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Building A Means Of Discourse For Integrative Medicine

A Tibetan Medical Perspective On Irritable Bowel Syndrome

Eliot Tokar, Ariana Vora
Copyright 1998 Eliot Tokar
Originally published in Alternative & Complementary Therapies Volume 4, No. 5; October 1998
Pub. Mary Ann Liebert, Inc.

~~ARTICLE CONTENTS~~
1. INTRODUCTION
6. CONCLUSION
2.

DIAGNOSIS AND TREATMENT
IN WESTERN MEDICINE

7. REFERENCES
3.
COMPARATIVE DIAGNOSIS
8. ADDITIONAL REFERENCES
4.

DIAGNOSIS OF THE CONDITION
IN TIBETAN MEDICINE

9. ABOUT THE AUTHORS
5.
TREATMENT IN TIBETAN MEDICINE

.

Figure A

..... a) Behavioral Modification
..... b) Diet
..... c) Herbal Medicines
..... d) Physical Therapies

.



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INTRODUCTION

A very highly regarded Tibetan physician in West Bengal, India, recently expressed that he was wary of the negative effects when younger Tibetan doctors feel they must address Western medical diagnoses. He said that such information does not help the doctor to make an accurate Tibetan medical diagnoses and instead spreads the hegemony of Western medicine.

This is a persuasive argument. The most important issue regarding traditional medical systems is their complete preservation. The economy of time and commerce and the influence of Western medical approaches are endangering the more classical, holistic approach to Tibetan medicine. Already, Tibetan medicine is becoming a hot new commodity in the new alternative medicine industry. The use of the classical treatment protocol described above is giving way to the use of Tibetan herbal pills as an oversimplification of Tibetan medical treatment. This creates a senario easily exploitable by the growing nutriceutical industry which is always looking for potential new products.

The active cooperation of various systems of medicine is an important goal, a hasty integration will limit us to a "Disneyworld" version of these vast and varied medical approaches. That is, we may find ourselves using only some of the form and some of the substance of complex traditional systems of natural medicine squeezed into easily marketable and salable forms. "Complementary medicine" has become a ubiquitous term in current discussions of alternative medicine. Simply creating a field of "complementary medicine" as a new industrial category to modify the term "alternative medicine" underestimates the needs and insults the intelligence of the American people. That intelligence has been well expressed during the past three decades through their investigation and use of alternatives in healthcare.

However, adopting the isolationist perspective of the aforementioned Tibetan physician is not the only way to preserve Tibetan medicine. We must work to understand the system and teach its true meaning so that healthcare consumers can discern what is real and what is commercial. Before a system of truly complementary medicine can exist in the United States, the essence of traditional natural medical practices needs to be properly understood by allopathic health professionals and more fully incorporated into American sensibilities. The first step in that process is developing a means of discourse so that lay people, allopathic physicians, and practitioners of traditional natural medicine can speak to and educate each other.

To begin establishing a complementary approach to medicine, we must create a common language through which traditional doctors and allopathic doctors can communicate clearly about their disciplines. For example, traditional Asian medicine is not about acupuncture points, herbal remedies, or other therapeutic devices. Rather, it is about the scientific, cultural, and spiritual knowledge which gave rise to those applications. Creating such a language is a complex but essential task which at worst is overlooked and at best is attempted in an intellectually and scientifically inadequate fashion.

The following example is offered as an illustration. A meeting was recently held at Columbia University with two Ayurvedic physicians and a group of Western health professionals. In the question and answer session one Western practitioner, who was working at a hospital unit which utilizes complementary medicine, asked the Vaidyas if and how they treat multiple sclerosis (MS). They answered that they did treat MS and then attempted to explain their approach to treatment. As they spoke, the American practitioner posed numerous additional queries regarding the details of MS. As this happened, the discussion became progressively obtuse and frustrating.

