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Frances Garrett (Published July 2003; Revised July 2007)

Nosology and Etiology in Tibetan Medicine

A large proportion of the Four Tantras is devoted to explaining and classifying imbalanced states of existence. In addition to the chapters in the Explanatory Tantra (bshad rgyud) on disease states, the Four Tantra's third text has ninety-two chapters detailing the causes, types and treatments of various diseases. Disorders are classified according the humor which is most pervasively imbalanced, so there are wind disorders, bile disorders, phlegm disorders, or disorders that are a combination of two imbalanced humors.

Learn more:
On the classification of diseases, see Health Through Balance, 15-20; Quintessence Tantras, pgs. 88-99; Tibetan Medical Paintings, pgs. 96-108. On diabetes, see Health Through Balance, 189-194. On tumors, see Health Through Balance, 194-207. On goiter, see Burrow, Hopkins, Dhondhen, and Dolma, "Goiter in Tibetan Medicine" in Tibetan Medicine 5 (1982), pgs. 39-46. On diabetes, see "Diabetes Mellitus in Tibetans: A Descriptive Study" in sMan-rTsis Journal 2:2 (2000), 79-91, and Dorjee Rapten Neshar, "Efficacy of Traditional Tibetan Medicine against Diabetes Mellitus" in sMan-rTsis Journal 2:2 (2000), 25-35. On arthritis, see "Arthritis: Its Causes and Treatment in Tibetan Medicine" in sMan-rTsis Journal 2:2 (2000), 49-58. For additional studies on individual conditions, also see the bibliography, Recent Publications on Tibetan Medicine.

Causes of Disease

Disease states are understood as an imbalance of the psychological and cosmo-physical energies associated with the individual. Such imbalances are explained to be caused on two levels: at the fundamental level, using the theory of the three poisons (dug gsum) and the five elements ('byung ba lnga), and also on the more immediate levels, using explanations of diet, behavior, and environment.

The former refers to the Buddhist premise that the cause of human suffering is ignorance (gti mug), which is also associated with attachment, or desire ('dod chags), and hatred, or aggression (zhe dang). These are known as the "three poisons," a concept which is intensively studied in Buddhist philosophical and psychological literature. According to the Four Tantras, and in agreement with Buddhist philosophy, the principal cause of disease is ignorance: "Even though beings may live and act with contentment, because of possessing ignorance they cannot be separated from disease" [1].

In the context of medicine, these three poisons are also associated with the three humors, wind (rlung), bile (mkhris pa), and phlegm (bad kan). Other factors cited as affecting the disturbance of equilibrium include particular causes and general causes. Particular causes, resulting in an overflow of one of the three humors, have to do primarily with food and behavior. General causes include the operation of negative forces, poisoning, seasonal and other environmental or cosmological factors, mistaken medical intervention, or activation of negative karma.

On the more immediate level, an individual's diet and behavior can affect the balance of health, as can environmental factors. Analysis of environmental causes of imbalance involves an understanding of seasonal changes and how seasonal climate interacts with the humors of the body and with one's diet. When a patient’s treatment is understood to be correctly applied to the correct diagnosis but the patient’s condition does not respond, other negative forces (for instance, "evil spirits") may be said to be the cause of the disorder.

Study videos:
In the English-language videos Causes of Disease in Tibetan Medicine and Illness and Disease, Dr. Leslie Blackhall, an American physician who has studied Tibetan medicine, discusses these topics with first-year medical students at the University of Virginia.

Learn more:
On etiology, see Fundamentals of Tibetan Medicine, pgs. 5-12; Health Through Balance, pgs. 54-70; Quintessence Tantras, pgs. 75-83; Tibetan Medical Paintings, pgs. 96-108.

NOTES:

[1] The Quintessence Tantras of Tibetan Medicine, translated by Barry Clark (Ithaca: Snow Lion Publications, 1995), 76.