AN OVERVIEW OF HEALTH CARE IN THE TIBETAN MEDICAL TRADITION

Giorgos Halkias

paper tibetanmedicalpicIn Tibetan, medicine is called gSoba Rig-pa, the knowledge of healing. The core of the Tibetan Medical Tradition (TMT) is over 1200 years old, dating back to the times of a powerful Tibetan Empire that extended from Ganges to Samarkand, Turfan, and Tun-Huang. TMT received formative influences from Indian, Chinese, and Persian medicine, and according to records, the Tibetan Emperor Srong-bTsan sGam-po (617-698 CE) solicited the expertise of a physician from the Byzantine areas (Phrom) who was trained in the Greek medicine of Galen and later founded three medical lineages in Lhasa.1

Native Tibetan healing knowledge claimed veterinary science and folk-shamanic healing techniques, the latter being similar to those of other indigenous people who recognized and utilized in their surrounding resources (physical and social environments) an interplay of positive and negative agents affecting bodily health and mental well-being.  These folk-doctors were drawing knowledge and support from the physical elements, such as water, air, light, minerals, plants, animal products, and from a philosophical world-view that drew meaning in demonizing the `disease’ and psychologically empowering the ill person by soliciting divine intervention and performing healing rituals on the afflicted.

The origins of Tibetan medicine are attributed to Sakyamuni, the historical Buddha (ca. 6th century BCE). Hundreds of years after his passing away he is said to have manifested as Medicine Buddha and through his emanations taught the fundamental texts of the Tibetan medical corpus known as the Four Treatises (rGyud-bzhi). Contemporary efforts by TMT physicians have been to distance the medical canon from its divine origins; the reason being so that amendments to the orthodox medical corpus would not be viewed by suspicion from Buddhist theologians who hold the word of the Buddha to be infallible.

TMT continues to be practiced throughout the vast domain of the Tibetan cultural region. Tibetan medicines are prescribed today by many thousand Tibetan doctors who have been trained in recent decades in the Tibet Autonomous Region (TAR), Qinghai, Gansu, Yunnan, and Sichuan province. At least 10 cities in the People’s Republic of China (PRC) have TMT academic and clinical units, with 60 hospitals and over 30 pharmaceutical factories operating throughout the PRC and specially large-scale research, training, and production facilities in Lhasa and Beijing. Additional TMT colleges operate in India (Dharamsala, Darjeeling, Ladhak), Bhutan, and Mongolia (Buryiat). TMT has also spread to Europe and North America under the guidance of a small number of Tibetan refugee physicians while Tibetan herbal formulas have been available as pharmaceutical products in Europe since 1980.


THE MEDICAL CANON
‘The Four Secret Oral Tantras on the Eight Branches of the Essence of the Elixir of Immortality’ (bDud-rtsi sNying-po Yan-lag brGyad-pa gSang-ba Man-ngag gi rGyud-bzhi)  is TMT’s medical canon. Although a Sanskrit title of this text is given in the original Tibetan, modern philological studies show no evidence of it being a translation of a lost Sanskrit text.  Most likely, the FourTreatises is an original work of Tibetan authorship edited and supplemented by the court physician, and father of Tibetan Medicine, Yu-thog Yon-tan mGon-po (708-833 CE). The historical origins of the Treatises have been discussed elsewhere.2

The TMT medical canon is divided into: 1) the Root Treatise (rTza-rGyud) which is a synopsis of the principles, diagnoses and treatments in 6 chapters; 2) the Explanatory Treatise (bShad rGyud) which contains expanded theoretical teachings on the Root Treatise; 3) the Instructional Treatise (Man ngag rGyud) which contains applied medical teachings; and lastly, 4) Subsequent Treatise (Phyi-ma rGyud) devoted to the diagnostic and therapeutic activities of the physician. The Four Treatises cover the following eight branches of medicine with varying emphasis: a) 70 chapters on general medicine;  b) 3 chapters on paediatrics; c) 3 chapters on gynaecology and obstetrics; d) 5 chapters on disorders caused by harmful influences; e) 5 chapters on the treatment of wounds; f) 3 chapters on toxicology; g) 1 chapter on geriatrics; and h) 2 chapters on sexuality (reproductive/aphrodisiacs).

