Welcome to the scheduled Tibetan Buddhist Chat!
Tonight we have as a SPECIAL GUEST ....
Eliot Tokar, Practitioner of Asian Medicine
!! We are using chat PROTOCOL this evening !!

RBCF Padma:  Dr. Tokar will begin with a lecture, followed by a Question and Comment period. He has kindly offered to stay for all questions (as long as it doesn't get boring! *smile*). Everyone will have an opportunity to ask questions or to add a comment. Please take your conversations to IM!
!! We are using chat PROTOCOL this evening !!

If you have a question TYPE ONLY '? If you have a comment TYPE ONLY '!' Questions and comments will be taken in the order in which they are received. We will keep track of the que and inform you when your turn has come up. Thank you so much for cooperating!

Our guest practices traditional Asian medicine in NYC.  He has studied Tibetan medicine from '83-'86 as a student of Dr.Yeshi Donden, from '86 as apprentice to Dr.Trogawa Rinpoche, and '90 with Dr. Shakya Dorje. Dr. Tokar is one of the only North Americans to have received extensive clinical training in Tibetan medicine. He has lectured on Tibetan Medicine at Princeton and Brandeis Universities, Mt. Sinai School of Medicine, Columbia Presbyterian Hospital, Assoc. of American Medical Colleges, and the New York Botanical Garden. His web page, www.tibetanmedicine.com, is dedicated to bringing the voice of practitioners, students and scholars of Tibetan medicine to the internet. He currently serves as an advisor to the American Medical Student Association's Project on Humanistic Medicine.

Now, with a bow to our guest for his kindness in being with us this evening, and a bow of gratitude to RBCF Alaya for arranging this evening's chat, we would like to introduce .... Eliot Tokar

ETokar:
I have been asked to make some formal comments then we will do Q&A.  So first I thought it important to say something about Tibetan medicine.  Tibetan medicine is a rich repository of knowledge drawing direct influences from the major medical systems of the ancient world.  Beginning in the 7th century the Tibetans synthesized the medical knowledge of the pre-Buddhist, Tibetan shamanistic religion Bön with the medical practices of India, China, Persia, and Greece. Fortunately, the relative geopolitical isolation of Tibet until the late 1950's allowed this knowledge to grow into a unique system of medicine with an unbroken lineage of doctors.

Tibetan medicine teaches that any case of illness needs to be understood based on an appreciation of the inherent relationship between an individual's physical health, and factors of psychology, behavior, diet, environment and our spiritual existence.  It then provides the set of diagnostic tools a doctor needs to find the causes of the imbalance resulting in illness. The Buddhist teaching that existence is inherently fraught with suffering and frustrations is the primary consideration.  The fact that the true cessation of this suffering comes from spiritual development through practice is the final consideration. Between these two is where Tibetan medicine functions.  It first looks at the exact process of how we come to be born in this life, and the specific stages of physical and cognitive development in the womb. Once born we are prone to the ignorant viewpoint that who we are essentially is that impermanent physical being driven by the information we gain from our senses.  This misunderstanding is what Tibetan medicine views as the ultimate cause of all illness.

Having been born into this plain of existence we are defined by the physical laws of nature.  The Tibetan medicine's theory of the Five Elements is an effort to define the qualities of the basic forces which exist in nature. Like all traditional people, Tibetans lived in direct contact with the natural environment.  They understood through experience and study that the forces manifest in the natural world directly correlated with and influenced the functioning of the human organism. Once defined they are then named for their most identifiable manifestations:  earth, water, fire, wind and space.  The characteristics of any substance (such as its taste) and therefore the nature of all matter then result from the qualities of these elements individually or in combination.  The aspect of mind interacting with the five physical elements gives rise to the three principal systems (Nyepa) which control all functions of our body.  The mind expressed as attachment, desire or a materialist view is manifested as the principal system of Lüng(Wind).  Lüng creates an enormous number of functions such as circulation of our blood, circulation of the nervous system's impulses, circulation of thoughts in our mind and circulation of food through our digestive tract and eliminative organs.  The mind expressed as aggression, hatred, anger or the like is manifested as the principal system of Tripa (Bile). Tripa provides heat in the body, and as such, it gives rise to and controls functions such as metabolism, liver function, vision and allows our mind to function with discriminating intellect.  The mind as expressed as ignorance or incomprehension is manifested as the principal system of Bädkën (Phlegm) Bädkën, which has a cold quality, creates the physical principle whereby energy can create function, provides our body's lubrication, creates the will and allows us to have good memory among other things.  The disturbance in one of these three energetic systems result in illness.

