Tibetan Medicine

Western medicine is predominantly a symptom based practice, whereas the Tibetan medical practice focuses on treating the root of the disease. Additionally in the Western practice physical illnesses have historically been the problem medical institutions have been working on understanding and finding solutions for, while mental illnesses have often been stigmatized and seen as part of the personality of the person rather than an illness. More recently, mental illnesses have been given a similar footing to physical illnesses in the seriousness Western physicians treat them. In Tibetan medicine both mental and physical illnesses are treated in similar ways. In this paper I will investigate how the Tibetan medical practice’s understanding of human physiology allows for treatment of the root of mental illnesses. Understanding the Tibetan conceptualization of the body is important because thinking about the body in a different way may change the way Western medicine thinks about the body and it may allow treatment to be proactive rather than reactive and ultimately more holistic.

To start with understanding the Tibetan concepts of the body, it is important to understand the Western concept, since that is the implicit position from which we are starting, in order to see the distinctions. Western medicine’s origin is the Cartesian perspective. The Cartesian perspective is that the mind and body are distinct and separate, mind meaning the immaterial consciousness and body meaning the physical biology. This divide implies a clear difference between the individual and the environment and sequentially a clear difference between illnesses of the body and illnesses of the individual’s mind. It is logically impossible for an immaterial subjective entity to arise from a material and objective entity. With this understanding of the mind and body there is no way to cure or even treat mental illnesses with science because they are beyond the material world. The solution this logical paradox has found, is to equate mind with brain. When the mind is a brain then the difficulty in treating a subjective issue with an objective treatment dissipates because now, it is an objective treatment to an objective problem. This is where the historically dominant Western medical thought has arrived, the human experience is an entirely physical experience because the brain and body are both material and so is consciousness. 

The Tibetan medical conception of the mind/body does not run into the same dualist problem. Additionally it is not a monistic view, meaning there is not just one substance that everything is with no distinct parts. In Tibetan Buddhism the mind, consciousness, is defined as gsal-rig, which is a combination of the two words gsal-ba, meaning luminous, and rig-pa, meaning cognizing. In this working translation of Tibetan, ‘luminous’ refers to the concept of the mind’s capacity to reflect any object of cognition, similar to the way mirrors reflect. ‘Cognizing’ refers to the mind’s capacity to apprehend, perceive, or understand an object, object meaning both physical and thoughts, concepts, and mental images. So in the Tibetan understanding of the mind and body, it first seems very similar to the Cartesian view. Consciousness is connected to the body but is not physical and was not caused by a physical phenomenon. Consciousness arose from a prior moment of consciousness. The logic diverges however because in Buddhist thought it is illogical to equate the mind and the brain. The leap of an immaterial object to a material object is not possible so the Western view of brain/body disintegrates in the Tibetan worldview. Instead, the relationship between the immaterial object, the mind, and the material object, the body is understood through different and distinct levels of consciousness which are associated with different physical processes. 

Although all of these levels of consciousness are occurring simultaneously within the individual, the individual is rarely aware of them. These levels of consciousness are the gross levels, the subtle levels, and the very subtle levels. In order to access the different levels one must quiet the activity, both mental and physical, of their current level to move to the next. The very subtle levels reveals the true nature of the relationship between the mind and body, however first one must move through the others. The gross levels of consciousness are associated with physical sensory perceptions and the mental states of anger, desire, and ignorance. Most people are not fully aware of the gross levels, much less the subtle levels. The physical association of the subtle levels are similar to a state of deep sleep or the process of dying. Only highly trained meditators can reach these levels and the ordinary person would not experience it. The very subtle levels of consciousness are associated with the mind and body being indivisible and is understood as both mind and body being subtle energy. The Tibetan Buddhist solution then, to the Cartesian body, is understood by the inseparable nature of very subtle consciousness and very subtle energy, although at the subtlest level they are intandam, it is usually covered up and therefore imperceptible by grosser levels. This connection of the body and mind is crucial in the way Tibetan physicians treat mental illnesses; there is an understanding that psychological and physiological systems are the same system and therefore illnesses of both the body and mind arise from similar roots. 

