Dr. Yeshi Donden, the long-time personal physician of HH the Dali Lama, draws from over fifty years of practicing and teaching this ancient tradition of healing.

Dr. Yeshe Dhonden was trained by the Venerable Dr. Khyenrab Norbu (1883–1962), personal physician to Holinesses the Thirteenth and Fourteenth Dalai Lamas and founder of the Men-Tsee-Khang and Tibetan Medical and Astrology Institute in Tibet. He has conducted research at the University of Virginia and has conducted clinical trials at the University of California San Francisco.

Author's Acknowledgments

9

(2)

Translator's Preface

11

(2)

Introduction: A Brief History of Tibetan Medicine

13

(3)

Questions and Responses

16

(3)

Part I: The Body in a State of Balance

19

(46)

The Constituents of the Body in Good Health

21

(8)

The Digestive Process

29

(16)

Questions and Responses

34

(3)

The Transformations of the Nutriment

37

(2)

Questions and Responses

39

(4)

The Transformations of the Residue

43

(2)

The Humors

45

(20)

The Classification of the Humors

45

(2)

Questions and Responses

47

(2)

The Formation of the Bodily Constituents in the Womb

49

(2)

The General Locations and Functions of the Humors

51

(1)

Questions and Responses

52

(3)

The Specific Functions and Locations of the Humors

55

(3)

Questions and Responses

58

(2)

The Humoral Constitutions

60

(5)

Part II: The Body in a State of Imbalance

65

(42)

An Overview

67

(3)

The Distant Causes of Illness

70

(2)

The Accumulation, Arousal, and Pacification of Humoral Disorders

72

(5)

The Causes

72

(2)

The Essential Natures

74

(1)

The Seasons

74

(3)

Conditions Contributing to Illness

77

(6)

Common Contributing Conditions of Illness

77

(4)

Specific Contributing Conditions

81

(2)

The Manners of Entrance of Illnesses

83

(2)

The Characteristics of Humoral Imbalances

85

(9)

Symptoms of Excess

86

(2)

Symptoms of Deficiency

88

(2)

Symptoms of Disturbance

90

(4)

Classifications of Diseases

94

(13)

The Classification of Diseases on the Basis of Their Causes

94

(2)

The Classification of Diseases on the Basis of Body Types

96

(1)

Diseases Common to Everyone

97

(10)

Part III: Healing from the Source

107

(86)

On Being a Tibetan Physician

109

(18)

The Causes of Becoming a Physician

109

(7)

The Nature of a Physician

116

(1)

The Designation of a Physician

116

(1)

Categories of Physicians

116

(5)

The Activities of a Physician

121

(5)

The Results of Being a Physician

126

(1)

A Tibetan Medical View of AIDS

127

(10)

A Tibetan Medical View of Cancer

137

(7)

Benign and Malignant Tumors

144

(15)

Questions and Responses

155

(4)

Wholesome Behavior

159

(19)

Lifetime Behavior

159

(8)

Mundane Conduct

159

(6)

Spiritual Conduct

165

(2)

Seasonal Behavior

167

(2)

Occasional Behavior

169

(6)

Questions and Responses

175

(3)

The Potencies of Tastes

178

(6)

Wholesome Diet

184

(9)

Questions and Responses

186

(7)

English-Tibetan-Sanskrit Medical Glossary

193

(6)

Tibetan-English-Sanskrit Medical Glossary

199

(6)

Glossary of Names

205

(2)

Glossary of Texts

207

(2)

Bibliography

209

(2)

Index

211

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Chapter One

The Constituents of

the Body in Good Health

The Root Tantra is the primary, or fundamental, tantra , and it is also the most concise of the four. It consists of six chapters, beginning with a description of the environment of Sudarsana in which these tantras were revealed. It then gives an overview of the entire field of Tibetan medicine. The six chapters of this tantra correspond to the central metaphor for the whole of Tibetan medicine, namely the tree of medicine, with its three roots, nine trunks, forty-seven branches, 224 leaves, two flowers, and three fruits, each corresponding to specific topics within this medical system. The topics corresponding to the two flowers and three fruits are the professional and spiritual qualities achieved by a totally proficient physician in this tradition.

The first of the three roots, representing the nature of the body, has two trunks, the first of which represents the body that is in good health, when it is said to be in its "unaltered," or natural, state. That trunk has three branches, on which grow twenty-five leaves. The twenty-five topics represented by those leaves explain the differentiation process that takes place during the different phases of digestion, and understanding those topics is crucial for fathoming this medical system as a whole.

