Tibetan medicine has aroused the interest of Western physicians during recent years, principally because of claims of its practical value1. Tibetan doctors of the Tibetan Medical Institute at Dharamsala, India, are by now well known visitors to American and European universities, where they have lectured on theory and practice of Tibetan medicine. However, there is great difficulty in communicating the concepts of Tibetan medicine to the West. One reason often given for this difficulty is the overall difference between these two medical cultures and philosophies.
As a Western physician, my interest in Tibetan medicine stems from the fact that four generations of physicians in my family, educated in European schools, have combined Western medical concepts with those of Tibet in their practice 1, 2 ,3 ,4 ,5 ,6 ,7 . Knowledge of Tibetan medicine was acquired in our ancestral home in the Asian part of Russia, the Buryat Republic. This is one of the few places outside of Tibet where Tibetan culture has continued to flourish 3,7.
Tibetan medicine is rooted in ancient traditions. Its first written document is approximately 1,300 years old 8, 9. The consensus among Tibetologists is that this medical system was developed under the influence of the medicine and philosophy of India. However, at least at the beginning of the Tibetan Empire, that knowledge was primarily Western (i.e. Greek) and secondarily Chinese in origin 10.
The Tibetan Empire, which lasted from the seventh to the ninth centuries, extended south to the plain of the Ganges, north to Samarkanda, and included part of China8. The vast and culturally varied territory of that empire had an impact on the development of Tibetan medicine. Buddhism was brought from India to Tibet, providing a philosophy that has become essential in medical education and knowledge in that country8,9. Symbolically, Buddha occupies an important position in the medical hierarchy of Tibet. One of his titles there is "Supreme Physician" and he is often thought of as the "Tibetan Aesculapius".
The Tibetan king Ti-song-De-tsen invited in VIII century AD Padma-Sambhava, a famous Buddhist teacher from the College of Nalanda, in India, to Tibet. The three kings who ruled the Tibetan Empire were, in chronological order, Song-tsen Gam-po, Ti-song De-tsen and Rolpa-chon. They are regarded as the most prominent figures in Tibetan history. In addition to the introduction of Buddhism, their reigns were highlighted by a medical convention which took place between 755 and 797 AD, at Samye, southeast of Lhasa, the capital of Tibet 11. During that meeting, renowned physicians from Persia, Greece, India, China, Afghanistan, Nepal, East Turkestan and Kashmir translated their medical works into the Tibetan language.
The eighth and ninth centuries have also been remembered in the history of Tibetan medicine through the work of a physician known as the "Elder gYu-thog Yon-tan mGon-po" or as the "Excellent Protector". During the 120 years of his life, the Elder earned the reputation as a charismatic teacher. He was probably the first to compile the scattered texts on Tibetan techniques of diagnosis and treatment 12. One of his descendants, the "Younger gYu-thog Yon-tan mGon-po" is credited with adding a broad knowledge to the canon textbook of Tibetan medicine the yGyud-bzhi. In fact, the original of the yGyud-bzhi (pronounced Zud-shi, meaning"Four Roots") was brought to Tibet from India during the active period of the Empire. According to one source, the book was written originally in Sanskrit in the fourth century. Most likely, the translation into the Tibetan language was accomplished in the eighth century by Vairochana , with the assistance of the Tibetan physician, Zla -ba mNon-dgha 9. That translation was presented to Padma -Sambhava, the famous teacher of Buddhism, who became skeptical whether the yGyud-bzhi could readily be understood and appreciated by a majority of the physicians of that time. In the late nineteenth and early twentieth centuries that ancient work was translated from Tibetan and Mongolian into Russian by my granduncles Dr. Alexander Badmaev and Dr. Peter Badmaev 14.
Historically, medical education in Tibet has been based on a highly structured system, with Buddhist monasteries functioning as medical schools 9. The first medical college in Tibet, Kong-po-menlung, was built in the eighth century at Lhasa. Among medical schools established since then, the best known are the Chagpori Medical College, built in the seventeenth century, and Mentsi Khang built in 1915 , both in Lhasa. Since 1959, the Tibetan Medical Institute, at Dharamsala, India, is the center recognized as upholding this medical tradition.
Tibetan medicine has also been practiced in Mongolia, where it was introduced in the year 1235 by the physician, Sakaja, who cured Godon, the ruler of that country, of a form of paralysis15. The Mongolian people, in recognition of the Tibetan contribution to their medical knowledge, as well as the teachings of Buddhism in Mongolia, awarded the ruling priest-prince of Tibet in 1547 the Mongolian title of "Dalai-Lama," meaning "Ocean Priest"16. In the eighteenth century, Tibetan medicine was brought from Mongolia to the Asiatic part of Russia, and both that medicine and Buddhism have flourished in the Buryat Russian Republic.
