Professor Troru Tsenam's
life has been the very reflection of the fortunes of Tibetan culture during
the 20th century, mirroring its glorious heritage, the catastrophies which
have befallen it in the last half century, its present hope of survival
and its gradual diaspora throughout the world. A living legend, Professor
Tsenam is a small, wrinkled and extraordinarily endearing figure in his
late sixties, full of wit, in every sense of the term, and a walking encyclopaedia
not only of Tibetan medicine, of which he is probably Tibet's greatest
exponent, but also of many other domains of Tibet's traditional culture,
such as poetry and Buddhist metaphysics. Before the 1959 annexation of
Tibet by China, he held the equivalent of several chairs in Buddhist monastic
universities. He presently holds two chairs within the modern Chinese
academic system. He has been instrumental in the re-establishment of traditional
Tibetan medicine in Tibet itself, where his life is presently dedicated
to ensuring that as much as possible of the unique knowledge and experience
that he embodies be passed on to younger generations of Tibetan doctors.
Khempo Tsenam is someone deeply respected, not only on account of his
knowledge and all he has done for Tibetan medicine in the past 20 years
but also for loving care and healing power which he radiates. As another
Tibetan doctor said recently, "Khempo Tsenam may administer exactly the
same medicine to a patient as I would but somehow it is always more effective
when given by him. He undoubtedly has something special. He is a bodhisattva
and his patients and others doctors sense that." This is more than just
a subjective appreciation of the qualities of the man himself. It is a
perception of the qualities of the traditional physician-lama — which
he incarnates amid a world of Tibetan medicine which for many years was
stripped of its religious context and reduced to a solely materialistic
science. However it may have worked, the psychological aspect of healing—expressed
through the Buddhist religion— was a vital part of traditional Tibetan
medicine and it is now being enthusiastically reintegrated into the training
being given in the medical schools of Tibet.
Khempo Tsenam was born in 1928 in the Derge Kingdom of DhoKhams in a place
which is presently known as Troru Deshok, in the District of Terton, within
the Chamdo region of the Autonomous Region of Tibet. From 1933-43 he lived
as a monk in Troru monastery where he received his first tuition. Having
learnt to read and write, he studied continuously and completed his training
in the general skills related to monastic ritual. Under the guidance of
the then Khempo (Professor) of Troru monastery, he received instruction
in the three stages of Buddhist vows and in the most profound aspects
of meditation of the Kagyu tradition. For the latter, he studied commentaries
on the profound and secret yoga practices of Naropa and teachings on mahamudra,
the meditation treasure of the Kagyu tradition which unveils the very
nature of the human mind. From other teachers he received instruction
in grammar and composition and teachings on both element-based and planetary
Having successfully completed this first phase of his education, he spent
the years from 1943-46 in pilgrimage, going first to Lhasa and f rom there
to India, Bhutan and Sikkim. In 1946 he returned to Eastern Tibet and
after staying for a few months at his home. Throughout the earlier parts
of his studies and his pilgrimage, the masters under whom he studied recognised
a tremendous potential in him and encouraged him to carry his studies
to their fullest conclusion. One of his traveling companions in particular,
a Khempo (professor) of Katok monastery in Eastern Tibet, insisted that
he pursue his education at Katok, as it was a very great seat of learning.
Shortly after his return to Tibet, Troru Tsenam did go to Katok monastic
university where, for the five years up to 1951 he studied medicine, elemental
and planetary astrology, poetic composition and the various fields of
study proper to all the traditions of Buddhism, namely madhyamika, prajnaparamita,
abhidharma and vinaya. Besides these, he received a thorough training
in vajrayana Buddhism, becoming well-versed in both the Nyingma and the
Kagyu traditions, whose theoretical teachings he mastered in their totality.
In particular he became one of the rare person entrusted with the secret
medicinal science of preparing "detoxified mercury". He received the latter
teachings from Tachung Lama Tsering Chopel. Thus he became a physician-monk,
learned in all domains and particularly gifted in medicine.
The monasteries in Tibet, like those of Europe in the Middle Ages, were
major centres of learning and of medical study and practice. They served
as bases from which lama-doctors would tour surrounding areas. The religious
aspect of Tibetan medicine was a vital one: the whole science of medicine
was presented as being teachings given by the Buddha, through his emanation
as the Healing Buddha. The collecting of medicinal plants, their preparation
and administration were all accompanied by prayer and performed as a semi-religious
act. When medicines could not help the patient, specific healing religious
ceremonies were performed. Besides providing this spiritual context to
healing, the monasteries were important seats of medical study inasmuch
as medical knowledge was seen as a key part of an overall education in
the nature of the human condition and hence something which needed to
be understood, in the Buddhist quest for a complete wisdom. Medicine forms
the second of the five main fields of Buddhist study.
Khempo Twice Over
The young and gifted monk that Troru Tsenam was at that time showed such
an extraordinary aptitude for study — often understanding topics well
after a single reading and sometimes adding details which no one had taught
him — that his teachers thought it likely that he was the reincarnation
of a great scholar. This was confirmed by the IIIrd Shertse Rinpoche,
who declared him to be an emanation of the early Tibetan master Bu.sTon.Pa.
