The most natural and accurate diagnosis.

COMPREHENSIVE DIAGNOSTIC SYSTEM OF TIBETAN MEDICINE (SOWA RIGPA).

Namo Buddhaya! It is with the Buddha’s teaching of Four Noble Truth that is: Truth of suffering, Truth of the cause of suffering, Truth of way to the cessation of the suffering and finally, the Truth of liberation from the suffering, that Tibetan Medicine finds its true expression.  Firstly, one need to know the truth of the suffering:  that the suffering is truth and that it is very much a part and parcel of our life; that we, as an imperfect human being, the disease follows us like a shadow no matter how much we try to avoid and there is no escape from its clutches.  Once we fully realize that suffering and disease is innate and that it can affect anyone anytime irrespective of caste, creed and religion, it becomes essentially important to find out its cause; it’s distant and immediate factors responsible for bringing the sufferings. Once we come to know about the true cause of suffering, then we also come to know about the way and blueprints of prevention and counteracting the suffering.  Consequently, we get liberated from this vicious cycle of life, death and suffering once we find the perfect way through diligent practice and realization.  Therefore, it is quite imperative that we understand the true nature of the disease and its main causes; why, when, where and how the disease strike us.

Leaving aside the conventional medicine’s approach and shortsighted diagnosis of the disease, we find that many of the well established and popular ancient medical traditions have developed their unique system of medical practices, concept and methods of diagnosis and treatments according their local traditions, culture and belief system.  We could also find many common links between these medical traditions symbolizing the intercultural exchanges in respect for the precious knowledge that stand apart in its service of humanity.  Tibetan Medicine or Sowa Rigpa too shares many of its medical knowledge with its neighboring countries like India, China, Nepal and quite interestingly, from the distant countries like Persia for its Galeno’s tradition*.

However, when it comes to the in-depth knowledge and understanding  of the true cause of disease and thereby, to establish a sound principles of diagnosis, Sowa Rigpa stands apart quite rich and varied with its multidisciplinary and multidimensional approach to the sound investigation and methods of diagnosis.  Amongst all, the method of Pulse and Urine examination in Sowa Rigpa is found to be highly developed and very ingeniously practiced by the Tibetan Medical practitioner. Though one could find the references on pulse and urine examination in Ayurveda, Unani and Chinese Medicine too, but the extent to which it was developed and described in Sowa Rigpa medical text with detailed exposition in most systematic manner is something very unique.  Thus, sTag-Tsang Lo-sTza-wa*, arguably one of the great scholar and writer of the 15th century wrote: “The diagnostic system of pulse and urine examination was not borrowed from superior land of India, but was developed by the bodhisattva physicians of Tibet”. Throughout the centuries, Tibetan Physicians have held this twin methods of Diagnosis called rTza-Chu as most reliable diagnostic procedures in understanding the dynamic condition of the Nespas( Three humors), Lus-zuns-bDun( seven bodily constituents) and Drima-sum( three excretory products) in their physiologically healthy conditions and in pathological conditions as well. It provides, to the physician’s delight, a most distinctive and vivid pictures of an individual in its most dynamic state as well as in diseased state. Moreover, it allows the physicians to foresee the course of the Nespas in its different manifestations; etiological and pathological conditions, treatment plans and in giving accurate prognostications as well.

The major portion of this work on the comprehensive diagnostic system of Sowa Rigpa was taken partly from the chapter three of the rTza-rGyud or Root Tantra and chapter 18 of the bShed-rGyud and mainly from the chapter two of the Phyi-ma rGyud of the classical rGyd-bZhi widely known as the Four Great Tantras. I have given my own opinions where ever necessary based on my long years of practice and experiential journey into this most wonderful diagnostic system.  I have also consulted few other reference books the names of which are given below at the last page as source books only.

THE PRINCIPLE OF DIAGNOSIS IN TIBETAN MEDICINE.

According to the classical medical text of rGyud bzhi or Four Great Tantra, all aspects of the comprehensive examination of the diseases and proper diagnosis are made through three major criterions:

1. Aggravating cause of the disease.
2. Signs and Symptomatic characteristic of the disease.
3. Analytical confirmation of positive and negative effects of diet, life style, medicines and therapies.

ANALYSING THE AGGARAVATING CAUSE OF THE DISEASE:

The aggravating cause of the disease should be traced on the basis of what food and life style the patient on question is habituated too and, which food he or she has taken recently and what new life style changes have been made. Based on this finding, all the probability of the disease can be made. Particularly, one needs to look for the negative and positive contributing factors that respectively goes against and for the nature of the disease.  This is in line with the law of cause and effect. If one have been taking an excess of hot spicy and too oily foods along with some alcohols and also, have been engaging in some strenuous physical activities and, that too, in a hot and sultry places all of which bears the characteristic nature of mKrispa or hot disease, the resultant disease will be surely of mKrispa type and certainly not that of rLung type.  This is because the effect cannot go against the cause.  Such novel way of analytical examination is very crucial in confirming the diagnosis.

SIGNS AND SYMPTOMATIC CHARACTERISTIC OF THE DISEASE

This is achieved through four modes of analysis such as:

1. Objective analysis. This is mainly to focus on the state of three principle Nes-pas through their increase, decrease and aggravated state and conditions. The main objective is to restore the balance of the health and hence, notwithstanding all the varied signs and symptoms of Nespas; the state of accumulation and aggravation etc, one should be able to discern and confirm the hot and cold nature of disease.
2. Subjective analysis. This involves checking the five sensory organs and its five functional activities and also, the five impurities of the body. The details of this analysis are covered below.

3. Gateway of ascertaining the disease. There are seven gateways of ascertaining the disease namely:

A1. Place and its climatic condition.  This is to verify whether the place is breezy and cold all the times or dry and hot conditions, or damp and moist to confirm respectively the Nespa of rLung, mKrispa and Bad-kan.

A2. Seasonal factor.  Depending upon the seasonal factor, one should see whether it is spring, the time of Badkan aggravation; summer the time of rLung rising, autumn the period of mKrispa,  or winter, the time of cold kidney disease.

A3. Body Constitutional factor.  Closely observing the patient’s physical features and mental attributes (personality type), one can find out whether he or she may be having rLung type of body constitution; mKrispa and Badkan type or the combination of two of the Nes-pas or all three together. Accordingly, the doctor should draw their lines of diagnosis.

A4. Age Group factor: Whether the patient is old associated with rLung disorder or middle age associated with mKrispa disorder or, is just a child associated with Badkan disorder.

A5.  Time factor: Whether the disease is more active in early morning and evening hours; midday or midnight, or is more pronounced in twilights of the day or not.

A6. Food factor: Whether or not the disease becomes more intense right after the food intake; or during the course of the digestion, or post digestive factor.   Also, it is worthwhile to see if one becomes worse after taking some cold and light potency food or, worse after taking some heavy, oily and hot type of foods.

A7. Location of the disease or pain: One should observe carefully whether the pain or the disease is located mostly at the upper body part, middle body part or the lower body parts as from these locations, we can infer the condition and nature of disease depending upon the natural location of Nes-pas and body organs.

4. METHODS OF DAIGNOSIS.

There are three methods of diagnosis which forms the most important and main diagnostic system that encompasses all other form of diagnostic criteria too.  They are as follows:

1. blTa-wa or Visual
2. Reg-pa or Touch
3. Dri-wa or Interrogation.

The first category called blTa-ba or Visual examination covers all those that our eye could see such as physical size, shape, structure, angle, length, color and complexion etc,  and particularly, the tongue and urine. The visual also includes five sensory organs like eye, ear, nose, tongue and body and the five sensory objects such as physical form, sound, odors, taste and tactile, and five impurities such as sputum, stool, vomits, urine and blood.

