Essentials of Complementary and Alternative Medicine (June 1999)

E
VALUATION OF THE
 U
RINE
Urine sample evaluation (i.e., odor, color, steam, bubble formation, and sedimentation) provides the physician with an important diagnostic clue. Urine evaluation, 
however, requires compliance and cooperation from a patient. On the evening before the examination, the patient must eat a simple diet, avoiding food rich in fats, 
protein, and simple carbohydrates. The patient's thirst should be quenched satisfactorily, preferably with spring water. After a good night's rest, the midstream urine 
passed at dawn should be collected in a clean, transparent vessel.
The urine of a healthy person should be straw-colored, form a moderate quantity of bubbles, give a typical uremic smell, and have a light vapor with moderate 
sediment. When the urine cools, it should have a clear appearance and whitish yellow color. The urine of those suffering from  Chi disorder (and often elderly people) 
is bluish, forms big bubbles, and has a rusty smell; steam disappears quickly, and the sediment has a sprinkled appearance. Upon standing and cooling, the color of 
this urine remains bluish.
The urine of those affected by Schara disorder is dark yellow, forms few bubbles that disappear quickly, and smells like burnt butter; the steam is dense, and the 

sediment is plentiful. In cases of indigestion afflicting  Schara, the urine has a food smell. Upon standing and cooling, the color of this urine remains yellow.
The urine of those suffering from  Badahan disorder is colorless (but may be dark brown in cases of metabolic intoxication), forms small bubbles, and has a stale odor; 
steam disappears quickly, and the sediment is scant. Upon standing and cooling, the color of this urine becomes brown to dark brown.
THERAPY
Physician as Healer
In addition to technical knowledge, a good physician in the Tibetan tradition has to have certain qualities, including wisdom in implementing the knowledge and equal 
compassion for all patients. The art of healing is a result of combining those qualities. The qualities of a healer can in part be inherited but, above all, must be 
acquired and sustained by continuous training and contact with patients. The relationship between physician and patient should not be casual, and the mind of a 
physician should operate in absolute concentration (or in a  zone) when dealing with a particular patient. The ability for absolute concentration requires continuous 
training of the concentrating ability of the mind on present time. As a result of the training, a physician is able to isolate his or her mind from past and anticipated 
future events, and instead focus on the patient. Working in the zone translates to gaining the patient's confidence, which is of paramount importance to a physician.
In the Tibetan tradition, initial eye contact is critical in establishing the physician–patient relationship. With good eye contact, a physician can convey a message of 
assurance to the patient and also learn about the patient's emotional and physical condition by skillfully reading the patient's eye expressions.
A proper physician–patient relationship, leading to an open-minded and positive attitude from a patient, is important for a physician, whose role is to educate patients 
about the nature of the disease and eventually gain full support and patient compliance with the treatment regimen. An important step in this interactive process is 
helping the patient realize that none of the techniques devised by humans against any disease can be as helpful as the body's own means of fighting the disease. 
Thus, it is important to educate patients about individual predispositions and how to take advantage of this knowledge; specifically, to increase strengths and diminish 
weaknesses for optimal functioning and recovery from a disease.
This physician-mediated awakening to one's abilities is particularly important in the sphere of spirituality, psychology, and emotional life. According to Tibetan 
medicine, our individual triadic makeup can operate at different potentials, contributing to either healing process, an intermediate state, or disease—that is, the 
optimal, the middle, and the lowest states. Each of these states can be recognized by a psychological and emotional profile of an individual. The optimal state is 
characterized by a great ability to love, compassion for everybody, poise, steadfastness, and confidentiality in relationships. The middle state is characterized by 
disturbed qualities of the optimal state (e.g., the inability to share one's good nature with everybody, but rather with a particular person). The lowest state does not 
have any good qualities, but rather certain faults (e.g., being prone to anger, inability to have gratitude and to forgive, lack of patience, inability to speak well about 
others, being unreliable). The role of a good physician in recognizing a patient's good qualities and faults can help enhance the patient's spirituality and bring out full 
potential in the healing process.
Finally, a physician's healing qualities and services should not be confused with those provided by a spiritual teacher. This confusion should be avoided, particularly 
in view of Tibetan tradition in which the titles  lama or priest are often held by physicians. Spiritual teaching, as typically provided by a lama, should be received by a 
person who is healthy and ready to receive that teaching. Persons who have unresolved personal conflicts and psychological or psychiatric problems should receive 
professional help from a physician who is also trained as a lama. Spiritual teaching cannot be a substitute for help from a properly trained physician. Also, a healing 
process that is facilitated by enhanced spirituality should be augmented, in addition to the medical intervention, by living a proper life style, maintaining proper 
nutrition, and meeting specific personal needs in various seasons of the year.
