Tibetan Medicine

Living and Dying in Harmony with My Constitution

Margeaux Candlin University of Minnesota CSPH 5315 - “Traditional Tibetan Medicine: Ethics, Spirituality, & Healing” Faculty, Miriam E. Cameron, PhD, MS, MA, RN April 1, 2021

This paper will describe an overview of Tibetan Medicine and how to live and die in harmony with my constitution. Tibetan medicine (TM) is an ancient healing system that has stood the test of time and explains the connection between “mind, body, and science” (Cameron &Namdul, 2020). It is important to understand the basic principles of Tibetan Medicine because it “provides a cost-effective, holistic model for making informed decisions to create health and happiness”(Cameron &Namdul, 2020). Additionally, Tibetan medicine teaches the practices of compassion, peace, and mindfulness which are beneficial in my personal life and with those I work with. The Constitutional Self-Assessment Tool (CSAT) (Cameron, et al., 2021) was used to determine the distribution of my energies and I had a Tibetan Medicine Consultation over Zoom. The CSAT showed I have a baekan/ loong constitution and the consultation with the Tibetan Medicine doctor I participated in, also demonstrated I had a baekan/ loong constitution. I will compare and contrast these two constitutions in the paper.

It is important to know my constitution so I can live a healthy and happy life and experience a peaceful death. Additionally, when I feel a greater sense of health and well-being, I will be able to help others more effectively. To describe how I can live and die in harmony with my constitution I will describe how the three primary energies affect my constitution, the strengths and weaknesses of my constitution, what I can do to support my strengths and weaknesses, and how I can prepare for a good death. Additionally, scientific evidence will be discussed in this paper on how Tibetan Medicine, particularly the principle of compassion, can benefit myself and others.

The five elements TM teaches all phenomena consist of energy which is composed of the five elements. Tibetan Medicine uses everyday terms to name the five elements: earth, water, fire, air, and space.

Earth provides stability and structure, someone who exhibits strong earth elements may have a regular weekly schedule and a strong home life.

Water produces moisture, and smoothness, and sustains life, someone with a strong water element exhibits adaptability to multiple environments.

Fire is demonstrated by the drive someone has to grow developmentally, spiritually, and physically. Those with a strong sense of fire are leaders.

Air creates flexibility in the mind and the body. Air allows for thoughts to move through the mind without attachment, when something is difficult one can see the positive and the negative to what has occurred. Someone who exhibits air would be someone who loses a job and sees the opportunities ahead of them for new choices in addition to the loss of their current position.

The last of the five elements is space, space allows for the elements to work together. In life we are always moving and changing, different elements are needed at different times, and without space, we are unable to fluidly balance with the other elements. When someone exhibits space they can utilize all of their strengths, find their stability, be adaptable to their environment, and grow developmentally (Cameron et al, 2020).

A philosophical principle of Tibetan Medicine is interdependence, this means that everything is interdependent on the interaction between the five elements. When I am without one element I crave it as my life depends on it, for example, if I am lost in the desert I’m going to crave water, when I’m in a crowd, I search for space, when I’m underwater, I come to the surface gasping for breath (Cameron et al, 2020).

The three primary energies

“Each of us is born with a unique combination of the three primary energies, loong, tripa, and baekan. Our constitution doesn't change, but our three primary energies can rise, fall, and become disturbed depending on what is going on in our lives. To be happy and healthy, I need to make mindful, informed choices to keep the current percentages of my three primary energies (nyepa) about the same as their percentages in my constitution (Cameron, 2021).

The five elements interact to form the three primary energies, loong, movement energy, tripa, heat energy, and baekan, cold energy. The below sections will define the energy, how it shows up if there is an imbalance, what type of mental poison will come from that particular imbalance, how to heal each of these energies, and which constitutions (dominant energy) are under each energetic category.

Ultimately, healing results from rooting out the three mental poisons that are the result of energy imbalances, because the mind is the source of suffering. Someone’s constitution is determined by the most dominant energy, there are seven constitutions and each constitution demonstrates a different personality type with a variety of strengths and weaknesses. People who have all three energies equal are said to be “enlightened”, however, this is rare. Those who are completely balanced, loong/tripa/ baekan, are those who practice Tibetan medicine regularly, such as a Buddhist monk.

