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A Series in Integrative Medicine

Traditional Tibetan Medicine


A Concise Overview
James Lake, MD
and
Rogier Hoenders, MD , PhD
Moderator: Ronald Glick, MD
January 23, 2014

Jointly sponsored by Vanderbilt University School of Medicine


Department of Medicine, Division of General Internal Medicine and Public Health
and the
Consortium of Academic Health Centers for Integrative Medicine (CAHCIM)
AMA Objectives
After participating in this CME activity, participants should be able to
describe and discuss how to:

• Engage their patients with a holistic and collaborative approach


to healing
• Refer patients with chronic illness and chronic pain to appropriate
integrative modalities for care
• Use basic coaching and motivational interviewing skills to engage
healthy behavior change
APA Objectives
After participating in this CE activity, participants should be able to:

• State an understanding of the basic philosophical approach, cause of


pathology, and common treatment approaches to Tibetan Medicine
as a whole medical system
• Identify specific lifestyle and treatment approaches that may be
applied in Traditional Tibetan Medicine to treat metal health
problems
• Identify three principles of Traditional Tibetan Medicine that are
relevant to mental health
Target Audience
Physicians, Psychologists and other health professionals from the
United States and Canada who are members of the
Consortium of Academic Health Centers for Integrative Medicine.

Instructional Level
Intermediate
Disclosures
It is the policy of Vanderbilt University School of Medicine and the Consortium of Academic Health
Centers for Integrative Medicine to require the disclosure of financial relationships from individuals in a
position to control the content of a CME activity; to identify and resolve conflicts of interest related to
those relationship; and to make disclosure information available to the audience prior to the CME
activity. Presenters are required to disclose discussion of unlabeled/unapproved uses of drugs or
devices during their presentations.
Course Director: Gurjeet Birdee, MD, Assistant Professor in Internal Medicine and Pediatrics at
Vanderbilt University School of Medicine
Planner: Tobi Fishel, PhD, Associate Professor in the Departments of Psychiatry, Psychology and
Pediatrics at Vanderbilt School of Medicine
Planner: Jeff Feldman, PhD, Assistant Professor of Neurology at Wake Forest Medical Center
Planner: Amy Locke, MD, Assistant Professor in Department of Family Medicine at University of
Michigan Medical School
Speaker: James Lake, MD, Chair Emeritus of the International Network of Integrative Mental Health and
Psychiatrist at Monterey VA Clinic
Speaker: Rogier Hoenders, MD, PhD Integrative Psychiatrist, Founder and Director of the Center for
Integrative Psychiatry in Lentis, Netherlands.
Moderator: Ronald Glick, MD, Asst. Professor Dept. of Psychiatry and Physical Medicine and
Rehabilitation at University of Pittsburg
All course directors, planners and speakers have no financial relationships to disclose.
This educational activity received no commercial support.
CME Credit
This activity has been planned and implemented in accordance with the Essential Areas and
Policies of the Accreditation Council for Continuing Medical Education through the joint
sponsorship of Vanderbilt University School of Medicine and the Consortium of Academic Health
Centers for Integrative Medicine. Vanderbilt University School of Medicine is accredited by the
ACCME to provide continuing medical education for physicians.

Vanderbilt University School of Medicine designates this live activity for a maximum of 1.0 AMA
PRA Category 1 Credit(s) ™. Physicians should claim only the credit commensurate with the
extent of their participation in the activity.

CE Credit
Vanderbilt School of Medicine is approved by the American Psychological Association to sponsor
continuing education for psychologists. Vanderbilt University school of Medicine maintains
responsibility for this program and its content.

Vanderbilt University School of Medicine designates this educational activity for 1.0 CE credits
toward the continuing education of psychologists.

No partial credit may be awarded.


Credit Requirements
This CME/CE activity consists of a simultaneous Power Point presentation and conference call
followed by an evaluation, and will require approximately one hour of your time.

To obtain CME/CE credit for your participation in this activity, you must:
• View the entire presentation.
• After the call, submit to Marina Kaasovic at mkaasovi@umn.edu , your name and the phone
number you called in from for today’s program.
• You will receive an evaluation form and contact form to be completed and returned within 7
days after the CME/CE session.
• Once your CME certificate is available you will receive an email notification from
CME@Vanderbilt.edu with log-in information to the CME Website. By following the email
instructions, you may retrieve your certification.
• If you do not receive anemail notification, please check your spam/junk folder before
contacting CME or Marina Kaasovic.
• Personal information is used for issuing a CME or CE credit certificate and storing that credit
in the Vanderbilt OCPD database.

