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Frances Garrett (Published July 2003; Revised July 2007)

Diagnosis in Tibetan Medicine

Traditionally, diagnostic techniques are organized into visual techniques, pulse analysis, and interrogatory techniques. Today in Lhasa's Tibetan hospitals, new diagnostic techniques are being integrated into clinical practice as well.

Diagnosis involves relating symptomology with pathology by means of the "three examinations" and the "three methods of diagnosis." The three examinations are etiological, pathogenetic and interrogative examinations, and, as an extension of these, the three methods of diagnosis involve questioning, examination by seeing, and examination by touching. Etiological examination consists of discovering the causes and factors responsible for a disorder by questioning and examining the patient. The nature of the disease is confirmed further by obtaining a pathogenetic history. Questioning the patient about diet and behavioral habits can then determine the best course of treatment. In the interpretation of disease states, therefore, consideration of the condition of the constituents and humors of the body is balanced with consideration of the patient's diet and behavior, and the potential effects of medicines and other interventionary treatments.

Learn more:
An introductory essay on diagnosis is available in Fundamentals of Tibetan Medicine, pgs. 13-29. Also see Health Through Balance, pgs. 71-131.

Visual Diagnosis

This includes a physical examination of the body, with an emphasis on examination of the tongue and urine. The appearance of the tongue-its color and texture-and its taste to the patient are taken into consideration, indicating an imbalance of one or the other of the three humors. A red, dry and rough tongue indicates a wind disorder. A thick, pale yellow coating indicates a bile disorder. A pale, lusterless tongue that is thick, soft, and damp indicates a wind disorder. Additional specifications are made for variations on humoral disorders. The tongue of a healthy individual is red, soft, moist and flexible, and a person who is about to die has a black, cracked and very dry tongue. Urine samples are analyzed for color, odor, and the quality of its steam and bubbles. Samples are analyzed when fresh, when lukewarm, and again when cold. The qualities of the urine sample indicate an imbalance in one or the other of the humors.

Study videos:
Urinalysis

Learn more:
For the Four Tantras' presentation of urinalysis and tongue diagnosis, see the traditional medical paintings and excellent accompanying essays on this topic in Tibetan Medical Paintings, Volume 1, pgs. 140-150; for urinalysis, also see Health Through Balance, pgs. 113-131. Also see Lobsang Rabgay, “A Guide to Tibetan Medical Urinalysis,” in Tibetan Medicine 9 (1985), 28-47, and Lobsang Rabgay, “Urine Analysis in Tibetan Medicine,” in Tibetan Medicine 3 (1981), 53-60.

Pulse Analysis

Involving the recognition of extremely subtle variations in the pulse, this form of diagnostic analysis requires extensive theoretical study and years of experience.

Because the pulse can be affected by any dietary or behavioral activities, patients are often asked to avoid certain foods and activities prior to a pulse examination, such as very cold food, thick tea, raw food, strenuous exertion, sleeplessness, overeating, and so forth. Pulse analysis is most accurately performed at dawn, when external disturbances are at a minimum and the patient is relatively calm, although in emergencies pulse analysis can be performed whenever warranted.

The physician uses three fingers to take the patient's pulse, generally at the radial artery of each wrist. Diagnosis can be made based on a reading of other arteries, but the radial artery at the wrist is considered most accurate because they are not too close to any of the main internal organs. With the index finger, the physician applies a light pressure on the wrist; with the middle finger the physician presses slightly harder; and with the ring finger, the physician presses to the bone. Each finger, applying pressure in three ways on the right and left wrist of the patient, obtains a reading that corresponds to each of the major organs in the patient's body.

The physician's first task is to identify the patient's constitutional pulse, as individuals vary in constitutional pulse type. The three types of constitutional pulse are known as the male pulse, the female pulse, and the neuter pulse, although these three are not based on the sex of the individual but rather on other characteristic features of the pulse, such as whether it is rough, rapid, or smooth. Next, the patient's disorder is classified as "hot" or "cold," which is sometimes explained as a reading of whether the pulse beats more than five times per respiratory cycle (indicating a hot disorder), or less than five times (indicating a cold disorder). Then, other characteristics involving the rate, nature, and volume of the pulse are noted and interpreted as indicative of specific organ dysfunctions or humoral imbalances.

Environmental factors also play a role in pulse analysis, as the seasons and the time of day influence the characteristics of the pulse. Arriving at a correct diagnosis involves adapting one's interpretation of the characteristics of a patient's pulse with the season and time of day.

The art of pulse analysis is said also to include the ability to prognosticate. In addition, it is said that examination of the pulse of a close friend or relative can determine the prognosis of a patient who is unable to visit the doctor in person.

Study videos:
Department of Liver Disorders: patient 1 examination,
Department of Liver Disorders: patient 1 analysis,
Department of Musculoskeletal Disorders: patient 1 examination,
Department of Musculoskeletal Disorders: patient 2 examination,
Department of Musculoskeletal Disorders: patient 2 analysis,
Kunchok Jiatso Visits the Doctor,
Visiting a Neighborhood Clinic,
Out-patient Department: patient 4 examination,
Writing a Prescription, and
A Visit to the Hospital, or
A Visit to the Hospital (Abridged) .

Learn more:
For the Four Tantras' presentation of pulse diagnosis, see the paintings and essays on this topic in Tibetan Medical Paintings, Volume 1, pgs. 124-138. Also see Health Through Balance, pgs. 75-113; as well as Lobsang Rabgay, “Pulse Analysis in Tibetan Medicine,” in Tibetan Medicine 3 (1981), 45-53.

New Diagnostic Technologies

At the Tibetan hospital in Lhasa today, new technologies are being integrated into diagnostics as well.

Study videos:
Department of GI Disorders: New Diagnostic Technologies

Learn more:
For more on the changing landscape of Tibetan medical practice in the 20th-21st centuries, see Vincanne Adams, "Suffering the Winds of Lhasa: Politicized Bodies, Human Rights, Cultural Difference, and Humanism in Tibet" in Medical Anthropology Quarterly 12:1 (1998), pgs. 74-102; and Craig Janes, "The Transformations of Tibetan Medicine" in Medical Anthropology Quarterly 9:1 (1995), pgs. 6-39.