The State of Disease
In the practice of Tibetan medicine, disease is defined as an unphysiological increase in  Chi, Schara, or Badahan. Treatment is aimed primarily at alleviating the 
out-of-range function. As a secondary aim, treatment adjusts the remaining two elements, which tend to be particularly afflicted in chronic conditions.
Food as Medicine
Both foods and medicines are prepared in Tibetan tradition based on specific taste combinations. There are three basic tastes groups—sweet, bitter, and sour—and 
their respective moderating tastes are pungent, salty, and astringent. These pairs of tastes are used to prepare meals appropriate for a specific season of the year. 
Also, because these tastes directly affect the psychosomatic elements of  Chi, Schara, and Badahan, they may be used in regulating the corresponding taste 
elements. A correlation between eating habits/patterns and foods/flavors that either bring on symptoms of a disease or produce relief from symptoms is important in 
determining the diet for a given disease.
As a rule, Chi diseases are alleviated by smooth and heavy foods that taste sweet, sour, or astringent;  Chi diseases are aggravated by rough and cool foods that taste 
bitter and acrid. For example, a recommended menu for Chi diseases includes dried meat, sour cream, butter, sesame seed oil, fresh milk, and raw sugar.
Schara diseases are treated with cool and soft foods that taste bitter and astringent;  Schara diseases are aggravated by warm, sharp, and smooth foods that taste 
sour, salty, and acrid. For example, a recommended menu for Schara diseases includes goat and game meat, raw barley, black tea, and spring water.
Badahan diseases are treated with light, rough, and sharp foods that taste sour, salty, or astringent;  Badahan diseases are aggravated by heavy, smooth, and cool 
foods that taste sweet and bitter. For example, a recommended menu in Badahan diseases includes mutton, fish, honey, sour milk, yogurt, and boiled water.
There are exceptions to these food rules that can be recognized by a trained practitioner. For example, some foods, although astringent, are not effective against  Chi 
or Badahan diseases. Garlic and long pepper, although acrid, do not aggravate the diseases of  Badahan. The cited exceptions are caused by secondary food 
qualities of these acrids, rendering potentially deleterious primary qualities of the food harmless (i.e., the acrid qualities of garlic or long pepper are modified by these 
herbs' other components, making them harmless against functions of Badahan). The distinction between deleterious versus harmless can often be made only by 
understanding the inner nature of the food stuff acquired through the ability to meditate.
Botanic Treatment
According to the tradition carried by the Badmaev family lineage, there is a regimen for herbal treatments based on the concept of proper nutrition (
18
). The treatment 
usually starts with a digestive formulation because, in Tibetan medicine, disease is considered primarily a derangement of nutrition and the nutrient delivery process. 
There are three kind of nutrients: nutrients derived from “mental and emotional” (sensory) food, oxygen as nutrient, and the food-derived nutrients. Herbal and mineral 
formulae, as passed down in the family tradition, have been referred to as  condensed food for specific disease conditions. Along with the treatment of the suspected 
nutritional pathology, the appropriate treatment of any secondary disease is instituted.
The herbal formulations are composed of several herbal and/or mineral ingredients. These formulations have been arranged based on triadic philosophy into three 
therapeutic groups of ingredients:
1. The main-acting ingredients.
2. The ingredients that support the main action.
3. The ingredients that prevent any untoward effects of the first two groups and increase gastrointestinal absorption of the active principles.
Table 14.2
 shows a partial list of herbal and mineral formulae developed and used for more than 100 years in the Badmaev family tradition. Each formula is known by 
its numerical designation. The cited list is partial, including only the most commonly used formulae that have been made available to patients and health practitioners 
in Russia, Europe, and the United States.

Table 14.2. Partial List of Products Used in Clinical Practice in Badmaev Family Tradition
Tibetan Massage
This form of physiotherapy is performed on the abdomen, spine, head, and neck. The massage regulates the pressure between the organs in the abdomen, improves 
digestion, increases the lymphatic circulation, increases the blood supply, increases peristalsis, lowers blood pressure, and improves respiration. Massage also has a 
stimulating effect on a patient's mental condition; in the course of therapy, the patient's psychological status changes from passive to active. Towards the end of the 
massage session, the majority of patients feel relaxed, and some of them even fall asleep; patients who have respiratory difficulties (e.g., asthma) start to breathe 
more normally during massage.
