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Khempo Troru Tsenam,
Tara-Rokpa's Director of Studies
a more detailed biography and interview
The reader is warmly invited to read all this fascinating interview, held
between Professor Khempo Troru Tsenam Rinpoche and Ken Holmes, Director
of Studies at Kagyu Samye Ling Tibetan Centre in Scotland, where the interview
took place. It formed the basis for a section in the beautiful Serindia
publication "Oriental Medicine". We are extremely grateful for Anthony Aris
for permitting us to use it here.
The hyperlinks below make make navigating through it easier in subsequent
readings.
Biography
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.
Early Life
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 astrology.
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.
Education
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.
Imprisoned
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 invaluable.
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 in Tibet
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
young girls.
The Present
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
ethics ?
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
wastes.
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 event.
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 involved.
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 coming millenium.
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Last updated 16th April 1998
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