Essentials of Complementary and Alternative Medicine (June 1999)

S
EASONAL
 F
OOD
 A
DJUSTMENTS
Just as we have to adjust to the physical environment that we live in, proper nutrition is a logical step when we adjust to changes of weather. A monodiet throughout 
the year, no matter how well fitted to calorie and essential nutrient requirements, will likely result in too little or too much, too rich or too restricted, nutrition for a given 
season. Traditionally, the season is not determined exactly according to the calendar, but is based on the atmospheric conditions characteristic of a particular season.
Winter Nutrition
In a healthy individual, when the cold weather arrives, the digestive ( Schara, Badahan) and absorptive (Badahan, Schara) functions are well balanced and ready for 
the heavy seasonal demands of providing energy from the caloric value of food. The excretory  Chi functions of the body are diminished to further save energy. The 
nutritional mission in the winter is to eat a variety of foods, with no particular food-taste admonition. Meals should be frequent and in small quantities to continuously 
sustain the digestive capacities and nutritional demands of the body. It is particularly important to eat regularly and not go hungry during the winter season. A 
disproportion between increased demand and diminished food supply may, in the short term, cause indigestion; it may also have a far-reaching detrimental effect on 
health and disease prevention.
Spring Nutrition
Between the winter and summer solstices, the digestive functions of the gastrointestinal tract are gradually diminishing in comparison to their activity in the winter. The 
changing atmospheric conditions, as measured by increased solar energy, decrease the need for energy supplied by digestion and absorption. Thus, the functions of 
Schara and Badahan become progressively weaker and are prone to be upset by dietary errors. The spring menu is recommended to prevent an upset of  Schara and 
Badahan functions, particularly until unstable atmospheric conditions yield to the more stable conditions of summer. The menu should be based on the rough, bitter, 
astringent, and pungent tastes characteristic of spring vegetables and fruits. Of all the seasons, spring is the most plausible time to eat sparingly or even fast (if 
needed) to provide the least burden to body homeostasis.
Summer Nutrition
The peak solar energy operating during the summer puts little stress on digestion to extract energy for the body. The digestive tract exercises the option of economy: 
it does not work to its full potential because it does not have to. That dormant state of the gastrointestinal tract makes it nevertheless vulnerable to strong-tasting 
foods that may stimulate and upset the unprepared functions of  Schara. During the summer, food should be light and cool, with a predominantly sweet taste. Bitter, 
pungent, and astringent foods should be avoided. Greasy, heavy, and canned food should also be avoided. By avoiding the bitter taste, functions of  Schara will not be 
upset; also, salty taste will moderate an undesired stimulation of  Schara with bitter-tasting foods.
It is preferable to quench a summer thirst with warm tea and lemon rather than a cold drink. This is recommended to avoid upsetting thermoregulation, a 
Schara-dependent process, which is particularly vulnerable during the summer. For example, the common cold or cold sores are often experienced during summer 
because of the poor response of the body's ther moregulatory mechanism to challenging conditions, such as drafts, swimming after a prolonged sunbath, ice-cold 
drinks, and alcoholic beverages.
Autumn Nutrition
As summer advances toward autumn, the menu gradually becomes limited. Traditionally, it is believed that energy from the sun is decreased and the digestive 
functions, particularly related to  Schara and Badahan, undergo transition in preparation for their peak activity during the winter. Because the digestive functions are 
again in transition, from low to high activity, they are prone to be upset by dietary errors. The autumn menu should consist of light food with predominantly sour, salty, 
astringent, and sweet tastes (in that order). The main purpose of the autumn diet is to avoid strong, stimulating tastes and heavy food while a gradual increase in 
overall gastrointestinal performance is accomplished.
Meals should be frequent and small to keep digestive functions moderately busy, but not overwhelmed. Although meals should always be enjoyed, it is particularly 
important to have a specially designated time and place for daily meals during the autumn.
