Essentials of Complementary and Alternative Medicine (June 1999)

History
The origins of Tibetan medicine, based on accounts of the Bonpo tradition, can be traced to the teacher sTon-pa gShen-rab, who lived approximately 500 years 
before Buddha Shakyamuni (
7
, 
8
). The first king of Tibet, Nya-khri bTsan-po, who ruled around 150 
BC
, had a prominent physician, Dung-gi Thor-cog, who most likely 
practiced an indigenous Tibetan medical art. The Bonpo traditions have been misunderstood and undervalued, particularly after Tibetan culture was influenced by 
Buddhism in the seventh and eighth centuries 
AD
.
K
EY
 F
IGURES AND
 L
ITERATURE
The historical period of the Tibetan Empire shaped the body of knowledge known as Tibetan medicine (
1
). The Tibetan Empire lasted from the seventh to the ninth 
centuries 
AD
 and extended south to the plain of the Ganges, north to Samarkanda, and included part of China. The vast and culturally varied territory of that empire 
effected development of Tibetan medicine, mostly because of special interest that the three consecutive rulers of that empire had in acquiring and nourishing 
knowledge of other cultures (
1
, 
2
).
The three kings who ruled the Tibetan Empire were, in chronological order, Song-tsen Gam-po, Ti-song De-tsen, and Rolpa-chon. They are regarded as the most 
prominent figures in Tibetan history (
1
, 
2
). In the eighth century 
AD
, one of the three rulers, king Ti-song De-tsen, invited Padma-Sambhava, a famous Buddhist 
teacher, to Tibet. Since then, Buddhist philosophy has been essential in the medical education of Tibetan culture (
1
, 
2
). Symbolically, Buddha occupies an important 
position in the medical hierarchy of Tibet. One of his titles is Supreme Physician, and he is often thought of as the Tibetan Aesculapius. The Tibetan Empire was also 
highlighted by a medical convention that took place between 755 and 797 
AD
 at Samye (
5
, 
10
). During that meeting, renowned physicians from Persia, Greece, India, 
China, Afghanistan, Nepal, East Turkestan, and Kashmir translated their medical works into the Tibetan language.
The eighth and ninth centuries are also noted for the work of a physician known as the Elder gYu-thogYon-tan mGon-po, or the Excellent Protector (
18
). He is 
credited with writing a first document on Tibetan techniques of diagnosis and treatment. He and one of his descendants contributed to the final form of the  yGyud-bzhi 
(pronounced Zud-shi, meaning “Four Roots"), a canon textbook in Tibetan medicine (
2
). The nucleus document of the yGyud-bzhi was probably written in Sanskrit in 
the fourth century 
AD
 and was brought to Tibet from India during the active period of the Empire (
19
). Most likely, the translation into the Tibetan language was 
accomplished in the eighth century by the Buddhist scholar Vairochana, with the assistance of the Tibetan physician Zla-ba mNon-dgha (
2
). In the late nineteenth and 
early twentieth centuries, that ancient work was translated from Tibetan and Mongolian into Russian by the present author's great grand-uncles Alexander Badmaev, 
MD (known by his Buddhist name as Sul-Tim-Badma) and Peter Badmaev, MD (known by his Buddhist name as Zhamsaran-Badma) (
20
).
E
ARLY
 T
IBETAN
 M
EDICAL
 E
DUCATION
Historically, medical education in Tibet has been based on a highly structured system, with Buddhist monasteries functioning as medical schools (
2
). The first medical 
college in Tibet, Kong-po-menlung, was built in the eighth century at Lhasa. Among medical schools established since then, the best known are the Chagpori Medical 
College, built in the seventeenth century, and Mentsi Khang, built in 1915. Since 1959, the Tibetan Medical Institute at Dharamsala, India, has been the center that 
upholds both the medical tradition and the Tibetan culture under the guidance of His Holiness Dalai Lama (
5
, 
9
).
