On another page we describe briefly the history of Tibetan medicine, how the distilled medical understanding of several cultures was refined and developed into an effective system of healing, which led to Tibet's reputation throughout central Asia as the Land of Medicine.
Now Tibetan medicine has come to the West, and we have an opportunity to work toward a system of natural healing that would give people all over the world access to this unique insight into health and well being.
On this page the emphasis is on the research efforts aimed toward making Tibetan medicine more widely accessible, and in the process helping to preserve it. Let's start by considering several types of research that could contribute to this effort:
1) Biological and agricultural research is needed for preserving the plant species that are used in traditional Tibetan medicines. Many of these species are now endangered by widespread deforestation, and over-harvesting by local herb gatherers who are hired by outside companies to pick the plants. Trained just to recognize the plants, but not to care for them, they often pull them up by the roots, even when only the flowers or leaves are needed. Research can determine which species are endangered and which are too rare to support expanded use of Tibetan medicinals, and what can be done in each case to improve the supply, working to protect the surviving populations while exploring suitable environments for growing them as crops or for replanting wild herbs.
2) Along with this effort to preserve and if possible increase the abundance of the species that were traditionally used will come efforts by Tibetan physicians to evaluate plants, indigenous to other regions, for use as substitute ingredients in traditional formulas and in developing new healing preparations.
3) Evaluation studies can explore whether Tibetan physicians, using traditional Tibetan methods of diagnosis and treatment, can successfully treat or help to prevent various health problems of all sorts.
4) Basic scholarly studies and translations of the literature of Tibetan medicine will help Western students study Tibetan medicine in depth without first learning to read Classical Tibetan. To date, most of the basic Tibetan medical texts are not available in any Western language. Also, traditionally, Tibetan written teachings assumed that a thorough explanation by an accomplished practitioner would support the reading of the texts. Recording, transcribing, editing these oral instructions is still possible, with the cooperation of the few surviving master teachers.
5) If evaluation studies (Type 2) show Tibetan medical diagnosis or Tibetan medical treatment to be effective for certain diseases or other health problems, that will immediately raise questions about how it works. Answering those questions will be difficult, because Tibetan medical treatments involve a great many different factors, any or all or which may be contributing in various ways to the effectiveness of the treatment. For example, the herbal prescription for a particular individual may include several medicinal formulas to be taken each day, each of which can contain many different herbs and other ingredients, and most of these ingredients contain many different chemical compounds, several of which may be medically active. Behavioral and dietary counseling, spiritual practices to be done by the physician and by the patient, these and other influences may also be making a real contribution to the patients healing. Add to all of that the fact that different medicines and recommended changes in diet and behavior may be prescribed for different individuals who seem, from the Western perspective, to have the "same" medical problem.
In general, we can take two different approaches to such questions: First, we can try to understand what the Tibetan system itself teaches about how various physical, psychological and spiritual factors contribute to healing and health, with the help of Tibetan master physicians, in collaboration with the few physicians who have trained in both the tibetan and Western systems. Second, we can use Western scientific research, for example, factorial evaluation studies, to study the contributions of various aspects of the Tibetan system of medicine. Details of such research can be safely left till later, after preliminary evaluation studies have shown Tibetan treatment to be effective.
The research of Types 1 and 2 is the focus of another page, Herbal Sources of Tibetan Medicines, with materials relevant to preserving the plant species used in making Tibetan medicines, and increasing the supply of those herbs or finding substitutes. The supply of medicinal herbs is now so limited that there will be little room for wider use of Tibetan medicine before that problem is addressed.
Research of Type 3 is the subject of the editorial in the following section, Tibetan Medicine in Prime Time. There I criticize some recent studies aimed at evaluating particular Tibetan herbal formulae with no involvement of Tibetan physicians in diagnosis nor in prescribing treatment. I argue that studies of that sort are inadequate for evaluating the real potential of the traditional Tibetan medical system. Even research that does involve Tibetan doctors may fail to fairly assess the effectiveness of Tibetan medicine, if we impose restrictions on the therapeutic choices of the Tibetan physicians.
