This exploration focuses on diagnosis and healing in the Tibetan medical system. The domain of the Tibetan medical system, and arguably all medical systems, is regarding health and illness. But the Tibetan medical domain also extends to suffering, which I believe is a key concept and facet that differentiates their system. Plus, within this broad domain of illness and health, the definitions of those two things are fundamentally different depending on the system of medicine; it can be culturally or experientially constructed, can be in terms of gender, age, etc. So, there are key concepts and constructs that go into building and explaining this specific domain. Constructs in a general sense are tools that we create and use to carve up this abstract space in order to talk about it and form inquiries, investigations, etc. about. With constructs we are able to explore abstract things. But with Tibetan medicine, specifically, concepts and constructs are a necessary means of defining what illness is (both patient and doctor related) and understanding what constitutes an illness.
Concepts & Constructs
Disability, dysfunction and disease are three concepts within the Tibetan medical system. Then there’s also this idea of treatment/cure or prevention and diagnosis. But with diagnosis comes a required knowledge of the illness/disease along with knowing what you’re looking for. In Tibetan medicine there is a clear understanding of what healthy versus unhealthy urine looks like – so you know what to look for and you know what each type of unhealthy urine is related to. For example, the urine of Loong disorder has certain characteristics, the sediment is hair-like and the scum is scattered. It is vital that an individual can read and understand the body and how it works along with this mind-body knowledge, an embodied knowledge that individuals who practice Tibetan medicine have by using their senses. But this is not just in the form of the doctor, the patient must also have an embodied knowledge about what’s “wrong” or different from their “normal.” It is key for an individual to pay attention to what’s going on in their body, guided by previous experience but also guided by what health and a good body should feel like so when there are deviations the individual knows something is wrong or “unhealthy.” There are four facets of diagnosis: signs and symptoms, interpretation, triangulation, and exclusion and dialectics – all four of these things aid in giving an individual the knowledge to determine that something is “wrong.” Another key concept/construct is that of the patient and the doctor/healer. This relationship is highly constructed in that one person is trusted to have the knowledge/expertise in order to gain the other’s trust to hand over their vulnerable body and share/show the healer intimate things.
Principles & Pragmatics
Now if we take a look at the principles and pragmatics of Tibetan medicine and its domain, the ideas are fascinating. Generally speaking, principles and pragmatics refer to the metaphors used to describe a certain domain and why we think in the way that we do regarding that domain. In Tibetan medicine, the body is looked at as a field of movement; it’s an interrelated non-mechanistic system. This is very different from western medicine, which views the body as a machine to be “fixed.” In the Tibetan system, it’s more about this vulnerability in the constitution of the person; there’s something internal that makes you susceptible to a disease/illness/”deviation” of your normal state of well being. Basically, something is off-balance – and this balance is the ultimate and beautiful metaphor that encompasses the Tibetan medical system as a whole. Now a question you might ask is, what can put you out of balance in the Tibetan system? And the answer to that is the mind; the mind is the ultimate source of illness and suffering in Tibetan medicine. It can even be described as a philosophy because it embraces three key Buddhist principles of compassion, karma and ethics. But this dynamic relationship between the mind, body and soul is an important principle in Tibetan medicine. It begins with the inverse relationship between knowledge and ignorance. Ignorance then leads to egotistical emotions which causes things like desire/attachment, aggression/anger, and closed-mindedness/obscuration which ultimately makes us conscious of our body in relation to the five elements of earth, water, fire, air and space and the three faults/humors (Loong, Tripa, and Baekan) that can affect us. Ultimately, the principles and pragmatics of Tibetan medicine are extremely important in understanding the organization and underlying facets of the domain itself.
Motivations & Intentions
There are many motivations and intentions involved in any domain of knowledge. With Tibetan medicine, the ultimate point is to understand and make meaning of well being and illness. “Tibetan Medicine is a science, art, and philosophy that consists of a holistic approach to health,” (Tsarong et al., 1981). Tibetan medicine intends to look at the mind body relationship with each other and its environment in order to maintain optimal health and well being among the people. Tibetan medicine’s motivation is healing, but not just healing the body, it emphasizes healing the mind as well. In doing so, it aims to heal mental poisons and create/maintain a healthy mind. This includes ridding the mind of feelings of attachment, anger, and/or obscuration. In healing the body, Tibetan medicine aims at balancing the three energies of Loong, Tripa, and Baekan. “Tibetan medicine seeks to foster a state of optimal health in the individual through the resolution of underlying states of disorder and elimination of their fundamental causes” (Dakpa, 2009), this basically sums up the motivation and intention of Tibetan medicine in a beautifully worded way. But the spiritual aspects of this domain are extremely important as well, as one of their intentions is empathy. Empathy shows the patient that their relationship with their healer is not superficial, but rather deeper and more meaningful, which results in the patient feeling less powerless and vulnerable.