If you have questions or need additional information contact Marina Kaasovic at


mkaasovi@umn.edu
Americans with Disabilities Act
It is the policy of Vanderbilt University School of Medicine and the
Consortium of Academic Health Centers for Integrative Medicine not to
discriminate against any person on the basis of disabilities.

If you feel you need services or auxiliary aids mentioned in this act in
order to fully participate in this continuing education activity, please
speak with a course director or planner.

3
TRADITIONAL TIBETAN MEDICINE
A CONCISE OVERVIEW

Consortium Clinical Working Group


Integrative Mental Health
23 January, 2014

James Lake M.D.


www.IntegrativeMentalHealth.net
Medical Education

Biomedicine Tibetan medicine


 Different fields within the  Tantra (तन्त्र) or rgyud (རྒྱུད།):
health care system Lineage of Teaching
 Team work  Methods of study

Doctor Nurse Therapist Physician


Theory…

Biomedicine Tibetan Medicine


 Basic Sciences  First & Second Tantra
 Anatomy  Display of the body
 Physiology  Body functions
 Pathology  Conditions of diseases

 Clinical Studies  Third Tantra


 Internal medicine  Body as a whole
 Pediatrics  Children’s disorders
 Obstetrics & Gynecology  Women’s disorders
 Psychiatry  Disorders caused by spirits
 Surgery  Injuries
Energies in TTM
 Life-sustaining
wind in the ocean
of channels

རླུང་།  Brainwaves
rlung
Wind
 Metabolic heat
in the small Literally ‚motion‘
intestine
 Digestion  Inner liquid and
བད་ཀན། solid elements
མཁྲི་པ།
bad kan  Body cells
mkhris pa
Phlegm
Bile
Literally ‚dew &
Literally ‚burning‘
earth‘
Pathologic Basis of Diseases

Biomedicine Tibetan Medicine


 Metabolic =  Cold natured
 Inflammatory =  Hot natured
 Degenerative =  Cold natured
 Neoplastic =  Self-originated
 Infectious =  Caused by srin
 Traumatic =  Caused by weapons

 Psychological =  Caused by provocations


Therapy
Biomedicine Tibetan Medicine
 Treatment of the physical body  Rebalancing energy
 Chemistry and technology  Natural resources

Advantages Advantages
 Standardized treatments  Self-administered treatments
 Strong physical effects  Fewer side effects
 Proven efficacy  Less costly/lower environmental impact

Limitations Limitations
 Dependence on technology  Difficult to get required training
 Side effects  No standardized treatments
 High expenses/environmental  Not evidence based
impact
TRADITIONAL TIBETAN
MEDICINE

Mental health and mental illness


Mental Health
& Mental Illness
What is good mental health?

Biomedicine Tibetan medicine


 Psychological well-being  Balance of body, mind & energy
 Absence of a mental disorder  good health & long life
 WHO: state of well-being  Dharma
 Realization of one‘s abilities  Wealth
 Coping with normal life stresses
 Happiness
 Productive and fruitful work
 Contributing to community
 Expression of emotions
 Enjoyment of life
 Balance between life activities
and efforts to achieve
 Ultimate realization of mind
psychological resilience  spiritual enlightenment
Mental Disorders

Biomedicine Tibetan Medicine


WHO: ICD-10 & Buddhist Psychology
F0 Organic disorders 79 Dementia
80 Planetary provocations
F1 Substance use • Destructive emotions
F2 Psychotic disorders 78 Madness provocations
F3 Mood disorders 34 Snying rlung disorders
F4 Neurotic and somatoform disorders 81 Naga provocations
F5 Behavioral disorders + physical 77 Element provocations
disorders
F6 Personality disorders 77 Element provocations
F7 Mental retardation • Karmic disorder
F8 Disorders of psychological 73 Children’s provocations
development
F9 Behavioral and emotional disorders 73 Children’s provocations
with early onset
Depressed mood—etiology
Biomedicine Tibetan Medicine

Etiology  Personality  Diet


 Life events  Lifestyle
 Social causes  Seasons
 Physiological causes  Provocation
 Other syndromes
Pathophysiology  Emotional or cognitive disorder  སྲིང་རླུང་། (snying rlung) Energy
 Hormonal/neurotransmitter imbalance of the heart
imbalance  Destructive emotions 
 Structural brain changes imbalance of the mind
Divisions & Symptoms  Depressed mood  Bad kan disorder
Fatigue  Heavy or dull mind
 Feeling empty  Sadness
 Mania  Mkhris pa disorder
 Insomnia  Active mind
 Increased appetite  Increased digestion
 Cyclic mood changes  Rlung disorder
Depressed mood—assessment
Biomedicine Tibetan Medicine