On another page, Medical Research, Tibetan Style, I present a research plan with the power to truly show whether the Tibetan system of medicine, as defined by the preferred diagnostic and therapeutic practices of respected Tibetan physicians, is truly effective, using Western standards of evaluation.
The links on the Resources section of this page are very much a mixed bag, mainly relevant to evaluation studies and scholarly research and translation of medical texts.
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I was excited to see Tibetan medicine beginning to be recognized by a respected American research hospital, with a major news service considering the story worth telling in prime time. However, as a scientist I was concerned about several problems with the study, which will prevent the results -- whatever they may be -- from truly assessing the potential of Tibetan medicine for dealing with this disease. Eventually the scientist convinced the Tibetan medicine fan, which is why I'm writing this editorial.
The most obvious problem with the study was that it restricted Dr. Dhonden's choice of Tibetan herbal medicines: He was allowed to use only a few dozen formulas, approved by the U.S. Food and Drug Administration for research purposes, out of the hundreds that would normally be available to him. (Presumably, later studies will suffer less from this problem, because the list of herbal formulae approved for research purposes will get longer as time goes by. However, some of the most powerful of the traditional Tibetan medicines will probably never be approved by the FDA, because they contain substances that are automatically rejected as poisonous.)
A more serious problem, though, is that participation in the study was restricted to stage-four patients, all of whom have had extensive courses of chemotherapy and/or radiation therapy which had proved ineffective -- in other words, cancers which the Western physicians consider to be incurable. Doctor Dhonden did say that he expects these patients to improve, or at least to stop getting worse with his treatments; however, a Tibetan physician once told me that although Tibetan medicine can treat cancer successfully, if a patient has had a lot of chemotherapy or radiation, their vital systems may be deeply damaged, and the herbal medicine may not be able to save the person's life. The UCSF study will not accept patients with early stage cancer, presumably because allowing them to try 'unproven' herbal therapies before trying conventional Western cancer therapy would be considered medically irresponsible.
What I'd really like to see would be research that could show whether Tibetan medicine is truly effective, by Western medical standards, in studies that would involve Tibetan physicians practicing medicine in whatever ways seem most appropriate to them. Western scientists would be in charge of the evaluation statistics, and Western doctors would be included to provide diagnosis before and after treatment -- so the results will make sense to us -- but the Tibetan physicians should be entirely in charge of how their diagnosis and treatment is done.
[Since this was written, I've developed a research plan that meets these criteria, discussed on a page titled Medical Research, Tibetan Style.]
It's an open question whether such research could be legally done in this country. One possibility would be studies with patients who have refused chemotherapy and radiation, and have chosen to work with Tibetan doctors in established clinical practices. [The clinics that I know about are listed on another Web page: Tibetan Medical Clinics and Pharmacies.]
I do appreciate the USCF study as a big step in the right direction, when we compare it to some of the research in the literature. Some studies are aimed at evaluating particular Tibetan herbal formulae as medications, without any involvement of Tibetan physicians in diagnosis -- for example research on the medications sold by Padma, Inc. Even worse, from the perspective of demonstrating and preserving the potential of the Tibetan medical system, are "ethno-pharmachology" studies that use traditional medicines merely as sources for new drugs.
The drug companies, the FDA and most American Medical Association doctors are mainly working out of the Magic Chemical Bullet view of disease treatment: most diseases are thought to have simple causes, and to be curable if we find a drug that will remove the cause without unacceptable side effects. On this view, traditional medicines are only useful as a good source of ideas about what chemicals to try next.
In contrast to the search for magic chemicals, at least testing Tibetan herbal formulae has some potential for respecting Tibetan medicine's freedom from negative side effects. Each of the hundreds of medicinal formulae used by the Tibetan physicians contains from a dozen to several dozen herbal ingredients, and some of them include mineral or animal ingredients as well. In addition, each herb included in one of the formulas contains in itself many different molecules, several of which may be medically active. All these very many substances are combined in the various formulas so as to prevent most side effects while improving the patients condition in many different ways.