At Katok he received the title of "Khempo of the Five Disciplines" - a
high honour, roughly equivalent to a professorship, recognising his prowess
in all the major fields of study.
Despite requests from several monasteries, including his home monastery
of Troru, for him to come and lead their colleges, he was kept by Shertse
Rinpoche at Katok, where he continuously furthered his own understanding
under the guidance of visiting scholars. The 1956 troubles in the far
Eastern areas of Tibet allowed him to return to Troru, where he took up
the chair of the monastic university, becoming Troru Khempo Tsenam. For
three years he was responsible for the education there of some 30 tulku
and some 200 monks.
When the Chinese annexed Tibet in 1959, the monasteries were closed and
all religious activity had to cease. Those lamas who did not flee the
country and who escaped the wrath of the Chinese forces were obliged to
lie low. This Khempo Tsenam did for two years. Then, because of his former
high monastic position, he was placed in a prison in the Pomi (spo.mes)
area, where he was to spend ten years. The conditions in prison were tough,
not only physicaly but also psychologically. Khempo Tsenam looks back
on that period in a positive way, "I could see how those who let themselves
get into a state of depression suffered, adding mental anguish to their
physical pains. I managed to keep my own mind peaceful and spacious, according
to the Buddhist training, and realised that this, like any life situation,
was an opportunity for development. I tried to comfort my fellow inmates.
Many of them were young and gifted, their education incomplete. I did
my best to pass on some of my medical and academic knowledge to them."
This tuition took place in secret, after lights-out at night. He taught
them reading, writing, grammar, Buddhist ethics and philosophy and other
subjects, according to the wishes of those he taught. During that time,
which was one of great threat to the Tibetan culture, he tried to write
down what he could of his knowledge, on tiny strips of paper gathered
from here and there. This gradually produced quite a volume of literature
which, unfortunately, was discovered and destroyed. Khempo Tsenam took
particular care to ensure, as best he could, the education of the young
tulkus (reincarnate Abbots) emprisoned there. Pomi was more of a labour
camp than a closed prison and he had the opportunity of gathering simple
herbs in the surrounding countryside to treat sick inmates. This proved
The Clinic at Pomi
By 1971 his obvious use, as a gifted doctor, to the Tibetan community
and his immense medical knowledge had become recognised and appreciated
by the authorities who not only released him but apologised formally for
his emprisonment. They excused their action by saying that he had been
emprisoned because he had initially been considered to be a lama — but
since he was in fact a doctor and therefore someone of real use to the
people, a mistake had been made which should now be rectified.
Following his release, Khempo Tsenam continued to treat his patients in
the Pomi area and the small dwelling he used as a clinic became known
as Pomi hospital. There, he prepared his own medicines from local plants,
minerals and animal products. He was unable to make many of the traditional
compounds because they required ingredients from other parts of Tibet
and also from other countries. Nevertheless, as years went by, Khempo
Tsenam managed to treat some 10,000 patients a year. His renown spread.
The Revival of Tibetan Medicine
The period from 1977 to 1981, during which more traditional cultural expression
was allowed the Tibetans by the Chinese, was one of intense activity for
Khempo Tsenam and those like him. It marked the begnning of a restoration
of Tibetan medicine. He travelled, first locally to Derge and then to
other former medical centres in Kham and eventually to Lhasa, to assess
the situation and make contact with other Tibetan doctors. In the Derge
printing house he found the Tai Situpa's text on mercury detoxification
and the preparation of mercury medicines. Using this as a basis, he transmitted
the secret keys of the process to suitable physicians, who acted as his
apprentices and helpers in the complex alchemical processes involved.
Due to him, detoxified mercury was prepared in Derge, then in Chinghai,
Sining and other medical centres. Once these institutions had detoxified
mecurial compound as a raw material, they were able to produce the famous
Rinchen Rilbu—"Precious Pills" by combining it with various gemstones
and herbs etc. In 1981 his expertise was sought by the authorities in
Lhasa, the capital of the Tibetan Autonomous Region. Since that time he
has devoted himself to the restoration of the Lhasa Astromedical Institute
(mintsikang). It has grown from a small building with a handful of doctors
to a major teaching hospital, with some 1,000 staff and students, several
hundred beds and a factory for the production of Tibetan medicine.
With the Mintsikang well-established, Khempo Troru Tsenam next established
a more advanced teaching unit, which now has university status. With its
own medicine-making centre and clinic, it is training hundreds of doctors
on Tibetan Medicine and their training now satisfies a high academic standard.
Furthermore, they are being introduced to the principles and equipment
used in modern-day medicine. In 1997, two specialised research units were
established to carry out investigations in to use of Tibetan medicine
for various diseases which afflict the modern world. These tests should
satisfy the rigours of modern scientific investigation.
Traditional Tibetan medicine now seems to have become acceptable to the
governing Chinese authorities through its sheer efficacity. Another, and
not unimportant factor, is its cost, being relatively cheaper to implement
than more modern treatments requiring expensive machinery and facilities.
This recognition means that doctors who qualify in state-recognised medical
schools become state employees with a wage. There are five levels of doctorship.
