Sowa Rigpa Tibetan Medicine

Sowa rigpa Tibetan medicine	Science of Healing, Science of Health and Happiness
Sowa (heal) rigpa (knowledge/pure awareness)	Using medicine as our “Dharma teaching”. Transform temporary happiness and relief to ultimate happiness and freedom.
3 humors: Loong, Tripa, Beken	Wind, bile, and phlegm
4 sources:	Medical knowledge from non-human beings (spirits)
	Medical knowledge from meditation and clairvoyance (samadhi, interdependence and emptiness (tendrel/tongyi in tibetan)
	Medical knowledge from everyday experience and conventions (trial and error)
	Medical knowledge from the natural environment (places like hot springs, astrological knowledge)
Chapt: 3: Neluk Nezhi
Tree of Health and disease
Bonpo- Bum Zhi text Shenrap Miwo
4 tantras, 156 chapters
Triangle of health	mind-body-energy
Triangle of disease	disorder-deficiency-excess
Homestasis	humoral energy, bodily constituents, (cells, tissues), and bodily waste products.
ne/neepa	humoral energies
luzung	bodily constituents
drima	waste products
loong	wind
Tripa	bile
Beken	phlegm
Harmers and harmed	humors are agents of harm
noche	the ones that cause the damage, agent of harm
tenpa	the occupiers dependent on the support
	if waste products increase there will be poor health
	if the waste products are deficient, strength and vitality decrease
nyepa	help make the body tissues, digestion, nutrient absorption
	when nyepa imbalanced then digestion and metabolism will be imbalanced
Loong (wind image)	wind element
Tripa (sun image)	Bile, fire element
Beken (moon image)	Phlegm- water and earth element
space element (emptiness)	Affects all things.
	The three humoral energies can be gross (physical) and subtle (thoughts, emotions, feelings).
	Dzogchen- the purest elements are the 5 lights. (sounds rays, light). All arising from emptiness.
	Sound can influence our bodies and inner elements- music can calm or upset us.
	Tripa is fire and burns, hot diseases
	Beken- destroys body heat, nature of earth and water- heavy and downward, cold. Cold disorders.
	Loong: hot and cold nature diseases, solar heating, lunar cooling, it can aggrivate both hot and cold diseases
Long- tripa- beken	specific order. Lighter to heavier elements.
	loong can fan tripas heat and freeze bekens cold. Swelling like edema, makes masses grow.
	Loong is present in beginning, middle, and end of disease.
6 characteristics of Loong (a rough deal)	Rough: physical and mental stress, rough and dry skin and hair. Stress, anxiety. rude, cursing, negative self-talk.
	Light: excessive thinking, spaced out, ungrounded, hyper-sensitivity. Lightheaded, dizziness.
	Cold: cold feeling in body, shivering, numbness, and depression.
	Subtle: scattered, pain not localized and moves, psychosomatic pain and sensation, recurrent thoughts, dissociation from the body.
	Hard: Muscle stiffness, hardening of tissues, stubbornness. Tumors.
	Mobile: easily changeable mind, moodiness, erratic emotions, shifting pain, hyper-activity, instability, weakness.
Tripa (Hot and greasy)	Oily: oily skin and hair, rapidly dissolve fat, without weight gain.
	Sharpness: sharp acute pain, sudden appearance of a disorder, aggressive reactions, words, intellect. Anger.
	Hot: elevated body temperature, inflammation, impulsiveness. “Hot-blooded”.
	Light: sudden appearance of a disease, may resolve quickly with cold, may move and reappear somewhere else. Short temper.
	Smelly: profuse sweating, strong pungent odor, bad breath, foul-smelling urine, feces, gas, infection, feet smell.
	Purgative: sudden passing of fluid or diarrhea.
	Moist: sweating and dampness, seeping of fluids, clamminess.
Beken: cold and fatty	Oily: body fat, overweight
	Cold: Persistently cold skin, reduced metabolism, feeling cold inside. Sluggish,
	Heavy: Density, downward, deep, slow development, slow blood, serious demeanor, slow to recover, imposing personality.
	Dull: physical and mental laziness, mental dullness, pale, colorless complexion and tongue. Sleepy and lethargic.
	Smooth: Smooth soft skin, and structures, kindness and gentleness. Easy to get along and non-abrasive.
	Stable: consistency, mental and physical stability. Ability to tolerate strong emotions.
	Sticky: viscous substances like mucus, sputum, saliva, or other residues.
Humoral energies: Nyepa	Loong: connected to respiratory, neuromuscular, and cognitive functions. Wave or vibration.
Life sustaining wind (Sokdzin loong)	Brain in sowa medicine. Sensory gates to the brain. Medicines can be nasal drops or herbal snuffs, using warmed oils.
	Nejang yoga, physical exercise with breath. Neuroplasticity. Stress, excessive thinking, cognitive impairment, psychosis.
Ascending wind (Gyengyil loong)	Speech and emotional expression. Yawning, belching. Heartburn, acid reflux, insomnia, speech pathologies.
	Inhaled medicines, smoke, orally ingested formulas.
Pervasive wind (khyapche loong)	Walking, limb contraction and extension, heartbeat, circulation of blood and nutrients, vessel dilation, tissues and organs,
	open and closing pores, sleep and dreaming,
Fire-accompanying wind (Menyam loong)	Digestive and metabolic function, body heat, unifies with digestive bile and phlegm digestive movement for good digestion
	Digestive difficulties, irregular bowel movements, Sokdzrin loong can cascade into digestion- stess, anxiety, fear.
Descending wind (Tursel loong)	Pelvic region: feces, urine, sexual fluids, waste products, menstruation, child birth. Masturbation/partner sex can balance if excess.
	Constipation, bloating, diarrhea, urinary incontinence, irregular menstruation, seminal leakage. Tx: enema.
Digesting Bile (juche tripa)	Digestive bile, separate pure and turbid, Stomach and small intestines, regulates body temp.
	Chemicals like enzymes, bacteria, chemical breakdown of foods.
Color-changing bile (Danggyur tripa)	Pigmentation of the skin, which can change based on lifestyle, diet, state of health, sunlight. Resides in Liver.
	Biliary and jaundice.
Accomplishing Bile (Drupche tripa)	Ego of the heart, courage, assertiveness, hot firery energy. Pride, dignity, self-worth.
