More and more funds are being allocated to research in mind/body relationships, how stress affects the body, and how positive thinking can affect well-being. These are basic principles in TM, incorporated in the practice for thousands of years. Given this, is not unexpected that Tibetan medicine is transitioning from an obscure medical system, to a desired alternative to biomedicine. However, there are still issues to be addressed.
- Tibetan medicine is becoming a popular form of holistic medicine in the U.S.
- The adoption of Tibetan medicine in the U.S. is fraught with difficulties in translation: in the literal language as well as in the perception and presentation of ideas
- This article discusses these points in the framework of an interview conducted with one well-known Tibetan medicine practitioner near San Francisco, CA.
This article focuses on the translation, accessibility, and integration of Tibetan medicine in the West, and it’s potential contributions to U.S. healthcare as an evolving medical system. This article examines three key aspects of Tibetan medicine in the U.S.:
- The literal translation of Tibetan medical terminology into English.
- The perception of Tibetan medicine in the U.S.
- The scientific presentation of Tibetan medicine in the U.S.
Tibetan medicine (TM) is a healing system originating in Tibet, incorporating medical knowledge from India, China, Persia and Greece. The Tibetan medical practice is believed to be over 5000 years old, spanning throughout areas of Central Asia, and more recently Europe and North America . In contrast to biomedicine in the U.S., Tibetan medicine views the patient holistically, focusing on a number of moral, physical, spiritual and emotional factors in treatment.
In the U.S., Tibetan medicine is increasingly emerging as a viable alternative to biomedicine. When looking at emergence of Tibetan medicine in the West, however, it is important to consider how the system is perceived, practiced, and translated into a non-Tibetan culture. Tibetan medicine presents a comprehensive medical system, and Tibetan practitioners are currently treating U.S. patients in many areas. How is Tibetan medicine assimilated into U.S. culture, and what barriers to integration exist?
These and several other issues are approached in discussion with Dr. Yangdron Kalzang, a Tibetan medical provider who lives and practices in the San Francisco Bay Area. Dr. Kalzang was born and raised in Tibet, obtaining her medical degree from the University of Lhasa. After moving to the United States, she received her licensure to practice acupuncture and herbalism, being the first Tibetan Doctor to obtain such credentials. Dr. Kalzang also teaches Tibetan medical courses at the institute where she obtained her acupuncture training, and has collaborated with researchers at both Stanford and UCSF.
In my conversations with Dr. Kalzang, various problems with Tibetan medical translation were addressed. Dr. Kalzang explained that language barriers are a key integration issue in practice. The foundation text for most Tibetan practice is a book called “rGyudbshi.” The methods outlined in rGyubshi are often translated from Tibetan into English. Translations are not always accurate, however, and much meaning can be lost in the translation process.
Dr. Kalzang explains her own method of “translating” in the clinic. Rather than relying only on English terms, she attempts to elaborate in her classes and practice. As she says, many texts simply do not incorporate both the broad view of Tibetan medical concepts as well as the narrow view when translated. For example, literal translation of the Tibetan word for “kidney” is restricted. The view of the word kidney in Tibetan refers to structure, but also implies a relationship to other areas; bodily humors, mental states, and spirituality, among other factors. When considering a “kidney” issue, the provider may incorporate an aspect of TM theory such as nyae pas, which is a three-part model of body/mind interaction: rlyng, treepa, and bad kan. Each of these refers to a physical and/or mental relationship to bodily organs, such as the nervous system or circulatory system . When describing a kidney issue, Dr. Kalzang may indicate an imbalance with treepa. A complex relationship between many organ systems can therefore be conveyed by one word in Tibetan medicine.
The word “energy” also poses an issue of terminology and schema. It is a word that has no single definition in English, and most commonly points to something that is subjectively perceived by the patient. A concrete concept of “energy” is an integral part of Tibetan medical diagnosis and treatment, as is common in many Asian medical theories. In Tibetan medicine, the mind is seen as a conductor of energy, which flows through the body as well. Energy thus affects physical health in the same way as any endogenous or exogenous factors could. It is believed in Tibetan medicine that life is sustained through these energy channels, bodily humors and mental states. The balance of the three humors of the body: blood, phlegm, and bile is emphasized. In treatment, the imbalance of any of these is the cause or illness, and the balance is believed to sustain mental awareness and well-being . Therefore, addressing energy imbalances is key in Tibetan medical treatment. Mistranslation or a lack of an understanding of “energy” can create barriers in transmission of ideas between patient and provider. In the case of Dr. Kalzang, she continues to address translation the best she can; orally presenting information in both broad and narrow views to her patients and clients.
The Perception of Tibetan medicine in the U.S.
In addition to translation issues, it may be difficult for a patient to understand the complexity and unfamiliarity of TM diagnosis. Moreover, the patient may develop misconceptions if they do not have a proper understanding of such theories. Confusion may be perpetuated by that fact that there is little scientific explanation for some TM models of mind/body as of yet. Mind/body interventional approaches have only been studied in recent years in biomedicine, and linkages between the two systems are only starting to be widely accepted.
As with any medical system, there are mixed responses to Tibetan healing. Dr. Kalzang explains that patients come to her for various reasons. Some are referred from within local Buddhist communities, persons who have some connection to the spiritual foundations of the practice. Others come to her out of curiosity or desperation for relief, probably without spiritual relation to TM. Dissatisfaction with biomedicine has attracted patients who are not Buddhist or Tibet-affiliated, but may have tried other treatments unsuccessfully.
