Tibetan medicine derives from the Ayurvedic knowledge, and spread to Tibet around the 5th century along with the spread of Buddhist influence. It is widely believed that Saint Padmasambhava was invited to Tibet from India during the reign of King Trison Detsen in the early 7th century, and is credited with the establishment of Dharma in Tibet. Saint Pamasambhava was renowned for his mastery of all the tantric practices. His disciple, Vairochana, went to India and procured and translated various Sanskrit medical texts and is now referred to by the title rGyud-bZhi or the Four Tantras. This knowledge was passed on by Vairochana to Yuthog Yonton Gonpo, who is the first great doctor-saint of Tibet. The second Yuthog Yonton Gonpo produced a new version of the text called the Eighteen Auxiliary Aids, which has remained the standard accepted version to this day.

The Dalai Lamas, Tibets spiritual and temporal rulers since the late 17th century, have encouraged the growth and practice of Tibetan medicine, and initially only monks were taught the art of healing. They established medical schools and research centers. In 1670, Desi Sangye Gyatso was made the vice-chief of all Tibetan doctors and later appointed Prime Minister, he wrote the Blue Lapis Lazuli.

The rGyud-bZhi
The rGyud-bzhi contains the entire teachings of Tibetan medicine, and is written as a question-answer dialogue between Rishi-master Vidyajnana and disciple Rishi Manasija. It is comprised of four volumes, 156 chapters, 5900 verses, and explains the cures of 1616 diseases. The four volumes are:
(1) The Root Treatise or Mula Tantra
(2) The Explanatory Text or Akhyata Tantra
(3) The Practice Instruction Text or Upadesha Tantra
(4) The Last Text or Uttantra.

These traditions of ancient Tibetan medicine have been continued by the present Dalai Lama, even in exile. The headquarters of the Tibetan Medical and Astrological Institute are now based in Dharamsala, North India. One has to undergo rigorous training for a minimum of seven years, before they can qualify to be a Tibetan doctor. For the student to understand the medical texts and knowledge of Tibetan linguistics, grammar and poetry is required. The first four years of training are taken up with studying the four main medical tantras, or rGyud-bzhi. In the fifth year students take exams both oral and written on these four tantras. For the sixth and seventh years students are sent for practical training under a senior and experienced doctor (amchi) at one of the branches of the Tibetan Medical and Astrological institute. At present there are now over 30 branches in India and Nepal, and in addition to this there are a number of private clinics.

The Basics
Tibetan medicine is a traditional form of healing which uses natural materials like herbs, trees, rocks, resins, soils, precious metals, saps etc. However, 95% of Tibetan medicine is based on herbs, and precious metals are used for the seven kinds of precious pill known as Rinchen rilpo. If the physician is able to make the right diagnosis and administer the right medicine, then Tibetan medicine is good for all kinds of illness. However, it has been particularly successful in its treatment of chronic diseases such as rheumatism, arthritis, ulcers, chronic digestive problems, asthma, hepatitis, eczema, liver problems, sinus problems, anxiety and problems connected with the nervous system. It uses a holistic approach, tackling the disease at both the physical and emotional levels which has profound roots in Buddhist philosophy.

The basic cause of a disease is ignorance of believing in the self. The ignorance leads to the three mental poisons of desire, hatred and close-mindedness. These in turn give rise to imbalance in the three humours or Nyes-pa. Desire stimulates rLung (or vital energy) in our body, hatred stimulates mKhrispa (or bile or bodily heat) and close-mindedness stimulates Bad-kan (phlegm) in our bodies. Physiologically, our body is made up of the three humours, seven physical energies and three excretions. The three humours are the biological representations of the five elements (earth, fire, air, water and space). The seven physical energies are: nutritional essence, blood, flesh, fat, bone tissue, bone marrow and the sperm or ovum. The three excretions are stools, urine and sweat. It is the balance or imbalance of the three components of the human body that causes the body to function well or not well in various degrees. The disease enters the body through stages before it manifests itself completely. These stages are the skin, the flesh, the channels, the bones, the vital organs and the hollow organs. Then, the disease localizes itself in the body. Phlegmatic disorders are usually on the upper side of the body, bile disorders in the middle part, and the wind disorders in the lower part of the body.