The Four Treatises, a large work of 156 chapters in toto, attracted many Tibetan medical exegetical texts and supplements over the centuries, the Vaidūyra mNgon-po (Blue Beryl) standing as one of its most famous commentaries. It is beyond the scope of this article to describe the TMT canon in detail. It suffices to say that nowadays it takes a minimum of seven years of studying and training in it before a medical student is qualified to practice as a TMT physician. The Explanatory Treatise covers diverse subjects such as, embryology, pathology, conduct, diet, signs of death, characteristics and classifications of diseases, pharmacology, the attributes of a practicing physician, etc. The Instructional Treatise, by far the most extensive of the Treatises, is divided into 92 chapters and lays the framework of the primary and secondary pathological causes of disease, its classification, its diagnosis, medication and the course of treatment to be followed. Here we find treatments for poisoning, indigestion, tumours, dropsy, epidemic fever, small pox, colitis, muscle inflammation, cardiac, pulmonary, hepatic, spleen, stomach, genital and intestinal disorders, anorexia, diabetes, gout, nerve disorders, insanity, epilepsy, wounds,  etc.  Lastly, the Subsequent Treatise provides a lucid exposition of the practical techniques which are to be applied in 4 parts: methods of diagnosis; the compounding of medications which cure ailments; cathartic procedures; and external therapies, such as acupuncture and moxibustion.3 

PATHOGENESIS
In the opening lines of the second chapter of the Four Treatises we read:

At that time of that life the Teacher (Sakyamuni), the Surpassing Conqueror, the Sustainer of Life, the Priest of Medicine, the King of Beryl Light entered into the meditative state called the ‘King of Medicine which Pacifies the Four Hundred and Four illnesses.’

Immediately upon his entering into equanimity the emanation of as many as one hundred thousand coloured rays from his heart-centre to the ten directions removed the faults of the defects in the minds of all sentient beings, the migrators of the ten directions.

After having pacified all the illnesses of the three poisons (lust, anger, confusion) which arise from delusion, having gathered the light rays back to his heart-centre, an emanated teacher, a seer, one called Primordial-Wisdom-of-Awareness, having been projected from the Buddha’s heart, having appeared and settled in the space in front of the Medicine Buddha addressed the retinues of seers with these words:

’Ho! Friends know this!

Whoever desires to remain without illness and whoever desires to heal illness ought to learn the oral instructions of the knowledge of healing.

Whoever desires an interval of long life should learn the oral instructions of the knowledge of healing.

Whoever desires to accomplish Dharma, prosperity and happiness, should learn the oral instructions on the knowledge of healing.

Whoever desires to liberate any migrator from the misery of illness, and whoever desires to be carried with respect from others, ought to learn the oral instructions of the knowledge of healing.4

According to the Buddhist tradition, Prince Siddhartha (later to become Sakyamuni Buddha) abandoned a sheltered life of comfort in search of a higher understanding upon the shock and despair he felt at the sight of a sick person, an old feeble man, and then a stiff corpse lying on a funeral procession. The healing process as a dominant Buddhist metaphor for spiritual development goes back to the times of early Buddhism when monk-physicians employed their healing powers and knowledge as means of popularizing the Buddhist teachings and converting non-believers. In Tibet, the preservation and development of medical literature, pharmacology and clinical practice did not take place entirely within Tibetan monastic contexts. They were systematically included in them at least from the seventeenth-century onwards.5

TMT is a holistic healing system that employs several complimentary and semi-autonomous interpretive layers for classifying illness, offering diagnosis, and prescribing treatments. At the deeper metapsychological layer it locates the manifestation of all illness in the motility of consciousness. A migrating mind-stream is one that is not fully awakened but inhabits and attaches itself to mental-states that are by their nature fragmentary and transient. Man suffers in his present embodiment by failing to recognize his own insubstantiality and that of all dependent-arising phenomena. Caught up chasing after or withdrawing from his own delusive projections of a self-grasping reality he misses to abide in his own nature of mind which is a piercing, stainless and unobstructed awareness.