Unlike Ayurveda and Chinese medicine, Tibetan medicine came to the attention of the West relatively recently, in the middle of the nineteenth century. The pioneers were Alexander Csoma de Koros, a Hungarian "hero of learning, " who had spent years in seclusion in Tibetan monasteries studying the language and Tibetan medical treatises 17. The other pioneer was my ancestral, Buryat physician, Dr. Sul-Tim-Badma, who, in recognition of his medical skills, was invited in 1850's to the European part of Russia by the then governor of Siberia, Muraviev Amurski. Later, Dr. Sul-Tim-Badma settled in St. Petersburgh and changed his name to Dr. Alexander Badmaev 2, 3.
Alexander was soon followed to St. Petersburg by his younger brother Dr. Peter Badmaev, whose Buryat name was Zham-saran. Both Alexander and Peter are well recognized figures in the latest Russian history for their ties to the last two emperors of Russia.18
Both Badmaevs provided their own interpretation of Tibetan medicine, which now could be seen as an effort to integrate traditional knowledge with mainstream (allopathic) medicine. Not everybody agreed with their approach to the subject, and they have been at times criticized for providing a too simplified version of Tibetan medical knowledge.
However, there is no denying that they enjoyed a reputation as good doctors. Pyotr was also a successful entrepreneur, establishing a Tibetan clinic at Poklonnaya Gora in St. Petersburg where in-patients and out-patients were seen and treated, and young adepts of Tibetan medicine were trained.
Both Badmaevs emphasized a practical rather than esoteric approach to Tibetan medicine, stressing to their western colleagues and patients alike that this non-conventional medical system is based on logic; thus it can be confirmed by science. 14 Their thought process centered around principles which are touched upon by today's integrative or complementary medicine
- the majority of diseases are not caused by an abrupt insult but result from long-standing abuse of the organism;
- the gastrointestinal system is central in the pathogenesis of most diseases;
- any disease affects all the organs and body systems, despite the obvious manifestation associated with the body organ/system affected most;
- the role of any treatment is to support but not to replace the organism's natural defense mechanism against disease.
Uncharacteristically for the Tibetan way of teaching, the Badmaevs did not use a lot of Sanskrit terminology but instead used descriptive language to explain their diagnostic and therapeutic approach. They argued, for example, that since most diseases (according to Tibetan medicine) are regarded as a result of a long-standing pathological process, most treatments in that tradition have been aimed at a correspondingly gradual recovery. To insure that improvement related to therapy is gradual, the treatment with a drug usually starts with one third of the maximum therapeutic dose over a period of weeks. Based on the reaction of the individual patient, the dose may be increased, and after accomplishing the therapeutic goal gradually tapered off. Usually therapy spans from one to three months and is followed by a one month break and re-evaluation. If improvement has not been accomplished the cycle of treatment is repeated. The one month break between cycles was designed not only for re-evaluation of the condition but also to enhance the organism's own physiological defense mechanisms against the disease.
While in St. Petersburg, Alexander and Peter Badmaev Sr., maintained close contacts with their homeland, which was a source of herbs and minerals for their botanical formulae, and more importantly a source of talented and knowledgeable medical students and professionals. Among those Buryats who joined Pyotr in St. Petersburg was my grandfather Jamyan-Badma, later known as Dr. Vladimir Nikolayevich Badmaev. His middlename is derived from his godfather, the last Czar of Russia Nicholas II.
At the age of twelve, around the year 1896, Vladimir Sr. was brought by his uncle Peter Sr. to St. Petersburg, where his education continued at the Tibetan medical complex at Poklonnaya Gora. After graduating from high school, Vladimir entered the Military Medical School in Moscow, where he obtained the diploma of a physician. Following the 1917 Revolution in Russia, an almost 40 year old Badmaev escaped to Poland, where he obtained a license to practice medicine. The family name underwent further phonetic changes to Badmajeff and Badmajew during the Oddysey to the West.
In his medical practice Dr. Vladimir Badmaev combined both the Western and the Tibetan knowledge of medicine. As a medical professional, he was confronted by the double standards applied by the people to his practice. Officially, his medicine was controversial and even held in contempt by the academicians. On the other hand, the number of patients in his office kept growing and included patients prominent in the public eye.
According to the tradition carried in my family, herbal treatments have a certain regimen 18. The treatment usually starts with a digestive formulation because, in Tibetan medicine, disease is considered primarily a derangement of nutrition. After the initial treatment, and to correct the suspected nutritional pathology, the appropriate treatment of any secondary disease is then instituted. Nutrition is central in the theory and practice of Tibetan medicine. According to that concept, prevention of disease can be accomplished by seasonal adjustment of the menu to comply with changing nutritional requirements. The taste of the food is the single most important consideration in defining proper nutrition and preventive medicine during the seasons of the year. Tibetan pharmacotherapy has been based on the concept of proper nutrition, and in fact herbal and mineral formulae, as passed down in my family tradition, were referred to as a "condensed food" for a specific disease condition.
The Tibetan herbal formulations as practiced in my family have been composed of several herbal and/or mineral ingre¬dients. These have been arranged based on triadic philosophy derived from Ayurveda into three therapeutic groups of ingredients occurring in each formula:
1. the main acting ingredients,
2. the ingredients which support the main action, and
3. the ingredients that prevent any untoward effects of the first two groups and increase gastrointestinal bioavailability of the active principles.