Partly because of the vast cultural influence of the Tibetan empire, Tibetan medicine has also been practiced in Mongolia (
5
, 
9
, 
10
). According to some accounts, 
Tibetan medicine was particularly welcomed in that country because of a Tibetan physician named Sakaja (first half of the thirteenth century) who cured Godon, the 
ruler of that country, of a form of paralysis (
9
). In recognition of the Tibetan and Buddhist contributions to their medical knowledge, the Mongolian people awarded the 
ruling priest-prince of Tibet in 1547 the Mongolian title of Dalai-Lama, meaning Ocean Priest (
5
). In the twentieth century, Tibetan medicine was brought from 
Mongolia to the Asiatic part of Russia, and the principles of both that medicine and Buddhism have flourished in the Buryat Russian Republic, where it has been 
taught in the Aga monastery, which is in the vicinity of Lake Baikal (
5
, 
10
, 
12
 and 
13
).
TIBETAN TRADITIONS AND LINEAGES
Although all Tibetan medicine teachings have central texts and core concepts, the actual practice of Tibetan medicine has developed variations from different 
lineages or traditions. These lineages usually follow the special practices of one teacher or family tradition. In addition, these lineages will take on certain 

characteristics of the local medicine traditions where they are practiced. It would be beyond the scope of this chapter to describe all these lineages and their 
practices. The author is trained in one of these traditions that came to the West via Russia and was taught by his ancestor, Buryat physician Dr. Sul-Tim-Badma, who 
settled in St. Petersburg in the late 1800s and changed his name to Dr. Alexander Badmaev (
11
, 
12
 and 
13
, 
22
, 
23
). Descendants of Alexander and his brother Peter 
continue to practice in St. Petersburg (
22
, 
23
 and 
24
). The examples of specific herbal treatments described in this chapter come out of this lineage and are not used 
by all Tibetan physicians. They do, however, serve to illustrate basic principles of Tibetan plant use and similar formulae are used in Tibetan practices around the 
world.
Unlike Chinese and Ayurveda medicine, Tibetan medicine has only recently come to the attention of the West. Probably the greatest pioneer of Tibetan medicine for 
the West was Alexander Csoma de Koros, called the Hungarian “hero of learning,” who spent years in seclusion in Tibetan monasteries studying Tibetan medical 
treatises and translating them for the West (
21
). The Badmaev family also brought Tibetan medical practices to the West. After Alexander and Peter Badmaev, 
Valdimir N. Badmaev, MD, Sr. (Buryat name Jamayan Badma) established a Tibetan pharmacy and practice in Warsaw in the 1930s. Later, his son (Peter Badmaev, 
MD, Jr.) and Mr. Karl Lutz helped to establish the commercial manufacture and clinical testing of herbal and mineral treatments based on the Badmaev tradition (
14
). 
In 1985, the present author established the Laboratory of Applied Pharmacology in New York to carry on the development and testing of these formulae for the 
Western market (
17
). The PADMA company in Switzerland is another company that has developed and tested Tibetan formulae for Western use.
More recently, and under the guidance of His Holiness the Dalai Lama, other Tibetan traditions have been introduced to the West. Tibetan physicians trained at the 
Tibetan Medical Institute in Dharamsala and elsewhere have come to the West to give demonstrations and open practices in conjunction with conventional Western 
clinics. In addition, organizations like the Dharma Hinduja Indic Research Center at Columbia University; Pro-Cultura, Inc.; the Alternative Medicine Foundation, Inc., 
and the Smithsonian Institute have stimulated increased understanding and exchange of information on Tibetan medicine traditions and lineages in the West. In 
recent years, a number of institutes for the practice of Tibetan medicine have opened in Western countries.
PRINCIPAL CONCEPTS
The three elements, or the triadic theory, is the distinguishing medical theory in Tibetan medicine. This theory is a Tibetan doctor's basis for the determination of 
psychosomatic types of humans, as well as for the prevention, diagnosis, and treatment of a disease.
The triadic theory evolved from the philosophical perception that every form of existence depends on other factors and requires the three essential elements:  Chi 
(different meaning than the Chinese chi), Schara, and Badahan (
25
). At the level of the macrocosm (the universe), Chi can be illustrated by the element of space. 
