FourTantras

ThebasictextofTibetanMedicine

TheFourTantras
ThebasictextofTibetanMedicineiscalledthe"Four
Tantras"andwastaughtbyBuddhahimself.AllTibetan
physiciansstudyit.
Tantrameans"lineage".Itiscomposedoffourbooks:
TheFirstTantraiscalled"RootTantra"andit
containsverybrieflyanexplanationofalldiseases.It
islikeaseed.
TheSecondTantra,composedof31chapters,is
called"ExplanatoryTantra".Itexplainsallaboutthe
anatomyandphysiologyofourbodytheprocessof
birthanddying.
TheThirdTantra,composedof92chapters,iscalled
"OralTransmissionsTantra"anddealswiththecause,
thenature,thetreatmentofdiseasesandtheir
classification.
TheFourthTantra,composedof25chapters,is
called"LastTantra"anditexplainsthe18methodsof
diagnosis,pharmacologyandsupport,orexternal
treatments.

Theentiretextincludes156chapters.
BuddhagavetheteachingsoftheFourTantrasinBenares
(Varanasi,India)whenhewas71yearsold.Hegavethem
inordertobenefitsentientbeings,nottoallowdoctorsto
becomerich.
Forthisreason,TibetanMedicinestressestheattitudea
physicianshouldhave.Inthepast,inIndiaandTibet,
doctorswouldnotpresentthepatientwithafee.Patients
wouldsimplygiveanofferingandiftheydidnot,the
doctorwouldnotcomplainhismaingoalwasthepractice.
ThemotivationsthatbringpeopletostudytheFour
Tantrasarediverse:tobehealthyandlivealonglifeto
practicethespiritualpathtoaccumulaterichnesstobe
happy.
Thosewhostudythistexttobecomerichhaveawrong
motivationandmisunderstandthemaingoal,thatis,to
benefitothers.
ThetextbeginswithaphraseinSanskrit:Amritahridaya
anghaashtaguhyaupadeshatantranama.Amritahridaya
means:"theessenceofimmortality".Itindicatesthatthe
FourTantrasareliketheamrita,thenectarofimmortality.
Ifwedrinkamrita,orifwestudyandfollowthese
teachings,webecomeimmortal.InSanskritamritameans:
"immortalitynectar"hridayameans:"essence".
Anghameans:"branches",ashtameans:"eight"eight
branches.Guyaupadeshameans:"secretoral
transmission",anoralinstructionthatisnottaughtin
public,instead,itistaughtonlytowhomistrulyinterested
andwishestolearn.Whoeverreceivestheseteachingshas
tokeepthemsecret.
ThisintroductiontoTibetanMedicinefollowsthemedical
thangka(painting)ofthemedicinetree(seepictureabove).
Thefirstmedicalthangkasdatebacktothetimeofthe
FifthDalaiLama.DesiSangyeGyatsowasagreatmaster
andheconceived80medicalthangkasinordertooffer
someclearandimmediatelyunderstandableoutlinesof

TibetanMedicineaswellastoallowilliteratepeopleto
studymedicine.

Themedicinetree
Themedicinetreehastwomainbranches:theleftoneis
thebranchofhealththeright,thebranchofdisease.
Atthebasisofthegeneraltheory,wecometothethree
humours:wind,bileandphlegm.Thesethreehumours
existinallofus,whetherwebehealthyorsick.Thecause
oftheirexistencearethethreepoisons:hatred,attachment
andignorance.
Thethreementalpoisonsaretherootsofthethree
humoursandthethreehumoursarethefruitofthethree
mentalpoisons.
Inthemedicinetree,blueisthecolourforwind,yellowfor
bileandgreenforphlegm.Insideourbody,thereare7
constituentsand3excretions.Theessenceoffood,when
transformed,producestheseconstituents.Wasteis
expelledthroughthethreeexcretions.Whenthissystem
workswell,weareingoodhealth.Thenumberofchakras,
three,five,nineandsoon,variesaccordingtotheTantra
thatexplainsthem:eachTantrahasadifferentchakra
system.
IntheTibetanmedicalsystemweconsiderfive5chakras:
thechakraofthehead,throat,heart,navelandsecret
chakra(atthegenitalorgans).
Furthermore,wehave5typesofwind,5typesofbileand
5typesofphlegm.Wind,Bile,Phlegm
The5windsare:
1. Thelifesustainingwindthatresidesinthehead
chakra,governsthebodilyfunctionsandsustainslife.
Itisthewindthatpermitsactionssuchasbreathing,
swallowing,sneezingandspitting.
2. Theascendingwindthatresidesinthethroatchakra,
whosefunctionistoproducesoundwhenwetalk,
givesusapleasantappearance,makesusstrongand