The lowest involves a traditional medical theoretical medical training
over some three years followed by some years of practical work alongside
established doctors in hospitals or clinics. This gives the title "doctor"
but not a medical university degree. The second level requires a longer
training, within a university context, and ends up with the award of a
medical degree. The remaining three levels are attained through numbers
of years of practice and experience, teaching, research, papers published
etc. Khempo Tsenam is one of Tibet's few Grade Five doctors.
The main re-establishment of Tibetan medicine has taken place through
the growth of medical centres-cum-teaching hospitals in large towns. As
the doctors trained in these centres take their practice out to the nomads
and remote rural areas, it is likely that, as in the old days, they will
take on apprentices who will commence their learning in the field rather
than in the classroom. There is also a combined effort, now under way
for several years, between local authorities and the international charity
Rokpa, to pur more doctors in remote areas. Seven medical colleges, providing
first a primary and secondary education and then traditional medical training
for more than 300 people, have so far been set up, with a view to providing
country doctors and to giving priority and career opportunity to bright
Khempo Tsenam is presently Directing Physician and Professor of Medicine
at the Central Institute in Lhasa, Professor at the China Advanced Buddhist
Centre and Editor-in-Chief of the Tibetan Medicine volumes of the China
Medical Encyclopaedia. He has written several major medical textbooks
and published some 200 articles on Tibetan medicine. The following is
taken from an interview given by Professor Troru Tsenam during his 1994
visit to the Kagyu Samye Ling Tibetan Centre in Scotland. This centre
hosted the first teaching session of the Tara-Rokpa Tibetan Medical College,
set up by the Rokpa Trust (Scotland) in conjunction with the Central Institute
(Lhasa) to create the first Tibetan Medical College in the Western world.
Khempo Tsenam officially opened this College and supervised the first
month of instruction, given by himself, Dr Sonam Chime, Assistant Professor
at the Lhasa Mintsikang, and Dr Thubten Phuntsog, of the Institute of
Nationalities in Beijing.
An Interview with Khempo Troru Tsenam Rinpoche
Q .. Would you be kind enough to tell
us how far back Tibetan medicine goes and where it originally came from?
A .. Tibetan Medical science has
its main roots in the land of Tibet itself, in the age-old experience
and ingenuity of the Tibetan people, who have always lived close to nature
and had to rely on their own resources to survive. To this has been added,
over the last two millenia, the medical wisdom of other lands and civilisations,
integrated into the indigenous system either intentionally or by the natural
cross-fertilisations of cultures which have taken place over the ages.
All in all, we can identify three main streams which have contributed
to make the waters of the healing lake which is Tibetan medicine. These
three streams are depicted on the insignia of the Central Institute, the
governing body of the Lhasa Astromedical Institute (Mintsikang). The longest
stream in the insignia comes from the snow mountains, representing Tibet
itself. This is joined by two other streams which represent Chinese medicine
and Indian ayurvedic medicine.
The many facets of medical knowledge which together form the wealth of
Tibetan medicine were all brought together in what is undoubtedly the
best-known of all the Tibetan medical treatises - the rgyud.bzhi - the
Fourfold Medical Treatise. Tibetan medicine itself has a recorded history
of about 2000 years and the Fourfold Medical Treatise dates back about
1,000 years. Although there have been so many ups and downs in Tibetan
society during that long period of our history, the Tibetan medical system
was preserved throughout, without damage either to its integrity or to
the living lineage of the transmission of knowledge from doctor to doctor.
It is, without doubt, one of the greatest glories of the Tibetan people.
Q .. I think that the extent and influence
of Tibetan Medicine is little known in the West, could you say something
about this please ?
A .. This ancient tradition of medicine
has helped maintain the health and longevity not only of the people of
the five kingdoms known collectively over the centuries as "Tibet" but
also of neighbouring countries, such as Bhutan, Nepal, Sikkim, Ladakh,
Mongolia, Sinkiang etc., where its use was widespread. Moreover, Tibet
has long been reputed as the land of medicines throughout Asia. Tibetan
medicine is undoubtedly one of the oldest and most profound medical systems
in the world and it has contributed a lot to humankind's understanding
of health and sickness. It is not simply one simple localised national
medical folklore among others. It has been a vast and complete science
will fully-elaborated notions of the bases of health and sickness, a simple
but exceptionally efficient system of diagnosis and a very full range
of treatments, based on diet, lifestyle, medication and external treatments.
In my opinion it is unexcelled.
This opinion is reinforced when I observe people from various countries,
most benefitting from the finest of modern scientific development, nevertheless
showing a lot a interest in, and doing research into, the Tibetan ways
of diagnosis and treatment. For instance, in the East, in Japan, I found
a very strong interest in Tibetan medicine. Also in the West, many people
are keen to study Tibetan medicine. I visited Hungary in 1987 and there
also I met many doctors who not only showed much interest in Tibetan medicine
but also came to understand certain basic points of its practice and sincerely
expressed a strong appreciation of it. For me, this is a small proof that
the Tibetan medical system holds some profound understanding about the
nature of the human body and mind and that this is intuitively recognised
by people even though they come from very different cultural backgrounds
than the Tibetans.
