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  The Art of Tibetan Medicine
From Asia, Secrets of Keeping the "Body In Balance"
By Susan Okie
Tuesday, October 27, 1998
An illustration from a Buddhist medical text in the exhibition "The Buddha's Art of Healing" at the Sackler Gallery. (The History Museum of Buryatia)
Many Americans think of medicine as a scientific search for the truth. It's easy to forget that, like art or politics, medicine is also a shifting expression of our culture.

"The Buddha's Art of Healing," an exhibit of paintings about traditional Tibetan medicine on view in Washington through Jan. 3, is an exquisite reminder that any medical system reflects the wisdom and values of the society that developed it. Doctors, even the most scientifically minded ones, are initiates trained in a set of beliefs. And talented healers schooled in radically different disciplines can use a combination of empathy, observation, intuition and deductive reasoning to diagnose illnesses and help sick people.

Viewers of the exhibit at the Smithsonian's Arthur M. Sackler Gallery – and those attending a conference on Tibetan medicine to be held in Washington next month – are likely to find some aspects of Tibet's healing system exotic. But others will seem familiar or even trendy, especially in view of Americans' current interest in alternative therapies and herbal remedies.

For example, Tibetan doctors emphasize behavior as a cause of illness, and often treat by prescribing changes in diet and lifestyle. They draw no division between diseases of body and mind, believing that both psychic and physical symptoms are manifestations of disorders that affect the whole person.

"Not only are body and mind one. The person is seen in relation to the entire ecological environment," writes Fernand Meyer, a French physician and Tibet scholar, in the exhibit catalogue. "Everything in the material world . . . derives from a combination of some or all of the five elements: earth, water, fire, wind and space."

Traditional Tibetan medical theory ascribes disease to an imbalance of three bodily "humors" or vital essences: bad-kan (the water humor, associated with bodily cohesion and support); mkhris-pa (the fire humor, responsible for heat and digestion); and rlung (the wind humor, producing breath and mobility). The humors, blood and other fluids are thought to circulate through a network of channels that intersect at various important points within the body called chakras (a concept derived from India's Ayurvedic medical tradition).

Unhealthy behavior (including sexual indiscretions), toxins and improper diet are thought to cause humoral imbalances, as are unfriendly spirits or evil deeds performed in past lives. Treatment often includes traditional mixtures of Tibetan herbs – sometimes as many as 165 plant species in a single pill – which doctors are taught to identify, collect and prepare.

All of Tibet's medical schools were destroyed during or after the Chinese invasion of the country in 1959, and many Tibetan doctors went into exile, including some who established the Tibetan Medical Institute in Dharamsala, India. In the 1970s, however, the Chinese government allowed local doctors to open the Hospital of Tibetan Medicine in Lhasa, Tibet's capital. Traditional medicines made from herbs grown on high-altitude Tibetan farms are sold throughout China.

To diagnose illness, Tibetan physicians talk to and keenly observe the patient. They also check the color, smell and other characteristics of urine and perform a detailed and subtle evaluation of the patient's pulse, which they examine with several fingers placed on the wrist. The ability of some Tibetan doctors to pinpoint the cause of a patient's symptoms using these techniques has astonished Western physicians who observed the procedure.

As a young surgeon-in-training at Yale University, physician and writer Richard Selzer had the job of choosing patients to be examined by a visiting Tibetan physician, Yeshi Dhonden, in the 1970s. He said witnessing Dhonden's skill expanded his notions of the practice of medicine. Selzer described Dhonden's encounter with one patient in his book "Mortal Lessons."

"It was uncanny," Selzer recalled recently in an interview. "All he did was beat the urine with sticks and inhale it . . . and then he felt her pulse for a long, long time. He parted from us, really. Then he emerged to give, in this metaphoric way, the exact diagnosis."

"I was completely floored," he added. "It is one of the things that has made me open to an otherness, if you will, in disease and the treatment of it."