activeandisresponsibleformemory.
3. Thepervasivewindthatresidesattheheartchakra,
pervadesthewholebodyandallowsforall
movements.
4. Thefirelikewindthatresidesinthenavelchakra,
allowsforthefunctioningoftheinternalorgans
(heart,liver,intestines...)itsmainfunctionisthe
digestion.Itdistinguishesthenutrientsfromthe
wastesinthefoodthatweeat.Thefinestpartofthe
foodthatweeatistransformedintoblood,bones,
musclesansoon(thesevenconstituents).Thiswind
allowsfortheprocessoftransformation.
5. Thedescendingwindthatresidesinthesecretchakra,
flowsinthebladder,intheintestinesandinthe
genitalorgansitsfunctionistoexpelsperm,menses
andurine.
The5bilesare:
1. Thedigestivebile.Ifyoudividethestomachinto
threeparts,thisbileresidesintheupper.Itsfunction
istorefineanddigestfoodandtostrengthensthe
otherfourbiles.
2. Thecolouringbilethatresidesintheliver,whose
functionistogivecolourtothepartsofthebody.
3. Theaccomplishingbilethatresidesintheheart,
whosefunctionistobringupthoughts,worries,
anxiety,angeretc.
4. Thesightbilethatresidesintheeyes,whosefunction
istoallowustosee.Ifitweakens,oursightalso
weakens.Whilethisbileishealthy,wehaveperfect
sight.
5. Thepigmentingbilethatresidesintheskin,whose
functionistocolourtheskin.Whenwehaveabile
sicknessourskinchangescolourandbecomesfirst
yellowthenblack.
The5phlegmsare:

1. Thesustainingphlegmthatresidesinthechest,
sustainsallotherfourphlegmsitsfunctionisto
moveallbodyfluids.
2. Thedecomposingphlegmthatresidesinthatpartof
thestomachwherethefoodisnotyetdigested,whose
functionistogrindallkindsoffoods.
3. Thetastingphlegmthatresidesinthetongue,helpsto
beawareoftastes.
4. Thesatisfyingphlegmthatproducesthesatisfaction
feelingresultingfromwhateverisgoodinlife.
5. Theconnectivephlegmthatresidesinthejoints,
allowsustomovethem.Whenitdoesnotfunction
wellweexperiencepainandjointproblems.
Tobeingoodhealthallthesehumourshavetobe
balanced.Whenahumourbecomesweakortoostrongit
createsunbalanceandtherefore,disease.

Constituentsandexcretions
Whenweeat,ourbodytransformsthefooduntilitforms
the7constituentsifweeatrichfoodthetransformationis
faster.Thefoodessencebecomesbloodfromtheblood
derivesflesh,fromthefleshfat,fromthefatbones,from
thebonesmarrowandfromthemarrowspermandovum.
The3mainexcretionsare:sweat,urineandfeces.We
have15humours,7constituentsand3excretions:inall,
25components.Ifthese25componentsworkwell,weare
healthyotherwise,webecomesick.
Inthemedicinetreearedepictedthreeanimals:the
rooster,thesnakeandthepig.Thesethreeanimals
symbolicallyrepresentthethreementalpoisons:the
roostersymbolisesattachment,thesnakehatredandthe
pigignorance.
Thethreementalpoisonsarethecauseofthediseasesof
thethreehumoursandofthethreehumoursthemselves.
Attachmentproduceswindhatredproducesbileand
ignoranceproducesphlegm.
Attachmentproduceswind:youwillnoticeitwhenyou

