Three Humors
Tibetan medicine regards disease as an imbalance of the three basic humors that make up human physics . In Tibetan these three humors are called: rlung, mkhris-pa, and badkan; in Mongolian: chi, shara, and badgan. I will use the Mongolian terms here, as they are more common in Buryatia. Chi literally means wind and is responsible for the breathing and in a broader sense for psychic activity in general, like intellect, speech, and the locomotor system. Shara means bile and regulates the process of digestion and metabolism. Badgan literally means phlegm and is, amidst many other things, in charge of the mucus membranes.
Wind, bile and phlegm as regulating systems are subjected to environmental conditions. Their balance changes with the seasons of the year and the age of the individual. In children phlegm prevails, in adults normally bile and in elderly people wind. Furthermore everybody has some kind of predisposition that makes him or her more vulnerable to a certain kind of imbalance.
The three regulating systems are closely linked to the five elements, or the five major representations: earth, water, fire, wind and space.
Badgan/phlegm can be understood as a composition of earth ("bad") and water ("gan"). Earth as substance “builds” the bones and is linked to the sense of smell. Water is fundamental for all body fluids and the sense of taste.
Shara/bile is responsible for digestion and the required digestive heat is linked to fire. Fire itself is again linked to eyes and vision.
Wind and Space belong to chi. Wind – as it strokes the skin – is associated with the sense of touch, space with sound and the sense of hearing.
Another important concept in Tibetan medicine is the dichotomy between warm and cold. Diseases as well as remedies and food are distinguished between warm and cold, warming and cooling respectively. Shara is warm and badgan is cool. Chi is a special case and is basically neutral. Chi can aggravate ‘warm’ and ‘cold’, much like wind is able to boost a fire as well as cool down the body. A Chi-imbalance lies at the root of most diseases. Tibetan medicine follows the allopathic principle – a cold disease is antagonized with warming remedies, therapies and nutrition, and vice versa.
Wind, bile and phlegm as regulating systems are subjected to environmental conditions. Their balance changes with the seasons of the year and the age of the individual. In children phlegm prevails, in adults normally bile and in elderly people wind. Furthermore everybody has some kind of predisposition that makes him or her more vulnerable to a certain kind of imbalance.
The three regulating systems are closely linked to the five elements, or the five major representations: earth, water, fire, wind and space.
Badgan/phlegm can be understood as a composition of earth ("bad") and water ("gan"). Earth as substance “builds” the bones and is linked to the sense of smell. Water is fundamental for all body fluids and the sense of taste.
Shara/bile is responsible for digestion and the required digestive heat is linked to fire. Fire itself is again linked to eyes and vision.
Wind and Space belong to chi. Wind – as it strokes the skin – is associated with the sense of touch, space with sound and the sense of hearing.
Another important concept in Tibetan medicine is the dichotomy between warm and cold. Diseases as well as remedies and food are distinguished between warm and cold, warming and cooling respectively. Shara is warm and badgan is cool. Chi is a special case and is basically neutral. Chi can aggravate ‘warm’ and ‘cold’, much like wind is able to boost a fire as well as cool down the body. A Chi-imbalance lies at the root of most diseases. Tibetan medicine follows the allopathic principle – a cold disease is antagonized with warming remedies, therapies and nutrition, and vice versa.
Diagnosis
Three diagnostic approaches are described in the Gyushi: listening, looking and feeling. Listening means first of all listening to the patient, his or her case history, and the circumstances in which he/she lives and the diet he/she is used to. Looking mainly consists of a first visual impression of the patient (posture and movements), as well as the examination of his/her tongue and urine. Color, smell, and bubbles in the urine are examined.
The third approach – feeling – leads to the most distinctive diagnostic technique: pulse reading. The doctor reads the pulse with three fingers on the radial artery on both wrists. With each finger two pulses are felt, one on the left, and one on the right side of the fingertip.
In this way a total of 12 points are examined. Consecutively the pressure at each of the 12 spots is raised for a couple of seconds, and the pulse is observed. Notions like sunken, protruding, faint, strong, bulky, thin or more complex ones such as “like a banner in the wind”, “like dripping water” or “like a jumping frog” are used to describe the state of a pulse.
Every pulse corresponds to an organ. On the right wrist the forefinger measures the pulses of heart and small intestine (for men: lungs and large intestine), the middle finger the ones of liver and gall bladder, and the ring finger the ones of left kidney and bladder. On the left wrist the forefinger is linked to lungs and large intestine (for men: heart and small intestine), the middle finger to spleen and stomach, and the ring finger to right kidney and sexual organs. Pulses vary with seasons, age and sex. Note the difference for lung and heart pulses between men and women.
The third approach – feeling – leads to the most distinctive diagnostic technique: pulse reading. The doctor reads the pulse with three fingers on the radial artery on both wrists. With each finger two pulses are felt, one on the left, and one on the right side of the fingertip.
