Topic - Different Diagnostic

In order to learn the section on diagnostic approaches, it should

be known that the relationship between a disorder and its signs
and symptoms is like the relationship between a fire and smoke.
Accordingly, a disorder should be identified on the basis of its
related signs and symptoms.
Any physician ignorant of the basic knowledge on diagnostic
techniques will not understand the definite signs and symptoms
of a disorder and its true manifestations. It is like smoke being
mistaken for a steam or like predicting inevitable rainfall
whenever clouds gather. Consequently, these uncertain signs
could be taken for a real one, resulting in a wrong diagnosis.
Therefore, the knowledge on the method of identifying signs and
symptoms is very important for every physician.
In order to impart accurate diagnosis and to prescribe correct remedies, the
diagnostic principles that reveal the actual manifesting nyepa should be
employed. In order to earn public admiration and popularity, diagnostic
techniques based on indirect skillful means should be employed. In order to
determine whether to accept or to refuse a patient during the course of
treatment, four diagnostic criteria of a patient’s condition should be employed.
Diagnostic techniques associated with the actual manifestation of
nyepa consists of an examination based on the causes and
conditions of a disorder, an examination on the basis of the signs
and symptoms of a disorder and an examination on the basis of
assessing the benefit and harmful effects of diet and behavior.
The causes and conditions of a disorder can be ascertained from the food
that one has taken and the kind of lifestyle that one has indulged.
Specifically by knowing the arousal condition one will know the nature of
a disorder, as every cause must yield its corresponding effect.
The characteristic features of signs and symptoms consist of four: the
basis of investigation, the objects of investigation, the basic criteria
of investigation and the method of investigation.
The bases of investigation are the three imbalanced states of loong, tripa
and baekan. Their characteristics are based on the signs and symptoms
of the excess, deficiency, accumulation, manifestation and the disturbed
states. The ultimate diagnosis has to be made by condensing all
characteristics of disorder into hot and cold disorders.
The objects of investigation include the five sensory organs, their
respective objects and the five waste products. The sensory organs
are the eyes, ears, nose, tongue and the body. Their objects are
form, sound, smell, taste and touch. The impurities include sputum,
stool, vomitus, urine and blood.
The basic criteria of investigation which enables correct identification

of a disorder are assessing the place, season, nature, age, arising

time, after-effects of foods and the location of a disorder.

Methods of examination involve visual examination,

palpation and interrogation.

Objects of a physician’s visual examination include observing the
size, structure and color. Specifically, the tongue and urine
should be examined thoroughly. This diagnostic approach is the
visual grasping of the object of sight.
Objects of touch include feeling temperature, growth and softness of

the physical body. Specifically, the radial pulse is examined to receive

information that is transmitted by the messenger pulse. This diagnostic

approach is an analytic study of the nature of disorder.

Diagnosis through interrogation includes all objects of hearing. Related
questions regarding which, how, where, when and what are asked. The
physician must specifically ask the cause and condition, site, signs and
symptoms of a disorder. The information on the causes and conditions helps
to ascertain the imbalanced state of nyepa, whereas knowing the location of
a disorder reveals its entrance and the signs and symptoms determine the
specific disorder. Therefore, interrogation forms a very important part of an
entire examination. This diagnostic approach is called the analytical study of
the case from what is being heard.
Diagnostic criteria based on the beneficial and harmful effect consists of
four: diet, lifestyle, medicine and external therapy. All disorders can be
identified on the basis of whether the cause corresponds to the nature of
disorder or whether or not the diet and the medicine that was prescribed
had been favourable. One must persistently observe the disorder by
mindfull investigation and not just by superficial appearance. In this way,
the physician will gain confidence and will understand the best means for
treating the patient.”
Diagnosis through indirect skillful means involves understanding

characteristics of a disease disorders, digging up information, taking one’s

time, investigating prior treatments, voluntary disclosure, restricting the

patient from speaking, declaration and taking cover in an excuse.