Three ways illness is classified in Tibetan medicine are 1) those which are karmic illnesses, 2) those caused by our life experiences., and 3) those which are a combination of both.  Examples of the karmic illnesses can be seen in some aspects of genetic illness, any illness due to a persons innate characteristics and illnesses which resist any type of treatment.  Our life experiences, however, are the cause of the great majority of illnesses. Our life experiences, however, are the cause of the great majority of illnesses.  These illnesses result from things such as climate, behavior, diet and/or spiritual and environmental factors which negatively effect the three principle systems.

To put theory into practice we have specific diagnostic tools.  A doctor should first speak to the patient and find out their medical history as well as pertinent aspects of their personal history.  We then look at a urine sample observing the color and the odor, the size, color, amount, and persistence of bubbles, and any deposits. From this information we can begin to confirm such things as the nature of the illness, the presence of infection, the localization of the illness among other things.  Next we feel the twelve pulses.  They are felt at the radial artery of each wrist at a specific placement using three fingers on each wrist, each finger taking two distinct pulses on each side of the finger.  We feel for such things as the width, depth, strength, speed and quality of the pulse. Each of those factors when understood properly allow us to clearly define the illness, its location, hidden complications and its etiology.  To further confirm the illness we can look at the color, shape and coatings of the tongue and the sclera of the eye.

The first level of treatment that we use consists of behavior and lifestyle changes, and adoption of an appropriate diet. Activities and foods which have qualities similar to the energetic system which is imbalanced are eliminated and replaced by those which can reverse the problem.  If behavior and lifestyle changes are not sufficient, then, herbal compounds should be given based on the vast Tibetan herbal pharmacopoeia. Herbs are chosen for each compound based on their qualities such as taste, to coordinate with the qualities of the energetic system which is imbalanced.  If this is not sufficient to return the patient to good health physical therapies such as acupuncture, massage.

In addition to medical training, a practitioner of Tibetan medicine needs to receive spiritual training so he or she can develop the necessary emotional stability, moral sense as well as the insight and intuition required to put this theory into practice.  In describing how he works as a physician, my teacher, Dr. Trogawa Rinpoche, has remarked: "my external activity is the practice of medicine, and in my inner thoughts I meditate on the Medicine Buddha".  Properly understood, this remark displays the first step in the process and practice of Tibetan medical diagnosis.  It is an ongoing practice toward spiritual development and its resultant awareness and intention, toward which the physician continually strives.

Given the differing levels of practice and development that exist among Tibetan doctors, there is no quantitatively prescribed standard for this aspect of medical practice.  Still, the primary classic principle of Tibetan medical practice is that the bedrock of one's approach to diagnosis lies within the doctor's spiritual practice. Because the historical Buddha described his role and teaching in a fundamentally medical fashion, this connection is very direct.  In fact, because the Buddha's teachings were meant to cure suffering, he was known as "The Supreme Physician".  The Buddha is therefore a direct inspiration for Tibetan doctors, who attempt to emulate this model of a spiritually realized being who makes a conscious choice to cure others. Buddhist teachings delineate Tibetan doctors' image of themselves and their patients as well as the doctor-patient relationship.  Buddhism's central teachings and practices place great emphasis on:

          (1) understanding and discovering the nature of one's mind, and thereby transcending ego;
          (2) developing a practice of compassion toward all other conscious beings,
          (3) developing a sense of equanimity.

Therefore, for the doctor of Tibetan medicine there is no psychological or professional dilemma in directly identifying with his or her patient -- as there can be, for instance, in Western medicine.  In a sense, the Tibetan physician intentionally seeks to identify with the patient.

