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)
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
AMA Objectives
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 [email protected] , 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 [email protected] 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 [email protected]
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.
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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 health care system
Team work
Doctor Nurse Therapist
Tantra (तन्त्र) or rgyud (རྒྱུད།):
Lineage of Teaching
Methods of study
Physician
Theory…
Biomedicine Tibetan Medicine
Basic Sciences Anatomy
Physiology
Pathology
Clinical Studies Internal medicine
Pediatrics
Obstetrics & Gynecology
Psychiatry
Surgery
First & Second Tantra Display of the body
Body functions
Conditions of diseases
Third Tantra Body as a whole
Children’s disorders
Women’s disorders
Disorders caused by spirits
Injuries
Energies in TTM
རླུང་།
rlung
Wind
Literally ‚motion‘
བད་ཀན།
bad kan
Phlegm
Literally ‚dew & earth‘
མཁྲི་པ།
mkhris pa
Bile
Literally ‚burning‘
Life-sustaining wind in the ocean of channels
Inner liquid and solid elements
Metabolic heat in the small intestine
Brainwaves
Body cells
Digestion
Pathologic Basis of Diseases
Biomedicine Tibetan Medicine
Metabolic
Inflammatory
Degenerative
Neoplastic
Infectious
Traumatic
Psychological
Cold natured
Hot natured
Cold natured
Self-originated
Caused by srin
Caused by weapons
Caused by provocations
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Therapy
Biomedicine Tibetan Medicine
Treatment of the physical body
Chemistry and technology
Advantages
Standardized treatments
Strong physical effects
Proven efficacy
Limitations
Dependence on technology
Side effects
High expenses/environmental impact
Rebalancing energy
Natural resources
Advantages
Self-administered treatments
Fewer side effects
Less costly/lower environmental impact
Limitations
Difficult to get required training
No standardized treatments
Not evidence based
TRADITIONAL TIBETAN MEDICINE
Mental health and mental illness
Mental Health
& Mental Illness
What is good mental health?
Biomedicine Tibetan medicine
Psychological well-being
Absence of a mental disorder
WHO: state of well-being Realization of one‘s abilities
Coping with normal life stresses
Productive and fruitful work
Contributing to community
Expression of emotions
Enjoyment of life
Balance between life activities and efforts to achieve psychological resilience
Balance of body, mind & energy
good health & long life Dharma
Wealth
Happiness
Ultimate realization of mind
spiritual enlightenment
Mental Disorders
Biomedicine WHO: ICD-10
Tibetan Medicine & Buddhist Psychology
F0 Organic disorders
F1 Substance use
F2 Psychotic disorders
F3 Mood disorders
F4 Neurotic and somatoform disorders
F5 Behavioral disorders + physical disorders
F6 Personality disorders
F7 Mental retardation
F8 Disorders of psychological development
F9 Behavioral and emotional disorders with early onset
79 Dementia
80 Planetary provocations
• Destructive emotions
78 Madness provocations
34 Snying rlung disorders
81 Naga provocations
77 Element provocations
77 Element provocations
• Karmic disorder
73 Children’s provocations
73 Children’s provocations
Depressed mood—etiology Biomedicine Tibetan Medicine
Etiology Personality Life events Social causes Physiological causes Other syndromes
Diet Lifestyle Seasons Provocation
Pathophysiology Emotional or cognitive disorder Hormonal/neurotransmitter imbalance Structural brain changes
སྲིང་རླུང་། (snying rlung) Energy
imbalance of the heart Destructive emotions imbalance of the mind
Divisions & Symptoms Depressed mood Fatigue
Feeling empty Mania
Insomnia Increased appetite
Cyclic mood changes
Bad kan disorder Heavy or dull mind Sadness
Mkhris pa disorder Active mind Increased digestion
Rlung disorder
Depressed mood—assessment Biomedicine Tibetan Medicine
Diagnosis History Physical examination Lab results EEG, CT, MRI
Asking questions Pulse reading Urine analysis Dream analysis
Findings Symptoms Physical disorders (thyroid dysfunction, etc.) Hormonal imbalances Structural changes
Epilepsy Hyper or hypoactive brain areas
Signs Heart pulse
Rlung pathology Mkhris pa pathology Bad kan pathology
Provocation signs in urine Destructive emotions
Depressed mood—treatment Biomedicine Tibetan Medicine
Diet Depressive disorder: warming food Maniac disorder: cooling food Bipolar disorder: nourishing food
Psychotherapy Psychodynamic psychotherapy Cognitive behavioral therapy Other forms of therapy
Lifestyle Daily life (individual, social, spiritual) Seasons Physiology
Medicine Antidepressants Antipsychotics Sedative-hypnotics Stimulants
Medicine Herbal medicine Animal products Minerals & metals
External Therapies (viewed as CAM) • Yoga and taijichuan • Massage • Exercise • Chiropractic
External Therapies Depressive disorder: compress therapy, moxa Maniac disorder: blood letting, water therapy, acupuncture 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!“
Biomedicine Tibetan Medicine
Working With the Mind
Diet, lifestyle, medication, external therapies
Spirituality
Advantages
Familiar cultural background (law of cause and effect, karma)
Connection to nature
Limitations
High training required
Acceptance of karma
Medication
Psychotherapy
Advantages
Empirical knowledge and research
Practical clinical methods
Limitations
Medication side effects
Cost and availability
Taboo topic
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