Loong Loong is movement energy which encompasses moving thoughts and physical movement. Loong is related to the breath which produces “life force or chi”. Loong is creative energy and stimulates new ideas and actions. People who are writers, dancers, or have an artistic background typically have high loong energy. An example of someone who has high loong energy may be seen playing music and feeling it through their entire body with physical movement (Cameron et al, 2020).

Loong Imbalance and Mental poison.

Greed, attachment, and desire, the mental poison of loong (Cameron & Nandul, 2020), cause imbalance. The mental poison of loong creates suffering because it leads to a focus on what I am lacking. When I focus on my desires I am trying to make the things in my life permanent and what I feel attraction and aversion to. The principle of impermanence states everything is always changing, so accepting that nothing is permanent allows for more freedom in my mind and body. Additionally, what I want and don’t want will change as well since everything is impermanent. When we are focused on what we desire, what we do not have, and making things permanent, tension is produced in the body. Tension shows up as “nervousness, stiffness of neck and shoulders, and sleepless nights” (Cameron et al., 2020). Those who have a strong loong imbalance often have heart attacks and chronic intestinal problems. Loong can also show up as mental illness, mental illness in Tibetan medicine can be described as, dissatisfaction, too much thinking, or racing thoughts (Deane, 2019).

Healing Loong.

TM says if you have loong imbalance (greed, attachment, and desire) meditate and come to accept impermanence. Allowing yourself to find awareness of when you are trying to make what is impermanent, permanent, such as a job or a relationship, loong will be healed. Specific actions to take if you have loong imbalance are to eat or drink something warm, practice gentle yogic poses to ground, and face change with optimism and courage. Another recommendation to heal loong is “by dancing joyfully with the constant movement of life” (Cameron et al, 2020).

Types of Loong Constitutions.

Movement energy dominates tripa and baekan. 1) Loong / Tripa and Tripa/Loong: movement and hot energy dominates baekan energy 2)Loong/ baekan and baekan/loong: movement and cold energy dominates loong

Tripa

Tripa is heat energy and is responsible for the digestion of food and ideas. Tripa in balance is demonstrated by clear thinking, determination, and being able to accomplish goals. Leaders are particularly high in Tripa. An example of high tripa would be a doctoral student, who is working, and taking care of a family.

Tripa imbalance and mental poison.

Anger, hostility, and aggression, the mental poisons of tripa, cause tripa imbalance. A tripa imbalance can be demonstrated by trying to accomplish too much at once, which leads to feelings of stress, irritability, and antagonism (Cameron et al., 2020). An imbalance in tripa leads to too much focus on self and the result is isolation, isolation leads to depression and discouragement. The mental poison of tripa energy puts the focus on the fault of others, it prevents us from reflecting on how we can do better and taking responsibility for our actions. Anger, hostility, and aggression raises our blood pressure and puts our body into the flight or fight response which is hard on our organs and will lead to disease over time.

Healing Tripa.

To heal tripa imbalance I will meditate on and develop compassion. Compassion is the practice of recognizing all humans suffer and wishing for the relief of suffering. Practicing compassion also includes being kind, regardless of someone's behavior. Healing tripa includes slowing down and not trying to do so much. Additionally, part of practicing compassion is finding what is meaningful and inspiring to myself, so I can bring compassion to others. When I am enjoying my life, and doing what is most meaningful to me, I will be more likely to be compassionate towards others. In Mary Gullates YouTube video on compassion fatigue (2012), she discusses how if I am feeling unable to provide compassion to others it means I need to meet my own needs through inspiration, this will allow me to have a greater capacity of compassion for others.

There are also dietary and physical recommendations to heal tripa. Dietary recommendations include eating lightly cooked vegetables and avoiding alcohol, spicy foods, and other hot beverages. Activity recommendations include avoiding vigorous exercise and living in a cool peaceful environment (Cameron et al., 2020).

