The Five Elements in Tibetan Medicine

Amji Tabke

In the Tibetan tradition the elements are five: space, wind, fire, water and earth. All phenomenas, both internal and external, on the subtle or gross level, their formation, destruction and existence depend on them. Our own body consists of numberless particles formed by these elements.
You should not think that the five elements are like atoms or particles; they are rather principles or forces.
For example: earth correspond to mass/extension, water to fluidity, fire to temperature and wind to movement; space allow other elements to exist and to interact.
In Tibetan tradition there are different systems that explain the elements: according to medicine, to astrology (in particular to the Kalachakra Astrology), to Tantra and so on. Apparently between these systems there are little differences but, if we look carefully, we can see that, at a deeper level, the explanation is the same.

The elements characteristic shows also their function: earth gives solidity, weight and mass; water gives fluidity and cohesion (the power of the water is to keep things together, like when you mix water with flour); wind is movement; every movement depends on the wind element; fire is the temperature, what ripens; and, lastly, space allows other elements to interact, grow and transform.
When the five elements - the five energies- are in harmony there is health, development, growth; when they are out of balance the result is sickness and destruction. This is true at microcosmic level, which means our body, and also at macrocosmic level. A serious disharmony between the elements of our planet causes flood, earthquakes, fires and so on.

The beginning and the end of the universe itself, and of our planet, depend on the five elements’ harmony or disharmony. Our body grows and ripens until the five energies co-operate. Death is caused by the dissolution of the elements: they stop to co-operate and then dissolve.
Birth and death are the most extreme examples; there are also less serious imbalances that we experience every day.

For example: the wind element, called "wind humour" in Tibetan medicine (Tib. Lung), usually resides in the middle part of the body, level with the hips. If, due to an imbalance, it abandons its "home" and, according to its nature, flows upwards we experience headache, fears, anxiety.
If you had been in Tibet or Nepal, or if you have just seen pictures of these countries, you have surely noticed that Tibetans hang everywhere flags of five colours: white, red, blue, yellow and green (the colours of the elements). The purpose of these flags is to re-equilibrate and harmonise the five elements: for example, for the Dalai Lama long life they would hang green flags, because he is born in a wind element’s year.

Elements are influenced by many factors like climate, season or even the time of the day.
Spring, for example has a strong influence on the "phlegm humour"; because of that in this season we often feel tired, sleepy and a little weak.

You should not feel confused if before I was speaking about elements and now I am speaking about humours; in fact they are the same thing. In Tibetan medicine we mostly speak about humours: "wind humour" correspond to the wind element; "bile humour" to fire and "phlegm humour" to earth and water.

Illness manifests due to an imbalance of the humours and the duty of the Tibetan doctor is to bring them again to harmony.
If the wind becomes too strong, the doctor will intervene to control it; if it becomes weak he will give medicine to make it stronger and so on.

I took as an example the wind humour because I know very well Italian people (but I think it is the same in all the advanced countries): in Italy life is becoming very complicated, fast and stressful. All these situations overstimulate the wind humour and unbalance it.
I meet many patients with wind problems so I give them the right cure to pacify it.
Another fact is that Italian people like sweets very much. Sweet flavour has a cold quality and it damages the digestive fire and weakens the kidneys. In that case I have to give medicines that strengthens the kidneys and increase the digestive fire.

When the doctor prescribes medicines he has to take into consideration also the daily cycle of the humours.
Wind element tends to manifest in the morning, so the medicines to control wind are given in the morning or in the evening.
Bile imbalances tend to manifest during the day, so the medicine for bile problems are usually given at midday but also at midnight. Medicines for controlling phlegm problems are given in the morning and evening.

Before we spoke about the "Four Tantra", that is still the fundamental text in Tibetan medicine. This text is divided in four parts, the first one is called the "Root Tantra". The Root Tantra explains that the primary causes of illness are the three mental poisons; attachment, hatred and ignorance (or, in other words, attraction, repulsion and inertia) which are the mental aspects of the elements. Attachment corresponds to the wind humour, hatred to bile and ignorance to phlegm.
One single humour, or two or three humours together, can be the cause of a disease.
In this respect we have seven groups of diseases.

Another way to classify sicknesses, in Tibetan medicine, is to divide them in four categories:

1. Temporary diseases, which do not require any treatment. Of course if you take medicines you can recover faster.
2. Diseases caused by spirits, negative energies, black magic and so on. The only cure for these problems are special rituals (Pujas).
3. Karmic diseases: problems caused by very negative actions done in a previous life. They are very difficult to cure and also to diagnose. When all treatments fail the chance is that the problem is a karmic one; so the doctor can suggest to the patient a special practice of purification like, for example, prostrations.
4. Actual diseases: caused by the humours imbalance; this is the normal field of a doctor.