Buddhism maintains that the most profound healing process is spiritual healing which in effect means the elimination of three toxic states of mind (dug-gSum), namely, the three poisons of lust, anger and confusion. These destabilizing mental-states, if prolonged,  they give rise to a systemic pollution that expresses itself in three kinds of health disorders. These disorders are explained as a disruption of the three nyes-pa. In TMT, physiology and psychopathology are discussed within the apparatus of a single unitary theory of pathomechanics.6 Tibetan medical theory correlates Buddhist metapsychology with pathogenesis and explains illness as a disequilibrium of the three nyes-pa, namely, irregular presence of wind (rLung), bile (mKhris-pa) and phlegm (Bad-kan) affecting the physical body and its subtle counterpart, the body-without-organsShort-term causes of nyes-pa imbalance are attributed to time and season, the influence of disruptive spirits, improper diet, and inappropriate behaviour.

The nyes-pa
The term nyes-pa has been translated, in Galenic fashion, as the humors wind, bile and phlegm. It should be noted, that nyes-pa is a TMT diagnostic matrix that has no exact Western equivalent. In Tibetan medical literature nyes-pa do function as humors in that they ‘may be blocked or constricted in their flowing, are accumulated and discharged, and may be deficient or excessive in quantity’. rLung (wind), the first of the nyes-pa, is the ‘insubstantial agent of all physiological movement.’7 For this reason it is often described in terms of movement, lightness and breath and is linked with functions such as, respiration, urination, defecation, ejaculation, burping, menstruation, speech and mental concentration. mKhris-pa (bile), which is not the bile which comes from our gall bladder, has the qualities of fire and is generally associated with metabolism, digestion and body-heat. mKhris-pa is said to be responsible for hunger, thirst, digestion, and vision. Bad-kan (phlegm) is explained in terms of restraint and moistness.  It is responsible for regulating body fluids, the six tastes of sweet, sour, salty, bitter, astringent and acrid, the satisfaction of the five senses, and the smooth operation of the body’s joints.

The body-without-organs
In TMT clinical practice there are 25 constituents of the body. These include the seven tissues: chyme, blood, flesh, fat, bone, marrow, and semen; the three excrements of urine, faeces and sweat, and the five sub-types of each of the three nyes-pa, each coordinating a different set of physiological functions. There are five principal organs: heart, lungs, spleen-pancreas, liver and kidneys. And also the six vessel organs: large and small intestines, stomach, gall bladder, urinary bladder and seminal vesicles (gonads and ovaries).

In addition to this anatomical typology, which relates to the Western medical tradition, TMT and other Asian health-care systems utilize in their diagnosis and treatment a subtle body which is said to be localized inside the physical body and is in dynamic relation with all mental and physiological activities. This body-without-organs has no clear counterpart in Western medicine. It is permeated by 84,000 channels of varying size and density  – their paths coincide with those of many blood vessels and nerve fibres, often following the same course or winding around them. They are divided into 4 main varieties: 1) channels of formation which develop from the navel of the foetus; 2) channels of existence which intersect the brain, heart, navel and genitals; 3) connecting channels that relate to Western medicine’s circulatory system and peripheral nervous system; and 4) life-protecting channels.8

The body-without-organs also contains energy-wheels (’khor-lo) that closely correspond to thechakra system in Buddhist and Hindu tantric yogic traditions. These energy-wheels are explained as psychophysiological centres arrayed along the central axis of the body just forward of the spiral column. Each centre coordinates a different aspect of bodily and/or mental operation through one of the five sub-types of energy-currents that traverse it. The five seminal energy-wheels are located at the forehead, throat region, heart region, upper abdomen, and central pelvis. Just as imbalances of nyes-pa can be detected in any of the regions of the gross anatomy, in the organs and tissues, they can also be diagnosed across the body-without-organs. In this respect, illness is recognized as a disruption of the energy flows across an extensive psychophysical network of main and secondary subtle channels and coordinating energy centres.


