Khenpo Tsenam

Biography
Professor Troru Tsenam's life has been the very reflection of the fortunes of Tibetan culture during the 20th century, mirroring its glorious heritage, the catastrophies which have befallen it in the last half century, its present hope of survival and its gradual diaspora throughout the world. A living legend, Professor Tsenam is a small, wrinkled and extraordinarily endearing figure in his late sixties, full of wit, in every sense of the term, and a walking encyclopaedia not only of Tibetan medicine, of which he is probably Tibet's greatest exponent, but also of many other domains of Tibet's traditional culture, such as poetry and Buddhist metaphysics. Before the 1959 annexation of Tibet by China, he held the equivalent of several chairs in Buddhist monastic universities. He presently holds two chairs within the modern Chinese academic system. He has been instrumental in the re-establishment of traditional Tibetan medicine in Tibet itself, where his life is presently dedicated to ensuring that as much as possible of the unique knowledge and experience that he embodies be passed on to younger generations of Tibetan doctors. Khempo Tsenam is someone deeply respected, not only on account of his knowledge and all he has done for Tibetan medicine in the past 20 years but also for loving care and healing power which he radiates. As another Tibetan doctor said recently, "Khempo Tsenam may administer exactly the same medicine to a patient as I would but somehow it is always more effective when given by him. He undoubtedly has something special. He is a bodhisattva and his patients and others doctors sense that." This is more than just a subjective appreciation of the qualities of the man himself. It is a perception of the qualities of the traditional physician-lama which he incarnates amid a world of Tibetan medicine which for many years was stripped of its religious context and reduced to a solely materialistic science. However it may have worked, the psychological aspect of healingexpressed through the Buddhist religion was a vital part of traditional Tibetan medicine and it is now being enthusiastically reintegrated into the training being given in the medical schools of Tibet.

Early Life
Khempo Tsenam was born in 1928 in the Derge Kingdom of DhoKhams in a place which is presently known as Troru Deshok, in the District of Terton, within the Chamdo region of the Autonomous Region of Tibet. From 1933-43 he lived as a monk in Troru monastery where he received his first tuition. Having learnt to read and write, he studied continuously and completed his training in the general skills related to monastic ritual. Under the guidance of the then Khempo (Professor) of Troru monastery, he received instruction in the three stages of Buddhist vows and in the most profound aspects of meditation of the Kagyu tradition. For the latter, he studied commentaries on the profound and secret yoga practices of Naropa and teachings on mahamudra, the meditation treasure of the Kagyu tradition which unveils the very nature of the human mind. From other teachers he received instruction in grammar and composition and teachings on both element-based and planetary astrology. Having successfully completed this first phase of his education, he spent the years from 1943-46 in pilgrimage, going first to Lhasa and f rom there to India, Bhutan and Sikkim. In 1946 he returned to Eastern Tibet and after staying for a few months at his home. Throughout the earlier parts of his studies and his pilgrimage, the masters under whom he studied recognised a tremendous potential in
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Khenpo Tsenam him and encouraged him to carry his studies to their fullest conclusion. One of his traveling companions in particular, a Khempo (professor) of Katok monastery in Eastern Tibet, insisted that he pursue his education at Katok, as it was a very great seat of learning.

Education
Shortly after his return to Tibet, Troru Tsenam did go to Katok monastic university where, for the five years up to 1951 he studied medicine, elemental and planetary astrology, poetic composition and the various fields of study proper to all the traditions of Buddhism, namely madhyamika, prajnaparamita, abhidharma and vinaya. Besides these, he received a thorough training in vajrayana Buddhism, becoming well-versed in both the Nyingma and the Kagyu traditions, whose theoretical teachings he mastered in their totality. In particular he became one of the rare person entrusted with the secret medicinal science of preparing "detoxified mercury". He received the latter teachings from Tachung Lama Tsering Chopel. Thus he became a physician-monk, learned in all domains and particularly gifted in medicine. The monasteries in Tibet, like those of Europe in the Middle Ages, were major centres of learning and of medical study and practice. They served as bases from which lama-doctors would tour surrounding areas. The religious aspect of Tibetan medicine was a vital one: the whole science of medicine was presented as being teachings given by the Buddha, through his emanation as the Healing Buddha. The collecting of medicinal plants, their preparation and administration were all accompanied by prayer and performed as a semi-religious act. When medicines could not help the patient, specific healing religious ceremonies were performed. Besides providing this spiritual context to healing, the monasteries were important seats of medical study inasmuch as medical knowledge was seen as a key part of an overall education in the nature of the human condition and hence something which needed to be understood, in the Buddhist quest for a complete wisdom. Medicine forms the second of the five main fields of Buddhist study.