These five sensory organs and their associated five sensory objects refer to that of patients own and not that of doctors. Physicians have to check the patient’s five sensory organs and their respective place of activity for any possible diagnostic signs or clues that may help the physician to come to diagnostic conclusions. Generally, for any pathogenic situation, patient’s sensory organs would experience an essentially opposite feeling towards its associated place of action instead of the normally accepted reaction. For instance, where ever and whichever place one looks, its object appears yellowish in color and whatever food he eats, the taste becomes bitter, then it is a clear sign of mKrispa. Similarly, one feels invariably a taste of acridness in the tongue; humming and noisy sounds in the ear, and feeling of roughness in the skin no matter how much soft and comfortable cloth one wears, one could gather that it is nothing but a clear sign and symptoms of rLung disease. All this could be achieved with proper interrogation from the physician’s side.

Similarly, another field of visual examination is the five impurities of the patient such as sputum, stool, vomits, urine and blood.  One could find some scattered yet very important references to these impurities in their related chapters in rGyud-bZhi. For instance, one could find some references on the color and texture of the sputum in the chapter of lung disease, and on the color, texture and qualities of blood in the chapter of embryology.

Special emphasis is given to the tongue because of its unique position and ability to show the imbalanced nes-pas and organ dysfunction through it color and texture as given below:

rLung( Wind energy): The color of tongue looks reddish, dry and rough.

mKrispa(Bile energy): The color of tongue becomes pale yellowish with thick coating.

Badkan(Phelgm energy):  color of the tongue is whitish, pale, smooth and moist.

Yellowish color with dry surface comes from rLung and mKhrispa combined Nespa.

Pale and dried up tongue is due to combined Nes-pa of Badkan-rLung and fever.

Extremely dry tongue with reddishness is a sign of cardiac disorder with fever.

Black color on the two sides of tongue is a sign of kidney disorder.

sMan dPyd Dawa’i Gyalpo, one of the most authentic and ancient classic medical text also gives some interesting reference to the analysis of tongue as follows:

.The tongue of dying person is retracted towards the base.

.A shortened reddish colored tongue spotted with pigmentation is also a sign of imminent death.

. Reddish color tongue with rough surface is blood disorder.

.Blackish color tongue with rough surface is rLung disorder.

.Yellowish colored tongue having yellowish taint on the deep lingual veins with dried up appearance is affected with mKrispa.

.Tongue with extreme whitish color is a sign of Lung problem.

.Blackish color around the sides of the tongue is a sign of liver disease.

.Tongue having dryness in the middle portion comes from heart disease.

.Reddish color with shortened tongue is a sign of kidney disease.

.Tongue covered with black pigmentation on all sides is due to liver and spleen disorder.

The second category called Reg-pa or Touch implies mainly to the touch by physicians hand over the patient’s body and skin surface to look for some temperature changes, hardness, softness and roughness etc. Feeling of the various meridians through finger pressure is also an important part of examinations that often gives some clue to various internal organ and neuro-muscular problems.  And most important, the examination through pulse reading is the major chapter in this category.

The third category Dri-ba or Interrogation involves three important investigation steps. This is much like taking a patient’s entire case history, his food habits and life style as follows:

The 1st step is to find out the possible cause and contributing factor which may have directly caused or contributed to the aggravation of the already dormant disease. For instance, if the patient has been staying in some dry and windy area with regular intake of strong black tea and coffee, or stale and cold food items on top of his or her stressful life, one can easily infer the disease as rLung.

 The 2nd step is to look for the signs and symptoms of the disease. For instance, if the patient in question is showing some clear symptoms of having hips and generalized body pain, stiffness and swelling, often yawning and stretching himself, and difficulty in sleeping etc, then it could well mean that he or she is almost suffering from rLung.

The 3rd step is then to enquire whether he is having some relief in the symptoms after taking some country made wine or some vegetable soup rich with garlic and ginger additions, whether he sleeps better after giving some Agar pills or even a glass of warm milk, and whether he feels better with the company of his loved one or not.  If all these steps are positive, then the diagnosis of the disease is no less than the notorious rLung disease. With this confirmed diagnosis at hand, one can then plan and administer the treatments accordingly.

rTza-Chu or Pulse and Urine Analysis as the backbone of the diagnostic system of Tibetan Medicine, I’ve chosen to present them in details as given in the rGyud-bzhi as follows :

PULSE EXAMINATION ( rTza brTag-Thabs)

The examination of pulse is one of the most extensive subject and unique diagnostic methods that is employed in Sowa Rigpa(Tibetan Medicine) system of Medicine. It is essentially like carrying out a whole body scan through the expert fingers of physician; analyzing all the streams of energy flow containing gross and subtle information about the working conditions of our body system the message of which are transmitted through the networks of arteries to the radial artery. It is from the radial artery that the physician read and intercept all the messages contained in the varied forms of pulse characteristics; interpret them and relate them with the different body organs and its state of health and disease. Though very simplistic in its practice, it takes years and years of hard work and experience in mastering this most reliable and wonderful diagnostic techniques. The entire subject is explained  through thirteen essentials as follows:

1. The preliminary compliances.
2. Timeof Pulse examination.
3. Anatomy of Pulse reading
4. Pressure to be applied while taking the pulse.
5. Method of taking the pulse
6. Constitutional or Natural Pulse
7. Seasonal Pulse
8. Seven extraordinary Pulse
9. Healthy Pulse
10. General and Specific Pulse
11. Prognosis of the Pulse
12. Unnatural Pulse
13. Life span Pulse

1. PRELIMINARY COMPLIANCES.

Over indulgence in any particular diet and lifestyle can greatly influence the nature of pulse during the actual time of pulse reading. So as not to conceal the true nature of disorder and to avoid any misleading information from the nature of pulse, observing preliminaries is very important.

For instance, the day before the pulse reading, if one consume more alcohol or fatty foods and engages in strenuous physical activities leading to  increase in bodily heat that matches the same characteristics of fire element and mKhrispa energy, his pulse during the examination could show as having the same characteristic of hot disorder. Likewise, if one consumes more of heavy and cold food items in a cold environmental condition without any exercises, this could obscure the true nature of pulse and instead manifest itself as having some characteristic of bad-kan disorder.

Therefore, it important that one should be wise enough not to fall into two extremes of hot and cold influences. One should neither over eat nor remain without any food, and should not lose any sleep. It is best to have enough rest with one’s normal routine.

2. STANDARD TIME FOR PULSE READING.

The appropriate time for pulse examination is early morning hours when the sun has risen in the sky but its radiance has not yet fallen on the plain; when our inner warm breath has not escaped outside nor the external cold air has entered or inhaled, when one has not moved from one’s bed, and when one has not eaten anything. To be precise, the pulse should be examined when gDags the solar energy and Sribs the lunar energy, and the respiration of our body are all in a dynamic state of equilibrium to find an unaltered state of the pulse flow.

Having said that, we may find it extremely difficult to find such an ideal time and on the other hand, it may also seem quite preposterous to find Tibetan physician in present day situation checking the pulse of the patient all through the day. This is mainly because of the whole medical practice now being institutionalized and whole pattern of patient care has undergone dramatic changes since the ages. Yet, under present day circumstances, most physicians may not be able to read the pulse of the patient in its full synergistic beauty, but it still assumes lot of importance to read the pulse in morning hrs and may be in the early evening hours when the sun is in its setting horizon to achieve desirable result. If possible, try to avoid reading the pulse in thick of the day and night. Under any circumstances, it is important that patient should be relaxed and his or her heart rate should be in its normal self while reading the pulse.

3. PLACE and ANATOMY OF READING PULSE.

The importance of this section is to emphasize the need to find a right place to read the pulse from where we can collect the correct information about the imbalances of Nespas and internal body organs. Although, there are many accessible arteries in all parts of the body, radial artery is considered  centrally located in the body being neither too close to the internal solid organs such as heart  nor too far off from them .  If it is too close to the heart like that of carotid arteries, it is much like a place near the heavy water fall; too noisy and gushingly strong where it is difficult to comprehend the different characteristics of the pulse that brings various information on the Nes-pas and their activities.  If the location of reading pulse happens to be very far from the heart like the place of Dorsalis Pedis pulse, it is like receiving information from a messenger who is far away from the scene of activity in which case the authenticity of his message can be doubtful.  Therefore, as the arterial blood passes through every part of body much like a busy merchant who travels all over the trading places and gives information about all the business prospects, arteries with its blood and wind flowing inside carries with it all the vital information as to the conditions of all the Nes-pas and their imbalances of the body system.