The Root Tantra is difficult to understand, for it is very complex and quite cryptic, because it includes so much information in each of its short chapters. Thus, it reads like a collection of lists, with virtually no explication. In these lectures I shall first discuss the body in its unaltered, or healthy state, which corresponds to the twenty-five leaves of the first trunk. I shall include in this explanation all the crucial information about these twenty-five topics by drawing on all four of the medical tantras . Once I have given a general presentation of these constituents of the body in good health, I will discuss the nature and origins of illness (symbolized by the second trunk), including the role of the mind and specific mental processes that contribute to disease. In particular, I shall explain the three mental poisons--namely attachment, hatred and delusion--and their role in upsetting the equilibrium of the body and the three humors, which leads to a wide variety of illnesses. The way Tibetan medicine is being taught is improving nowadays due to Tibet's contact with the modern world. In the old days, medical students had to do a lot of rote memorization, without knowing what they were memorizing, but now the traditional texts are being revised so that students are introduced to the meaning sooner.

A general presentation of these twenty-five topics explains many bodily processes, such as retracting and extending the limbs, opening and shutting of the eyes and so forth. When one understands how the various humors, namely wind, bile, and phlegm, function when the body is healthy, one can then comprehend how the humors contribute to disease. Then one is in a position to explore the primary causes and the contributing factors for various types of illnesses.

The twenty-five topics represented by the twenty-five leaves on the first trunk of the first root of the tree of medicine include:

A. Seven Bodily Constituents

1. nutriment

2. blood

3. flesh

4. fat

5. bone

6. bone marrow

7. regenerative substances

B. Three Waste Products

1. excrement

2. urine

3. sweat

C. Five Winds

1. life-sustaining wind

2. ascending wind

3. pervading wind

4. fire-accompanying wind

5. descending wind

D. Five Biles

1. digestive bile

2. color-transforming bile

3. accomplishing bile

4. sight-giving bile

5. complexion-clearing bile

E. Five Phlegms

1. supportive phlegm

2. decomposing phlegm

3. experiencing phlegm

4. satisfying phlegm

5. connective phlegm

The origins and the natures of the three humors of wind, bile, and phlegm are not discussed elaborately in The Root Tantra , but it may be useful to introduce these now for the sake of clarity. The bodies of all creatures on this planet born from a womb are composed of the five elements: earth (solidity), water (fluidity), fire (heat), air (motility), and space. Other life forms, too, such as flowers, consist of these elements. The earth element is the basis from which flowers arise. The water element provides the moisture and fluidity in plants. The fire element is that which provides warmth and leads to maturation of flowers. The wind element produces the growth of any organism, whether it be a flower or a being born from a womb. And finally the space element provides the dimension in which growth can take place. If there were no space, there would be nothing to grow into. Those are the functions of these five elements.

Phlegm has the potency of the earth and the water elements, bile has the potency of the fire element, and wind gives rise to the motion of the blood and the breath within the body. The space element is in evidence in the various cavities within the body, such as the nostrils, the ears, and so forth. These five elements will be discussed in greater detail later on.

If you were receiving the formal, traditional training in Tibetan medicine, you would first memorize long lists of subjects set forth in The Root Tantra , before receiving any explanation of them. Only thereafter, when you received instruction on The Oral Instruction Tantra and the other two tantras would the meanings of those terms and subjects be taught. But I shall explain some of the basic terms and concepts right now.

The locations of the five winds are presented in the following chart:

Winds

life-sustaining wind

ascending wind

pervading wind

fire-accompanying wind

descending wind

Location

crown of the head

chest

heart

large intestine

perineal region

According to the medical tantras , the life-sustaining wind is located at the crown of the head, and the pervading wind is at the heart; but according to many other tantras within Vajrayana Buddhism, such as the Guhyasamajatantra , the pervading wind resides at the crown of the head, and the life-sustaining wind is at the heart. So the positions of those two are reversed.

As a point of interest, the function of the pervading wind is to govern all bodily movements, of extending and retracting the limbs, walking, and so forth. As it is located on the top of the head, it roughly corresponds to the brain, which Western medicine has found to control the movements of the body. According to Vajrayana Buddhism as a whole, the life-sustaining wind is located at the heart. Moreover, when Tibetans refer to disorders of the life-sustaining wind, we always refer to the heart, which is where such disorders are felt, with symptoms such as heaviness, palpitation, throbbing, and so forth. Thus, even though the medical tantras say it is located on the top of the head, in actual practice Tibetan doctors identify it as being located in the heart. So there is somewhat of an incongruity between theory and practice here.

Why then does the Tibetan medical tradition not conform with the rest of the tantras in locating the pervading wind in the head and the life-sustaining wind in the heart? The reason is that all Tibetan medical literature is unanimous in its insistence upon the opposite locations for these two winds. Tibetan medical literature consists of kama , which are canonical teachings of Buddha Sakyamuni, and terma , which are teachings concealed by such masters as Padmasambhava and eventually revealed at the appropriate times. In the course of time, five lineages of Tibetan medicine developed, tracing back to the great Tibetan translator Vairocana, Padmasambhava, Yuthok Yönten Gönpo, Rinchen Zangpo, and Tertön Drapa Ngönshey, who revealed termas of The Four Tantras . Throughout their development, they did not have much contact with each other. Since all the writings of all these lineages state that the pervading wind is located in the heart and the life-sustaining wind is on top of the head, no Tibetan has had the audacity to contradict them!