T
RADITIONAL
 B
OTANIC
 F
ORMULAE
Not only has the Tibetan medical tradition recognized the importance of nutrition in maintaining health, but, more importantly, it has recognized the  fallibility of humans 
to maintain a proper nutritional regimen. Therefore, the Tibetan medical art is particularly abundant in the use of herbs and minerals as well as compound formulae 
used to assist the digestive process, particularly the process disrupted by nutritional errors. Although seasonal adjustment of the menu is the first step in nutritional 
intervention, the traditional botanic formulae have often been used to assist nutritional intervention.
Mental and Emotional Digestion
In Tibetan medicine, central nervous system functioning is often likened to the functioning of the digestive tract, which transforms food into the elemental nutrients that 
can sustain metabolism and life. Therefore, reference to the “mental and emotional digestion” of an individual is made. The “food” for the empiric soul is the complex 
source of sensory stimuli and information that is transformed into the mental energy that makes life possible. The concept of mental and emotional digestion is a 
clinically useful way to approach some of the most difficult aspects of human life and existence (i.e., psychological phenomena in health and disease).
Attaining harmonious mental digestion depends on an individual's day-to-day life. An important aspect of the digestive process is recognition and knowledge of what 
constitutes proper nutrition and digestion. A healthy empiric soul has all the necessary potential to recognize the importance of proper mental and emotional digestion 
and is fully equipped to seek the solution that realizes an individual's mental and emotional well-being. No one is born with the solution, and seeking it is a task for 
each individual. This continuous search is gradually rewarded by peace of mind. Peace of mind is traditionally defined as the state of joyful  but purposeful existence 
and should not be mistaken for the feeling of an unconditional serenity.
Recognizing the importance of seeking true peace of mind has a cost: suffering and fear. A person can then understand that whatever causes the misery, and the 
misery itself, is totally foreign to and runs against the individual's deepest nature. This understanding is linked to the faculties of mind and memory. A person cannot 
truly be healthy without a sense of identity, which memory provides. Memory pervades all that we do, who we are, our personalities, and how we interact with other 
people; it literally creates our internal and external worlds.
Mind and Memory
Understanding mind and memory is indispensable for understanding the process that causes suffering and fear; it is also indispensable for finding practical solutions 
and peace of mind. Memory impairment leads an individual towards hurtful circumstances as well as those that cause ill effects and a never-ending sequence of 
self-inflicted suffering and fear. An individual will continue to revisit the  hurtful past for as long as he or she is ignorant of his or her innermost nature and/or does not 
remember and understand that certain actions and situations cause emotional, mental, and physical harm. Examples of these attitudes and actions are covered in 
Table 14.1.

Table 14.1. Attitudes and actions that cause Emotional, Mental, and Physical Harm
Proper memory functioning, therefore, can be viewed as a necessary element to maintain or restore mental and emotional digestion, which results in peace of mind.
Another important consideration of mental and emotional digestion is the perception of ego. Ego is often viewed as a culprit that causes misery. A selfish ego is 
blamed for unhappiness, for the inability to draw mental strength from intellect and patience, and for failing to take a proper “history” lesson from memory. In Western 
culture, a healthy, integrated, and rationally functioning personality is strengthened by the loss of what Tibetan medicine calls the selfish ego, which is characterized 
by infantile craving, attachment, and anxiety. Ego should be limited to a useful, not a disturbed, function. The French philosopher and mathematician René Descartes 
said, “Cogito ergo sum”—“I think, therefore I am.” This statement may be an appropriate definition of a useful function of ego: awareness of existence, but only 
awareness. According to Tibetan medicine, care for an individual's deep nature—not his or her image—should be the priority.
Realization of the inevitability of decay and death as well as the ephemeral nature of life (e.g., relationships, interests, professional and personal positions and 
possessions) provides additional understanding of misery and self-inflicted fear; why fear something that is unavoidable in the course of life?