The technique of massage can be exemplified by the abdominal massage: The massage should be performed after a complete examination of the patient and 
exclusion of all contraindications. The patient should have an empty stomach. The hands of the physician should be warm and soft. The first contact with the abdomen 
must be very gentle to produce relaxation of the muscles. Massage is usually started from the right lower quadrant. The classical physiological narrowings, such as 
the ileocecal valve, the hepatic flexure, the splenic flexure, and the sigmoid, should be massaged longer. The right hand performs vibratory movements in the 
direction of peristalsis. The left hand presses slightly on the epigastrium to divert the patient's attention from the action of the right hand. The massage is carried on 
along the large bowel, particularly over all intumescences, until they disappear. After massage of the large bowel is complete, the epigastrium and hypogastrium along 
the middle line is the next area. Contraindications for this massage include all acute diseases of the abdomen, internal hemorrhage, patients receiving anticoagulant 
therapy, and abdominal aortic aneurysm. The massage can concentrate on particular areas corresponding to the internal organs, as depicted in 
Figure 14.2
.
F
IGURE
 14.2. The massage points of the abdominal area; outline of the main energy channels (central, left, and right): I, heart; II, stomach; III, liver; IV, spleen; V, 
gallbladder; VI, large intestine; VII, triple caloripher; VIII, kidneys; IX, small intestine; X, urinary bladder.
Subtle Body and Energy Channels in Therapeutic Intervention
In many cases, Tibetan medical therapy is based on the concept of the  subtle body, which is described as a network of channel structures carrying energy in the 
transformed form from the three categories of physical nutrients—that is, sensory-, oxygen-, and food-derived nutrients. In the transformed form, this energy is called 
psychic energy, which pervades the body and has a controlling and overriding role over the body's somatic functions. The subtle body is not an anatomic entity like 
the nervous or cardiovascular system. According to Tibetans, the subtle body can be discovered through visualization and imagination, as is done in the process of 
meditation. That is, this network runs parallel to the body's nerves and blood vessels, facilitating and coordinating the conductivity of neural impulses and the blood 
flow. The physiological processes are regarded as functions of the psychic energy.
Although the energy channels form a network maze in the body, the three main channels are most commonly described and used in Tibetan medicine therapy—that 
is, the central, left, and right channels, or columns. The central channel runs from the top of the head (the “Gate of Brahma,” Brahma being a mythic figure of creation 
in Indian culture) to an area located approximately four finger widths beneath the navel called the triple caloripher, because it is formed by the merging of the three 
energy channels (
Fig. 14.2
). This central channel is visualized as hollow and blue, representing the philosophical emptiness, which is an absolute aspect of wisdom 
(wisdom being used interchangeably with psychic energy). The left and right columns are born out of the main channel immediately above the eyebrows, run parallel 
approximately 1 inch to the central channel, and rejoin it just below the navel. The left channel (visualized as white) and the right channel (visualized as red) are filled 
with a physical nutrient-like atmospheric air to be transformed into psychic energy.
E
NERGY
 T
RANSFORMATION
There is an exercise that leads to energy transformation best explained in conjunction with the respiratory process. During inspiration, the left and right columns are 
inflated with the physical air brought in through the left and right nostrils. This physical air has to be held skillfully in the area where the three channels merge. With 
proper mental exercise, this allows the person to visualize the transformation of the ephemeral and imperfect aspects of the physical air into the psychic air 
(conversion of ignorance into wisdom). Although the psychic air, or “air of wisdom,” supplies the central column—providing psychic energy to the subtle body 
network—the remnants of physical air are exhaled. The simple way to visualize this transformation is to see the red and white color of the right and left channels, 
respectively, being gradually changed at the merging point with the central channel into the translucent blue color (i.e., color symbolizing the central channel).
This described exercise creates a vital energy called the “living warmth.” This energy also arises when a person is experiencing the feeling of compassion. In Tibetan 
medicine, the living warmth is an all-important concept: It is a measure of the state of health, the ability to withstand adverse conditions, and the ability to recover from 
a disease. The levels of living warmth can be evaluated by a skilled practitioner by analyzing the overall appearance of the patient; the way he or she listens, speaks, 
and behaves; and pulse reading.
Preventive and therapeutic interventions are aimed at securing the physiological flow of energy in the subtle body. For example, the  moxa technique uses both 
mechanical and thermal stimuli to influence the subtle body. In this technique, a needle slightly covered with a vegetable tinder is placed at the  moxa-point on the 
skin, and then the tinder is lit at the upper end of the needle. The needle is removed at the moment the smoldering tinder touches the skin. This treatment aims to 
remove the energy blockage and redirect the flow of energy to the deprived sections of the subtle body. A similar purpose is served by yogic breathing exercise, 
massage, and Tibetan pharmacological treatments.
USE OF TIBETAN MEDICAL PRACTICE IN THE CONTEMPORARY HEALTH CARE SYSTEM
Integration of Tibetan medicine into contemporary health care requires properly trained medical professionals in the United States and other countries. Training 

activities are needed to provide ready-to-use information for the accredited programs in medical schools and to develop new diagnostic and therapeutic methods 
derived from ancient, time-proven traditions.
