I don't know very much about the subject, but I am willing to give it a try.
I tried once before, in November 2004, when I gave a series of five lectures on the subject of Tibetan medical compounds. This was done in Southern California, through the kind auspices of some indulgent friends in the medical profession, and took place over a period of five days: one lecture each day. The conditions were ideal -- we were at the Los Angeles County Arboretum, surrounded by unimaginable richness and beauty. Only five years ago, but it seems a million miles away.
Now, we are going to inflict the second lecture upon you, as follows. To avoid re-typing, I have done a cut and paste from the annotated transcript that was published in 2005, and caution you that the formatting may not be all that smooth depending upon your viewing platform.
Human bodies are a collection of spaces. Some of these spaces are immediately tangible while others are not. Different systems of categorization describe, define, and delimit such tangibles and intangibles. For example: we can speak of organs and skeletal structures, or energy centers and pathways. How we name these constituents is culturally specific or peculiar to belief, and changes with the age or circumstance in which we live.
Airs and fluids are an important essence of the collective space and are a kind of space themselves. The whole of these spaces is porously enclosed, and exposed to yet another space: the space around us. Thus, we can say the human body is an aggregate transparency, seemingly regulated by subtle natural laws that affect the intersection of the space around us and the space within us.
The ancient medical systems of India, China, and Tibet use different words but the concepts they communicate are the same. Human beings are created, sustain for a while, decline, and then pass away. Human beings want to remain free from pain and disease, and we want to live as long as possible, so how life sustains becomes an important study.
The Five Courses
Over several thousand years, philosophers in Asia began to understand that we are created and sustained by evolutionary courses or principles of natural existence, sometimes referred to as the “five elements.”
[3]
In India, these are named ether, air, fire, water, and earth. In China, these are named wood, fire, earth, metal, and water.
There is a tremendous corpus of information surrounding the five courses, in both the Indian and Chinese natural philosophies. Much of this is also readily available in the West, and is being incorporated into modern Western thinking. This information explains the great variety encompassed by nature, and is exquisite in detail. For the moment, we need not examine such detail. We only need to observe that both systems recognize five principles, and putting aside cultural constructs, both systems describe the same thing.
What they describe is the relationship and interaction between the subtle and the gross, between space and density. Wellness is perfectly balanced interaction. Disease is either excess or deficiency that places interaction out of balance.
Because we are oxygen-breathing terrestrials possessed of the complex notion of volition, excess and deficiency arise synergistically within, and with our relationship to the environment. There is a profound connection with how we think, how we act, where we are, what time it is—and how we feel.
Tibetan medicine works when we remember three things:
(1) The five courses devolve into three basic physical states of being, together with their sub-types.
(2) There must be harmony of the courses within such types.
(3) We can alternately stimulate and soothe to correct imbalance and restore harmony.
The Three States of Being
The primary physical states of being—the three somatotypes—suggested in Tibetan Ayurvedic theory are in the Sanskrit language called: Vata (sometimes Vayu), Pitta, and Kapha.
[4] In the Tibetan language, we translate these as rLüng [pronounced “lhuoong”], mKhris-pa [pronounced “tripa”], and bad-kan [pronounced “bekan”].
[5] In English, we translate these as air, bile, and phlegm. Collectively, these are known as
nad, or humors; alternately, when considered in their morbid state, they are called
nyes pa, or afflictions.
Singular properties are assigned to each of the three somatotypes: rLüng corresponds to ether and air,
[6] and metabolic process; mKhris-pa to fire, and catabolic process; bad-kan to water and earth, and anabolic process. Imbalance or disturbance of said elements is reckoned as the root cause of the various and sundry disorders afflicting the human body and mind. Thus, we speak of rLüng conditions, mKhris-pa conditions, and so forth.
Cultivated knowledge of the three somatotypes is the single most important tool available to Tibetan physicians. Accordingly, I will discuss each type in detail. You may feel such detail excessive until I explain a complete exposition would require volumes of considerable size. As it is, I will try to impart the classic fundamentals, as taken directly from the
Four Treatises. I invite you to consider the information concerning each type carefully, and as you do so, try to apply what you read to various acquaintances you have. This is the best way to begin training your eye.
Over the past, a few books have been published that describe the states of being in modern terms deemed suitable for Westerners.