Q .. We are all aware of the tremendous
social changes which have occured in Tibet over the past 35 years. Is
Tibetan medicine in Tibet today the same as it was traditionally?
A .. Tibetan medicine as it is now
being taught and practised these days in Tibet is much the same as it
has always been. There has been little qualitative degradation. Quantitatively,
it is hard to estimate. In earlier times hospitals or training centres
were not established — as they have been in recent times — by the local
governments of the five kingdoms. Medicine was principally studied in
monasteries, with almost every monastery having some medical activity,
and there were also doctors in private practice as well as clinics sponsored
by local aristocracy. The transmission of medical knowledge was carried
out through apprenticeship and through family tradition.
All in all, medicine was practised in a highly proficient way. To give
you an idea of the wealth of Tibet's pharmacoepia, you must understand
that the number of plants alone involved in medicine-making numbered more
than 3,000. These were combined in all sorts of ways to produce medications
containing sometimes 8 or 15 or 30 or up to 100 different ingredients.
Then there are mineral and animal ingredients as well. Doctors obtained
some of these raw material for their medicines locally, some from other
parts of Tibet and yet other ingredients were imported through traders.
Not only has it always been an efficient and excellent system in itself,
but also something implemented in the highest way, inasmuch as medicine
was a vocation based upon a very high moral code and altruistic approach.
Q .. Are you referring to the Buddhist
A .. Yes. Throughout the centuries,
the ethical code of the doctor was that of the bodhisattva, a person inspired
by the buddhist motivation to free all beings from suffering. There is
a wealth of teaching on this in mahayana Buddhism, explaining how to keep
one's mind pure and in an altruistic frame and how to live in a way which
aspires to perfection of action - perfect generosity, perfect self-control,
perfect forbearance, perfect diligence, perfect meditation and perfect
wisdom. It is with this in mind that one practised medicine. As long as
there are beings with physical bodies which suffer, one of the noblest
professions is to practise medicine, to alleviate that suffering.
So many Buddhist scriptures say that all the many qualities of the bodhisattva
can be summed up by one word - compassion — and the role of compassion
in the healing art is a vital one. Compassion, as it was traditionally
understood in Tibet down the centuries, involves a very careful and skilful
refinement of the human mind. In the case of medicine, compassion is not
a fixed attitude of the doctor's mind, rooted subjectively in abstract
notions of love, but is a clarity of awareness and a quality of openness
and sensitivity on the part of the healing physician concerning what is
objectively happening in the patient. This is why compassion is described
as being, "inseparable from wisdom". It means being as fully aware as
possible of what is taking place in the body and mind of the patient being
treated, not just at present but over all sorts of timescales.
Q .. Could
you speak some more about the doctor's wisdom and the Tibetan understanding
of sickness and health ?
A .. One obvious aspect of the wisdom
involved in the diagnostic phase is to be able to detect the imbalance
of the humours which is the cause of the symptoms which the patient is
presenting. You have probably heard of the three "humours." The word itself
means ill — the three ills. They are three absolutely fundamental sets
of systems within the body's functioning. When a person is healthy these
three work together in harmony. But when one or more of the humours is
deficient, over-active or upsetting the others, there is ill-health —
hence the name nyes.pa, ill.
The humours themselves are manifestations of the
interplay of the elements. To understand to flux of the elements in a
patient's body at any given time, one needs to be aware of the nature
of the elements where the patient lives and works, the play of the elements
due to the changes of the seasons, the times of day and so forth and the
power of the elements in the patient's diet. Everything is a manifestation
of these prime elements, by which I mean earth, water, fire, wind and
space. We can also describe the elements as wood, fire , earth, metal
and water. To understand the meaning behind these simplistic names - earth,
fire, water etc. - requires much study and experience.
Q .. Would you be kind enough to
explain them simply for me?
A .. The elements exist on many different
levels and their manifestations vary according to the level. Earth is
the material quality of things - their matter, weight, hardness, resistance
etc. - which means, in the case of the human body, the flesh and bones
etc. Water is really the power of bonding between the various aspects
of matter - between particles etc. - and also therefore the fluid, lubricating
quality. In the body this is the fluids and the overall cohesion between
the physical constituents. Fire is the development, the transmutation,
the coming to maturity, of matter. In the body it is its physical heat,
of digestion and so forth. Wind is the dynamic aspect - movement, flow
- represented in the body by all the circulations of oxygen, the flow
of blood in the veins and arteries, the impulses in the nervous system,
the lymphatic system etc. Space is the dimensioning that allows the other
elements to fulfil their functions - in the human body it is the hollow
spaces and the orifices.
The elements within the body are in constant interplay with those outside
it, as it relates to its environment. The body-environment dialogue occurs
through the ingestion of nutrients, such as oxygen, food and drink, through
the impulses received through the senses and through the way the person
reacts in response to other people and the world around. Those nutrients
are composed of the elements; the world, experienced by the senses, with
its trees, rocks, sun, sky and so forth is composed of the elements and
likewise other sentient beings are composed of the elements. The person
himself or herself is composed of the elements.