However, testing individual formulas falls far short of testing the real potential of the traditional Tibetan system of healing. Even if we focus only on medicines -- leaving aside behavioral and dietary counseling and the psychological and spiritual aspects of healing -- the standard practice of Tibetan physicians is much more complex than anything we can see by studying the effects of a single herbal preparation, in a search for an Herbal Magic Bullet.
Tibetan physicians are able to respond to widely ranging differences in individual makeup and disease status by flexibly combining various medical preparations in the prescription for a particular patient at a particular time. A patient typically will take three or four different medicinal preparations each day. Further flexibility is added by checking the patient's condition after they have been taking the medicines for a while -- e.g., two weeks, or whenever the patient reports a change in symptoms -- and changing the prescription according to the new diagnostic information. All this flexibility, plus the fact that Tibetan medicines work more gradually than the concentrated chemicals in Western drugs, lets a Tibetan physician reduce most side effects so thoroughly that they are rarely bothersome, and never really harmful.
The side effects we are talking about avoiding are not always mere inconveniences. In Western medicine, they can be life threatening, or emotionally debilitating, or both. One of the patients in the UCSF study said she had no strength to continue her work -- chemotherapy had shrunk her tumors, but with devastating side effects: “It was killing me. What good is a shrunken tumor ... with a body that's lost its vitality and its will to live?” The chemotherapy also destroyed this woman's fertility and damaged her heart, and she finally decided to try alternative treatments, which is why she was eligible for the study.
With all the patients included in an evaluation of the healing potential of Tibetan medicine already deeply damaged by the side effects of failed Western treatments. Tibetan doctors have told me that a person who has had extensive chemotherapy and radiation may have been damaged so deeply that Tibetan medicine cannot save the person's life. Tibetan medicine may help the person to be more comfortable, it might reduce the negative side effects of the Western treatments, but if the fundamental vitality has been destroyed there is not much for the Tibetan medicine to work with.
What we most need to preserve from the Tibetan medical system is neither some particular medicines, nor their active principles, but the system itself -- the understanding that led to the discovery of those medicines and the methods for using them. We don't know how to cure disease without risking severe negative side effects: The Tibetans do. Grabbing a few new chemicals from them, or even a lot of new chemicals, will not help us find the way to make the fundamental changes in our medical system that are needed to develop the sort of gently powerful treatments that they have demonstrated. We have no business trying to decide in advance which parts of their approach to healing can be dispensed with, before we understand their methods and the knowledge those methods are based on.
Of course, research of the sort that I am interested in would be nearly useless to the people who want to use Tibetan medicine as a source of new drugs; but helping wealthy corporations take inexpensive herbal medicines, that can heal without negative side effects, and turn them into a way to develop expensive patented purified chemical drugs with many negative side effects -- why would we want to help them do that?
Another concern is the effect these big drug hunts have on the plants that provide the medicinal chemicals. A few years ago, for example, scientists became concerned about a threat to the Pacific Yew (Taxus brevifolia), native to the rain forests of western North America, from over harvesting. A drug, Taxol®, isolated from the bark of the trees had been used somewhat successfully in the treatment of both breast cancer and ovarian cancer in women. The bark of about 10 of the ancient trees was required to make enough of the drug to treat one patient, and the trees were going fast. Now, even though the active principle has been successfully synthesized, excessive harvesting of yew varieties continues and has spread to include related species in Asia and elsewhere. The trees are hunted by people producing a cheaper alternative to the patented synthetic, and by drug companies looking for sources of possibly more effective or less toxic variants of the drug that would be eligible for new patents.
The H.H. The Dalai Lama has said that the health of the billions of people in this world cannot depend on rare Himalayan herbs that are already endangered. I do believe that research can make a valuable contribution to our efforts to preserve Tibetan medicine and develop sustainable supplies of the plant and animal species that provide the ingredients of the medicines. However, whether our research projects will ultimately prove beneficial or detrimental will depend on what our real goals are, and on our awareness of the effects of our actions.
Tibetan physicians can help us find new herbal medicines that can be used without negative side effects, but only if we help them to preserve their entire medical system, and let them help us begin understanding how it works.