Firstly, understanding the characteristics of a disorder involves knowing the general
and specific signs and symptoms of all disorders. This enables the physician to
understand the presence of specific disorder by merely knowing the location and
nature of an illness. Therefore, it is important to familiarize oneself with this
technique. For instance, the proper identification of the genuine and the fake precious
stones and other items depends not only on theoritical knowledge but also on
practical knowledge.
Digging up information is collecting relevant information by befriending the
medical attendent or relatives. Information of what the disorder is, how it
hurts, the nature of treatment, who prescribed the medicine and how long
the treatment was taken should be skillfully asked and assessed by the
doctor well before the patient speaks.
Taking one’s time refers to sitting near the patient for a while,

during which time one should carefully listen to each word of the

patient without being distracted by one’s own mind and speech.

Investigating prior treatment involves discerning whether the
patient has been treated with venesection or moxibustion, and
what kind of prescription is being employed. By realising this, one
can understand whether the disorder is hot or cold in nature.
Voluntary disclosure refers to a situation when the patient refuses to
speak and the physician could not collect information. Under such
circumstances, as it might bring bad reputation to the physician, gently
advice the patient to refrain from unfavourable things. Inform the
patient that if a particular medicine is taken, after controlling the evil
spirit that could be helpful. Under the given situation, the patient will
voluntarily disclose all information.
Restricting the patient from speaking refers to a situation in which one
encounters a patient who says everything before being asked. After fully
understanding the disorder, restrict the patient from speaking further by
saying that the physician know what the patient is suffering from.
Speaking with such confidence will bring appreciation.
Declaration refers to a situation when one has completely understood the patients’s
disorder without any confusion. Declare that unlike other physicians, who adopt
various diagnostic techniques like reading pulse, analyzing urine and studying signs
and symptoms, you can diagnose a disorder by adopting only one technique. This will
earn you the reputation of being a capable physician who can diagnose a disorder by
merely looking only once at a patient. Otherwise, one has to examine vigilantly and
thoroughly to gain a reputation of being an expert in diagnosis.
The first of these relates to declaring the cause of the disorder to an
unwholesome diet and lifestyle or attributing it to the influence of an evil
spirit, having eaten rotten or sour food or having participated in
strenuous activities combined with the intake of raw food. Give
prescriptions that have neither beneficial nor adverse effects.
Escaping with an excuse refers to mentioning a type of disorder and a

medicine that is hitherto unknown. State that no one knows about this

medicine and that it is something very special. Although one could not

understand the case, at least, a credit for ones skillfulness will be achieved.”
Four diagnostic criteria of refusing or accepting a patient for
treatment include: easily cured, hard to cure, barely curable and
the case to be given up.
An easily cured condition is based on the availability of the essential
conditions for treatment, the nature of the patient and the nature of the
disorder.
An easily cured condition which is based on the availability of the essential

conditions consists of a physician, medicine and the attendant to the patient.

A physician must have scaled the pinnacle of being learned, have

theoritical expertise, have obtained complete practical experience and

have a flawless character.

Medicine should be available in various forms, endowed with rich

qualities, possess all essential features and is compounded

favourably to gain an exceptional therapeutic effect.

The attendant to the patient should be capable, compassionate,

hygienic and intelligent. If these twelve essential conditions are

present, an easy cure is enabled.

The patient for an easy cure should be young, well-mannered, courageous,
capable of tolerating all types of treatment, who can afford the medical
expenses, obedient, capable to understanding the related aspects of the
disorder and its cure, and proficient in answering every question related
with the signs and symptoms of a disorder.
The nature of a disorder which is easily cured consists of disorders which are
associated with an insignificant cause and manner of manifestation, and being
characterised by insignificant signs and symptoms. A disorder can be an easily cured if
the factors like the basis of affliction, place, season and the constitution are not of the
same nature. If the disorder have no additional complications, entered through only
one passage, is involved with a single nyepa and is fresh, it can be an easily cured.
Contagious diseases that correspond with the place and season, urinary retention
accompanied by constipation, and chronic blood tumors, are all said to be easily cured.
The category of a hard to cure condition comprises conditions

having mixed features of an easily cured condition which require

various therapeutic techniques and a long-term treatment.