I would now like to discuss the twofold category of the components of the body that are subject to being harmed, namely the bodily constituents, and the afflictive elements of the body, namely the humors. There is a mutual dependence between these two. If there were no elements of the body to be afflicted, there could be no afflictions, and if there were no afflictive elements, nothing would be afflicted. These are called the characteristics of the body . There are ten afflicted elements of the body, including the following seven bodily constituents and the three waste products:

1. nutriment

2. blood

3. flesh

4. fat

5. bone

6. bone marrow

7. regenerative substances (sperm and uterine blood, or ovum)

8. excrement

9. urine

10. sweat

The afflictive elements of the body are the three humors:

1. wind

2. bile

3. phlegm

The interdependence of these ten characteristics of the body and the three afflictive elements are the basis for the formation, sustenance, and eventual demise of the body at death. I shall now address the body when it is in a state of good health. As long as the body is healthy, which is said to be its "unaltered" state, these three afflictive elements, or humors, are supportive of the body, and they perform the various necessary functions for its sustenance and vitality. On the other hand, when the body is in an "altered" state of ill health, these three humors take on the role of afflictions in that they give rise to various types of illnesses, and finally they lead to the dissolution of the body, to death.

The twenty-five components of the body corresponding to the twenty-five metaphorical leaves are first presented within the context of the body in its healthy state, without relating them to the nature and the origins of illness. The ten characteristics of the body that may become afflicted are subject to a fourfold process: (1) digestive warmth, (2) the transformation of food and drink during the digestive process, (3) the results of digestion, and (4) the culmination of the digestive process. The seven bodily constituents are also separated into the two classifications of nutriments and residues. Further subdivisions are made in terms of, for example, the nutriment (or finer portion) and the residue (or coarser portion) of each of the seven bodily constituents, such as the blood and flesh. The nutriment and residue of each of the subsequent constituents are gradually separated following the initial digestive process. Digestive warmth is the primary basis for the transformations of food and drink during the digestive process.

Let us briefly examine the functions of each of the seven bodily constituents and the three waste products. Blood is produced from the nutriment of the food and drink that one ingests. Blood has the function of supplying moisture to the body, it is of primary importance for sustaining the life-force, and it allows for the growth of flesh, which fills out the body. Fat lubricates the body, and the function of the bone is to supply a firmness and structure to the body. The function of the bone marrow is to provide the vital essences for the body, which are closely linked to the body's vitality. The regenerative substances (the sperm and the ovum) have two functions: they give the body its luster, and they are instrumental for procreation.

As for the three waste products, excrement has the function of retaining the subsequent residues in the intestines so that partially digested food is not expelled prematurely, and then it expels the stool. Urine has a similar twofold function with respect to fluid waste products. And finally sweat has the two functions of providing pliancy to the skin and of supporting the growth and maintenance of hair.

The order of the seven bodily constituents relates directly to the progression of the digestive process. When you first ingest food and drink, it takes six days for them to be completely digested and for all of the seven bodily constituents to be produced. The nutriment and the blood are already being produced from the very first day of digestion. Flesh is produced from the nutriment of the blood, and fat is formed in dependence upon the flesh; bone forms in dependence upon the fat; bone marrow is produced in dependence upon the bone; and finally the regenerative substances form in dependence upon the bone marrow. From the time that one ingests food and drink, it takes six days for the regenerative substances to be produced.

Generally speaking, one does not experience immediate effects from Tibetan medicine, and the reason for that is that the medicine has to be assimilated through this whole digestive process. Thus, one will commonly not see the effects of Tibetan medicine until six days after one begins taking it. In contrast, when one takes a modern pharmaceutical drug, this tends to have very swift effects, indicating that it is not being assimilated by way of this entire digestive process. Moreover, when one ingests natural or artificial poisons, they can harm one within an hour or less; for they, too, do not pass through this full digestive process.

To review the functions of the ten characteristics of the body, the nutriment has the function of producing blood, and the blood has the function of nourishing all the moist constituents of the body; and it is the principal support for one's life-force. The flesh throughout the body--on the exterior, the interior, and in-between--may be likened to the plaster on a building. The fat lubricates all parts of the body. The bones function like the pillars that uphold the walls and the roof of a building. The major function of the bone marrow is to supply the body with vital essences. According to Tibetan medicine, the regenerative substances pervade the entire body, so they only roughly correspond to the sperm and the ovum. These substances bring luster to the body, and they are also crucial to the formation of the fetus in the womb. Excrement is located in the large intestine and the rectum, and it has the function of blocking the intestines to support the subsequent residues of the food, which transforms into excrement, and is then evacuated. The major repository for fluid residues is the kidneys. Just as excrement has the function of retaining partially digested food, the urine has a similar function of retaining some of the fluid residues until they have been fully processed. Sweat, once again, has the function of lending pliancy to the skin and supporting the growth of hair. It also has the function of preventing the pores from becoming blocked, which is very important for one's health.