	Dysfunction can be depression and lack of motivation.
Vision-producing bile (tongche tripa)	Clearly perceive forms, and also see within. See dreams as well. Eyes are the flowers of the liver.
	Intoxicants affect the liver and the eyes, migraines cause auras
Complexion-clearing bile (Doksel tripa)	Clearness and radiance of skin.
	May manifest as skin issues and imbalances.
Supporting phlegm (Tenche beken)	in the chest and supports all Beken functions.
	Water and earthly nature, governs fluids and fluid related processes in the body.
Breaking down phlegm (nyakche Beken)	Aids digestion and movement of the food in Stomach, chew, saliva. Mucous.
	Needs action not sedentary lifestyle to help with digestion. Increase fattiness, heaviness and cold in body needs movement.
Tasting phlegm (nyongche beken)	Resides in the tongue, ability to taste. Sweet, sour, salty, spicy, astringent tastes.
	Loss of taste and tongue dysfunction.
Satisfying phlegm (Tsimche beken)	Head and brain, feel satisfied from foods and enjoyment. Sensory faculties. No need to over-eat once satisfied.
	Avoid sedentary lifestyle, eat bad food choices, enjoy your food!
Connecting phlegm (Jorche beken)	Joints. Joints and ligament connections, lubrication, extend and contraction of joints. Collagen and cartilage.
	roughness, hardness, stiffness. Inflammation, swelling, redness. Cold aggrivates, Warm medicinal baths, Moxa, for treatment.
Body Constituents	dangma- clear essence, nyikma- impure dregs.
Nutritional Essence	becomes blood
Blood	nyikma removed from blood becomes muscles
Muscles	dangma of muscle becomes fat
Fat	dangma of fat becomes bones
Bones	dangma of bones is the bone marrow (Cerebral spinal fluid as well)
Marrow	dangma of marrow becomes reproductive essence
Reproductive Essence	Khuwa the male and female reproductive essence.
Medro	Digestive heat is critical in all of this transformation. Strong medro helps one be disease-free
	Indigestion- the bodily constituents cannot develop.
	Eat light and warming to gain longevity and bodily strength.
Nyikma	stomach mucs, bile fluid, fatty substances, sebum, teeth, nails, body hair, fats and oils in stool
Dang/Damgma	Bright, healthy glow, nourishment, , well-being, wholeness, happiness, vitality, joyful, libido.


Waste products	Drima- waste products. Impurity, taint, stain, smell. Fowl-smelling.
Feces (Shang)	Eliminated by tursel loong. Colon to anus.
	Not too much or too little, it needs to be consistent.
Urine (Chi)	Process of kidneys stored in urinary bladder. Drinking right amount of water.
	Scanty, painful, difficulty are indicators of imbalance. Excessive, dark urine. Infrequent can be kidney or heart problem.
Sweat (ngulnak)	Khyapche loong and doksel tripa. Khyapche loong regulares pores, doksel tripa influences how sweat is formed.
	By product of body heat. It flows to keep skin clear, hydrated, and healthy.
Conclusion:
Good Health	Eating well, diet, food digests well, balanced metabolism, healthy excreations. Prevention of disease.

Longevity	Staying healthy and happy is easy, dealing with disease and curing it is difficult.
	longevity and health together into old age without much sickness. Then the 3 next fruits can flourish:
Dharma (nor)	3 fruits: Dharma, wealth, and happiness ripen when body health and energy are balanced and fulfilled.
	Using 4 noble truths as path to reduce suffering for birth, sickness, old age, death.
Wealth (cho)	Way of life, reality, awakened view beyond dogma, mental, psychological, neurologically awake to how things truly are.
	Cho ki sem: dharma mind, open and flexible mind. Mind tamed by training in meditation, ethicical conduct, yoga,
Happiness	Physical and energetic health, leads to mental happiness, and mental happiness leads to physical and energetic balance.
	Need health and logevity as a bsis. Less materialism, but balance life, spirit, health of body, speech, and mind.
Inspection: Self-analysis	Self analysis to know own mind, tendencies, afflictions. Apply sowa rigpa medicine to ourself
Dharma-Wealth_happiness	Assess those. Big strong egos are fragile, having flexibility of mind, open.
Mind- energy- body	Self assess this.
loong types:	Over thinkers, express feeling, emotionally sensitive, , touchy, dream heavy.
Tripa	Smart, quick, sharp-tongued, angry, incisive
Beken	slow, patience, easy-going, sleepy
Primary Causes: (gyu)	40 distinctive states from desire-attachment, 33 from anger-hatred, 7 from ignorance-confusion. 84,000 inner poisons.
Ignorance (timuk)	Beken related. Marigpa: failure to see one’s true nature.

Anger (zhedang)	Tripa related.

Desire (dochak)	Loong related.

Stress	Creates cortisol, affects immune system and can lead to chronic inflammatin. Hippocampus in brain is affected.
	Stress is different in people, some leads to food cravings, strong attachment can become anxiety, anger can be high blood pressure.
	inability to make good decisions can occur, excess desire can become frustratioin, anger, and animosity.
Secondary Causes: (kyen)	Adverse or unfortunate circumstances.
Seasons (du)	Hot and dry aggravate tripa (bile). Cold and wet increase beken (phlegm), worse in dawn and aggraved by cold Loong (wind).
	Astrological influences as well like 24 jieqi, planets, directions, ect. Feng shuai.
Provacations (don)	Animist view: disturbing the nature spirits. Bacteria, viruses, parasites (sinbu).
	Water spirits: skin diseases, leprosy, water retention, swelling, cancers, malignant growths.
	Mountain, fire: heart attack, strokes, sudden unexpected pain. Provoking nautre- spirits can be upset, virus, bacteria released.
	Emotional: Fear, worry, anger, grief, etc.
Diet (ze)	Quanitiy: too much or too little. Qualtity: poor food choices fat, sugar, low nutrients.

Lifestyle (cho)	Individual behavior, seasonal behavior. Circumstantial behavior, exercise, work, sexual behavior, rsting habits, hygiene, bathroom
	grooming, sun exposure, adjust to seasons, weather, first aid, preventative care, and stress/risk management.
Sleep	Sleep is a healing power. No good sleep causes roughness/stress.
	If you did not sleep well, fast and then rest/sleep 1/2 amount of time you should have been sleeping.