A barely curable condition has features opposite to
those of easily cured and hard to cure condition. A
patient may temporarily feel benefitted because of a
habituated diet and lifestyle, and may possibly survive
if the lifespan is not completely exhausted.
Patient to be refused is of two types:
curable and incurable conditions.
Patients who detest one’s leader, spiritual masters and human beings; who
are ungrateful to the physicians for their kindness and even despise them;
who are devoid of time and money; who are disobedient and whose
lifespans have been exhausted; who are intensely depressed, and those
who are actively engaged in religious subversion should be refused to be
treated although the problem is curable as they will bring defamation.
Refusal of patient having incurable conditions includes the presence

of an extremely irreversable condition, observing omens of

imminent death or having one or more of the nine fatal disorders.”

The section on the methods of healing, deals with how to treat a disorder

after it has been diagnosed. It is revealed in two categories: the

therapeutic principle and the methods of treatment.

First, therapeutic principle is revealed as under: although there is

innumerable healing methods, without a proper therapeutic principle, it

is like shooting an arrow in the darkness. There are three therapeutic

principles: the general, specific and particular.

The general therapeutic principle is revealed under three

aspects: therapeutic technique, remedial measures and the

signs of recuperation.
Firstly, most of the disorders such as loong disorder should be treated
during its accumulation stage. Since the manifestation and progression of
disorder disturbs other disorders, it should be treated with appropriate
compounds before it disturbs other disorder. If other disorder develops,
then one should treat the one which is more critical.
Remedial measures involve two forms of treatment; pacification and evacuation.
Pacification is recommended when a disorder is in a state of accumulation,
whereas an aggravated disorder should be treated with evacuative measure.
Care on diet and lifestyle must be taken in order to avoid disturbing other
disorder during the course of pacification. However, due to certain immediate
conditions, disorder may accumulate and manifest simultaneously at an
inappropriate season. If not treated in time, it may eventually become chronic
and will be difficult to cure. Hence, it should be treated immediatey.
There are ten ways of administering medicines based on factors like the manifesting time
of a day, dietary habit, and their relation to the nature of disorder. The ten ways are
medicines to be taken on an empty stomach early in the morning, just before a meal, in-
between meal, just after a meal, with a meal, after the digestion of a meal, small doses
but given more often, mixed with food, right before and right after a meal, and before
bed. Administering medication only after digestion without considering the nature of a
disorder is an unwise practice, and is difficult to affect the intended disorder. Therefore,
the ability to administer appropriate medication at an appropriate time for the disorder
is like identifying the correct pebble from a pile of stones.
In spite of giving appropriate treatment, persistent formation of saliva
and mucous, experiencing heaviness of the body, loss of appetite,
indigestion, constipation or loose bowel movements, irregular bowel
movements and urination, physical weakness and low voice indicates non
-abatement of the intensity of a disorder. Signs and symptoms which are
opposite to the above occur when the disorder is cured. Treatment should
continue till the disorder is fully cured and then no further remedy should
be given after the disorder is fully cured.
The specific therapeutic principle is of three: treating

disorders associated with indigestion, disorders of an

independent nature and dependent nature.