Schara is the element of energy, and Badahan is the material element. According to the triadic theory, these elements can exist by depending on each other; 
according to Tibetan theory, in reality there cannot be an absolute space without the elements of energy and the matter contained therein. Subsequently, it is the 
dominance of either Chi, Schara, or Badahan that determines the nature of a perceived phenomenon or form of existence.
The interdependence of the three elements and the dynamic balance among them are manifested by the transition of one quality into the other—analogous to the 
known paradigm in physics where energy (equal to  Schara), matter (equal to Badahan), and light (medium of transition in space equal to  Chi) are interdependent and 
interchangeable. As part of the macrocosm, earthly life is permeated by the infinite number of examples of the three elements at work.
The human is seen as one of the expressions of  Chi, Schara, and Badahan elements, and as such it incorporates all forms and processes of the universal existence 
(
Fig. 14.1
) (
26
). The concept of 10 essential elements points to the links among the anatomical forms, physiological and psychological function in humans, and any 
conceivable elements of the larger Universe, including animate and inanimate matter as well as psychic existence. Subsequently, the  Chi, Schara, and Badahan 
elements in the human are approximated to the universal forms of those elements.
F
IGURE
 14.1. The ten essential elements of humans (all forms and processes of universal existence): I, awareness; II, willpower; III, compassion; 1, element of 
structure and temperature; 2, element of gaseous, aqueous, and solid substances; 3, element of plants; 4, element of gender; 5, element of animals; 6, element of 
man; 7, element of mind.
For example, the space (Chi) is perceived as a supportive element in the Universe to facilitate transition of energy ( Schara) to matter (Badahan) and matter to energy. 
At the level of the human body, a form of Universe in miniature, the  Chi element can be exemplified by the skeleton, which supports body tissues, organs, and 
systems, and facilitates the physiological functions. In principle, the  Chi element represents the tissues, organs, systems, and physiological functions that provide the 
body with structure and integrity (e.g., cell membranes, connective tissue, skeleton, skin); basic support of life by introducing and carrying nutrients to the mind and 
body (i.e., sensory stimuli as nutrients), oxygen supply as nutrient, and the food-derived nutrients (e.g., receptacles of sensory nerves, receptors of autonomic 
nervous system, nasopharynx, bronchial tree, upper digestive tract); and basic support of life through elimination of metabolic waste from the body (e.g., large 
intestine, urinary tract, excretory functions). Element  Chi therefore initiates and makes possible the process of life.
In the universe, Schara represents the element of energy. In humans,  Schara is associated with the digestive processes (applicable to the three categories of 
nutrients mentioned) and the distribution of the absorbed nutrients. Therefore,  Schara is primarily located in the relevant tissues, organs, and systems, and is 
expressed by corresponding physiological functions (e.g., muscles, upper gastrointestinal tract, liver, pancreas, energy channels [subtle body], nervous and 
cardiovascular systems).
The matter, or the element, of Badahan is understood in the triadic theory as an outcome of interaction between  Chi and Schara—an element of energy being realized 
within the space. Thus, Badahan is listed as a third essential element, after the space ( Chi) and energy (Schara), which in a way secures and justifies the existence of 
space and energy. Consequently, the Badahan element is represented by the tissues, organs, systems, and physiological functions that secure and protect the 
functioning of the other two elements in the body. In this capacity, the  Badahan element dominates and regulates the nutrients' absorption and processing (e.g., 
converting sensory perception into intellectual process, such as hearing verbal commands and coordinating the reaction and response to them), diffusion of oxygen 
and its use by the tissues, and absorption and integration (bioavailability) of absorbed food nutrients within the tissues.  Badahan element predominates, for example, 
in the adipose tissue, the upper gastrointestinal tract (absorptive functions), the lungs, the brain, and the immune system.  Badahan is the outcome of the process 
initiated by  Chi and implemented by Schara.