	Power nap if you are drunk or intoxicated, when physical energy is depleted, when depressed, overwhelmed, or grieving.
	Power nap: when exhausted, if you talk too much, eldelry, anxious, or overcoming trauma.
	Late spring early summer: Loong/wind stress: with longer days, shorter night, excess loong causes the vitality to weaken. Beken increase;
	(Loong/wind: connected to respiratory, neuromuscular, and cognitive functions.)
	Beken/phlegm: increase causes swelling, mental fogginess, headaches, lethargy, infectious to colds and flu.
	Excessive sleepiness: can use fasting, a purgative to vomit, or sex.
	Insomnia: dairy like milk, yogurt, fermented grain alcohol, meat broth. Oil massage the head, fill ears with warm oil (Karna Purana).
	Consider: Stomach full or empty sleeping, effects on cognition and memory, emotional well-beling, link to immunity,
	Suppressing sleep can cause physical and emotional apathy, mental dullness, cognitive decline, vision problems, digestive problems.
	suppressed crying, emotionally overwhelmed, mood disorders, can benefit from naps.
	Over-sleeping: symptom of depression, can worsen depression, however good for early stages of bereavement.
	Sleep is the cheapest treatment for Loong/wind problems.
Sex	Regular sex and ejaculation can be healthy. Do not get caught up in monk celibacy or tantric retention.
	Excessive sex can distrurb loong and give rise to loong disorders. Frail, ill, very elderly, pregnant should refrain from too much sex.
	men: limit ejaculation in the monsoon season/summer, loong is sensitive.
	Sex can balance all nyepas (loong, tripa, beken), can be relaxing, pain-relieving, mood enhancing. Reduce anger and anxiety,
	improve quality of sleep, deepen bonds, clarify mind and senses. Can be exercise and improve blood, digestion, loong.
	Libido- high or low can be indications of health.
	Practice middle way- not too much sex nor too little. Eat healthy have a good balance of spiritual training.
Health and disease	example if you have a primary cause of desire like craving for sugar, you can control craving, not eat those aggravating foods
	and the inner poison can wither. Importance of controlling the inner poisons.
	Sutric path: path of avoidance or rejection. Avoiding the poison all together.
	Tantric path: path of transformation. Transform poison to edicine with antidotes. Samantha, vipassana.
	Dzogchen: take the posion but release them naturally and spontaneously. Self liberation, looking at the nature and non-conceptualization.
	Sowa Rigpa: keeping a dynamic balance. Mindful of imbalances
Treatment for the 3 humors	Seven point posture Vairocana: Cross-legged, Spine straight, vajra fists on groin, tongue on roof of mouth, arms straight/vulture pose, Tuck chin, Gaze in front of nose.
	Nine-fold breathing practice for the poisons and nyepa.
Entrances (jukgo)	How pathogen disorders advance through the body.
Skin	spreads through the skin
Muscles	expands or grows in the muscles
Channels	Flows through channels and nerves, blood vessels.
Bones	Stick to the bones
Solid Organs	lands on the solid organs
Hollow Organs	Descends into the hollow organs
Sites of nyepas
Beken	Brain and upper part of body like head and neck. Head confusion, illusion, delusion,
Tripa	Liver, Gall bladder, middle part of body. Anger/fire element
Loong	Hips, waist, low back, lower part of body. Sexual energy/ desire
Loong pathways	Bones- osteoporosis
	Ears- tinnitus
	Skin and hair- dermatitis
	Heart and Aorta- heart palpitations
	Colon- constipation
Tripa pathways	Blood- infection
	Sweat- odorful sweat
	eyes- red eyes
	Liver and GB- gall stones
	Small Intestines-
Beken pathways	Nutritional essence, muscles, fat, bones marrow, reproduction essence.- metabolic issues
	Feces, urine-
	Nose and tongue- loss of taste
	Lung, spleen, kidney
	Stomach, Urinary bladder- indigestion, incontinence
Times of Nyepa	periods of life, location, season, time of day.
Loong:	Elderly (over 70), cold, windy , and harsh locations, summer, late afternoons, dawn. (4-7am/pm)
Tripa	Adulthood (16 to 70), Dry and hot locations, Autumn, mid-day, mid-night. (midnight/mid-day to 3 am/pm)
Beken	Children (under 16), Wet and humid locations, Spring, late evening, early morning. (8-11am/pm)
9 Terminal Conditions	Incurable conditions that usually result in a loss of life.
1	Exhaustion of 3 causes of life. Lifespan, merit, karma: can do yoga, mantra, long life practices, Generate merit with good deeds
	karma can be genetics and epigenetics. Longevity, merit, and karma is “used up”. No matter what we do people still die.
2	Humoral energies becoming antagonistic: hot and cold disorders combining fatally.
3	Applying a treatment that is the same as the disorder fatally. Medical Malpractice, negligence.
4	Fatal injury to a vital organ or point. Patient fatally shot or stabbed.
5	Loong disorder past the point of treatment which severs the life support (sokten): heart, Lung, CNS, brain: heart beat fail, stop breathing, paralysis, brain dead.
	heart, Lung, CNS, brain: heart beat fail, stop breathing, paralysis, brain dead.
6	Failing to treat a hot natured disorder on time. (Tsawa)
7	Waiting too long to treat a cold natured disorder which causes it to lodge too deep inside the body. (drangwa)
8	When the body, bodily constituents, or immunity are too depleted or damaged to withstand treatment. Body rejects treatment
9	overwhelming, fatal harm caused by don provocations. Spirit attack, accident, injury, trauma, coma, anything shocking.
Palliative care	help patient for the inevitable, plan for death, no false hopes, mortality
12 Adverse reactions:	Deficient (men) Excess (lhak), and wrong use (lok). Side effects
Loong is cured but a tripa imbalance occurs
Loong is cured but a beken imbalance occurs
Tripa is cured, but a loong imbalance occurs
Tripa is cured but a beken imbalance occurs
Beken is cured, but a loong imbalance occurs.
Beken is cured, but a tripa imbalance occurs.
Loong is not cured and a Tripa imbalance occurs.
