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Frances Garrett (Published July 2003; Revised July 2007)

Anatomy and Physiology in Tibetan Medicine

Tibetan medical systems regard the body as composed of two principal components, bodily constituents and "humors." The bodily constituents and the humors are related as object and subject, medical texts calling the constituents "those which are disturbed" and the humors "those which disturb." The bodily constituents are the substances of the body: the nutritive aspects of food and drink, blood, flesh, fat, bone, marrow, and sperm. Each of these has specified functions in maintaining bodily structure and processes. Explication of these substances is presented in the fourth chapter of the Explanatory Tantra (bshad rgyud), which includes a numerology of bodily constituents, an explication of the circulatory system of channels present throughout the adult body, a notation of bodily points most vulnerable to injury, and an explanation of the pathways and orifices of the body. The bony structure of the body is not explained in this chapter but in the brief chapter preceding this one, Chapter Three, Similes of the Body. There, the structure of the body is graphically depicted using an architectural analogy:

"The two hip bones are like the foundation for the walls. The spine is like a pile of gold coins and the life channel is like a pillar of agate. The square sternum (breast-bone) is like the supporting beams whilst the twenty-four ribs closely resemble the cross-beams. The costal cartilages are like (projecting) brackets. The channels and ligaments are like a network of roof-laths (struts), whilst the flesh and skin are like the plaster..." [1]

In a politically inspired system reminiscent of Chinese medicine, the Four Tantras states that inside the structure of the body-house, the organs are imaged as courtly inhabitants, with the heart as the king and the other important organs, his queens and attendants.

Study videos:
See the Tibetan-language video Teaching About the Body Using Similes for a medical scholar's explanation of why this chapter from the Explanatory Tantra is useful in medical education today.

Learn more:
On basic anatomy and physiology, see Quintessence Tantras, pgs. 53-68; Health Through Balance, pgs. 27-55; Tibetan Medical Paintings, pgs. 28-46.

The Three Humors

Described in the fifth chapter of the Explanatory Tantra (bshad rgyud), the humors occur in three aspects, which are united in an individual from the moment of conception. The humors are referred to as "the fundamental force which can act by creating, maintaining or destroying." [2] While the three aspects can disturb health and even cause death, it is important to note they are not the sole causes of ill health. Also, significantly, they are only the causes of ill health when they are in a state of imbalance--in their "natural state" they are sources of bodily health and well-being. The three humors are wind, also translated as ‘air’ (rlung), bile (mkhris pa), and phlegm (bad kan). (These three "humors" correspond to the three dosas of Indian Ayurvedic medicine, vayu (or vata), pitta, and kapha. These are generally translated into English as wind, bile or gall, and phlegm or mucus, respectively, following the humoral theory of ancient Greek thought. Although for simplicity's sake we will continue to use these English translations here, new translations equivalents should be investigated.)

Each of the three humors is first divided into five types according to individual functions. Each of the three also possess six qualifying characteristics, which further describe the specific effects or qualities these humors express as bodily experiences. So, for instance, wind is characterized by the six qualities of rough, light, active, subtle, cold and hard. Roughness, experienced as a rough tongue or rough skin, is thus a quality expressing the presence of wind in the body. Wind's quality of coldness is likewise what causes an individual to shiver or desire hot drinks.

Each of the five types of the three humors is also assigned a particular set of five functions and five locations in the body. Wind is responsible for sensation, including the workings of consciousness, as well as for the movement of substances and qualities around the body, and it is located in the vessels linked to the sense organs, which are located in and around the head, chest, heart, stomach and anus. Bile, responsible for bodily color and heat, including the digestion of food, is found in the stomach/intestines, liver, heart, eyes and skin. Phlegm is located around the chest, stomach, tongue, head and joints.

Study videos:
See the English-language video Functional Physiology and the Three Humors for more on this topic.

Learn more:
For a description of the three humors written in western biomedical terms, see Loizzo and Blackhall, "Traditional Alternatives as Complementary Sciences: The Case of Indo-Tibetan Medicine" in The Journal of Alternative and Complementary Medicine 4:3 (1998), pgs. 311-319.

The Natural Elements

The theory of the five natural elements states that all phenomena, including the human body, are composed of five dynamic forces or "energies": earth (sa), water (chu), fire (me), air (rlung), and space (nam mkha). An imbalance of these energies can result in a state of disease for the human body. These elements are also linked to the three humors. These elements refer not to static states but dynamic functions, where, for instance, the earth energy refers to the quality or function of hardness, or the water energy refers to the quality or function of cohesiveness, flexibility or coolness. Thus, within the human body, the earth energy influences the formation of tissue and bones; the water energy influences the formation of blood and other bodily fluids; the fire energy influences body temperature; the air energy influences respiration; and the space energy has to do with bodily cavities.