Khempo Twice Over

The young and gifted monk that Troru Tsenam was at that time showed such an extraordinary aptitude for study often understanding topics well after a single reading and sometimes adding details which no one had taught him that his teachers thought it likely that he was the reincarnation of a great scholar. This was confirmed by the IIIrd Shertse Rinpoche, who declared him to be an emanation of the early Tibetan master Bu.sTon.Pa. At Katok he received the title of "Khempo of the Five Disciplines" - a high honour, roughly equivalent to a professorship, recognising his prowess in all the major fields of study. Despite requests from several monasteries, including his home monastery of Troru, for him to come and lead their colleges, he was kept by Shertse Rinpoche at Katok, where he continuously furthered his own understanding under the guidance of visiting scholars. The 1956 troubles in the far Eastern areas of Tibet allowed him to return to Troru, where he took up the chair of the monastic university, becoming Troru Khempo Tsenam. For three years he was responsible for the education there of some 30 tulku and some 200 monks.

Imprisoned
When the Chinese annexed Tibet in 1959, the monasteries were closed and all religious activity had to cease. Those lamas who did not flee the country and who escaped the wrath of the Chinese forces were obliged to lie low. This Khempo Tsenam did for two years. Then, because of his former high monastic position, he was placed in a prison in the Pomi (spo.mes) area, where he was to spend ten years. The conditions in prison were tough, not only physicaly but also psychologically. Khempo Tsenam looks back on that period in a positive way, "I could see how those who let themselves get
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Khenpo Tsenam into a state of depression suffered, adding mental anguish to their physical pains. I managed to keep my own mind peaceful and spacious, according to the Buddhist training, and realised that this, like any life situation, was an opportunity for development. I tried to comfort my fellow inmates. Many of them were young and gifted, their education incomplete. I did my best to pass on some of my medical and academic knowledge to them." This tuition took place in secret, after lights-out at night. He taught them reading, writing, grammar, Buddhist ethics and philosophy and other subjects, according to the wishes of those he taught. During that time, which was one of great threat to the Tibetan culture, he tried to write down what he could of his knowledge, on tiny strips of paper gathered from here and there. This gradually produced quite a volume of literature which, unfortunately, was discovered and destroyed. Khempo Tsenam took particular care to ensure, as best he could, the education of the young tulkus (reincarnate Abbots) emprisoned there. Pomi was more of a labour camp than a closed prison and he had the opportunity of gathering simple herbs in the surrounding countryside to treat sick inmates. This proved invaluable.

The Clinic at Pomi

By 1971 his obvious use, as a gifted doctor, to the Tibetan community and his immense medical knowledge had become recognised and appreciated by the authorities who not only released him but apologised formally for his emprisonment. They excused their action by saying that he had been emprisoned because he had initially been considered to be a lama but since he was in fact a doctor and therefore someone of real use to the people, a mistake had been made which should now be rectified. Following his release, Khempo Tsenam continued to treat his patients in the Pomi area and the small dwelling he used as a clinic became known as Pomi hospital. There, he prepared his own medicines from local plants, minerals and animal products. He was unable to make many of the traditional compounds because they required ingredients from other parts of Tibet and also from other countries. Nevertheless, as years went by, Khempo Tsenam managed to treat some 10,000 patients a year. His renown spread.

The Revival of Tibetan Medicine in Tibet

The period from 1977 to 1981, during which more traditional cultural expression was allowed the Tibetans by the Chinese, was one of intense activity for Khempo Tsenam and those like him. It marked the begnning of a restoration of Tibetan medicine. He travelled, first locally to Derge and then to other former medical centres in Kham and eventually to Lhasa, to assess the situation and make contact with other Tibetan doctors. In the Derge printing house he found the Tai Situpa's text on mercury detoxification and the preparation of mercury medicines. Using this as a basis, he transmitted the secret keys of the process to suitable physicians, who acted as his apprentices and helpers in the complex alchemical processes involved. Due to him, detoxified mercury was prepared in Derge, then in Chinghai, Sining and other medical centres. Once these institutions had detoxified mecurial compound as a raw material, they were able to produce the famous Rinchen Rilbu"Precious Pills" by combining it with various gemstones and herbs etc. In 1981 his expertise was sought by the authorities in Lhasa, the capital of the Tibetan Autonomous Region. Since that time he has devoted himself to the restoration of the Lhasa Astromedical Institute (mintsikang). It has grown from a small building with a handful of doctors to a major teaching hospital, with some 1,000 staff and students, several hundred beds and a factory for the production of Tibetan medicine. With the Mintsikang well-established, Khempo Troru Tsenam next established a more advanced teaching unit, which now has university status. With its own medicine-making centre and clinic, it is training hundreds of doctors on Tibetan Medicine and their training now satisfies a high academic
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Khenpo Tsenam standard. Furthermore, they are being introduced to the principles and equipment used in modernday medicine. In 1997, two specialised research units were established to carry out investigations in to use of Tibetan medicine for various diseases which afflict the modern world. These tests should satisfy the rigours of modern scientific investigation. Traditional Tibetan medicine now seems to have become acceptable to the governing Chinese authorities through its sheer efficacity. Another, and not unimportant factor, is its cost, being relatively cheaper to implement than more modern treatments requiring expensive machinery and facilities. This recognition means that doctors who qualify in staterecognised medical schools become state employees with a wage. There are five levels of doctorship. The lowest involves a traditional medical theoretical medical training over some three years followed by some years of practical work alongside established doctors in hospitals or clinics. This gives the title "doctor" but not a medical university degree. The second level requires a longer training, within a university context, and ends up with the award of a medical degree. The remaining three levels are attained through numbers of years of practice and experience, teaching, research, papers published etc. Khempo Tsenam is one of Tibet's few Grade Five doctors. The main re-establishment of Tibetan medicine has taken place through the growth of medical centres-cum-teaching hospitals in large towns. As the doctors trained in these centres take their practice out to the nomads and remote rural areas, it is likely that, as in the old days, they will take on apprentices who will commence their learning in the field rather than in the classroom. There is also a combined effort, now under way for several years, between local authorities and the international charity Rokpa, to pur more doctors in remote areas. Seven medical colleges, providing first a primary and secondary education and then traditional medical training for more than 300 people, have so far been set up, with a view to providing country doctors and to giving priority and career opportunity to bright young girls.