Based on my experience in traditional Asian medicine, I offered the comment that the Vaidyas were actually not diagnosing or treating MS because it does not exist as a diagnostic category in Ayurvedic medicine. I recommended that we share some case studies of their own patients with a Western diagnosis of MS and discuss in detail the condition they had diagnosed and the results of their treatment. The discussion immediately became a more organized and clear dialogue. It ceased to have the tone of an inquisition or the strain of a person struggling to fit the wrong size shoes onto the opposite foot. After the meeting the Indian doctors told me, "This often happens to us at meetings of this kind where we are asked about Western diagnoses. To accommodate the Western doctors we answer, but it is never adequate."

Western diagnoses such as irritable bowel syndrome, cancer, and diabetes are not in fact illnesses; rather, they are conceptual descriptions of the etiology of illness with related treatment protocols. When we appreciate this point, the concepts of Tibetan medicine or any other system of medicine can be considered on equal terms with the concepts of the Western model. Only then can we create a language that enables meaningful dialogue among different medical systems. The development of such a language is an often ignored prerequisite which is crucial for an effective integrative analysis.

The following article attempts to contribute to this language of discourse with the long-term objective of creating such an analysis. As a starting point in building this language, the condition defined by Western medicine as irritable bowel syndrome provides an example of a useful model for comparative analysis with the same condition as defined by Tibetan medicine.



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IRRITABLE BOWEL SYNDROME: DIAGNOSIS AND TREATMENT IN WESTERN MEDICINE

According to Harrison's Principles of Internal Medicine, irritable bowel syndrome (IBS) is the most common gastrointestinal disease in Western clinical practice(1). Its etiology is not clearly understood by Western medicine, and it has no organic disease as its basis(2). Psychological conditions ranging from stress and anxiety to deeper disturbances frequently trigger exaserbations of symptoms(1). Compared to the general population, patients with IBS have an increased frequency of psychiatric diagnoses including personality disorders, anxiety, depression(1).

Symptomatically, IBS is experienced as as either abdominal pain, intermittent diarrhea or constipation, bloating and excess gas(3). IBS is a disorder of motility or sensory function in the GI tract, often leading to rapid transit of food to the small intestine(1,3) A diagnosis of IBS is supported by symptomology of a chronic and intermittent nature, an absence of physical signs of deterioration and emotional stress(4) The rest of the diagnosis is established based on the exclusion of other conditions, such as infection, neoplasia, thyrotoxicosis, obstruction and malabsorption(1).

IBS is considered treatable but not curable(1). Dietary treatment includes fiber supplements, osmotic laxitives, and easily digested carbohydrates(3). Sypmtoms can be medically controlled with anti-diarrheals, prokinetic agents, tricyclic antidepressants, and/or anxiolytics(1). Since IBS is thought to be incurable, patients are advised to adapt to the symptoms(4). In cases of great severity or where patients do not respond to treatment physicians often recommend psychotherapy, hypnotherapy or biofeedback(1).

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COMPARATIVE DIAGNOSIS

Figure 1 illustrates a basic difference in the diagnostic approaches of the Tibetan and Western systems. Consider two pyramids, one inverted and the other upright. Western diagnosis can be graphically represented by the inverted pyramid. In the process of performing a Western diagnosis, the physician begins by considering the broad spectrum of a patient's chief complaints, history of present illness, past medical history, and social history. The Western physician then progressively narrows the differential, eliminating what is regarded as extraneous or secondary. Finally, a singular definition of disease is reached, such as IBS. Once this diagnosis is established, information about treatment options and expected prognosis can be accessed from statistical and experimental research tested in study populations. However, in this approach very little is understood about the difference between one individual with IBS and another individual with the same diagnosis. Beyond the subjective observation of the Western physician, no satisfying explanation is available regarding why individual patients experience the disease differently, with varying symptoms, course, prognosis, and quality of life.

FIGURE 1


Tibetan diagnosis can be graphically represented by the upright pyramid. At the apex of the pyramid is the individual. The Tibetan physician places a particular emphasis on individuality because all illnesses are rooted in each patient's unique background and situation. This concept of the individual is then expanded to include the chief complaint, accompanying symptoms, and relevant medical, personal, dietary, and spiritual history. Through this process, the physician perceives the broader complex which characterizes the illness. Once the illness is diagnosed on such terms, the root cause of the entire complex of symptoms and conditions can be understood. It is this root cause of illness in addition to the acute symptoms that Tibetan physicians diagnose and treat. In this approach, each patient's diagnosis, treatment plan, and prognosis are determined on an individual basis. Therefore, what might be perceived as one disease in Western medicine is actually perceived as a range of conditions in Tibetan medicine.