In this way a total of 12 points are examined. Consecutively the pressure at each of the 12 spots is raised for a couple of seconds, and the pulse is observed. Notions like sunken, protruding, faint, strong, bulky, thin or more complex ones such as “like a banner in the wind”, “like dripping water” or “like a jumping frog” are used to describe the state of a pulse.
Every pulse corresponds to an organ. On the right wrist the forefinger measures the pulses of heart and small intestine (for men: lungs and large intestine), the middle finger the ones of liver and gall bladder, and the ring finger the ones of left kidney and bladder. On the left wrist the forefinger is linked to lungs and large intestine (for men: heart and small intestine), the middle finger to spleen and stomach, and the ring finger to right kidney and sexual organs. Pulses vary with seasons, age and sex. Note the difference for lung and heart pulses between men and women.
Treatment
Treatment consists of external therapies (massages, moxibustion, baths), ritual treatments (reading mantras, meditation practices) and mostly herbal medications. Which therapy is applied when and where varies from doctor to doctor and from region to region. Generally treatment with herbal medications is the most common and most important. Very often a consultation consists of a short interrogation, a pulse diagnosis, sometimes a urine analysis, and the prescription of herbal medications.
Formulas and medications
The Tibetan materia medica consist of minerals, animal substances and a huge number of medical herbs. Especially in Mongolian and Buryat traditions minerals and animal substances are used only rarely; in Tibet and Northern India they are still common, especially for the preparations of so-called Jewel Pills. The Gyushi says there is nothing on earth that could not be used as medicine.
Medical substances are grouped by their properties. The grouping process relies on taste. Taste is of paramount importance in Tibetan pharmacology. There are six different tastes: sweet, sour, salty, bitter, astringent and hot. Every taste is linked to the three humors. Sweet, sour, salty lower chi; sweet, bitter, astringent lower shara, and sour, salty, hot lower badgan.
Another important dimension of properties are the so-called eight potencies: heavy/light, oily/rough, hot/cold and blunt/sharp. The taste of a substance is directly linked to one of the eight potencies. Sour, hot and bitter in this order are increasingly light and rough.
All the properties can be perceived without technical equipment. A subtle sense of taste is crucial for a Tibetan pharmacist and is developed through training. Taste is the basis for working with formulae. First, the properties of taste make it possible to test a single plant for its quality. Second, they enable a pharmacist to substitute rare plants with readily available ones.
A Tibetan drug always consists of several ingredients, often 20 or more. One group of ingredients usually affects the warm-cold balance, another group takes care of rebalancing wind, bile and phlegm, and a third group operates directly on the organs (Nikolayev 1998:52). According to another source, there is, in most cases, one major group of ingredients and two minor ones. Of the two minor ones, one supports the effect of the major group and the other one helps suppress unwanted side effects .
The raw materials are first dried and grinded, then mixed and eventually pressed into pills or simply used as a powder or decoction. The actual process of mixing is considered very important. The ingredients need to be mixed into a perfectly homogeneous whole. There is also a metaphysical dimension to this. During the process of mixing mantras are chanted to increase the potency of the remedy. Mixing and chanting can last for several days. Today in most places machines are used to grind and mix. Several emchis told me that they considered it a compromise or necessity of modern life, which would eventually always affect the drug's potential negatively.
Continue with: How Tibetan medicine is practised in Buryatia today
Medical substances are grouped by their properties. The grouping process relies on taste. Taste is of paramount importance in Tibetan pharmacology. There are six different tastes: sweet, sour, salty, bitter, astringent and hot. Every taste is linked to the three humors. Sweet, sour, salty lower chi; sweet, bitter, astringent lower shara, and sour, salty, hot lower badgan.
Another important dimension of properties are the so-called eight potencies: heavy/light, oily/rough, hot/cold and blunt/sharp. The taste of a substance is directly linked to one of the eight potencies. Sour, hot and bitter in this order are increasingly light and rough.
All the properties can be perceived without technical equipment. A subtle sense of taste is crucial for a Tibetan pharmacist and is developed through training. Taste is the basis for working with formulae. First, the properties of taste make it possible to test a single plant for its quality. Second, they enable a pharmacist to substitute rare plants with readily available ones.
A Tibetan drug always consists of several ingredients, often 20 or more. One group of ingredients usually affects the warm-cold balance, another group takes care of rebalancing wind, bile and phlegm, and a third group operates directly on the organs (Nikolayev 1998:52). According to another source, there is, in most cases, one major group of ingredients and two minor ones. Of the two minor ones, one supports the effect of the major group and the other one helps suppress unwanted side effects .
The raw materials are first dried and grinded, then mixed and eventually pressed into pills or simply used as a powder or decoction. The actual process of mixing is considered very important. The ingredients need to be mixed into a perfectly homogeneous whole. There is also a metaphysical dimension to this. During the process of mixing mantras are chanted to increase the potency of the remedy. Mixing and chanting can last for several days. Today in most places machines are used to grind and mix. Several emchis told me that they considered it a compromise or necessity of modern life, which would eventually always affect the drug's potential negatively.
Continue with: How Tibetan medicine is practised in Buryatia today