DIAGNOSIS
According to  TMT’s medical canon, a physician has  38 methods of diagnosis at his disposal. These are divided into visual diagnosis, sphygmology, and interrogation.  Six methods of visual diagnosis consist of checking all parts of the body with special attention paid to the condition of the patient’s tongue and urine sample. Analysis of the urine involves checking for colour, steam and sediment. Dr. Tsarong explains:

The balanced and healthy urine has a clear whitish-yellow colour. Its steam is of sufficient quantity and duration, and when stirred vigorously with a stick, medium-sized bubbles appear. When the steam evaporates, it disappears concentrically from the peripheral to the centre. The urine sediments are light and properly diffused. 9

TMT sphygmology is a complex science that involves knowledge of the Tibetan calendar (for seasonal pulse changes), thorough training, and intuition. Its origins probably go back to the famous Chinese physician Pien-chueh (5th century BCE) who is said to have discovered the diagnostic implications of the pulse.  The TMT physician ‘roughly measures the length of the patient’s distal phalanx of the thumb from the first wrinkle of the wrist and then places his index, medius, and ring fingers on the arteria radialis’ and proceeds to ‘correctly identify the patient’s connatural pulse.’10  The connatural pulse is classified, regardless the anatomical gender of the patient, as either male, female, or neuter and by its distinct pulsation the physician may correlate the type of nyes-pa imbalance the patient is suffering from.11 

Interrogation forms an important clinical aspect of the overall diagnosis. The TMT doctor determines the type of illness and its treatment in a private QA session. Usually, 29 standard questions suffice to determine the site of the illness and recognize the causative factors of the disorder. Studying the signs and symptoms of disease involves the doctor asking the patient directly about his illness, diet, lifestyle, and mental well-being. For example, a patient suffering from rLung (wind) disorder may experience cold chills, dullness of the senses, pain especially in the hips, waist, bones and joints.


TREATMENT

Generally, there are many methods of treatment that may be prescribed by TMT physicians. Faithful to the principles of viewing the human body as a delicate state of dynamic equilibrium between mental and physical operations,  TMT therapies are effective over time and are divided below from the mildest form of intervention to the most extreme. Often a combination of the following treatments is prescribed.

1. Dietary Therapy.  Three chapters in the Four Treatises are devoted to this simple, yet effective form of medical intervention often neglected by Western medical practice.  In TMT, specific advise is given on proper dietary regiments to aid the healing process. The consumption of grains, oils, meats, and beverages have been studied to possess inherent properties that in different seasons, climate, quantities, and in relation to different body constitutions, may offset or aid the organism towards recovery. Likewise, in TMT prognostication there is a causal relationship between improper dietary habits and several nyes-pa disorders.

2. Lifestyle Therapy.  A majority of health problems can be directly or indirectly linked to mental and emotional factors, behavioural patterns, relationship-formations, and repressing habits. Examples of these include alcoholism, obesity, anxiety, mental disorders, hypertension, and heart disease. TMT physicians do not consider medication as the first option of therapeutic intervention. Advise on the patient’s behaviour and lifestyle is essential for treatment and prevention of future ailments. In Buddhist philosophy and psychology all illnesses have a corresponding mental reality. By reducing our mental afflictions we can participate in an enlightened lifestyle. Contemplation, compassion towards our surroundings, reducing attachment and anger, and sustaining joy towards life, are some immediate ways to take control of our daily psychophysical states. Lifestyle therapy is about healing the mind-body organism not just of the symptoms but of the underlying causes of disorder.  It is also about learning to cope with understanding while in dis-ease.