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DIAGNOSIS OF THE CONDITION IN TIBETAN MEDICINE

It follows that the etiologies and manifestations of illness can be understood within several diagnostic categories in Tibetan medicine. These categories relate to three principle systems which give rise to and regulate all functions of the body and mind: Lüng  (Wind), Tripa (Bile), and Bädkën  (Phlegm). Below is a rudimentary description of the three systems and a brief discussion of their relation to the diagnosis of IBS.

The three principle systems which create and sustain all the body's functions (Wind, Bile, Phlegm) are created at various stages of development in the womb by an interaction of our mind's developmental process and the five physical elements (discussed later in the section on DIET). Embryologically, the mind acts as the basis for the creation of each individual's three principle physical systems. A materialist view of the world, based on ignorance of a spiritual perspective, is inherently related to Wind.

In Buddhism, stress can be defined at its most basic level as the conflict created between the pursuit of worldly desires and our limitations in fulfilling these desires. Therefore, stress is a reaction rather than a response to given circumstances. This reaction results in psychologic and physical reactions which disturb Wind. The results of stress can include improper diet, harmful lifestyle (e.g. erratic sleep habits), and poor adaptation to one's physical environment (e.g. overexposure to cold in winter or to heat in summer).

IBS has as its major component an emotional stress reaction resulting in symptoms such as diarrhea and/or constipation. Therefore, a characteristic etiology of this condition is the disturbance of what in Tibetan medicine is called Wind. Wind gives rise to all circulation in the body. As the basis of circulation, it is associated with processes of the human organism characterized by movement, from the intangible (e.g. thoughts), to the physical (e.g. nerve impulse, blood and lymphatic circulation and movement of chyme through the digestive and excretory systems).

A disturbance of Wind can occur alone or in combination with dysfunctions of one or both of the two other principal systems. When it occurs alone, this disturbance is termed a Wind disorder. Typical symptoms of such a disorder include erratic and diffuse pain, lower back and hip pain, dry skin, abdominal distention, constipation, diarrhea, anxiety, anorexia, depression, mood swings, insomnia, psychosomatic disorders, irregular blood pressure and metastasis of tumors.

The second principle system is Bile. Bile is associated with thermoregulation, metabolism, vision, liver and gallbladder function, and blood production. It allows the mind to function with discriminating intelligence. A disturbance of this system can include such conditions as anger, hypertension, vomiting, gastric acidity, hepatic dysfunction and the development of fast growing tumors.

Cases of IBS defined by the basic Wind disorder in combination with a Bile, disorder are called Wind/Bile disorders. They can include symptoms such as erratic episodes of hypertension, sharp pains which move around the body, fluctuating fevers, reflux, regurgitation, and a combination of symptoms of both Wind and Bile disorders.

Phlegm is the third principle of physical and psychologic function. It is associated with the proper breakdown of food in the initial stages of digestion, the maintenance of the body's internal fluids, and the proper functions of the senses overall. Typical manifestations of Phlegm disorders can include a sensation of physical or mental heaviness, kidney disorders, hypotension, slow metabolism, hypersensitivity to cold, weakness, diarrhea, the development of soft cysts, and slow tumor growth progression.

If the case of IBS is characterized by a Wind disturbance combining with the principle system of Phlegm, it is called a Wind /Phlegm disorder and is characterized by an inability to properly break down foods at the initial stages of digestion. In this case, the IBS is accompanied by symptoms such as hypersensitivity to cold, mucus or undigested food in the stool, excessive urination and a combination of Wind and Phlegm derived pathology.