havelongsessionsofsexualactivity,withoutpausethe
nextdayyouwillfeelconfused,fullofairandwitha
headache.Thisisjustanexampleinfact,attachment
producesmanytypesofwind.
Hatredproducesbile:youcanclearlyseeitwhenyouget
veryangry.Yourbodytemperatureincreasesandyour
facebecomesred.Doctorsadvisetodrinkwatertocalm
down.
Ignoranceproducesphlegm.Whenphlegmincreaseswe
becomefat,lazy,slothful.Wefeellikedoingnothing,we
don'tevenfeellikeeating.

Imbalanceandillness
Nowwearegoingtoexplaintherightsideofthemedicine
tree,thepartonimbalanceandillness.Thethreemental
poisonsarethecausethatgeneratesthethreehumours,but
theyarealsotheprimarycauseofalltheillnesses.
Therefore,ifwewanttohealourselvesdeeply,wehaveto
treatourmentalpoisonstoo.Thisatthesubtlelevel.
Atthegrosslevel,thesicknessesarecausedbymany
factors,forexampletheclimate.Iftheclimateisunusual,
iftheseasonsarenotbalanced,itiseasiertobecomesick.
Forexample,coldweatherinsummerortoohotasummer
ortoocoldawinter.
Otherfactorsofdiseasearediet,behaviourandsoon.
Furthermoretherearemanymalignantspiritsthatcause
healthproblems.ManyWesternersdonotbelieveinspirits
butinTibetanMedicinewetalkaboutthem.
Wefallsickduetowrongdietforexample,whenthe
climateishotthebilehumourincreases:ifweeatalotof
meatanddrinkalotofwine(warmingfoods)thebile
humourincreasesevenmoreandwebecomeeasilysick.
Wefallillduetowrongbehaviour:forexample,ifwe
wearheavyclothesinsummerorifwestaynakedin
winter,whenitisverycold.

Localisationofthethreehumours

Phlegmdiseasesaffecttheupperpartofthebody.
Bilediseases,liverandkidneys.
Winddiseases,backandlowerpartofthebody.
Thephlegmhumour,whichisofthenatureofignorance,
residesinthebrain.Thisisthereasonwhyphlegm
diseasesaffecttheupperpartofthebody.
WhenTibetansbecomeangrytheybeattheirchest,
becauseangerresidesintheheartchakra.Angerisofthe
natureofhatred:whenwelosetemperourtemperature
increasesand,sinceheatisofbilenature,bileincreases.
Attachmentproduceswindwindresidesinthesecret
chakraandisproducedfromvariousattachments,like
attachmenttosexandsoon.
Thethreehumoursmoveinspecificplaces.Eachonehits
itsownterritory:forexample,biledoesnotaffectthefeet.

Wind
Ifwehaveastrongwinddisease,thefirsttroublewe
experimentispaininthebones.Thismeansthebonesare
awayofthewind.Asforthesenseorgans,thewindruns
throughtheears:therefore,withstrongwindproblemsears
willring.
Sometimesthetroubleissostrongthathearingis
hindered.Thewindalsogoesthroughtheskin:withstrong
windproblemstheskinflakesoff.Thefivevitalorgans
are:heart,liver,kidneys,lungs,spleen.Thewindruns
throughtheheartwithstrongwindproblemstheheart
suffersforexamplewecanhavestrongpalpitationsand
soon.
Thewindrunsalsointhecentral"vital"channelofthe
body.Theholloworgansare:wherethespermforms,
bladder,gallbladder,intestines(both),colon,stomach.
Thewindhumourrunsthroughtheholloworgans:witha
seriouswinddiseasewefeelinflatedatthelevelofthe
navel.Sothewindentersthebones,thentheears,theskin,
theheartandtheholloworgans.

