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MAIN EXPLANATION PRACTICE COMMENTARY ARTICLES CLINICAL RESOURCES



DIAGNOSIS

Interview

To put theory into practice we have specific diagnostic tools. As taught to me by my teacher Dr. Trogawa Rinpoche, we should first speak to the patient and find out their medical history as well as pertinent aspects of their personal history.

Interview

Urine

Urine

We then look at a urine sample. In the urinalysis we observe such things as the color of the specimen and its odor and then after vigorous stirring the size, color, amount, and persistence of bubbles, and any deposits. From this we can begin to confirm the nature of the illness, the presence of infection and the localization of the illness among other things.


Pulse

Next we feel the twelve pulses. There are six distinct pulses at the radial artery of each wrist. We feel for such things as the width, depth, strength, speed and quality of the pulse. Each of those factors when understood properly allow us to clearly define the illness, its location, hidden complications and its etiology.

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Additional Diagnostic Techniques

To further confirm the diagnosis we can look at the color, shape and coatings of the tongue, the sclera of the eye and we may look for sensitivity at certain pressure points on the body.


TREATMENT

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 psychological or psychosomatic.

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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 t herapies 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.


Behavior

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 Lüng  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 Tripa  disorders, emphasis may be placed on generating a deep feeling of love and compassion as a cure for aggression and anger. In Bädkën  disorders, meditation will focus more on developing wisdom as a cure for ignorance.

Physical activity, lifestyle, exercise and habits are also considered. For example, patients with Lüng  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 Tripa  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 Bädkën  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.


diet

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. 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.


herb

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 Bädkën  disorders or digestive disorders. Afternoon remedies are typically used to treat Tripa disorders. Remedies given in the late afternoon or evening are usually given to treat Lüng  disorders. Ultimately, the organization of the prescription is based on both the doctor's judgment and the patient's lifestyle.


Physical Therapies

If the above treatments are not sufficient to cure the illness, physicians employ therapies such as acupuncture, moxabustion, cupping, massage, and inhalation therapy.


Spiritual Considerations

But despite even the best use of medical treatment we cannot attain good health simply by being physically healthy. We need to have a healthy mind as well.

Based on the centuries-old Buddhist study of the mind, Tibetan medicine gives priority to factors of psychological and spiritual development in its definition of health. It seeks to understand and explain the nature and reason for the suffering we experience in our lives.

Spiritual

It teaches acceptance of and gives meaning to the cycle of birth, sickness, old age, and death we all encounter. Common experiences such as not getting what we want, not wanting what we get, being separated from whomever or whatever is dear to us, and being joined with people and things we dislike becomes a basis of spiritual understanding and growth.

Tibetan medicine explains how hatred, anger and aggression, ignorance and incomprehension and a materialist view of the world result in states of mind which are at the root of our suffering. How our habitual patterns of thinking and behaving are the primary cause of illness. Finally, it asserts that through study and spiritual practice an understanding and awareness can gradually be achieved which transcends that suffering.

In Tibetan medicine we attempt to become aware of the process of our physiological, spiritual and psychological evolution as it originates from what we do what we say and what we think. Every action sows its seed in the mind and will eventually ripen in accordance with its nature. No experience is seen as causeless. The transient, ever-changing nature of all things is embraced. The conclusion which is reached from this view is the interdependent nature of all things. The highest value is placed on the attainment of compassion and what is termed loving kindness.



For a Biography of the Author:
Eliot Tokar

Correspondence:
etokar@aol.com

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Copyright 1998, Eliot Tokar