    In the eastern direction is then mountain know as Fragrant Mountain or Ponadan. It is a mild jungle climate which contains the medicine known as the supreme medicine, myrobalan. The myrobalan is the plant that the medicine Buddha holds in his hand. “Myrobalan has all six tastes and all eight powers of Tibetan medicine. Its perfume drives away all four hundred and four diseases.” (Clifford p119) This is the category of medicinals that treat all diseases. 

   The “Cool Mountain” or Malaya is in the west. This is the category of medicine which is for the maintenance of the body. These are divided into six: Nutmeg for wind, clove for the life vein in the heart, cubeb for the spleen, cardamon for the kidney, saffron for the liver, bamboo pith for the lungs. This mountain also contains the medical minerals, metals and gems. “In the rocky parts of the mountain are found five kinds of pitch-gold, silver, copper, iron, and lead-which are good for fevers. Five kinds of quartz are also there, and five kinds of medicinal hot springs. The springs coming from coal are good for fever; from coal and sulfur are good for cold diseases and disordered fluids; from coal and pitch for bile diseases, act. In Tibet, there are many kinds of hot springs and the Tibetan medicinal use of thermal springs was an entirely indigenous development.” (Clifford p119) Also contained in this mountain are medicinal animals and gem stones such as turquoise which is said to be good for all diseases. 

   In the north is the “Snow Clad Mountain” or Gangchen, which is said to have the nature of the moon. Being a cold place, it grows medicine that are good for hot diseases. Here grow many fragrant substances that are used in medicinal incense such as sandal wood, camphor, and aloes wood. 

   In the South is “Thunderbolt Mountain” or Begche. It is said to have the nature of sun and grows medicinals good for treating cold diseases. These include black pepper, long pepper, and pomegranate. In the center of the mandala sits the Medicine Buddha.

   Also, very important in the gather, preparing and use of these substances is the state of mind off the doctor or herbalist. “The main thing is that one should not make medicine without utter and complete devotion to the guru and to the Medicine Buddha. Without demonstrating devotion of this kind, one will not even be able to receive medicine teachings. Tibetan doctors are not interested in telling their secrets or convincing anyone. They are interested in maintaining a pure samaya (tantric vow) with the Medicine Buddha, for from that comes all medicine power.” (Clifford 121) Some things the doctor must be aware of when going to collect medicinals are soil and weather conditions and how these effects the predominate element in each plant. However, when gathering these herbs, he must be mindful to regard himself as the Medicine Buddha and the plants he is gather as the mandala of the Medicine Buddha. He must maintain this mindfulness while cleaning and measuring the medical substances. This is to be done with grace and skill and even the arranging of the substances on a plate is to be seen in terms of creating a mandala. The actual preparation of the medicine is to be accompanied by prayer and even substances such as feces are to be viewed with the pure perception of a Buddha, meaning that they are not to be thought of as vile or disgusting. No matter how long the process of preparation, once begun it must be completed without taking any breaks. On top of this no negative emotions, such as boredom should be allowed to arise during the process.

Clifford, Terry, Tibetan Buddhist Medicine And Psychiatry: The Diamond Healing.  Samuel Weiser, Inc. 1984 

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