To correct what goes wrong in the body-world dialogue, we compensate by
administering medicines. Medicinal compounds are also concentrates of
the elements. Not only the prescribing of medication but also advice on
diet and behaviour is seen as a very important factor in bringing the
patient back to good health. It is a question of using the resources at
one's disposition — whatever they might be — to bring the imbalanced elements
in the patient's body back into harmony . Deficiency in one or another
of the elements can be compensated for by a diet or an environment rich
in that element. Likewise, excess of one or another of the elements can
be corrected by reducing the power of that element in the diet, environment
or behaviour, and so on and so forth.
Q .. And is
sickness simply an accidental elemental imbalance, then?
A .. Besides the shorter term elemental
and humoural causes of the ailment - due to the diet, lifestyle and the
specific behaviour of the person - there are also the psychosomatic triggers
of illness which, according to the traditional teachings of medicine,
exist on three levels, called remote cause, long-term cause and proximate
cause. These are, respectively:
a. the degree of lack of contact between the person and the innate purity
of their mind,
b. the powerful tendencies to strong emotions such as craving or anger
in the more distant past, including past lives, and, finally,
c. more recent emotional patterning.
Of course, one could continue. Medicine is a complex subject. What I have
just mentioned is just a glimpse of the complexity of the composite phenomenon
which is a human being, from the Tibetan medical point of view. In actual
medical practice, sometimes mind and body are quite distinct, the one
from the other. Sometimes they are indistinguishable and very often they
are powerfully interconnected.
Q .. We
live here in a world very concerned with diet, foodstuffs, additives,
vitamins, whether to eat fats or not etc. Is the quality of these sort
of things considered important in Tibetan medicine?
A .. Besides the psychosomatic triggers
of illness and short-term elemental factors, there are also longer-term
physical considerations related to the proper functioning of the metabolism;
particularly in terms of the intake of nutrients and the elimination of
Tibetan medicine discusses this health of the metabolism in terms of a
sevenfold cycle. It is almost as though the prime nutrients, by which
we mean the food we eat, the liquids we drink and the air we breathe,
go through seven reincarnations within us to produce the very substance
of life; the glow of health. These seven reincarnations are seven major
steps of transformation, each of which produces by-products and wastes
which need to be eliminated. All the major organs and systems of the body
are involved in this complex and subtle process of refinement. When there
is some malfunctioning in this constant process of refinement, there is
a potential cause for illness; the longer and more serious the malfunctioning,
the more serious the consequences can be. In fact, it is remarkable how
many illnesses have their root in one of the major steps in the metabolic
cycle, namely digestion and, indirectly therefore, diet. Digestion is
one of the earlier stages in the sevenfold process and a lack of suitable
nutrition at this stage will have its repercussions throughout all the
later stages. Needless to say, Tibetan medicine aims to detect the long-term
deficiencies or excesses in the overall metabolic picture and to correct
them as much as is possible, given the circumstances of the patient.
Q .. So
a tibetan doctor has to be aware of many things when making a diagnosis?
A .. Yes. Let us return to compassion.
The compassionate task of the doctor is to arrive at an accurate appreciation
of what is truly ailing the patient, by taking into account all of the
aforementioned factors. Without compassion, which is the sensitivity the
physician has for what is taking place in the patient, there will only
be an awareness of the symptoms related to the immediate physical condition
of the patient. Sometimes this is enough, when a patient is suffering
merely from a cold, a minor food poisoning or the like. In such cases
a straightforward diagnosis will lead to a simple treatment or sometimes
no treatment at all and the patient recovers, But other than in these
instances, the main task of Tibetan medicine is to bring the whole psycho-physical
unity of the patient back into true health. Without the clear awareness
of all the long-term and short-term factors involved and a truly compassionate
motivation, what a doctor can achieve in this domain is relatively limited.
This is in fact a very important point, because the doctors are the main
persons responsible for helping the patients —those who, by their very
definition, are suffering. The role of the doctor in providing not just
medicine but overall support for the patient has been stressed greatly
in the traditional Tibetan medical texts and in earlier times this was
given its due emphasis in daily medical practice. More recently, since
doctors in Tibet did not receive a full bodhisattva training and saw medicine
in a more materialistic light — as a job among others for which they received
a salary from the government — this has fallen into the background. Fortunately
it is now being restored, thanks to the relative liberty we enjoy to follow
the bodhisattva training and due to the drive we are leading to restore
traditional Tibetan medicine in all its fullness. As I mentioned before,
the medical art was the great glory of Tibet and now it is vital that
new doctors learn it as it was, in its entirety.
My own aim therefore is to be able to train all these doctors according
to the traditional Tibetan system - with a high standard or ethics and
altruism and also how to use all the aspects of traditional medicine,
including the use of rarer mineral and precious substance medicines and
the ancient operation skills using the spoons etc. That is our plan.
Q .. Is physical
health connected with spiritual well-being, in your opinion ?
A .. The understanding of what true
health really means, in the long term, is a very profound one. Since,
as I mentioned above, it is the purity or impurity, the maturity or immaturity,
of mind which is the main long term factor in determining the well-being,
the health, of the person, it follows that it is only the enlightened
who have true mental and physical felicity. This does not necessarily
mean however that more highly-evolved beings have less physical sickness.