The Present
Khempo Tsenam is presently Directing Physician and Professor of Medicine at the Central Institute in Lhasa, Professor at the China Advanced Buddhist Centre and Editor-in-Chief of the Tibetan Medicine volumes of the China Medical Encyclopaedia. He has written several major medical textbooks and published some 200 articles on Tibetan medicine. The following is taken from an interview given by Professor Troru Tsenam during his 1994 visit to the Kagyu Samye Ling Tibetan Centre in Scotland. This centre hosted the first teaching session of the Tara-Rokpa Tibetan Medical College, set up by the Rokpa Trust (Scotland) in conjunction with the Central Institute (Lhasa) to create the first Tibetan Medical College in the Western world. Khempo Tsenam officially opened this College and supervised the first month of instruction, given by himself, Dr Sonam Chime, Assistant Professor at the Lhasa Mintsikang, and Dr Thubten Phuntsog, of the Institute of Nationalities in Beijing.

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Khenpo Tsenam

An Interview with Khempo Troru Tsenam Rinpoche

Q .. Would you be kind enough to tell us how far back Tibetan medicine goes and where it originally came from? A .. Tibetan Medical science has its main roots in the land of Tibet itself, in the age-old experience and ingenuity of the Tibetan people, who have always lived close to nature and had to rely on their own resources to survive. To this has been added, over the last two millenia, the medical wisdom of other lands and civilisations, integrated into the indigenous system either intentionally or by the natural crossfertilisations of cultures which have taken place over the ages. All in all, we can identify three main streams which have contributed to make the waters of the healing lake which is Tibetan medicine. These three streams are depicted on the insignia of the Central Institute, the governing body of the Lhasa Astromedical Institute (Mintsikang). The longest stream in the insignia comes from the snow mountains, representing Tibet itself. This is joined by two other streams which represent Chinese medicine and Indian ayurvedic medicine. The many facets of medical knowledge which together form the wealth of Tibetan medicine were all brought together in what is undoubtedly the best-known of all the Tibetan medical treatises - the rgyud.bzhi - the Fourfold Medical Treatise. Tibetan medicine itself has a recorded history of about 2000 years and the Fourfold Medical Treatise dates back about 1,000 years. Although there have been so many ups and downs in Tibetan society during that long period of our history, the Tibetan medical system was preserved throughout, without damage either to its integrity or to the living lineage of the transmission of knowledge from doctor to doctor. It is, without doubt, one of the greatest glories of the Tibetan people. Q .. I think that the extent and influence of Tibetan Medicine is little known in the West, could you say something about this please ? A .. This ancient tradition of medicine has helped maintain the health and longevity not only of the people of the five kingdoms known collectively over the centuries as "Tibet" but also of neighbouring countries, such as Bhutan, Nepal, Sikkim, Ladakh, Mongolia, Sinkiang etc., where its use was widespread. Moreover, Tibet has long been reputed as the land of medicines throughout Asia. Tibetan medicine is undoubtedly one of the oldest and most profound medical systems in the world and it has contributed a lot to humankind's understanding of health and sickness. It is not simply one simple localised national medical folklore among others. It has been a vast and complete science will fully-elaborated notions of the bases of health and sickness, a simple but exceptionally efficient system of diagnosis and a very full range of treatments, based on diet, lifestyle, medication and external treatments. In my opinion it is unexcelled. This opinion is reinforced when I observe people from various countries, most benefitting from the finest of modern scientific development, nevertheless showing a lot a interest in, and doing research into, the Tibetan ways of diagnosis and treatment. For instance, in the East, in Japan, I found a very strong interest in Tibetan medicine. Also in the West, many people are keen to study Tibetan
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Khenpo Tsenam medicine. I visited Hungary in 1987 and there also I met many doctors who not only showed much interest in Tibetan medicine but also came to understand certain basic points of its practice and sincerely expressed a strong appreciation of it. For me, this is a small proof that the Tibetan medical system holds some profound understanding about the nature of the human body and mind and that this is intuitively recognised by people even though they come from very different cultural backgrounds than the Tibetans. Q .. We are all aware of the tremendous social changes which have occured in Tibet over the past 35 years. Is Tibetan medicine in Tibet today the same as it was traditionally? A .. Tibetan medicine as it is now being taught and practised these days in Tibet is much the same as it has always been. There has been little qualitative degradation. Quantitatively, it is hard to estimate. In earlier times hospitals or training centres were not established as they have been in recent times by the local governments of the five kingdoms. Medicine was principally studied in monasteries, with almost every monastery having some medical activity, and there were also doctors in private practice as well as clinics sponsored by local aristocracy. The transmission of medical knowledge was carried out through apprenticeship and through family tradition. All in all, medicine was practised in a highly proficient way. To give you an idea of the wealth of Tibet's pharmacoepia, you must understand that the number of plants alone involved in medicinemaking numbered more than 3,000. These were combined in all sorts of ways to produce medications containing sometimes 8 or 15 or 30 or up to 100 different ingredients. Then there are mineral and animal ingredients as well. Doctors obtained some of these raw material for their medicines