In addition to the behavioral recommendations for healing tripa there is also medication that can be used. TM uses a particular medication that can improve blood flow to the heart, for those with coronary artery disease, this medication is called, Sanwei-Tanxiang powder (Sun, Y.H., Bu, R., Wang, Y.W, Hu, Y.C., Wang, X.M., Dong, X., Zu, W., Niu, Y., Zhao, P.W., Sun, P., Ru, S.H., Lu, J.K., & Na S.S., 2021). This medication has been shown to improve angina, and chest pain, and is possibly effective at relieving oxidative stress in the liver.

Tripa Constitutions Hot energy dominates loong and baekan. Tripa/ baekan and baekan/ tripa: Hot and cold energy dominates loong.Tripa/loong, loong/tripa

Baekan

Baekan, loosely translated as phlegm, is cold energy and provides structure, lubricates the body, and induces sleep. Baekan energy is often demonstrated as patience and contentment (Cameron et al, 2020). I demonstrate high Baekan energy because I am happy with what I have and I tend to do things at a slower pace. Baekan Imbalance and mental poison. An imbalance in baekan leads to laziness, procrastination, weight gain, obesity, sinus congestion, colds, and edema. The mental poison of baekan is delusion, confusion, and closed-mindedness. When I have a baekan imbalance I am not open to new ideas and possibilities which restricts personal development. An imbalance of baekan leads to an overall dullness and a mind that lacks awareness of self and others.

Healing Baekan

Delusion, confusion, and closed-mindedness is the mental poison of Baeken and leads to a baekan imbalance. In order to heal baekan imbalance I will meditate on and develop wisdom through the practice of mindfulness. Mindfulness, being present and seeing things as they are allows myself to become awake(Cameron et al, 2020). Physical recommendations to heal baekan include exercising regularly and not procrastinating. A pharmaceutical recommendation to heal baekan by TM is ingestion of the plant, Rhamnella gilgitica Mansf. et Melch. (RG), this plant is grown throughout Tibet and is given for pain in the joints, rheumatism, and has demonstrated anti-inflammatory and anticancer properties (Su, J., Li, Q., Liu, J., Wang, H., Li, X., Wuntrang, D., Liu, C., Zhao, Q., RuyuYao, Meng, X., & Zhang, Y. , 2021).

Baekan Constitution

Baekan: Cold energy dominates loong and tripa. Baekan/loong, loong/baekan. Baekan/ tripa, tripa/baekan.

Philosophical Foundation of Tibetan Medicine. Tibetan Medicine teaches happiness, Karma, suffering, healing, mindfulness, meditation, and impermanence are essential philosophical principles and they are related to health and disease (Cameron & Namdull, 2020). TM teaches to be happy you need a healthy mind and with happiness comes flourishing, self actualization, wellbeing, and meaning (Cameron & Namdul, 2020). In order to heal from our mental poisons and experience happiness and avoid suffering we must behave ethically, ethical behavior leads to healing.

Karma

The principle of karma determines our happiness, karma teaches us “what you sow, so shall you reap” (Cameron & Namdul, 2020, p. 18) meaning if you behave ethically, treating others as you would wish to be treated, then you will be happy. If I make poor choices suffering and disease will be experienced.

Suffering and or dis-ease begins in the mind (Cameron & Namdul, 2020), suffering can be eased by the practice of meditation because it awakens the mind, or “tames the monkey mind” (Cameron & Namdul, 2020). If the mind is not trained harm will be done to oneself and others (Rinpoche, 2002). Meditation allows for the“investigation of the nature of reality, to transform the mind into a tool to create health and happiness “(Cameron & Namdul, 2020). When I meditate I am able to see the occurrences in my life more objectively and I am less likely to act on my aversions and attachments. As the Dalai Lama says in his video, Conquer Your “Self” (2009), we are our own worst enemy without the ability to observe the mind we become victims of our emotions and act in irrational ways.

