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This makes TTM ideally suited
to remote areas where the doctor has to cope completely on his/her
own. And it is remarkably efficient. A Indian army major - quite
a celebrated gastro-enterologist - told the London Royal College
of Surgeons in the mid-1980s:
"I have my hospital
just next to a Tibetan clinic in Gangtok, Sikkim. About half
the local people come to me and half go to them. I am here,
with my endoscopes and other equipment. They are there, taking
pulses and stirring urine samples. What often strikes me is
that, in the end, there is not really much difference in our
success rates."
Of great interest to us at
Tara is to assess the effectiveness and application of TTM in
the modern world. The anecdotal evidence we have from our own
clinics leaves us in no doubt that it offers an excellent complement
to modern allopathic medicine as well as providing a possible
alternative in cases where modern allopathy has been unsuccessful.
There is a need for finance so that proper scientific research
can be carried out into themany areas where TTM seems, to all
appearances, to be extremely helpful.
GENERAL
EXAMINATION The doctor studies the
general complexion and demeanour, examines the tongue and sclera
of the eyes, feels the temperature of the forehead and sometimes
palpates the ear lobes and glands of the neck region. This will
be followed by a specific examination of a wounded or painful
part of the body.
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QUESTIONING
This vital component of the diagnostic process
can take two forms: direct and indirect. Overtly, the patient
will be asked about symptoms, their duration, general diet and
lifestyle, previous history and so on and so forth. However,
if the doctor is dissatisfied with the response and feels that
the patient is being untruthful, partially truthful or in some
other way unable to supply the information needed, s/he alsohas
many ways of using deduction, through indirect questions, designed
to bring out the truth. The physician may also feel it necessary
to question those close to the patient, especially in cases
where the latter is too ill or confused to express his/her condition
clearly.
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PULSE
PALPATION
"The
pulse is the messenger carrying messages from the illness to
the doctor"
(Fourfold Tantra)
Pulse palpation is one
of the most refined tools in Tibetan medicine and, equally,
one of the hardest to master. Similar - though not identical
to - pulse palpation in Traditional Chinese Medicine - pulse
palpation in TTM usually requires something like the experience
of some 10,000 pulses before real 'feel' and mastery is acquired.
For those unfamiliar with this process and finding it hard to
understand how the pulse can be such an important and complex
vector of information, it may be helpful to think of the refinement
of a wine-taster's art, able to pick up so much detail compared
to that of a novice, or to know the difference between what
the ear of a musician with perfect pitch can detect - in the
way of harmonics, subtle differences of tone etc. - compared
to that of the layman.
The pulse is the intermediary
allowing the physician to attune to (as much as is possible)
and 'listen in' to the activity of the patient's body. It requires
almost total stillness on the part of the doctor, changing the
usual two-sided, patient-doctor dialectic into an extremely
silent, attentive space (of the doctor's awareness) in which
the patient's body can tell its story. This is a very physical,
non-cerebral and direct contact, followed immediately by a series
of intellectual deductions. The physician is in fact seeking
six areas of information from each wrist palpated, as well as
general information on the body's functioning as a whole.
Using his/her own controlled
breath cycle as a gauge, the doctor first notices the speed,
then the strength, prominence, substance, tension and firmness
of the pulse. Pulses are divided into two main types, known
as hot and cold. Information gathered needs to
be moderated by two important considerations:
1. the
'constitutional' pulse of the patient. People's regular
healthy pulses differ markedly. Broadly, there are three types:
the dense and gross so-called "male" pulse
the fine and rapid so-called "female" pulse
and
the drawn out, smooth and supple so-called "bodhisattva"
pulse.
2. the
'temporal' pulse. Human biology is affected by the time
of day and the season of the year. Certain effects appear in
the pulse according to time of day and season of the year. A
novice might confuse these with clues of organic misfunction
if s/he were not aware of such influences.
Following these general observations,
specific information is sought concerning the full
and hollow organs of the body. Using three fingers, the
doctor palpates on the patient's radial artery of one hand then
the other. Each side of each of the doctor's fingers is sensing
information:
|
doctor's finger
|
patient's right wrist
|
patient's left wrist
|
| radial
side of index |
lung
(heart for woman) |
heart
(lung for woman) |
| ulnar
side of index |
colon |
large
intestine |
| radial
side of middle finger |
liver |
spleen |
| ulnar
side of middle finger |
gall
bladder |
stomach |
| radial
side of ring finger |
right
kidney |
left
kidney |
| ulnar
side of ring finger |
bladder |
bsam
se'u |
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URINE
EXAMINATION
Urine can convey important information
about the body's functioning. In TTM, this information is gathered
through visual, olfactive and sometimes gustative inspection,
not through chemical analysis. In line with TTM main classification
of pathogenesis, observations are translated in terms of the
three biodynamics. An excess of
any one of these three biodynamics will give characteristic
indications of colour, odour, consistency, vapour, sediment
(if any), surface film and so forth. Ideally, the urine inspected
is that passed at dawn, assuming that on the previous day and
evening certain prescriptions have been observed. The urine
is examined when still warm, while cooling and when cold. It
is sometimes agitated with a stick so that the sort of bubbles
it gives rise to may be observed. Obviously, the urine samples
brought by patients during the day can only be inspected cold.
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RECENT
ADDITIONS
Traditional Tibetan Medicine
has always been open to improvement and criticism. As mentioned
in other pages, it has incorporated the finest elements of Indian
ayurveda, Chinese traditional medicine and other medicines as
well. Its genius has been in knowing how to relate and combine
the various elements of medicine to make a meaningful and practical
whole. During the last half century TTM has been more and more
exposed to modern allopathic medicine. It is an interesting
meeting which may take another 50 years to produce some very
useful results. Some elements of modern medicine, such as x-rays,
electrocardiograms, some blood tests etc. have such evident
benefit that TTM doctors who have access to such faciltiies
have decided to learn more about them. This is particularly
true on the Tibetan plateau, where several major TTM teaching
hospitals work jointly with modern allopathic ones in the same
town. Some TTM doctors take extra years of training so as to
be able to communicate more efficiently with their colleagues
in the allopathic world and to share wisdom and resources.
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