Loong is not cured and a Beken imbalance occurs
Tripa is not cured and a loong imbalance occurs
Tripa is not cured and a Beken imbalance occurs
Beken is not cured and a loong imbalance occurs
Beken is not cured and a Tripa imbalance occurs
Hot natured conditions	Tsawa (fever). Tripa and blood disorders tend to be hot natured and fire. Inflammation, silent inflammation, HBP,
Cold natured condtions	Drangwa. Loong and Beken disorders tend to be cold natured and water. Metabolic disorders, indigestion, tumors, water retention.
(need to think if patient diseae is hot/cold)	Tumors are like mushrooms from cold and damp.
	Swelling, edema water stops flowing from tenche beken and khyapche loong.
	Tenche Beken: in the chest and supports all Beken functions. Water and earthly nature, governs fluids and fluid related processes in the body.
	Khyapche Loong: Walking, limb contraction/extension, heartbeat, circulation of blood/nutrients, vessel dilation, tissues,organs, open/lose pores, sleep/dreaming,
	Sin and Chuser disorders exist as hot and cold natured disorders equally.
	Chuser (yellow fluid). Hot/cold natured disease. Lymph, blood serum and synovial fluid.
	Light colored chusen: loong and beken cold-natured disorders.
	Dark color chusen: blood, trip, hot natured disorders.
Chapter 4: Ngondzin Tak
Tree of Diagnosis and Symptoms
Seven Natures
	Single loong typology
	Single tripa typology
	Single beken typology
	Double loong tripa typology
	Double loong beken typology
	Double tripa-beken typology
	Combines loong tripa beken typology
Loong	Thin build, erratic and sensitive digestion, psychological digestion issues, stress causes indigestion or constipation.
Tripa	Medium build, strong digestive heat, can eat many things,
Beken	Heavy build, weak, heavy digestion, slow,
Stomach in types	Loong have heavy strong stomachs, might take slow to respond to laxative.
	Tripa: soft or loose belly, they will respond quickly to a laxative
Loong topology:	Rounded or stooped posture, skinny, blueish complexion, talk a lot, Cold aversion, creaky joints, little wealth, short lifespan, sleep plightly,
	Short and slight build, enjoy singing, laughing, joking, fighting, sports.
	Crave sweets, sour, bitter, hot tasting. Personality like a vulture, crow, fox.
Tripa topology	Thirsty and hungry most the time, hair and skin yellowish in tone, keen intellect, proud, arrogant.
	Sweating, body odor, average lifespan, wealth,
	Medium build, , crave sweet, bitter, astringent and cooling foods.
	Personality: Tiger, monkey, Yak.
Beken topology:	Cold body, low temperature, joints and tendons not visible, fat, stout, big bodied,
	Pale complexion, swayed back posture, can withstand hunger, thirst, mental-emotional suffering.
	Tall, long limbed, strong durable bodies,
	Live long, wealthy, deep sleepers, hold grudges, angry and resentful.
	Generally patient and good-natured,
	Crave hot, sour, astringent tastes,
	Personality like a lion or elephant.
Loong animal	Vulture: desire for freedom, strong impulse to move, acrobatic, athletic.
	Fox: crafty, playful, mischievous, silliness, fleeing, skittishness.
	Crows: constantly moving, clever, vindictive, taunting, load tone or voice.
tripa animal	Tiger: powerful, full of energy, initiative, ferocious, physically capable.
	monkey: mental and physical agility, intelligent, good memory.
	Yaksha: (nature spirit), wealth-possessing nature spirit, proud and proprietary nature.
Beken animal	Lions: strong, imposing
	elephant: calm, stable, unflappable, long term memory.
Sizing up patient	Be caution coming to fast conclusions.
	Look at physical, personality, how they move, speak, actions,
Solid organs (roots)	dangma- suport and process pure essence from foods.
Heart
Lungs
Liver
Kidneys
Spleen/pancreas
Hollow organs (Stem/leaf)	Containers or vessels, 5 senese: tongue, Nose, Eyes, Ears, Lips.
Small intestines
Colon
Gall Bladder
Urinary bladder
Reproductive organs
Stomach
Royal palace of the human body
Hips	Like supports placed beside a wall
Spine	like a stack of gold coins
Artery	Main artery is like a agate pillar
Sternum	like a load bearing beam
Ribs	24 ribs are like rafters placed over the beam
rib cartilage	Like supports for the rafters
Nerves, vessels, sinews, ligaments	are like sticks laid over the rafters
Muscles and skin	Are like the plaster materials
Clavicles	like pointed parapets attached to a castle
Scapulae	like the materials laid down to make the squared corners of the castle.
Head	domed story of the castle
Sensory openings	Outward facing windows
Skull	gilded cover laid over the dome
Brahma’s aperture	Opening of a chimney
Ears	rear heads of a garuda decorating the sides of the castle
Nose and nostrils	beautifying ornaments at the top of the building
Lock of hair	male to female roof tiles
Arms and hands	Banners which attach to the side of the castle and hang down
Upper and lower torso	Upper and lower courtyards and passages
Diaphragm	like a spread silk curtain
Heart	King seated in throne
Posterior portion of lungs	are like internal ministers
Anterior portion of lungs	like the king’s sons and princes
Liver and spleen	are like senior and junior queens
Kidneys	are like external ministers who are like a wall that holds up the weight of the central beam
Reproduction organs	are like the storehouse filled with jewels and other riches
Stomach	like a cooking pot to extract nutrients
Colon	Queens attendants
Gall bladder	like a bag filled with spices
Urinary bladder	like a clay pot filled with water
Urethra and anus	are like water drainage holes
Legs and feet	Like the entrance to the castle, place to dismount from horse
vital points of the body	like the intermediaries and subordinates charged with executing the commands of the King.
Observing tongue, Urine, and Sensory Organs	*caution rushing to decisions. Look at entire picture. Smoke is the symptom, fire is the root cause. (example)
Eye observation	4 quadrants: 1. above the iris is Lung, 2. below iris is Liver, 3. inner toward nose is kidney, 4. outer canthus area is Stomach.
	Dry eyes with visible veins: excess heat in liver, GB, and blood.
	Black or dark spots at end of eye veins can be Tripa related liv/gb.
	Eyes have fire natures. Protect thme from too much light, heat and overuse.
	Use eye drops and barberry.
	Eyes with bluish tint may indicate loong issues.
	Yellowish eyes are a tripa issue
	Pale colorless eyes can be Beken issue
	Red, bloodshot eyes are a blood issue.