The processes that govern state of health, transition to a disease, and determination of disease origin represent the dynamic interactions taking place among the  Chi, 
Schara, and Badahan elements in the body. The balance among those elements corresponds to the state of well-functioning homeostasis and health; disruption of 
these elements corresponds to the disease condition. It should be noted that it is not the absence of any physical ailment that defines health solely. For example, a 
physically healthy person may be unfulfilled spiritually and emotionally. Therefore, it is the spiritual, mental, and physical (balance) well-being along with the absence 
of the physical ailment that characterize optimal health in Tibetan practice.
The Human as a Psychic Phenomenon

T
HE
 E
MPIRIC
 S
OUL
Knowledge of human psychology dominates the theory and practice of Tibetan medicine and stresses a practical approach to the human psyche, which is comparable 
with the approach that a physician takes in examining the physical body. The  empiric soul, which is distinct from the nonmaterial and clinically inaccessible absolute 
soul, is a key to understanding the structure and clinical relevance of the human psyche in Tibetan medicine. The classic ancient text in Indian medicine by Caraka 
Samhita describes the concept of the empiric soul. The empiric soul is comprised of the mind, the mind's attributes (i.e., intellect, ego, memory, emotions), and the 
senses (i.e., sound, touch, vision, taste, smell). Although the empiric soul is an autonomous entity in relation to the absolute soul, its function depends on the absolute 
soul; these two entities communicate through spirituality. It is believed that a properly functioning empiric soul is conductive to spirituality.
The mind is the most important element of the empiric soul. Because it receives, records, and analyzes information from the other five sense organs, the intellect, the 
ego, and so forth, the mind is regarded as a separate sixth sense. The mind has the ability to process the information provided, which leads to understanding.
Emotions such as happiness, sorrow, misery, love, and one particularly important emotional state—compassion—originate in the mind. Memory also originates in the 
mind. The senses provide critical information about the outside world; they are a source of external information for the functioning of the mind. The five senses and 
their attributes are traditionally listed in a specific order—sound, touch, vision, taste, and smell—based on the increasing quantity of attributes that are believed to be 
inherent to a particular sense.
The intellect and ego are considered inseparable in Tibetan understanding. Intellect is the executive branch of the empiric soul, which implements the understanding 
provided by the mind. At the same time, it also reports the implementation and results of the understanding by continuing feedback to the mind.
Ego is perceived as being derived from the intellect. Ego is seen as a result of the ongoing self-evaluation and validation process that is a direct outcome of the 
feedback provided by the intellectual process. Ego may indeed frequently play a negative role in human psychology. For example, when there is too much 
preoccupation with the personal image, then there is, paradoxically, little energy left for self-improvement, which is exactly what is needed to become perceived by 
others in a better light.
Maintaining Health and Disease Prevention: General Rules
Maintaining health, disease prevention, or both are, according to Tibetan medicine, primarily the individual's responsibility. The important aspects of that responsibility 
involve proper nutrition, good lifestyle habits, proper adjustment to the seasons of the year, and self-awareness of one's physical and psychological predisposition. To 
fulfill these four conditions, besides devoting time and effort to the task, a person has to be at peace with oneself and understand one's place within the family, 
community, society, and universe. Being at peace with the self is understood in triadic philosophy as the state of objectivity or adequacy in a given reality. This state is 
often referred to and measured by Tibetan practitioners as a feeling of  compassion. It should be noted, however, that although compassion is commonly understood 
to be an emotional feeling, it is used here to mean  feeling emotionless, which should not be confused with the state of emotional exhaustion. And compassion should 
also not be mistaken for the feeling of being “in love.” Objectivity or compassion can also be defined as the state of mind devoid of ignorance, attachment, anger, 
jealousy, and pride. The embodiment of this state conductive to health is known in Tibetan medicine as the high levels of “living warmth,” or vitality.
W
ISDOM
In traditional Tibetan understanding, the state of objectivity in the universe is achieved by certain laws of nature. To comprehend, learn, and follow these laws are 
separate tasks for every living creature. The animal upholds these laws by instinct. Humans, however, have been provided with a far greater skill than the animal, and 
that skill originates with a special kind of wisdom. This wisdom is derived from an individual's faith in God. Tibetan medicine stresses the vital need for each of us to 
seek out and cultivate our relationship with God to strengthen our faith in the divine authority of God.