Therefore, the most ideal place to read the pulse happens to be radial artery near the wrist. There should be a distance of one distal phalanx of the thumb from the first wrinkles of wrist measuring downward. One should place the Tson or index, Kan or middle and chag or ring finger just below the bony part of wrist maintaining some space between the fingers.

To find the condition of life-span pulse, one should examine the ulnar pulse located almost between the ligament and tendon. To confirm a dying person one should first check the Dorsal Pedi’s pulse as the nature of pulse tends to withdraw from lower extremities towards the heart during the process of death.

4. AMOUNT OF PRESSURE APPLIED

Due to the nature of pulse formation, pressure applied on each pulse also varies. Therefore, the pressure applied by the index finger should barely touch the skin and the pressure applied by the middle finger should touch the muscle, whereas the pressure applied by the ring finger should touch the bone. As the radial artery ascends upwards to the forearm like a shape of a radish, the finger pressure so applied should be little stronger (from index to ring finger) as one moves down the arm to feel the pulse appropriately.

5. METHOD OF READING THE PULSE

To be able to read the pulse correctly, it is important that the physician’s hand should be smooth, sensitive and should possesses a balanced heat. The left wrist of a male patient is normally read first with physicians right hand and right wrist of female patient is read first with left hand of physician. Due to some difference in the flow of vital energy from the heart in male and female body, the position and pulse of heart/intestine and lung/colon is interchanged in male and female’s index finger.  Therefore, female’s right hand is checked first by the physician’s left hand and vice versa.  It is said that  as a matter of importance given to the heart as a mighty King of all the organ, patient’s hand having the heart organ is checked first.

Each Tson(index), Kan(middle) and chag(ring) fingers of both right and left finger of physician are divided into two halves as upper part and lower part totaling of twelve parts accommodating twelve body organs in all.  In normally accepted conditions, physician’s right hand should check the patient’s left hand first following which physician’s left hand should check patient’s right hand.  Practically, it doesn’t matter much and do not really alter anything by which hand you see first in male and female as long as you are able to get the pulse information correctly as given in the diagram given below.

 Please see the table below.  Physician’s right hand is divided into following sections.

Physician’s Right Hand	Upper Part	Lower Part
Index(Tson)	Heart	Small Intestine
Middle ( Kan)	Spleen	Stomach
Ring (Chag)	Left Kidney	Reproductive Organ

 Physician’s left hand is divided into the following sections:

Physician’s Left Hand	Upper Part	Lower Part
Index(Tson)	Lung	Large Intestine
Middle ( Kan)	Liver	Gall Bladder
Ring (Chag)	Right Kidney	Urinary Bladder

 

6. CONSTITUTIONAL PULSE

Based on different constitution or personality of an individual, the constitutional or natural pulse of an individual is grossly categorized into three: male, female and the Boddhisattva pulse. These three constitutional pulses have its different characteristic and both male and female can possess any one of the three. The male constitutional pulses are bulky and strong. The female pulse is thin and faster while the bodhisattavas or neutral pulse beats in long continuum and is gentle in its beat.

Certain prognostication can be made on individual personality depending upon the nature of the constitutional pulse. For instance, male person having female constitutional pulse is said to be blessed with long life and if a female person has a male pulse, she can be blessed with more male offspring. Person having Boddhisattva pulse may be blessed with long life, good health and can expect more love from his/her superior but, he or she can also become a target of jealousy and hatred by their subordinates, uncle and aunts. They could also go without having any offspring and thus depriving of having any family lineage. However, if both the couple happens to have male pulse, they will be blessed with more male child and if both the couple happens to possess female pulse, they will be blessed with more female child. If one of the couple has Boddhisattva pulse and the other possess any of the male of female pulse, they will be blessed with only one child and it will be of their same constitutional pulse influences. Therefore, It is imperative that the physician should know about the patient’s constitutional pulse before diagnosing the disease so as not to be mislead by the nature of constitutional pulse to that of the diseased pulse.

7. SEASONAL PULSE

This section explains about the inter-relationship between the internal organs of our body system (the micro-cosmic world), the outer environment (macro-cosmic world), the four different seasons and their relation to the five cosmo-physical elements. First, it teaches about the inter-relationship between the different seasons, internal organ of our body system and their elemental nature, and their relation to the seasonal pulse. Secondly, it teaches about the calculation of Mother/Son and Friend/Foe relationship.

Calculation of the four seasonal pulses in relation to the five elements is being carried out as follows. First, correlate the four external seasons with the inner vital organ’s elemental nature and their pulse characteristics in keeping with the same fundamental nature of the five elements. With the result, the intricate calculations of four fold mother-son and enemy-friend relationship are established. Spring, summer, autumn and winter are the four seasons and an addition of one intermediate season makes a total of five seasons.

 

The three months of spring is the season with its earthly distinguishing factor of sprouting plants and vegetations; the space distinguishing factor consisting of three stars of Tava, Wo, Nagpa that appears in consecutive successtion in the sky starting from 1^st to 3^rd of Tibetan month respectively to control the time and space, unmistaken bio-diversity sign of birds like skylarks making their own voice heard. During these first three phases of seventy-two days, the wood element is predominant and consequently the liver pulse becomes more active predominant with thin and twisted beats like the chirping of a skylark. However, the earth element will be predominant during the remaining eighteen days and hence the spleen pulse will be more active during that time.

The three months of summer is the monsoon time with unmistaken earthly distinguishing factor of blossoming flowers, leaves and branches of trees; space distinguishing factor highlighted by three stars of Saga, Noen and Chutoe that appears consecutive succession in the sky from 4^th and 6^th of Tibetan month to rule the time and space, and unmistaken bio-diversity sign of cuckoo, the king of birds, making its voice heard. During this period of seventy-two days, the fire element rules the body with heart organ dominating the pulse flow which is characterized by thick and long in continuum like the chirping of a cuckoo. However, the earth element will rule during the remaining eighteen days with spleen pulse dominating the flow.

The three months of autumn is distinguished by its earthly display of harvesting season when crops and fruits ripens; unmistaken space is distinguished by the successive appearance of three stars of Dro-shun, Trumtoe and Yugpa in the sky that rules the time and space from 7^th to 9^th Tibetan month, unmistaken bio-diversity sign of dragon fly flapping its  newly acquired wings with bustling sounds. During these seventy-two days, the metal element rules and consequently the lung pulse becomes more dominant with characteristic short and rough beats like the sounds of Jidpo. However, the remaining eighteen days will be ruled by an earth element hence the spleen organ will dominate the flow of pulse in the body during that time.

The three months of winter is distinguished by its unmistaken earthly sign of frozen land and water: the three stars of Mindruk, Go and Gyal appears successively in the sky over three Tibetan months of ten, eleven and twelve respectively to rule the time and space, and unmistaken bio-diversity sign of black deer with its wailing sound. During these seventy-two days, the water element with its kidney pulse beats more dominantly with its characteristic gentle and slow beats like the chirping of water bird sandpiper. For the remaining eighteen days the earth element with its spleen pulse flows predominantly.

According to Sorig system, whenever the month of solstices appear will it be considered as the midsummer and the midwinter. The four intermediate seasons, each with eighteen days make seventy-two days. It is the time when the earth element with its spleen pulse flows predominantly characterized by short and gentle beats like the chirping of a sparrow.

RELATIONSHIP OF MOTHER-SON & FRIEND-FOE.