Loong eyes	small, sunken, may move or twitch nervously, eyelids can be droopy. Dark iris.
Tripa eyes	medium size, sensitive to light, gaze can be penetrating, light iris.
Beken eyes	Big and beautiful, can be moist, long eyelashes, Isis is bright or rich in color.
Nose analysis	Nostrils represent the lungs, the tip represents the stomach.
	Overall state of nostrils, breathing, congestion, and mucus tell us much about the state of the lungs and colon.
	Excess beken in the head: constant sniffing.
	Inflamed red nose, running nose, may be sign of cold or allergy reactions.
	Pulmonary disorders are often found in patients with dry or obstructed nose.
	Pus and frequent sneezing may indicate chronic internal disease.
	Excessive sebum production around nostrils may indicate excess heat in spleen or liver.
Mouth analysis	Related to spleen and stomach
	Upper lip represents the stomach.
	Lower lip represents the spleen
	Corners of mouth represent the liver and gall bladder.
Ear analysis:	Kidney, bladder, and reproductive organs.
	Used in tibetan pediatrics. Examine the veins and arteries in the back of the ear.
Men	Right ear: upper part is HT/Si, Middle is Liv/GB, and lower is Rt. Kidney and bladder.
	Left ear: upper part is Lu. Li, middle is SP/ST, and lower is left kidney and reproductive organs.
Women	Left ear: upper part is HT/Si, Middle is Liv/GB, and lower is Rt. Kidney and bladder.
	Right ear: upper part is Lu. Li, middle is SP/ST, and lower is left kidney and reproductive organs.
	This is just like pulse in tibetan: there is a reverse with men and women.
Dx:	Scattered veins of uneven thickness indicate loong. Loong excess also make the veins more visible in light.
	Thick swollen or protruding veins indicate tsawa (root,channel, vein) in their corresponding organ.
	Minimally visible veins may indicate beken.
Tx:	Venesection/bloodletting therapy is used on the veins associated with afflicted organ. Be gentle on children.
	Prick with needle for one or two drops is enough.
	Thyroid or goiter typically may present as large veins near top of ear. Do the opposite side of ear if thyroid is swollen on left or right.
Tongue analysis:
	Loong: red, dry, and rough tongue
	Tripa: thick yellowish-white mucus.
	Beken: greyish, dull, lusterless, smooth, and wet.
Zones	Tip: heart, heart line runs through the center.
	Front right: Liver
	Front left: spleen
	Back right: right kidney
	Back left: left kidney
loong tongue	Red, dry, rough, reddish bumps, cracks, lines in middle (heart issue) which may present as chest pain, palpitations, tremblng,
	dizziness, insomnia, mania, anxiety, paranoia, and mental issues.
	Thick blue veins under the tongue can indicate heart issues.
Tripa tongue	thick yellow-white coating, may appear dirty, bad smell, patient may have bitter taste in mouth. White-ish tongue.
Beken tongue	Soft, sticky, mucus, saliva, minimal odor, pale and dull, big, cold, moist, greyish, swollen, teeth marks.
Urinalysis:	Urine carries imprints of bodily functions. A looking glass to patients inner organs and health.
	Studied when warm, lukewarm, and cold.
3 temperature times to study	Warm: color, steam, vapor, odor, bubbles
	Lukewarm: sediments, surface for filmy layer or scum coating it.
	Cold: how long it took for urine to change color and consistency, color and viscosity from edges to center.
	patients need to avoid medications, drugs, alcohol, soda, caffeine, faw foods, spicy, oily greasy, and sex the night before urine testings in morning.
	First of the morning urine is used in a clear glass container.
Urine color explained	dangma- suport and process pure essence from foods. (passes through the station in liver and transforms to blood.
	Nyikma- the waste products. (of the blood, accumulates in the gall bladder as bile).
	Gyudrok channels: ureters
	Chuser – yellowish-fluid. (the dangma of the bile becomes the chuser)
	Kuya- sediments of particular in urine. (nyikma of bile become kuya, the sediment in urine).
	This explains the color change in urine by food. Sediments are from blood and bile and hot (tsawa)/cold (drangwa)nature disorders.
	Urine accumulates info from all over the body (liver, kidney, GB, blood, bladder) like a merchant that picks up news while traveling.
Wisdom in waste	Compare it with tongue, urine, pulse, etc.
	medro: metabolic digestive heat. This impacts the 7 constituents. If for example patient has oily skin the medro may be weak transforming fat.
Feces	Loong imbalance: hard compact feces
	Tripa imbalance: foul-smelling diarrhea
	Beken imbalance: undigested food particles
	Pulse: disorders of the solid organs, life or death.
	Urine: disorders of the hollow organs, hot or cold natured disorders.
Healthy urine:	warm: color almost amberish, normal musky smell, moderate steam, blanced foam/bubbles,
	lukewarm: sediments not to thick or fine, minimal film surface,
	cold: transforms once steam has disappeared, from edges of container inward it forms, yellowish white color.
Loong disorder urine	Bluish, blue-green with big bubbles.
Tripa disorder urine	Reddish yellow- lots of vapor and bad smell.
Beken disorder urine	Whitish, little smell or vapor.
Combination	loong tripa: dilute, bluish urine with bubbles
	tripa-beken: pungent orange-red, small bubbles
Broadly	tripa/Tsawa (hot): repulsive odor, abundant sediment
	drangwa (cold): absence of color and sediment
	Kidney issue/kidney stone: gritty sand-like sediment
	Digestion issues: urine smells of recently eaten food.
Urine questioning:	Ask about foods, beverages, drugs, vitamins, supplements before assessment of urine.
	Reddish can be causes by foods like rhubarb, blackberries, and beetroot.
	Blood in urine indicates an organ like kidney or liver issue.
	Reddish brown in cancer patients.
Palpating the pulse	Feeling radial artery and other pulse points
	Tibetan pulse taking is spiritual, energetic, and physical.
Physical	Strength- weak/deep, Full/surface
	Speed- Slow/rapid
	Regularity- Irregular/regular.
Energetic	Loong/Wind: irregular or regular, wind-like a pulse that rises up
	Tripa/Bile: fast, over 90 bpm
	Beken/Phlegm: slow, less tah 55 bpm
	What do you notice with the quality and you? Do you feel wind, heat, cold, damp, dry, earthy?