It is important for us as physicians to intimately understand the basic nature of suffering -- both the patient's and the doctor's -- as well as to understand that our relationship to the patient has both a professional and spiritual significance. Through spiritual practice the Tibetan doctor is trained to emulate a highly spiritually evolved person.  A direct connection develops between the doctor's perception of the patient and a Bodhisattva's perception of all beings.  The term "Bodhisattva" literally means "hero of enlightenment". Bodhisattvas are spiritual trainees who strive to generate an altruistic mind of love and compassion.  They are basically Buddhas in the making who have dedicated their pursuit of spiritual awareness to the single goal of bringing about the welfare of all. We can get a glimpse of the professional ethic Dr. Trogawa endeavors to practice in an instruction from the Buddhist sage Vimalakirti:  "I am ill because all sentient beings are ill.  If the illness of all sentient beings were to come to an end then my illness would be ended.  Why is this so? Because when the Bodhisattva enters into the realm of birth and death for the sake of beings, he becomes subject to the laws of this realm and thereupon becomes ill.  If all sentient beings were to be cured of their diseases, then the Bodhisattva would never be ill again.  It is like the rich man who only has one child. When his child becomes ill, his parents become ill.  If the son is cured of disease, so also are the parents.  It is the same for the Bodhisattva:  He loves all beings as if each of them were his child.  When all beings are cured, then the Bodhisattva will be cured." Before seeing our first patient, practitioners of Tibetan medicine do meditation, visualization and mantra practices which allow us to identify ourselves as the idealized doctor/healer embodied in the Buddha of Medicine. Through this training we work to develop the capacity of compassion and equanimity through which we can view our patients as who they are essentially, and not defined by their presenting illness.

For a doctor to practice the traditional form of Tibetan medicine he or she must draw upon all aspects of human cognition, as well as a deep spiritual understanding and sense of compassion. So in the end it is our responsibility to provide not just treatment for our sick patients but also an example through which we can teach our fellow citizens that living with a sense of compassion derived from ecological and spiritual awareness is the most practical and cost effective way to reduce suffering in our bodies, minds, and in the world in which we live. That concludes my formal remarks. Now I will take as many questions as you have.

RBCF Alaya: fiftea.. you're up first!

Fiftea: Ok, my question is.... If Karmic illness resists treatment, then what is recommended?

ETokar: In the Gyud Zhi the primary text of Tibetan medicine it is said that if a person has a true and singularly karmic illness it is not curable. So, they should place emphasis on spiritual practice to deal with the cause.

Alikali123: when making diagnosis, what skills are required to ascertain the condition of the patient in addition to those acquired from study?

ETokar: As to what skills are required for making diagnosis.... One needs all one's skills of perception and intellect and the openness and sensitivity one tries to achieve thru spiritual practice.  I personally make no special claims in any of these areas. Next question.

Khandi337: *Bow* How does Oriental Medicine address Diabetes? Would that be a Lüng type?

ETokar: This is a very important type of question.  Diabetes, cancer, arthritis, etc. are not things. They are ideas.  Ideas of allopathic medicine.  A tumor, for example is a thing. Cancer is an idea. However, if presented with a patient with a western medical diagnosis of diabetes there are several possible diagnosis and treatments that the tibetan doctor will use.  Now with all the interest in TIbetan medicine many Tibetan doctors are being forced to speak in terms of western medical diagnostic terms this is quite problematic .  For further reference on this look at article #2 on my site http://www.tibetanmedicine.com. It addresses IBS but can be taken as a universal answer to such questions. Next question.

Jen108: I met with H.E. Bontul Rinpoche who gave me 3 medicines. They are almost gone now, where can I get more? He was a wonderful dr, by the way. I saw dr. Bontul Rinpoche who gave me 3 medicines.  Cho Nga Dak Jo, Kyungmar25 & Agar35 are their names.  I am almost out of them and he is unreachable. Any suggestions? They worked great, by the way. What a wonderful lama and dr.

ETokar: The first medicine you mentioned is n=misnamed the other two I have a question about.  Was 'Kyungmar25' wrapped in a silk or paper?

Jen108: He gave them to me in small plastic baggies. It came out of a leather pouch it is for my back, very red and iron-y tasting.  It is a powder mixed with hot water at breakfast.

ETokar: How often do you take it and how many pills?  This might be hard to get.  Did he give a prescription?

Jen108: The cho nga etc is the one I want the most.  He filled the prescription himself, and I am not sure if i kept it.

ETokar: Write to me separately and I will try to help you.  Next question.

DJE0101: Are the current incurables such as AIDS,cancer,etc. Karmic to large groups,or individuals?

ETokar: Cancer is often curable or treatable AIDS is treatable if caught on time so they are not karmic.  Next question.

Lama108: Eliot -- we have talked before by phone. I met with and interviewed Dr. Yeshi Donden for an article I was writing while in Dharamsala last year. He told me that there were times when he referred patients to western medicine. For such things as broken bones, emergencies. When do you refer patients for western medicine? Also would you speak about "precious pills".