This postulation of Mother-Son and Friend -Foe relationship is based on the theory that certain sensitive relationship exists between individuals and their environment commonly connected by their cosmic energy of elemental relationship.  It helps to determine and influence not only the family’s health and welfare, but that of the community as a whole.  It is derived from the understanding that there is a positive and negative kind of interrelationship between each of these six cosmic elements. For example, Wood, Fire, Earth, Metal and Water are placed in an ascending vertical row and Fire, Water, Earth, Wood and Metal are placed in horizontal line from left to right with the element Earth forming the centre point of modal. Ascending order of these elements constitute the motherly relationship such as mother of water is metal, mother of metal is earth, mother of earth is fire and mother of fire is wood, and mother of wood is water, whereas descending order of the relative elements constitute the son like relationship. Likewise the calculations from left to right elemental row constitute the friendly relationship and right to left constitute enemy.

Functionally, this cyclical interrelationship between these cosmic elements can be understood in terms of cosmic energy giver or source (Mother), Energy product (Son), negative energy (enemy) and positive (Friend). For instance, a source of earth is fire and source of fire is wood, and product of wood is fire and product of fire is earth. Likewise elements that contradict or give negative energy become the foe and which nurtures or gives positive energy becomes the friend. Since water extinguishes fire, Water becomes the foe of Fire, and since Woo d enjoys the nutrients from Earth, Earth is a friend of Wood. Please see the picture below.

 If the pulse of an individual beats in synchronization with the pulse characteristic of the Mother of the dominating seasonal pulse and that of the dominating seasonal pulse itself, the best of prognostication could be expected. If one’s pulse characteristic beats in line with the pulse characteristic of the Friend-pulse of the prevailing season, one could expect more fortunes. If it beats in line with Son’s pulse, one may enjoy more power and domination. If it beats in line with an Enemy-pulse, one may encounter misfortune or succumb to an incurable disorder.

 

8. SEVEN EXTRAORDINARY PULSE.

The law of seven extra-ordinary pulses and its calculations are based on the same interrelationship between the individuals, environment (seasonal)and their elemental connections. These prognostications through the pulse analysis are carried only on totally healthy individuals and not in all the conditions or all patients. The calculations are made to give some predictions or prognostications relating to family issues; approaching guest, on one’s enemy, wealth and fortune, negative vibrations or evil spirit influences, examination of substitute pulse, and pregnancy issue.

Firstly, to examine the family predictions from the context of law of dependant arising, sunken and indistinct characteristics of the pulse signify some paralytic conditions or an occurrence of defilement. Non-palpable and indistinct pulse beats indicate an approaching sorrow and grief. Forceful pulse beats with intermittent pauses signals panic. Pulse beats resembling a sharp pricking sensation from the thorns of berberis aristata plant indicates endless sufferings. Pulsation resembling the characteristics of boiling water indicates severe backbiting or criticism. Pulsation resembling the characteristics of dying flame with alternate ups and downs and irregular flapping indicate loss of wealth. If any of the above six negative pulse characteristics appear in the form of one’s own seasonal pulsation, then the pulse examinee has to suffer the all the consequences. If it appears on the mother of the seasonal pulse, mother and maternal uncles would experience adversities, and if it appears on the season’s child pulse, the child and the nephew will experience the same. If it appears on the season’s friend pulse, wealth of the family will be affected. If it appears on the season’s enemy pulse, then one’s enemy would suffer the consequences.

In making the prediction for an approaching guest, firstly, from the context of close relevance, examine the pulse of the family member who is closest to the guest. If any of the liver, lung, heart, spleen and kidney pulse beats predominantly strong, this indicates respectively that the guest is either still at his destination, on his way home, quite close by, at the doorstep, or that the guest has encountered an enemy on the way. On the other hand, on the basis of enemy-friend calculation, if either of the prevailing seasons own pulse flow or the mother of the season’s pulse beats predominantly stronger, it indicates that the guest is still at his destination. If the son of the dominating seasonal pulse beats stronger, this indicates that the guest is on the way and if the enemy of the dominating seasonal pulse beats stronger, this indicates that the guest will arrive shortly. Determining whether an assignment would be accomplished or not is as follows: If the heart, liver and kidney pulses beat predominantly stronger irrespective of the seasonal pulse, this indicates respectively that some obstacle has come from an enemy, accomplishment of an assignment, or returning home empty handed. If the enemy of the dominating seasonal pulse beats stronger, it shows failure of a mission, and if the friend of the dominating seasonal pulse beats stronger, it indicates accomplishment of an assignment.

To predict the might of an enemy, from the perspective of close relevance, examine the pulse of the chief commander. While attacking an enemy, if his lung pulse beats stronger, it indicates victory; spleen pulse indicates defeat, as the rival’ force is more powerful. On the basis of enemy-friend calculation, for the enemy pulse of the dominating seasonal pulse, if its enemy pulse beats stronger, it indicates victory of the self, and in the face of one’s seasonal pulse, if its enemy pulse beats stronger, it indicates defeat of the self. Similarly, if the rival coming for an attack, if the enemy of the dominating seasonal pulse beats strong, one will be defeated. If the dominating seasonal pulse and its mother pulse beat stronger, one will not be defeated.

To predict wealth and fortune outcome, Firstly, from the context of close relevance, examine the pulse of a wealth owner. If his liver pulse beats stronger, the wealth would grow and there will be no loss at all. If the heart and spleen pulse is found weak, one could incur loss. Now from the perspective of enemy- friend relationship, for the friend pulse of the dominating seasonal pulse, if its friend pulse too beats stronger, it indicates an excellent fortune. But, if its mother pulse and its own natural pulse beat predominantly strong, it indicates moderate and poor fortune respectively. Also, if its Son pulse beats predominantly stronger, it indicates no fortune, and if its enemy pulse beats stronger, it indicates wealth or fortune being taken by one’s enemy.

8. PREGNANCY PULSE.

The pregnancy pulse is characterized by bulky and rolling beats.  If the pulse of the right kidney beats stronger, a baby boy will be born, and if the pulse of the left kidney beats stronger, a baby girl will be born. If either the mother pulse or her child pulse beats stronger on the child pulse of the dominating season, it indicates easy nurturing of the child after delivery, and if the enemy pulse beats stronger, it indicates difficulty in nurturing the child.

 

9. HEALTHY PULSE.

 

During one complete cycle of respiration, the pulse should beat five times for a normal healthy person. Notwithstanding one or two times of checkup, in a cycle of hundred such respiration, if the pulse shows no sign of strong, weak, differences in upper and lower part in terms of its varying strength such as sometimes overflowing; sometimes sinking, hidden, irregular rhythm, loose and tight, missing and pulling, and if it beats rhythmically the same every time, it is a sign of healthy pulse.

Contrary to this, if the pulse exhibits any of the above differences in the one or more cycle of respiration, it indicates pathogenesis or imbalance in the body system. Sometimes even in a healthy state, some people do possess a natural pulse of irregularity, absence of pulse and abnormal position of pulse. Therefore, it is very important that the physician should ask the patients if he or she has any abnormal pulse beat or not, also about his or her natural or constitutional pulse so as not to make any wrong diagnosis. If one does not know about the basic pulse or three constitutional pulse of male female and Boddhisattva, this could cause some confusion in making proper diagnosis.

1. DISEASED PULSE

The explanation of diseased pulse is elaborated under two divisions of Common and Specific.

Common pulse is again categorized into six hot pulses and six cold pulses. This can be further studied through the method of pressure, number of beat and length of beat to understand the intensity of disorder. Specifically, through the six fingers one can take information about the five vital organs, six vessel organs, position of disorder in the body and its location.

The six common characteristics of pulse that distinguishes hot and cold natures of the disorder are as follows:

S.No.                    Hot Disorder                                                    Cold Disorder

1.	Strong	Weak
2.	Expanding	Sunken
3.	Rolling	Declining
4.	Fast	Slow
5.	Wiry	Loose
6.	Solid	Empty

However, pulse characteristics of hot disorders could be differentiated from three different angles: elevation, speed and tenacity. Pulse with elevated height and more frequency indicate vitiated fever and acute infectious fever. Pulse with more depth but fewer paces indicate chronic fever. The six distinctive characteristics of the cold disorder are the opposite of the six hot characteristics and are as follows: weak, sunken, declining, slow, loose and empty. However, pulse with deep seated but more tenacity or continuous beat indicate newly acquired cold disorder whereas pulse with less speed and low elevation signifies chronic cold disorders.