Spiritiual	connected to divination and intuition
	Future business of the patient
	Sex of the baby in pregnant woman
	Determine return of traveling family members, their health.
	Used when someone very sick, have the son or daughters pulse taken (stand in) for father or mother ill at home and too sick to travel..
	Requires many retreats to get good at.
Shamanic pulse taking.	Tsa Tra Tra: clairvoyant scrying: gazing in mirror or water to see past, present future and psychic impressions.
	Tsa tra pulse taking: Calling on medical deities’ male or female in pulse taking. Example mantra use: BAM HA RI NI SA (5 dakini family) empowerment for pulse.
danjor trinpa tsa ‘messenger pulse”	Pulse conveys information, news from the royal family of internal organs.
	Pulse is reading in a analytical form of knowing, receiving information depends on mental discernment and parsing carefully sensory impressions.
	Innate/constitutional pulses, seasonal pulses, pathological pulses.
Innate/cponstitution pulse	From birth, can change by lifestyle and diet. Three types: Male, female, and intersex pulses.
	60 to 100 beats per minute is normal. 75 normal depending on age, sex, constitution, physical fitness.
	5 beats per breath.
	Male pulse (po tsa) is thick and rough, floating. Loong. This throbbing pulse “punches”.
	Female pulse (mo tsa) is thin and fast, tense and rapid. Tripa. This pulse “stabs or pricks” more.
	Bodhisattva pulse (jangchusem tsa) is long, soft, and loose. Beken. In-between the Male and Female type of pulses.
	A person can have one of these types of pulses. Doesn’t matter what sex they are born with.
	Couples with male pulse will have a boy.
	Couples with female pulses will havea girl.
	Bodhisattva pulse couple will have one child.
Temporal , Seasonal, Astrological factors	Seasons, external kham elements on various pulses.
	In-between seasons is Earth like in the Taoist.
Season	Spring: 3 months, 72 days: trees and plants grow, Wood, Liver, Pulse is taut and fine, wiry, guitar string.
	18 day Earth transition: Earth, Spleen, short and soft pulse.
	Summer: 3 month 72 day, rain falls, Fire, Heart, thick and extended pulse.
	18 day Earth transition: Earth, Spleen, short and soft pulse.
	Autumn: 3 month, 72 days, Crop ripen, harvest. Lung, Metal, pulse is short and rough.
	18 day Earth transition: Earth, Spleen, short and soft pulse.
	Winter: 3 month 72 days, Ice freezes, Kidney, Water, pulse is soft, slow.
	18 day Earth transition: Earth, Spleen, short and soft pulse.












Interview: Questioning the Patient	Medical history, Triggers, Symptoms, Responses
	look for habits, condition before illness, diet, behaviors, environment, medications.
Loong (Wind) Triggers (longkyen)	“Rough and light”, Diet and Lifestyle. Roughening foods, ligthening foods, lifestyle.
	Rough foods: lack oil, dense, have little nutritional value.
	Light foods: Quickly digested foods which do not sit heavy in the digestive tract.
	Lifestyle: harshness, irregular, excess sensory stimulation, physical and mental tension and friction. Stressful.
	Activities that contribute to distraction, disorientation, instability, and irregularity.
	Rough and light lifestyle can prevent groundedness, cohesion, and stability.
	Constant, hectic, multitasking, spending time outdoors in extreme weather, skipping meals, missing sleep,
	Inconsistent eat, sleep, amounts of food, low nutrition, stimulant drinks, substances, loud places, sensory overwhelming like movies, social media
	Aggravating loong: multitasking like a parent on computer and helping kid, drinking coffee and driving to work listening to a lecture for school.
	Coffee, Teas, soft drinks, energy drinks, exacerbate loong. Increase heart rate, blood pressure, over think, over stimulate, anxious, nervous.
3 process related to Nyepa (loong, beken, tripa)	Sokpa: accumulation, storing, stagnation of nyepa.
	Dangpa: manifesting, arising, welling up of a nyepa.
	Zhiwas: pacify or cure the nyepa.
Loong symptoms (naluk)	Yawning and shivering: ascending loong in the chest and throat. Khyapche loong, Psychological trembling and shaking “of the heart” as well.
	Yawning and stretching the limbs repeatedly: Khyapche loong: walking, directing energy to the limbs.
	Stagnation and accumulation make them want to stretch and move.
	Cold Chills: nature is cold, psychological chills, psychologically can think themselves sick without a physical source.
	Discomfort in hips, low back, pelvis: also includes heart, skin, and ears. Tinnitus is listening to the proliferation of loong.
	Inconsistent and migrating pain: subtle and pervasive and travels everywhere. Treat with oil massage and warm baths, steam baths.
	Dry heaving and retching: empty vomiting, nausea and gagging. Loong vomiting is related to stress and emotional disturbances. Tx: heat press
	Dull, deteriorated sensory function: sokdzin and khyapche loong both affect senses. Deficiency, excess, wrong or disordered use.
	Harsh sounds enter ear and affect brain and sokdzen loong. Bright flashing lights as well, abrasive music, smoke, chemicals, fumes, can dull senses.
	Turbulent mind, agitated cognition, thinking or mind: excessive can lead to mental issues, erratic thinking, concentration issues, emotional, mania, psychosis.
	Increased discomfort and symptoms when hungry: pain and sickness when hungry: menyam loong affected, psychological digestion.
Loong Responses (gompa)	oily, nutrient rich diet helpspatientst feel better.
	Doctor questioning: what makes symptom better or worse?
Tripa (Bile) Triggers (longkyen)	“Sharp and Hot diets” foods and drinks that increase heat and inflammation. Heavy in spices, fats, oils, sour, fermented and warming aggravate tripa.
	Lifestyle in the hot and sun, over-heating environments, intensive exercise, playing sports. Hard labor, strenuous physical activity.
	angry, competitive, aggressive interactions can increase sharpness and aggravate tripa.
Tripa symptoms (naluk)	Biitter taste in mouth: smelly substances like breath and body odor tend to be connected to Tripa. An unchanged state of smelly.
	Strong unpleasant smells that can be sweet, smelly stool, smelly breath. Hot and sharp create excessive odor.
	Think of a hot pice of meat left in the sun that gets putrefaction and chemical changes.