Diagnosis History  Asking questions


 Physical examination  Pulse reading
 Lab results  Urine analysis
 EEG, CT, MRI  Dream analysis

Findings  Symptoms  Signs


 Physical disorders (thyroid  Heart pulse
dysfunction, etc.)  Rlung pathology
 Hormonal imbalances  Mkhris pa pathology
 Structural changes  Bad kan pathology
 Epilepsy  Provocation signs in urine
 Hyper or hypoactive brain  Destructive emotions
areas
Depressed mood—treatment
Biomedicine Tibetan Medicine

Diet
 Depressive disorder: warming food
 Maniac disorder: cooling food
 Bipolar disorder: nourishing food
Psychotherapy Lifestyle
 Psychodynamic psychotherapy  Daily life (individual, social, spiritual)
 Cognitive behavioral therapy  Seasons
Other forms of therapy  Physiology
Medicine Medicine
 Antidepressants  Herbal medicine
 Antipsychotics  Animal products
 Sedative-hypnotics  Minerals & metals
 Stimulants
External Therapies (viewed as CAM) External Therapies
• Yoga and taijichuan  Depressive disorder: compress therapy, moxa
• Massage  Maniac disorder: blood letting, water therapy,
• Exercise acupuncture
• Chiropractic  Bipolar disorder: ku nye massage, moxa
A Zen student asked his master, "Is it OK to use email?“

"Yes," replied the master, "But no attachments!“


Working With the Mind

Biomedicine Tibetan Medicine


 Medication  Diet, lifestyle, medication, external
 Psychotherapy therapies
 Spirituality
Advantages Advantages
 Empirical knowledge and research  Familiar cultural background (law of
 Practical clinical methods cause and effect, karma)
Limitations  Connection to nature
 Medication side effects Limitations
 Cost and availability  High training required
 Taboo topic  Acceptance of karma
INTERNATIONAL ACADEMY FOR
TRADITIONAL TIBETAN MEDICINE
Traditional Production of Herbal Medicine
External Therapies & Materials
External Therapies & Materials
TTM Anywhere & For Anyone
Why is it important to
preserve and promote TTM?
• Sowa Rigpa has existed on its own right as a unique highly evolved
system of medicine since the 12th century
• Uses rigorous empirical methods and similar concepts of anatomy
& physiology
• 80% of disorders are equivalent to Western disorders
• Unique assessment tools, preventive and therapeutic methods
including diet, lifestyle, over 10,000 herbal formulas, external and
spiritual therapies
• Adapts to Western medical theory and practice because of
philosophical roots (Ten’drel); can be used by and for anyone
regardless of ethnic, cultural, religious background
• May be safely combined with other medical systems
Why preserve TTM?

• TTM acknowledged by WHO as traditional


Bhutanese and Traditional Mongolian
Medicine however…
• TTM at risk of being misinterpreted
• Knowledge of TTM may be compromised due
to political issues affecting Tibet
• The spiritual philosophy at the core of TTM is
forbidden in Tibet
IATTM Activities
 Regular IATTM courses in over 20 centers in America, Asia,
Australia and Europe
 Courses reach thousands of students include herbal
medicines, external therapies and spiritual teachings
 Online study opportunities increasing
www.SorigInstitute.org
 TTM study tours to Tibet with co-operation from:
 Qinghai TTM University
 Qinghai TTM Hospital
 Mahlo Traditional Medicine Hospital
 International TTM Congress, most recent in September 2013,
Innsbruck, Austria
We must recognize that the suffering of one
person or one nation is the suffering of
humanity.
That the happiness of one person or nation is
the happiness of humanity.

14th Dalai Lama


May all sentient beings be free of suffering
and the causes of suffering.
Books on Tibetan Medicine

• The Spiritual Medicine of Tibet, Pema


Dorjee, Jones & Moore
• Healing Elements: Efficacy and the social
ecologies of Tibetan Medicine, Craig
• Tibetan Medicine, Rechung Rinpoche
• Essentials of Tibetan Medicine, Thinley
Gyatso & Chris Hakim
Books on Tibetan Medicine
• In Search of the Medicine Buddha: A
Himalayan Journey, Crow
• Tibetan Buddhist Medicine and Psychiatry:
The Diamond Healing, Clifford
• Mind in Tibetan Buddhism, Lati Rinpoche
& Napper
• The Root Tantra and the Explanatory
Tantra, Men-Tsee-Khang, Dharamsala