LONGEVITY, REGENERATION, AND OPTIMAL HEALTH

“Subtle” Psychosomatic Aspectsof Tibetan Medicine

Tenzing Dakpaa and Brooke Dodson-Lavelleb

aGaia Holistic Health Center, New York, New York, USAbColumbia Integrative Medicine Program, Department of Surgery, Columbia University

Medical Center, New York, New York, USA

The theory and practice of traditional Tibetan medicine (TTM) is based on an under-standing of a tri-level psycho-physical system; this bi-directional connection betweenthe psycho-somatic realms is mediated by a distinct, yet inseparable energetic system– the subtle body. TTM practitioners approach both diagnosis and treatment from anunderstanding of this subtle energetic system. In the Tibetan yogic tradition, controlof this system via advanced yogic and meditative technologies is the path to realizeextraordinary levels of health, happiness, and longevity. As a result, understanding thisintricately linked philosophical, medical, and yogic system is critical for engaging indialogue about longevity-enhancement within this tradition.

Key words: Tibetan Medicine; subtle body; addictive emotions; mind-body complex

Introduction

Both the theory and practice of traditionalTibetan medicine (TTM) is inextricably linkedto Buddhist philosophy, psychology, and con-templative science. TTM defines health as astate of balance, and while its treatment strate-gies are primarily preventative and therapeutic,its approach aims to remove all forms of suffer-ing and help ordinary individuals realize theirinnate, optimal health potential. Drawing on itspsychological roots, TTM recognizes the rootof imbalance, and by extension, disease, to bedestructive emotional patterns. In brief, suchimbalances can be overcome via the practicalapplication of medicinal, and meditative tech-nologies aimed at training and transformingthe mind.

TTM practitioners primarily treat disease byaiming to restore balance between the three hu-mors (nyes pa) – “wind” (rlung), “bile” (mkhris pa),and “phlegm” (bad kan) – typologies that refer topervasive psychological, physiological, and sub-

Address for correspondence: Brooke Dodson-Lavelle, M.A., ColumbiaUniversity Medical Center, Integrative Medicine Program, 177 Fort Wash-ington Avenue, MHB 7-435, New York, NY 10032. bd165@columbia.edu

tle energetic processes. “Wind” has the proper-ties of motion or activity; “bile” has the natureof fire or metabolism; “phlegm” has the char-acteristics of structure or stability (see Loizzoet al. in this volume for further description). Thehumors themselves are composed of five basicelements – wind, earth, fire, water, and space.All things, both animate and inanimate, areconstructed from these same basic constituents;since TTM views health as a state of balance,illness can be conceived as a disharmony be-tween the microcosm and the macrocosm.1

Humoral imbalances may result from mal-adaptive cognitive-behavioral patterns, includ-ing improper diet, as well as environmentalfactors such as climate change. Each humoris also associated with a particular period ofthe day, season, and stage of life; disorders ofeach type are therefore said to naturally pre-dominate during the according periods or un-der the according conditions. Disturbances of-ten involve a combination of humors as theirfluctuations affect each other. As mentioned, inTTM, the root cause of humoral imbalance,and by extension of all disease, is understoodto be destructive habitual or addictive emo-tional patterns. These addictive emotions are

Longevity, Regeneration, and Optimal Health: Ann. N.Y. Acad. Sci. 1172: 181–185 (2009).doi: 10.1196/annals.1393.015 C© 2009 New York Academy of Sciences.

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broadly categorized under one of the “threepoisons” of delusion, attachment, and anger,which refer generally to the automatic, subtlemovements of the untrained mind. These auto-matic patterns of reactivity condition compul-sive addictive behavior, which in turn influencesmaladaptive cognitive, affective, and behav-ioral tendencies – forming essentially a learnedcognitive-behavioral complex – thereby predis-posing individuals to specific humoral imbal-ances.

All levels and functions of the mind in-teract with the humors and thus there is adirect linkage between psychological and phys-iological processes. A predominance of one hu-mor over others originates from the basic men-tal confusion, or ignorance: delusion gives riseto “phlegm,” desire gives rise to “wind,” andanger gives rise to “bile.” Therefore, under-standing the nature of mind and its relation-ship to health and balance is essential for ef-fective diagnosis and treatment of disease. Thisperspective encompasses a recognition of thenecessity of training the mind to develop con-scious regulation of the subtle physiological andpsychological processes, in order to root outfundamental misknowledge and overcome ad-dictive emotions which continue to reinforcethe maladaptive cognitive-behavioral complexand negatively impact overall health. Accord-ingly, treating symptoms of a presenting illnesswithout addressing underlying root causes ofthe disease is considered to be an insufficientmedical approach in this tradition. This is thebasic psychosomatic theory of TTM.