Impermanence

An additional cause of suffering is rejecting the concept that everything is impermanent. If I don’t accept impermanence, the fact that constant change exists within everything, I will experience dis-ease, for example if I try to make something permanent such as a relationship or job I will experience suffering. One way to accept impermanence is to practice mindfulness. Mindfulness allows for the unconscious mind to move to the conscious mind (Cameron & Namdul, 2020). Mindfulness includes focusing the mind, and allowing yourself to see how you cause suffering to yourself. Becoming familiar with the mind through observation of it’s thinking patterns will allow for a greater sense of compassion for yourself and others (Cameron et al, 2020). Living in Harmony with My Inborn Constitution. Finding balance through assessment of one's constitution leads to improved health in the body, mind, and a more fulfilled life overall. My inborn constitution determined by the CSAT (Cameron, el al., 2021) is Baekan/ Loong, meaning my primary energies are cold and movement energy. Baekan energy has shown up for me in my life by having a tendency for procrastination, slow digestion, and to my benefit an acceptance of life as it is (Cameron & Namdul , 2020). Loong energy shows up for me with the constant need for exercise, adventure, and my love of music and yoga.

How the 3 primary energies affect my Baekan / Loong constitution. Baekan, (38%) my most dominant energy is the cause of my low digestive heat, heavy sleep, and sense of contentment with life (Cameron & Namdul, 2020). I love where I live, I have great friends and family, and am accepting of the way things are.

Loong, movement energy, (34%) shows up as creative energy (Cameron & Namdul, 2020). I love being creative, through singing, dancing, and playing guitar. I also love to move through exercise, skiing, hiking, biking, or walking my dog. Tripa, heat energy, (27.6%), is also a part of my life. I am participating in a doctorate program and have to set and accomplish many goals. Goal setting and accomplishment contributes to tripa energy.

In order to support my baekan energy I will set my intention to meditate regularly, so I can cultivate wisdom. Additionally, I will practice being grateful for the things I have and appreciate the contentment I feel with the life I am living. To support my loong energy I will exercise vigorously on a regular basis and I will celebrate my creativity. In order to support the Tripa in me I will intend on completing my goal of obtaining my DNP of Integrative Health and Healing. The weakness of my baekan/ loong constitution shows up as low digestive heat, procrastination, lethargy, a lack of concentration, feeling nervous or tense, having a dull mind and craving for permanence (Cameron et. al, 2020). In order to prevent my weaknesses from sabotaging me I will eat small regular meals, use a calendar regularly to ensure I am staying on top of tasks, and meditate frequently to strengthen my concentration and keep my mind sharp. How the 3 primary energies affect my Baekan / Tripa constitution. Even though the CSAT results showed I had a Baekan / Loong constitution I had a constitutional assessment with an experienced ™ doctor who told me I had a Baekan / Tripa constitution. According to Cameron & Namdul (2020) this constitution is generally harmonious because it is a combination of hot and cold energies. The baekan/ Tripa constitution generally manifests itself through a thoughtful and trustworthy individual, which I believe I am. This constitution has a risk of becoming imbalanced, leading to fiery and aggressive behavior. If this occurs I will practice compassion for myself and others. The recommendations for this constitution include, living in a moderate climate and ingesting a nutritious lukewarm diet (Cameron & Namdul, 2020).

How I Will Create a Healthy Mind based on My Constitution. In order to create a healthy mind, I will recognize when the three mental poisons arise. The mental poison of baekan, delusion, confusion, and closed mindedness (Cameron & Namdul, 2020) can be brought into balance by practicing mindfulness in my daily actions and a sitting meditation. I will also remind myself to be open to new ideas.

The mental poison of loong shows up as greed, attachment, and desire (Cameron & Namdul, 2020). In order to keep loong in balance I will remember I have everything in life that I need to be happy. Additionally, I will try to move my physical body so that my thoughts do not race. I find after I exercise it is much easier for me to relax and concentrate.

The mental poison of tripa, anger, hostility, and aggression can be brought into balance by practicing compassion. In order to practice compassion in my life I will remember when I have difficulty practicing compassion, I need to focus more on meeting my own needs by doing the things I enjoy. This will allow me to have more compassion for others (Cameron & Namdul, 2020).

In addition to balancing my mental poisons to create a happier and healthier life, I will strive to develop spiritual immunity. Spiritual immunity results from behaving ethically, thinking positively, and “promptly letting go of negativity” (Cameron et. al, 2020). Additionally, during my meditation practice I will recognize that if I feel a “strong attachment or aversion, egotistical thoughts are bothering me” (Cameron et al, 2020).

