In an early Mahayana text, the Buddhist sage Vimalakirti mused that, "All sentient beings are ill" (Birnbaum, p.13). To the Tibetan, the inevitability of suffering and illness is a reflection of the fact that we are born. The Tibetans believe that we "take birth" because we are ignorant of the true nature of reality and that it is this ignorance that is the cause of all suffering and disorder. Dr. Yeshi Donden remarked that "the root [of illness] is beginningless ignorance" and that "ignorance is with us like our own shadow . . . even if we think that we are in very good health, actually we have had the basic cause of illness since beginningless time" (Donden, p. 26). 

Tibetans believe that our false perceptions of the world and its projections actually change the world, which is fundamentally neutral. Moreover, people become attached to ego-centered views, which "contain the seeds of profound misunderstanding of what it means to have Being in this world" (Walsh-Frank, p. 8). Consequently, because "all phenomena are mere reflections and designation of the mind" (Thonduk, p.193), and the mind is driven by delusional thinking, samsara (our perception of the phenomenal world) is filled with suffering. 

Furthermore, the Tibetan Buddhist believes that karma(simply stated, the law of cause and effect) from one's previous incarnations can also be responsible for our illnesses in our present experience. Sakyamuni, the historical Buddha, explained this principle when he said: 

In sooth to every man that's born 

A hatchet grows within his mouth, 

Wherewith the fool, whene'er he speaks 

And speaks amiss, doth cut himself . . . (quoted from Samyutta-nikaya in Birnbaum, p.9) 

However, our emotional energies are neither good nor bad in themselves; for example, the energy/intelligence that turns to hatred when siezed in the neurotic grip of ego can also manifest as simple, clear awareness of the true situation--thus it is how we relate to our emotional energies that is crucial to well-ness. Understanding one's emotions is an essential part of the Buddhist journey to full awakening and freedom form unwanted conditions of all sorts. However, since most of us have very little ability to work with our emotional energies without creating negative experiences, medicines and other remedies are required. 

While Tibetan notions of the law of karma imply infinite interlinked causes for any single event, three emotions, known as the "Three Interior Poisons," are considered to be at the root of all illness. The first poison is desire or passion, which implies grasping at objects or pleasant experiences. Desire is also perceived as "grasping at self" where self is our involvement with any object of our desire whether it is a chair, person or idea (Tsarong, p.17). And self, which involves a subject grasping an object, is an illusion to which we cling, because we still do not understand that anitya(impermanence) is a primordial condition of living in samsara. Similarly, hatred, or aversion, regarded as the second poison, consists of pushing away unpleasant experiences or objects. Finally, ignorance, or confusion, which involves misunderstanding the nature of an object or a particular experience, is the third poison of the mind.

The physical manifestations of the Three Poisons assume the form of three humors or nyes-pa (literally the three "defects" or "faults" or "forms of punishment") (Ragpay, p.32). They have a dual function: when they are in harmony, they maintain well-being, but when they are disturbed or out of harmony, they are the cause of illness (Rapgay, p.33). 

Desire corresponds to disharmony of rlung (wind; pronounced 'loong'). Both medical and religious texts consider the flow or blockage of rlung to be central in pathology. Some symptoms of rlung disorder are frothy urine, a rough dry tongue or a "jumpy" pulse. 

Hatred corresponds to disharmony of energy, or bile. Some symptoms of a bile disorder include the presence of thick or yellowish-red urine, thick, yellowish fur on the tongue or a "full" pulse. 

Ignorance is related to heavy, or phlegm, disorders. The urine is odorless, thin and whitish, and the pulse is "sluggish or heavy" (Rapgay, p.17, p.20, Thondup, p 12-13). 

Tibetan medicine views emotional, physical and cognitive interactions as "essential components in the understanding of the cause, aggravation and duration of virtually all major diseases" (Rapgay, p.10). As Patricia Walsh-Frank noted, "Mind (reason) and spirit (in part emotion) co-mingle in this holistic philosophy" (p.7). Thus, the principal medicine, which frees us from most afflictions and enables us to live in well-ness, must be that which loosens the grip on the "self" and ego-centered thinking. Consequently, to the Tibetan, the mind is the vehicle by which one can enter the world of non-self and become liberated from the self-centered causes of suffering. 

Diagnostic techniques necessitate complex calculations in order to reach a diagnosis and formulate a treatment plan. The Tibetan physician must be thoroughly trained in analyzing a large number of complications in the practical application of the complete doctrine. The most popular and widely commented upon Buddhist medical text, which is used in medical training, is the four-part, 156 chapter rGyud-bzhi or TheFour Secret Oral Tantras of the Eight Branches of the Medical Tradition (Rapgay, p.32). Compiled in about the fourth century A.D., the teachings are believed to have been revealed by the Medicine Buddha in the form of four Buddhas (Donden, p.23). The Tibetan physician-in-training must commit to memory at least three of the four Tantras: the Root Tantra, Explanatory Tantra and Last Tantra. 

