Diagnosis In Tibetan Medicine -Learning To See

By Eliot Tokar

In the teachings of Tibetan medicine there is a metaphor that refers to the stages of development of the diagnostician. At the first level a student of medicine is likened to a person standing on a mountain top who is unable to perceive what is on the top of the opposite peak. At the next level the student can see that something is there. At a higher level the student can perceive that someone is standing on the opposite peak but he or she still lacks the ability to perceive anything about that person. At many succeeding levels, more and more can be perceived about this person until, ultimately, at the most advanced degree of ability, the student recognizes precisely who is there.

This metaphor describes the evolution of perceptive abilities in learning Tibetan medical diagnosis. Its meaning can also apply to the gradual process that practitioners of different medical systems must be undergo to truly perceive what a doctor from another scientific world view sees. Performing a medical diagnosis requires an understanding of the technique and language of the system within which one is operating. The foundation of diagnostic skill, however, is the development of a capacity of awareness that leads to clear and precise perception.

The following article will explain the basic tools and language of Tibetan diagnosis and begin to clear the mist that stands between the peak of Tibetan medicine and that of other medical traditions. To begin establishing a truly complementary approach to medicine, there must be a common language created through which traditional and allopathic doctors can effectively communicate about their disciplines. Medical traditions are not the sum total of their diagnostic or treatment techniques; instead, they are the result of the scientific, cultural, and spiritual knowledge that gave rise to those therapeutic applications. To establish a common language of communication, we must begin by seeing clearly.

This point is demonstrated in the book Mortal Lessons by the surgeon and Yale professor, Richard Selzer, MD.1 In this book Dr. Selzer recounts a diagnostic session performed by my first teacher, Dr. Yeshi Donden. The session was part of a demonstration conducted at an American hospital. Dr. Donden was shown a patient about whom he was told nothing. Before an audience of skeptical Western physicians, Dr. Donden performed the Tibetan pulse diagnosis and urinalysis. To the amazement of his audience he was able to accurately diagnose that the patient had a chronic heart problem. He diagnosed an imbalance in the basic circulatory principle of the body as it relates to blood and heart function. This disorder had progressed to a stage in which it affected the patients pre-existing heart irregularity, which had developed during a specific stage of embryological development. Dr. Selzer1 recounted the diagnosis in this manner: "

[Dr. Donden] speaks of winds coursing through the body of the woman, currents that break against barriers, eddying. These vortices are in her blood, he says. The last spendings of an imperfect heart. Between the chambers of her heart, long, long before she was born, a wind had come and blown open a deep gate that must never be opened. Through it charge the full waters of her river, as the mountain stream cascades in the springtime, battering, knocking loose the land and flooding her breath."

The allopathic diagnosis had been "congenital heart disease", an "interventricular septal defect, with resultant heart failure". To Dr. Selzer, who was used to the worldview, technique, and jargon of his profession, the Tibetan diagnosis seemed remarkably poetic. Dr. Selzer described this diagnosis as a largely divine mystical experience accessible to priests but not to mere doctors.1 Interest, fascination, and perhaps even respect were engendered, but little understanding between the doctors seems to develop. In fact, what Dr. Donden was doing was not magic. He was doing what is expected of a properly trained Tibetan physician, albeit at its highest level.