	Headaches: heat blazing upward from the chest. Tx: yogic headstand can redirect heat and rebalance upward flaring tripa.
	Headaches re often sharp, stabbing headaches, with vision issues and nausea.
	Increased body temperature, fever: hot and inflammatory, fast and sharp when flaring up, producing friction and combustion, everything heats up.
	Upper body pain: headaches, chest, throat, upper back and shoulder pain.
	Increased discomfort and symptoms post digestion: when the food leaves the stomach and goes to the small intestines. Juche tripa
	juche tripa: chemical digestion, bile, nausea, biliousness, digestion of fats and oils.
	Example eating cheese or dairy and having discomfort an hour later. Beef would be two hours later.
Tripa responses:	Relief that comes from colder environments, taking a cold shower, ice packs, cooling ointments, cooling foods and medicines.
	Relaxing in a cool, shady locations, activities that cool the body and emotions. If cooling worsens condition, they may have a cold-natured problem.
Beken (Phlegm) Triggers (longkyen)	Heavy fatty diet and lifestyle: eating heavy, fatty foods and sedentary lifestyle. Heavy, cold, oily, fatty, without regular warming physical exercise.
	Cold, Damp places aggravate Beken.
Beken symptoms (naluk):	Poor or lost appetite: beken in stomaches causes nyakche (breaking down acids) disturbances causing loss of appetite. Feel full on small amounts of food.
	Beken-dominat people snack often throughout the day without paying much attention to what and how they are eating. No appteitie at mealtimes.
	Difficulty digesting foods: beken is heavy an slow, opposite of Tripa fast and sharp. Beken gives rise to metabolic disorders.
	Excess beken weakens the digestive fire, slows and obstructs digestion. Weight gain and metabolic problems from snacking and sedentary life.
	Vomiting: loong vomiting is dry heaves and empty, Tripa vomit is hot and bilious, Beken vomit is undigested foods. Vomit often from eating too much food.
	Treatment is emetic medicines, vomiting can help to resolve beken related issues by eating grasses and emetic weeds.
	Loss of Taste: Nyongche beken in our tongue enables sense of taste, tsimche beken in our brain is related to sense of gratification when eating.
	Too much beken can compromise our ability to taste, smell, and enjoy food.
	Excess Beken mucus can block nose, ear, throat and sense of taste.
	Stomach distention, feeling of fullness: heavy and cold nature makes stomachs feel bloated, heavy and full without eating.
	Belching: disruption of nyakche beken and overal digestion. Beken related belching is connected to other beken symptoms (loong may also burp).
	Physical and mental heaviness, lethargy: excess beken makes people feel heavy mentally and physically and sense of laziness, apathy, or lethargy.
	Mild depression, feeling stuck, struggling to move around and feel motivated.
	Surface level and inner coldness: low body temperature and sense of feeling cold, numbness.
	Loong cold can be shivering and inconsistent, beken is deep and lasting.
	Beken are quite insensitive to touch, pressure, cold, hot, all sorts of sensations. Deken react slowly if not at all. Beken are clammy and cold to touch.
	Discomfort after eating: when food passes into stomach, urges to belch after eating, even vomiting.
Beken responses (gompa)	Definite improvement with warming diet and lifestyle.
	Eating light, rough, and warming foods, staying warm, dry locations, physical exercise will help condition.
Questioning Patients, Danger in quick diagnosis	Shared information from patient, listen carefully.
	Condense all the points they mention symptoms
	You’ll most likely find a patient with some of two Nyepa, like 5 or 6 loong and 4 tripa, example.
	Take time in terview and gther details, don’t rush to diagnosis or recommendations.
Chapter 5: Soche Tap
Tree of Treatment methods.	4 remedies (nyenpo zhi): Trunk of diet, Trunk of Lifestyle, Trunk of medications, Trunk of external therapies.
	Diet: food and drinks, how they are prepared, hen they are eaten, food combinations, and amount eaten.
	Lifestyle: regular, seasonal, and circumstantial behaviors, physical, emotional, psychological, and spiritual activities and health.
	Medications: treatment, internal, ingested and topical.
	External therapies: gently non-invasive treatments and aggressive ones.
	Gentle: hot and cold compresses, water, bath, and steam therapies.
	Massage, bone-setting, cupping, tapping therapy, moxibustion.
	Invasive: acupuncture, blood-letting, and surgery.
Need patient cooperation 50/50	Tree of collaboration in the aspect of patient and doctor work together.
	Use tact and skillful communication with patient.
Spiritual therapies	mantra, meditation, yogic exercises, ritual procedures
	subtle channels, chakras, tantric yoga, divination, amulet-making, invocations, rituals.
	Exorcism of spirits, healing through meditation, energy work.
Suffering (4)	rebirth (medicine of pregnant mothers, newborns, children), sickness (medicine of origin, diagnosis, treatment), aging (longevity, prevention), death.
	death (powa and bardo yoga).
Rituals	Don: pediatric disorders, psychiatric conditions, tumors, skin problems, paralysis, neurological disorders,
	contagious diseases and infections.
	Depends on type of spirit: Peaceful rituals, apologies, offerings.
	hooking back life force and auspicious energy, soul retrieval.
Meditation and yoga	Diety Yoga. Pure vision and perception that all things are divine and pure.
	Samatha, vipassana help treat don disorders.
	Breathing meditations, breath control/pranayama, physical yoga, asana, Tummo, sexual yoga, long-life empowerments.
	24 nejang yoga, Lujong body training and purifying. Breath retention.
Mantra healing	line up body, speech, and mind, with outer , inner, and secret phenomena.
	mantras protect mind from destabilizing thoughts and emotions
Daily practice for Sowa rigpa students:	9 breathings
	Refuge and Bodhichitta prayer
	4 Immeasurable (happiness, freedom from suffering, supreme joy, equanimity free from aversion, attachment, and sorrow.)
	prostrations and mandala offering
	Medicine buddha mantra: tagatha om bakenze bakenze maha bakenze ranze samugate so ha.
	Obstacle clearing: Vajra Samdza dza hum bam ho (visualize Yuthok and 4 dakini) mantra: Om Maha guna Siddhi Hum.
	Aspiration prayer: medical knowledge increase, prescribe and diagnose with accuracy, make good medicine, provie beneficial, blessed with siddhi.
