Categories of Disease
To gain an overview of the Tibetan medical system, let us first examine how it classifies and understands diseases. One system for doing this divides diseases into three general categories:
- Dependent (gzhan-dbang) diseases – sicknesses that arise from the influence of other factors; for example, imbalances within our bodily system, unhealthy diet or behavior, external conditions, the environment, micro-organisms and so on. This is the largest category of diseases and includes the most usual ones.
- Thoroughly established (yongs-grub) diseases – inherited, congenital or genetic defects. Such sicknesses are very difficult to cure, such as hemophilia, or asthma or allergies that someone has had from infancy.
- “Conceptional” (kun-btags) diseases – psychosomatic disorders. These are often seen as stemming from harmful spirits. They are treated mostly by rituals performed primarily by monks or nuns, which seem to be effective in many cases.
Even if we do not accept the metaphysical basis for ritual treatment of psychosomatic diseases, we can understand their frequent effectiveness on a psychological level from something analogous in certain African systems of treatment. If someone in a tribe is ill and they are surrounded by the entire village dancing and chanting all night with the aim of curing them, the person receives great emotional reinforcement and support that everyone cares. This certainly can be very helpful, particularly for psychosomatic problems.
If we look purely from a scientific point of view, we can describe a similar mechanism in the Tibetan Buddhist system. If someone has a group of monks or nuns performing complex rituals on their behalf, and especially if they have great confidence and faith in their spiritual efficacy, the person will feel much more positive about getting better and in many cases will improve. Recent scientific studies have suggested that our psychological frame of mind affects the body’s immune system. If we feel ourselves part of a community and loved, if we are optimistic and cheerful, if we are calm and relaxed, if we feel we can somehow control the situation and have hope and so forth, our immune system is strengthened. Our chances of recovery are much higher than if we are anxious, pessimistic, easily angered and feel alone, alienated and helpless. This has been shown to be true over a broad spectrum of sicknesses, such as cancer, heart disease and so on, not merely psychosomatic ones.
In another classification scheme, there are:
- Disorders of this lifetime – these correspond to dependent diseases. They arise primarily from the influence of conditions or actions of this life and then manifest in this life.
- Disorders from previous lives – these correspond to thoroughly established diseases. They arise primarily from the influence of karmic actions of previous lives.
- Disorders from harmful spirits – these correspond to conceptional diseases.
A fourth category is then added:
- Superficial disorders – these arise simply from improper diet or behavior and require merely modification of those in order to be cured.
Each of these four categories has 101 major diseases, from which is derived the often-heard number of 404 sicknesses discussed in Tibetan medicine.
Let us go into detail about this first category of sicknesses, those that arise from the influence of other factors, since this is the main focus of the Tibetan medical system. In theory, however, each of the three or four general categories of disease has the same subdivisions.
Classification in Terms of Imbalances of the Three Humors
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.: dosha) 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. vata), “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.
Classification of Diseases as Hot or Cold
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.
Classification of Diseases in Terms of the Five Elements
The Tibetan Buddhist medical system sometimes also classifies diseases as imbalances of the pan-Indian set of five elements. These five are:
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.
Seven Variables Affecting the Classification of Diseases
Furthermore, for one disease, such as asthma or ulcers, there are seven variables that affect its classification in the Tibetan Buddhist system.
- 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.
- 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.
- 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.
- The site – the location of the disorder within the body. An ulcer of the duodenum is different from one of the stomach.
- 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.
- 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.
- 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.
Detail Concerning the Classification of Disease According to Its Site within the Body
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
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.
Classification of Diseases According to External Conditions
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.
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 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 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.
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.
The Psychological Sources of Disease
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.
Scientific Findings Concerning the Effects of Our Attitudes on the Immune System
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.
Comparison with the Indian Ayurvedic, Greek and Chinese Approaches
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
- 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