As Dr. Khangkar states, the essence of health is the holistic harmony between the microcosm of the body and the macrocosm of the universe which are constantly dancing with each other. When they are out or step or out of tune with the spiritual reality than disease results.

Diagnosis
The Tibetan doctor utilizes three main methods of diagnosis:
(1) Visual
(2) Pulse reading and
(3) Interrogation

Visual diagnosis includes the study of height, body structure, color of the eyes, sputum, faeces, color of the skin, examination of the tongue, and urine analysis. The latter is extremely important. Diagnosis by touch includes reading the pulse, and observing abnormalities in skin texture and temperature. The reading of the pulse is the most important, and must be done appropriately. Lastly, interrogation is necessary to understand dietary and lifestyle factors, economic conditions, profession, family health history etc.

Tibetan medicine classifies all diseases either cold or hot. Four patterns of disharmony are:
(a) cold external symptoms with hot internal
(b) hot external symptoms with cold internal
(c) cold external symptoms with cold internal
(d) hot external symptoms with hot internal
nature of illness.

Prognosis
All diseases are classified as:
(a) dependent diseases causes by past karma
(b) imaginary diseases caused by demons
(c) absolute diseases of this life
(d) ostensible diseases.

These are
(a) untreatable
(b) treatable by ritual means
(c) treatable by medication- internal/external and behavioural or dietary changes and
(d) without need of treatment because they heal spontaneously respectively.

Herbs, Minerals, Gemstones and Animals
It is believed that the site from which Sri Hanuman picked up Sanjeevani to cure Laxman, may have been in Tibet. Thousands of herbs, roots, animal products and minerals are used in the production of Tibetan medicine. For the rLung patient various herbal ingredients are used such as aqullaria agollocha, allium sativum, myristica fragrans, asafoetida, santalum album etc. For the mKhris-pa patient's medicine, swertia chirata, momordica charantia, holarrhena antidysenterica, aconitum naviculare, ixers gracilis, chrysosplenium nepalense, swertia hookeri and berberis asiatica etc. are used. Chaenomeles, inula helenium, coriandium sativum, meconopsis discigera, punica granatum, kaempferia galanga and phyllantus emblica etc. are used for the Bad-kan patient's medicine.

Diet and behaviour
Diet and behavioral changes are very essential under Tibetan medicine. Generally the rLung patient must try to eat food which has got heavy and nutritional potency, such as butter, molasses, milk, soups, garlic, ginger and onions. The mKhris-pa patient should eat vegetables, fresh butter, fresh low fat cheese, cow's yogurt and buttermilk, drink weak tea, spring water and have less greasy food. The Bad-kan patient should have honey, barley, wine, ginger decoction and plenty of hot water and cooked vegetables.

For behaviour the rLung patient should stay in dark and warm places, the surroundings should be very quiet, and there should be beautiful scenery. He or she should have good company such as loved ones and close friends. The patient should also rest both physically and mentally without any worries. For the mKhris-pa patient's behaviour he or she should have cold baths and showers, sit in shaded places and walk by the sea and use a cool perfume such as sandalwood. For the behaviour of the Bad-kan patient, he or she should have lots of sun, warm fires in the home; perform exercise such as prostrations, walking and running.

In Tibetan science of healing, the root cause of the disease and illness is cured and not just the symptoms. Without treating the root cause of the disease it is like poisonous tree - just cutting off the leaves and branches without pulling it up from it's roots. If you just cut the leaves and branches it will still continue to grow.

References
The Buddhist Way Of Healing by Dolkar Khangkar,
Introduction to Tibeten Medicine by Dr. Tamdin Sither Bradley
Mysteries of Tibetan Medicine by Dr Victor Vostokov