As mentioned, attaining harmonious mental and emotional digestion is a continuous process that, according to Tibetan medicine, depends primarily on an individual 
effort. Having had a glimpse of true peace of mind allows a person to more peacefully reconcile with the common experience of the occasional “mental and emotional” 
indigestion. This measure is the Tibetan way to attain first-hand knowledge of good mental and emotional nutrition, digestion, and health.
P
ATIENCE
According to traditional Tibetan understanding, patience is the most important factor in sustaining peace of mind. Patience alone pacifies ego and sustains a 
harmonious intellectual process. Patience in this context is understood primarily not as a “patient waiting,” but as an acquired ability to contain emotions and desires 
in favor of mental and emotional discipline. Patience is praised in Western culture as a great virtue, but it is not fully recognized that patience can be used 
therapeutically. In Tibetan medical tradition, the true peace of mind is equated with unquestioning recognition of the divine authority of God. Also, the true peace of 
mind signifies a special kind of wisdom that is a guide to a total and sustained health.
PRACTITIONER–PATIENT INTERACTION
Diagnosis of Health, the Transition to Disease, and Disease
According to Tibetan tradition, the first visit to a doctor should be scheduled in the morning, when the patient is well rested and fasting. Obtaining relevant information 
includes noting the patient's appearance (e.g., psychosomatic, or triadic, type; facial expression; expression of eyes); obtaining information on the patient's complaints 
(e.g., eating habits, behavior, mental state, sexual activity, personal and social life); and physical examination and additional tests (e.g., pulse reading, evaluation of 
patient's urine).
D
ETERMINATION OF THE
 P
SYCHOSOMATIC
 T
YPE
Determining a person's triadic type is an important step toward the diagnosis and self-diagnosis of individual health. In Tibetan medicine, the three basic 
psychosomatic types are Chi, Schara, and Badahan.
Chi
A person of Chi type has the following somatic characteristics: a tall, lean physique; poor muscle tone; long, thin neck; narrow chest; long extremities with small, thin 
hands and feet, and relatively long fingers and toes; thin, dry nails; and dry skin, with prominent veins and dull complexion. The head, covered with scanty and soft 
hair, is small and elongated with a narrow forehead, thin eyebrows, and small eyelashes. The eyes are small, unfocused, and usually blue. The nose is small, thin, 
sharp, and crooked; the ears are projecting; the shoulders are narrow and dropping; and the abdomen is small and flat.
On the mental and emotional level, a  Chi type may be anxious, with nervous behavior (similar to the stereotype of an artist's personality). The  Chi person has an 
everchanging, chimerical, and adaptable mind in search of new ideas. New ideas come easily to the  Chi type, but often are not followed through, mostly because of 
lack of perseverance and courage to implement. The  Chi type is intelligent but impractical, and creates a mental picture of an ideal world. These individuals do not 
have good paternal or maternal instincts and are often troubled by parental duties.
The sexual life of a Chi type is characterized by strong desire but low energy and multiple partners. The favorite foods are sweet, hot, and light in nature.
A Chi type is very susceptible to disease, but at the same time shows good resistance and adaptability to disease. These individuals are prone to nervous disorders 
(e.g., psychoneurosis, schizophrenia, insomnia) and neurological disorders (e.g., epilepsy, neurodegenerative disorders, neuralgia, herpes zoster, optic neuritis, and 
neurological conditions affecting urogenital and rectal regions). This psychosomatic type often suffers from rheumatoid arthritis and osteoarthritis.  Chi-type disorders 
tend to break out or be aggravated in the fall and winter, and they tend to afflict the elderly.
Schara
A person of the Schara type is characterized by a well-proportioned physique; medium height; strong muscles; strong, medium-size neck; well-developed chest; 
strong arms and legs; medium-size hands and feet; medium-size soft, square pink nails; and skin with a pink complexion that is often covered with moles, freckles, or 
acne. The head is short and covered with moderate, early graying and balding hair; the forehead is wide and has folds. The eyebrows and eyelashes are fine; the 
eyes are medium-size, often congested (bloodshot), and attentive; the nose is medium- size; and the ears are proportionate and well-formed. The shoulders are 
medium-size and straight, and the abdomen is small and muscular.