Firstly, weak digestive heat causes indigestion which eventually combines with either loong
and other disorders or mingles with bodily constituents and waste products. For such
nature of disorders, medicines for ripening and promoting digestive heat should be
employed in order to control the severity of indigestion. Upon observing the signs of
maturity, the disorders should be cleansed thoroughly depending on the passage nearest to
the location of the disorder. However, if cleansing occurs of its own either through vomiting
or diarrhea, no medication should be administered to stop the flow. Immature disorders
should not be cleansed by medication as it will harm the bodily constituents because the
disorder adheres to them. It is like draining out liquid from unfermented chhang.
Disorders of an independent nature are those which are not associated
either with indigestion or with any other disorders. These disorders
appear after encountering their specific causes, bringing in loong disorder
in the first phase, and often complementing with other disorders. Such
disorders accumulate and remain at their own locations without
manifesting themselves, until coming into contact with the arising
conditions of diet, lifestyle and time. It is similar to a weak person who,
after being defeated, would wait until he could secure support from
others for retaliation. In the same way, the accumulated disorders, once
coming into contact with their conditions will first secure strength and
then manifest from their locations. Since loong develops first and then
disturbs other disorders, a diet capable of decreasing the strength of
loong and promoting digestion should be administered to ensure that the
ripening of disorders does not occur. Consequently, the loong that
disturbs a disorder should be subdued and other dispersed disorders
should be gathered internally. It is like subsiding wind prior to rainfall.
Thereafter, disorders should be cleansed from the passage nearest to its
locations. If the disorder could not be gathered internally, due to
disorders being located on the outer part of the limbs, they should be
dislodged by cleansing from the outer and inner channels.
Dependent disorders are the ones which combine with additional disorders.
In this case, the disorder leaves its own place and moves to another place,
and then retaliates and disturbs the disorder that occupies its previous place.
If the disorder at the secondary place is less critical, treat only the disorder
which is in the primary place. If the succeeding disorder is more critical, treat
the additional disorder; this will make the disorder at the primary place to
settles in its own place and will be cured without treatment. It is like over-
powering the gang leader who supports other burglers.
There are nine particular therapeutic principles. A disorder which is not
fully understood, appears doubtful and on which one is not confident;
these should be treated carefully on a trial basis like a stalking cat.
Disorders having been understood fully, well determined and confidently
assessed, these should be treated openly like hoisting a flag on a mountain top. In a case
where the remedy does not strike the intended disorder, one must follow the pathway of
the disorder carefully and then treat it like overpowering a wild horse after trapping it
within narrow walls. When treating an old case previouly treated by someone else, analyze
the three faults of the inadequacy, the excessiveness and the adverse treatment, and then
treat the disorder accurately like a fish being caught by a heron. Serious disorders should
be treated simultaneously with the four-fold application of medicine, external therapy,
diet and lifestyle; like confronting an enemy face to face at a narrow lane. Minor disorders
should be treated with lifestyle, diet, medicine and external therapies successively, like
climbing each rungs of a ladder. A single disorder should be treated with a remedy that
cures it specifically without harming others, like a warrior conquering his enemy. While
treating the combined disorders, it is important to restore the dynamic equilibrium like a
chief resolving a family dispute. When treating every disorder, the ten features should be
applied to give a balanced remedy like appropriately assigning a zho load to a zho and a
sheep load to a sheep.”
Although there are numerous methods of treatment,

they can be summarised into two methods: treating

them in common and treating them particularly.

Common healing modalities comprise two subjects and these

include two techniques. These are the promotion of physical

strength by building up the body and losing the weight by fasting.

