The Four Tantras
The basic text
of Tibetan Medicine is called the "Four Tantras" and was taught by
Buddha himself. All Tibetan physicians study it.
"lineage". It is composed of four books:
- The First Tantra is called "Root Tantra" and it
contains very briefly an explanation of all diseases. It is like a
The Second Tantra, composed of 31 chapters, is
called "Explanatory Tantra". It explains all about the anatomy and
physiology of our body; the process of birth and dying.
Third Tantra, composed of 92 chapters, is called "Oral
Transmissions Tantra" and deals with the cause, the nature, the
treatment of diseases and their classification.
Tantra, composed of 25 chapters, is called "Last Tantra" and
it explains the 18 methods of diagnosis, pharmacology and support,
or external treatments.
The entire text includes 156
Buddha gave the teachings of the Four Tantras in
Benares (Varanasi, India) when he was 71 years old. He gave them in
order to benefit sentient beings, not to allow doctors to become
For this reason, Tibetan Medicine stresses the attitude a
physician should have. In the past, in India and Tibet, doctors
would not present the patient with a fee. Patients would simply give
an offering and if they did not, the doctor would not complain; his
main goal was the practice.
The motivations that bring people to
study the Four Tantras are diverse: to be healthy and live a long
life; to practice the spiritual path; to accumulate richness; to be
Those who study this text to become rich have a wrong
motivation and misunderstand the main goal, that is, to benefit
The text begins with a phrase in Sanskrit: Amrita
hridaya angha ashta guhya upadesha tantra nama. Amrita hridaya
means: "the essence of immortality". It indicates that the Four
Tantras are like the amrita, the nectar of immortality. If we drink
amrita, or if we study and follow these teachings, we become
immortal. In Sanskrit amrita means: "immortality nectar"; hridaya
means: "essence". Anghameans: "branches", ashta means: "eight";
eight branches. Guya upadesha means: "secret oral transmission", an
oral instruction that is not taught in public, instead, it is taught
only to whom is truly interested and wishes to learn. Whoever
receives these teachings has to keep them secret.
introduction to Tibetan Medicine follows the medical thangka
(painting) of the medicine tree (see picture above). The first
medical thangkas date back to the time of the Fifth Dalai Lama. Desi
Sangye Gyatso was a great master and he conceived 80 medical
thangkas in order to offer some clear and immediately understandable
outlines of Tibetan Medicine as well as to allow illiterate people
to study medicine. The medicine
The medicine tree has two main branches: the
left one is the branch of health; the right, the branch of disease.
At the basis of the general theory, we come to the three
humours: wind, bile and phlegm. These three humours exist in all of
us, whether we be healthy or sick. The cause of their existence are
the three poisons: hatred, attachment and ignorance.
mental poisons are the roots of the three humours and the three
humours are the fruit of the three mental poisons.
medicine tree, blue is the colour for wind, yellow for bile and
green for phlegm. Inside our body, there are 7 constituents and 3
excretions. The essence of food, when transformed, produces these
constituents. Waste is expelled through the three excretions. When
this system works well, we are in good health. The number of
chakras, three, five, nine and so on, varies according to the Tantra
that explains them: each Tantra has a different chakra system.
In the Tibetan medical system we consider five 5 chakras: the
chakra of the head, throat, heart , navel and secret chakra (at the
Furthermore, we have 5 types of wind, 5 types
of bile and 5 types of phlegm. Wind, Bile, Phlegm
The 5 winds
- The life-sustaining wind that resides in the head chakra,
governs the bodily functions and sustains life. It is the wind
that permits actions such as breathing, swallowing, sneezing and
- The ascending wind that resides in the throat chakra, whose
function is to produce sound when we talk, gives us a pleasant
appearance, makes us strong and active and is responsible for
- The pervasive wind that resides at the heart chakra, pervades
the whole body and allows for all movements.