	Abide in emptiness (visualize dissolved) Om gate gate para gate, parasamugate bodhi so ha.
	Dedication prayer to Yuthok, and manta on interdependence.
Diet and Nutrition:
Loong (Wind)	balanced with warming, oily, nutrient dense food and drinks. Heat up cold imbalance
	heavy foods, beverages that help heat up, meat, daily, egg, nuts, cheese. Garlic, onions,
	brown sugar, molasses, butter, seed oil, angelica, wine, bone wine/broth.
Beverages: Milk, water, alcohol	Milk: decrease loong, but increase beken. Can help loong and beken (fertility and libido as well), increase beken. Lukewarm best.
	Water: can increase or decrease tripa.
	Alcohol: decrease beken, but aggravate loong.
	wines/beers: sweet, sour, bitter,pacify loong. Bitter will increase it.
	warming oils for loong, linseed for warming. Coconut and olive oild for cooling. Seasame oil best for loong.
Tripa	Pacifying foods: milk, deer, game meat, goat, barley grain soup, chicory green soup, dandelion greens soup.
	Drinks: cow or goat yogurt, buttermilk, think porridge, cool spring water, cooled boiled water.
	Fresh and cooling, bitter, liver and blood supporting foods.
	Tripa people have strong digestive fire and should avoid: warming, sharp, oily, fatty, salty, purgative.
	Fresh juices are good for Tripa as long as not too sour.
Beken	Beken pacifying foods: mutton, wild yak , predatory animal meat, fish, honey, warm dough.
	Drinks: yogurt and buttermilk, matured alcohol, warm boiled water.
	Pork, fish meat, fat, bone, seafood.
Deteriorate Medro and imbalance Beken:	Incompatible foods, eating irregular meals in inconsistent portions, eating too much cold, fresh, or raw foods, excessive intake of fats and oils,
	consuming too much processed foods, , eating spoiled, stale, burnt, under-cooked, overly and poorly preserved, and rotten foods.
	Raw, cold, oily vegetables, grains, pulses and fruit
Beken supportive:	vegetables easy to digest, steamed, cooked, and aged grains and vegetables.
	Chickpeas, yogurts, cheeses, meats, onions, garlic. Drinks: Yogurt and buttermilk, Garchang (concentrated alcohol), boiled water (first original medicine).
	Exercise, sauna, warming oils, weight loss therapies, sweating, baths,
Three Nyepa Diet Trunk
General principles	Loong: warm food, warming, oil, nutrient rich foods
	Tripa: cold, cool, fresh foods
	Beken: Hot foods, warming, spicy, light foods
Drinks:	Loong: warm milk, warm water, herbal teas like chamomile, carraway, fennel, anise, clove, red wines, rice wines, sherry, brandy, wheat based whiskey, run, honey based mead.
	Tripa: Chilled boiled water, cool water, green and black tea, fresh juices, hoppy beer, bitter digestifs.
	Beken: Hot/warm water, ginger, green, black teas, black coffee, rice wines, vodka, rum
Fruits	Loong: banana, date, watermelon, fig, pomegranate, lychees, pear, mulberry, strawberry, peach, guava.
	Tripa: apple, peach, cranberries, pear, lemon, dates, cherry, melon, tropical fruits,
	Beken: Apple, grapes, pear, plum, date, pomegranate, papaya, pineapple, various citrus fruits.
Vegetables	Loong: alliums (onioins, garlic, leeks, chives, etc.), sweet roots like carrot, beet, etc., cruciferous like broccoli and cauliflower, potatoes, winter squash,
	nightshades: tomato, eggplant, leafy greens.
	Tripa: Celery , cucumber, asparagus, zucchini, cruciferous veggies, sweet root veggies, leafy greens, lettuce, cabbage, watercress, argula, chicory, spinach, tomatoes.
	Beken: Al, liums, cooked radish, horseradish, rhubarb, peppers, chili peppers, nettle, seaweed, tomato, leafy greens, carrots, winter squash.
Grains	Loong: rice, millet, barley, wheat, oats, quinoa, lentils, beans.
	Tripa: rice , buckwheat, millet, quinoa, oats, lentils, peas, corn
	Beken: rice, barley, buckwheat, ots, quinoa, chickpea, pea, corn, lentil, beans.
Meats:	loong: mutton, lamb, beef, chicken, duck, turkey, eggs, fish, dried meats.
	Tripa: goat, beef, pork, herbivorous game animals
	Beken: fish, mutton, lamb, pork, yak, carnivorous animal meat, chicken, duck, rabbit, seafood.
Fats and Oils	Loong: sesame oil, linseed, ghee, sunflower oil, olive oil, animal fat and marrow
	Tripa: ghee, olive oil, coconut oil, almond oil
	Beken: olive oil, sesame oil, ghee, sunflower oil, walnut oil
Dairy	Loong: butter, milk, yogurt, cheese, aged cheese
	Tripa: butter, yogurt, goat milk and cheese, skim milk, kefir, fresh cheese.
	Beken: Whey, yogurt, buttermilk, sheep milk, butter, yogurt.
Spices:	Loong: coriander, cumin, nutmeg, clove, garlic, cardamom, pepper, mustard, salt.
	Beken: Saffron, turmeric, basil, mint, parsley, dill, cilantro, coriander.
	Beken: ginger, chili, pepper, salt, mustard, cumin, cinnamon, cardamom, and anise.
hot/cold natured foods and hot and cold meals	pay attention to foods hot and cold in nature. Cold energy foods can be steamed, boiled, cooked in oil to change the nature.
	When you are balanced eat neutral temperature foods, the cold or hot can throw off balance.
Eating portions	Eat appropriate amount if a heavy or light food.
	4 parts of the stomach: 1/4 loong, 1/4 liquids, 1/2 soild.
	Snaking not good for Beken types, better for Loong types as long as nutritious.
	Try not to eat 2 hours before bed.
Fluids	loong: fluids or small amount of alcohol after eating, helps with weight gain.
	tripa: ingesting fluids in middle of eating with solid food, helps maintain current weight
	beken: ingesting before meals with water and honey, helps to lose weight.
	warm water after meal supports digestion.
	Tibetan diet shuns raw vegetable diets. Tripa types do better with it, like athletes.
	Agreeable and disagreeable foods. Make changes gradually. Food combinations can be almost poisonous-like, or allergenic.

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