Tibetan & Li-Zhu Medicine: Different Theories, Same Praxis

by Bob Flaws, Dipl. Ac. & C.H., FNAAOM

I originally began the study of Chinese medicine because, at the time, I could not find a way to study Tibetan medicine. I was a Tibetan Buddhist with an interest in health and healing. Therefore, it was only natural that I was interested in Tibetan medicine. However, in the 1970s, it was easier to study acupuncture and Chinese medicine than Tibetan medicine in the U.S. Nevertheless, for a number of years, I attempted to study both. At first this mostly confused me. When I would look at famous Tibetan "herbal" formulas, I could not make sense of them from a Chinese medical point of view. Many of the medicinals in these two medicines are the same. However, when I tried to apply Chinese pattern discrimination to the analysis of Tibetan formulas, I could not make sense of them. They seemed to contain hot and cold and supplementing and draining medicinals at the same time, and they did not fall into the neat categories of Chinese medicinal formulas. Eventually, I decided "not to look for problems inside the horns of the water buffalo" and devoted myself single-mindedly to Chinese medicine.

Over the years, as my knowledge of Chinese medicine deepened, I began to see that it was the theories of Li-Zhu medicine (also called Jin-Yuan [dynasty] medicine and yin fire theory) which seemed to explain the complicated combinations of most of my Western patients and, more importantly, what to do about these. In my experience, most Western patients with chronic, difficult-to-treat conditions present with combinations of 5-10 patterns, not the single, discreet patterns of beginner's textbooks. According to Li Dong-yuan and Zhu Dan-xi, most chronic, difficult-to-treat conditions involve the core disease mechanisms of spleen vacuity, liver depression, and some kind of evil heat, most commonly depressive, damp, and/or vacuity heat. These core disease mechanisms then lead to others, such as blood stasis, phlegm, defensive qi vacuity, yin and/or blood vacuity, and yang vacuity. Based on yin fire theory, I have created Blue Poppy formulas, "complex formulas for complex conditions." All Blue Poppy formulas have complex combinations of hot and cold, supplementing and draining medicinals for such complex conditions.

In addition, Blue Poppy formulas are also based on gu worm theory and practice. According to Zhu Dan-xi, gu worms or parasites causing multi-symptom, complex, difficult-to-treat diseases are due to the same core patterns as yin fire - spleen vacuity, liver depression, and dampness or damp heat. According to Qing dynasty gu worm specialists, gu worm diseases are always accompanied by both digestive and mental-emotional complaints on top of a number of other complaints that nowadays we would tend to lump under allergies and autoimmune diseases. In gu worm theory, intestinal dysbiosis (i.e., a pathological mix of intestinal flora and fauna) plays a major role in such complex, difficult-to-treat diseases.

Now, when I look back at Tibetan formulas, such as Dza Ti 20 (Nutmeg 20), I can see that the Tibetan doctors who formulated these prescriptions were seeing fundamentally the same things as the great Chinese medical theorist of the Jin-Yuan dynasties. As it happens, this was a time of cross-fertilization between Chinese and Tibetan medicines under the patronage of the Mongols; so maybe this should not seem so surprising. Dza Ti 20 is composed of Fructus Myristicae Fragrantis (Rou Dou Kou), Lignum Aquilariae Agallochae (Chen Xiang), Melia Composita (a relative of Cortex Meliae Toosendan, Chuan Lian Zi), Fructus Corandri Sativi (Yan Sui Zi), Bulbus Allii Sativi (Da Suan), Ferula Jaeschkeana ( a relative of Ferula Asafetida, E Wei), Fructus Terminaliae Chebulae (He Zi), Fructus Terminaliae Belericae, Fructus Emblicae Officinalis, Lignum Santali Albi (Tan Xiang), Pterocarpus Santalinus, Concretio Silicea Bambusae Textilis (Tian Zhu Huang), Flos Carthami Tinctorii (Hong Hua), Flos Caryophylli (Ding Xiang), Fructus Cardamomi (Bai Dou Kou), Fructus Amomi (Sha Ren), Shorea Robusta, Acacia Catechu (Er Cha), elephant's gallstone, and an species of Geranium. Those medicinals which are simultaneously Chinese materia medica are followed by their Chinese name in Pinyin in parentheses.

This formula is indicated for mental-emotional distress (called sog lung in Tibetan) due to upward counterflow affecting what in Chinese medicine is called the chong mai. Patients with sog lung disorder suffer from irritability, anger, tension, anxiety, insomnia, impaired, memory, and lack of concentration. In my experience, most patients with mental-emotional disorders have liver depression, phlegm, and some kind of heat harassing the heart above. If they are women, they invariably manifest with spleen vacuity and possibly blood stasis. This means that many, if not most, patients with mental-emotional disorders exhibit some kind of yin fire scenario. Therefore, when treating these kinds of conditions with Chinese medicine, one uses a combination of qi-rectifiers, spleen-supplements, heat-clearers, phlegm-transformers, and blood-quickeners. If the condition also involves intestinal dysbiosis (i.e., gu worms), then one also needs medicinals which are worm-killing and gu-combating.

Seen from this point of view, Dza Ti 20 makes perfect sense as a Chinese medicinal formula (even if we cannot identify the Chinese medical functions of every single ingredient). Within this formula, Chen Xiang, Ding Xiang, Bai Dou Kou, Sha Ren, and Yan Sui Zi all rectify the qi, warm the spleen, and harmonize the stomach. Tan Xiang is also a qi-rectifying medicinal which especially loosens the chest, and Chen Xiang is a qi-rectifier which especially downbears counterflow causing mental-emotional distress. The Melia and Ferula used in this formula probably also rectify the qi in addition to killing or dispelling worms. Other worm-dispelling medicinals in this formula include Da Suan and Er Cha. He Zi is an astringent with marked effects on the gastrointestinal tract. I believe it is also an anti-gu medicinal as would be Terminalia Belerica and Emblica. Hong Hua is a blood-quickening medicinal which dispels stasis, and Tian Zhu Huang transforms phlegm and clears heat, especially phlegm heat harassing the heart and misting the spirit. Finally, elephant gallstone probably has similar functions to Calculus Bovis (Niu Huang) which clears heat, opens the orifices, awakens the spirit, and transforms phlegm at the same time that it clears the liver and extinguishes wind.

The point I am trying to make here is that, by happy coincidence, Blue Poppy's yin fire formulas for complex conditions contain very similar combinations of medicinals as do many Tibetan medical prescriptions. And, just as most Tibetan formulas help to regulate the emotions, stabilize the mind, and quiet the spirit, so do most Blue Poppy formulas. According to yin fire and gu worm theory, it is evil heat due to dampness, phlegm, and depression counterflowing upward and harassing the heart spirit which causes most mental-emotional disease. Tibetan medicine calls this sog lung, upwardly counterflowing qi along the sog tsa or chong mai. In Chinese medicine, we call it upwardly harassing heat, and Li Dong-yuan understood that this heat travels via the chong mai to the heart. Because so many of our formulas help clear yin fire from the heart, most of them also help ease patient's mental-emotional discomfort at the same time as addressing their somatic complaints. So don't surprised when your patients tell you that, not only do they have more energy, better digestion, and less joint pain, but they are sleeping better and feel much calmer. Once I thought it a great loss that I could not further my study of Tibetan medicine. Now I realize, I don't need to. By understanding Li-Zhu medicine's yin fire theory, I have come to realize that everything we need we have within Chinese medicine, at least in terms of complex formulas to treat complex patients.

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