3. Pharmacological Intervention. A large part of Tibetan medical literature is dedicated to pharmacology. Unfortunately, no comprehensive studies in Western languages exist, possibly to the difficulty of determining Latin or Greek equivalents of these TMT agents to be found mainly in Tibet, adjacent Himalayan regions, and in parts of China. For Dr. Tsarong,12 the most well known systematic work for a Tibetan Materia Medica is the Dri-med Shel-gong Shal-phrengwritten by Geshe Tenzing Phuntsog in 1717 CE. In it are enumerated 2,294 main raw drugs classified below according to their source and pharmacodynamic utility:

Source Classification:                                                          Pharmacodynamic Properties:

1. Precious stones, (Rin-po-che) e.g., turquoise; anti-toxin, hepatic, phlogistic

2. Rocks and Minerals, (rDo), e.g., serpentine; constipative, febrifuge

3. Soil and Minerals, (Sa), e.g., sulphur; haemostatic (esp., nose)

4. Trees, (Shing), e.g., Santalum album Linnfebrifuge (heart & liver)

5. Mucilaginous, (rTsi), e.g., musk;anti-toxin, nephritic, vermifuge

6. Shrubs, (Thang), e.g., Glycyrrhiza glabra Linn; antitussive, expectorant

7. Plants, (Ngo), e.g., Picrorhiza kurroa Royle; hepatic, coagulant, febrifuge

TMT physicians possess specialized training in collecting these pharmaceutical agents from nature. In their time-consuming preparation, as medications to be administered, they vary from decoctions, powders, general pills, precious-substance pills, butter, and syrups.

4. Accessory Therapies. Many disorders require additional medical intervention. These are divided into mild and drastic measures. Among mild measures, treatment with gentle massages using various medicinal oils is suggested for diseases of the nerves and muscles, as well as pain and insomnia. Likewise, medicinal and natural spring baths are recommended to treat an assortment of skin disorders as well as, chronic arthritis, gout, rheumatism, and stiffness of the extremities. Many disorders, caused by proliferation of bad blood are treated by bloodletting at one of the body’s seventy-seven bloodletting points. Venesection, cupping, moxibustion, and golden-needle therapy are considered more drastic and may be used to stimulate the energy flows across the body-without-organs.  Surgery is usually discouraged, yet it may be approved in minor forms for removing foreign bodies, cauterizing abscesses, curetting of severely damaged tissues, etc, and as last resort treatment.13

CLOSING REMARKS
TMT is a multifaceted and subtle traditional healing system and a comprehensive discussion of its health-care system is beyond the scope of this paper. I have considered some aspects of the tradition which I recognized as integral for any basic understanding of the subject. First, I gave an overture on TMT origins and present status. Second, I introduced its medical canon. Third, I sketched the aetiology of illness from a Tibetan Buddhist perspective. Fourth, I disclosed some of its diagnostic methods. And lastly, I enumerated different treatments available. I am aware at taking the risk of oversimplifying a potentially more intricate medical system and at worse, misrepresenting it in the process. I am not a TMT physician, nor have I been trained in the Tibetan healing system, and for the writing of this article I had to rely on my personal experience with Tibetan medicine and religion, a substantial bibliography on the subject, and the resources at the Tibetan Medical College in Dharamsala, India.

Although a systematic research by Western medical scientists is still lacking to determine the efficacy of TMT’s pharmaceutical regimes, there has been much research carried out in Lhasa, for example on the Tibetan king of herbs (rhodiola) growing on rocky slopes at 3,500-5,000 meters. The Tibet Institute of High Altitude Biology has conducted extensive research on this herb of the Crassulaceae family, confirming that it is of benefit as an adaptogen with specific use against mountain sickness. A capsule with rhodiola and hippophae (plus lycium fruit) is produced by one factory in the PRC and is promoted as a treatment for altitude sickness.14  