Building up the body involves five topics: the
basis, the means, the benefits, the negative effects
of excess medication and its treatment.
The patients in need of building up the body are people with excess loong
disorders, depleted bodily constituents, exhausted newly wed couple due
to overindulgence in sex, pregnant, postpartum women, excessive
bleeding, haemoptysis, the elderly, insomniacs, depressed and exhaustion
due to strenuous activity. Building up the body is primarily recommended
during the early summer season.
The positive effects of these will develop the physical strength
and will subdue all disorders. It is like a weak but obedient
person accquiring the strength to overcome his enemy.
Excessive treatment will lead to obesity, cancer,
lymph node disorders, mental dullness, chinyi,
increase in sputum and baekan disorders.
To alleviate these problems, a diet and medication capable of reducing fats
and relieving baekan disorders are helpful. Gugul, Drak shhun and the
concentrated decoction of Kyerpa mixed with honey cures all disorders of
obesity. The three myrobalan fruits mixed with honey on the compound of
Chaga, Yabak khyara, Jitanga, Kyurura and barley flour mixed with honey also
cure obesity. It is preferable to be lean than to be obese and hence treatment
for building the body must be done with control.
Fasting involves five topics: the basis, the means, the benefit,
the negative effect of excess medication and its treatment.
The basis of slimming include people who are suffering from indigestion,
have taken excess fatty foods, stiff thigh syndrome, contagious diseases,
chinyi, cancer of the visceral organs, gout, arthritis, as well as disorders of
the spleen, larynx, brain or heart. Those with tropical diarrhea, vomiting,
lethargy, loss of appetite, constipation, obstruction of urine, obesity,
chhuser disorders, aggravated combined disorders of baekan and tripa,
and physically strong adults should be made to fast. Treatment with
fasting should be done during the winter season.
Medicine comprises of two: pacification and evacuation. Balancing an
imbalanced state of nyepa is termed as pacification and is undertaken
through diet, medication, lifestyle and therapies. A physically weak
person should undertake only fasting. Thereafter, small amount of light
and easily digestible foods and drinks should be introduced.
For a person with medium strength, decoctions
and powdered compounds that generate heat
and promote maturation can be taken.
A sturdy person should undertake physical exercise day
and night to bring perspiration. They can be treated with
external therapies like moxibustion, compresses,
medicinal baths and venesection.
Evacuation entails activating the disorder and then evacuating it. The
technique for evacuating disorders located in the undigested region is by
emesis, whereas if the disorder is located in the digested region it should
be evacuated by a strong enema. Disorders located in the whole body or
those in the channels should be cleansed with purgation and channel
cleansing therapies respectively.
Shedding weight through proper pacification and
evacuation techniques gives benefits such as, clarity to
sense organs, a physical sense of lightness, a good appetite,
enthusiasm to work, enhancing timely hunger and thirst,
and ensuring smooth bowel movements and loong energy.
Slimming therapy, if given excess leads to depletion of bodily constituents,
emaciation, giddiness, insomnia, poor complexion, and weakening of
voice and sensory functions. It also results in thirst, loss of appetite and
pain in the calves, thighs, coccyx, ribs, heart and brain. One may becomes
susceptible to contagious diseases, nausea and loong disorders.
For treating these problems, all means of building the body are
beneficial. Specifically, eating the meat of carnivorous animals,
administering mild enemas and sleeping after a heavy meal will help
develop a fatty body like a pig. In general, there is nothing better
than meat to build one’s body and to sustain life.
In brief, person in need of building the body should not
be given slimming therapy. If evacuation is required,
employ mild enemas. For those who require slimming
therapy, avoid all the means of building the body.
An excess loong and a simultaneous deficiency of other nyepa should be
treated with therapies that build the body, whereas the simultaneous
excess of baekan and tripa and a deficiency of loong should be treated