The specific diagnosis is of two: differentiating various diseases through specific pulse characteristics and determining whether a disorder is located in the upper or lower body or in the specific vital or vessel organs through examining twelve different pulsations felt under the index, middle and ring fingers.

Firstly, examination of the specific pulse characteristics is as follows: the pulse of rLung nes-pa is floating, empty and pauses in between; mKrispa nes-pa is thin and wiry. Badkan nes-pa is sunken and declining. The pulse of the combined rLung and hot disorder is empty and fast,  badkan and mKrispa combined disorders are superficially sunken but wiry in depth, pulse of badkan and rlung combined disorders are empty and slow whereas the pulse of badkan sMugpo is thick, full, and faint under the middle finger. The pulse of blood disorders are protruding and rolling whereas the pulse of lymphatic disorder is quivering and sluggish in flow. The pulse of microbial disorders are limping and flattening on the length. The leprosy pulse is faint, quivering and fluttering.

The pulse of disturbed hot disorder is thick, overflowing, protruding and rolling. The pulse of dispersed fever beats thin, tight and wiry. The pulse of infectious fever beats thin and fast. The pulse of infectious disease is twining and with parallel beat. Zerthung or kind of infectious Lung disease beats short and small. The pulse of compounded poisoning is rough, short, wavering and uncertain while pulse of meat poisoning beats thin, fast, faint and sunken.

The pulse of un-ripened fever is thin, fast and fluctuates like a wind.  The pulse of expanding fever is strong and wiry. The pulse of empty fever is empty and fast. The pulse of hidden fever is low in elevation and yet, wiry. The pulse of chronic fever beats thin and wiry whereas the pulse of mixed- up fever is thin yet fast in depth. The pulse of an inflammatory wound is thick, taut and fast. The pulse indicating a foreign body lodged inside the body appear faint and have parallel beats.  In case of a head injury, a strong pulse under the index finger, a wiry pulse under the middle finger and a fast pulse under the ring finger indicate injuries to the head muscles, the skull and the brain respectively. The pulse indicating a pus formation is quivering, or strong and fast.

The pulse characteristics of cold disorders are as follows:  New indigestion problem has a thick and taut pulse whereas the pulse of a chronic indigestion is weak and thin. The pulse of tumor is weak and faint at the site of tumor. The pulse of ascites, localized edema, and generalized edema are all similarly thin, sunken and tight in the depth. If vomiting occurs, pulse on the index fingers become weak whereas for diarrhea, pulse on the ring finger will be weak.

However, there are six avenues of mistakable pulse conditions. Pulse of blood and rLung combined disorder could be mistaken due to their common floating beats; pulses of acute, and empty fever could be mistaken due to their common fast beats, and pulses of badkan and chronic blood disorder could be mistaken due to their common sunken beat.

In order to ascertain the specific location of the above mentioned pulse characteristics of various diseases, whether in the upper or in the lower part of the body, either in the vital organs or in the hollow organs, the two Tson-rtsa perceive the diseases in the upper part of body such as heart and lung; two Kan-tsa perceive the diseases from the middle part of the body such as liver and stomach, and two Chag-tsa perceive the diseases in the lower part of the body such as kidney and lower back. Six pulses of the gDags or hot energy pulse and the six pulses of Sribs or the cold energy pulses examines the disorders of the five vital and the six vessel organs respectively. gDags pulses are those that can be felt on the upper-left part of the fingertips of both the hands corresponding to five vital organs of the body and is the pulse that beats during the course of exhalation, while sib pulses are those that can be felt on the lower-right part of the fingertips of both the hands corresponding to six vessel organs of the body and is the pulse that beats during the course of inhalation. Usually, the signs and symptoms of the vital and the vessel organs do not appear contradictory. It is possible to have a hot disorder in the vital organs and a cold disorder in the related vessel organs simultaneously. However, it is not possible to have a hot disorder in the vessel organs and a cold disorder in the related vital organs simultaneously. The occurrence of hot and cold disorders in the upper and the lower body should be understood in the same manner as well. Therefore, without really getting mixed up or confused with all the general and specific pulse characteristics mentioned above, one should be able to analyze in detail and comprehend the pulse characteristics of various diseases and their corresponding site of accumulation to reach for a correct diagnosis.

Here, I would like to point out that not all the pulse characteristics of every disease are given in the medical text. The pulse characteristics of some of the diseases that are not found in the chapter of pulse diagnosis may be available in the chapter of the particular diseases that are discussed in the third Tantra or oral transmission Tantra. One would also wonder why characteristics of diabetes, cancer, hypertension so on so forth are not given in the medical text. It is because most of the pulse characteristics that are mentioned in the medical text do not pertain to particular disease by its name, but to the nature of aggravation and influence of Nespas like rLung,Krispa and Badkan in that disease. Once we know the fundamental pulse characteristics of all the Nespas and their double and triple combination characters, one would gradually know what kind of pulse characteristics are expected in those diseases mentioned above.  Therefore, it is important for the beginners to know and understand the fundamental nature of various pulse characteristics that relates to the different health conditions of our body system rather than hastening to know the exact pulse beat of particular disease as given above.

11. DEATH PULSE

Pulse of a dying person can be confirmed through the three nature of pulse such as change in pulse, absence of pulse and pause in pulse.

1. CHANGE IN PULSE

If the pulse beats irregularly like a flatter of banner in the presence of wind, it is a sign of death pulse due to rLung disorder, whereas if the pulse beat with a very fast rhythm like a hawk shaking its tail while preparing an attack is a sure sign of death pulse due to mKhrispa disorder. If the pulse beats without interval like a droplet of water falling through the rooftop is an indication of death pulse due to Badkan disorder. Likewise, if the nature of pulse beat with sudden force like a fish coming out of water to grasp food particle or resemble to that of toad springing forward or if the pulse appears to stretch like a saliva dripping from the mouth of an old elephant, these signifies death pulse. If a critical illness show a pulse of chronic disorder and a chronic emaciated body show a strong pulse, this could again be taken for death pulse. Likewise, a hot disorder acquiring a pulse of cold nature and cold disorder acquiring a pulse of hot nature are signs of death pulse. Patients of chronic pulmonary infection, food poisoning and chronic gastro problem when manifest a healthy nature of pulse, is again a sign of death pulse.

1. ABSENCE OF PULSE

Along with the absence of specific pulse if the patient tends to manifest physical sign of malfunction, this can be taken for the sign of death pulse. Few example of such nature are: absence of heart pulse with patient’s tongue turning completely black and who stares blankly into air could suggest death in a day. Absence of lung pulse with patient’s nostril getting flat and inversion of nasal hair predicts death in two days. Absence of liver pulse with patient’s eye turning upward and drawing in of eyebrow predicts death in three days. Absence of spleen pulse with patient’s lip hanging down and deepening of xiphoid process predicts death in five days. Absence of kidney pulse with patient’s inability to hear and ear-lope attaching backward predicts death in eight days.

1. PAUSE IN DEATH PULSE

Pause in pulse has three types: pause related to the disease, pause due to an impending death and pause due to an evil spirits. Pause due to disease indicates missing of the pulse of some organs due to its pathological conditions, pause due to evil spirit features irregular pause with fluctuating strong and weak beats. And, pause with same counts at rhythmic interval is the real pause of impending death. Perform necessary spiritual rites if the pause is due to evil spirit and, if it is due to the disease itself, then treat them properly with the medicines. If no improvement is found notwithstanding proper rituals and remedies, it is an indication of an imminent death. However, some pulse could be found seemingly missing because of sinking pulse effects of some serious cold disease; hidden because of sudden anxiety conditions, and concealed because of some evil spirit influences. In such conditions, although the pulse may be absent, yet it does not necessarily signify impending death as it could be recovered if properly treated.