locally, some from other parts of Tibet and yet other ingredients were imported through traders. Not only has it always been an efficient and excellent system in itself, but also something implemented in the highest way, inasmuch as medicine was a vocation based upon a very high moral code and altruistic approach. Q .. Are you referring to the Buddhist ethics ? A .. Yes. Throughout the centuries, the ethical code of the doctor was that of the bodhisattva, a person inspired by the buddhist motivation to free all beings from suffering. There is a wealth of teaching on this in mahayana Buddhism, explaining how to keep one's mind pure and in an altruistic frame and how to live in a way which aspires to perfection of action - perfect generosity, perfect self-control, perfect forbearance, perfect diligence, perfect meditation and perfect wisdom. It is with this in mind that one practised medicine. As long as there are beings with physical bodies which suffer, one of the noblest professions is to practise medicine, to alleviate that suffering. So many Buddhist scriptures say that all the many qualities of the bodhisattva can be summed up by one word - compassion and the role of compassion in the healing art is a vital one. Compassion, as it was traditionally understood in Tibet down the centuries, involves a very careful and skilful refinement of the human mind. In the case of medicine, compassion is not a fixed attitude of the doctor's mind, rooted subjectively in abstract notions of love, but is a clarity of awareness and a quality of openness and sensitivity on the part of the healing physician concerning what is
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Khenpo Tsenam objectively happening in the patient. This is why compassion is described as being, "inseparable from wisdom". It means being as fully aware as possible of what is taking place in the body and mind of the patient being treated, not just at present but over all sorts of timescales. Q .. Could you speak some more about the doctor's wisdom and the Tibetan understanding of sickness and health ? A .. One obvious aspect of the wisdom involved in the diagnostic phase is to be able to detect the imbalance of the humours which is the cause of the symptoms which the patient is presenting. You have probably heard of the three "humours." The word itself means ill the three ills. They are three absolutely fundamental sets of systems within the body's functioning. When a person is healthy these three work together in harmony. But when one or more of the humours is deficient, over-active or upsetting the others, there is ill-health hence the name nyes.pa, ill. The humours themselves are manifestations of the interplay of the elements. To understand to flux of the elements in a patient's body at any given time, one needs to be aware of the nature of the elements where the patient lives and works, the play of the elements due to the changes of the seasons, the times of day and so forth and the power of the elements in the patient's diet. Everything is a manifestation of these prime elements, by which I mean earth, water, fire, wind and space. We can also describe the elements as wood, fire , earth, metal and water. To understand the meaning behind these simplistic names - earth, fire, water etc. - requires much study and experience. Q .. Would you be kind enough to explain them simply for me? A .. The elements exist on many different levels and their manifestations vary according to the level. Earth is the material quality of things - their matter, weight, hardness, resistance etc. - which means, in the case of the human body, the flesh and bones etc. Water is really the power of bonding between the various aspects of matter - between particles etc. - and also therefore the fluid, lubricating quality. In the body this is the fluids and the overall cohesion between the physical constituents. Fire is the development, the transmutation, the coming to maturity, of matter. In the body it is its physical heat, of digestion and so forth. Wind is the dynamic aspect - movement, flow - represented in the body by all the circulations of oxygen, the flow of blood in the veins and arteries, the impulses in the nervous system, the lymphatic system etc. Space is the dimensioning that allows the other elements to fulfil their functions - in the human body it is the hollow spaces and the orifices. The elements within the body are in constant interplay with those outside it, as it relates to its environment. The body-environment dialogue occurs through the ingestion of nutrients, such as oxygen, food and drink, through the impulses received through the senses and through the way the person reacts in response to other people and the world around. Those nutrients are composed of the elements; the world, experienced by the senses, with its trees, rocks, sun, sky and so forth is composed of the elements and likewise other sentient beings are composed of the elements. The person himself or herself is composed of the elements. To correct what goes wrong in the body-world dialogue, we compensate by administering medicines. Medicinal compounds are also concentrates of the elements. Not only the prescribing of
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Khenpo Tsenam medication but also advice on diet and behaviour is seen as a very important factor in bringing the patient back to good health. It is a question of using the resources at one's disposition whatever they might be to bring the imbalanced elements in the patient's body back into harmony . Deficiency in one or another of the elements can be compensated for by a diet or an environment rich in that element. Likewise, excess of one or another of the elements can be corrected by reducing the power of that element in the diet, environment or behaviour, and so on and so forth. Q .. And is sickness simply an accidental elemental imbalance, then? A .. Besides the shorter term elemental and humoural causes of the ailment - due to the diet, lifestyle and the specific behaviour of the person - there are also the psychosomatic triggers of illness which, according to the traditional teachings of medicine, exist on three levels, called remote cause, long-term cause and proximate