Bile
Bileenterstheblood,thereforewhenwehavebile
problemstheveinsbecomethickerbecausetheblood
circulatesveryquicklyanditgetsverywarm.Bile
problemsmakeussweatverymuchwhenwesweatalot
itmeansthebilehumourisunbalanced.
Amongthesenseorgansbileresidesintheeyes:ahigh
bilemakestheeyesyellow.Vitalorgans:liver.Hollow
organs:intestines,gallbladder.Duetobileimbalancethe
eyesbecomeyellowandtheliverswells.

Phlegm
Phlegmcirculatesinmeat,bones,fat,sperm.Normallyan
imbalanceofthethreehumoursisdetectedinthefaeces
andtheurineseriousphlegmproblemsarewelldiagnosed
fromtheurine.
Whenphlegmbecomesunbalanced,wehavecatarrhfrom
thenoseandthetonguebecomethickandswollen.Phlegm
isfoundinthelungs,spleen,stomach,kidneys,bladder
andfeet.
Thethreehumoursdonotonlydividebodyzonesbutalso
thevarioustypesofenvironmentsandlifeages.

Divisionaccordingtoage
TibetanMedicineexplainsthatfrom0to16yearsoldwe
arechildrenfrom16to70,youngandafter70,old.
Oldageisthetimeoflifewhenwindhumourprevails.
Duetothisreason,winddiseaseshappensespecially
duringthisage.Childrenoryoungpeoplerarelysuffer
fromwinddisorders.Winddiseasescaughtatanoldage
aredifficulttoheal.
Youth:thisistheageinwhichbileprevails.Thereforebile
problemsaremoredifficulttocureandeasiertoget.
Childhoodisthephlegmageoflife:atthisagephlegm

problemsarethemostdifficulttocure.

Divisionaccordingtogeographicareasand
seasons
Thefirstdrawing(inthemedicinetree)representsa
mountainwithsnowandwind:thatmeansaverycoldand
windyplace.Thisplacehasthenatureofwind,wherewe
catchwinddiseases.
Theseconddrawingrepresentsahotdesert,likeRajasthan
inIndia.Hotplacesfavourbiledisorders.
Thethirdplaceisgreen,wetandrainy:aplacevery
conducivetophlegmdiseases.Thisistruebothforwarm
andwetandcoldandwetenvironments.Whatmattersis
thepresenceofmuchdampness.

Seasons
TheFourTantrasalsoexplainhowtheseasonsinfluence
thehumours.
Insummerwindproblemsmanifest:peoplefeelweak,
especiallyinthemorningandintheevening.
Bilemanifestsinautumn:itgetsworseduringthedayand
intheevening.
Phlegmmanifestsinspring,wheneverythingsprouts:
manypeoplesufferfromheartburns,asignofaphlegm
worsening.Especiallyintheeveningandatdawn.
Itisveryimportant,fordiagnosisandcure,totakeinto
considerationallthesefactors:age,geographicareaand
season.

Incurablediseasescausingdeath
Ourlifedependsonthreeconditions:vitalenergy,fortune
andkarma.Ifvitalenergy,fortuneandkarmaarenot
depletedwekeeponliving.Otherwisethereisnothingwe
cando,wehavetodie.
Ifoneoftheseconditionscomestoanendevenpositive

things,likeappropriatetreatments,cancausedeath.
Forexample,forapatientwithfeveritisnormallygoodto
drinkwater.But,ifoneofthethreelifesupportingcauses
ismissing,evenwatercanchangeintoapoisonandkill
thepatient.Thefavourablecausebecomesunfavourable
andprovokesdeath.
Thepictureoftheburninghouserepresentsapoisoned
patientthatnobodycanhelp:forhimeventreatments
becomepoison.Anotherpictureshowsabrokencentral
channel,orshushuma.Thistooisacauseofcertaindeath:
thecentralchannelcannotberepaired.Evenafevertoo
highisacauseofcertaindeath.Andwindproblems,when
theybecomeveryserious.
Whenweareveryweaknomedicinecanhelpourbodyis
notabletoassumemedicinesandthereforewedie.
Thenwehave"changeable"incurablediseases.
Forexample,thediseaseappearsasabileproblemandso
itreceivesabiletreatmentbut,duringthecureorshortly
after,itmanifestsasawindorphlegmdiseaseandsoon.
Thesearethechangeablediseases.

