Details of Tibetan Medicine 2: Classification of Diseases

One important point to note before proceeding: Tibe­tan medi­cine is a holis­tic system that considers and treats the body as a whole and does not simply consider one aspect alone. Thus, due to either internal or exter­nal factors or both, imbalances occur within the body as a whole.

The Tibetan medical system discusses these imba­lances in terms of what is most often translated as the three “humors.” The Tibetan and original Sanskrit words for “humor” (nyes-pa, Skt. doṣa) connote something that can go wrong or be faulty. The three may be referring to various bio­chemi­cal, neuro-electrical, physiological or energy systems within the body, but it is best to try to understand the Tibe­tan view within its own context.

The three humors are mostly translated as “wind” (rlung, Skt. vāta), “bile” (mkhris-pa, Skt. pitta) and “phle­gm” (bad-kan, Skt. kapha). Sometimes a fourth humor, “blood” (khrag) is added. They can be either too strong or too weak, and to varying degrees and in vary­ing combi­na­tions. Fur­thermore, each of the three includes five sub-catego­ries. It is not always easy to understand why each of these groups of five con­sti­tutes a set.  

The Five Types of Wind

The five types of wind are:

• Life-supporting wind (srog-’dzin)– located from the crown of the head through the throat and down to the chest. It is the energy involved with inhaling and exhaling, swallowing and vomiting, spitting, coughing, sneezing, hiccoughing and burping. It is life-supporting in that it provides the physiological basis for the mind to func­tion with concentration and the senses to be clear.
• Ascen­ding wind (gyen-rgyu) – found primarily in the throat region. It is responsi­ble for outgoing functions, such as speech, physical strength, body tone, comple­xion and bulk. It also controls strength of mind in terms, for instance, of memory and diligence.
• Diffusive wind (khyab-byed) – residing or originating from the heart, it is found throu­ghout the body. This is the energy involved with the mus­cles and motor ac­tivity such as walking, lifting, stretching, grasping, open­ing and shutting the mouth and eye­lids, and so on.
• Fire-accom­panying wind (me-mnyam) – located in the lower portion of the stomach and throu­ghout the organs and channels of the body. It is the energy involved in diges­ting the nutritional essence of food that has been separated from the waste por­tion. It also drives the function­ing of the body’s organs, cir­cu­lation, the nervous system and metabo­lism in general.
• Down­ward-void­ing wind (thur-sel) – located in the lower abdomen and genitals. It is the energy invol­v­ed in ex­pell­ing and retaining urine, fe­ces, semen, menses and a fetus.

The description and location of these five winds in Tibetan medi­cine is different from those found in the various Bud­dhist tan­tras, and both are dif­ferent from the Ayurvedic system.

If we speak in general, disorders of wind can involve such things as high or low blood pressure, heart disease, gas, nervousness and both muscular and mental tension. Many psycho­logical imbalances are due to disturbances of wind, such as paranoia, depression, melancholy, being fidgety and restless, and the syndrome known in colloquial English as a “broken heart,” such as when a loved one leaves us.

The Five Types of Bile

The five types of bile are:

• Digestive bile (’ju-byed) – located in the middle part of the stomach. This is responsible for the separation of certain nutri­ents from in­gested food once the food has been broken down. It provides bodily heat and strength, and in general sup­ports the proper functioning of the other four types of bile.
• Achieving bile (sgrub-byed) – at the heart, gives us drive, a­mbi­tion, desire, determination and self-confidence.
• Color-regulating bile (mdangs-sgyur)– in the liver, is responsible for the red-coloring of the blood and muscles, so hemoglobin, for instance, as well as the white-coloring of the bones, semen and so on.
• Seeing bile (mthong-byed) – in the eyes, is involved in the func­tioning of the eyes and sight.
• Comple­xion-clearing bile (mdog-byed) – in the skin, is respon­sible for skin-co­lor, such as when we have jaundice or sunburn.

In general, then, it is difficult to say whether these types of bile are energies or biochemical substances. But we can see a correlation here between liver and gall bladder problems of digestion with jaundice, eye-strain, bad temper and feeling feverish. These are typical symptoms of a bile disorder in general.