cause. These are, respectively: a. the degree of lack of contact between the person and the innate purity of their mind, b. the powerful tendencies to strong emotions such as craving or anger in the more distant past, including past lives, and, finally, c. more recent emotional patterning. Of course, one could continue. Medicine is a complex subject. What I have just mentioned is just a glimpse of the complexity of the composite phenomenon which is a human being, from the Tibetan medical point of view. In actual medical practice, sometimes mind and body are quite distinct, the one from the other. Sometimes they are indistinguishable and very often they are powerfully interconnected. Q .. We live here in a world very concerned with diet, foodstuffs, additives, vitamins, whether to eat fats or not etc. Is the quality of these sort of things considered important in Tibetan medicine? A .. Besides the psychosomatic triggers of illness and short-term elemental factors, there are also longer-term physical considerations related to the proper functioning of the metabolism; particularly in terms of the intake of nutrients and the elimination of wastes. Tibetan medicine discusses this health of the metabolism in terms of a sevenfold cycle. It is almost as though the prime nutrients, by which we mean the food we eat, the liquids we drink and the air we breathe, go through seven reincarnations within us to produce the very substance of life; the glow of health. These seven reincarnations are seven major steps of transformation, each of which produces byproducts and wastes which need to be eliminated. All the major organs and systems of the body are involved in this complex and subtle process of refinement. When there is some malfunctioning in this constant process of refinement, there is a potential cause for illness; the longer and more serious the malfunctioning, the more serious the consequences can be. In fact, it is remarkable how many illnesses have their root in one of the major steps in the metabolic cycle, namely digestion and, indirectly therefore, diet. Digestion is one of the earlier stages in the sevenfold process and a lack of suitable nutrition at this stage will have its repercussions throughout all the later stages. Needless to say, Tibetan medicine aims to detect the long-term deficiencies or excesses in the overall metabolic picture and to correct them as much as is possible, given the circumstances of the patient.
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Khenpo Tsenam Q .. So a tibetan doctor has to be aware of many things when making a diagnosis? A .. Yes. Let us return to compassion. The compassionate task of the doctor is to arrive at an accurate appreciation of what is truly ailing the patient, by taking into account all of the aforementioned factors. Without compassion, which is the sensitivity the physician has for what is taking place in the patient, there will only be an awareness of the symptoms related to the immediate physical condition of the patient. Sometimes this is enough, when a patient is suffering merely from a cold, a minor food poisoning or the like. In such cases a straightforward diagnosis will lead to a simple treatment or sometimes no treatment at all and the patient recovers, But other than in these instances, the main task of Tibetan medicine is to bring the whole psycho-physical unity of the patient back into true health. Without the clear awareness of all the long-term and shortterm factors involved and a truly compassionate motivation, what a doctor can achieve in this domain is relatively limited. This is in fact a very important point, because the doctors are the main persons responsible for helping the patients those who, by their very definition, are suffering. The role of the doctor in providing not just medicine but overall support for the patient has been stressed greatly in the traditional Tibetan medical texts and in earlier times this was given its due emphasis in daily medical practice. More recently, since doctors in Tibet did not receive a full bodhisattva training and saw medicine in a more materialistic light as a job among others for which they received a salary from the government this has fallen into the background. Fortunately it is now being restored, thanks to the relative liberty we enjoy to follow the bodhisattva training and due to the drive we are leading to restore traditional Tibetan medicine in all its fullness. As I mentioned before, the medical art was the great glory of Tibet and now it is vital that new doctors learn it as it was, in its entirety. My own aim therefore is to be able to train all these doctors according to the traditional Tibetan system - with a high standard or ethics and altruism and also how to use all the aspects of traditional medicine, including the use of rarer mineral and precious substance medicines and the ancient operation skills using the spoons etc. That is our plan. Q .. Is physical health connected with spiritual well-being, in your opinion ? A .. The understanding of what true health really means, in the long term, is a very profound one. Since, as I mentioned above, it is the purity or impurity, the maturity or immaturity, of mind which is the main long term factor in determining the well-being, the health, of the person, it follows that it is only the enlightened who have true mental and physical felicity. This does not necessarily mean however that more highly-evolved beings have less physical sickness. It is a question of how "well" a human beings feel and how well they can cope with life situations, including physical health. This is quite a subtle point but one which also needs to be taken into consideration. One is not simply treating the body with its specific problem but the body as part of a body and mind combination which is suffering. Although in daily medical practice the physician is not assuming responsibility for the
