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A Brief Introduction to Traditional Tibetan Medicine in Ladakh

by Amchi Tsewang Smanla

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History and Practise

Tibetan medicine is an ancient synthesis of the art of healing, drawing on the knowledge of medical systems existing in a wide region of Southeast and Central Asia. Through the process of this synthesis, Tibetan medicine was established during the 7th to the 12th centuries A.D. The fundamental theoretical concepts are based primarily on the Indian Buddhist system of medicine. The Buddha himself developed this system of medicine 2500 years ago. Tibetan cultural notions and the Buddhist belief system underline the socio-ecology of Ladakh.

Ladakh is one of the few remaining Himalayan area where the Tibetan system of medicine remains undisturbed. This indigenous health care system plays a major part in the health care of Ladakhi communities. Tibetan medicine known in Ladakh as 'Amchi' medicine has usually been passed down from fathers to son or daughter within the village. This is known as the rGYUTPA lineage. New 'Amchis' have to take their passing out examination orally in front of the whole village. Thereby they are examined by a panel of respected senior Amchis from surrounding villages. In every village, there is usually one or sometimes two amchi families.

Most of the Amchis are the sixth generation of unbroken family lineages. They provide health care in the villages. No charge is made for treatment, but Amchis are helped by the villagers with farm work particularly with spring ploughing and autumn harvest. Occasionally, the villagers collect barley during the harvest and offer it to the Amchi family. The Amchi doctor holds a high position in Ladakhi society. They are often not only the medical doctors but also very strong community leaders. Often they hold the position of the 'Goba', the head of the village.

Many Amchis practise Buddhist astrology and astronomy. These subjects play an important role within Amchi medical practise as they do within Ladakhi society in general. In fact, there is very strong relationship between Buddhist astrology and Tibetan medicine.

As well as its curative role, Tibetan medicine has played crucial part in preventive health care within the villages, emphasising water and spring cleanliness, good diet and healthy lifestyle practices. In present day, Ladakhi Amchi practice still plays a crucial role within Ladakhi communities.

Basic Principles of Tibetan Medicine

Like the phenomena of conditioned existence, diseases are also the product of causes and conditions. There are two main causes of the disease: a long term cause and short cause. Ignorance or unawareness is the ultimate cause of all diseases. Because of ignorance or delusion, one cannot see the reality of the phenomena and thereby clings to personal self or ego which in turn give rise to the three mental poisons: desire. hatred and stupidity. So ignorance and three mental poisons constitute the long term cause of disease. Secondly the short term causes of disease are the three humours: wind energy (Tib. rlung), bile energy (Tib. mkhris pa) and phlegm (Tib. bad kan). They are in fact produced by the three mental poisons: desire gives rise to wind, hatred to bile and stupidity to phlegm. These three humours constitute the basic energy system in the body. They are interrelated to all vital functions of the body, organs, seven constituents and three excretions. Seven constituents of the body are: food (nutrition), blood, flesh, fat, bone, marrow, semen. The three excrements are: sweat, urine and faeces.

When the three humours, seven body constituents and the three excrements are balanced one is healthy, when they are unbalanced one becomes sick. There are four factors responsible for the imbalance, they are: improper climate, influence of demons, improper diet and improper behaviour. Since everything is interrelated, imbalance in one organ or one of the humours effects the rest of the organism. Because of the interdependence of humours and body constituents etc., their imbalance can be diagnosed by the methods specially used by Tibetan doctors.

Diagnosis Procedure

  1. Interrogation

    Considering the patient's history is very important as a Tibetan diagnostic method.

  2. Visual Examination

    Visual examination consists of examining the patient's physical structure, eyes, tongue and urine, etc.

  3. Tactile examination

    This method of diagnosis is concerned with such things as temperature of the body, inflammations, etc. Most important here is diagnosis by pulse.

Methods of Treatment

There are four methods of treatment:

  1. Through diet
  2. Through behaviour modification
  3. Through medicine
  4. Through physical therapy

The most important therapeutic technique is to restore the balance of the three "NYES-PA" (humours) and to ensure that the seven constituents of the body are always in a healthy state. These seven constituents are:

  1. Essential nutriment (Dangsma)
  2. Blood (Khark)
  3. Fat (Tsil)
  4. Muscle tissues (Sha)
  5. Bone (Rus)
  6. Marrow (rKang)
  7. Regenerative fluid (Khuwa)
  1. Diet

    The first treatment involves the prescribing of a proper diet. For example, if the patient is suffering from a bile disorder he should not take alcohol and should drink cool boiled water.

  2. Behaviour Modification

    Treatment through behaviour modification: for instance, a patient with a bile disorder should not do heavy physical activities. He should rest in the shade and not sleep during the day. If these two factors fail to bring about: a positive result, further treatment should be carried out.

  3. Medicine

    Prescription of natural drugs. Here again the physician starts with less potent concoctions and turns to stronger forms, if necessary. The drugs can be classified in 10 forms: decoction, pills, powder, gruels, medicinal butter, medicinal calxes, concentrated extractions, medicinal wine, gem medicine and herbal medicine.

  4. Physical Therapy

    Apart from the prescribing of natural drugs, the physician may also have to depend on other therapeutic techniques. They are again to be classified in gentle and rough techniques. Massage, hot and cold compresses, mineral spring bath therapy and medicinal bath are the gentle techniques. Blood letting, cauterisation, moxibustion, cupping, golden needle therapy are considered as rough techniques. There is also some minor surgery such as the draining of abscesses. Surgery is no longer practised by Amchis.

Conclusion

Tibetan medical philosophy is a holistic philosophy involving the harmonious operation and balance of all the energies that constitute the human psycho-physical being. These energies are the psychologically originating three "NYES-PA", or humours, which correspond to the three mental poisons, and the five cosmo-physical energies that are at the basis of all phenomena. If all the factors that influence these energies (seasonal factors, diet and nutrition, life style and mental attitudes) are positively disposed, then these energies remain in balanced operation and health is experienced. It is the objective of Tibetan medicine that the balance in these energies should be maintained.

Drawing of Amchi Tsewang Smanla
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