It is a question of how "well" a human beings feel and how well they can
cope with life situations, including physical health. This is quite a
subtle point but one which also needs to be taken into consideration.
One is not simply treating the body with its specific problem but the
body as part of a body and mind combination which is suffering. Although
in daily medical practice the physician is not assuming responsibility
for the spiritual or psychological progress of the patient, some understanding
of this longer term spiritual and emotional dimension is needed for there
to be a wise analysis of an ailment, especially where hard-to-treat, deep-rooted
or chronic ailments are concerned. Besides these considerations of mind's
effect upon the body, there is also serious mental sickness itself - a
whole branch of Tibetan medicine.
Q .. How does
our mind influence our health ? I know this is a big question but perhaps
you would care to mention some important points.
Q .. I would like to speak briefly
about the commonplace and longer-term psychosomatic triggers of illness.
In Tibetan medicine these are discussed under three groups —that of desire,
covering all sorts of human feelings from those of greed through to sexual
passion, that of anger, ranging from frustration to real hate, and that
of ignorance, ranging from thick mental torpor through to ignorance of
the innate purity of mind. These three areas are called the three poisons.
They each have many subcategories and there are many states of mind which
contains elements of two main groups or even all three - such complex
things as jealousy, for instance.
In the long term a predominance of desire, attachments, frustrated longings
etc. will create an imbalance in the physical system known as "wind (rlung)
humour". Wind is the dynamic quality within the various physical systems.
When the wind humour is in harmony, the digestion, the nervous system,
the blood flow etc. are all working fluidly. A long-term predominance
of anger will create imbalance in the "bile (mkhris.pa) humour". This
does nor mean just the physical bile or the gall bladder. It refers to
the production of heat and energy in the body, especially through the
ingestion and transformation of nourishment. A long-term predominance
of ignorance will create imbalance in the "phlegm (bad.kan) humour". This
particularly concerns the fluid balances in the body and what we might
describe generally as its coolness.
Q .. I know
it is not easy for you to speak of what has happened to Tibet since 1960,
but I would appreciate it if you could say how this affected Tibetan Medicine
and you personally.
A .. The widespread application of
this wonderful healing science by dedicated physicians was the status
quo in Tibet for more than a thousand years but, during the cultural revolution,
as in many other things all over China, the Tibetan medical system suffered
very great damage and, with the exception of one or two, the great centres
of medical learning were destroyed. Moreover, the medicine practised by
individual doctors in rural areas almost came to an end too. One of the
few things to survive partially was the Lhasa mintsikang - the Astro-Medical
Institute. The indigenous Tibetan medical system suffered because it was
viewed by the communist regime of the time as being solely based on superstition
- an invention of the lamas - and not a real medical science. It was not
until after the 3rd National Assembly that there was the beginning of
a restoration of some Tibetan national cultural activities. Since then
there has been a steady revival of Tibetan medicine, sometimes through
the initiative of governmental bodies, sometimes through that of local
authorities and sometimes, more recently, with the support of Rokpa, an
international charity deeply committed to the restoration of Tibetan medicine
in Tibet. Actually, it is not simply a question of restoring what was
there previously but of reviving Tibetan medicine in a way which responds
intelligently to the needs of today.
The revival has resulted in a significant and organised growth of medical
schools. Some hosptals and medical centres have been established in places
where there were none previously and certain institutions have been restored
far beyond their previous capacity. The Lhasa Astromedical centre, for
instance, has been significantly developed and its present form and capacity
- in terms of number of dcotors, beds, machines, buildings and allocaton
of funds - is much greater than it was formerly. The staff number almost
1,000, there are several hundred patient beds, a major medicine-producing
factory and it is a teaching hospital with university status.
Large astromedical centres have also been founded in Shigatse, Chamdo,
Nagchu, Soka, Nyitri, etc. These have provided hospitals, doctors and
medicines where there were none before and made regional centres of health
care. Other astromedical centres which have been restored in major towns
are the likes of De-Ge, Pa-Yul, Dartse-Do and some in the Chinghai province.
Thu s, in one way, at present Tibetan medical science and education is
going through a period of great development. In all these centres, Tibetan
medicine is taught according to the tradition and also they have started
using modern scientific methods and machines and are trying to see how
modern ways can be combined with ancient wisdom. This is of course an
ambitious task and at the same time a very necessary one which has to
be tackled one day or another. It is being approached in a pragmatic and
open-minded way and should, if handled intelligently, move both medical
systems further towards joint overall goal of eradicating and preventing
all diseases, thereby rendering great service to all beings.
It is evident, for instance, that a Tibetan doctor who has successfully
diagnosed a tumour in a certain location in a patient will be happy to
have an x-ray or other information which shows the exact size of the tumour
and its effect on the internal organs around it. In the past, the strength
of Tibetan medicine came through it absorbing and integrating things from
other medical systems which proved to be of real use — you will remember
the analogy of the three rivers. There are many medical systems throughout
the world and we are not averse to adopting what they might have to offer.