The psychological features of  Schara are similar to the stereotype of a strong-willed political or corporate leader. The  Schara type has an intelligent, penetrating, and 
critical mind. This person implements well-defined ideas with bold, reckless determination. The  Schara type can be ruthless, caring more about ideas than about 
people.
The sexual life of this type is passionate and dominating. As a parent,  Schara represents a demanding, unsentimental, authoritarian individual. The  Schara type is 
fond of sweet and bitter foods (which also can be described as dense and cool foods).
The Schara type has low resistance to disease but good endurance against psychological and physical suffering. A  Schara type is prone to infectious diseases, 
venereal diseases, and resulting infectious psychoses. The  Schara type is also prone to neoplastic diseases.  Schara types often complain of digestive disorders 

manifested by hyperacidity, gastrointestinal ulcers, infectious diseases of the liver, and diseases of the pancreas. Allergic and infectious skin disorders, rashes, and 
boils often afflict persons with the  Schara constitution. These Schara conditions tend to flare up in late spring and summer and are more likely to affect young and 
middle-aged adults.
Badahan
A person of the Badahan type is characterized by a heavy physique that tends to be overweight; a short, beefy neck; a broad, overdeveloped chest; inappropriately 
short extremities compared with the trunk; large hands and feet; large, thick, white nails; pale, thick, moist, and smooth skin. The person's head is large and oval and 
covered with abundant, thick, lustrous hair. The forehead is large, with thick and bushy eyebrows; the eyelashes are large and firm; and the eyes are wide, prominent, 
and expressive. The nose is thick, big, and firm; the ears and earlobes are large. The shoulders are broad and firm, and the abdomen is large.
The Badahan type is similar to the stereotype of a caring figure of the community: he or she provides a sense of stability, love, and compassion, but not necessarily 
leadership. This type of person has a pleasant personality, is a good listener, but is slow to react, is not talkative, and is not imaginative. The sexual life of  Badahan is 
characterized by good sexual energy and devotion to one partner.  Badahan values comfort and peaceful surroundings of the home.  Badahan-type males are 
family-oriented men; Badahan-type females are good wives and mothers, with strong maternal instincts.  Badahan types are particularly fond of foods with sour and 
strong flavors.
Badahan types have high resistance to disease. However, once this resistance is broken, the person shows low endurance. These people are prone to states of 
emotional deprivation and abnormal metabolism, which results in metabolic intoxications (e.g., diabetes, cardiovascular disease, tumors, skin diseases, asthma, 
bronchitis, and emphysema). They also tend to have decreased acuity of taste and smell.  Badahan disorders are aggravated in late winter and early spring; children 
and young people (up to 16 years of age) are more prone to the disorders of  Badahan than are other age groups.
It should be noted that the clear-cut  Chi, Schara, and Badahan types are rarely, if ever, encountered in practice. Usually a person has a combination of the three 
factors, with the predominance of one or two types. Often there may be no match-up between the physical and psychological characteristics described for the 
particular psychosomatic type. For example, a Badahan steadfast mind may not necessarily be in the Badahan body frame, but can be present in either the lean  Chi 
physique or well-built  Schara types.
A
PPEARANCE OF THE
 P
ATIENT
A patient's general appearance, which is affected by thoughts, desires, actions, and overall physical and mental condition, can provide an important clue for the 
examining physician. A person who has Chi disorder has worried, fearful, and examining eyes in the absence of a direct reason for this display of emotions. In  Chi 
disorders, a carefully interviewed patient may report premonitions, sentimentalism, telepathy, and telekinesis. A person who has  Schara disorder appears aggressive 
and tense, which may be underscored by blood-shot eyes; this appearance often brings to mind a “human machine.” Upon careful interview, a picture emerges of an 
arrogant, contemptuous mind, with constant scheming and plotting activities, as well as workaholic and perfectionist behaviors. A person who has  Badahan disorder 
appears with hollow eyes and an emotionless facial expression. The appearance often brings to mind a “mask face." The careful interview may reveal a wandering, 
blunt mind and feelings of persecution, prejudice, self-pity, greediness, and lack of general direction and purpose in life. These examples provide  extreme facial and 
bodily expressions, which in clinical practice can be less easily distinguishable.
