Likewise, these three biodynamics (which become three pathogens when things go wrong) are not separate things from all the individual bodily systems one can observe and of which they are composed. Each of the three dynamics is a group of real physiological systems which are similar in nature and which share the same main elemental nature. For their relation with the psychological capital of the individual, see section on pathogenesis.

Just like the traffic engineer who re-phases the lights, the Tibetan doctor is aware of the overall workings of the body. His or her task is to know how to modify specific physical processes and parameters to bring it back to health and ensure its smoother running. Ideally, this gives a preventative medicine which detects and remedies fundamental deficiencies, excesses or conflicts before they lead to clinical ailments. In practice - since most people consult a doctor only when clinical conditions are presenting - it gives a holistic medicine which treats the specific ailment while at the same time setting in motion a treatment which will bring the individual as much as is possible back to balanced health.

Quite a few translators have used the term humour for these biodynamics. This is unfortunate as it immediately equates the Tibetan notions with medieval medicine in Europe. This is not at all the case. As years go by, biodynamic may not prove to be the best term, but let it suffice for the moment. Furthermore, there is a problem finding any real equivalent in English for the individual names of each of the three biodynamics. As these came to Tibet from Indian medicine, we shall use here the Sanskrit terms, as they are easier for the Westerner than the Tibetan ones. The three are:

   VATA - (Tib: rlung) - the kinetic dynamic                 related to the wind element
   PITTA - (Tib: mkhris.pa) - thermo-dynamics             related to the fire element
   KAPHA - (Tib: bad.kan) - the solid-fluid dynamic     related to the water and earth elements

For those interested, the Tibetan words are pronounced loong, tree-pa and payken respectively.

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THE THREE BIODYNAMICS AS POTENTIAL PATHOGENS    

When these three are each working correctly, not adversely affecting each other and not in excess or depletion, the body functions normally and one is in good health. In this sense, we have three main vectors of health and as such they are called dhatu in Sanskrit, meaning "vector" (of health). We could call them "healthogens". When one or more of the dynamics malfunctions, is depleted, is in excess or starts to interfere with other systems, it becomes a pathogen. Then it is called dosha, meaning "trouble". The latter term was transposed directly into Tibetan, as nyes.pa, pronounced nyay.pa. to denote the biodynamics.

Below, we will examine the specific function of each biodynamic in times of health.

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VATA

This primarily kinetic dynamic is the generic term for the movements and flows in the body. The principal ones are respiration, motricity, mobility, excretion and the circulation of the blood and other bodily fluids, as well as the oxygen and other vital components of health they transport. It also include the flow of messages through the nerves. These various flows, through their specific channels, are considered in five main areas:

   Life-sustaining    This "pertains to flows seated around the sinciput, with a field of action in the pharynx and the thorax". It mainly concerns the brain's control over motor functions such as breathing, swallowing, crying, sneezing, eructation etc. as well as its maintenance of clear senses and a sharp intellect.
   Upward-moving   "pertains to what is seated in the thorax, with its field of action in the nose, tongue and throat". It mainly concerns the production of breath and oxygen, which permit speech, physical strength, good complexion, industry and awareness.
   Pervading    "pertains to what is seated in the heart, with a field of activity throughout the body". It mainly concerns mobility of all the muscles and limbs of the body, from the flexing of limbs to the opening and closing of the eyelids, the prime function being the heartbeat.
   Fire Companion    "pertains to what is seated in the gastro-intestinal tract, with a field of activity throughout the internal organs of the abdomen". It mainly concerns the movements which enable digestion and the thermodynamic processes of metabolism, in which nutrients are separated from wastes and the seven sorts of tissues generated.
   Downward expeller    "pertains to what is seated in the rectal area, with a field of activity in the colon, bladder, genitals and thighs". It mainly concerns excretion of faeces, urine, menstrual blood, semen as well as the process of childbirth. These involve retention as well as expulsion.

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PITTA

This primarily concerns the thermodynamic processes through which the body is nourished and sustained by food, drink and sense stimulation. This sustenance covers mental processes as well as physical ones. There are five main areas:

   Digestive    This "pertains to what is seated between the undigested and the digested". This mainly concerns the physical and chemical processes which separate foodstuffs into nutrient and waste, take energy from food to provide bodily heat and generally support the following four Pitta.
   Colouring    This "pertains to what is seated in the liver". It concerns processes which give tissues their proper colour, making blood and flesh red, fat white, the marrow pinkish white and other body fluids yellow or white.
   Stimulating    This "pertains to what is seated in the mind". It is the generation of the energy and strength that enable self-esteem, determination, intelligence and the resources to achieve one's goals.
   Giver of sight    This "pertains to what is seated in the eyes". It covers the proper functioning of the visual organ as well as the optic nerve and related parts of the brain: everything in fact which enables colour and form to be properly distinguished.
   Complexion-clearing    This "pertains to what is seated throughout the skin". It covers all the processes which make for a good, clear complexion.

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KAPHA

This primarily concerns the proper constitution of the various bodily fluids, as well as the maintenance of the physical frame which houses them and forms the arena within which life is preserved. It is also related to the senses and mental satisfaction. There are five main areas:

   Supporting    This "pertains to what is primarily seated in the chest". It concerns the skeleton, in particular the bones, cartilage and so forth of the sternum. This, and by extension the rest of the physical frame, is the actual housing upon which the following four depend.
   Decomposing    This "pertains to what is seated in the place of the non-digested". It concerns the fluids which break up foodstuffs by various chemical processes.
   Gustatory    This "pertains to what is seated in the tongue" and which enables the six tastes (sweet, sour, salty, bitter, hot and astringent).
   Satiating    This "pertains to what is seated in the head" and which enables sense satisfaction.
   Joining    This "pertains to what is seated in/around all the joints", enabling flexion and extension.

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The three biodynamics each have specific times of the year in which they accumulate strength then come to their full and finally subside, like incoming and outgoing tides. These are related to the elemental changes accompanying seasonal changes. This needs to be well borne in mind by the TTM physician, who will adjust his diagnosis according to the seasonally-predominant biodynamic which is manifest and who will take care not to damage the accumulation process which is not manifest but under way.

These general categories are but the basis for a vast topic of study, extending throughout the various fields of TTM. The science of how and why these three vectors of good health can turn into pathogens and then how to treat the clinical problems which emerge fills hundreds of pages of the Fourfold Tantra and thousands of pages of commentary. TTM enumerates 404 diseases, with some 1200 subcategories, each with their etiology, pathology and treatment.

The TTM physician is not unlike the conductor of an orchestra who, having spent a long apprenticeship of musical theory and developing knowledge of each instrument, possesses an overview which enables him to lead the whole orchestra into beautiful expression.