Herbal therapy plays an important, but not primary, role in the overall approach to the treatment of a disease in Tibetan medicine. Before prescribing any specific formulation to a patient, a physician makes sure that a patient understands the overall approach to the disease. According to this approach none of the techniques devised by man against any disease could be as helpful as the body 's own means of fighting the disease. These natural means should be supported, during critical moments, by specific treatments. But, in the first place, the patient should be maintained in good shape by: 1) proper nutrition, 2) good life-habits, 3) proper adjustment to the seasons of the year, and 4) awareness by the individual of his/hers physical and psychological predispositions. In order to fulfill these four conditions of well-being a man should guide himself/herself with awareness, will power and compassion. These three aspects, based on the triadic philosophy were named in Buryat language Chi, Schara and Badahan corresponding to Vata, Pitta, Kapha in Ayurveda.
In modern medicine there is, regrettably, little recognition of moral values as a means of disease prevention and treatment. Indirectly, this void in contemporary western medical practice is becoming recognized and the role of family physician by some is being restored and enlarged so that a patient is approached on a more personal level. The communication with a patient in Tibetan medicine is a critical part of a visit to the doctor's office. Physician recommendations, given to a patient during office visits, are not only to be acknowledged but also understood by the patient. Thus, the patient acquires a sense of health-care philosophy, and can identify with it and could further propagate it. This simple approach results in an efficient system of preventing disease in the first place.
The above discussed doctor to patient recommendations were given to patients during office visits by my grandfather Vladimir, and were not only acknowledged but generally well received and understood by his patients. In addition to legacy of the patients, Dr. Badmaev managed to preserve his interpretation of Tibetan medical concepts in four books published in the 1930s and two journals, edited by him quarterly (1920s-1930s). 12, 13 Dr. Vladimir Badmaev Sr. died in 1961 in Poland.
Vladimir's Sr. son Peter Jr., named after Peter Badmaev Sr., graduated from the Medical Academy at Lodz, Poland, became a successful surgeon and carried tradition of Tibetan medicine to Switzerland and then to the USA. Peter faced the dilemma of a physician molded in modern ways. Although well versed in Tibetan medicine through father-to-son teachings, he was at the same time acutely aware of a spectacular feast of contemporary Western medicine.
My interest in and knowledge of Tibetan medicine did not originate with father-to-son teachings, since my father Peter started his journey West when I was barely a teenager. That brings me to an intriguing point: what really has kept the family tradition going even in the absence of a direct father-to-son input?
My conscientious interest in Tibetan medicine began in the late 1970s, when after obtaining an MD degree was working on a PhD thesis in the Department of Microbiology of my alma mater, the Medical School at Bialystok, Poland. In early 1980s after immigration to the USA and usual routine of going through residency program to advance medical career I started building research program of the traditional Tibetan formulas as well as individual ingredients from Ayurveda and Tibetan (Indo-Tibetan) material medica. The mission was to investigate Tibetan medicine scientifically, to oversee the clinical studies on Tibetan herbal formulae and ultimately to and establish Tibetan and Ayurveda medical traditions in the West.
The cumulative almost three decade experience indicates that although the overall education of Western society is analytical in nature and favors single component drugs, there is also growing understanding that herbal formulations could be advantageous for the treatment of ailments in which known synthetic drugs and allopathic methods of treatment failed.
In fact, the multi-component Tibetan formulae and allopathic treatments could be complementary in the following ways:
- safety and efficacy of a synthetic drug can be improved by scientific evaluation and lessons drawn from a three-group design of the formulae;
- treatment of multi-factorial and chronic diseases requiring long-term treatment is safer and more efficacious with Tibetan formulae;
- there have been no reported negative interactions among the Tibetan formulae practiced and researched by the Badmaevs and commonly used synthetic drugs;
- expert use of numerous gastrointestinal formulae in the Badmaev tradition with regulatory action upon the exocrine and endocrine functions of the digestive tract to sustain functions which often are compromised with the use of many synthetic drugs.
In conclusion, introducing Tibetan medicine and integrating its principles into the Western medical practice can improve existing healthcare considerably in many ways. It is not only a matter of advanced technology that allows people to be and feel healthier. Despite tremendous advancement in medical technology we, as a society, are not healthier. It suffices to observe that the work of man, his thoughts and the outcome of his deeds, are chiefly directed towards destruction and based on short-sighted goals. Today, economic and political life has become a kind of thoughtless game of chance; the cult of the power of the group and the State has overshadowed the real aims of humanity. Regrettably the delivery of modern health care became an integral part of this bureaucratic and technocratic system.
The medical tradition as known to me stresses an unusual approach to health care, where a man should guide himself with moral values, with the ultimate goal being compassion. As unusual as it may sound, however, to recognize moral values as a means of well-being and an integral part of the treatment method would be a meaningful step towards better medicine. Perhaps we should go back to the past and only then to the future.