P
RESENTING
 T
RIADIC
 D
ISORDERS
In Chi disorders, the patient usually complains of feeling tired, uneasy, and giddy, and of experiencing aches and pain, shivering, and stiffness. The patient may 
appear hyperactive, with disorganized speech and poorly coordinated body movements. The patient may have an acidlike, rancid body odor, and the breath may be 
unnatural, sharp, and rusty smelling. In  Chi disorders, the patient's tongue tends to turn red or dark brown, have irregular cracks, and be rough; the mouth may feel 
dry and taste bitter. The pulse feels hollow and spurts up and down.
In Schara disorders, the patient may report feelings of warmth, excessive sweating, thirst, frequent urination, purging, and nausea. The patient's body language 
exhibits impatience, and the speech is rushed, with an angry and arrogant-sounding tone. The body odor may be strong and pungent, and the breath may have a 
putrid smell (as in liver disorder, hyperacidity, or tooth decay), or it may smell like stomach acid. The tongue is often covered with a furry yellow to yellow-green coat. 
The patient may report that the mouth tastes bitter-sour. The pulse feels hard and pulsates fast.
In Badahan disorders, patients complain of tiredness, mental depression, and desire for sleep. They often report generalized skin itching and stiffness of extremities 
and joints. The patient's speech may be slow and slurred, and body reactions and movements tend to be subdued. The body odor may be rancid, and the breath may 
impart a “bad breath” odor (e.g., as in periodontal disease or tooth decay). The patient may report that his or her breath often  acquires the smell of the environment. 
The tongue is typically covered with a white coat, and taste sensation may be diminished. The pulse feels low and beats at a slow pace.
Pulse Reading
Pulse reading is an important and complex diagnostic technique used by Tibetan physicians. Pulse reading provides information not only about the cardiovascular 
system, but also about other major systems and organs. The accuracy of the pulse readings depends on the patient, who should be well rested and on a light diet at 
least 1 day before examination; accuracy also depends on the physician's experience and ability to concentrate.
The pulse is read at the radial artery at each wrist (1 inch from the wrist joint), and the index, middle, and ring fingers are used for this purpose. The varying pressures 
of the three fingers are applied to determine the pulse (i.e., the ring finger is applied with more pressure than the middle finger, and the middle finger is applied with 
more pressure than the index finger). The three examining fingers should not touch each other. For a male patient, the physician first reads the left wrist using the 
right hand fingers; in a female patient, the physician first reads the right wrist using the left hand fingers. Gender differences in pulse readings are due to different 
anatomies of the energy channels for the lungs and heart.
Each finger feels two beats, with the radial and ulnar side of the tip. An examiner will feel heart–large intestine beats on the left wrist index finger; spleen–stomach 
beats on the middle finger; and left kidney–genital beats on the ring finger. Also, the examiner will feel lungs–small intestine beats on the right wrist index finger; 
liver–gallbladder beats on the middle finger; and kidney–bladder beats on the ring finger. In the female patient, the heart readings are taken on the right wrist, and the 
lung readings are taken on the left wrist. Because of the close proximity of the heart and lungs, pulse readings should not be taken on the vessels of the neck; also, 
pulse readings should not be taken on leg vessels because they are too far away from the vital organs.
The pulse rate is evaluated in beats per breathing cycle (i.e., inhalation and exhalation). A healthy person has 5 beats per respiratory cycle; a person with a feverish 
condition will have more than 5 beats; and a person with below-normal body temperature will have less than 5 beats per respiratory cycle. The pulse rate and 
qualitative change in the pulse beats help the physician in final diagnosis.