I will follow the ethical guidance in Tibetan Medicine by observing The Four Noble Truths. The first noble truth is, the truth of suffering, which indicates everyone suffers, it is part of being human, suffering in Tibetan Medicine is known as dissatisfaction (Cameron & Namdul, 2020).

To apply the first truth to my life I will recognize that dissatisfaction is normal when I am experiencing it. Additionally, I will recognize that just because I am not happy with something it does not mean I need to change course; it may be best to let things be initially and see what happens.

Additionally, I will recognize I am affected by my previous life (Cameron et. al, 2020). Tibetan medicine teaches that we live out a previous existence if the mental poisons were strong in our previous life, this way we can attempt to find balance in this life. The first noble truth asks us to acknowledge our unethical behavior and our dissatisfactions (Cameron et. al, 2020).

The second truth is “suffering is caused by fundamental ignorance and confusion on how to be happy” (Cameron et. al, 2020, p.118). This ethical guideline will teach me not to look for happiness outside myself. When I look for happiness in a relationship, a job, or an activity I will recognize that these things are impermanent, and they will not lead to happiness. When I search for permanence through something outside myself, I will become frustrated. This truth also teaches me that it is important to acknowledge my suffering, acknowledging the suffering releases stuck energy, without acknowledging how I am feeling healing and happiness will be delayed (Cameron et. al, 2020).

The third noble truth states liberation from my own suffering is possible, by realizing that there is not an existence “of an inherent self” (Cameron et. al, 2020, p. 114). Recognizing the impermanent nature of the world prevents me from being influenced by my emotions and allows for a more objective view of life.

The fourth noble truths teach me I can free myself from my own suffering by practicing the eightfold path, practicing an ethical life and meditating regularly to awaken the mind. Within wakefulness, enlightenment occurs, and the craving for fleeting desires is absolved and replaced with compassion and wisdom (Cameron et. al, 2020).

Tibetan medicine teaches The Eight Fold Path of Ethics to practice the Four Noble Truths, the eightfold path includes:

1. Right knowledge: I will recognize that I am suffering and find guidance within the four noble truths 2. Right aspiration: I will stop behaving in a way that causes myself and others suffering. I will focus on awaking my mind. 3. Right speech: I will speak truthfully and with compassion. 4. Right behavior: I will not promote or engage in violence, I will practice compassion, and behave responsibly. 5. Right livelihood: I will work in ways that promote ethics and spiritual growth. 6. Right Effort: I will persevere according to the teachings of ethics and spirituality 7. Right mindfulness: I will become awake and practice things as they truly are. 8. Right Concentration: I will devote my life to ethical living and spiritual practice. (Cameron, et. al, 2020) How I Will Create a Healthy Body based on My Constitution.

The slow digestive heat that comes with my Baekan indicates I will feel healthiest when I eat warm foods and beverages and small portions of nutritious food at regular intervals (Cameron et. al, 2020). Particular recommendations I am going to take are eating more sour foods because they decrease loong and baekan and increase tripa, which will help me become more balanced. Pungent foods will also be something I eat more of, hot spices, like peppers, mild spices such as cinnamon, and fresh herbs like oregano, thyme, and mint. Since I have slower digestion, I will eat basil, which is said to decrease baekan in the lungs (Cameron et. al, 2020) and cumin, which strengthens digestion (Cameron et. al, 2020). Additionally, I will drink pure boiled water daily, which Tibetan medicine teaches is the “primordial essential medicine” (Cameron et. al, 2020). Behaviors that will support my constitution are avoiding getting sick, sleeping well, engaging in respectful sexual relationships, and living in a clean and organized environment. In the morning I will eat a warm breakfast to keep my Baekan in balance, to balance Loong I will eat dinner by 6:30 PM.

Behaviors that will support me during seasonal changes include brisk walks in the winter. Keeping myself warm and when spring comes and exercising vigorously. Summer is ideal for my constitution, however in the fall I will continue to exercise vigorously and eat spicy foods to increase tripa. In order for me to rejuvenate myself I will practice prostrations through my yoga practice. Prostrations “help tone the body, release nervous energy and help focus the mind” (Cameron et. al, 2020). I will also set time aside daily to meditate and cleanse the body. Scientific Evidence.