Finally, if the condition derives from a complex dysfunction of all three main principle systems mentioned above (Wind, Bile, and Phlegm ), it is termed a Mukpo (lit. Brown Phlegm) disorder and reflects a combination of liver and stomach dysfunction that chronically undermines digestive and assimilative processes. This results in a variety of symptoms, including intestinal pain, sour vomiting, indigestion, nausea, lack of appetite, blood in the stool, and constipation. In more severe cases, or if left untreated , this condition may lead to tumorigenesis.

Appropriate diagnosis of the condition is determined through an interview and physical examination, in which the patient's history and presenting symptoms are elicited. Next the physician analyzes a urine sample, feels the twelve distinct pulses on the radial artery of each wrist, observes the tongue and the sclera of the eyes, and if necessary, applies pressure to appropriate points on the body. Treatment is then tailored to address the specific etiology of the individual's condition.

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TREATMENT IN TIBETAN MEDICINE

Treatment is specific to each of the four diagnostic categories. The first consideration in treatment is the principle that all illness ultimately originates in the mind. This does not mean that all illness is psychologic or psychosomatic. Rather, it means that due to ignorance we misperceive the nature of reality and act in ways which create suffering such as illness. Given this basic principle, when treating an illness physicians first begin by recommending specific behavioral and lifestyle modifications. If this is not sufficient, then physicians work at the level of dietary therapy. If these are not enough to cure the problem, physicians employ herbal medicines or, if needed, physical therapies such as acupuncture. As stated by Dr. Trogawa Rinpoche, the treatment ultimately must fit the patient; that is, treatment must be formulated in a manner which can and will be effective for that individual.



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Behavioral Modification:

Behavioral modification can include meditation instruction, spiritual advice, counseling, exercise, or the reorganization of habitual patterns such as sleep habits and eating schedules.

Initial stages of meditation generally include simple breathing practice and working with one's thoughts in a manner which calms the mind. Meditation then evolves beyond that point to include specific contemplations and visualizations which begin a process leading to a new understanding and perception of the world. This aspect of the treatment may vary slightly with the diagnosis. For example, in the case of Wind disorders, meditation may be specifically directed toward understanding the impermanent nature of physical phenomena as a cure for materialism and attachment. In the case of Bile disorders, emphasis may be placed on generating a deep feeling of love and compassion as a cure for aggression and anger. In Phlegm disorders, meditation will focus more on developing wisdom as a cure for ignorance.

For example, the following is a basic meditation for people experiencing anxiety and depression, which are fundamentally Wind disorders. Because it calms Wind, this meditation can be helpful in some etiologies of IBS. After awakening in the morning patients are asked to sit with their back to the sun in a place where they can look at the clear blue sky. If this is not possible, they can simply visualize the clear blue sky in their minds. Patients are then taught some simple breathing practice. When thoughts arise, they must not try to suppress them or to become involved with them; rather, they should allow them to arise in the mind and pass away. Such relaxing practices allow patients to focus and calm their minds. Patients are then asked to look at the sky, taking particular notice of its expanse into infinity. Next, they are told to focus on their mind and locate their consciousness. Then, on the exhalation, they are taught to project their consciousness out of their body and into the sky where it diffuses into an infinite blue expanse. Although it is very basic, this meditation begins to train patients gripped with mental turmoil to let go of their thoughts. In Tibetan medicine, this grasping to thoughts is considered an exacerbating factor of anxiety and depression.

Physical activity, lifestyle, exercise and habits are also considered. For example, patients with Wind disorders are told to pay special attention to regularity of lifestyle (eg. eating, sleeping and excretory function), find time for calm activities and socializing, and exercise in ways that promote good overall circulation, using techniques such as yoga. Individuals suffering from a Bile disorder should avoid situations causing conflict. They should avoid direct, excessive exposure to the sun and engage in physical activities which relax them. Patients with Phlegm disorders should keep warm and perform vigorous exercise such as running or dancing. Swimming is not appropriate if it involves immersion in cold water. In the case of a combined disorder such as Mukpo, behavioral modification is tailored to the particular form the illness takes.