- The fire-like wind that resides in the navel chakra, allows
for the functioning of the internal organs (heart, liver,
intestines...); its main function is the digestion. It
distinguishes the nutrients from the wastes in the food that we
eat. The finest part of the food that we eat is transformed into
blood, bones, muscles an so on (the seven constituents). This wind
allows for the process of transformation.
- The descending wind that resides in the secret chakra, flows
in the bladder, in the intestines and in the genital organs; its
function is to expel sperm, menses and urine.
The 5 biles
- The digestive bile. If you divide the stomach into three
parts, this bile resides in the upper. Its function is to refine
and digest food and to strengthens the other four biles.
- The colouring bile that resides in the liver, whose function
is to give colour to the parts of the body.
- The accomplishing bile that resides in the heart, whose
function is to bring up thoughts, worries, anxiety, anger etc.
- The sight bile that resides in the eyes, whose function is to
allow us to see. If it weakens, our sight also weakens. While this
bile is healthy, we have perfect sight.
- The pigmenting bile that resides in the skin, whose function
is to colour the skin. When we have a bile sickness our skin
changes colour and becomes first yellow then black.
- The sustaining phlegm that resides in the chest, sustains all
other four phlegms; its function is to move all body fluids.
- The decomposing phlegm that resides in that part of the
stomach where the food is not yet digested, whose function is to
grind all kinds of foods.
- The tasting phlegm that resides in the tongue, helps to be
aware of tastes.
- The satisfying phlegm that produces the satisfaction feeling
resulting from whatever is good in life.
- The connective phlegm that resides in the joints, allows us to
move them. When it does not function well we experience pain and
To be in good health all these humours
have to be balanced. When a humour becomes weak or too strong it
creates unbalance and therefore, disease. Constituents and excretions
we eat, our body transforms the food until it forms the 7
constituents; if we eat rich food the transformation is faster. The
food essence becomes blood; from the blood derives flesh, from the
flesh fat, from the fat bones, from the bones marrow and from the
marrow sperm and ovum.
The 3 main excretions are: sweat, urine
and feces. We have 15 humours, 7 constituents and 3 excretions: in
all, 25 components. If these 25 components work well, we are
healthy; otherwise, we become sick.
In the medicine tree are
depicted three animals: the rooster, the snake and the pig. These
three animals symbolically represent the three mental poisons: the
rooster symbolises attachment, the snake hatred and the pig
The three mental poisons are the cause of the diseases
of the three humours and of the three humours themselves. Attachment
produces wind; hatred produces bile and ignorance produces phlegm.
Attachment produces wind: you will notice it when you have long
sessions of sexual activity, without pause; the next day you will
feel confused, full of air and with a headache. This is just an
example; in fact, attachment produces many types of wind.
produces bile: you can clearly see it when you get very angry. Your
body temperature increases and your face becomes red. Doctors advise
to drink water to calm down.
Ignorance produces phlegm. When
phlegm increases we become fat, lazy, slothful. We feel like doing
nothing, we don't even feel like eating. Imbalance and illness
Now we are going to
explain the right side of the medicine tree, the part on imbalance
and illness. The three mental poisons are the cause that generates
the three humours, but they are also the primary cause of all the
illnesses. Therefore, if we want to heal ourselves deeply, we have
to treat our mental poisons too. This at the subtle level.
the gross level, the sicknesses are caused by many factors, for
example the climate. If the climate is unusual, if the seasons are
not balanced, it is easier to become sick. For example, cold weather
in summer or too hot a summer or too cold a winter.
factors of disease are diet, behaviour and so on. Furthermore there
are many malignant spirits that cause health problems. Many
Westerners do not believe in spirits but in Tibetan Medicine we talk
We fall sick due to wrong diet; for example, when
the climate is hot the bile humour increases: if we eat a lot of
meat and drink a lot of wine (warming foods) the bile humour
increases even more and we become easily sick. We fall ill due to
wrong behaviour: for example, if we wear heavy clothes in summer or
if we stay naked in winter, when it is very cold. Localisation of the three humours
Phlegm diseases affect the upper part of the body.
diseases, liver and kidneys.