with fasting. The excess and deficiency of both the bases of affliction
and the objects that afflict are treated with the same methods.”
The six qualities of an eminent physician are being
intelligent, being compassionate, being committed, having
dexterity, being diligent and being proficient in social ethics.
Firstly, being intelligent means having the three virtues of
broadmindedness, mental stability and a discerning mind. The quality
of being broad-minded facilitates the comprehension of the concise and
detailed treatises of medical science. Mental stability enables the
physician to implement all practices without any apprehension. A
discerning mind helps in developing clairvoyance using analytical
approach. Intelligence is therefore supreme among all qualities for
becoming an eminent physician.
Being compassionate is to have a mind of enlightenment, the Bodhicitta. To develop
Bodhicitta, it necessitates three processes of the preliminary, the actual practice and
the engagement. The preliminary practice is to realise the true nature of all suffering,
to develop a true aspiration to help all sentient beings, to have absolute faith in the
Three Jewels and to remain unbiased by avoiding discrimination between good or evil.
Based on the four immeasurable thoughts of compassion, love, joy and equanimity,
generate the aspiration for enlightenment and engage in the actual practice.
Engagement implies continuous practice while realizing the virtuous qualities of the
medical tradition and imparting treatment without favouring the ones who praise you
and holding grudge against others. The attainment of these qualities ensures the
ability to make easy cures and assists in a large number of recoveries.
Being committed involves the six mental obligations, two
obligations to be maintained and three obligations to be
understood.
Firstly the six mental obligations, which one has to maintain consistently,
are to consider the master as the Buddha, the teachings as the non-
deceptive words of the Buddha, the medical text as the authentic words of
the Buddha, fellow students as friends or spiritual siblings, the patients as
one’s own children and the pus and blood of the patient as the dropping of
one’s pet dogs and pigs.
Secondly, all eminent holderes of medical
knowledge should be revered and preserved as
protectors of Buddha’s words and the medical
instruments as their emblems.
Thirdly, medicines should be regarded as precious jewels, nectar
and substances for spiritual offerings. One should regard them as
wish fulfilling jewels which fulfill all needs; should also be looked
upon as nectar that cures every disorder and regard them as
spiritual offerings to the eminent holders of medical knowledge.
First, one should collect and keep various
precious jewels and medicinal substances.
Secondly, compound medicines properly and consecrate them,
then visualize oneself as being the King of the Rays of
Aquamarine Light. Visualize the medicine as nectar and the
container as the Buddha’s begging bowl filled with nectar.
Visualize that one is being surrounded by different sages who
utter these auspicious words.
O, Medicine Buddha, the Supreme Healer, the King of Physicians, the
Victorious Conquerer, The conquerer of the diseases of the three
mental poisons, The Enlightened Buddha of Medicine, To the sapphire
blue body, emanates all pervading aquamarine light. Your spiritually-
manifested body is adorned with virtuous names and marks, For the
suffering caused by loong, tripa and baekan disorders, Holds the Arura
in the right hand and a begging bowl filled with nectar in the left
hand; I pay homage before the divine Aquamarine Light.
Well-versed in the eighteen supreme Knowledges, Receiver of
Elixir and Supreme Attainment to command longevity, And
with divine premonition and compassion, Bring harmony to
the life of all supreme beings. I pay homage before all sages,
holder of this sacred lineage.
Like divine nectar to all Gods, Like Crown-Jewels to all Looh , And like an
Elixir to all sages, May this medicine be always with you. Four hundred
and four disorders caused by loong, tripa and baekan May those that
endanger life be pacified. One thousand eighty harmful obstacles, And the
three hundred sixty spirits of disturbing emotions, May all those that
obstruct the mind be pacified.
Om Namo Bhagawate Bhekhaze Guru Bendurya Prabha Razaya Tatha