The Five Types of Phlegm

The five types of phlegm are:

• Supportive phlegm (rten-byed) – in the thora­cic and abdominal regions. It provides moisture in the body, as with saliva and mucous, regulates bodily fluids, and in general supports the functioning of the other four types of phlegm.
• Decomposing phlegm (myad-byed) – in the upper stomach, breaks down solid food into a semi-liquid state.
• Exper­iencing phlegm (myong-byed) – in the tongue, allows the sense of taste to function.
• Satia­ting phlegm (tshim-byed) – in the brain, ends our appe­tite and makes us feel satiated in terms not only of eating, but in relation to all the senses. It also allows us to differen­tiate tastes, smells, sounds, sights and tactile sensations.
• Connect­ing phlegm (’byor-byed) – in all the joints, allows for flexibility.

Phlegm in general, then, deals with the various fluids of the body, the mucous and lymphatic systems, and the lubri­cation of the joints. Phlegm disorders would include colds, allergies, running nose, congested lungs, cer­tain types of asthma, frequent urination, arthritis, rheumatism and so on.

The Tibetan Buddhist system also classifies diseases as hot or cold:

• Phlegm disorders – heavy and cool. Phlegm smoth­ers the bodily heat, and so all phlegm disorders are cold.
• Bile disorders – fiery. All bile disorders are hot.
• Wind disorders – common to both hot and cold and assist whichever is prominent. Thus, wind imbalances can be either hot or cold.

When four humors are presented, then bile and blood disorders are hot, while phlegm and wind are cold. The Mongolian tradition of Tibetan medi­cine emphasizes this hot and cold classification.

The Tibetan Buddhist medical system sometimes also classifies diseases as imbalances of the pan-Indian set of five elements. These five are:

• Earth
• Water
• Fire
• Wind
• Space.

As for the correlations:

• Earth and water imbalan­ces correspond to phlegm disor­ders
• Fire imbalances to bile disorders
• Wind imbalances to wind disorders
• Space is all-perva­sive and imbalances in it can be found in any disorder.

The pan-Indian elements can be understood as follows.

• Earth – influences the for­mation of muscles, tissues and bones. It refers, then, to the solid aspect of the body.
• Water – deals with the formation of blood and the other bodily fluids, so the body’s liquid aspect.
• Earth and water – both are cooling, and so dampen the bodily heat, just as phlegm is cold; while bone and bodily fluid disorders are likewise most commonly phlegm. 
• Fire – deals with bodily tempera­ture and comple­xion, or skin coloring, both of which are bile functions and likewise hot. Tem­perature and what is called “digestive heat,” the acidity of the stomach, etc., would all be involved with the digestive processes of bile.
• Wind – deals with respiration and energy, which are most often involved with wind disor­ders. Wind can either fan the heat or increase the cold.
• Space – refers to the bodily cavi­ties and passageways, the positions of the various organs within the body and so on, which could affect any ill­ness.

The classification of diseases is actually quite complex, because any one sickness is often a complicated combination of imbalan­ces of not only one, but two or all three of the humors. And we must remember that each of these humors has five sub-categor­ies.

Furthermore, for one disease, such as asthma or ulcers, there are seven vari­ables that affect its classification in the Tibetan Buddhist system.

1. The cause – such as the spe­cific humors that are out of balance as a result, on a deep level, of their corres­pond­ing disturbing emotions, to be discussed in a moment. One disease may have several varie­ties that can be caused by an imbalan­ce of any of the three humors, or any combina­tion of them.
2. The condi­tions – those that contributed to the cause’s giving rise to the di­sease, such as diet, behavior, seasonal influ­ences, the wea­ther, malevo­lent spirits and so on. A bile-caused asthma brought on by working in a pollu­ted factory is different from a bile-caused one brought on by the weather or con­tact with a substance to which we are allergic.
3. The point of entry – there is a sequence of how dis­eases spread in the body in gener­al, and a specific illness could have en­tered into the body’s systems at any point in that se­quence.
4. The site – the location of the disorder within the body. An ulcer of the duodenum is different from one of the stom­ach.
5. The general charac­teris­tics of the sick­ness – such as its level of severity and where it is coursing within the bounds of how severe it can become.
6. The specific details – whether it is a wind, bile, phlegm or complex disorder of a child, adult or old person, living in this or that climate, at this or that altitude, and at this or that season of the year.
7. The speci­fic conclu­sion – namely, how the first six variables add up to give the stage of progress of the dis­ease, all the way up to its being a terminal case.

From among the above-mentioned seven variables for classifying diseases, the sites of a disease refer to the type of organ involved. There are two sets of bodily organs:

• Vital or solid organs, all of which are classified as hot
• Hollow or reservoir organs, all of which are classified as cold.

The five vital or solid organs (don-lnga) are:

• The heart
• Lungs
• Liver
• Spleen
• Kidneys.

