1 Outline of Disease
In this world, all breathing creatures, all beings – whether human beings, animals, whatever – are exposed to different forms of suffering. In the Tibetan system we believe that whether we are physically healthy or not, basically all of us are sick. Even though disease might not be manifest, it is present in dormant form. This fact makes the scope of disease difficult to fathom.
THE ORIGINS OF ILLNESS
With respect to the origins of illness, Shakyamuni Buddha propounded that there are 84,000 different types of afflictive emotions, such as desire and hatred, which have corresponding effects on beings, thus producing 84,000 different types of disorders. These can be condensed into 1,016 types of disorders which can further be condensed into 404.
The factors giving rise to disorders are causes and conditions, the latter enabling the causes to ripen or manifest. Causes are of two different types – distant and proximate. The proximate causes are wind, bile, and phlegm.3 With regard to the distant ones, the distinct causes for each disorder are difficult to enumerate because basically all disorders have their origin in the mental environment of the past – prior afflictive emotions – and it is these mental factors that are ultimately responsible for all types of disorders. These afflictive emotions impel actions (karma) that establish potencies in the mind, ripening later as specific diseases. Hence, it is impossible to determine all the specific distant causes involved in a particular disease; however, the basic entities of those causes are the afflictive emotions of desire, hatred, and obscuration. These three, in turn, depend upon ignorance.
Ignorance refers to a state of mind that not only is not aware of how things actually exist, but also misconceives the nature of phenomena. Ignorance gives rise to desire which, in turn, leads to hatred, pride, jealousy, harsh speech, more obscuration, and so forth. In rough terms, from the activity of these negative states of mind arise the three types of humoral disorders of wind, bile, and phlegm. Forty-two types of wind disorders arise in dependence upon desire; twenty-six types of bile disorders arise in dependence upon factors of hatred such as pride and jealousy, and thirty-three types of phlegm disorders arise in dependence upon obscuration – making a total of one hundred and one diseases.
CLASSIFICATION OF DISEASE
Disorders can be classified by different methods in terms of location in the body, type, environmental factors, and so forth. Here, by considering four classes of these one hundred and one diseases, there come to be four hundred and four:
1 101 disorders that are under the strong influence of actions (karma) in previous lifetimes
2 101 disorders of this lifetime – which have their causes in an early period of the life and manifest later in this same lifetime
3 101 disorders involving spirits
4 101 superficial disorders, so called because by simply following proper diet and behavior patterns one can correct them without having to resort to medication and accessory therapy.
The last type, superficial disorders, may result from improper intake of food – imbalanced diet – or behavior patterns; thus, these are self-curing without resorting to any form of treatment if the temporary conditions of diet and behavior giving rise to them are corrected. However, disorders of one lifetime, which have their cause in an earlier part of your life and manifest at a later time and are related with karma, will usually prove to be fatal unless treated. Seeking treatment is vital in this type of disorder. Moreover, in some cases mere material medication may not suffice; you will have to resort to spiritual practices such as disclosing past ill-deeds (confession), lessening their force by engaging in virtuous practice, and developing an intention to refrain from such deeds in the future. In these cases, virtuous activity and medication work together.
With respect to diseases that involve interference by spirits, there are, according to the Buddhist explanation, unseen forces that can harm an individual, and thus, even if there may not be any visible cause for a disorder, the person can be afflicted with pain and different forms of disorders due to the influence of such spirits. Though treated for a long period of time with medicine, the person does not respond to treatment and continues to suffer. The reason for this is the spirit behind the disease, and unless it is subdued by spiritual methods, no form of therapy – external or otherwise – will be able to free the person from that disorder. When the spirit is exorcised, however, the disease is cured.
With regard to the one hundred and one types of disorders that are due to past actions, Buddhists believe in rebirth, that is, we believe that there are past lives; these types of disorders are attributed to negative actions committed in past lives. When that karma ripens and a disease manifests in the present lifetime, it is very powerful and thus is generally fatal. In Tibet, people with this type of disorder would often renounce all worldly activities and engage in spiritual practices; however, few survive this type of disorder because the disease is a ripening of a powerful action that has been committed in the past.