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Khenpo Tsenam spiritual or psychological progress of the patient, some understanding of this longer term spiritual and emotional dimension is needed for there to be a wise analysis of an ailment, especially where hard-to-treat, deep-rooted or chronic ailments are concerned. Besides these considerations of mind's effect upon the body, there is also serious mental sickness itself - a whole branch of Tibetan medicine. Q .. How does our mind influence our health ? I know this is a big question but perhaps you would care to mention some important points. Q .. I would like to speak briefly about the commonplace and longer-term psychosomatic triggers of illness. In Tibetan medicine these are discussed under three groups that of desire, covering all sorts of human feelings from those of greed through to sexual passion, that of anger, ranging from frustration to real hate, and that of ignorance, ranging from thick mental torpor through to ignorance of the innate purity of mind. These three areas are called the three poisons. They each have many subcategories and there are many states of mind which contains elements of two main groups or even all three - such complex things as jealousy, for instance. In the long term a predominance of desire, attachments, frustrated longings etc. will create an imbalance in the physical system known as "wind (rlung) humour". Wind is the dynamic quality within the various physical systems. When the wind humour is in harmony, the digestion, the nervous system, the blood flow etc. are all working fluidly. A long-term predominance of anger will create imbalance in the "bile (mkhris.pa) humour". This does nor mean just the physical bile or the gall bladder. It refers to the production of heat and energy in the body, especially through the ingestion and transformation of nourishment. A long-term predominance of ignorance will create imbalance in the "phlegm (bad.kan) humour". This particularly concerns the fluid balances in the body and what we might describe generally as its coolness. Q .. I know it is not easy for you to speak of what has happened to Tibet since 1960, but I would appreciate it if you could say how this affected Tibetan Medicine and you personally. A .. The widespread application of this wonderful healing science by dedicated physicians was the status quo in Tibet for more than a thousand years but, during the cultural revolution, as in many other things all over China, the Tibetan medical system suffered very great damage and, with the exception of one or two, the great centres of medical learning were destroyed. Moreover, the medicine practised by individual doctors in rural areas almost came to an end too. One of the few things to survive partially was the Lhasa mintsikang - the Astro-Medical Institute. The indigenous Tibetan medical system suffered because it was viewed by the communist regime of the time as being solely based on superstition - an invention of the lamas - and not a real medical science. It was not until after the 3rd National Assembly that there was the beginning of a restoration of some Tibetan national cultural activities. Since then there has been a steady revival of Tibetan medicine, sometimes through the initiative of governmental bodies, sometimes through that of local authorities and sometimes, more recently, with the support of Rokpa, an international charity deeply committed to the restoration of Tibetan medicine in Tibet. Actually, it is not simply a question of restoring what was there previously but of reviving Tibetan medicine in a way which responds intelligently to the needs of today. The revival has resulted in a significant and organised growth of medical schools. Some hosptals and medical centres have been established in places where there were none previously and certain institutions have been restored far beyond their previous capacity. The Lhasa Astromedical centre, for instance, has been significantly developed and its present form and capacity - in terms of number of dcotors, beds, machines, buildings and allocaton of funds - is much greater than it was formerly. The staff number almost 1,000, there are several hundred patient beds, a major medicineproducing factory and it is a teaching hospital with university status.
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Khenpo Tsenam Large astromedical centres have also been founded in Shigatse, Chamdo, Nagchu, Soka, Nyitri, etc. These have provided hospitals, doctors and medicines where there were none before and made regional centres of health care. Other astromedical centres which have been restored in major towns are the likes of De-Ge, Pa-Yul, Dartse-Do and some in the Chinghai province. Thu s, in one way, at present Tibetan medical science and education is going through a period of great development. In all these centres, Tibetan medicine is taught according to the tradition and also they have started using modern scientific methods and machines and are trying to see how modern ways can be combined with ancient wisdom. This is of course an ambitious task and at the same time a very necessary one which has to be tackled one day or another. It is being approached in a pragmatic and open-minded way and should, if handled intelligently, move both medical systems further towards joint overall goal of eradicating and preventing all diseases, thereby rendering great service to all beings. It is evident, for instance, that a Tibetan doctor who has successfully diagnosed a tumour in a certain location in a patient will be happy to have an x-ray or other information which shows the exact size of the tumour and its effect on the internal organs around it. In the past, the strength of Tibetan medicine came through it absorbing and integrating things from other medical systems which proved to be of real use you will remember the analogy of the three rivers. There are many medical systems throughout the world and we are not averse to adopting what they might have to offer. In the other direction, it is now seeming more and more likely that in many cases traditional Tibetan herbal and mineral remedies will be able to provide more effective and less intrusive solutions than present-day surgery or modern chemical medicines can. For instance, our preparations for removing kidney stones and gallstones, some of which I have developed in recent years, have impressed modern Chinese scientists by their efficacity. Another area where there is great promise is that of Tibetan medicines based on detoxified mercury. From