12. EVIL SPIIRT PULSE.

The evil spirit pulse has irregular beats with many fluctuations: uncertain pause and pull and with parallel beats.  Most of the explanations of this evil spirit pulse pertain to the beliefs and traditions of the local culture; hence I am not going into the details of such explanations as it may create unnecessary confusions.  But be it evil spirits or negative elements as is popularly known in modern language, it is important to understand the pulse characteristics as given above and under such circumstances, try to analyze the conditions as per one’s own belief system.

13. LIFE-SPAN PULSE.

Due to afflictive emotions, human being loses its control over their mind and mind tends to wander into many negative mental afflictions.  With basic ignorance still tainting our mind we are condemned into never ending cycle of cyclic existence. Hence, we have inherited this wandering bLa-rTsa as part of our supporting life force energy. If bLa-rTsa  is present and beats normally, life will be stable but, if it fluctuates and misses its beat, our life will be unstable accordingly. If bLa-rTsa pulse disappears, one will die as soul energy has already departed. bLa or soul energy could be retrieved if one engages in special long life rituals and perform many life saving actions.

If the life-span pulse is stable and beats hundred times continuously, it predict hundred years of life and if it beats fifty times it means a life of fifty years. One beat of life span pulse is calculated to a year of life. Comprehending all these teachings and proficiently practicing it is a doctor who is a good listener too. So do not let your mind go astray; concentrate and bring all the essentials into practical solution and enjoy serving the needy sentient beings with joy and compassion.

Thus the chapter on Pulse examination concludes here.

 URINE EXAMINATION.

Urine analysis is one of the important and common diagnostic methods of Tibetan Medical system to distinguish between hot and cold state of the diseases. It also helps Tibetan doctors to observe the changes of pathological conditions during the course of the treatment process. Urine analysis is described through eight sections comprising eight sections as follows:

1. Preliminary Compliances.
2. Time of Analysis.
3. Choice of Container to be used.
4. Formation of Urine.
5. Healthy Urine
6. Unhealthy Urine.
7. Sign of death
8. Indication of Evil Spirit.

PRELIMINARIES COMPLIANCES OF URINE ANALYSIS

To avoid any untoward changes in the urine composition, one should avoid over consumption of black or green tea, and liquor. One should also avoid undergoing long period of thirst, over indulgence in sex, sleepless night, excess physical exertion and excess rest, and emotional stress as these can grossly influence the compositional nature of urine. Early morning urine should be collected for the urine specimen as the urine collected during the first half of night is more influenced by food and will not reflect the true nature of disease.

TIME OF URINE ANALYSIS.

The most appropriate time for the urine examination should be in the morning with sun light to light up the utensil of the urine as one has to check mainly the color, streams and presence of albumins in it.

3. CONTAINER TO BE USED FOR THE URINE EXMAINATION.

The color of the container should be preferably white porcelain cup or white ceramic type of bowl with wide opening, slight whitish metallic container or laboratory jar. The container should be clean without any presence of any other particles or foul smell. One should not use mud pot, bronze and iron container of red color as these may influence the color of urine specimen.  It seems quite okay to collect the urine in a clean transparent mineral water bottle too as one could see the color and composition of the urine quite clearly from outside.

4. SYNTHESIS OF URINE

Urine is synthesized after passing through several channels of the body organs. After the ingestion of food, it is broken down into nutritional essence and waste substances in the stomach. The waste substance is transported into the intestine where it is further assimilated into solid and liquid form. The liquid part is then transported to the urinary bladder through kidney for further absorption and filtration through the process. The nutritional essence is transported to the Liver where it is further synthesized into finer essence called blood and its waste as bile which is collected into the gall bladder. The bile thus collected is further synthesized into finer essence as lymphatic fluid and waste products as albumin. The former gets distributed all over the body and later into the urinary bladder to be evacuated with the urine. Thus, it is clear that the nature of the food influences the nature of urine and, the albumin having it source from blood and bile, give information on the nature of hot and cold disorder.

5. HEALTHY URINE

Color of healthy urine is light yellowish color that of a freshly melted butter made from milk of Dri(female yak); should have the distinctive odor of urine and the steam that stays for some time, and middle sizes bubble should appear after stirring.  Sediments and albumins should be evenly distributed and lightly formed over the surface of urine. The transformations of the urine after the disappearance of the steam should start from sides to the centre, and finally settles down into healthy light yellowish color.

Specifically, as infant are more dominated by Badkan energy their urine usually appears more whitish in color. Adulthood being more dominated by mKrispa energy can give an appearance of more yellowish color in urine. Urine of aged person being more dominant of rLung energy can give an appearance of little bluish color. Urine of pregnant women has a clear bluish color like that of the sea.

6. DESEASED URINE.

Contrary to the healthy urine, observation of diseased urine is explained through general and specific:

General analysis of urine is classified into two categories:  time of observation and method of observation. The time of observing the urine is further divided into three stages which include observing the urine at the state of warm, lukewarm and cold.

One can check the color, stream, odor and bubble when urine is in warm state. Urine at the state of lukewarm can give information from its presence of albumin and cream. When urine is in cold state, one can observe the time of transformation and the color effect after transformation take place.

Through the above three phases of urine and the nine methods of observation, we can gain information about the body in relation to the disorder of Nes-pa-sum, dual combined Nes-pas, triple combined Nes-pas, disorder of vital and hollow organs and poisoning. Specifically, one can distinguish the disorder whether it is under the influence of hot or the cold nature.

OBSERVING THE URINE WHEN FRESH.

When the urine is fresh, one should observe color, stream, smell and bubble.

a). OBSERVING THE COLOR.

The color of urine is observed when urine is still warm.

bluish like the spring water	Rlung
Yellow color	mKrispa
Whitish color	Badkan
Reddish color	Blood disorder
Pinkish or reddish yellow	Lymphatic disorder
brownish with foul smell	Triple Nes-pa combined disorder
Whitish yellow	badkan and mKrsipa combined
Black mustard oil or dark cocoa color	Infectious disease or  jaundice

Reddish with slight yellow tinge:                           May be due to Vitiated Fever

Dark with rainbow color:                                           Effect of poison.

Menchad Dawa’ Gyalpo, explains different shades of colors that we can see in the urine which includes: red, reddish yellow, reddish black, yellow, brownish, bluish yellow,  dark maroon, bluish maroon, maroon brownish yellow, broken black, brownish black, bluish black, greenish, white and mixed color. Look below for some more references from Dawa’ Gyalpo:

.liver disorder associated with increase state of blood will give the urine a bright red color.

.Disorder of lymphatic fluid will give reddish yellow color.

.Bright yellow color in urine signifies jaundice or precipitation of bile in the colon.

. Acute mKhrispa disorder combined with recent rLung disorder gives light bluish with yellow tinge. .Maroon color in urine is a sign of chronic gastro intestinal disorder.

.Appearance of brownish black color in urine signifies black lymph disorder.

.Urine of light bluish color is an influence of Badkan disorder associated with cold disorder and rLung. .Black color in urine may be a sign of poisoning.

.Greenish color in urine is a sign of aggravated rLung and cold disorder.

.Mixed rainbow color in urine is a sign of internal poisoning.

It further explains that though there are innumerable shades of urine coloration, it can be condensed into thirty six different shades of color which can be further grouped into eighteen.

In nutshell, it is sufficed to conclude that urine having clear whitish color can be grouped under cold disorder and the reddish color of urine into hot disorder.

1. b) OBSERVING THE STEAM

.Urine which gives strong and long lingering steam is a sure sign of hot disorder.

.Urine with less steam which stays for a short duration is a sign of cold disorder.

.If the steam is negligible and disappears instantly; it is a sign of badkan and cold disorder.

.Moderate yet very persistent steam indicates hidden or chronic fever.

.Alternate strong steam and light steam indicates presence of both hot and cold disease.

1. c) OBSERVING THE ODOR.

.Very foul and disengaging smell is a sign of hot disorder.

. None or very less odor indicates cold disorder.

.Smelling of particular food in the urine specimen means indigestion of that particular food.