Major Indications/Preventive Value
In addition to the discussion of Tibetan medicine's approaches as a means to attain health, the concepts of synthesis medicine and Tibetan pharmacology are 
inspirations for a better health care delivery system.
S
YNTHESIS
 M
EDICINE
The terms medycyna syntetyczna and syntetische medizin, corresponding to the English term synthesis medicine, was first used in 1930s Tibetan medicine literature 
(
27
). The term refers to a specific reasoning in diagnostic and therapeutic approach. Practicing synthesis medicine is based on a physician's ability to deal effectively 
with a medical condition with relatively simple means of diagnosis and treatment at his or her disposal. For example, with a single measurement of the radial pulse, a 
well-trained Tibetan practitioner can obtain an in-depth reading from the patient's organs and body systems. By comparison, Western medicine uses a sum of analytic 
findings taken separately that results in a  synthetic picture and diagnosis of a disease. According to synthesis medicine, a patient is not a compilation (a sum) of parts 
working together, but an outcome of a psychosomatic fusion, or synthesis, occurring within the mind and body. In synthesis medicine, the patient, rather the cell, is 
seen as the elementary unit on which the diagnostic and therapeutic efforts are focused.
The concept of the subtle body provides important insight into the theoretical precepts of synthesis medicine. The subtle body and its energy channels run parallel to 
the cardiovascular and nervous systems of the body. Whereas the cardiovascular and nervous systems are the anatomical entities, the energy channels can be 
perceived only through meditation and visualization techniques. This comparison may illustrate a distinguishing feature of synthesis medicine: Because the subtle 
body can be accessed by visualization, it cannot and does not need to be analyzed to be  perceived. However, the anatomical cardiovascular and nervous systems 
need to be dissected and analyzed; based on these analyses, the structure and functioning of the systems emerge.
In general, practicing synthesis medicine brings a physician closer to a patient. The synthesis approach allows the physician to grasp the “big picture” in the process 
of diagnosis, treatment, and follow-up, effectively minimizing diagnostic and therapeutic errors. Practicing synthesis medicine leads to diagnosis and treatment 
primarily because of the physician's ability to relate to the patient at both personal and psychological levels.
The synthesis approach does not diminish the importance of analytical thinking. In fact, Tibetan medical texts provide plenty of examples of analytical approaches 
(e.g., anatomy and physiology charts, distinguishing types and subtypes of a particular disease, and the causative and symptom-oriented treatments). Therefore, 
synthesis medicine complements the analytical approach by maintaining focus on a patient and the totality of that patient's well-being.
The theory of synthesis medicine is best represented by the triadic concept. Understanding the interaction among the  Chi, Schara, and Badahan is helpful in 
developing skills of synthesis thinking. For example, understanding that element  Chi leads to Schara and subsequently results in Badahan provides a model for the 
synthesis.
T
IBETAN
 P
HARMACOLOGY
The design of Tibetan pharmacological therapies was the result of synthesis medicine. These therapies are based on a  uniform three-group design for each 
pharmacological preparation (i.e., providing active ingredients, ingredients to modify gastrointestinal absorption, and ingredients to offset the potential adverse effects 
of the active ingredients). The broad range of therapeutic activity secured by this design has provided a basis for a recent discussion of the newly defined 
bioprotectant mechanism of Ayurveda- and Tibetan-based formulae; that is, pharmacological action operating through  prevention and intervention on the disease 
pathology (
28
). This approach leads to very complex combinations of herbs (
Table 14.3
).
Table 14.3. Ingredients of Formula 28*
Research0014 Comparison to Western Pharmaceuticals
The following formulations and a description of related research are examples of how treatment modalities derived from Tibetan medicine can gradually be introduced 
into contemporary health care through continuous research. Continuous research to validate and improve those therapeutic herbal methods is important. For 
example, a Tibetan treatment successfully implemented through a research program led to the standardization of 25 herbal and mineral ingredient nutraceuticals with 
clinically proven efficacy in 5 double-blind studies in the treatment of peripheral vascular disease (PVD) (
29
, 
30
, 
31
, 
32
 and 
33
). This formula is referred to here as 
Formula 28. Ingredients of the formula are listed in 
Table 14.3
.
According to a literature data comparison, Formula 28 appears to provide more therapeutic benefit than most cited pharmaceutical drugs in improving PVD conditions 
(
Table 14.4
). Based on these findings and indications from Tibetan medical theory, the results of an open field study in improving mental performance in elderly 
patients (
44
), the effectiveness of the formula in treating CNS inflammatory vascular condition in experimental animals (
28
), and plans for a clinical study of Formula 
28 in patients with the memory loss due to cerebrovascular insufficiency are in process.