Mind-Body Complex

This connection between the psychosomaticrealms is mediated by a distinct, yet inseparableenergetic system. Descriptions of this energy or“subtle” body differ depending on the medicalmodel or various tantric systems involved. De-spite this, extensive overlap exists among theseaccounts. We will offer only a very generaloverview of this subtle energetic system.

This sophisticated mind-body complex con-siders three layers: the “gross body,” whichrefers to the physical body as well as the gross,sensory mind; the “subtle body” or energeticbody composed of “channels” (rtsa), “energycenters” or “wheels” (rtsa ‘khor), “winds” (rlung)

and “drops” or “vital essences” (thig le); andthe “extremely subtle body” or “indestructibledrop” which refers to the extremely subtle mindof clear light.2 This extremely subtle body nor-mally resides in the life vein that connects tothe heart1 or in the heart center according tothe respective yogic or tantric system. It is use-ful to note that heart is synonymous with mindin the Tibetan psychosomatic system, and themind-body distinction is abandoned at this ex-tremely subtle level. These terms are employedvery precisely in this tradition, yet are very dif-ficult to describe. A complete expansion of thisidea is well beyond the scope of this paper.

Subtle Body

This subtle or energetic body is composedof 72,000 subtle energy channels or “circula-tory passages” which radiate out from five (toseven) “wheels” or energy centers located alonga three-channel central axis.2 This axis includesthe central channel (dbu ma), and the right (roma) and left (rkyang ma) channels. According totraditional Tibetan medical texts, these threechannels are considered life veins or vessels(srog rtsa): the right channel is considered theblood life vessel (khrag rtsa), the central channelis described as the wind life vessel (rlung rtsa),and the left channel is considered the water lifevessel (chu rtsa). The central channel is locateddirectly in front of the spinal cord. It beginsbetween the eyebrows, ascends to the crownof the head, and then descends to a space lo-cated four finger widths beneath the navel (orto the tip of the sex organ according to sometantric systems1). It is straight, hollow, luminousand blue. It represents the absolute, conscious-ness, and non-dual wisdom. The right and leftchannels (which are red and white, respectively)

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begin at the tip of the nostrils and run alongthe sides of the central channel, coiling aroundit at various “wheels” or energy centers. Theright channel represents the wisdom aspect ofthe path, and the left channel represents themethod aspect of the path. Again, physiolog-ical details of the wheels and channels mayvary between medical and tantric systems, andthus further description requires more elabo-rate explanation than is possible or appropriatehere.

The mind is said to “ride” the subtle windsas a rider rides a horse. The subtle windsflow throughout the channels, which in turnsupport the physical body and its physiolog-ical processes. There is a dialectical inter-action between the gross physical body andsubtler winds, as well as between the inter-nal and external environments. Thus humoralimbalances, influenced by addictive emotionsor stress-reactive drives, can affect the circu-lating winds and vital energies. Though nodirect anatomical correlates exist, the subtleenergy body can be seen as roughly corre-sponding to the central nervous system (CNS).A key point of correspondence is the high con-ductibility of the CNS – just as neurons transmitelectrical signals which spark biochemical reac-tions throughout the nervous system, the mind“rides” the winds which pervade the chan-nels and in turn effect change in the physicalbody.

The subtle winds are interconnected, andthus humoral imbalances and disturbancesof the circulating winds can affect the vitalessence, or life force, at the heart center.1

On a gross level, the exacerbation of vari-ous winds by addictive emotions can be ob-served in changes in respiratory rate, depth,and patterns. The mind is closely linked towind, and changes in breathing patterns alsohave an effect on cognitive processes.3 From theTTM perspective, excessive circulating windsin the uppermost part of the chest (often as-sociated with anxiety-related shallow breath-ing patterns) contribute to the development ofmental disease. Mild therapy consisting of deep

breathing (also known as “pot” breathing) maybe prescribed.1 The damaging effect of addic-tive emotions on autonomic and immune func-tion as well as on the progression of chronicdisease is well documented within the contextof Western biomedical research.4,5 From thisperspective, it is plausible to suggest that learn-ing to tame the mind and overcome addictiveemotions is essential for overall health, which isa fundamental tenet of Buddhist contemplativescience and TTM.