The restoration of harmony and order is crucial to the healing process which includes spiritual, social and psychological well-being as well as physical health. The ideal image of a healer, is that of "a man of noble character, but he is also capable of immediately making the right diagnosis of a patient's illness, without any examination or the least assistance" (Burang, p.12). Needless to say, such physicians are quite rare. Consequently, before a physician acquires credibility, he must train at least twenty years in the tradition. 

Tibetan medicine is a holistic tradition, which is "oriented around symptoms, and therefore it is delicately responsive to symptom clusters, no complaint being disregarded" (Donden, p.8). Since a lasting cure can only take place when the whole psychosocial environment of the patient is accounted for, superficial methods which consider only the outward symptoms of illness are frowned upon. The physician must be willing to consider more than the diseased organ, or even the whole person: "he must view the man in the world" (Harvey Cushing as quoted in Rapgay, p.8). Consequently, Tibetan medicine is increasingly gaining recognition in the West as particularly effective for patients with "chronic diseases such as hepatitis, certain kinds of mental illness, ulcers, paralysis, gall stones, kidney stones, and arthritis" (Donden, p.8, p.20). 

In the Tibetan system, regardless of whether or not one is manifesting symptoms of illness, one is still considered to be sick. Disease, if not evident, is in dormant form. Thus the scope of disease is extremely difficult for the physician to fathom ( Donden, p.16). For example, there are 84,000 different "affective emotions" which generate 84,000 types of disorders. These can be condensed and condensed again into 404 specific diseases⁽¹⁾ (Donden, p.56). 

In a simplified rendition of Tibetan disease classification, imbalances of three types of humors, wind, bile and phlegm, are thought to occur. The more complex the imbalance, the greater the therapeutic urgency. Diseases are classified into forty-two types of wind disorders, twenty-six types of bile disorders and thirty-three types of phlegm disorders for a total of 101. There are also 101 disorders whose origins lie in the karmaof the past life. They are illnesses of a serious nature, which are typically considered the consequences of "mistakes committed in a previous life" (Burang, p.2). Such illnesses are usually considered to be fatal, unless they are treated with meditation and other spiritual practices, such as confession or exorcism. There are 101 disorders caused by "spirits" and 101 considered as superficial; i.e., they are caused by, and cured by changes in, behavioral patterns such as smoking, diet, bathing, and lack of exercise, or activities such as stealing, adultery, lying and dishonesty (Donden, p.16). 

Tibetans look at well-ness as a consequence of three integrated types of medical practices: secular therapies, such as medicine, diet, surgery, etc.; spiritual cures; and as a metaphor for spiritual growth, where Buddha is the Absolute healer and the Dharma, orteachings of Sakyamuni, is the "King of Medicine" (Birnbaum, p.13). In the third case, when it is a potential "catalytic factor" which hastens one toward spiritual enlightenment, Tibetans view illness and its consequences more optimistically (Birnbaum, p.9). 

Some of the secular methods used in treating illness include pharmaceuticals; moxibustion (burning herbs upon designated areas of the patient's body); wearing gemstones and animal skins, which are believed to have curative powers due to their emanations; burning incense against "air diseases"; acupuncture, which is "practiced with care and reserve" (Burang, p.64); massage; mineral baths; bloodletting; the occasional use of laxatives and emetics; and behavioral adjustments regulating smoking, diet and sexual activity (Burang, p.60). 

Surgery is considered only as a last resort, and it is exceedingly primitive compared to Western standards. Yeshi Donden indicates that surgery is not performed in Tibet, both because "it is better to cure the organ than to remove it" and for religious reasons, since "it is better to undergo the illness and take medicine to cure it than to seek to avoid the illness and be operated on" (p.183). Consequently, surgery is considered a violent approach to disease, but the "painful removal of foreign bodies, cauterization of abscesses, curetting of severely damaged tissues, etc." is performed after all other options are exhausted (Burang, p.67). Moreover, in many cases, surgery is performed without the use of anaesthetics, because the Tibetan is thought to be "far less sensitive to pain than the average Westerner" (Burang, p.60). 

Ron Leifer, a scholar of Tibetan medicine, considered the practice of Tibetan medicine a science because it is based on "observation and logical reasoning rather than faith, scripture or religious authority" (Leifer, p.753). However, even though the therapeutic methods described above may appear to be divorced from spiritual implications, they are not. Tibetan medicine typically directs its attention toward spiritual factors regarding the cause and cure of illness which by Western standards would be regarded as the "domain of the priest or psychiatrist" (Burang, p.59). 