Wind diseases, back and lower part
of the body.
The phlegm humour, which is of the nature of
ignorance, resides in the brain. This is the reason why phlegm
diseases affect the upper part of the body.
When Tibetans become
angry they beat their chest, because anger resides in the heart
chakra. Anger is of the nature of hatred: when we lose temper our
temperature increases and, since heat is of bile nature, bile
Attachment produces wind; wind resides in the secret
chakra and is produced from various attachments, like attachment to
sex and so on.
The three humours move in specific places. Each
one hits its own territory: for example, bile does not affect the
have a strong wind disease, the first trouble we experiment is pain
in the bones. This means the bones are a way of the wind. As for the
sense organs, the wind runs through the ears: therefore, with strong
wind problems ears will ring.
Sometimes the trouble is so strong
that hearing is hindered. The wind also goes through the skin: with
strong wind problems the skin flakes off. The five vital organs are:
heart, liver, kidneys, lungs, spleen. The wind runs through the
heart; with strong wind problems the heart suffers; for example we
can have strong palpitations and so on.
The wind runs also in
the central "vital" channel of the body. The hollow organs are:
where the sperm forms, bladder, gall bladder, intestines (both),
colon, stomach. The wind humour runs through the hollow organs: with
a serious wind disease we feel inflated at thelevel of the navel. So
the wind enters the bones, then the ears, the skin, the heart and
the hollow organs. Bile
Bile enters the blood, therefore when we
have bile problems the veins become thicker because the blood
circulates very quickly and it gets very warm. Bile problems make us
sweat very much; when we sweat a lot it means the bile humour is
Among the sense organs bile resides in the eyes: a
high bile makes the eyes yellow. Vital organs: liver. Hollow organs:
intestines, gall bladder. Due to bile imbalance the eyes become
yellow and the liver swells. Phlegm
Phlegm circulates in meat, bones, fat,
sperm. Normally an imbalance of the three humours is detected in the
faeces and the urine; serious phlegm problems are well diagnosed
from the urine.
When phlegm becomes unbalanced, we have catarrh
from the nose and the tongue become thick and swollen. Phlegm is
found in the lungs, spleen, stomach, kidneys, bladder and
The three humours do not only divide body zones but also
the various types of environments and life ages.
Division according to age
Tibetan Medicine explains that from 0 to 16 years old we are
children; from 16 to 70, young; and after 70, old.
Old age is the
time of life when wind humour prevails. Due to this reason, wind
diseases happens especially during this age. Children or young
people rarely suffer from wind disorders. Wind diseases caught at an
old age are difficult to heal.
Youth: this is the age in which
bile prevails. Therefore bile problems are more difficult to cure
and easier to get.
Childhood is the phlegm age of life: at this
age phlegm problems are the most difficult to cure. Division according to geographic areas and
The first drawing (in the medicine tree)
represents a mountain with snow and wind: that means a very cold and
windy place. This place has the nature of wind, where we catch wind
The second drawing represents a hot desert, like
Rajasthan in India. Hot places favour bile disorders.
place is green, wet and rainy: a place very conducive to phlegm
diseases. This is true both for warm and wet and cold and wet
environments. What matters is the presence of much dampness.
Tantras also explain how the seasons influence the humours.
summer wind problems manifest: people feel weak, especially in the
morning and in the evening.
Bile manifests in autumn: it gets
worse during the day and in the evening.
Phlegm manifests in
spring, when everything sprouts: many people suffer from heartburns,
a sign of a phlegm worsening. Especially in the evening and at dawn.
It is very important, for diagnosis and cure, to take into
consideration all these factors: age, geographic area and season.
