Tibetan Medicine, known as Sowa-Rigpa—or referred to as Amchi Medicine—is to gain a comprehensive understanding of one of the world’s oldest continuously practiced healing systems. With a living history, Sowa-Rigpa continues to be widely practiced in regions such as Tibet, Mongolia, Bhutan, Nepal, parts of China, the Himalayan regions of India (including Ladakh in Jammu & Kashmir), as well as in several parts of the former Soviet Union, and increasingly in developed countries including the USA and parts of Europe. In Tibetan medicine, medicines based on herbs (herbal medicine) are primarily used: compresses made of herbs, berries, leaves and roots that grow in specific places and are harvested at certain times of the day and year. Therefore, medicines are natural in the full sense of the word. In contrast to the approach of Western medicine, Tibetan medicine does not count on an external invader (virus or bacteria), but works on restoring the energy balance, which, if filled and established in the body, becomes untouchable by any disease.
The spiritual element is also present in Tibetan medicine, with a great deal of attention paid to the patient’s personality. Treatment is specific to each patient, but what they are first told is that the illness is in their mind. It is not thought that they have imagined the illness, but that their lifestyle is wrong and that they should pay more attention to their body, which include spiritual practice, exercise, and reorganization of life skills such as sleeping, eating, and daily schedule. Meditation is also recommended, which includes simple breathing exercises and mind control. Physical therapies are applied in the form of acupuncture, massage, and inhalation therapy. Herbal and mineral compresses, bloodletting, medicinal baths, and wraps are also used. Tibetan acupuncture differs from traditional Chinese acupuncture; it generally uses only one Golden needle on the chakras, the basic energy centres, and especially on the seventh chakra, which is located at the top of the head along with Tibetan moxibustion to treat illness.
The behaviour of physician and patient are also largely based on Buddhist principles. Like Buddhism, Tibetan medicine is based on the belief that pain can be alleviated or cured only by understanding the nature and causes of disease. The behaviour and ethics of both physician and patient are heavily rooted in Buddhist principles. Ignorance gives rise to the three root causes of disease (Nespa-gsum / Three doshas):
- Dodchags (desire/lust) – root of rLung (Wind / Vata)
- Zessdang (anger) – root of mKhrispa (Bile / Pitta)
- Timug (mental darkness) – root of Badken (Phlegm / Kapha).
Due to the presence of 84000 afflictive emotions in mind it gives rise to the same number of diseases. That is why in Tibetan the diagnosis is called Ngozen which means “to recognize” or “to identify”. Over time, Tibetan medicine has developed a variety of treatment methods, systematically adopting the experiences of each physician, complementing them with the Chinese medical concept and the Ayurvedic system of medicine. In Tibetan diagnostic theory, all diseases can be categorized into “hot” and “cold”, or a complex combination of the two types of disease. Hot disorders are caused by an increase in bile, while cold ones are generally the result of an imbalance of Phlegm or Wind.
The human body is explained in Sowa-Rigpa with different chapters on embryology, anatomy, physiology and neurology in an appropriate manner with functions of each and every part of the body. The lower branches of the “tree of physiology and pathological transformations” illustrate the five types of wind, bile and phlegm that build the three bodily juices or forces. Related to the central and peripheral nervous systems, the five types of wind, as depicted on the blue leaves (anatomical representation through the Tree of Life), govern the lungs, heart, blood vessels, circulation, speech, digestion, excretion, and growth. The five types of bile, illustrated by the yellow leaves, are associated with gallstones, the small intestine, blood, and lymph. Their work includes regulating body temperature and metabolism. Mucus, which is composed of the elements of water and earth, and is illustrated by the five remaining leaves, maintains the flow of fluids and regulates the initial stages of digestion. When in balance, these forces in the body are essential for maintaining and improving health.
The science of Sowa-Rigpa is deeply intertwined with Buddhist philosophy, which holds that all living beings are sick until they overcome ignorance, the root cause of suffering. Anger, desire, and confusion create the three disturbed humours — Wind, Bile, and Phlegm. Pulse diagnosis is the most important diagnostic tool in Sowa-Rigpa. Practitioners use pulse diagnosis as a tool to assess the health of all the major organ systems of the body. When taking the pulse, various factors are taken into accounts such as the time of day, season, and sex of the patient. The doctor palpates one’s pulse with six fingers (three fingers on each hand) – thus the composition of doshas, condition of internal organs and duration of a disease are determined. Pulse diagnostics can detect an existing or an oncoming imbalance or disease. Examination analysis of stools provide important information about the digestive system. It is extremely important to check the urine —observation of urine color, clarity and odor. Another diagnostic method is questioning the patient — exploring case history, current condition, family background, and physical or emotional changes. An experienced doctor already sees many things through visual examination (tongue, ears, urine, etc.).