Ghataya Arhate Samyak Sam Buddhaya, Tayatha, Om Bhekhaze,

Bhekhaze, Maha Bhekhaze, Bhekhaze Razaya, Samung Ghate Svaha .

Recite this mantra seven times and visualize the medicine as being
transformed into nectar and make a offering of it to the eminent
holders of medical knowledge. Placing a small amount of it on your
tongue, visualize acquiring spiritual attainment that cures all your
disorders and the negative influences of the evil spirits. Visualize that it
overcomes the impending death of the patient when taken by them.
These spiritual practices when undertaken with thoughtful
commitment and blessing will bring accomplishment of auspiciousness
and the accumulation of merits.
Dexterity involves the role of the physician’s
body, speech and mind. A skillful hand
facilitates expertise in preparing effective
medicines, in making excellent medical
instruments and in performing effective
applications. Pleasant words enable the patient
to be joyful. Intelligence brings understanding
without obscuration. Mastering these skills will
eventually gain expertise among all arts.
Diligence involves two aspects: fulfilling one’s own need and the
needs of others. Becoming a competent physician involves
cultivating the cause, seeking favourable conditions, generating
devotion towards one’s companions and employing incessant
efforts to become familiar with these practices.
Learning thoroughly the fundamentals of reading and
writing is the cause and the determination of
whether one can become learned or not depends
entirely on this primary education.
Seeking favourable conditions means is to find a
master. This has three features: the qualities of
the master, how to seek the master and the
objective of seeking the master.
The qualities of the master are having profound
knowledge of different medical studies and their
application, being enriched with various medical
instructions, having forbearance, being non-
materialistic, compassionate and worthy of veneration.
The right approach for seeking the master is to single-
pointedly entrust oneself to the master without any
reservations in his teaching. Every assignment should be
performed without deceit. Conduct should be in total
compliance with the master’s aspirations. One should always
remember and remain indebted of the master’s gratitute.
The objective of seeking the master is to enable
oneself to quickly absorb the knowledge and
ultimately to become learned.
Generating devotion towards one’s companion means to obtain
important instruction and knowledge by means of intense discussion
and debate with one’s fellow companions. One should always bear the
important teaching in one’s mind and contemplate on its implication by
avoiding laziness as it is an enemy that hinders progress in learning.
Employing incessant effort to become familiar with these
practices requires consistant practise and being mindful, of what
one has acquired either from seeing or hearing, until so
integrated with the practice that leaves no room for hesitation.
Diligence in the needs of others, primarily concerns service to the patient.
Any assignment related to treatment should never be delayed or disrupted.
Like a person who will be faced with an execution if he fails to cross the high
narrow wall carrying a cup full of melted butter on his head without spilling
even a drop of oil; one must always assiduously endeavour to give timely
treatments to patients with single-pointed concentration.
Being proficient in social ethics entails three conducts: worldly, religious and the
combination of both. First, one must study hard to become learned, treat everyone
with a loving nature and then one should use stronger measures if leniency does not
help. Equipped with these three qualities will fulfill the aspiration of wordly conduct.
Complying with spiritual conduct gives one a calm disposition, allowing one to be
pleasant with others, provides contentment and eventually benefits oneself and
others. Conduct that is a combination of both pertains to taking care of the sick and
the destitute with extreme compassion. By doing so, your superior will admire you
and will fulfill your needs. Possessing all six prerequisites for becoming an eminent
physician will undoubtedly lead one to reap the reward.
The nature of a learned physician is to fully
understands all distinct characteristics of every
aspect of the principal energies and the basis of
affliction, and all characteristics of the remedial
measures.
The definition of Menpa implies those who cure
disorders and help the well being of the body; those
who are sensibly courageous in employing various
external therapies; those who are like a
compassionate father who saves all beings and those
who are highly honored by kings to be their king.
There are three classifications of
physicians: unsurpassed, extraordinary
and ordinary.
The unsurpassed physician is the highest of all who has conquered
the causes of the three mental poisons together with their
corresponding resultant disorders. The extraordinary physician is the
one who has a clairvoyant mind and being compassionate they
righteously rectify the defects of their body, speech and mind and
harmonise all the imbalances of others.The ordinary physician
includes Nangrig Menpa , Jejang Menpa and Laegom Menpa and are
the real friends of all suffering beings. Those driven by greed and
temporary gains and who merely hold the medical instruments and a
scripture are quacks and are the agents of death.
However, only two types of physicians have been generally categorised: the supreme and
the inferior. The supreme physician is the one who holds a genuine medical lineage; is
intelligent, loyal and committed; is well-versed in medical theories; is skilled in employing
instructional therapeutic approaches; is well-acquainted with all practical applications; is
fully devoted to spiritual practice and has therefore forsaken sensual desire; is serene; is
skilled in producing medicines and making medical instruments; is compassionate to all
sentient beings; has unwavering devotion to others’ needs and considers others’ need as
one’s own and is not ignorant in aspects of medical theory and their practical