Science and religion are one and the same in Tibetan Buddhism. Therefore health is not a just physical question but a cosmological question as well. In order to describe the nature of illness and treatment in the Tibetan medical practice it is important to understand what the true nature of the pure state is, in other words, what is the patient attempting when seeking better health. The pure state is described as a “detachment to worldly life and possessions, few desires, and attitude of contentment.”  Regardless of which mental level we are existing on these aspects of the pure state are not what we should be aiming toward but rather what we are aiming toward, whether conscious of it or not. This pure state is also known as being enlightened or awakened and there are numerous interpretations about what that means. Some describe it as “the indestructible refined essence possessed of three features [body, speech, and mind]”, while others describe it as the “emptiness of mind being devoid of true existence.” This natural state of the mind is not in human form because the mind in the human form is inherently delusional and is misunderstood about the nature of this reality. Instead the nature of the mind, the pure form is “intrinsically pure, in itself luminous clarity, the emptiness of the ultimate dimension of phenomena.” Additionally the nature of the mind has existed continuously since beginningless time and is present, with not distinctions, in every sentient being. The nature of the pure mind, without any stains, is the awareness of the unification of body and mind. 

These stains are integral to the human experience, they are what distinguish us from purer mental, and therefore physical, states. Stains are “the karmic traces of wholesome and unwholesome actions which serve solely as the cause of cyclic existence.” These are mental states, attachment, anger, and close-mindedness, which conceal the essence of enlightenment and are the root of human suffering. The medial tradition in Tibet, therefore, is attempting to purify these stains, implement certain balance in the physical and mental aspects of the patient in order to move towards a more pure state of being. 

Now that it is known that the state of health is a nonhuman form, it is necessary to understand the nature of the human form: illness. The root of illness and suffering is ignorance in the mind. Since the relationship of the mind and body is understood differently on different levels of consciousness, the impact and factors of disease on the mind/body is also understood differently on different levels of consciousness. Additionally it is understood that when ill, the disease will have both physical and mental effects on the person since the mind and body are understood as indivisible. On the gross levels, sickness is a physical issue caused by physical factors: climate, diet, sleep, exercise, evil spirits (spirits are not seen as superstition in the Tibetan culture). On subtle levels illness is understood to be caused by the physical humours, the channels of wind, bile, and phlegm energy, which exist as a byproduct of the three mental poisons. On the subtlest levels the person is without disease because they have transcended the delusion of the separation between mind and body and have treated the mental poisons.

The three mental poisons are attachment, hatred, and close-mindedness. These mental poisons have physical parallels for which they are each associated: the nyes pa, the three humours. The meaning of the word nyes pa or humour is understood as ‘fault’ or ‘defect’, and the nyes pa are seen as the cause of death, the mind and body separating. When these humours are in balance the body and mind are understood as being healthy, however when they are out of balance there is disease. Attachment is associated with rlung (wind), hatred is associated with mkhris pa (bile), and close-mindedness is associated with bad gan (phlegm). These poisons are understood as the mental or psychic cause for the three humours. Additionally, within the Tibetan view of the body there is an elemental cause for the humours. There are five elemental energies that exist in our environment but also are very much what we are made of. Rlung (wind humour) is produced by the wind element, mkhris pa (bile humour) is produced by the fire element, bad gan (phlegm humour) is produced by both the water and earth element, and it is understood that the space element is present in all the humours. In addition to the mental and elemental existence of these humours, these humours could also been seen, understood, and treated on the physical and gross levels of consciousness. Rlung (wind humour) is associated with the nervous system, mkhris pa (bile humour) is associated with blood, blood circulation of the metabolic system, and the menstrual system, and bad gan (phlegm humour) is associated with the production of sperm, the endocrine system, and lymphatic system. 

In the Four Tantras, the Tibetan medical text taught by the Buddha, psychiatric illnesses are called sems nad and smyo nad: Illness of the mind. Sems nad is most similar to depression and anxiety disorders, while smyo nad resembles psychosis, schizophrenia, and dissociative disorders. As explored earlier, the treatment for mental illnesses is focused on the causation of the illness rather than functionality and symptoms. In order to clarify this point the distinction between the Western definition of mental health and the Tibetan definition will be provided. The World Health Organization defines mental health as “a state of well-being in which every individual realizes his or her own potential, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to her or his community.” This definition of mental health is focused almost entirely on the individual’s ability to function from an outside viewer rather than an internal balance. A Tibetan definition of mental health is “a mind freed from the influence of the afflictive mental factors, of the three types of mental factors the afflictive factors (such as greed, hatred, pride, envy, lack of insight, etc.) are seen as the ultimate underlying causes of both physical and mental diseases.” Additionally in the Western tradition psychiatric issues are seen as excessive or deficient emotional expressions. Emotions, in the Tibetan tradition, are not seen an intrinsic to a person but rather something that trains the mind to adopt a certain perspective. Mental illness is therefore not excess or deficiency of emotions but rather an inability to control one’s mind and perception of the world. 