[7] For example: I have seen attempts to correspond the three somatotypes to ectomorph (rLüng), mesomorph (mKhris-pa), and endomorph (bad-kan), but these are not precisely on point. Interpretation becomes necessary because literal translation from the Tibetan and Sanskrit originals, while philosophically precise, is difficult to appreciate when one habitually uses subjective or relative phrases to describe human behaviors. For example: if I say, “her actions fail her views,” you might not understand that she is what you call frustrated, and you will likely miss the deeper implication of her inability to put acquired knowledge into meaningful practice. I thus have no exception with modernization, as it is useful. Still, I believe there is enduring benefit in the classical exposition.
[a]. Pattern recognition of rLüng.
The rlüng Somatotype
The rLüng somatotype arises in worldly passion: desire, attachment, and lust. rLüng’s locus is the pelvic and lumbar regions, where it remains and regulates the lower third of the body. Like the other two conditions, it worsens or lessens in response to time or season, diet, conduct, and the influence of spirits. rLüng is aggravated by cold or windy climates; old age; late summer; the afternoon, and the late night: specifically, diseases form in spring, break out in summer, and subside in autumn. The best times are in the afternoon, between 1200 to 1500, and again at night, between 2400 to 0200. The worst times are in the early morning, before 0700, and again in the evening, between 1700 to 2000. Indulgence in light foods, or an insufficiency of oils is contraindicated.
Manifestations
[8]
The five rLüng manifestations are Srog-’dzin, the life sustaining wind, resides in the heart; Gyen-rgyu, the ascending wind, resides in the chest; Khab-byed, the pervasive wind, resides in the head; Me-mnyam, the fire accompanying wind, resides in the abdomen; Thur-sel, the descending wind, resides in the genital area.
Morbidity
rLüng, like the other two nyes pa, once morbid permeates through the skin; courses through the muscles; is transported through the vessels; adheres to the bones; attacks the solid viscera, and then falls upon the hollow viscera.
rLüng morbidity is indicated by yawning; contraction of the muscles; shivering with cold; pain in the pelvic region, the lumbar region, and in the joints and bones; vague and shifting pain; dry heaving; diminished senses; unclear thought; pain after digestion, and hunger pain. It is recognized by observing a red, dry, and rough tongue, and water-like urine with excessive bubbles. Palpation discloses an empty pulse that skips beats.
Alleviation
The condition is relieved by residence in a hot climate, and the company of agreeable friends. Diet should include heavy meats, marrow soups, oils, aged butter, garlic and onion. Light alcoholic drinks are helpful.
[b]. Pattern recognition of mKhris-pa.
The mKhris-pa Somatotype
The mKhris-pa somatotype arises in anger and hatred. mKhris-pa resides in the liver and gall bladder, where it remains and regulates the middle third of the body. mKhris-pa is aggravated by deserts and dry climates; adulthood; autumn; midday and midnight: specifically, diseases form in summer, break out in autumn, and subside in winter. The best times are in the morning, between 0800 to 1100, and again in the evening, between 2000 to 2400. The worst times are in the afternoon, between 1200 to 1500, and again in the night between 2400 to 0200. Indulgence in hot or spicy foods is contraindicated.
Manifestations
The five mKhris-pa manifestations are ’Ju-byed, the digestive, residing in the small intestine; mDangs-sgyur, the color transforming, residing in the liver; sGrub-byed, the accomplishing, residing in the heart; mThong-byed, the sight giving, residing in the eyes; mDog-gsal, the complexion clearing, residing in the skin.
Morbidity
mKhris-pa morbidity is indicated by a bitter taste in the mouth; headache; sensation of heat in the muscles; pain in the upper third of the body, and pain during digestion. It is recognized by observing a thick coat of pale yellow phlegm on the tongue, and steamy, reddish or yellowish urine of foul odor. Palpation reveals a rapid pulse.
Alleviation
The condition is relieved by residence in a cold place, and a stress-free lifestyle. Diet should include dairy products such as curds, buttermilk, and butter, meat of animals from an arid region, barley, spinach, and dandelion. Black tea and cold water are helpful.
[c]. Pattern recognition of bad-kan.
The bad-kan Somatotype
The bad-kan somatotype arises in illusion and ignorance. Bad-kan resides in the brain, where it regulates the upper third of the body. Bad-kan is aggravated by moist and humid climates; infancy; spring; the evening and early morning: specifically, diseases form in winter, break out in spring, and subside in summer. The best times are in the early morning, before 0700, and again in the evening, between 1700 to 2000. The worst times are in the morning, between 0800 to 1130, and again in the night between 2000 to 2400. Indulgence is heavy, oily food is contraindicated.