THE BASIC MEDICAL LITERATURE
The medical teachings of the Buddha are primarily four texts called the Four Tantras.4 The first is known as the Root Tantra.5 It is a very short text and mainly presents an outline of the whole medical teaching. The second is the Explanatory Tantra.6 It deals with formation of the human body (embryology), anazomy, signs of death, how conditions cause the manifestation of disorders, the characteristics of particular disorders, the functions of wind, bile, and phlegm when these operate properly and how they bring about diseases when imbalanced, and the corresponding medicines required to correct particular disorders. This second tantra also prescribes the diet and behavior patterns for maintaining health and for combatting disorders – for instance, the types of food one should refrain from, the quality and quantity of food that one should take, and different types of behavior – seasonal behavior, daily behavior, and temporary behavior.
The third, the Oral Tradition Tantra,7 is an extensive technical textbook that identifies the different types of disorders – their causation (etiology), nature (pathology), and therapy. It presents each of the major disorders individually and in great detail – discussing their causes, conditions, and symptoms as well as the methods of treatment to be used.
The fourth, called the Last Tantra,8 deals with methods of diagnosis such as urinalysis and pulse-taking as well as the manufacture of medicines.
In particular, in the third text, the Oral Tradition Tantra, it is explained that this is a period of ruination, beings having coarse behavior, pride, desire, hatred, and obscuration -householders having no ethics and clergy not being without lust. Buddha mentioned that later during this period of degeneration, human beings would develop various types of chemicals that would lead to different types of disorders, called the eighteen malignant or critical disorders during the era of degeneration.
Types of cancer and so forth that are prevalent nowadays but were not so in the past are found among these eighteen types of critical, malignant disorders. These can be further classified in terms of wind, bile, and phlegm and combinations of these, each having eighteen types with individual subdivisions.
We can also categorize types of cancer, for instance, by referring to the four classifications outlined earlier. In those terms, there are tumors having superficial factors involved caused by improper diet and behavior patterns; these are naturally curable by restoring good diet and behavior patterns. Then, there are types caused by factors within one lifetime which if treated can be cured but, if untreated, can prove fatal. Those caused by spirits are very difficult to treat and will generally prove fatal unless spiritual methods are employed. Then, there are cancers that have their origin in a negative action committed in a previous lifetime; this final type of cancer cannot be cured by any physician.
Another way in which these critical disorders are further classified is in terms of the area or location affected – the vital organs, reservoir organs, vessels, bone, flesh, the sense organs, and so forth. Tumors, also, are described separately from these eighteen critical disorders under a classification of eleven types – these being related with the five vital organs (heart, lungs, liver, spleen, and kidneys) and the six reservoir organs (stomach, small intestine, large intestine, gall bladder, seminal vesicle, and urinary bladder). Again, these are further treated in terms of tumors on the surface, inside, and inbetween; for instance, on the surface, inside, or inbetween the surface and the inner part of a lung, liver, or the stomach.
From my own experience I have found Tibetan medicine to be effective in certain cases of cancer. Several Indian patients who were considered terminal cases have been greatly helped by Tibetan medication over the past several years; some report this in person, others have written to this effect. I will not make claims that there have been a great many.
Other types of disorders for which I have found Tibetan medicine to be extremely effective are hepatitis, certain types of mental disorders, ulcers, paralysis, gallstones, kidney stones, and arthritis. Thus, from my own practice I have found that our system of medicine has proved to be effective for several chronic disorders.
This has been a general introduction or outline of the types of illness; they are described in great detail in the texts.
2 Course of Study
How is Tibetan medicine studied? As mentioned earlier, there are four primary medical texts which Tibetan medical students have to study. During a year or two of preliminary study, they have to memorize at least three of the Four Tantras, these being the first, second, and fourth – Root Tantra, Explanatory Tantra, and Last Tantra. The third, the Oral Tradition Tantra, need only be studied, not necessarily memorized during this preliminary time.