A. Tibetan medicine consists of many key practices associated with diagnosis and healing. It is referred to as an “art” because it “uses a range of diagnostic techniques to identify various problems and diverse therapeutic measures” in order to maintain optimal health (Tsarong et al., 1981). There are three main diagnostic practices: visual (tha), touching (rek), and questioning (dhe). The visual diagnostic test involves an examination of the complexion of the skin, texture and color of the blood, feces, irregularities of the body, and other things of the sort. One widely known example of this is a urine examination, which consists of eight general sections ranging from preliminaries (diet and lifestyle) to urine formation to urine indicating death/evil spirit influences. There are clear cut characteristics of healthy and unhealthy urine, this is knowledge that all individuals who practice Tibetan medicine must have in order to have success within their domain. For example, healthy urine is clear light/yellow while unhealthy urine can be bluish, yellowish, or whitish and turbid.
B. The touching diagnosis consists of feeling multiple parts/vital points of the body that have pain or irregular growth; an essential aspect of Tibetan medical practice used in this diagnosis in sphymology or pulse reading. The pulse examination has thirteen general sections ranging again from preliminaries (diet and lifestyle) to time/place/pressure to conclusions about what kind of pulse the individual has (constitutional, seasonal, healthy, death, influenced by spirit, etc.). With the urine examination, the healer must have knowledge of the physical characteristics of urine in order to determine its health impact, but with the pulse examination the healer must know how to do this procedure and how to read the results they receive – it’s not merely about physical characteristics, it’s a specific practice. The Tibetan doctors use a specific variation of finger pressure based on their index, middle and ring fingers in order to properly examine a patient’s pulse. They must press lightly, moderately, and strongly to feel the skin, flesh, and bone respectively. The Tibetan doctors also understand the twelve distinctive pulse characteristics and use those along with their sense of perceptions, insights, etc. to create this constant inner dialogue in order to ultimately heal their patient.
C. Then there is the questioning diagnosis, which involves asking about the individual’s history, signs and symptoms, lifestyle, diet, and other things of the sort as well. This type of method is characterized by tracing the different facets of any patient and using that individualized knowledge to help the diagnosis and healing process.
D. There are four key practices in the healing process: diet, behavior, medicine and accessory therapies. As said before, imbalance is the biggest factor in any illness within Tibetan medicine. The two biggest areas that Tibetan doctors focus on healing are the body and the mind. It is believed that “healing negative thinking and making healthy lifestyle choices” (UMinnesota, 2014) can ultimately restore this loss of balance in one’s mind and body. Tibetan healing practices commonly use herbal medicine, prayers/mantras, and visualization/meditation techniques such as thought transformation.
Division of Labor
As I researched deeper into Tibetan medicine, I didn’t find too many sources that spoke of a huge division of labor among this specific domain. I did find some interesting points in the book Soundings in Tibetan Medicine (Brill, 2007), which described this division of “therapeutic labor” between classical Tibetan physicians (“amchi”) who treated “wind illnesses” that were said to be uncomplicated by spirits, and specialized lamas who worked with exorcism in cases of spirit attack/possession. However this division of labor was present specifically in regards to mental illness. Moreover, an article in “The Tibet Journal” by Denise Glover discussed a division of labor in Tibetan medicine between doctors who diagnosed illness (C, kanbing) and doctors who mixed medicine for the illness (C, peifang). The article explains this change in medical practice between two generations of Tibetan doctors, a chance that has to do with specializations. She explains that students studying Tibetan medicine were encouraged to pick one of the two specializations (diagnosis or medicine-mixing) so that they can be placed in a facility once they graduate, and that this division of labor is reinforced by the Tibetan Hospital administrative units. But besides this inconsistent division of labor, there are concrete roles involved in Tibetan medicine. Ultimately, there is the role of the patient and that of the healer/doctor. The patient’s role is to understand and have knowledge about their own body so that they can detect when something is “wrong;” their role also requires them to become vulnerable, trusting, and willing to share their body with another individual. However that other individual is a healer whose role is to know and understand exactly what the “problem” is with their patient and be able to “heal” them in one way or another.
Sources of Knowledge
I believe that most of what I’ve said thus far in my exploration relates to the sources of knowledge found in Tibetan medicine. So I will just emphasize that the patient and healer must share mutual knowledge about what is wrong with the patient and what is off balance in order for the healing process to occur. Then there is also a very empathetic form of communication that must take place between patient and healer so that the patient trust their doctor and the doctor genuinely cares about the health of their patient, thus increasing their chance of successful healing. There is also the relationship between knowledge and skill; while the patient has a source of knowledge regarding the imbalance in their body, the doctor has the skill to be able to restore that balance. But please take into account the concepts, principles, and practices already mentioned as evidence for these sources of knowledge as well.
Conclusion & Assumptions
In conclusion, I will discuss the foundational assumptions regarding Tibetan medicine. First and foremost, Tibetan doctors believe that there are other foundational materials in the world; it’s not just physical/material but rather mind and soul. In order to understand this assumption, I looked at the Buddhist concept of mind. “The mind is non-physical; it is formless, shapeless, colorless, genderless, and has the ability to cognize or know” (Hawter, 1995). This is vital in Tibetan medicine, as the mind is believed to be the creator of any and all problems, meaning that the etiology of the disease is internal rather than external/physical. Tibetan medicine values empathy and compassion. These are the two main foundational assumptions of this domain and they are two facets of Tibetan medicine that make it a holistic approach to health and well being, combining the physical body with the nonphysical mind and soul.
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