ETokar: It is true western medicine is good for certain emergency and acute life threatening cases.  Otherwise I refer people to Western medicine when either I want to confirm some diagnostic point. Or if they are not capable of following a natural medicine cure.  As for precious pills this is a big topic what do you want to know?

Lama108: I am familiar with them and their use -- I thought those here might be interested in knowing more about them.

ETokar: They are complex (up to sightly over 100 ingredients) herbal compounds which consist of herbal, animal and mineral ingredients some ingredients are alchemically (in the true traditional, not new age sense) purified they are medicines used for addressing chronic or profound illness because they have very purifying properties one caveat though many people even Tibetans think because they are very special meds and very expensive that they are generically good for every one and every condition this is not true.  Each pill has a specific potency and use next question.

Hauteman: I'll stand aside to William, my ? was already answered {:>

William771: Bow.. I have 3 short questions.. 1-- How can we get a log of this chat? 2- How many practitioners are there of Tibetan medicine in the U.S? 3- How can you tell if a practitioner is a good one?

ETokar: I do not know how many Tib med practitioners there are. Not many. To tell if a practitioner is good find out their background and clinical experience and ask people who have gone to them . I have a bias as a student of Dr. Trogawa.  I think doctors who do not explain their diagnosis and do not give proper lifestyle and dietary advice but only give out pills are not doing their job, but this is a traditional perspective.  In 1992 Drl. David Eisenberg of Harvard wrote an article in the NE Journal of medicine introducing alt med to the medical industry he spoke of only two things:  How may people were using alt med and how much $$$ was being spent .  Now there are two potentials for alt med here:  One is a renaissance of healthcare where many different kinds of doctors cooperate. The other is the CAM industry which is trying thru legal and economic means to coopt natural medicine.  They are succeeding because many are not aware of their work but the info is easily available. Next question.

DJE0101: Do you treat chemical addiction as illness, and is manifested as Phlegm, Wind or Bile?

ETokar: Well first there is the ground of the condition, the addiction. This is often a psychological issue so some Wind is possibly involved. Then there is the physical state of the person, this must be diagnosed and treated. But still, as Buddhists we know that addiction is a curious issue.  I had a patient who was bulemic.  She came to me for counseling mainly.   At out first session she told me that she had been to a gamut of therapists psychiatrists psychologists.  Then she said she went to a 12 step program .  She asked me if I believed in the 12 step idea that being an [bulemic] or addict was a permanent state [in this life anyway].  I replied that if this mode of thinking was helpful to a person to stay unaddicted it was ok to think that way. 12 step has helped many people but from a buddhist perspective it is obviously not a permanent or inherent state. It has a physical aspect in some cases but primarily it is a state of the mind's attachment to some feeling due to aversion to another feeling or other such complexes.  So when thinking about addiction we must be very thoughtful about the person and not just classify them.  Next Question.

KChoedak: Do you have the need for an apothocarian to prepare for you and also, you may be happy to know I am growing myrobalam in south Florida.

ETokar: Marvelous send me some info on your experience with growing myrobalam in south Florida in e-mail.

KChoedak: do you use an apothocarian to prepare medicine prescriptions for you?

ETokar: Not at the moment, but if I can find funding for the Tib med center I would like to see the we will need people to come and help.  Next question.

RBCF Dorje: HOw long does the potency of precious jewel and other pills last, i.e., what's the shelf life?

ETokar: If stored in a dry cool dark place medicines retain potency for over a year.  The precious pills if stored correctly have an indefinite life.

RBCF Dorje: What about 2-3 years?

ETokar: What do you have?  How did you store it?

RBCF Dorje: Rinchen drangjor rilnag chemo and something else written in an u-me script i can't read.  I stored it in a dark place, cool room temperature.

ETokar: DRANGJOR is ok ,but it is very cooling so if you have a cold condition do not take now.  Next question.

EHaungs: ??Please advise the purpose of eliminating regular tea from the diet before the exam?

ETokar: It can color the urine sample.

EHaungs: Is that the caffeine or the color of the tea?

ETokar: color

Zong99: Do you know of any herbal remedies for kundalini imbalance?

ETokar: Define kundalini imbalance as you understand it.

Zong99: Can't sleep, too much energy, too much air & fire, not enough earth and water.

ETokar: First you must eliminate those dietary and behavioral aspects which aggravate air, fire.  Then we can see if herbs are needed.

Zong99: So you do know of herbs for this?

ETokar: Well, as described yes.

Zong99: how does a person connect for these herbs?