Then, during the first year of actual study, medical students study the Root Tantra with the help of visual aids called the “Illustrated Trees of Medicine.” Three trees are used to illustrate physiology and causation, diagnosis, and treatment. During the second year they study the Explanatory Tantra, beginning with embryology and emphasizing causation, In the third year they study the Last Tantra which deals with diagnosis, particularly methods of urinalysis and pulse taking, two of the most important forms of diagnosis a Tibetan doctor uses in determining a patient’s disorder. After that, during the fourth year, or even longer periods, they spend time in a clinic with a doctor, observing how all the topics learned are applied in practice; they also study medical commentaries.
In Tibetan medicine, physicians and pharmacologists are not separate persons. A doctor must know all aspects of medicine. Therefore, especially during the summer, students accompany physicians to the mountains to study herbs and plants, taking particular notice of their potencies, faults, and advantageous qualities. Then during the winter, they learn how to manufacture medicines. Thereby, they learn all aspects of medical practice.
Regarding the people who trained in Tibetan medicine before the Communist Chinese takeover, most doctors were monks. However, each district in the country selected two lay candidates and sent them to attend the Medical and Astrological College in Hia-sa, the capital of Tibet – one to become a doctor and one to become an astrologer. Apart from these two candidates from each district, two monks were selected from each of the major monasteries to attend the medical college. Thus, there were two categories of selections lay students selected by district authorities and monks from major monastic centers.
On completion of medical school, lay students returned to their district to practice. Of the monk students, one had to stay at the medical school to engage in practice or research there, and the other had to return to his monastery to practice.
ORIGIN OF THE FOUR MEDICAL TANTRAS
Regarding how the basic four medical texts originated, during an earlier time the Medicine Buddha appeared in this world, displayed the twelve deeds of a Buddha, including becoming enlightened and teaching trainees. He prophesied that in the future the fourth Buddha, Shakyamuni Buddha, would manifest as the Medicine Buddha in India for the sake of trainees.
Later, when Shakyamuni Buddha manifested as the Medicine Buddha, from his heart was manifested Ak~hobhya; from the crown, Vairochana; from the throat, Amitabha who requested the teaching; from the navel, Ratnasambhava; and from the secret region, Amoghasiddhi, Akshobhya, Vairochana, Ratnasambhava, and Amoghasiddhi taught the four medical tantras; however, it actually was the Medicine Buddha in the form of the Buddhas of these four lineages who revealed the teachings.
The Root Tantra was taught by Akshobhya; the Explanatory Tantra, by Vairochana; the Oral Tradition Tantra, by Ratnasambhava; and the Last Tantra, by Amoghasiddhi. Amitãbha, entity of the wisdom of individual investigation, requested each teaching. Thus, the Medicine Buddha first emanated Amitãbha, who requested the Medicine Buddha for the teaching. This request was accepted, and each of the other four Buddhas were emanated, thereupon giving their respective teachings. As in the Guhyasamdja Tantra, the speakers and requester are all the same being.
CONTENTS OF THE FOUR TANTRAS
The Root Tantra consists of six sections, the initial major topic being the healthy body.9 This is called the ordinary untransformed body, meaning that the three humors -wind, bile, and phlegm – are not acting as direct causes of disorders. Nevertheless, disease is naturally present in dormant form; the conditions to cause it to manifest have not yet been encountered. The three humors are, therefore, in a state of balance, not imbalanced.
It is important to remember that the three humors exist in all beings, acting as factors maintaining good health when they are not imbalanced and acting as causes of disease the moment they become imbalanced. Thus, their function is dual; in the state of balance they perform the functions of a healthy body, helping to keep good health, but the moment they are disturbed, these very three turn into causes of physical and mental disorders.
In this section on the healthy body, the Root Tantra mainly treats these three types of humors, with five varieties each, as well as the functions of all fifteen – the most important topic in Tibetan medicine. It also explains the activities of the five winds, five biles, and five phlegms when, in a state of imbalance, they promote disease. The Root Tantra also briefly speaks about symptoms of disorders and methods of healing as well as mentioning in a brief way topics that are discussed in detail in the other three tantras.
