Diagnosis In Tibetan Medicine-Like A Rich Man With One Child

By Eliot Tokar

In describing how he worked as a physician, my teacher, Dr. Trogawa Rinpoche,2 remarked: "my external activity is the practice of medicine, and in my inner thoughts I meditate on the Medicine Buddha". This comment does not simply tell us that Dr. Trogawa is a religious or pious man. Properly understood, this remark displays the first step in the process and practice of Tibetan medical diagnosis. It is an ongoing practice toward spiritual development and its resultant awareness and intention, toward which the physician continually strives. Given the differing levels of practice and development that exist among Tibetan doctors, there is no quantitatively prescribed standard for this aspect of medical practice. Still, the primary classic principle of Tibetan medical practice is that the bedrock of one's approach to diagnosis lies within the doctor's spiritual practice.

In describing the Tibetan approach to diagnosis it is vital to understand how the properly trained Tibetan doctor sees the world. After all, it is always within a doctor's subjective understanding of the nature of the phenomenal world that the relatively objective work of obtaining a diagnosis occurs. How, then, do Buddhist teachings determine the basis for making a clear diagnosis of illness?

Because the historical Buddha described his role and teaching in a fundamentally medical fashion, this connection is very direct. In fact, because the Buddha's teachings were meant to cure suffering, he was known as "The Supreme Physician".3 The Buddha is therefore a direct inspiration for Tibetan doctors, who attempt to emulate this model of a spiritually realized being who makes a conscious choice to cure others.

To appreciate how a particular medical system approaches diagnosis, one must discover how a doctor trained in that system perceives the patient. It is important to comprehend that doctor's conscious intention.

Buddhist teachings delineate Tibetan doctors' image of themselves and their patients as well as the doctor-patient relationship. Buddhism's central teachings and practices place great emphasis on (1) understanding and discovering the nature of one's mind, and thereby transcending ego; (2) developing a practice of compassion toward all other conscious beings; and (3) developing a sense of equanimity. Therefore, for the doctor of Tibetan medicine there is no psychological or professional dilemma in directly identifying with his or her patient -- as there can be, for instance, in Western medicine. In a sense, the Tibetan physician intentionally seeks to identify with the patient. It is important for us as physicians to intimately understand the basic nature of suffering -- both the patient's and the doctor's -- as well as to understand that our relationship to the patient has both a professional and spiritual significance.

Through spiritual practice the Tibetan doctor is trained to emulate a highly spiritually evolved person. A direct connection develops between the doctor's perception of the patient and a Bodhisattva's perception of all beings. The term "Bodhisattva" literally means "hero of enlightenment". Bodhisattvas are spiritual trainees who strive to generate an altruistic mind of love and compassion.4 They are basically Buddhas in the making who have dedicated their pursuit of spiritual awareness to the single goal of bringing about the welfare of all.

We can get a glimpse of the professional ethic Dr. Trogawa endeavors to practice in an instruction from the Buddhist sage Vimalakirti:

...I am ill because all sentient beings are ill. If the illness of all sentient beings were to come to an end, then my illness would be ended. Why is this so? Because when the Bodhisattva enters into the realm of birth and death for the sake of beings, he becomes subject to the laws of this realm and thereupon becomes ill. If all sentient beings were to be cured of their diseases, then the Bodhisattva would never be ill again.

It is like the rich man who only has one child. When his child becomes ill, his parents become ill. If the son is cured of disease, so also are the parents. It is the same for the Bodhisattva: he loves all beings as if each of them were his child. When all beings are cured, then the Bodhisattva will be cured.... 3

Before seeing their first patient, Tibetan doctors practice an archetypal diagnosis that becomes a basis for all the diagnoses they will perform throughout life. This diagnosis is visualized in a meditation practice used by traditionally trained Tibetan doctors.

In this meditation physicians visualize the Buddha Of Medicine, seeing all beings before him, with their particular suffering and all of the innumerable diseases they may have. The Medicine Buddha feels anguish for them and wishes them freedom from suffering. Through the power of his realized mind, this Medicine Buddha diagnoses the illnesses as symptomatic of fundamental spiritual disharmony caused by ignorance. This ignorance is a lack of understanding of the basic nature of reality, as understood from the Buddhist perspective.

The resultant confusion leads to activities of our body and mind which directly or indirectly lead to suffering and illness. Given this diagnosis, the Medicine Buddha understands the temporary, illusory nature of illness. Pushing through his sense of anguish, he delves deeper into this and sees that within every atom of every being who appears as suffering, there exists a Medicine Buddha. He experiences inner joy in the knowledge that despite suffering, there is the potential for boundless happiness. Having completed his diagnosis, the Medicine Buddha projects a purifying energy from himself to those before him that reveals their inherently healthy state.5

At this point in the meditation, practitioners merge their own selves with the being of the Medicine Buddha and become indistinguishable from him. They then proceed to a state of meditative emptiness derived from the understanding of the Buddhist teachings. In relation to this emptiness, all the forms and concepts we occupy in life -- including illness -- are understood as illusory, dream-like and therefore highly changeable. Thus, it follows that illness is made worse or better by changes in the mental perception we give it.

The Medicine Buddha's profound diagnostic skills are derived from wisdom based on deep awareness and perception. These qualities, along with his resultant capacity to heal, makes him the role model for the physician of Tibetan medicine By visualizing themselves as Medicine Buddha, doctors of Tibetan medicine pursue an aspiration to develop the same capacity for compassion, awareness and skillfulness. This process is the root from which diagnostic skill develops. It is established even before the first patient walks in the door.