Diseasescausedbyspirits
Diseasesprovokedbyspiritscanmanifestindifferent
waysbuttheyhaveonethingincommon:theyarenot
curablebymedicine.
WeneedtogoandseeaLamawhowillmakeamo
(divination),orsomethinglikethat,todiscovertheorigin
oftheproblem.
Afterthathewillprescribesomeritual.Onlyafterthe
ritualhasbeenperformedandthespiritsexorcisedthe
patientcanstarttakingmedicines.
Infact,themedicinebecomeusefulonlyafterthespirit
hasleft.Itmayalsohappenthatasickpeoplereceivesa
visitorfromfarawayandwhenthevisitordepartshegets
worse.Thismeansthatthevisitorwasfollowedbyspirits
thatdamagedthepatient.
Whenweareborn5differentspiritsarebornwithus

whichwillaccompanyusthroughoutourlife.
Wehavealsoathingcalledla,ourvitalenergy.Inthe
worldexistsomespirits,theDon,thatcanstealthelafrom
averyweakperson.Fromthenonthediseasegetsworse
andifthelaisnotrecovered,thepatientwilldie.There
existsomespecialpujas(ceremonies)torecoverthela.

Karmicdiseases
Karmicdiseasesareduetonegativeactionscommittedin
ourpastlives.Theyarenotcurablebymedicine.Likewith
thediseasescausedbyspirits,theonlychanceistogotoa
Lamaandasktherightpurificationpractice,forexample
the"100000prostrations".
InTibetmanytimespeoplethatwereconsideredincurable
afterthesepracticewerehealed.Unfortunately,itisnot
alwayspossibletoescapetheconsequencesofa
particularlyheavykarma.Sometime,nocureexists.

Types
Aswehaveseen,inTibetanMedicinetherearethree
humours.Whenweareborn,forkarmicreasons,
hereditarinessandsoon,wecanhaveaconstitutionmore
connectedtoonehumourthantotheothers.
Veryrarelywehavepuretypesorthebalanced
combinationofthethreehumours.Morefrequentlywe
havethecombinationoftwohumours(oneofthetwo
stronger).Sowecanhavewindbiletypesorbilephlegm
typesandsoon.
Howtorecognisethetypes:
Lungtype:lean,bent,withabluish,dryskindry
hairverytalkative.Itcannotbearthecold(heis
alwayslookingforwarmplaces).Heisagreatwalker
butgetseasilytired.Heisveryreactive.

Biletype:alwaysthirstyandhungrybutnot
necessarilyfat.Hairisblondeandtheskinyellowish.
Veryintelligent.Heisalsoveryproudandarrogant
andbecomeseasilyangry.Phlegmtype:basicallyfat,
withwhitecomplexion.Hisskiniscold.Heisalways
stickingouthischest.Hehaslittleappetite.Heis
verypatientandslow.
Thephlegmtypepersonisveryluckythebiletype
comessecondandthewindtypeisthelessluckyof
thethree.Alsofromthepointofviewoflifespan,the
phlegmtypehasthelongestlifethebiletypecomes
secondandthewindtypelast.Thisisthenatureof
thethreehumours.

Howtorecognisethetypeinachild
Withsmallchildrenphlegmnatureprevailsbutagood
Tibetandoctorcanstillrecognisetheirtype.

Howtoprolonglife
Thereisamethodtoprolonglife:bysavingthelifeof
manybeingsindanger.
Forexample,bybuyingandtheletfreeanimalsthatare
goingtobekilled.InIndiapeoplegotofishermen,buy
fishesandletthemfree.Savingthelifeoflivingbeingsis
thebestmethodtoprolonglife.Thisbehaviourisfollowed
bothbyBuddhistsandbyHindus.
AlsotheNagpoGutuppill,whichismadeof9substances
andcontainsmanyblessings,fromthepointofviewof
TibetanMedicinehasthepotencyofprolonglifeand
makesusmorehappy.

(lastrevision:August2001)