The causes of illnesses are numerous and each indicate different courses of treatment. Of the three nyes pa the rlung, wind humour, is usually associated with mental illness, with a rising wind energy, anger rises as well. With an imbalance to the rlung humour the individual experiences mental instability, impairment of senses, depression, misperceptions, and delusions. Although rlung is associated with the nervous system and treatment through the physical body may relieve suffering, the nervous system is not itself the root of this suffering. Therefore treatment can include the physical adjustments of the individual’s life such as diet changes, exercise, sleep, and herbal supplements, as well as a mental and spiritual treatment such as meditation. Mental illnesses can also have karmic causes. There are some cases in which a person, or a person close to the individual, did something greedy, ignorant, prideful, etc. and they will contract an illness of the mind. This greedy action can be either in the individual’s current life or in a past life. The treatment for illnesses rooted from wrongdoing in the current is often to rectify the situation, however treatments for negative activities in past lives can only be reached through purification practices from monks. Treatments can also include other buddhist practices such as reciting mantras, blessings from high monks, offerings, etc.

In addition to the long history and tradition of Tibetan medicine that shines light onto the Tibetan conceptualization of our physiology, it is important to investigate current language of Tibetan Buddhists to grasp a modernly accessible understanding. The Dalai Lama is the highest Lama in the Tibetan tradition. He now acts as a somewhat world celebrity is sharing the ideas of Tibetan Buddhism to the rest of the world, while he lives in exile. In a talk the Dalai Lama gave about depression and mental illness he began by stating that “there is a growing recognition of the connection between our states of mind and our happiness”. Although using slightly different language than the traditional Tibetan doctors, the recognition he is speaking of is the level of consciousness. In the Tibetan tradition we already know that emotions are seen as the way in which one views the world: the perspective. The Dalai Lama knows that “our states of mind” and “our happiness” are the same, but in the West that understanding has not always been made so explicit so he begins there. He then goes on to state that “all human beings have the capacity to be very determined and to direct that strong sense of determination in whatever direction they like”. This determination the Dalai Lama is describing can also be understood as the awareness and concentration that are central to the practice in meditation. Additionally this determination is the motivator to decide how we perceive our life. The very idea of mental health in the Tibetan view is the ability to control one’s own mind, so this determination that has “the capacity…to direct that strong sense [that concentration and awareness]”, is that control of the mind. The Dalai Lama completes the description by saying, “this recognition can act as a mechanism that enables us to deal with any difficulty, no matter what situation we are facing, without losing hope or sinking into feelings of low self-esteem.” Although an individual is already mentally healthy when it is already recognized that they have the ability to control their state of mind and therefore emotions and reality, the Dalai Lama posits the process in reaching mental health is through meditation. Recognition of the ability to control mental states is the very awareness that is gained as a result of digging into the levels of consciousness. This recognition is itself the result and the practice of escaping ignorance which is itself the cause of all suffering and disease. The Dalai Lama has weaved the very core ideas in traditional Tibetan medicine into a public speech on mental illness for the West.

The tradition of Tibetan medicine has allowed for mental illnesses to be deeply understood and treated in an accurate way that targets the root of the illness due to the Buddhist physiological conception of the human body. This medical tradition understands that at its core the body and mind are both the subtlest energies and are integrally intertwined and dependent. Additionally the root of all suffering and illness in Buddhism is ignorance and that ignorance gives rise to the mental roots of illness, attachment, hatred, and close-mindedness, as well as the physical roots of illness, the wind humour, the bile humour, and the phlegm humour. With both the understanding that this mind/body separation is an illusion and the understanding how both the mind and body present that ignorance, Tibetan doctors, traced back to the Buddha himself, have established a holistic method of treatment that balances the mental and physical aspects of illness in order to achieve the pure natural state of enlightenment and true health. Understanding the Tibetan physiology is crucial for academics, Western psychologists, Western doctors, and additionally each individual who is interested in health and happiness. This physiology is radically different from the Western physiology and, regardless of the level of an individual’s believe in it, can disrupt the preconceived implicit ideas and allow for further reflection and reconsideration of the relationship between mind and body. Additionally understanding the Tibetan medical practice may open the door for more holistic and deeper medical treatments and as well as shift the focus the West has on medical symptom treating to treating the root of the issue.