Compassion

Compassion, one of Tibetan medicines' founding principles is beneficial in healing and living a healthy life. Compassion occurs when I recognize everyone suffers and I have a desire to ease the suffering of others by improving their life. Particular studies demonstrate compassion decreases the incidence of depression, inflammation (Saarinen, Keltikangas‐Järvinen, Cloninger, et al., 2019 , abuse of alcohol and marijuana, (Wiseener & Khoury, 2021), anxiety and the tendency towards perfection (Tobin, Dunkley, 2021). “Those higher in mindfulness and self-compassion may have greater access to emotion-regulation strategies, which in turn may obviate or reduce the need to drink as a form of regulation or coping when one is feeling depressed” (Wiseener & Khoury, 2021). Practicing compassion allows for a kindness towards yourself and others that decreases the stressfulness of life experiences. Since, ™ teaches dis-ease begins in the mind, the practice of compassion seems extremely helpful when managing any type of distress to prevent dis-ease.

Dying

Healing My fears About Dying. In order to heal my fears about dying I will use the practice of compassion throughout my life and live in an ethical way. Compassion will encourage healing and allow for my spirit to move on to it’s next life once I die. If I live an ethical life I will anticipate a peaceful death. If I expect my death to be peaceful then I will not be afraid. Cameron and Namdul (2020) state “you die like you live, therefore, the art of dying is as important as the art of living (p.149)”. As I live my life I will forgive those who have wronged me and I will ask forgiveness for those I have wronged. Living with Aids: Ethical Problems Involving Death by Miriam Cameron PhD (2003) describes how many people are afraid to die because they feel they have responsibilities to take care of and once they die they will not be able to do what they intended, such as taking care of spouses or children. This article demonstrates the harsh reality of being on this earth one moment and being gone the next. Common fears include not knowing what is going to happen once you die and having unresolved conflict with loved ones. Tibetan Medicine teaches me if I live with good ethics and practice forgiveness and cultivate compassion with those in my life I will have a good death and I will not need to be afraid.

How to use Tibetan Medicine to create a good death. The first step in preparing for death is to accept impermanence. As I live my life I will practice gratefulness for the gifts I have and recognize that each moment is fleeting. The second step is to create good karma. I will treat those I encounter with kindness and as I would want to be treated. The third step is to heal the mind, in order to do this I will take the steps necessary to keep my constitution in balance, such as meditation, eat nutritious foods, heal the mental poisons, and practice forgiveness. I will focus on healing my mind through recognizing the love I have for others, forgiving those that have wronged me, and asking for their forgiveness. The last step is to prepare your legal and financial documents. Preparing the logistics of my death will alleviate any burden onto others after I can no longer manage my own affairs. To have a good death it is imperative to accept death, this will help me move into death peacefully.

Integrating Tibetan Medicine into Health Care.

To integrate tibetan medicine into health care I will meditate daily to encourage balance within my constitution. I will practice good ethics in my own life and with my patients. I will also practice compassion with everyone I come across in my life. I will set up a will so my death will not be a burden on anyone when the time comes. I will also recognize that after one physically dies their spirit is in a stage of transition for 49 days (NHK of Japan, Minstral Film of France, and National Film Board of Canada, 2011). This period of transition makes sense to me because I often can sense someones spirit after they have passed. During this period of transition I will pray for the one that has died to encourage the spirit to move into it’s next stage of being. I found comfort in praying for the person’s spirit during this transitory time because it helps me process the person’s passing and it may benefit the one who has died as well.

Conclusion.

This paper describes the tenets of Tibetan Medicine which is a logical yet complex system of health, healing, happiness, and suffering. Through the review of the five elements, the three energies, the mental poisons, the seven constitutions, and the philosophical foundations of Tibetan Medicine I can live my life in an ethical manner and I will experience greater peace and happiness.

Additionally, I explained how I can live and die in harmony with my constitution. Knowing these recommendations will help me live a happier and fuller life and die in a peaceful way.

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