. rLung disease will give a smell of rusted metal.

.mKhrispa will produce a burnt odor.

. Badkan will give an odor of lice infection.

.Urine with the disease of triple Nes-pa combination may give a fatty smell.

.odor of decayed leather indicates either aggravation of disease inside or may be a sign of poison.

d).   OBSERVING THE BUBBLE.

.Large and bluish color bubble signifies rLung disorder.

.Bubble of tiny, yellowish color which disappears easily is a sign of mKhrispa.

. Saliva type and stable bubble signifies bad-kan disorder.

.Blood related disorder may give a reddish look.

.Rainbow colored bubble indicates poisoning.

. Scattered or fast disappearing bubble indicates disease in scattered condition.

. Small bubble that does not disintegrate is an indication of fever.

.Big and productive bubble which do not dissolve easily indicates cold disorder.

. High Fever with no bubble indicates death.

.Cold disorder with no bubble indicates chronic and deep seated cold disease.

Following are some of the information taken from sMan dPyad Dawa’i Gyalpo, on the condition and appearance of bubble in the urine.

.Tiny bubble with yellowish color signifies the presence of fever or infection in the upper extremities of body.

.If the bubble is large and has a tinge of bluish-black, it is sign of disorder which is not critical or it could also be a sign of ripened disorder.

.Urine having tiny bubble with bluish color is a sign of Badkan disorder affecting the lungs or a sign of rLung disorder which is deteriorating.

.Large bubble with whitish color is a sign of Spleen problem associated with Lung which is characterized by loose motion, bloating and rumbling in the stomach.

. If the bubble gives a hue of rainbow, it is a sign that poison has entered the body.

.Extremely large bubble signifies presence of tumor or accumulation rLung in the colon.

.Bubble of yellowish color having small size is a sign of inflamed liver and gall bladder.

.Yellowish bubble and reddish bubble meant increase of bile and blood disorder respectively.

.Presence of long standing little bubbles which breaks down into pieces is a sign of fever.

. Large sized bubble which fills up the urine vessel but settles down easily indicates strong presence of cold disorder.

.Urine with clear sign of hot disorder but without any bubble formation is a sign of imminent death.

.Urine of cold disorder devoid of any bubble is a sign of chronic or intractable cold disorder.

. If the bubble is too tiny, it could mean remnants of blood disorder.

3. OBSERVING URINE AT LUKEWARM STATE

Urine at lukewarm state should be analyzed for its sediments and the albumin. Sediments are those which looks like woolen piece, thread like, sand or any other whitish dust like particles floating in the urine like a cloud in the sky but, which cannot be picked up in physical forms by any straws or sticks.  These sediments are important in the sense that no matter whatever the composition of the urine may be, if the sediments are found to be thick, it indicates hot disorder and if it is thin and scanty, cold disorder.  And there is no chance of mistaken identity in this. Hence it is highly advisable to analyze these sediments.

1. OBESERVING THE SEDIMENTS IN URINE.

.If the sediment looks like goat’s hair spread in the urine, it indicates rLung disorder.

. If it appears like cluster of wool thrown in the mid part of urine that hangs like a thick flat particle which conceals other particles lying beneath is a sure sign of blood and mKhrispa disorder.

. Thin hairy particles like that of hair fallen from white horse spread all over the urine is a sign of  Badkan disorder.

. Cloud like sediments indicates lung infection and Pus like sediments shows presence of pus in  any upper or lower body parts.

.Sand like sediments which settles at the bottom indicate renal problem.

.Above mentioned sediments if  found at the upper, middle and lower part of the urine, indicates the presence of same diseases in upper part of body like that of lung and heart, middle part of body like that of Liver and Stomach, lower part of body like that of kidney/bladder, intestine, or reproductive organs respectively.

. Sediments that looks like broken curd spread over the upper layer of urine could indicate aggravated rLung disease.

. Color of the sediments invariably follows the color of urine.

.Sediments thinly and evenly spread all over the urine is a sign of healthy urine.

.Color of sediments can also indicate the presence of different Nes-pas as follows:

.White sediments indicate rLung and Badkan disorder.

.Reddish colored is a sign of blood disorder.

.Yellowish sediments in the centre with bluish at the periphery is a sign of mKhrispa disorder.

Following are some of the important information on sediments in the urine that are explained in the text Dawa’i Gyalpo:

.Whitish urine with sediments like Golden sand indicates blockages in renal blood vessels and may cause impotency.

. Golden colored sediments at the bottom of urine indicate kidney or problems with the cervix.

.Powdered charcoal like sediments is an indication of accumulated black lymphatic fluids or can also be of poisoning.

.Sediments which clusters like that of a frog’s egg may indicate tumor in the stomach and others.

. Blood like sediments is a sign of liver disorder.

.Floating sediments on the surface of urine like white cloud is an indication of heart and Lung disease.

. If the sediments saturates like a vapor in the middle part, it signifies disorders of liver, gall bladder, stomach and spleen.

.If it settles at the bottom like a waste products, it indicates disorder of kidney, urinary bladder, cervix, intestine and colon.

. If the sediments spread evenly all over the urine from top to bottom, it indicates healthy urine.

.White sediments indicate rLung – Badkan disorder.

.Reddish sediments are a sign of blood disorder.

.Presence of yellowish sediments in the centre with bluish at the sides is a sign of mKhrispa disorder.

.Dark greenish urine with greenish sediments indicates toxic buildup or case of poisoning.

.Bluish colored urine with bluish sediments indicates pregnancy.

OBSERVING THE ALBUMIN or sPrtis-ma.

sPrTis-ma( pronounced as Tri-ma in Tibetan) or Albumin is like a formation of creamy layer over the urine surface in its lukewarm state like that of cream on the milk.

Formation of thin creamy layer over the urine surface is an indication of cold disorder, whereas formation of thick cream over the urine surface is a sign of hot disorder.  Generally, urine with sure sign of hot disorder having very thick indicates melting of the body essence while similarly thick albumin over the urine with sure sign of cold disorder may indicate indigestion of butter or any oily products. However, if the albumin can be picked up by an edge of spoon and is able to place it outside like any other thick cream and the same can be burnt like butter with its typical smell, it is indeed a case of indigestion of butter which need not be treated.  Without any disturbance to the specimen, if the albumin in urine tends to break up into many pieces, it is possibly a sign of tumor present in the body.

Dawa’Gyalpo explains that the albumin in the urine appears like the cream formed over milk; it is a sign of undigested wine and butter. If it appears like that of honey, it signifies indigestion of butter and milk. Albumin having brownish color indicates indigestion of meat. If it appears like the albumin of an egg, it signifies indigestion of fat.

OBSERVING URINE AT COLD STATE

Urine in a cold state can be observed through three periods of transformation, methods of transformation and color post- transformation.

OBSERVING THE PERIOD OF URINE TRANSFORMATION.

Transformation of urine means that if the urine when fresh looks like transparent and thin becomes thick and murky later after it becomes cold or vice versa.  The transformation has taken place.  However, it is important to consider the seasonal factor as well.  For instance, it is normal that during the winter times the transformation becomes very quick; spring and autumn time, slight delay and, the hot summer times the transformation becomes very slow.

If the transformations in color of urine takes place before the steam disappears, it signifies hot disorder, whereas if the transformation in color of urine occur after steam ceases and when urine becomes cold, it indicate cold disorder. Sign of a healthy state is when the transformation in color occurs just when the steam goes off.

OBSERVING THE PROCESS OF TRANSFORMATION

With no thickness and thinness in the urine composition, if the process of transformation begins from the sides of the urine container towards the centre, it signifies cold disorder whereas if the transformation occurs from the thicker part of urine, that is, from bottom of the container pushing upwards indicates hot disorder. If the transformation takes place hurriedly from the sideways, it is chronic fever. If sediments transform or disappears before the urine, it could mean an aggravation of both hot and cold disorder. Dispersed fever felt in all the bodily parts, deep-rooted cold disorder and the urine of patient who has the influence of evil spirit are exception as the urine in these conditions does not undergo transformation.  We find that the urine after excessive intercourse and in the case of black lymphatic fluids do not undergo transformation as is mentioned in the text Soma raza* or Dawa’ Gyalpo.