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Diet:

In recommending an appropriate diet, Tibetan physicians consider which types of food are harmful and which might be beneficial, the amount of food to be eaten, the number of meals per day and the proper meal times. Food is analyzed based on its qualities and nature as defined by a five element theory. All of the material which makes up our universe is based on the qualities of five basic elements which are described in the ancient physics texts of Tibetan medicine. Ancient Tibetans lived in direct contact with the natural environment. They understood through experience and study that the forces manifest in nature directly correlate with and influence the functioning of the human organism. In the theory of the five elements, we see an effort to define the qualities of the basic forces which exist in nature. Once defined they are named for their most identifiable manifestations: earth, water, fire, wind and space. The characteristics and therefore the nature of all matter then result from the qualities of these elements individually or in combination.

Specific arrangements of the five elements which occur during embryological development form the three basic principles of physical function (Wind, Bile, Phlegm ). This is important because the taste of different foods, their resulting natures, and therefore their effects on the human organism are also dictated by the specific arrangements of elements which make up the food. This principle enables practitioners to think intelligently about diet and health relative to each individual patient's lifestyle, environment and health condition.

The recommended diet for IBS varies significantly depending on the specific etiology experienced by the individual patient. Because stress is a significant trigger in IBS, Wind is usually a contributing factor. Therefore, a proper therapeutic diet must routinely treat Wind imbalances. Depending on the presence of imbalances of Bile and/or Phlegm additional foods must be added to or removed from the diet.

Wind Diet

Patients benefit from a diet of heavy nutritious foods, such as meat, cheese, butter, and soups made with bones (e.g. chicken soup). In the case of a Wind /Bile disorder, or some Mukpo disorders, or if the patient is a vegetarian, animal-based foods can be replaced with other foods. Substitutes include avocadoes, vegetable, legume or grain-based soups, onion, asparagus, and oats.

Foods that are irritating or 'rough' in nature should be avoided, because they would impede or distort the movement and circulation which is essential for the function of Wind. These include foods that are burned in cooking or processing (e.g., grilled meat, over-toasted bread, coffee, chocolate) because they induce stagnation of the circulatory energy; sugar, molasses and artificial sweeteners; puffed grains such as rice cakes; monosodium glutamate, improperly processed foods (e.g. distilled vinegar, low-grade soy sauce); and green tea. These foods, which might otherwise be benign or useful, are contraindicated in this situation for two reasons: (A) because they are irritants causing an exacerbation of stress related symptoms, or (B) because they impede proper circulation in the body.

Bile Diet

These patients observe the Wind dietary guidelines while incorporating additional principles that are tailored to the Bile condition. In this case a simple vegetarian diet is suitable, including legumes, potatoes, cumin, coriander, fenugreek, artichoke, bitter vegetables (e.g. dandelion), and turnips. Foods that are heating in nature should be avoided. These include peanut butter, mustard, spices, garlic, ginger, onion, alcohol, meats [esp. lamb], oily and greasy foods, and soups made with bones.

Phlegm Diet

These patients adopt a heating diet with respect to both the nature and the temperature of the food. For example, they consume hot water, cooked foods, pomegranates, sheep cheese, yogurt, ginger radish, honey, ginger, and garlic. They avoid cold drinks and raw foods such as salads, potatoes, tomatoes, eggplant, bell peppers, and sugar.

Mukpo Diet

Mukpo is the combined dysfunction of all three energies. This is a complex chronic condition in which each of the imbalances ultimately affects the digestive and metabolic functions. The diet includes fresh, cooked foods to facilitate the severely compromised digestion that is typical of this condition. Recommended foods include fresh meat, dairy products, vegetables, fruits, and whole grains. This condition is exacerbated by garlic, tomatoes eggplant, bell peppers, and foods that are aged, fermented, cured, smoked, sour, chilled, oily, or processed.

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Herbal Medicines

If the above approaches are not sufficient in relieving the condition, herbal medicines are prescribed. In Tibetan medicine, herbal treatments range from simple to very complex, in a using approx. 3 to 150 herbs per formula. Each formula or set of formulas is prescribed to fit the manifestation of the disease and the evolving condition of the individual patient. As a result, herbal medicines often need to be modified at each visit.