The six hollow or reservoir organs (snod-drug) are:

• The stomach
• Small intestines
• Large intes­tines
• Gall bladder
• Uri­nary bladder
• Reproductive organs, namely the ova­ries and seminal vesicles.

Any one disease, then, has a large number of varieties depending on its site in the body, and thus the treatments will differ accor­dingly. Also, since Tibetan medicine follows a holistic ap­proach, each patient will have his or her own basic, as well as cur­rent state of health, physical strength and set of other dis­orders, which likewise will affect the classifi­cation and treatment of the disease. This is why it is so difficult in the Tibe­tan system to speak about a disease in general, such as cancer, except on a very superficial level. There are just too many varie­ties and possibilities.

One factor that does not, however, affect the disease or treat­ment, since someone once asked about this, is the race or ethnic background of the pa­tient. Humans are humans everywhere, and within one race, all possibili­ties and permu­tations can be found.

The season and weather, as well as diet and behavior, may not only be causal factors for contracting a sickness, but will also affect its treatment and course. The same illness contracted in different seasons is considered and dealt with differently. Let us look at some of the details.

Seasonal Factors

In general, imbalances of any of the humors may form when the seasons are unusually too hot or too cold, and so the natural rhythms of the body are dis­turbed. They may also form if we do not dress in accordance with the weath­er, such as wearing too little in the cold or too much in the heat.

During different seasons of the year, the humors naturally accumulate, manifest or subside. This might also provide the condition for a sickness to build up, break out or naturally go away. Climates and seasonal characteris­tics differ around the world, and what is described in the Tibetan texts concerning the climate of India might not apply to other regio­ns. Never­theless, by seeing what the case for India is, we can become aware of some of the gene­ral principles.

In the hill regions of North India, although winter and spring are as in any temperate climate, the summer has two parts. The first is very hot, harsh and dry, while the second is the monsoon, which is rainy, humid and cooler. The autumn is quite warm again, and then comes winter.

• Wind disorders build up during the first part of summer, when the weather is light and rough, like wind. But since the nature of wind is cool, the heat of the season keeps it dor­mant. When the monsoon rains come and the weather be­com­es cool and windy, then the accumulated wind diseases become manifest. Af­ter the monsoon, when it becomes warm again in autumn, wind naturally sub­side­s.
• Imbalances of bile build up during the humid rainy season, but because the wea­ther is cool and the nature of bile is hot, it cannot become manifest. It only does so when the warm, sunny autumn arrives. In winter, bile naturally will subside due to the cold.
• Phlegm disorders build up during the winter, when it is heavy and cold. Phlegm itself is cold in nature, but winter cold almost freezes it, as it were, so that the phlegm becomes immobile and cannot arise. In the spring, the accumulated phlegm melts and becomes manifest. The summer heat then burns it off, so that the phlegm subsides.

Furthermore, children are more prone to phlegm imbalances, adults to bile and the elderly to wind. We must be careful, then, at certain times of year and age not to aggravate the humors by improper diet or behavior, which may pro­vide further circumstances for disorders to become manifest.

Dietary and Behavioral Factors

At any time of the year and in any weather, if we fixate for too long on sensory objects – sights, sounds, smells, tastes or physical sensations – that are either overly pleasant or excessively unpleasant, this may also cause an im­balance to form as the result of overstimulation. For instance, people obsessed with listening to loud music all day or those who live with the constant loud, abrasive noise of traffic may develop imba­lances of their winds. Excessive or too little physical exercise, talk or use of the mind may also cause imbalances of the humors to arise. Furthermore, straining to urinate or defecate, or forcefully withholding when we need to perform these functions, may also act as a factor for ill­nesses to form.

Wind Disorders

Wind disorders can be brought on and are harmed by exces­sive coffee, strong tea, cucumber, pork or goat meat. Coffee, especially at high altitudes, is very bad for wind problems. Potatoes, peas and beans that are merely boiled and then eaten with the water in which they were boiled being discarded can also aggra­vate wind prob­lems, as can fasting. Imba­lances of wind can also mani­fest due to excessive desire for sex, mater­ial objects, wealth and so on, and feeling very frustra­ted and depressed at not obtaining them. They may also arise with excessive crying, doing strenuous activity or exercise on an empty stoma­ch, going hungry for a long time, lack of sleep, overwork, exces­sive talking, expo­sure to cool, strong winds, sitting in front of a fan or power equipment, as well as bleed­ing, vomiting and diarrhea. When we think about this list, no wonder so many people in Western countries have wind disorders!