Patient treatment in Tibetan Medicine is primarily based on adjusting nutrition and lifestyle. If these adjustments are not sufficient for recovery, a doctor prescribes Tibetan herbal mixes, and medicine or accessory / external therapies. Advanced diseases may call for external therapies like moxibustion, venesection (bloodletting), fomentation, therapeutic massage, or surgical procedures, depending on severity. Compound medicines follow two major systems > Isro – taste-based combinations, and Nuspa – potency-based combinations. There are about several types of medicinal preparations, such as: decoctions, powders, pills, linctus, medicated ghee, bhasmas, medicated wine, paste, medicated bath. Buddhist rituals and mantras also play an important role in both treatment and the pharmaceutical preparation process — including prayers, sound healing (bells, himalayan bowls, etc.). According to the theory of Jung-wa-lna (Five Elements), Sowa-Rigpa holds that all natural substances have medicinal and therapeutic properties.
Medicinal materials are classified into eight groups:
- Rinpochesman – Precious metals and stones
- Sasman – Substances from mud and earth
- Rdosman – Stones and minerals
- Shingsman – Tree-derived plant substances
- Rtsisman – Medicinal essences and exudates
- Thangsman – Shrubs and plant materials for decoctions
- Snosman – Medicinal herbs
- Srogchagssman – Animal-derived substances.
This classification reflects the holistic understanding in Sowa-Rigpa that all elements of nature contribute to healing when applied in accordance with the patient’s elemental constitution and disease state. The ingredients of medicine are used in both single and compound forms; compound medicine is based on two major permutation and combination that Isro (taste) based combination and Nuspa (potencies) based combination. There are about seventeen different categories of medicinal preparation out of which some important preparations are decoction: Powder, Pills, linctus, Medicated ghee, Bhasmas, Medicated wine, Paste, Medicated bath. The elemental composition of a drug is determined on the basis of the six major tastes i.e., Sweet, Sour, Saline, Pungent, Astringent and Bitter.
Medicines are also categorized based on six primary tastes: sweet, sour, salty, pungent, astringent and bitter. Each taste corresponds to certain elements: sweet→ Earth + Water, sour→ Fire + Earth, salty→ Water + Fire, bitter→ Water + Air, pungent→ Fire + Air, astringent→ Earth + Air. These tastes help balance specific humours: sweet, sour, salty, and pungent alleviate rLung (Wind)→ bitter, sweet, and astringent alleviate mKhrispa (Bile)→ pungent, sour, and salty alleviate Badken (Phlegm). Additional factors in determining a drug’s effect include: Zuzessum – three post-digestive tastes→ Nuspa-rgyad – eight potencies→ No bo – specific actions of each medicines.
In the Tibetan Buddhist medical and tantric traditions, astrology is not regarded as superstition but rather as a practical tool to understand and heal our body and mind on the gross, subtle and very subtle levels. One can experience many sicknesses and misfortunes due to outer, inner and secret astrological reactions and malevolent celestial influences. Tibetan astrology (dkar rtsis) is a traditional discipline of the Tibetan peoples that has influence from both Chinese astrology and Hindu astrology Jyotish. Tibetan astrology is one of the ‘Ten Sciences’ (rig-pa’i gnas bcu; Sanskrit: daśavidyā) in the enumeration honoured by this cultural tradition. The experience of Vedic medical astrology psychotherapy is that cognition in man reveals an unchanging, healthy, divine essence, which creates an extremely constructive mood and gives great motivation for problem solving and healing. In their development, a person should indulge in the guidance of natural intelligence and not allow it to be suppressed by the external influences of Samskaras – deep-rooted patterns in the mind or by the overly egoistic part of us – the illusion (Maya).
These adverse influences take our original nature, Prakruti, out of balance and cause disharmony, Vikruti, which blocks the healthy development of a person. Otherwise, by nature a person develops harmoniously and healthily. The mind is always united with the soul, which is consciousness itself. Thus, the perception of the mentioned object became a conscious act. Then the soul sends an impulse to the motor-bodily organs (karmendriyas), these organs connect with the object in question and perform a certain bodily action. Feelings are interdependent, from someone or something. Expectations are natural in all people, if they do not exceed certain limits. Strong emotions block the power of reason and spirit.