In the other direction, it is now seeming more and more likely that in
many cases traditional Tibetan herbal and mineral remedies will be able
to provide more effective and less intrusive solutions than present-day
surgery or modern chemical medicines can. For instance, our preparations
for removing kidney stones and gallstones, some of which I have developed
in recent years, have impressed modern Chinese scientists by their efficacity.
Another area where there is great promise is that of Tibetan medicines
based on detoxified mercury. From what I am seeing of illnesses in the
West and the modern world, these medicines may bring great benefit to
sufferers of some of the diseases prevalent these days.
In the traditional Tibetan society, these mercury-based
compounds could not be manufactured by each doctor. The preparation of
the detoxified mercury which is the basic ingredient requires a great
deal of time, money and manpower. Hence it was only produced in the very
large monasteries or at the request of exceedingly rich spnsors. The knowledge
of how to produce this detoxified mercury is kept a secret. It is an oral
tradition handed down from master-physician to master-physician. Although
some of the technique has been committed to writing, certain key steps
are purposefully omitted in order to keep this knowledge tightly controlled
and free from abuse.
The knowledge of how to produce detoxified mercury was almost completely
lost. The actual practise had not been carried out for a long time and
the first revival was performed by myself and Dr Tenzin Chodrak, who later
becamethe private physician of H H the Dalai Lama. After the initial revival
it was manufactured by me in Pomi, before I went to take up my post at
the Lhasa Astromedical Centre. Since then I have transmitted the know-how
to many people - students and colleagues - and the continuity of this
rare and important aspect of Tibetan medicine has been preserved for posterity.
I have since manufactured this improtant medicine in Dege, Chinghai, Yushu,
Chamdo and many other places. Having made the mercury, I then proceded
to revive production of the various complex precious-substance medications
based on mercury, gold, gemstones and other rare substances. This has
proved very successful, to such an extent that now there are many doctors
all over Tibet well trained in the production of these vital medicines.
Now there is no longer fear of losing this knowledge forever.
The process for producing detoxified mercury in Tibetan medicine is not
quite the same as that of Ayurveda. It comes not from the vedic tradition
but from the revelation of Urgyenpa, the great siddha and Kagyu master.
Besdies this, the Tibetans have always had a good deal of alchemical knowledge
and understood how to transform one thing into another, when sucha transformatiobn
is possible. The mercury process itself involves some 100 people, working
constantly for about one month. Hundreds of grams of gold are needed.
Through the transformations which it undergoes, mercury which is at first
highly poisonous, shiny, highly mobile and like a liquid metal, becomes
medicinal, matt black, immobile and solid. It becomes the king of antidotes
for all types of poisoning.
The detoxified mercury is not just mercury alone - it is a complex compound
the making of which involves mercury, gold, silver, copper, various sorts
of iron, 8 types of mineral etc. During the preparation some astounding
things happen. For instance, during its transformations and detoxification,
the gold, which is a noble and immutable metal, becomes oxidisable i.e.
it burns. This amazed Chinese scientists who witnessed each stage of the
gold preparation, during which it was beaten and boiled in special ways
and treated with various natural chemicals over a period of several days
before being fired in an oven. In the old days it used to have to spend
45 hours in a charcoal oven, but with modern kilns the time necessary
has been reduced to about 10 hours. The end product isa gold powder which
can be burnt. There is an old Tibetan saying, "Don't worry if the gold
falls in the fire - it can never burn but on the contrary will improve."
However, the detoxified gold compound does burn and once burnt is of a
black colour. When we have prepared gold in the Lhasa Astromedical Centre,
we have at times burnt up to 3lbs of gold in these processes. As you will
understand, since just the preparation of the gold catalyst in the mercury
prepartion takes so many days and is quite complicated, when one takes
into account the preparation of all the other metals and minerals and
so forth then it is not surprising that the whole process takes 30 days
of non-stop activity.
The preparation of detoooxified mercury to which I have alluded above,
and which we currently use, is also slightly different from the process
talked about in the Fourfold Tantra. The technique was given to Khedrup
Orgyenpa, by Vajrayogini, in the land of Orgyen. He taught it to Karmapa
Rangjung Dorje, who taught it to Sonam Zangpo, who was the grandfather
of Sungkar Nyamme Dorje and it became the Tsurpu tradition. During the
time of the Fifth Dalai Lama it was made by Dharam Nyammo. Later Situ
Choji Jungnas made it in De-ge. Other famous lamas of more recent times,
in the last century, such as Kongtrul Lodro Taye, Jamyang Chentse Wangpo,
Mipham Rinpoche and so forth maintained the tradition, many of them having
a strong link with Derge, my own region. As the mercury detoxification
involves many people, much wealth and resources, its making was a rare
There are many secret techniques, preserved through an oral tradition,
for making very powerful and special medicines such as these. They involve
wonderful phenomena such as those mentioned above or such as the powdering
of diamond, to make it blend with other substances in medicinal preparations.