If we are prone to them, imbalances of wind can be pre­vented or alleviated by eating mutton, lamb, aged meat, aged butter, molasses, onion, garlic, drinking hot milk, stay­ing in cozy, warm places, having long distance views and stay­ing in the company of close friends, laughing and relaxing. Massage, especially with sesame oil, is also very helpful.

Bile Disorders

Bile problems can arise from and are harmed by eating too much chili pep­per, hot, spicy and greasy, fatty foods, oils, especially from grains, peanut butter, nuts, eggs, mut­ton, lamb, yak meat, butter, molasses and alcohol, espe­cially if it is aged. They are aggravated by staying out in the sun, stre­nuous physi­cal work, espe­cial­ly in the sun, sleeping after lunch, especially when it is hot, being angry, hard jogging or running, especially with a sense of compe­ti­tive­ness, and so on.

They can be alleviated or prevent­ed, if we are prone to such disorders, by eating yogurt from cow or goat’s milk, venison, goat meat, barley or dande­lion por­ridge, drinking cold, boiled water, staying near the sea or in a cool, breezy cli­mate, keeping out of the sun and remaining calm.

Phlegm Disorders

Disorders of phlegm can be brought on and are harmed by excessive sweets, sweet or unripe fruits, cauliflower, cab­bage, carrots, raw vegetables, cold food and cold drinks in gener­al, overcooked, undercooked, uncooked or burned foods, aged meats and excessive wheat and rice. They are aggravated by sleep­ing in moist places, sit­ting on the cold, damp ground, getting a chill after a cold swim or shower, sleeping during the day, having no exercise, remaining totally immobile after meals and so on.

Phlegm disorders can be alleviated or, if we are prone to them, prevented by eating mutton, fish, honey, drinking hot boiled water, aged wine, taking exer­cise, being out in the sun and keeping warm.

What is most interesting and unique in the Tibetan Buddhist system of medicine is the discus­sion of the deepest source of imbalance of the three humor systems. Al­though an imba­lance can arise from some­thing external such as staying out in the cold and rain, eating the wrong foods or coming in con­tact with certain micro-organisms; never­theless, on the deepest level, the main source of ill health is emotional im­balance. This is one of the unique fea­tures of the Buddhist approach to medi­cine.

Let us look at these underlying causes more closely.

• Longing desire, attach­ment and greed – wind disorders. For example, people with large greed to make a lot of money and get ahead in the world, and who push them­selves too hard and worry incessantly, will often get high blood pressure, insomnia and nervous ten­sion. These are wind disor­ders. Or people with much attachment to their spouses, lovers or loved ones, who then have the other person walk out and leave them, will often experience a broken heart, wi­th much depression and heartache. These too are due to a distur­bance of the winds.
• Anger and hostility – bile disorders. People who easily get angry, hold grudges and are spiteful have all the bile churning in their body. Their faces turn red and burn­ with rage. As a result, they may get indi­gestion and an ulcer.
• Naivety, closed-mindedness and stubbornness – phlegm disorders. For instance, people who are closed to learning anything and are unre­ceptive and insensitive to others will often have this attitude reflected in their body likewise being closed. Their sinuses or nose may be stuffed with a cold, their lungs closed with asthma or their joints stiff with arthritis.

This aspect is one of the more stimulating points in the entire system of Tibetan medicine. It is saying that no mat­ter how much we try to bring our body back into bal­ance, the slightest thing will cause it to go out of harmony again. This is an uncontrollably recurring syndrome – what in Buddhism is called “samsara.” If we were to work only on a physical level, we would constantly be battling to keep every­thing in balance; we could never achieve a lasting victory. This is be­cause the real source for physical health is mental and emotional well-being.

This is very profound and thought-provoking, especially concerning which psychological states of mind might correspond to and cause which types of sickness. For instance, often it happens that people with a very negative attitude toward themselves and toward life in general, who feel they have nothing to live for, deve­lop cancer. Parallel to their hatred of themselves, their body destroys itself with a malignant tumor. Frequently, this is seen with older people whose husband or wife has died and then, feeling their own life is no longer worthwhile, quickly develop cancer and die themselves.

Another example would be people who indulge excessively, with no restraint, in unprotected sex indis­criminately with numerous partners, or who have intra­ven­ous drug dependencies, who then contract AIDS. Parallel to their inability to exercise self-control and refrain from unhealthy practices, their body’s immune system fails and no longer wards off disease.

These ideas are very suggestive and give much to reflect upon. The deepest cause for all sicknesses, however, is the un­awareness and confusion about reality and our identity, which causes us to have these disturbing emotions of longing desire, anger and naivety.