Chris Beyrer, an assistant professor of epidemiology at Johns Hopkins School of Hygiene and Public Health, worked with traditional Tibetan doctors while caring for Tibetan refugees in northern India during the 1980s. He said the experience taught him that each of the two medical systems had its own strengths. At one point, he recalled, he was working in a tent clinic in a monastery courtyard, next to the tent of Tenzin Choedrak, the Dalai Lama's personal physician.

"He'd refer patients to me, I'd refer patients to him, and we started spending the time off . . . discussing our respective systems," he recalled. "His system of diagnosis was so extraordinary and so rapid. He sometimes diagnosed people as they were walking toward him."

Beyrer said Choedrak often sent him patients who had infections such as malaria, tuberculosis or dysentery. "But I sent him a lot of the chronic disease, certainly the arthritis and hepatitis, and he really seemed to be able to do things."

He said Choedrak would sometimes say, "There's nothing I can do for this patient. This is a person who must go see a Lama," a spiritual teacher.

"That happens to Western doctors all the time," Beyrer said. "You get a patient and you realize, I could give him something, but really why he is here is loneliness or despair. You recognize those things."

The Four Tantras

The roots of Tibetan medicine reach back as far as the first century B.C., when Indian medical theories, based on a healing system known as Ayurveda, were introduced to Tibet by way of the Buddhist monasteries of northern India. Over the succeeding centuries, Tibet developed its unique medical tradition, based chiefly on Buddhist philosophy but also influenced by thinkers from Greece, China and Iran. The first Tibetan medical college, Melung, was founded in the 8th century by King Trisong Detsen.

During the 11th century, a work known as the "Four Tantras" became the preeminent text in Tibetan medicine. The "Four Tantras" were ascribed to the Healing Buddha himself, an aspect of Buddha who was venerated as a divine physician in Tibet and other parts of Asia. Opinions differ as to whether the document was translated from Sanskrit or was the work of a Tibetan author. In the 17th century, the "Four Tantras" were revised by Sangye Gyamtso, the brilliant regent of the Fifth Dalai Lama, who was both a theologian and a wide-ranging scholar. Sangye Gyamtso also wrote a medical commentary known as the "Blue Beryl," and supervised the creation of the "Atlas of Tibetan Medicine," a series of 79 paintings illustrating Tibetan concepts of anatomy, disease and medical treatment.

The original paintings have been lost, but the Sackler exhibit consists of 17 paintings that are exact copies of some of them, selected from a set painted from the originals in about 1920 and currently housed at the History Museum of Buryatia in Ulan-Ude, part of Siberian Russia.

The Tibetan scroll paintings, or thangkas, are painted on cloth using brilliant reds, blues, greens and oranges made from mineral or plant pigments. The opening image shows the Healing Buddha as a dark blue figure seated in the center of his palace in the city of medicine, Sudarshana ("Irresistible Beauty.") Surrounding the city is an exquisitely painted array of medicinal plants, including the six principal ingredients of Tibetan medicines: clove, nutmeg, saffron, cardamom, bamboo pith and cubeb.

Another introductory painting called "The Tree of Health and Disease" depicts the causes of illness, including the three humors as well as the three human emotions – delusion, hatred and desire – that make them depart from balance.

A scroll on pregnancy and fetal development teaches that conception occurs through the union of semen, menstrual blood and consciousness (which is influenced by deeds and experiences from past lives). It shows the fetus developing during a 38-week pregnancy, passing successively through a "fish" stage, a "turtle" stage and a "pig" stage. Other images exhort the pregnant woman to eat plenty of fiber, to avoid strenuous exercise and to get plenty of sleep (but not to nap during the day, which was thought to be dangerous).

Tibetan understanding of anatomy, as depicted in the paintings, seems to combine a fairly detailed knowledge of body structures with a metaphorical concept of consciousness and where it resides. Blood, for example, is shown as flowing through channels that don't reliably correspond to the actual course of arteries and veins. Instead, the vessels cross one another symmetrically at chakras, five hypothetical sites ranged along the midline of the body from the head to the genitals. Each chakra is associated with a different emotional state.

