Dharamsala is the home of the Dalai Lama and the exiled government of Tibet, as well as home to thousands of exiled Tibetans. I went to Dharamsala, for the H.H. Dalai Lama's public teachings which are given every March. I have decided to see Dr. Donden for a reoccurring back problem. 

When you walk into the waiting room the first thing you notice are four long benches lined with waiting patients. Sitting next to me was a middle aged woman from Canada. She is a law professor and like myself is in Dharamsala for the teachings She tells me that she has always suffered from exercised induced asthma. Her asthma was getting worse here in the Himalayas because of the constant walking up and down hills. This is her follow-up after her initial visit a week ago. She has faithfully been taking the herbal pills that Dr. Donden prescribed and she tells me her asthma is now gone.

In the waiting room each patient is holding two things: a urine specimen and a hand painted piece of tin with a number indicating their order to see the doctor. Despite the dozen or so patients waiting to see the doctor the wait is short. When it is my turn, Dr. Donden invites me in his office as he takes my urine sample. Seventy-one year old Dr. Donden is about 5' 7" with a shaved head and wearing the maroon robes that all Tibetan monks wear. Dr. Donden is a highly respected Tibetan physician and was previously the personal physican to H.H. Dalai Lama. He motions for me to sit down and pours my urine into a white porcelain cup. He stirs it with a wooden stick and observes it carefully, noting it's three characteristics: color, vapors arising, and albumin (cloud like appearance). Normally Dr. Donden doesn't ask the patient why he is there, but rather tells the patient the nature of his disorder after completing his examination. Today, however in order to expedite the volume of patients waiting to see him he asks why I am here. I explain to Dr. Donden that my low back has been hurting me as a result of the daily long hours of sitting crossed legged on the ground for the teachings -- a common complaint from westerners like myself. This is a intermittent problem that I have had for several years and western medicine has failed to help.

Next he takes my pulse, which is the primarily method of diagnosis in Tibetan medicine. First he checks the pulse of my left wrist, then the pulse from my right wrist. Dr. Donden announces that I am suffering from a combination of a wind and flame disorder. He says something in Tibetan to his assistant who writes a prescription and the exam is over. Total exam time: less than 10 minutes. Next I take the prescription to Dr. Donden's own in-house pharmacy. I am given two sets of Tibetan herbal pills with instructions for taking. What did all of this cost? Any HMO would be envious -- the total bill, including prescriptions, came to seventy nine cents !

Over the next few days I take the pills as prescribed and to my surprise my back does feel better. On a subsequent visit I talk with several westerners all of whom have had remarkable success with Dr. Donden's herbal pills. One woman was there with a list of friends back home who have seen Dr. Donden in the past and wanted refills of their prescriptions for Tibetan herbal pills . Another westerner, from Germany, tells me he is here to see Dr. Donden for arthritis in hands. He had seen Dr. Donden a year ago and had found relief from his painful condition.

What exactly is Tibetan medicine and what is the basis of this ancient system? 

Tibetan Medicine is an ancient system of healing that emphasizes a holistic approach to health. In fact, the holistic medical system that is so popular today is really nothing new, Tibetans have been using this system of medicine since the 8th century when it was imported along with Buddhism from India. According to tradition, Tibetan medicine originated thousands of years earlier by a Buddha when he manifested as the Medicine Buddha and gave the medical teachings that today are known as the Gyu-zhi, or Four Tantras., considered the most important text in Tibetan medicine. Tibetan medicine, like Ayurvedic medicine from India and Chinese medicine, emphasizes balance of the body, mind and spirit. Health is defined when these three are in balance and disease when they are not.

To fully understand Tibetan medicine one must first also understand Buddhism, because the two are inextricably linked. Buddhism is a non-theistic religion that some argue is more of a philosophy than religion. With no creator god this ancient religion believes all external phenomena are created by "mind". Therefore mind also creates illness or wellness. This fundamental assumption is at the core of Tibetan medicine.

The Buddha who lived 500 years before Christ discovered that despite the fact that all sentient beings desire to be happy and want to avoid suffering, that in fact just the opposite is true -- that life is characterized by suffering. 