In the past few years, Western scientists have started to investigate the relation between emotional states of mind and health. So far [in 1990], they have studied only those who are prone to anger or depression, and those who tend to repress their feelings. They have not yet studied people with greed and craving. The preliminary evidence is that those who are filled with anger, stress or fear, or who have low self-es­teem, or a feeling of aliena­tion, depres­sion or disconnected­ness with family or community, or in general a pessimistic, negative outlook on life, or who repress their feelings, have a lower number of T-cells, natural killer cells and so on in their immune systems. They tend not to recover from ill­nesses as well, have a lower survival rate, shorter life ex­pectancy and get sick more often than those with a sense of joy in life, who frequent­ly laugh, are calm and relaxed, feel loved and part of a support group, and who are optimistic and posi­tive in outlook. The scientists have noted this with respect to patients with can­cer, high blood pres­sure, heart disease, AIDS and so on. They have not yet studied, however, the corre­lation between speci­fic emo­tional states and specific diseases.

Scientists have discovered, however, that the brain activity of the right and left frontal lobes is different for two basic emotional states and personality temperaments. They have noted greater activi­ty on the left side in those who are approach-orient­ed, while on the right side for those oriented toward with­drawal. In the context of these studies, approach implies wanting to engage in activity, being outgoing, so­cial, happy and optimistic. Withdrawal means being shy, fearful, pessimis­tic, depressed, or filled with disgust and anger.

These do not exactly correspond, then, to the two disturbing emotions, discussed in Buddhism, of longing desire, greed and attachment versus anger and hatred. We can either approach or withdraw due to a con­structive or destructive state of mind, as with friendliness or cra­ving on the one side, and hostility or a sense of pro­priety and considera­tion on the other. But, although modern studies have not yet made this finer differen­tiation; nevertheless, scientists have seen that increased electro-neural activity on the left side, either due to basic tempera­ment or a passing emotional state, corresponds to a weaker immune system. Much more research is needed.

The Indian Ayurvedic Medical System

Concerning this point of the ultimate origin of disease, Tibetan Bud­dhist medical theory dif­fers significantly from the Indian Ayur­vedic approach. The Ayurvedic system also has the three humors of wind, bile and phlegm. But there, a dishar­mony of the three fundamental, material as­pects of all matter causes imbalances in them, rather than emotional imbalance. These three aspects are called in Sanskrit the three “guna” or “constituent qualities”:

• Sattva – the physi­cal quality of lightness, which causes wind disorders
• Rajas – the active aspect of matter, which this causes problems with bile
• Tamas – the dark aspect, which causes imbalances of phlegm.

As with the Tibetan Buddhist medical system, the Ayurvedic system sometimes also adds a fourth humor, “blood.”

Philosophically, the Ayurvedic and Buddhist approaches to medi­cine are also quite different. As with the difference between the Hindu and Buddhist approaches to the spiritual path, Ayurveda stresses physical manipulations and aspects, while the Buddhist emphasi­zes mental change.

The Classical Greek Medical System

The classical Greek system of medicine also classifies disease in terms of four humors, but these are different from the Indian set. The classical Greek four humors are

• Blood
• Phlegm
• Yellow bile
• Black bile.

Wind is not a humor, but is some­thing that courses through the blood, giving energy to the body. The main source of imbalance is external conditions, not internal as in the Buddhist or Hindu approaches, whether that internal source is seen as mental or physical.

Furthermore, the Greeks believed that from physical disor­ders, we develop emotional upset, which is the opposite order from the Tibetan Buddhist way of looking. For instance, the Greek word for black bile is “melancholia,” from which is derived melancholy.

The Traditional Chinese Medical System

The traditional Chinese medical system does not speak of humors. Instead, it considers disease as an imbalance of “yin” and “yang.” This concept of yin and yang is not found at all in any Tibetan system, whether medical, astrological or philosophical.

The Chinese classification of the organs is the exact opposite of that in the Tibetan Buddhist system. If hot corresponds to yang and yin to cold, then in Chinese medicine the vital organs are yin and cold, while the hollow yang or hot. In the macrobiotic system of medicine, founded in the early twentieth century in Japan by George Oshawa, the vital organs are yang and the hollow yin, parallel to the Tibetan system.

The Chinese system also analyzes disease as an imbalance of the five elements or active agents that affect physical matter. But the Chinese set of five elements differs greatly from the pan-Indian set found in both the Buddhist and Hindu systems.

The Chinese five elements are

• Earth
• Water
• Fire
• Wood
• Metal.