OBSERVING THE COLOR AFTER TRANSFORMATION

One should observe the color after transformation take place and compare it to the actual nature of disorder. If the urine turns turbid after transformation takes place it is an indication of hot disorder, whereas if the urine becomes much clearer after its initial turbidity, it signifies cold disorder. However, one should keep in mind that the urine of breast feeding child looks turbid white like broken milk. Also, the urine of some cases of chronic kidney disease looks quite decayed and turbid with many waste particles in it. One do not see any steps of transformation in these conditions.

 The specific analysis of urine is grouped into two: urine of hot disorders and urine of cold disorders.

The urine of hot disorders is red or yellowish in color with thick concentration and foul smelling. The steam is dense and remains for a longer period of time. The bubbles are small and yellowish in color, and disappear instantly while the cream is thick.  Sediments are converged thickly at the centre of the urine. The urine transforms before the disappearance of heat and steam, and appears amber in color with more turbidity after its transformation.

The urine of cold disorders is white or bluish in color and watery like. The smell and steam are less while the bubbles are large. The cream and sediments are formed thin. The urine transforms when it cools down and appears bluish and watery after the transformation.

For general information, there are several mistaken factors or confusion with the urine findings which needs to be rectified so as to avoid any wrong diagnosis. They are as follows:

®Urine with whitish blue color (cold disease) with thick sediments (hot disease) indicates cold disorder at the superficial level but with fever or hot disorder inside.  Reddish yellow (hot) urine but with no odor and sediments (cold) appears like that of hot disorder superficially but is essentially a cold disorder.

® Urine with reddish yellow color having characteristics of hot disorder but quite slow in the transformation and also,  urine with whitish blue color resembling the characteristics of cold disorder but very quick in its transformation is understood to be hidden fever disease.

®Urine with all the composition of hot disorder but without any formation of bubbles could be a disease of fever which has gone deep and intractable. Similarly urine with all the composition of cold disorder but without any bubble formation is an indication of chronic and long standing cold disorder.

®Empty fever( fever because of rLung) and fever due to blood disease could be mistaken because of reddish color.

®Badkan sMug-po or better known as triple combined disorder and black lymphatic disease can be minstaken because of its brownish colored urine.

®Urine of Kidney, Liver and Spleen diseases having common reddish colored urine could be mistaken with each other, but if one analyze the composition of each urine, one finds that urine with kidney disease is more murky and have sediments at the bottom of the urine container; urine with Liver disease could be dark reddish or pale reddish with sediments spread all over, while urine with spleen disease though reddish in color but with greenish tint or light reddish but with sediments found in the middle of urine.

®Hidden fever, badkan rLung combined disease and typical cold disorder have urine with bluish color but after effective analysis, one finds that urine of hidden fever have fast disappearing small slender bubbles with thick sediments; urine with Bad-rLung disease have more stable big sized bubble with thin sediments while typical cold disorder urine is usually light bluish in color and more transparent than the former.

 SIGN OF DEATH IN URINE.

If the urine appears like a blood with a typical smell of decayed leather which do not responds to any effective treatment, it indicates bad prognosis due to hot disorder.  And if it does not undergo any transformation even after the disappearance of sediments, it is a sign of imminent death.

Urine with bluish color without any odor, steam and taste and which do not respond to any treatment is a sign of death due to a state of cold disorder.

Urine with a color of boiled decoction of green leafy vegetable that disintegrates into some layers with dark greenish color is a sign of death due to rLung disease.

Urine resembling a boiled decoction of green big leafy herb ( chu-tza in Tibetan)  that disintegrates into separate layers with decaying yellowish color indicates impending death due to mKris-pa disorder.

Urine with a red vermilion color without any uniformity and with different layers is a sign of death due to Blood related disease.

Urine that resembles broken or decayed milk is an indication of Bad-kan fatality.

Urine that resembles like that of broken black ink with multiple layers is an indication of death due to internal poisoning or toxicity.

With no sure sign of kidney disease but with urine that comes transformed from inside with decay (putrid) is called ‘Du-ba khons-rul meaning internally decayed condition and which is a sure sign of death.

DETERMINATION OF EVIL SPIRITS or NEGATIVE ENERGY THROUGH URINE.

This is a typical case of faith and belief according to one’s culture and tradition and may not necessarily reflect on every other case outside the domain of one’s belief system.  This is to determine different types of negative elements as per one’s own belief in the urine specimen. Because of confusing nature and complexities in explaining the different findings with no rational basis, I am not going to write about this in this article.

To sum up, it is generally believed that the diseases that originate from five vital organs can be clearly understood from the pulse analysis and the disease that originates from the six hollow organs can be better understood from urine analysis. Though the prognosis of the fatality of disease can be understood from both Tza and Chu analysis, but it is believed that pulse gives better picture of prognosis and Urine gives better picture of hot and cold nature of diseases.

Famous Yuthog Yonten Gonpo once said that though there are many confusions  in the characteristics of the pulse and urine analysis but, it is important to note that pulse characteristics with higher length or intensity is of hot in nature and lower intensity to that of cold disorder.  Similarly, urine with thick sediments is invariably hot disorder type and urine with thin sediments comes from cold disorder.

To be precise, mastering these methods of diagnosis depends heavily on one’s experiential journey through the dedicated service of serving the patients with continuous practice and familiarity with the art of pulse and urine examination. It is also very important to record your findings of the different characteristics of the pulse and the various compositional findings in the urine and their interpretation corresponding to patient’s health conditions.

ANALYTICAL CONFIRMATION THROUGH DIET, LIFESTYLE, MEDICINES AND THERAPIES.

This 3rd criterion of investigation is to find out the positive and negative effects of diet, lifestyle, medicines and external therapies. For instance, if one goes through the causative factors like that of food and medicine having bitter taste and cool potency; engaging in bit cooling type of life styles, and therapies like vene-section or bloodletting type the nature of which goes in sync with the nature of disease resulting in the aggravation of the current health conditions, then the diagnosis is more likely to be badkan and rLung combination with cold disorder of kidney.   Contrarily, when the nature of causative factor and the disease condition do not complement with each other and instead if it helps to relieve the disease, then the resulting diagnosis is certainly blood and mKrispa type with involvement of liver and bile organs.  Similarly, for any kind of diseases, if the given combination of diet, lifestyle, medicines and external therapies works out well and sees the regression of the disease or on the contrary, if it do not go well and instead flares up the disease, one could certainly draw the inference of what the nature of disease is. For instance, if all the food, life style, medicine and therapies having relatively oily and harmonizing effects are given to any person having some related symptoms of rLung type of disease resulting into some positive changes and remission of the disease, then one can infer that he or she is suffering from rLung disease.  On the contrary, if it brings negative effects and even aggravates the disease, then it is not rLung disease and instead, it can be inferred as having badkan and mKrsipa combined disease.

Therefore, such types of analytical confirmation of the disease, though not once or twice, and not immediately accepting the diagnosis at the superficial level,  should be repeated again and again until one gets completely convinced resulting into an accurate diagnosis.  Otherwise, it may be possible that one sees some positive changes in the initial phase but fails to work and instead observes aggravation in the health condition after persisting with the same combination. Conversely, one may see some negative effects in the initial phase but later works out to be perfect with the continuation of the remedies.  Therefore, with patience, perseverance and careful analysis of such positive and negative changes from the same or different combinations of remedial measures, one should indulge in the experiment and then gain confidence in the treatment of any type of disease and for the healing service of suffering humanity.

SARVAMANGALAM.

Main Source book of this article:

1. rGyud-bzhi

2.Drans-srons zal-luns by Kroru Tsenam

• Dawa’Gyalpo or Somaraza.

*1 Gans-jons gso rig nyin-byed rims byon gyi rNams-thars by Jampa Thinley.