Manifestations
The bad-kan manifestations are rTen-byed, the supporting, residing in the chest; Myag-byed, the decomposing, residing in the stomach; Myong-byed, the experiencing, residing in the tongue; Tshim-byed, the satisfying, residing in the head; ’Byor-byed, the connecting, residing in the body joints
Morbidity
Bad-kan morbidity is indicated by anorexia; difficulty in digestion; vomiting; distaste in the mouth; flatulence; belching; a heavy sensation in mind and body; sensation of cold, and a feeling of discomfort after eating. It is recognized by observing a pale, thick, dull, soft and moist tongue, and clouded urine. Palpation discloses a weak, slow pulse.
Alleviation
The condition is relieved by residence in a hot place, and physical exercise. Diet should include lamb and the meat of carnivores, fish, honey, and roasted flour of old grains from dry lands. Curd, buttermilk, strong alcoholic drinks, and hot water are helpful.
So, here we have the philosophical foundation upon which Tibetan pharmacology rests. We now turn our attention to the ingredients of medicinal compounds, which we find in the vast treasury of the Tibetan materia medica.
Holistic well-being, or the absence thereof, is intimately related to one’s native habitat, or immediate environment. The Chinese knew this, as witness the
Neijing Suwen (c. 300-100 bce), which assigns certain disorders to certain geographical locations. However, we humans have a natural tendency to think, “If it worked for him, it can work for me.” There is also the simple issue of falling ill in a foreign climate. Therefore, as travel and trade progressed, people started bringing in medical substances from far away places. If you think about it, this makes perfect sense.
The Tibetan materia medica consists in near entirety of natural substances indigenous to the Himalayan region, and the Central Asian plateau, with a few strategic components from elsewhere. The external components are an artifact of Tibet’s rich history of interaction with medical traditions of neighboring civilizations, and a feature of migration along the old Silk Route.
In seminal expression, a medical tradition allows people to maintain their health with the things near at hand. A medical system, which is something different, develops when people can treat more or less anything, anywhere.
It is a philosophically challenging exercise to pass from tradition to system. I know some master herbalists who only compound medicines with ingredients that originate where they will be used. For example: I know a Greek herbalist who refuses to export anything that he makes in Greece. He prefers to reformulate his medicines, using herbs indigenous to the area where they will be consumed. That is a very intelligent, almost divine approach but it runs contrary to human nature, and in the age of travel, pandemic necessity.
The principal materia medica of traditional Tibetan medicine includes less than 500 substances, about 200 of which are botanicals. These natural substances are divided into eight categories:
{1} precious: metals and gems, such as gold, silver, iron, copper, pearl, coral, turquoise, lapis lazuli, sapphire, diamond, ruby, or emerald.
{2} earth: such as saltpeter, yellow ochre, bitumen, suphur, vitriol, or lichen.
{3} stone: minerals such as realgar, stalactite, tourmaline, or limestone.
{4} wood: tree roots, trunks, branches, bark, sap, leaves, flowers.
{5} nectars: such as resins, exudates, and aromatics like saffron or nutmeg.
{6} shrubs: grown in the hot plains, or alternately, herbs with thin roots.
{7} herbs: the thick roots, stems, flowers, leaves, and fruits of all medicinal herbs.
{8} life sources: substances of sentient origin.
Therefore, we can say that Tibetan medical material comes from the earth, from things that grow in the earth, and from beings that inhabit the earth. This last category naturally includes beings of the sky and the waters.
All of these substances are traditionally classified according to tastes, of which there are six, post-digestive tastes, of which there are three, and inherent potencies, of which there are eight, devolving from a larger list of seventeen attributes. In Tibetan, we call this ro, zu-rjes, yon-tan, and nus-pa: tastes, post-digestive tastes, attributes, and potencies, respectively.
To this number we also add a fifth concept, which is called no-ba, or specific action. Usually we know what a therapeutic effect will be based on taste. Occasionally, taste will be overwhelmed by post-digestive taste, and similarly, post-digestive taste can be overwhelmed by potency. In other cases, an effect is produced which has nothing to do with taste, post-digestive taste, or potency; rather, this is the product of the substance’s enzymological action, or biochemical role. This is what we call no-ba.