Despite what may be the future outcomes of Western evaluation research on TMT traditional methods of treatment, in my opinion, there are many benefits in pursuing research in ethnomedicine and ethnopharmacy, as well as, in the individual and collective efforts of health-care specialists to utilize healing technologies across Eastern and Western health-care systems. For example, TMT even though is lacking in advanced surgery techniques and pharmacobiology, it might have much to offer in the field of holistic psychopathology, mental disorders, patient-doctor relationships, and in the patient’s own understanding of his illness as a contributing factor to recovery. In the words of a TMT specialist, Dr. Lobsang Rapgay:

Change is inevitable because it is the law of nature for all things to undergo transformation, and this is true of every aspect of existence. And yet in medicine, it would be wishful thinking to even imagine that any system can replace the Western orthodox system of medicine, for after all it is the only system that is universally recognized. At this stage, the scope of systems like the Tibetan one is to identify areas like psychiatry, doctor-patient relationships, the way to care for a patient, treatment and ways to handle terminal patients, and so on, and see how its own traditional methods can be modified to possibly serve as adjunctive methods of therapy in the practice of Western medicine.15


REFERENCES
1. Beckwith, I. C. ‘The Introduction of Greek Medicine into Tibet in the Seventh and Eighth Centuries.’Journal of the American Oriental Society, 99/2, 1979, 297-313.

2. Emmerick, R.E.. ‘Sources of the Rgyud-bźi.’ Zeitschrift der Morgenländischen Gesellschaft. Suppl. III/2,  1977, 1135-1136.

3. Tsering Dhondup, Dr. How to Study Tibetan Medicine: A Commentary on the Root Tantra. Tselha Dolmaling Institute, Kangra, 2003, 33-37.

4. Based on the translation by Jacobson, E. Situated Knowledge in Classical Tibetan Medicine: Psychiatric Aspects. (PhD thesis), Harvard University, Cambridge, 2000,

93-95.

5. Ibid., 71.

6. Ibid.,154.

7. Ibid.

8. This typology of channels is summarized from Clark’s  translation of the first two volumes of the Four Treatises, Clark, B. The Quintessence Tantras of Tibetan Medicine.: Snowlion Publications, Ithaca, 1995; and discussed in Jacobson, E. Situated Knowledge in Classical Tibetan Medicine: Psychiatric Aspects. (PhD thesis), Harvard University, Cambridge, 2000, 161-162.

9. T.J. Tsarong (ed). Fundamentals of Tibetan Medicine According to the Rgyud-Bzhi. Tibetan Medical Centre, Dharamsala 1995, 17.

10. Ibid., 20-21.

11. Donden Yeshi,  ‘Pulse Diagnosis in Tibetan Medicine.’ Tibetan Medicine Series No. 1, Library of Tibetan Works and Archives, Dharamsala, 1980, 13-19; Rapgay Lobsang, ‘Pulse Analysis in Tibetan Medicine.’Tibetan Medicine Series, No. 3,  Library of Tibetan Works and Archives, Dharamsala, 1981, 45-52.

12.  T.J. Tsarong (ed). Fundamentals of Tibetan Medicine According to the Rgyud-Bzhi. Tibetan Medical Centre, Dharamsala 1995, 38.

13. Burang, T. The Tibetan Art of Healing. Robinson & Watkins Books Ltd., London, 1974.

14. Subhuti Dharmananda, (PhD, Director), ‘Tibetan Herbal Medicine with examples of treating lung diseases using rhodiola and hippophae.’ Institute for Traditional Medicine, Portland, Oregon, 2001. Article available at: www.itmoline.org/arts/tibherbs.htm

15.Interview for Vajradhatu Sun. ‘Mind Made Health – A Tibetan Perspective,’ August 1983.


FURTHER READING
Tibetan Authors (in English):

Dawa Norbu. An Introduction to Tibetan Medicine. Tibetan Review, Delhi, 1976.

Lobsang Dolma Khangkar, (Dr.) Lectures on Tibetan Medicine. Library of Tibetan Works and Archives, Dharamsala, 1998.