Although now there are many people involved in the
practice of Tibetan medicine in Tibet itself and there is much medical
equipment and many medicines are available nowadays, there are still,
in my opinion, many requirements to be fulfilled and much deeper study
required, before we can consider the fullness of Tibetan medicine to be
well established for centuries to come. Especially now, that the Tibetan
Medicine Institute in Lhasa has been redeveloped, there is the scope for
doing this. A lot of money was spent on it and a lot of foresight has
gone into it - and it has been given the status of an indepenedent university.
I myself hold the post of Directing Physician and Professor of Medicine
and am responsible for assuring the preservation of Tibetan medical study
for future generations - I try to do my best but you will appreciate that
I am old and there is still a lot left to do. I am very concerned to transmit
my own know-how in many specialised domains, while my health still permits.
This will involve, among other things, gathering the necessary rare ingredients
to make many traditional medicines which have not been prepared now for
some decades and which present-day doctors do not know how to prepare.
As with the mercury preparation, they will need to work alongside me as
I prepare these compounds so that they understand clearly all the steps
Much skill, knowledge and experience goes into the
preparation of Tibetan medicines. I am told, although I have not been
able to look into it myself, that the medicines prepared in Tibet itself
are often more effective than the same remedies prepared in other Himalayan
countries. If this is the case, one can imagine many reasons why it would
be so. First there is the land itself: it is certain that its geography,
climate and altitude are quite unique. A religious person might also say
that the centuries of widespread and profound religious practice imbibed
the hills and the valleys with something very special too. One must also
take into account the location of specific plants and the manner in which
they are collected.
Over the millenia, we have come to know the best places to collect each
herb and it is very important that this knowledge be preserved and that
the environment in which the herbs grow remain unpolluted. Each area,
as well as a specific location within each area, has its floral speciality
and the plants there have a particular potency. One needs to know exactly
when to pick the plant — not only in terms of its life cycle but also
in terms of astrology and the time of day etc. The traditional explanations
even explain who should pick the plant and how it should be gathered.
Following all these criteria properly produces a very different raw material
than would just the gathering of plants bearing that name, anywhere and
at any time, as I fear might happen elsewhere. Once one has the finest
raw materials, gathered as mentioned, these need to be processed and combined
to make the various medicines. Not only does this need to be done properly,
from a technical point of view, but, according to the medical tradition,
with prayer and in the proper state of compassionate mind
In the Lhasa Insititute we study the traditional
Tibetan medical literature, the Tibetan astological literature, but also
grammar, language and composition, Chinese language, English language,
as well as politics and other related subjects. Since in the Tibetan medical
literature and in the Tibetan medicine system, the purity of motivation
and conduct of doctors has always been greatly emphasised, it is essential
that there be enough training and instruction given on these topics. I
am referring to the bodhisattva attitude mentioned previously. In the
past this was nurtured by studying the classical Buddhist scriptures about
the bodhisattva path — the ratnavali, the bodhicaryvatara etc. These traditional
studies are gradually being reintroduced and I am very happy about this
since the quality of the physician's mind is quite determinant in establishing
the quality of the medical treatment itself. We also have plans to establish
a research wing in this Institue where we would investigate the newly-discovered
diseases now prevailing all over the world. There is tremendous scope
here and an enormous amount of work to be done, and to be done in such
a way as to satisfy not only our own doctors but the criteria of the present-day
worldwide scientific community. Over a fairly long term and a significant
number of patients, we would need to employ traditional treatments and
also to produce new medicines adequate enough to tackle those diseases,
from the Tibetan medicine point of view. Some people are very optimistic
in this domain. Personally I feel that in some areas a lot can be done
— either to cure or to attenuate serious illnesses — but there is no point
in raising false hopes. Proper research must be carried out and we will
see, as time goes by, what contribution Tibetan medicine might have to
make to the healing arts of the coming century.
Besides the restoration of all the traditional medicines and traditional
medical ethic, there is another area of restoration which interests us,
namely that of techniques used in more ancient times. It would seem that
in earlier times Tibetan medicine was studied in a very exceptional way.
Later, it became, relatively speaking, a little degenerated. We have records
and evidence of many things which were there before — such as operations
on the human brain, use of long, spoon-like implements to perform operations
on various organs etc. Unlike the type of operations one sees in the West,
where the body is opened up on a large scale, the latter was a minimally-invasive
form of surgery, mainly used to remove tumours, from all sorts of different
organs and parts of the body, These were part of Tibetan medical practice
at one point but seem to have been almost forgotten now. We hope to regain
the know-how of these old wisdoms and to re-introduce any of those things
which may be of use today. In brief, both in terms of quality and quantity,
we hope to restore Tibetan medicine to its fullness.
Looking beyond Tibet, it is evident that there are many new diseases in
the world, such as Aids, and new predominances of diseases causing death,
such as cancer. There are also diseases new to Tibet itself, now that
there is greater contact with the outside world. Through research and
an enthusiastic re-establishment of Tibetan medicine, we hope to be able
to contribute to the effort being put into combatting these maladies and
bring some hope of partial or total cures for at least some of them. The
healing art is a wonderful one — one of the finest sciences a human being
can apply himself to — and I am convinced that the traditional wisdom
and the exceptional possibilities offered by Tibetan medicine will have
something to contribute to the medical understanding of the new millenium.