ETokar: Well, as I described in my opening remarks, before herbs can be properly given, first a diagnosis is needed. So I recommend you see a competent herbalist in you area who can diagnose you and give what is needed.  This is the best. Next question.

VenomHoney: You mentioned "psychological issues" earlier. Does Tibetan medicine recognize such issues? If so, how are they treated?

ETokar: In a sense. Obviously when we say psychological issues we reference the Western psychological tradition.  Still, Buddhism recognizes various disturbed mind states and Tibetan medicine recognizes various kinds of mental illness. Generally, we must think at least of the Wind principal being affected then we must see what other contributing factors exist.  Then we treat with behavior/lifestyle, diet and if needed, herbs and/or physical therapy. Also counseling can be used.

Lets take two more questions.

Lama108: When in Dharmasala last year I witnessed a Tibetan monk obviously suffering some kind of mental illness --- being treated terribly.  It did not seem mental illness is recognized in the same way as it is here.

ETokar: No, it is not.

Lama108: He was not treated with compassion -- nor treated.

ETokar: I cannot say that all Tibetans or Americans or any other group does not have limitations in their culture or in individuals within that culture. I think the big problem is that despite the enormous contact that has occurred between Tibetans and Westerners for about 40 years there has been very little communication.  The relationships that evolve are often either the Westerner in the role of the 'sponsor/supporter' and the Tibetan as the supported. OR the Tibetan as the keeper of mystical culture and the 'ingee'. As we learn to stop communicating with each other in these limited and stereotyped manners, seeking true equal communication, we will be able to understand better both the beauty and the limitations, world views, biases and abhorrations of each culture.  I have seen things like you describe. Rather than judging them we must maintain a critical attitude and try and be of help ourselves.  Try to bring what compassion we have into the situation. Sorry for the lecture but the cultural divide between Tibetans and westerners is a constant limiting factor which, if worked on, can bring great benefit. In the Tibetan medicine world such misunderstanding has brought problems.
Last question.

Khandi337: You've bridged those worlds quite nicely, thank you.  Would you say the exercise, "The Five Tibetans" would be good phy. therapy? *smile*

ETokar: I am not familiar with this exercise.  What is it and who teaches it?

Khandi337: This was prescribed by one of my acupuncturists.  Very simple stretching exercises, and spinning.  I don't know the origin, but believe it was mentioned in KumNye.

ETokar: In wind conditions light movement and breathing exercise is good. In bile, only normal exertion is recommended lest the person get overheated.  In phlegmatic conditions a lot of excercize is beneficial. If that answers the question I would like to make a few remarks.

Khandi337: Thank you for a very interesting discussion Dr. Tokar.

ETokar: Well first I would like to thank Alaya and Padma for their invitation and all of you for participating.  If there is interest I will do this again.  Everything I know is from having good teachers and patients. I would ask all of you to remember that the natural state is health it is health that we study first in Tib med not illness.  So try to learn about how to maintain your health then you do not need to take bad tasting herbs!  Next, that small group of us N. Americans doing Tibetan medicine need your support.  So if that means speaking to your dharma brothers and sisters about this chat or telling Tibetan friends about it all this helps.  Then please educate yourself about the current state of alternative medicine and the aggressive acts being taken by the Complementary and Alternative Medicine industry to take all but the form of humanism and spirituality from our work.  I am currently trying to be accepted on the new White House Commission On Complementary And Alternative Medicine to do what I can. Just learn to meditate and practice compassion.  
Thank you all.

William771: Thanks for many interesting things said

EHaungs: <------Bow, Thank you for a very informative discussion.

RBCF Ray H: Thank you were much ETokar for coming and sharing with us tonight!!

Khandi337: **applause** I, for one, would be interested.

VenomHoney: RT: thanks esp for the "lecture" on Western/Tibetan relations.

CoNewsNet2: ETokar Thank you for sharing with us

KatzFive: I found it to be very interesting.  Thank you, Dr. Tokar and Alaya and Padma for arranging this chat.

RBCF Padma: Thank you so much for coming Dr. Tokar! We'll surely be asking you back. *smile*

RBCF Alaya: yes!! thanks a million!

EHaungs: visit:::: http://www.tibetanmedicine.com/ RBCF Ray H: Good luck on that ETokar!

CDPatton: Do upload it to the Forum's file library. ;-)

RBCF Ray H: Thank you again ETokar _Oo_

RBCF Alaya: yes.. thanks so much this has been great!

ETokar: Thank you all and good nite. Be in Touch