One fascinating painting instructs the Tibetan physician on how to interpret dreams and other omens to predict an illness's outcome. Diminishing function of any of the patient's senses is a bad sign, the painting warns. It also bodes ill if a patient dreams of riding naked on a buffalo, horse, pig, camel or donkey, particularly if traveling south. Adds Meyer in the exhibit catalogue, "If a patient's behavior changes dramatically from calm to violent, and they suddenly begin to criticize their physician . . . and they refuse to take any medicine, it is also a sign of decay."

A painting on healthy conduct illustrates a number of general rules, including such familiar ones as "Do not kill other beings," "Do not take what is not yours," "Do not lie," "Do not gossip" and "Do not be covetous." Advice on sexual conduct varies with the season. Adultery is always wrong, the scroll warns, but sex with one's spouse is considered safer in the winter (when any frequency is permissible) than in the summer (when having sex more often than every two weeks is thought to weaken the body).

The paintings on treatment include detailed botanical renderings of medicinal plants as well as illustrated instructions on bloodletting and moxibustion. Moxibustion is a traditional therapy in which special plant materials are dried, placed on specified areas of the skin and burned.

One elaborate painting shows the preparation of a "rejuvenation elixir," a medicine compounded by the physician from multiple ingredients, to be taken by an elderly patient after a cleansing regimen. "It was sort of like [going to] a spa," says Vidya Dehejia, curator of South and Southeast Asian art at the Sackler.

Training in Tibetan medicine traditionally took 11 years, according to John F. Avedon, a journalist and editor who describes the regimen in the exhibit catalogue. At Lhasa's Mendzekhang, one of the medical colleges destroyed during the Chinese invasion, 13-year-old students started their day at 4 in the morning, chanting excerpts from the 1,140 pages of the "Four Tantras," all of which they were required to memorize. During the morning they assisted in the treatment of patients from the surrounding city, then attended classes during the afternoon. After dinner, they debated in the central courtyard until 10 o'clock at night.

Students received special training in various subjects, including pulse diagnosis (which took a year to learn) and herb identification. Every July, students spent seven weeks in the mountains with grooms and pack animals, gathering medicinal plants. Herbs were the primary components of "Precious Pills," the most powerful traditional medicines, which contained no fewer than 18 ingredients and as many as 165. Medical school graduates served a four-year internship before becoming full-fledged doctors.

"With the Tibetan medical system," said Beyrer, "it's not, 'An infection causes a disease.' It's about the balance in each person's body . . . to figure out what your body is about, what isn't right about it, and what you could do."

Washington Conference Planned

Those who wish to learn more about Tibetan traditional medicine and perhaps see it in action can attend an international conference, to be held here Nov. 7 through 9, sponsored by George Washington University Medical Center and Pro-Cultura, a nonprofit organization dedicated to preserving the cultural and scientific heritage of vanishing societies. The conference's aim is to establish a dialogue between traditional Tibetan practitioners and Western doctors and scientists, as well as to present results of research on Tibetan healing techniques and to discuss the conservation of medicinal plants in the Himalayas.

Session topics range from Tibetan concepts of death to pulse-taking and herb lore, and Tibetan physicians will present medical "grand rounds" lectures on AIDS, cancer, arthritis, psychiatric disorders and other subjects. The Dalai Lama, the spiritual leader of Tibetan Buddhists, is to open the conference with a lecture on the relevance of Tibetan medicine today. Tenzin Choedrak, the physician who worked with Beyrer, and Yeshi Dhonden are also scheduled to speak.

Information on the schedule and registration fees for the First International Conference on Tibetan Medicine can be obtained by calling 1-800-805-3976 from 9 a.m. to 5:30 p.m. Monday through Friday or by visiting the Web site

The Dalai Lama will also conduct a day-long teaching session on how to maintain a spiritual perspective on life and how to cope with emotions on Nov. 8 at American University's Bender Arena. Tickets ($125 each) can be obtained by calling the university's box office, 202-885-3267.

© Copyright 1998 The Washington Post Company

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