The first seven chapters of the second text, the Explanatory Tantra, deal with the formation of the embryo, development of the fetus, birth, and so on right through to death. They also discuss how the five winds, biles, and phlegms function when in balance to maintain health in the body -how they function individually as well as the general qualities of wind, bile, and phlegm. These seven chapters finish with the process and signs of death, either due to disease or otherwise.
The next three chapters deal with the causes, conditions, and classifications of diseases. Conditions are those factors that help the cause to manifest as a particular disease. This means that even if the cause is present, if the conditions are not, the disease will not manifest. Then, it details the classifications of diseases, at the end of which it describes the characteristics of types of disease.
The following chapters describe the tastes of medicinal ingredients, their potencies, and post-digestive effects. The tastes of medicinal ingredients are important as indicators of their potencies with respect to counteracting disorders. After speaking of the potencies of ingredients in terms of their tastes, these chapters detail how medications with different tastes and potencies work. Finally, they speak of the post-digestive potencies of drugs how they work after digestion. The action of drugs is slightly different before digestion during the period of ingestion, and then after digestion, when they have been assimilated.
After this, there is discussion of treatment in terms of diet and behavior patterns, these being vital for maintaining good health as well as increasing life span. Diet is treated in terms of the way food should be taken and its quantity as well as recognizing improper diet. Next are chapters on behavior patterns – daily, temporary (such as during the seasons), and continual.
Then there is a section on methods of prolonging life -how to maintain good health by keeping the humors in balance and thus avoiding disease. There is also a section about the methods used to cure different types of disorders, and finally the last section is on the code that physicians should follow in conducting their profession. It talks about commitments, how doctors should regard patients, and so forth. In total, the Explanatory Tantra has thirty chapters.
The third text, the Oral Tradition Tantra, consists of fifteen main sections with ninety-two chapters in total. These deal with the one hundred and one humoral disorders of wind, bile, and phlegm – the causes and conditions of each of these disorders, the symptoms, therapy consisting of diet and behavior patterns to be recommended for the disorder, and medication to be prescribed once the diet and behavior patterns fail to bring about the requisite cure. Finally, it discusses accessory therapies used if medications fail.
The Last Tantra consists of four sections which altogether have twenty-five chapters. The first section deals with diagnosis, the first two chapters of which describe urinalysis and pulse reading. The second section deals with the preparation of medicines – their content, nature, potencies, and so forth – in the form of pills, powdered medicine, syrups, desiccated medication, medicinal butters, and so forth. After that, the third section discusses pacifying, or alleviative, medications – purgatives and emetics – and then, those types of medication that actually destroy or completely subdue disorders. Last is a section dealing with accessory therapy in mild and severe forms, used if the initial herbal medication fails to bring about the cure and also as a preventive form of medication. These include moxa, acupuncture, surgery, and so forth.
That is an outline of the contents of the four primary medical textbooks. Later, I will discuss relevant sections and chapters in some detail.
BASIC CAUSE OF DISEASE
What is the essential point of these many topics? The most important point concerns ignorance, for the entities and causes of all illness derive from ignorance. From ignorance, there is obscuration, due to which we do not recognize unsalutary states of mind as faulty and instead generate desire that leads to many ill-deeds and the accumulation of bad karma. Similarly, obscuration leads to hatred, resulting in, for instance, the speaking of harsh words, insults, and attacking others. Likewise, jealousy generates senseless competitiveness, and pride causes one to look down on others.
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. Due to this correspondence, desire produces wind disorders. Hatred is like fire; from it, bile disorders as well as blood-bile disorders arise.
The root is beginningless ignorance. Due to its force we are caught in cyclic existence, in the round of repeated birth, aging, sickness, and death. Ignorance is with us like our own shadow; thus, even if we think that there is no reason to be ill, even if we think that we are in very good health, actually we have had the basic cause of illness since beginningless time.