Typically, two to four formulas are prescribed, to be taken each day at specific times. Morning remedies commonly include those for Phlegm disorders or digestive disorders. Afternoon remedies are typically used to treat Bile disorders. Remedies given in the late afternoon or evening are usually given to treat Wind disorders. Ultimately, the organization of the prescription is based on both the doctor's judgment and the patient's lifestyle.

Although prescriptions are specifically tailored to each case, some herbs are more frequently found in formulas applicable to cases defined as IBS by Western medicine. For example, a set of three herbs (Terminalia chebula, Terminalia belerica, and Emblica officinalis) are often given together as a mixture or included as ingredients of a complex formula

Additional herbs are typically prescribed for each individual's condition. Herbs such as Aquilaria agollocha (Eaglewood), Asofedita, Saussurea lappa, Areca catechu, cardamom, nutmeg, and clove are often found in Wind disorder medications(5). Swertia chirata, Saussurea lappa, and berberis are commonly used in Bile disorder formulas(5). Phlegm disorders are commonly treated with pomegranate seeds, Piper longum, black salt, cardamom, and cinnamon(5). Commonly used ingredients for relevant Mukpo disorders are Saussurea lappa, Emblica officinalis, pomegranate seeds, cardamom, Piper longum, Veronica ciliata, and calcite(5).

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Physical Therapies

Other therapies may also be used if the above approaches are not sufficient. They include:

Massage

Massage is calming and promotes good circulation. For cold conditions such as Wind and Phlegm disorders, massage oils should be heating in nature, such as sesame oil or mustard oil.

Tibetan Acupuncture

Tibetan medicine has its own acupuncture system. In addition to the application of needles Tibetan physicians also use moxabustion, which may be used in conditions such as Phlegm and Wind .

Inhalation therapy

This modality is best illustrated by the medicinal use of incense formulated specifically to treat Wind conditions. When indicated, patients are prescribed such incense and asked to inhale the smoke as it diffuses into the air during times of the day when the Wind predominates such as in the late afternoon and before bedtime.

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CONCLUSION

The process of introducing new ideas regarding medicine and creating a new, integrative paradigm is already present in the history of Tibetan medicine. Centuries ago, before Buddhism entered Tibet, Tibetans like all ancient people had some degree of medical knowledge. According to traditional sources, in the beginning of the 4th century many new ideas regarding medicine began to enter the country. At first influences came from India in the form of what is now called Ayurvedic medicine, as well as more spiritual and psychologic systems from Buddhist and other sources. Around the 7th-8th century, government-sponsored conferences occurred in Tibet, where doctors skilled in the medical systems of China, Persia, India and Greece came to present and debate their ideas on health and the treatment of illness. Those with superior abilities were invited to stay and contribute to the country's medical knowledge base. It was not until the 11th century that this knowledge was integrated into a unified system. This system contained a synergy of various principles of physical and psychologic medicine imbued with a spiritual understanding.

For the past thirty years the American people have expressed that the medical system which has dominated this country for most of this century is not wholly adequate. The recent explosion of interest in alternatives in healthcare from allopathic doctors, researchers, the government and industry creates two possibilities. One is a renaissance atmosphere where doctors, researchers and independent practitioners of natural medicine meet on equal ground, freely exchanging ideas, experience and knowledge and thereby creating great benefit for patients. The other is expressed by the new presence of those in the healthcare industry who are seeking to co-opt and control this renaissance through professional, political, legal and commercial means.

People must learn to negotiate the landscape of alternative health modalities. However, Americans need a better understanding of the theory and practice of these disciplines before their efficacies can be truly understood. When understanding is achieved Americans can gain benefit from Tibetan medicine's insights into how to maintain health and cure illness based on centuries of accumulated knowledge of the spiritual, ecological, psychologic and physical aspects of health.