Rechung Rimpoche. Tibetan Medicine Illustrated in Original Texts. Welcome Institute of the History of Medicine, London, 1973.

__________. Tibetan Medicine. University of California Press, Berkeley, 1976.

Thondup, Tulku. The Healing Power of Mind. Shambhala Publications, Boston, 1996.

T.J. Tsarong. Handbook of Traditional Tibetan Drugs. Tibetan Medical Publications, Kalimpong, 1986.

Tsewang Dolkar, (Dr.) Journey into the Mystery of Tibetan Medicine. Yarlung Publications, Delhi, 1990.

Yeshi Dhonden, (Dr.) The Ambrosia Heart Tantra. Library of Tibetan Works and Archives, Dharamsala, 1995.

__________. Introductory Lectures on Tibetan Medicine. Center for South Asian Studies, University of Virginia, manuscript translation, Charlottesville, 1981.


Other Authors:

Aschoff, J. and Rösing I. (eds). Tibetan Medicine: East Meets West – West Meets East. Proceedings of the International Symposium, University of Ulm, 1996.

Aschoff, J. Annotated Bibliography of Tibetan Medicine (1789-1995). Fabri Verlag, Ulm, 1996.

Asshauer, E. (M.D.) Heilkunst vom Dach der Welt, Tibets sanfte Medizin. Herder Freiburg, 1993.

Birnbaum, R. The Healing Buddha. Shambala Publications, Boulder, 1979.

Cai Jinfreng. `A Preliminary Study of the Early History of Tibetan Medicine.’ Journal of the History of Medicine, 10/1, 1980, 49-55.

Clifford, T. Tibetan Buddhist Medicine and Psychiatry. Samuel Weiser, York, 1984.

Dummer, T. Tibetan Medicine and Other Holistic Health-care Systems. Routledge, London, 1988.

Epstein M and Rapgay L. ‘Mind and Mental Disorders in Tibetan Medicine’. Tibetan Review, 7-15, 1982.

Finckh, E. (M.D.) Studies in Tibetan Medicine.: Snow Lion Publications, Ithaca, 1988.

__________. Fundamentos da Medicina Tibetana. Editora Chakpori, Brazil, 1985.

Guo Jiening, et al., ‘Tibetan Medicine: Historical Development and Theoretical System.’ Chinese Journal of Ethnomedicine and Ethnopharmacy, 1995; (14): 1-5.

Janes, C. ‘The Transformations of Tibetan Medicine.’ Medical Anthropology Quarterly, 1995, 9/1: 6-39.

Matzner, Y.; Sallon, S. ‘The effect of Padma 28, a traditional Tibetan herbal preperation, on human neutrophil function. Journal of Clinical & Laboratory Immunology 46, 1995, 13-23.

Meyer, F. Gso-Ba Rig-pa. Le système médical tibétain.: Centre National de la Recherche Scietntifique, Paris, 1981.

Ryan, M. ‘Efficacy of the Tibetan treatment for Arthritis.’ Social Science and Medicine, 44/4, 1997, 535-539.

Parfionovitch, Y.; Gyurme Dorje; and Mayer, F. (eds). Tibetan Medical Paintings. Two volumes. Serindia Publications, London, 1992.

Semichov, B. V. ‘Tibetan Medicine in BMASSR.’ Newsletter of Ethnology, 5-6, 1932.

Smulski, H.; Wojcicki, J. ‘Placebo-controlled double-blind study to investigate the efficacy of the Tibetan plant preparation PADMA 28 in the treatment intermittent claudication.’ Forschende Komplementärmedizin 1, 1994, 18-26.

Vaidya B. D. Materia Medica of Tibetan Medicine. Sri-Satguru Publications, Delhi, 1994.

Zysk, K.G. Asceticism &Healing in Ancient India: Medicine in the Buddhist Monastery. Oxford University Press, Oxford, 1991.