The Tibetan physician focuses his attention on spiritual factors even in the treatment of the simplest illnesses. Every Tibetan physician vows to "regard medicine as an offering to the Medicine Buddha and all other medicine deities" and considers his "medical instruments as holy objects" (Dummer, p. xix). Even the pharmaceuticals, which are mixtures of vegetable, animal and mineral compounds, are prepared with meticulous attention to religious ritual. For example, after the Tibetan physician gathers the dozens of different ingredients that go into the making of the single small pill, he performs a meditative ritual. Before and after the ingredients in the pills have been assembled, the physician imagines himself and the medicine to be Hayagriva, a Buddhist deity. The physician and the deity are considered to be consolidated as one inseparable entity. The medicines are further blessed "into a magnificent state through being implanted with mantra [a prayerful vocalization]" (Donden, p.214). Because pills are blessed this way, Tibetans believe that even the dying can benefit from them. 

The emphasis on metaphysical principles in Tibetan medicine has its roots in the teachings of the historical Buddha, who lived about 2,500 years ago. The ancient texts of the Pali Canon record that early Buddhist communities believed that the four necessities of life are food, clothing, shelter and medicine. Since illness tended to weaken the focus of the mind, which was the liberating faculty, concepts of healing were important in the earliest Buddhist communities. 

In the teachings of the Pali Canon, a person "who is not liberated, who is still subject to the sufferings brought on by insatiable craving, is considered ill." (Birnbaum, p.15). Sakyamuni Buddha was portrayed as the Supreme Physician who used two basic healing methods: healing by means of instruction and healing by means of miracles. Sakyamuni Buddha, who was considered a link between humanity and myriad celestial beings, repeatedly reminded his disciples that they should diligently seek to be healed. And Sakyamuni Buddha proclaimed that "Lo, I am physician without peer . . . " (As translated by E.M. Hare in Woven Cadences of the Early Buddhists in Birnbaum, p.16). Consequently, his disciples could turn to the King of Medicines, (the Dharma, or Buddha's teachings) or the Supreme Physician himself for relief. 

Those whose illnesses were perceived to be fatal received lessons on impermanence as a fact of the natural world, whereas those who were curable were encouraged to meditate on the seven limbs (bojjhangas) of enlightenment: mindfulness, his teachings (dharma), striving, joy, tranquility, meditative trance and equanimity (Birnbaum, p.10). From the traditional perspective the bojjhangas are considered a method for overcoming the"Three Interior Poisons": desire, hatred and delusion. The emphasis on Buddha as the Supreme Physician, a model of selfless compassion who devoted his life to easing the pain and suffering of others, indicates a fundamental attitude regarding the nature of Buddhist medicine: "dispassionate compassion" (Birnbaum, p.17). This attitude serves as a behavioral prototype for contemporary Tibetan physicians.

About the third century A.D., the Medicine Buddha, also known as Bhaisajya-guru, was recorded in Buddhist texts as an emanation of the historical Buddha, who was considered the preeminent healing deity in the Mahayana Buddhist tradition. Bhaisajya-guru, also known as "Master of Healing, the Lapis Lazuli Radiance Tagatha," is one of a number of emanations of Buddhist deities whose purpose is to open the imagination of the supplicant to expanded understanding and empowerment. The teachings of the Medicine Buddha have been handed down throughout the centuries by means of oral tradition and practical applications gleaned from written works such as The Medicine Guru Beams of Lapis Lazuli Sutra and The Four Secret Oral Tantras on the Eight Branches of the Essence of Nectar--both works were attributed to Sakyamuni Buddha. Sakyamuni is recorded as saying that by uttering the Bhaisajya-gurumantra, one is free of the nine untimely causes of death and of all suffering. All subsequent reincarnations will be "peaceful and joyous" (Birnbaum, p.88). 

One can also petition the healing powers of the Medicine Buddha by visualization practices to "invoke the spiritual force of that deity, in order to heal all diseases, inner and outer" (Birnbaum, p.89).Intense identification with various characteristics associated with the emanation of the Bhaisajya-guru invokes a spiritual attitude which generates healing action along the devotee's psychosocial continuum. Even the name of the Medicine Buddha is believed to have the power to free one from the pattern of negative thoughts and emotions. Healing can occur just by speaking, hearing or concentrating on his name. Thus, for example, conceited persons will become humble, greedy persons will become charitable and those who cause dissent will become cooperative and loving just by hearing or saying his name. 

Every morning, the Tibetan physician reintegrates into his consciousness the spiritual, intellectual and practical teachings of the Medicine Buddha through visualization and prayers. The rituals enable the practitioner to "ward off any spiritual obstacles to the correct diagnosis and cure . . . as negative spiritual entities can either cloud the diagnosis or prevent the medicines from working properly in the patient" (Gold, p.89). 