what I am seeing of illnesses in the West and the modern world, these medicines may bring great benefit to sufferers of some of the diseases prevalent these days. In the traditional Tibetan society, these mercury-based compounds could not be manufactured by each doctor. The preparation of the detoxified mercury which is the basic ingredient requires a great deal of time, money and manpower. Hence it was only produced in the very large monasteries or at the request of exceedingly rich spnsors. The knowledge of how to produce this detoxified mercury is kept a secret. It is an oral tradition handed down from master-physician to master-physician. Although some of the technique has been committed to writing, certain key steps are purposefully omitted in order to keep this knowledge tightly controlled and free from abuse. The knowledge of how to produce detoxified mercury was almost completely lost. The actual practise had not been carried out for a long time and the first revival was performed by myself and Dr Tenzin Chodrak, who later becamethe private physician of H H the Dalai Lama. After the initial revival it was manufactured by me in Pomi, before I went to take up my post at the Lhasa Astromedical Centre. Since then I have transmitted the know-how to many people - students and colleagues - and the continuity of this rare and important aspect of Tibetan medicine has been preserved for posterity. I have since manufactured this improtant medicine in Dege, Chinghai, Yushu, Chamdo and many other places. Having made the mercury, I then proceded to revive production of the various complex precious-substance medications based on mercury, gold, gemstones and other rare substances. This has proved very successful, to such an extent that now there are many doctors all over Tibet well trained in the production of these vital medicines. Now there is no longer fear of losing this knowledge forever. The process for producing detoxified mercury in Tibetan medicine is not quite the same as that of Ayurveda. It comes not from the vedic tradition but from the revelation of Urgyenpa, the great siddha and Kagyu master. Besdies this, the Tibetans have always had a good deal of alchemical
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Khenpo Tsenam knowledge and understood how to transform one thing into another, when sucha transformatiobn is possible. The mercury process itself involves some 100 people, working constantly for about one month. Hundreds of grams of gold are needed. Through the transformations which it undergoes, mercury which is at first highly poisonous, shiny, highly mobile and like a liquid metal, becomes medicinal, matt black, immobile and solid. It becomes the king of antidotes for all types of poisoning. The detoxified mercury is not just mercury alone - it is a complex compound the making of which involves mercury, gold, silver, copper, various sorts of iron, 8 types of mineral etc. During the preparation some astounding things happen. For instance, during its transformations and detoxification, the gold, which is a noble and immutable metal, becomes oxidisable i.e. it burns. This amazed Chinese scientists who witnessed each stage of the gold preparation, during which it was beaten and boiled in special ways and treated with various natural chemicals over a period of several days before being fired in an oven. In the old days it used to have to spend 45 hours in a charcoal oven, but with modern kilns the time necessary has been reduced to about 10 hours. The end product isa gold powder which can be burnt. There is an old Tibetan saying, "Don't worry if the gold falls in the fire - it can never burn but on the contrary will improve." However, the detoxified gold compound does burn and once burnt is of a black colour. When we have prepared gold in the Lhasa Astromedical Centre, we have at times burnt up to 3lbs of gold in these processes. As you will understand, since just the preparation of the gold catalyst in the mercury prepartion takes so many days and is quite complicated, when one takes into account the preparation of all the other metals and minerals and so forth then it is not surprising that the whole process takes 30 days of non-stop activity. The preparation of detoooxified mercury to which I have alluded above, and which we currently use, is also slightly different from the process talked about in the Fourfold Tantra. The technique was given to Khedrup Orgyenpa, by Vajrayogini, in the land of Orgyen. He taught it to Karmapa Rangjung Dorje, who taught it to Sonam Zangpo, who was the grandfather of Sungkar Nyamme Dorje and it became the Tsurpu tradition. During the time of the Fifth Dalai Lama it was made by Dharam Nyammo. Later Situ Choji Jungnas made it in De-ge. Other famous lamas of more recent times, in the last century, such as Kongtrul Lodro Taye, Jamyang Chentse Wangpo, Mipham Rinpoche and so forth maintained the tradition, many of them having a strong link with Derge, my own region. As the mercury detoxification involves many people, much wealth and resources, its making was a rare event. There are many secret techniques, preserved through an oral tradition, for making very powerful and special medicines such as these. They involve wonderful phenomena such as those mentioned above or such as the powdering of diamond, to make it blend with other substances in medicinal preparations. Although now there are many people involved in the practice of Tibetan medicine in Tibet itself and there is much medical equipment and many medicines are available nowadays, there are still, in my opinion, many requirements to be fulfilled and much deeper study required, before we can consider the fullness of Tibetan medicine to be well established for centuries to come. Especially now, that the Tibetan Medicine Institute in Lhasa has been redeveloped, there is the scope for doing this. A lot of money was spent on it and a lot of foresight has gone into it - and it has been given the status of an indepenedent university. I myself hold the post of Directing Physician and Professor of Medicine and am responsible for assuring the preservation of Tibetan medical study for future generations - I try to do my best but you will appreciate that I am old and there is still a lot left to do. I am very concerned to transmit my own know-how in many specialised domains, while my health still permits. This will involve, among other things, gathering the necessary rare ingredients to make many traditional medicines which have not been prepared now for some decades and which
