Details of Tibetan Medicine 3: Diagnosis of Disease

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General Principles of Diagnosis

Now let us talk about the diagnosis of disease in Tibetan medicine. This is done by a three-fold process. First is a visual examination, which entails examining the tongue and urine. Sometimes the eyes are observed for signs of secondary effects, such as yellowing of the white of the eye indicating the bile disor­der of jaun­dice, but there is no system of diagnosis from the eyes such as in iridology. Second is the pulse examination and third is questioning the patient about symptoms.

The most common symptoms of a wind disorder in general are excessive yawn­ing, shiver­ing, sighing, stretching of the limbs, cold chills, pain in the hips and joints, particularly around the shoulder blades, empty heaves, dull­ness of the sen­ses, depression, paranoia, restlessness and pain when hungry. Bile symptoms are a bitter taste in the mouth, headache, fever, burning sensa­tion in the eyes, oversensitivity to bright light and sunlight, pain in the upper body and discom­fort when eating. Some of the most frequent phlegm symp­toms are no appe­tite, feeling bloated even with an empty stomach, con­stant burp­ing, heaviness of body and mind, indigestion, nausea, one’s food having no taste, a sensation of being cold both externally and internally, and also dis­comfort after eat­ing. Of course, one does not necessarily have all these symp­toms, but they are interesting and useful to know.

During a Tibetan medical examination, the questioning is actually just minimal. This is because everything can be known simply on the basis of the urine and pulse analysis; and for skilled physicians, examining either the pulse or the urine is sufficient. The questioning about symptoms is often just added at the end to confirm the diagnosis. There have been Tibetan doctors who have gone to hospi­tal clinics in the United States and Europe, and simply by examining the patients’ pulse, with­out asking any questions or being given any background infor­mation, have been able not only to diagnose their sick­nesses accurate­ly, but to tell their medical histories as well. The Western d­octors have been amazed.

Also, it should be noted that a Tibetan medical examination is much shorter than a Western one. Western patients, often considering them­selves very impor­tant and especially if they are paying a high fee for an examination, feel cheated if the doctor does not spend at least a half hour with them. They re­gard the doctor as almost a psychiatrist, and often will talk to him or her about their various personal, private problems concerning their marriage and so forth. Tibetan doctors, how­ever, and spiri­tual teachers or lamas as well, are not psychi­a­trists in a Western sense. A thorough Tibetan medical exami­na­tion usually takes no more than five minutes, often less, and there is never a consultation fee. Furthermore, a Tibetan doctor does not usually give spiri­tual advice, even if the doctor is a monk. One goes to an experienced Buddhist master for that. 

One important aspect that must be kept in mind when exami­ning a patient is his or her basic constitution. This is most often seen from what is known as the constitutional pulse. Regardless of the gender of the person, a male con­stitutional pulse is like a wind one, a female one is like bile and a bodhisattva or neuter one is like phlegm. Bodhisattva, in this context, has no spir­itual connota­tion.

These three constitutional pulses are reflected in the three basic body and personality types. A wind person has a weak constitution, talks a lot, looks nervous, unstable and not relaxed. A bile person is well-built, active and aggres­sive. A phlegm person is slow, fat and with a fair comple­xion. There are also com­bination types of any two or all three basic constitu­tions, making seven types of persons. One can also speak of wind persons having a fundamen­tal predomi­nance of the wind element, bile persons fire, and phlegm persons earth and water.

It gets rather complicated, actually, because it is not always the case that someone, for instance, with a bodhisattva pulse will be a phlegm type of person. He or she could be any of the seven types. All these factors about patients, then, their constitutional and basic body type, as well as age, environment, season of year and so on, must be taken into consi­deration when making a diagnosis, otherwise it is easy to make mistakes.

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