As I explained above, the mind is considered the origin of all illness and spiritual afflictions. Consequently, much of the healing that the Medicine Buddha promises lies within the mind. The mystical revelations into esoteric teachings regarding compassion, healing and enlightenment are too profound to express in ordinary speech or writing. Tibetan Buddhist art has transcendental implications which are "conveyed through the formal language of symbols, colors, gestures, and attributes [and] cause hidden chords to resonate in the depths of our being" (Birnbaum, p.78). Because art and ritual surrounding the Buddha focus and uplift the mind, the devotee's consciousness is transformed as he becomes sensitive to the healing rays of the Buddha as Absolute Truth. Thus, Tibetan art possesses incalculable value as a support for private meditative practices and as an agent for ritual devotions related to healing. 

Artistic depictions of the Bhaisajya-guru, which are rich in symbolism, reveal a deity whose skin is the deep, blue color of the gemstone lapis lazuli. The gemstone, which is very precious to central Asians, is considered to have divine origins. The deity is sometimes depicted holding myrobalan fruit called dug-bcom, which means "that which renders poison inactive" (Dummer, p.26). Dug-bcom is a Tibetan healing symbol and a metaphor for the Three Poisons: desire, hatred and confusion. 

Since every detail of the iconography associated with the image yields a teaching which is integral to the healing process, many elaborate forms of ritual worship have crystallized around the Bhaisajya-guru. Some examples of ritual involving the Medicine Buddha which are believed to have a curative or strengthening influence for the ill include meditating upon the deep blue color of lapis lazuli; making puja offerings of flowers and incense to the image of the deity; mentally or physically constructing an image of the deity; playing musical instruments and chanting; reading sutras; constructing altars, mandalas or banners; and lighting lamps. According to Birnbaum, the response will either be "dramatically immediate" or result in "improved karmic circumstances in the next incarnation" (p.84). 

The following ritual, which illustrates the Medicine Buddha's imagery as a dynamic conduit for invoking spiritual healing forces, is typically performed by a Tibetan lama/physician. Seated in a lotus position and repeating mantra, the lama/physician either actually or symbolically places medicinal pills in a begging bowl. Then he "generates an altruistic intention to become enlightened" (Donden, p.216). The physician meditates on the lapis lazuli image of Bhaisajya-guru. He visualizes the Medicine Buddha's right hand as forming a "gesture of meditative equipoise" and his left hand as holding a lapis lazuli begging bowl filled with amrta(healing nectar) (Donden, p.216). 

The lama/physician now meditates or visualizes a similar Medicine Buddha in front of himself. The physician then dissolves into "the emptiness of inherent existence" and re-emerges as Bhaisajya-guru with a complete mandala (Donden, p.216). At this point the healer believes that he has actually become the Bhaisajya-guru. The Bhaisajya-guru in front of him emits rays of light which gather and dissolve medicinal essences into the medicine in the physician's begging bowl. The mantrais repeated endlessly. After more complex visualizations are performed, the invocation of mantra and "meditative stabilization" ultimately impart highly potentialized medicines. 
 

The Tibetan art of healing is a highly sophisticated tradition whose practice has withstood the passage of time. Tibetan Buddhist medicine emphasizes an integrated approach to understanding the causes and treatment of illness. It requires a profound understanding of physical, emotional and metaphysical interrelationships as experienced on the universal macrocosmic and the human microcosmic levels. The significance of the Medicine Buddha as the Supreme Healer in Tibetan medicine for liberating the individual from suffering is an exemplary metaphor for the mystical elements which are universally inherent in the healing tradition. The tradition is truly a holistic approach to the problem of suffering, both individual suffering and suffering as a universal condition.

please grant me your blessings.

Birnbaum, Raoul. The Healing Buddha. Boulder: Shambhala Publications, Inc., 1979. 

Burang, Theodore. The Tibetan Art of Healing.London: Robinson & Watkins Books Ltd., 1974.

Donden, Yeshi. Health Through Balance: An Introduction to Tibetan Medicine. Ithaca: Snow Lion Publications, 1986.

Dummer, Tom. Tibetan Medicine: And Other Holistic Health-Care Systems. New York: Routledge, 1988.

Gold, Peter. Tibetan Pilgrimage. Ithaca: Snow Lion Publications, 1988. 

Leifer, Ron. "Psychological and Spiritual Factors in Chronic Illness." American Behavioral Scientist 39 (1996): 752-766.

Rapgay, Lobsang. Tibetan Medicine: A Holistic Approach to Better Health. India: Indraprastha Press, 1985.

Thondup, Tulku. The Healing Power of Mind. Boston: Shambhala Publications, Inc., 1996

Tsarong, T.J. Fundamentals of Tibetan Medicine. New Delhi: Tibetan Medical Centre, 1981

Walsh-Frankh, Patricia. "Compassion: An East-West Comparison." Asian Philosophy 6 (1996): 5-12.

I would like to express my appreciation to Dr. Terry Halwes for his help with the research for this paper.