The Digestive System

Once food consumed reaches the stomach it is processed through the three parts of the stomach: the upper stomach, in which digestion is guided by the "decomposing phlegm"; the middle stomach, in which digestion occurs by the digestive heat and digestive bile; and the lower stomach, in which the fire-like wind processes the consumed food substances. In addition to being central force in the process of digestion, the digestive bile or heat is also particularly important in maintenance of health generally. Disturbances of digestive heat or bile can result in many disease states.

After food has been digested it takes one of two forms, nutrients and wastes. This separation occurs in the lower stomach area. Waste products are further separated into liquids and solids and excreted as urine and feces. Nutrients pass to the liver and are further processed to form the basic substances of the physical constituents. In the liver, decomposing phlegm, digestive heat, and fire-like wind act to transform the nutrients into blood, which is sent throughout the body and then transformed into flesh. Flesh is transformed by additional metabolic factors into bone tissues, which in turn produce bone marrow. The nutritive aspects of marrow, when utilized by the reproductive system, produce the reproductive substances, semen and menstrual blood.

The three metabolic functions perform the separation of nutrients and wastes in other systems of the body too. For example, waste produces of the stomach serve to nourish the phlegmatic regions, waste products of blood generate bile, and waste products of flesh create earwax.

The digestive system of separation and transformation is precise, each substances providing direct nourishment for specific functions or organs of the body. The end-point of the digestive process is the creation of the reproductive substances, which are considered to be the essential distillation of all the physical constituents. The quality of one's general health, as well as one's life span and complexion, are determined by the quality of the distilled essence of the reproductive substances. It is said that on average the full digestive cycle, from the consumption of food to the creation of the reproductive substances, takes six days.

Learn more:
On the digestive system, see Lobsang Rabgay, "Digestive System According to Tibetan Medicine" in Tibetan Medicine 3 (1981), pgs. 27-32.

The Development of the Human Body

These humors influence embodied experience from before the time of conception throughout one's entire life. An appropriately balanced humoral makeup in both male sperm and female blood is one of the causes of successful conception and formation of the embryo. Other causes for successful conception are the presence of an intermediate-state consciousness impelled by karma to meet with the parental joining of sperm and blood, and the assembled presence of the five elements, earth, fire, water, air, and space. The presence of each of these factors is essential for conception; the Four Tantras carefully explains why defects in any of these factors will result in failure to conceive. Each of these factors--the semen, the blood, the intermediate-state being's own consciousness, and each of the five elements--contributes something specific to the developing embryo, such that "by the interrelationship and aggregation of causes and conditions the body is formed." [3]

The body is thus defined from the moment of conception as a particular balance of bodily constituents and humors, influenced by the elements. Each of the three humors is said to have the nature of one of the three principal elements-wind’s nature is air, bile’s nature is fire, and phlegm’s nature is water. "The circulation of the various types of rlung [wind] connected with the energy of the elements is determined directly by how the body originated, took shape, and became complete." [4] Although the causal sequence of events and the functional relationship of elements is defined in this system, a structural template for fixed or idealized human bodies is not provided. Each human individual is thus distinct, the product of a particular arrangement of the various causes and conditions of embodiment.

Study videos:
A THDL video on embryology will be available in 2004.

Learn more:
On embryology in medical texts, see Quintessence Tantras, pgs. 47-52; Tibetan Medical Paintings, pg. 26. On religious uses of embryology, see Lati Rinbochay and Jeffrey Hopkins, Death, Intermediate State and Rebirth in Tibetan Buddhism (Ithaca: Snow Lion Publications, 1979).

Related videos for additional study:
In the Tibetan-language video, Bla gnas in the Four Tantras, a medical scholar briefly comments on the presence of the "life-force" called bla in the teachings of the Four Tantras. In the Tibetan-language video, The Definition of rtsa, the same scholar scholar also comments on the Tibetan term rtsa, often translated into English as "channel," but sometimes also as "vein," "artery," or "nerve."

NOTES:

[1] The Quintessence Tantras of Tibetan Medicine, translated by Barry Clark (Ithaca: Snow Lion Publications, 1995), 51.

[2] Namkhai Norbu, On Birth and Life: A Treatise on Tibetan Medicine, trans. Enrico Dell'Angelo (Tipographia Commerciale Venezia, 1983), 6.

[3] Quintessence Tantras, 49.

[4] Norbu, 31.