Failure to obtain this wisdom disconnects a person from reality, compromises the overall well-being, and may initiate the transition from optimal health to an overt 
disease. This failure is not simply a lack of intelligence, but a lack of faith in life and the creative approach to life, which, as just explained, is equated to lack of faith in 
the divine authority of God.
S
PIRITUALITY
This health-sustaining wisdom can actually be cultivated by our spirituality, or harmonious communication between the empiric and absolute souls, as exercised by 
awareness, willpower, and compassion; these are three important functions of the mind and the intellectual process that correspond to the  Chi, Schara, and Badahan 
elements, respectively. The function of awareness, willpower, and compassion in developing spirituality can be described as follows:  awareness, or the inspiring force 
of Chi, provides a direction or framework for the individual's actions yet to be fulfilled; the fulfilling act of  willpower then follows due to the energy of Schara. As a result 
of this interaction between  Chi and Schara, a person can accomplish the state of objectivity measured by the feelings of  compassion. The state of objectivity or 
compassion embodies Badahan, which facilitates the healthy functioning of  Chi and Schara by making them “worthwhile.” Conversely, if awareness and willpower 
have not been used properly in the first place (e.g., the wrong action for the wrong reason, or the right action for the wrong reason, such as self-pleasing or merely 
pleasing others), then the effort has not been made “worthwhile,” and the state of objectivity has not been accomplished.
Exercising spirituality is important and, if left unfulfilled, can make an individual vulnerable to a host of health-compromising conditions and disease vectors.
Maintaining Health and Disease Prevention: Nutrition and Its Adjustment to the Seasons of the Year
According to the triadic theory, food is considered a form of the three elements— Chi, Schara, and Badahan—which, as such, are transformed into every aspect of the 
living and well-functioning organism. A singular cell, tissue, organ, or system of the body is composed of particular proportions of these three basic elements. Those 
proportions change due to seasonal variations of atmospheric conditions that are both responsive to and designed to meet the natural challenge of the environment. 
These seasonal differences in the three elements' proportions require appropriate nutrient delivery, which reflects the changing needs of the organism to maintain 
both short-term and long-term well-being. Balancing the dynamic processes in the body depends on timely (i.e., hourly, daily, and seasonal) delivery of the proper 
combination of supporting nutrients.
D
ELIVERY OF
 N
UTRIENTS
According to Tibetan medicine, one of the most important factors in sustaining health is timely delivery of nutrients. Lack of timely nutrition results in states leading to 
illness. This condition may not put people in the hospital, prevent them from working, or alienate them from family, but it can restrict their full potential, eventually 
exhausting their lifespan prematurely. Therefore, delivery of nutrients unsynchronized with daily and seasonal requirements amounts to poor nutrition. According to 
Tibetan tradition, the optimal diet is calculated partly on the basis of carbohydrate, fat, and protein content, but primarily on the taste value of the food.
Taste
The taste of food is a practical and important guide to adjust nutrition with changing seasons. Three kinds of basic, supplementary tastes are recognized:
1. Pungent-sweet.
2. Bitter-salty.
3. Sour-astringent.
These three basic tastes promote or modify specific functions done by those organs and systems in which elements of  Chi, Schara, and Badahan predominate, 
respectively. The three complementary tastes moderate or modify the Chi, Schara, and Badahan action of the corresponding basic tastes.
Pungent taste stimulates organs and systems with a predominance of  Chi, those of which participate in excretion of metabolites from the organism and improve 
alertness and awareness. Bitter taste stimulates the functions of organs and systems with a predominance of  Schara, those of which are related to the digestion of 

food and absorption of nutrients and promote willpower and self-control.
Sour taste promotes the functions of organs and systems that have a predominance of  Badahan, that is, those organs and systems that carry nutrients into the 
organism (e.g., upper gastrointestinal tract, lungs [oxygen nutrient]). Sour taste promotes the storage of nutrients, which induces feelings of satiety, calmness, and 
tranquility.