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Resources for Research on Tibetan Medicine
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Herbal Sources of Tibetan Medicines
Men-Tse-Khang -- Established by H.H. The Dalai Lama to preserve and practice the Tibetan system of medicine, astronomy and astrology, including training tibetan doctors and medical astrologers, preparation and dispensing of tibetan traditional medicines, providing affordable health care, and publishing books on tibetan medicine and astrology.
Facts about Men-Tse-Khang -- FAQ
www.tibetanmedicine.com -- Commentary "If our goal is to preserve Tibetan medicine we must be conscious of the powerful hegemony of our culture and avoid to the greatest extent possible negatively affecting Tibetan culture as we attempt to encourage its preservation and perpetuation. The economy of time and commerce and the influence of Western medical approaches places the more classical, holistic approach to Tibetan medicine at risk of being lost."
Between Heaven and Earth: Integrating Natural Medicine With Modern Healthcare.
The Yuthog Foundation for Tibetan Medicine: Preservation and development of traditional Tibetan medicine by education and training of Tibetan doctors in rural areas of Ladakh, and promoting the exchange of experiences in use and identification of medicinal plants. Also leading excursions designed for western people.
The Tibetan Plateau Project: to protect and conserve medicinal plants, support the practice of Tibetan medicine and assist local communities in developing income-generating projects using medicinal plants.
Medicine and it's Study in Buryatia: efforts to revive and use in practice
the achievements of Tibetan medicine. Studies "of the sources of Tibetan
medicine and investigations of the pharmacological properties of the remedies
are carried out in the Buryat Scientific Centre of the Russian Academy
of Sciences (Siberian Department). Besides, the Centre of Oriental Medicine
has been established, where the findings of scientific studies are used
Reviving Ancient Cures -- Research on Padma Formulas in Israel
Tibetan formula effective in peripheral artery disease
Research on PADMA 28®/PADMA Basic®
U.S. Source of PADMA 28®/PADMA Basic®
Research on Tibetan medicine at Padma, Inc.
Jürgen C. Aschoff's Tibetan Medicine - Tibetische Medizin
Annotated Bibliography of books and articles published in all languages except Tibetan from the year 1789 up to 1995, including an extensive collection of reports of Western medical research. The full text of the bibliography is online and searchable. A brief Review of Aschoff's Bibliography is available.
Medicine and Mercury an article by Juergen C. Aschoff
"‘Ayur’ means living and ‘Vijnana’ stands for the knowledge perceived through our sense organs, becoming itself realization. AyurVijnana seeks to establish a forum which shall encourage the integration of our research endeavors into our personal lives."
The International Trust for Traditional Medicine is sponsoring
several research projects
on Indian extent Ayurveda and Tibetan Sorig medical traditions and the
relationship between them.
Research on Tibetan Medicine -- NTSG (Dutch Foundation for Tibetan Medicine)
The International Trust for Traditional Medicine
Translation Project -- aims "to provide the electronic version of all available ancient Tibetan medical texts (published before 1959 in Tibet) for academic research and further translation into Western languages."
Glossary Project -- a glossary of Sanskrit and Tibetan medical terms with their German and English equivalents has been designed to identify, select and arrange the medical terminology of a traditional Ayurvedic text (7th century) and its Tibetan translation
University Library Online Catalog (ORBIS) -- A keyword search for "tibetan
medicine" yielded 55 relevant titles from the cataloged holdings of the
various libraries, mostly in Sterling Memorial Library and the Medical
library and the Beinecke rare-books library. Languages are English, Russian,
Tibetan, French and Sanskrit.
The National Center for Complementary and Alternative Medicine is a division of the U.S. National Institutes of Health, established by Congress in 1998 to "stimulate, develop, and support research on CAM for the benefit of the public." The agency is "dedicated to exploring complementary and alternative healing practices in the context of rigorous science, training CAM researchers, and disseminating authoritative information to the public and professionals."
Global Initiative for Traditional Systems of Health -- "A focal point for policy, research and public awareness of the health needs of the majority of the world's population, who rely on indigenous or traditional medicine for their health and well-being."
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Revised on August 29, 2002
Copyright © 2002 Dharma Haven
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