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Khenpo Tsenam present-day doctors do not know how to prepare. As with the mercury preparation, they will need to work alongside me as I prepare these compounds so that they understand clearly all the steps involved. Much skill, knowledge and experience goes into the preparation of Tibetan medicines. I am told, although I have not been able to look into it myself, that the medicines prepared in Tibet itself are often more effective than the same remedies prepared in other Himalayan countries. If this is the case, one can imagine many reasons why it would be so. First there is the land itself: it is certain that its geography, climate and altitude are quite unique. A religious person might also say that the centuries of widespread and profound religious practice imbibed the hills and the valleys with something very special too. One must also take into account the location of specific plants and the manner in which they are collected. Over the millenia, we have come to know the best places to collect each herb and it is very important that this knowledge be preserved and that the environment in which the herbs grow remain unpolluted. Each area, as well as a specific location within each area, has its floral speciality and the plants there have a particular potency. One needs to know exactly when to pick the plant not only in terms of its life cycle but also in terms of astrology and the time of day etc. The traditional explanations even explain who should pick the plant and how it should be gathered. Following all these criteria properly produces a very different raw material than would just the gathering of plants bearing that name, anywhere and at any time, as I fear might happen elsewhere. Once one has the finest raw materials, gathered as mentioned, these need to be processed and combined to make the various medicines. Not only does this need to be done properly, from a technical point of view, but, according to the medical tradition, with prayer and in the proper state of compassionate mind In the Lhasa Insititute we study the traditional Tibetan medical literature, the Tibetan astological literature, but also grammar, language and composition, Chinese language, English language, as well as politics and other related subjects. Since in the Tibetan medical literature and in the Tibetan medicine system, the purity of motivation and conduct of doctors has always been greatly emphasised, it is essential that there be enough training and instruction given on these topics. I am referring to the bodhisattva attitude mentioned previously. In the past this was nurtured by studying the classical Buddhist scriptures about the bodhisattva path the ratnavali, the bodhicaryvatara etc. These traditional studies are gradually being reintroduced and I am very happy about this since the quality of the physician's mind is quite determinant in establishing the quality of the medical treatment itself. We also have plans to establish a research wing in this Institue where we would investigate the newly-discovered diseases now prevailing all over the world. There is tremendous scope here and an enormous amount of work to be done, and to be done in such a way as to satisfy not only our own doctors but the criteria of the present-day worldwide scientific community. Over a fairly long term and a significant number of patients, we would need to employ traditional treatments and also to produce new medicines adequate enough to tackle those diseases, from the Tibetan medicine point of view. Some people are very optimistic in this
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Khenpo Tsenam domain. Personally I feel that in some areas a lot can be done either to cure or to attenuate serious illnesses but there is no point in raising false hopes. Proper research must be carried out and we will see, as time goes by, what contribution Tibetan medicine might have to make to the healing arts of the coming century. Besides the restoration of all the traditional medicines and traditional medical ethic, there is another area of restoration which interests us, namely that of techniques used in more ancient times. It would seem that in earlier times Tibetan medicine was studied in a very exceptional way. Later, it became, relatively speaking, a little degenerated. We have records and evidence of many things which were there before such as operations on the human brain, use of long, spoon-like implements to perform operations on various organs etc. Unlike the type of operations one sees in the West, where the body is opened up on a large scale, the latter was a minimally-invasive form of surgery, mainly used to remove tumours, from all sorts of different organs and parts of the body, These were part of Tibetan medical practice at one point but seem to have been almost forgotten now. We hope to regain the know-how of these old wisdoms and to re-introduce any of those things which may be of use today. In brief, both in terms of quality and quantity, we hope to restore Tibetan medicine to its fullness. Looking beyond Tibet, it is evident that there are many new diseases in the world, such as Aids, and new predominances of diseases causing death, such as cancer. There are also diseases new to Tibet itself, now that there is greater contact with the outside world. Through research and an enthusiastic re-establishment of Tibetan medicine, we hope to be able to contribute to the effort being put into combatting these maladies and bring some hope of partial or total cures for at least some of them. The healing art is a wonderful one one of the finest sciences a human being can apply himself to and I am convinced that the traditional wisdom and the exceptional possibilities offered by Tibetan medicine will have something to contribute to the medical understanding of the new millenium.

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