Given the speed of developments in the modern world, it will probably not take us seven centuries the Tibetans utilized to create a new paradigm of integrative medicine. However, we must not allow the agenda to be set by the rapid pace of economics and technology which has affected our American healthcare system. The above material is an illustrative example of how diagnoses can be understood across two disciplines. Additional dialogue is required to explain the meaning of basic concepts such as "blood quality", "slow metabolism" or "sweet taste" in Tibetan medical terms. More work needs to be done to create a language which allows for clear and constructive dialogue between systems. Practitioners of natural medicine need to become more sophisticated in the language of allopathic medicine rather than using it as an inaccurate convenience or as a way to pass in the healthcare system. Allopathic physicians and researchers need to truly understand the approach of natural medicine rather than seeing it as a collection of therapeutic devices which can be cut and pasted into the existing paradigm. When this work is fully accomplished, we can reach a point where different systems of medicine can act independently or in a complementary fashion where appropriate for a patient's condition. Once freed from the dangers of hegemony and dedicated to equality, "complementary medicine" will fulfill its promise in broadening American health care.

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References

1. Lynn, Richard B. and Freeman, Lawrence S. 'Irritable Bowel Internal Medicine, 14th edition, ed. Fauci, Anthony S. et. al.. New York: McGraw-Hill, 1998, pp.1646-1648

2. Glanze, W. et. al. The Mosby Medical Encyclopedia. New York:Penguin Books, 1992, pp. 433

3.Heuman, D., Mills, A., and McGuire, H. Gastroenterology. Philadelphia: Saunders, 1997, pp.121-122.

4. LaMont, Thomas J. and Isselbacher, Kurt J. 'Irritable Bowel Syndrome' in Harrison's Principles Of Internal Medicine, 13th edition, ed. Isselbacher, Kurt J. et. al.. New York: McGraw-Hill, 1994, pp.1421-1422

5. Tsarong, T.J. Handbook Of Traditional Tibetan Drugs: Their Nomenclature, Composition, Use and Dosage. Kalimpong, India: Tibetan Medical Publications, 1986, pp.1-88.



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Additional References

1. rGyud Zhi. Dharamsala, India: Tibetan Medical & Astrological Institute, 1994.

2. Shel Gong Shel Prang. Dharamsala, India: Tibetan Medical & Astrological Institute, 1994.

3. Kon sPrul, J. Gso Rig Zin Tig Gces Bsdus: A Treatise On Tibetan Medicine. Leh, Ladakh, India: Mrs. D. W. Tashigang, 1983.

4. rGya mTsho, sD. S. Bai Dur sNon Po. Leh, Ladakh, India: T. Y. Tashigangpa, 1973.

5. Trogawa, S. L. Unpublished Lectures, New York, Boulder, CO 1984-1989.

6. Dhonden, Y. Unpublished Lectures, Amherst, 1983-86.

7. Thondup, T. The Healing Power Of Mind. Boston: Shambala Publications, 1996.

8. Khangkar, L. D. Lectures On Tibetan Medicine. Dharamsala, India: Library of Tibetan Works & Archives, 1986.

9. Tibetan Medicine (gSo-rig) Vol 1-12. Dharamsala, India: Library 1989.

10. Guide To The Exhibition On Tibetan Medicine & Astrology. Dharamsala, India: Men-Tsee-Khang.

11. Parfionovitch, Y., Dorje, G., Meyer, F. Tibetan Medical Paintings: Illustrations to the Blue Beryl Treatise of Sangye Gyamtso. New York: Harry N. Abrams, Inc., 1992.





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About the Authors

Eliot Tokar is a NYC based practitioner of traditional Asian medicine. He has studied Tibetan medicine since 1983, first under Dr. Yeshi Dhonden and since 1986 with Dr. Trogawa Rinpoche. Mr. Tokar has also trained in Chinese medicine, acupuncture, and traditional Japanese natural therapies. He has lectured on Tibetan medicine, natural medicine and alternatives in healthcare at Princeton University, Mount Sinai School of Medicine, the Columbia Presbyterian Hospital, and the American Association of Medical Colleges. He currently serves as an advisor to the American Medical Student Association's National Project on Complementary and Alternative Medicine.

Ariana Vora was the 1997-1998 National Coordinator of the American Medical Student Association's National Project on Complementary and Alternative Medicine. She is currently a student at Mt. Sinai School of Medicine.

For a Biography of the Author:

Eliot Tokar

Correspondence:

etokar@aol.com


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