Kalzang claims that there are some Tibetan doctors who do not care to integrate their practice with other treatment options, such as acupuncture and herbalism, in an effort to preserve the integrity of traditional practices. However, Dr. Kalzang finds that this approach was ineffective for her. Rather than seeing patients and utilizing only Tibetan methods, Dr. Kalzang views each patient individually, and offers the treatments which are most suited to the patients condition, and comfort. Therefore, integrating her practice provides an extensive skill set from which to work, and Kalzang is able to individually offer patients their best option. The plurality of treatment options, such as acupuncture and herbalism used in conjunction with TM, may enable patients who are familiar with such practices to feel comfortable pursuing Tibetan medicine. This model is optimal in Dr. Kalzang's treatment.
Presenting Tibetan medicine as Science in the U.S.
Of importance is the issue of plurality in medical systems. In U.S. society where scientific evidence is valued, can the complex energetic processes of TM be appreciated as not only an alternative to but as a medical system equal to biomedicine? Or do some consider this a mystical ancient practice which has no place in modern science? According to Eliot Tokar, an American provider of Tibetan medicine, and researcher on the topic, it is imperative that Tibetan medicine be uplifted in U.S. society to a level of reputable treatment. Acupuncture, for example, has over the past few decades become a fixture in healthcare. Tokar finds that traditional medical systems should be integrated into health care. Not only to offer their own methodological treatments, but also to evolve and offer innovative solutions in public health.
It can be said that not all TM treatments have enough scientific research to account for positive results from traditional therapies. The same can be understood from acupuncture, which is known to have minimal health risks, is vastly successful, and found in almost every major U.S. city today. Moreover, traditional Tibetan medicine offers much in terms of medical system ethics, and a health modeling. In her book on Tibetan medicine and psychiatry, Terry Clifford explains:
“Tibetan medicine offers highly defined and relevant models with which we can enrich our modern views of healing. These include a model of holistic medicine, a model of psychosomatic medicine, a model of mental and psychic healing, an ethical model of the healer, and a model for using illness to develop wisdom.”
Tibetan medicine can offer much to current U.S. public health issues, in the same way that acupuncture and yoga are finding a niche in society, and promoting well-being and stress relief. Stress being a well-known cause of many common ailments, it also plays a key role in serious diseases and disorders. Tibetan medicine promotes proper health through relaxation techniques, exercise, sleep and diet, all known to play a role in countering stress.
The reception of alternative medicine depends on a number of factors, including a patient’s cultural, economic, and social background. All of these can affect the willingness to seek TM treatment. In the U.S., there are very few TM providers available. Thus, in increasing communication between patients and providers of Tibetan medicine, the issue of translation must be addressed to preserve the virtue of the system as practiced in foreign environments. Secondly, accessibility must be evaluated; the integration of Tibetan medicine with other practices such as acupuncture, welcome patients who have received similar treatments to approach TM. Thirdly, in terms of patient response, both translation and accessibility play a role. Patients from a secular medical background may find the spiritual aspects of TM difficult to understand, and the complex theories unfamiliar. However, according to TM provider Dr. Kalzang, it is not necessary for a patient to be a Buddhist or believe in TM in order to achieve well-being through treatment.
As TM is manifesting as a new alternative treatment, there are small amounts of research and literature on the topic of Tibetan treatment. As Dr. Kalzang explained, much of what she relates to others is iterated verbally, and primarily to colleagues and other practitioners. What she observes in patient response she uses to adjust her practice. Perhaps less-limited translations of Tibetan terms could be developed to resolve such issues. It could take providers to gather and consult on this topic to create a comprehensive translation guide to elucidate the intricacies of Tibetan Medical theory. In terms of accessibility, integration with other alternative therapies and complementary services to biomedicine seem conducive to bringing TM to large populations. Especially those who may have already accepted CAM and IM in other forms. Patient response depends heavily on the language used in TM, comfort with treatments (including spiritual aspects of diagnosis), patient-provider relationships, and patient adherence to self-motivated lifestyle modifications.
Progression in health care requires that health systems are approached more equally, with opportunity given for high-risk populations such as homeless, children, and elderly to access alternative care if needed. Increased advocacy for such treatments can implement better education, more effective translation, and the development of integrated models which can increase the accessibility of such systems.
In the past few decades, the U.S. has witnessed health shifts never encountered before. The current healthcare system is predominantly biomedical, with Eastern approaches, alternative treatments, and mind/body interventions appearing in progressive areas. The internet provides abundant resources on nutrition, diet, exercise, Ayurveda, yoga methods, meditation techniques, and stress relief. More and more funds are being allocated to research in mind/body relationships, how stress affects the body, and how positive thinking can affect well-being. These are basic principles in TM, incorporated in the practice for thousands of years. Given this, is not unexpected that Tibetan medicine is transitioning from an obscure medical system, to a desired alternative to biomedicine. However, there are still issues to be addressed.
by Kory Van Unen
NOTE: This article was written originally as a paper for the UCLA upper division anthropology course Perspectives on Complementary/Alternative & Integrative Medicine, taught by Dr. Sonya Pritzker. More information on the course can be found here.
- Clifford, T. An Overview. Tibetan Buddhist Medicine and Psychiatry: The Diamond Healing. York Beach, ME. Samuel Weiser, Inc. 1984
- Tokar, E. Preservation and Progress: Using Tibetan Medicine as a Model to Define a Progressive Role for Traditional Asian Medicine in Modern Healthcare. Asian Medicine, Tradition and Modernity. 2011 Vol 2 No 2.:304.
- Pritzker, S., Hui, K. English Translation of TCM Terminology: Terminology Standardization in Chinese Medicine; The Perspective from UCLA Center for East-West Medicine. Chin J Integr Med Mar;13 2007 (1):64-66