The Buddha, known as the "Great Physician", prescribed a set of teachings as a solution to this suffering. These teachings known as the Four Noble Truths state: 

1.  all of life is characterized by pain and suffering, 

2.  this suffering is caused by our desire, hatred and ignorance, 

3.  there is a solution to ending pain and suffering, 

4. the solution is to follow the eight fold path (of meditation).  

The Four Noble Truths are in actuality an analogy for a medical model because they 

1. identify (diagnose) the disease, 

2. states the cause of the disease (etiology) 

3. explains the cure to the disease, and 

4. describes the course of treatment. 

The Tibetan medicine system believes that all phenomena (both animate and inanimate) are comprised of five fundamental elements. The five elements each have unique characteristics: 

1. earth: base and mass; 

2. water: cohesion and liquidity; 

3. fire: heat & kinetic energy; 

4. air: growth & movement and 

5. space. These five elements are not static, but fluctuate as they are affected by seasonal changes.

From these five fundamental elements comes the three principles of life-energy within the human body, known as the Three Cosmic Humors. The three humors -- wind, bile and phlegm are primary to the Tibetan system of medicine. Imbalances of these three types of energies can be caused by diet, behavior, environment, age, or season. Imbalances may even occur as the result of karmic or spiritual causes. Imbalances lead to illness and even to death. Restoring health is accomplished through balancing of these three types of energies through a variety of modalities. The most common treatment are the use of the Tibetan herbal pills made from local herbs collected in the Himalayas. Other treatments include referral to an astrologer for astrological consultation or even referral to a Tibetan Lama for spiritual consultation.

Wanting to know more about these enigmatic herb pills I arranged a meeting with Dr. Donden. When asked through a translator about the pills he said, " There are 160 different herb pills, compounded from 30 different ingredients. In the old days Tibetan medicines contained some animal products, but today they 100% herbal." He went to explain that the herbs are collected from the slopes of the Himalayas, dried and then undergo a lengthy process of cleaning and detoxifying before they are transformed into pills. I asked Dr. Donden if he personally collects and processes the pills that he uses in his practice. He said, "I no longer collect the herbs, because I can order them from a reputable supplier, however I still do the compounding of the pills (used in his practice)." I asked Donden if he refers any of his patients to western medicine he said, "Yes I do make referrals for emergencies and for fractures (broken bones)."

How does western medicine feel about such an ancient system of medicine, that on the surface appears unscientific? Dr. Ron Fitch, an ObGyn physician who practices in north Kansas City, explained that Tibetan medicine and other ancient systems, are referred to as alternative and complimentary forms of medicine. It has only been recently that these systems have become to be looked at more closely and appreciated by western medicine. Dr. Fitch said, "Previously western medicine was practitioner based, whereby the physician was committed to do no harm, but was free to try different modalities if they had reason to believe they might be effective. Today, however because of third party insurance, we have become evidence based, whereby there is a demand to demonstrated efficacy through clinical studies."

Dr. Fitch explained that currently there are large number of studies on alternative and complimentary modalities. Clinical studies have already demonstrated efficacy of such alternative treatments as, manipulation, acupuncture and certain herbal medicines. Currently Germany conducts the largest number of such studies. As for the Tibetan herbal medicines, Dr. Fitch stated that the major classification of all modern drugs comes from plant sources. 

Just before leaving Dharamsala I develop a nasty cold. I felt lousy. This time I visit a different Tibetan doctor, at Men-Tsee-Khang -- the Tibetan Medical and Astrological Institute, a teaching hospital. I see Dr. Kelchoe Qusar, a female physician. I tell her about my cold and she prescribes three different sets of herbal pills to be taken with breakfast, lunch and dinner. The difficult part is the pills are not swallowed, but rather must be bitten and then taken with hot water. I am skeptical but take the pills as prescribed. The pills have a bitter taste but are not unbearable. Within 24 hours my cold is gone. Was it the result of the Tibetan medicine? I honestly don't know. All I do know is this is the shortest duration for a cold I have ever experienced. 

The Tibetan system of medicine, while strange to the western mind, is very compelling. After all how can anyone argue with attempting to live our lives with a sense of balance?