We could simplify this a bit and say that natural medical substances have intrinsic characteristics, i.e. the raw, or coarse potency; extrinsic characteristics, i.e. the latency they assume upon processing, and synergistic characteristics, which are assumed when processed substances interact with the human body. It is also important to understand that natural medicinal substances have synergistic relationships with each other. If they did not, there would be limited purpose to compounding them into medicines.
Synergy is an important word. “Synergy,” is simply defined as the phenomenon in which the combined action of two or more things is greater than the sum of their effects individually. Many years ago, everyone who compounded medicines understood such things. However, in the West, pharmacologists began to lose sight of this wisdom circa the first half of the nineteenth century, with the overthrow of the so-called vital force theory.
Until about 1850, organic chemists still believed that carbon compounds and other products of plant and animal life could not be produced without a “vital force,” supplied by living cells. Yet, in 1828, the famed German chemist Friedrich Wöhler—famed, because he discovered aluminum the year previously—was able to synthesize ammonia. Before this achievement, all ammonia was manufactured by heating animal urine with lime.
Wöhler was able to evaporate an inorganic salt solution of ammonium cyanate, converting it to urea, which is the product of the metabolism of protein, and present in the urine of all mammals. Thus, he was able to produce an organic substance from a nonliving source. A few years later, Wöhler’s student, Adolf Kolbe, was able to synthesize acetic acid. By the 1850s, scientists no longer believed in the vital force theory. Synthetic medicinal agents are the product of these early developments and beliefs, traced exactly thus.
Regardless of what Western chemists choose to believe or disbelieve, traditional medical agents are superior to synthetic medical agents precisely because of vital force.
I will prove it to you.
Let us take the example of an otherwise toxic material, such as aconite. The aconitum species all contain the alkaloid aconitine, which is one of the most toxic plant products known. You can be poisoned just by handling these plants. Tibetan medicine recognizes aconite, or Bong dMar, under ten names, and describes four varieties: white, red, yellow, and black. In the hands of a Tibetan physician, detoxified white aconite neutralizes poison, and cures bile disorders. Detoxified white, yellow, and red aconites cure infectious fevers.
Tibetan pharmacists have been doing this for well over one thousand years. To detoxify the aconite, they employ cow’s urine and sunrays, because bovine-derived urea acts with synergistic effect upon aconitine, in the presence of solar heat. The same effect cannot be obtained with Herr Professor Wöhler’s synthetic urea, nor indeed, with the urine of any animal other than those of the bovine species. As a further demonstration of synergy at work, consider the particular diet and habitat of cows, and the way they metabolize protein. There is surely a difference between this and the test-tube or chemical retort. As an aside, I should probably mention that seeds of Strychnos nux-vomica, or strychnine, are also detoxified by means of bovine by-products; by boiling in milk and frying in butter.
Tibetan natural medicines are divided into two broad potencies, i.e. warm medicines to alleviate cold disorders, and cool medicines to alleviate heat disorders. Thus, we speak of “cool” potencies, and “warm” potencies.
The two primary potencies are shaped by what we might call the five essentials:
1. The medicinal substances should be grown in their natural habitat, under pristine conditions, in environments that correspond to their inherent cool or warm potency. This is traditionally explained by reference to the mandala of the Medicine Buddha. The cool potency herbs grow on north-facing mountains, and warm potency herbs grow on south-facing mountains.
2. Each part of a medicinal plant has its own, optimal time of collection. Roots, branches, and stems should be collected in late autumn. Leaves, latex, and new shoots should be collected in late summer. Flowers can be collected when in bloom, while fruits should be collected in mid autumn. Bark, cortex, and resins should be collected in mid to late spring. There are also optimal times for collecting substances according to their intended use. For example: certain purgatives are collected in late autumn; certain emetics are collected in late spring. Finally, collection is ideally performed on auspicious days, at auspicious times, during the first fifteen days of the month, while reciting appropriate mantras.
3. The coarse potency of the medicinal plant must be removed. This is cleaning and detoxification, which sounds simple but is actually a very complex subject. Here we begin to approach the basic chemistry of Tibetan pharmacology.
4. Medicinal plants should be properly dried, according to their inherent natures. Thus, cool potency substances are dried in the shade, and warm potency substances are dried in the sun. In general, the substances should not be exposed to environmental factors that are antithetical to their potencies.
5. Raw herbs should be used within the year of their collection. This may come as a shock to Chinese herbalists—particularly those in the United States—but this admonition explains why Tibetan herbal remedies succeed where Chinese herbal remedies fail.