The six main mental illnesses in Ayurveda (India), and Sowa-Rigpa (Tibet) are: Kama (excessive desires), Krodha (anger, aggression), Lobha (greed), Moha (attachment), Mada (selfish pride), and Matsarya (jealousy, envy). The feelings that most affect the psychosomatic state of each individual are: Harsha (euphoric joy or anger), Kama (sensual desires and wishes), Shoka (sadness, grief), Lobha (greed), Dainya (helplessness), Krodha (anger, aggression), Irsya (intolerance, rudeness, Matsarya (envy, jealousy), Asuya (evil, gossip), Vishada (depression) and Bhaya (fear, phobia).
The Four Tantras (Gyud Zhi) constitute the central text of the Tibetan medicine Sowa-Rigpa, which consists of 156 chapters.
The First Tantra is called the “Root Tantra.” Its 6 chapters contain a very brief outline of the entire text, comparing the medical system with a tree. The Tantra, is comprised of six chapters giving a brief outline of the whole text and comparing the medical system with a tree. Three roots sprout into nine stems, which branch out into 47 branches bearing 224 leaves. The nine stems represent the nine sections of medical science; the branches stand for general information and the leaves illustrate the details. The Tantra explains the human organism and its functioning and encompasses two stems, which stand for the healthy and the sick body. The healthy body is represented by three branches and 25 leaves, the sick body by nine branches and 63 leaves. The first stem, the healthy body, bears three branches. One of the branches represents the three humours, the other represents bodily constituents (nutritional essence, blood, muscle tissue, fat or fatty tissue, bones, marrow and regenerative fluid) and the third branch the three excretions of the body (faeces, urine and perspiration). The association of advancement of diseases with the patient’s age, the seasons and the place where the patient resides is also discussed. Furthermore, the nine fatal disorders, the twelve contraindications due to inappropriate treatment and the condensation of all the disorders into hot and cold nature are also stated.
The Second Tantra, composed of 31 chapters, is called “Explanatory Tantra”. It explains the anatomy and physiology of our body; the process of birth and dying as well as the functioning of the three humours (wind, bile, and phlegm) and signs of death. It specifies the properties of medicinal ingredients and explains in detail diet, behaviour and the rules for maintaining health, etc. The informs about the methods of diagnosis, the examination of the tongue and urine, the pulse diagnosis and the questioning of the patient regarding the symptoms of the disease, the way of living, etc. This illustration displays three stems and depicts the three main diagnostic techniques used by Tibetan physicians: pulse reading, urine analysis and interrogation. The first stem deals with visual observation methods. It is divided into two branches; the first branch stands for observation of the tongue and the other branch for urine analysis. These branches possess three leaves each, showing that each of the three humours has a different effect on the patient’s tongue and urine, which can be visually detected by the physician. The second stem depicts the pulse analysis in three branches each comprising of a single leaf symbolising the different pulse natures of the three humours. The Tantra is concerned with the life cycle (conception, childbirth, functioning of the three humours and signs of death), causes, conditions and classification of the diseases. It specifies the properties of medicinal ingredients and explains in detail diet, behaviour and the rules for maintaining health, etc. It also contains a code which the physicians should up-hold in conducting his profession.
The Third Tantra is composed of 92 chapters. It is called the “Oral Transmissions or Tradition Tantra (The Pith Instructions)” and deals with the cause, the nature, and the treatment of the 101 disorders of the three humors. The three chapters that deal with psychiatry! The third stem deals with the method of interrogation. It consists of three branches with 11 blue leaves relating to rlung disorders, seven yellow leaves relating to mkhris-pa disorders and 11 white leaves to bad-kan disorders. These colours stand for the different ways of inquiring used to identify the humoral diseases and their symptoms as well as to determine their remedies. The root of treatment develops into four stems symbolising diet, behaviour, medication and external therapy. These treatments are generally used in combination depending on the nature of the person and the disease involved. The first stem stands for diet treatment, which has six branches. The first two branches with ten and four blue leaves, respectively, show the diet and the drink best suited to treat rlung disorders. The third and fourth branches with seven and five yellow leaves, respectively, stand for the diet and drink suitable for mkhris-pa disorders and the fifth and sixth branches with six and three white leaves, respectively, stand for the diet and drink recommended for bad-kan disorders. The second stem illustrates behavioural treatment. It has three branches with two leaves each representing the behaviours beneficial for the three humours. The third stem depicts the different medications. It has a total of 15 branches and 50 leaves. The first six branches each bear three leaves. These refer to the tastes and medicinal qualities favourable for treating rlung, mkhris-pa and bad-kan disorders, which are shown as blue, yellow and white leaves, respectively. The seventh to the twelfth branches bear a total of 23 leaves representing different medicinal preparations: broth and medicinal butter, decoctions and powders, pills and specific medicinal powders. The type of preparation prescribed depends on the afflicted humour. In addition to the above medications, there are three different branches symbolising medicinal preparations with a cleansing effect: enemas, purgatives and emetics used respectively for rlung, mkhris-pa and bad-kan disorders. They are represented by three blue leaves on the thirteenth branch, four yellow leaves on the fourteenth and two white leaves on the fifteenth branch. The fourth stem stands for external therapies, which are generally used as a last resort after all other treatments fail. It consists of three branches. The two blue leaves on the first branch portray the external therapy used to treat rlung disorders. The three yellow leaves on the second branch stand for external therapies used to fight mkhris-pa disorders and the two white leaves on the third branch signify external therapies used on bad-kan disorders.