approaches. They are the sole protectors of suffering beings and are like the child who
holds the lineage of the eminent medical knowledge holders and the sages. They are
believed to be the veritable emanation of the Medicine Buddha, the King of Physicians.
The weaknesses of an inferior physician are as follows:
A physician without an authentic lineage resembles a
fox on a king’s throne, who will not be honoured by all.
A physician being ignorant of the meaning of medical
treatises is like showing an object to a person who was
born blind. They will neither be able to identify the
particular disorder nor will they be able to differentiate
between the various therapeutic approaches.
A physician who is not acquainted with the experience
of seeing patient is like someone travelling on an
unfamiliar road. They will face doubts concerning the
signs and symptoms of a disorder and its treatment.
A physician who does not know about the correct
methods of diagnosis is like someone wandering in
a foreign land without any acquaintances. There will
be not a single disorder that he knows.
A physician who does not know about pulse
diagnosis and urine analysis is like a messenger at
war who does not know how to convey the correct
message. They will not be able to give the correct
identification of hot and cold disorders.
A physician who does not know how to make a
prognosis is like a leader who is unable to speak
wisely. It causes personal downfall due to
embarrassment and a bad reputation.
A physician who does not know the therapeutic
principle properly is like someone who shoots at a
target in the dark. The remedy will not correspond
to the intended illness.
A physician who does not have knowledge
about diet and lifestyle is like making one’s
own subjects the enemy. It will increase the
intensity of the disorder and will destroy the
bodily constituents as well.
A physician who does not know how to compound
a pacifying medicine is like a farmer who does not
know how to manage his field. It will give rise to
additional disorders due to excess, deficienct and
adverse compounding of medicines.
A physician who does not know how to correctly employ
evacuative therapy is like someone spilling water on a
mound of sand. It will aggravate the disorder and ruin
the bodily constituents, simultaneously.
A physician without medical instruments and
medicines is like a warrior without armour and
weapons. He will not be able to conquer the illness
which is like a mighty enemy.
A physician who does not know how to perform
venesection and moxibustion is like a burglar who steals
without knowledge of the valuables in the house. There
will be mistakes in performing the external therapy that
appropriately corresponds to the nature of the disorder.
Such incompetent physicians misapprehend every aspect of
medical knowledge and will ultimately give incorrect
treatments. Such physicians are devils of death in the guise of
physicians. They hold the whip of the Lord of death and are a
real threat to life. Hence they should not be engaged or they
will ruin the lives of many others around you.
The functions of a physician are of two types:
common and specific. The first of these pertains
to the actions of the body, speech and mind.
The actions of the body involve making available
essential medicines and medical instruments and, at
the same time, endeavouring to accomplish every
action related to the well being of the patient.
The actions of speech involve giving prognosis. When one fully
understands the condition, one must declare it openly like
blowing a conch in the marketplace. Give assurance about the
recovery of the patient or predict the time of death. When one is
unable to fully apprehend the situation, then declare the
condition like a snake’s tongue by relying on two possibilities and
take leave while focusing on the one that is the more favorable.
Other actions of speech include stating clearly the
common opinion, complying with a patient’s
opinion despite knowing the truth and not
excluding any possibility, one must take a safe exit.
First, if the patient’s presumption and the
physician’s understanding correspond,
pronounce it clearly.
The mental function involves learning and
practicing the medical obligations unerringly
with intense enthusiasm and forethought.
The specific function of a physician
includes the view, meditation and conduct.
The view of a physician is to take all medical principles
and their related approaches on the middle way, thus
avoiding the philosophical extremes of deficient,
excess and adverse thoughts and actions. The view
which perceives the middle way is the best of all.
Meditation implies cultivating the four
immeasureables of love, compassion, joy and
equanimity. It is imperative not to indulge in the
four contrary reflections.
The conduct of a physician includes actions that are to
be abandoned and those actions to be observed.
Abandon the ten non-virtuous actions, insanity,
nattering, unabashed, sinful action and evil conduct.
The perfections of generosity, ethical discipline,
patience and enthusiasm should be practised
systematically.
There are two rewards of being a
physician: the transient and the ultimate.
The transient rewards are happiness, power, wealth and prosperity in this life-
time. Since medical knowledge is the main source of all these benefits, one
should impart this knowledge to others. Treat everyone with ease and affection,
like one’s own relatives, even if it is someone who has harmed you. Investigate
thoroughly, be confident and give treatment according to the patient’s
disposition. This enables one to gain merit and acclamation, and desired foods
and means of livelihood will come automatically. Be modest and accept only
reasonable offerings. While rendering service one should accept anything in
kind for the service, but with the passage of time, the patient might forget the
kindness that was rendered, and therefore, gift should not be expected.
The ultimate reward for those physicians who
abandon deceitfulness and selfishness while
engaging themselves wholeheartedly in the service
of suffering patients, ultimately leads to the
unsurpassed state of perfect spiritual awakening.