These are the basics. When this is explained in Tibetan medical schools, the list is seven—called the Seven Essential Limbs—not five as I have told you here. Because the topic under discussion is compounding, I am leaving the best for last. The remaining two limbs are the techniques of smoothing coarse potency by three methods, and compounding by three methods. We will take up these illustrious six matters in our next session. However, for the moment, I will pose a deceptively simple question: how do we know which is a hot substance and which is a cold substance? Indeed, how do we make the determination of what works where?
I have already given you the answer.
The answer lies in the five elements, the six tastes, three post-digestive tastes, seventeen attributes, and eight potencies that began our discussion.
Medicinals dominated by earth are heavy, stable, dull, smooth, unctuous, dry, hard, and nourishing.
Medicinals dominated by water are liquid, cold, heavy, dull, unctuous, soft, moist, and smooth.
Medicinals dominated by fire are hot, sharp, dry, rough, light, unctuous, and mobile.
Medicinals dominated by air are light, mobile, cold, rough, pale, dry, not unctuous, have movement, and are not slimy.
Medicinals dominated by space bear the attributes of earth, water, fire, and air, and are in addition porous and light.
The six tastes are used to sort out the five elements. The six tastes are sweet, sour, saline, bitter, pungent, and astringent. They interact with the five elements as follows: sweet taste is dominated by earth and water; sour taste is dominated by fire and earth; saline taste is dominated by water and fire; bitter taste is dominated by water and air; pungent taste is dominated by fire and air; astringent taste is dominated by earth and air.
All Tibetan doctors and pharmacists must learn to recognize these tastes, and there are unique identifiers for each. Sweet taste causes a sticky feeling in the mouth. Sour taste causes sensation in the teeth, and creates saliva. Saline taste causes a burning sensation. Bitter taste kills the appetite. Pungent taste irritates the mouth, causes salivation, and makes the eyes water. Astringent taste causes numbness, constriction, and dryness.
The tastes alleviate each of the three humors as follows: sweet, sour, saline, and pungent tastes alleviate rLüng; bitter, sweet, and astringent tastes alleviate mKhris-pa; pungent, sour, and saline tastes alleviate bad-kan.
The six tastes are also further refined by examination of their specific therapeutic effect when consumed appropriately, and their harmful effect when consumed excessively.
The three post-digestive properties are sweet, sour, and bitter, which occur while the substance is in the blood, upper stomah, and lower stomach, respectively. Sweet and sour tastes have a sweet post-digestive property that alleviates rLüng and mKhris-pa. Alternatively, sour taste can remain sour in post-digestion and alleviate bad-kan and rLüng. Bitter, pungent, and astringent tastes have a bitter post-digestive property that alleviates mKhris-pa and bad-kan.
The seventeen attributes are divided into three categories based on their relationship with earth, which alleviates rLüng, water, which alleviates mKhris-pa, and fire, which alleviates bad-kan. From these seventeen, eight become primary potencies: heavy—light, unctuous—not unctuous, cold—hot, dull—sharp. Of these eight, the hot—cold nexus is the most important.
Today I have described three corners of a square. I believe you are all wise enough to discover the fourth corner without further assistance.
[1] Cordyceps has now been successfully cultivated by an American firm, Aloha Medicinals.
[2] For Mao’s views on traditional medicine and his medical preoccupations see: Li Zhisui, The Private Life of Chairman Mao (New York: Random House, 1994). Li Zhisui was Mao’s personal physician. He was assassinated for writing this book.
[3] I translate the Chinese wu xing as five courses rather than five elements because I find xing corresponds to “courses” better than “elements” in the implicit sense of meaning.
[4] There are no indigenous equivalents in Chinese.
[5] In combination, they form an additional four types, for a total of seven. The four combination types are vata-pitta, pitta-kapha, kapha-vayu, and tridosha. They may be subdivided even further, based on the predominance of one element in any given combination.
[6] Often correlated, for convenience of Chinese practice, with wood.
[7] See: Clifford (1984), Rapgay (1997), Dunkenberger (2000), Sachs (2001).
[8] Each type has five sub-types. These are useful to know simply because specific medications are employed to alleviate vitiation of sub-types.
[9] Reported in Jurgen C. Aschoff and T.Y. Tashigang, Tibetan Precious Pills: A Tantric Healing System (Ulm: Fabri Verlag, 2001).