The Fourth Tantra, composed of 27 chapters, is called “Last Tantra” and it explains the 18 methods of diagnosis (such as urine analysis and pulse reading), medicinal ingredients and their preparations (pills, powders, syrups, medicinal butters, etc.) pacifying medication (purgatives and emetics) and additional treatments (moxibustion, golden-needle therapy) which are applied when all other medicinal preparations have failed to cure the patient. Furthermore, the first stem bears two flowers standing for health and long life and three fruits representing religion, wealth and happiness. The second stem represents the sick body. This section deals with the three causes, the four conditions, the six different entrances, the locations and the fifteen pathways of the diseases.
The influence of Sowa-Rigpa, along with Buddhism and other Tibetan arts, gradually extended to neighbouring Himalayan regions such as India, Nepal, and Bhutan. The foundational medical texts were first translated into Russian in 1908. Since the early 20th century, portions of these texts have been translated into Japanese, German, French, and English. Notably, since the late 20th century, due in large part to the efforts and global presence of His Holiness the 14th Dalai Lama, increasing numbers of scholars and researchers—both from the East and the West—have come to recognize the profound depth, unique qualities, and holistic wisdom embedded in the Tibetan medical system. Consequently, we are witnessing a continuous growth in the number of people who appreciate and are interested in studying the Tibetan medical treatment system. Traditional Tibetan medicinal bathing was inscribed onto the UNESCO Representative List of the Intangible Cultural Heritage of Humanity. The entry is officially known as: Lum medicinal bathing of Sowa-Rigpa. In the Tibetan language, the word “Lum” refers to the traditional knowledge and practices of bathing in natural hot springs, herbal water, or steam to balance body and mind, maintain health, and treat disease.
In order to become a doctor of Tibetan medicine, they are joining you practitioners the providers of education include farmers, herdsmen and urban residents, with these the Manpa (physician), Lum Jorkhan (pharmacist) and Manyok (assistant) owning respective responsibilities in the practice. Sowa-Rigpa is being traditionally trained according to the Amchi system (Dorjee tseten bhutia – doctorate in Tibetan medicine), according to the guru-shisya system or under the gyud-pa (heritage) system in families where knowledge is passed from father to son through the generations. It takes several years to become a skilled Amchi or Manpa (traditional doctor of Tibetan medicine), through demanding theoretical and practical training. Upon completion of schooling, a student for becoming an Amchi should undergo education in front of the entire community in the presence of several professional Amchi, in the Amchi label award ceremony. Today, in addition to a modern social and educational system, some institutions provide education of Tibetan medicine with a certain duration (4 + 2 years), under the Ministry of Culture of the Government of India: Central Institute for Buddhist Studies, Leh; Tibetan Medical and Astrological Institute, Dharamsala; Central University for Tibetan Studies, Sarnath; Chagpori Tibetan Medical Institute Darjeeling.
Today Indian medicine Ayurveda as well as Tibetan medicine Sowa-Rigpa hold a significant place in the field of future medicine. Both medicines consider the physical body as the crystallization of deeply-rooted mental tendencies, which are transferred from previous lifetimes. This proves that the mind is the reflection of the body and the repository of impressions accessed through our senses. It also means that we can only acknowledge our real self and eternal nature outside of mind-body unity, where all bodily and mental problems have their roots into the understanding of our Ayur-Life path-Karma. Through legislation within the World Health Organization (WHO), Ayurveda – India well as Sowa-Rigpa – Tibet has been recognized as a traditional system (the prevention and and joint expertise treatment of chronic diseases), and has harmonized legal documents with from which knowledge derives, under the Indian Ministry of Traditional Medicine AYUSH (Ayurveda, Yoga and Naturopathy, Unani or Yunani, Siddha and Homeopathy).
Om Bekandze Bekandze Maha Bekandze Radza Samudgate Soha
ཨོཾ་བེ་ཀན་ཛེ་བེ་ཀན་ཛེ་མ་ཧཱ་བེ་ཀན་ཛེ་ར་ཛ་ས་མུད་དགཱ་ཏེ་སོ་ཧཱ།