Incurable diseases causing
Our life depends on three conditions: vital
energy, fortune and karma. If vital energy, fortune and karma are
not depleted we keep on living. Otherwise there is nothing we can
do, we have to die.
If one of these conditions comes to an end
even positive things, like appropriate treatments, can cause death.
For example, for a patient with fever it is normally good to
drink water. But, if one of the three life supporting causes is
missing, even water can change into a poison and kill the patient.
The favourable cause becomes unfavourable and provokes death.
The picture of the burning house represents a poisoned patient
that nobody can help: for him even treatments become poison. Another
picture shows a broken central channel, or shushuma. This too is a
cause of certain death: the central channel cannot be repaired. Even
a fever too high is a cause of certain death. And wind problems,
when they become very serious.
When we are very weak no medicine
can help; our body is not able to assume medicines and therefore we
Then we have "changeable" incurable diseases.
example, the disease appears as a bile problem and so it receives a
bile treatment but, during the cure or shortly after, it manifests
as a wind or phlegm disease and so on. These are the changeable
diseases. Diseases caused by
Diseases provoked by spirits can manifest in
different ways but they have one thing in common: they are not
curable by medicine.
We need to go and see a Lama who will make
(divination), or something like that, to discover the
origin of the problem.
After that he will prescribe some ritual.
Only after the ritual has been performed and the spirits exorcised
the patient can start taking medicines.
In fact, the medicine
become useful only after the spirit has left. It may also happen
that a sick people receives a visitor from far away and when the
visitor departs he gets worse. This means that the visitor was
followed by spirits that damaged the patient.
When we are born 5
different spirits are born with us which will accompany us
throughout our life.
We have also a thing called la
vital energy. In the world exist some spirits, the Don, that can
steal the la
from a very weak person. From then on the
disease gets worse and if the la
is not recovered, the
patient will die. There exist some special pujas (ceremonies) to
recover the la
Karmic diseases are due to negative actions
committed in our past lives. They are not curable by medicine. Like
with the diseases caused by spirits, the only chance is to go to a
Lama and ask the right purification practice, for example the "100
In Tibet many times people that were
considered incurable after these practice were healed.
Unfortunately, it is not always possible to escape the consequences
of a particularly heavy karma. Sometime, no cure exists.
As we have
seen, in Tibetan Medicine there are three humours. When we are born,
for karmic reasons, hereditariness and so on, we can have a
constitution more connected to one humour than to the others.
Very rarely we have pure types or the balanced combination of
the three humours. More frequently we have the combination of two
humours (one of the two stronger). So we can have wind-bile types or
bile-phlegm types and so on.
How to recognise the types:
recognise the type in a child
- Lung type: lean, bent, with a bluish, dry skin; dry hair; very
talkative. It cannot bear the cold (he is always looking for warm
places). He is a great walker but gets easily tired. He is very
Bile type: always thirsty and hungry but not
necessarily fat. Hair is blonde and the skin yellowish. Very
intelligent. He is also very proud and arrogant and becomes easily
angry. Phlegm type: basically fat, with white complexion. His skin
is cold. He is always sticking out his chest. He has little
appetite. He is very patient and slow.
The phlegm type
person is very lucky; the bile type comes second and the wind type
is the less lucky of the three. Also from the point of view of
life span, the phlegm type has the longest life; the bile type
comes second and the wind type last. This is the nature of the
With small children
phlegm nature prevails but a good Tibetan doctor can still recognise
How to prolong
There is a method to prolong life: by saving the
life of many beings in danger.
For example, by buying and the
let free animals that are going to be killed. In India people go to
fishermen, buy fishes and let them free. Saving the life of living
beings is the best method to prolong life. This behaviour is
followed both by Buddhists and by Hindus.
Also the Nagpo Gutup
pill, which is made of 9 substances and contains many blessings,
from the point of view of Tibetan Medicine has the potency of
prolong life and makes us more happy.