“Subtle” Medical Diagnosesand Treatments

TTM physicians diagnose disease througha comprehensive interview (which covers dietand health behaviors, emotional and psycho-logical status, family life and social support,environment, and contemplative practice); aphysical exam (in which the general cogni-tion of the body is observed, with particularattention to the condition of the tongue, eyes,and affected area); urine analysis (urine sam-ples are analyzed for foam, sediment, color,steam, bubbles, smell, etc., and the results areused to determine the existence of an imbal-ance of one or more humors); and a sophis-ticated pulse diagnosis (or channel examina-tion), which is the most subtle and preciseTTM diagnostic method. Evaluation of thepulse, most often conducted at the radial artery,assesses subtle variations in neural channelswhich are indicative of humoral imbalancesand specific organ dysfunctions. The pulse maybe affected by any dietary and behavioral activ-ity as well as season and time of day. Accuratepulse diagnosis, therefore, requires extensivetheoretical training and practice. The healthinformation gathered from pulse diagnosis isthen cross-checked with that gained from urineanalysis, interview, and physical examination toestablish the patient’s constitution and overalldiagnosis.6

TTM is an integrative and preventativetreatment model that fosters self-care as the

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primary method for attaining overall healthand balance. Therapeutic prescriptions oftenbegin with dietary and lifestyle modifications aswell as the administration of herbal medicines.TTM physicians will also recommend patientsengage in self-regulatory practices (i.e., yogaand meditation) as a strategic approach for re-alizing lasting health behavior change, and tobegin to root out underlying cognitive and emo-tional tendencies which negatively reinforcethe maladaptive cognitive-behavioral complex.Physicians must also consider what side effects,if any, may result from treatment and considerthe existence of any secondary humoral imbal-ances while prescribing dietary and medicinalregimens. Significantly, it is also believed thatthe wisdom and compassion of the physicianis directly related to his or her ability to ef-fect positive change in a patient’s health andwell-being – further evidence of the integrated,dynamic psycho-physical conception of healthand balance in TTM.

In this system, disease may also be conceivedof as a blockage in one of the vital channels.These energetic blockages may be caused bypsychological disturbances (excessive accumu-lation of negative energies or addictive emo-tions) as well as by maladaptive health be-haviors and physical disorders. Not only maythese blockages cyclically reinforce humoralimbalance and disease progression, they alsocreate resistance to medical therapeutics andtransformative contemplative technologies. Incases in which non-invasive treatments such asthose mentioned above are ineffectual, TTMphysicians may prescribe more invasive somatictherapies such as emetics, moxabustion, andacupuncture. The latter two therapies operateaccording to the subtle body map and manip-ulate the subtle veins and channels by openingblockages and restoring the “flow” of energeticwinds (interestingly, Western research has sug-gested that disease may be conceived of as apathology of conductance in the CNS – seeDan Brown in this volume for further discus-sion). Physicians may also recommend variousbreathing practices for various disorders, which

are said to bring the winds under control, purifythe channels, and, relevant to a medical model,improve oxygen levels.1

Medical treatment and meditative and yo-gic technologies are the doorway to the path ofself-regulation. Somatic treatments which relyon manipulation of the subtle body or subtle en-ergies overlap with the esoteric, tantric modelof transformative self-healing. While an under-standing of the subtle body may have developedin a medical context, the practice of cultivat-ing conscious awareness of the subtle energeticprocesses in order to gain control over sub-tle physiological and psychological processesevolved into a highly sophisticated system ofself-healing. Advanced contemplative practicesfound within this tradition seek to transformthe gross, subtle, and extremely subtle bodycontinuum by intervening at the subtle levelsof conceptual, perceptual, and psycho-physicalprocesses. The aim of tantric yogic and medita-tive practices is to learn to manipulate the subtleenergy in order to remove negative energetic orphysical blockages which cloud the mind’s nat-ural, luminous, and pure nature. Such practicesclear a direct path to optimal health, happiness,and longevity.

Ultimately, systematized mind trainingaims at interrupting the learned maladap-tive cognitive-behavioral complex (by erad-icating the fundamental misknowledge andovercome the addictive emotional instincts ofdesire, anger, and attachment). It is importantto note that the Tibetan medical and con-templative sciences are oriented toward theattainment of radically enhanced states ofpsycho-physical health, rather than the meremanagement of disease. Accordingly, mentaltraining is also a necessary prerequisite for theaforementioned subtle yogic practices whichaim to enhance and promote extraordinarylevels of health and well-being. Understandingthese intricately linked philosophical, medical,and yogic systems is critical for engaging in dia-logue about longevity-enhancment within thistradition. Gaining insight into the gross-subtle-extremely subtle continuum and its application

Dakpa & Dodson-Lavelle: “Subtle” Aspects of Tibetan Medicine 185

to current neuroscientific research could havetransformative impacts on both the conceptionand application of medical technologies.

Conflicts of Interest

The authors declare no conflicts of interest.

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