Within and Without

The fifteenth-century scholar-monk Tagtsang Lotsawa Sherab Rinchen said all the phenomena of the world—both immobile (inanimate/planetary/macrocosmic) and mobile (animate/sentient beings/microcosmic)—are formed and exist depending upon the earth, water, fire, air, and space. These are thus called elements (jungwa).  

Similarly, a line in Kalachakra Tantra states that the external world reflects the internal in its composition of the five elements: as within, so without. For instance, water does not mean a molecule of H2O but its inherent energetic function to bring about qualities of heaviness, flexibility, coolness, etc.  

The text emphasizes that all phenomena—all things that exist—are interdependent and explains the importance of understanding this interdependence in medical practice. It also conveys that the view perceiving the middle way is the right way and the best way.¹ A Tibetan medicine doctor must comprehend all medical principles and their related approaches when practicing so that deficiency, excess, and adverse thoughts and actions do not arise.  

For instance, eating too little, too much, or incompatible food and drink in the long run can cause issues with physical stamina, indigestion, and debilitation respectively. Therefore, it is advised to fill the stomach halfway if the food is heavy (appears difficult to digest), leaving the third quarter for beverage and the fourth quarter for the digestive warmth to take its course to effectively digest the food and drink. One can fully fill their stomach if the food is light and easy to digest, such as noodle soup. Such habits help us digest food with ease and comfort.²

The body that we cherish so much and care for day and night to maintain health and sustain life is impermanent in nature. Anything can happen to it at any time. The union of two parental seeds in the womb serves as the cause of formation of a new body. The conditions that help this formation are the parents’ physical relation; a desire to be born as an offspring in the mind of the being in the intermediate state, along with an arousal of afflictive emotions and karmic connections; and the convergence of the five elements of the cause, condition, and law of interdependence.³

The general cause of all disorders is the one and only ignorance (marigpa). Due to ignorance, one does not understand the intrinsic reality of the concept of non-self. From it, arises the three specific causes—the mental poisons of attachment, hatred, and closed-mindedness—and this in turn results in the development of the three forces or physical energies (nyepa), wind (lung), bile (thipa), and phlegm (beken) respectively.⁴

The body thrives depending upon the convergence and proper functioning of the three forces or physical energies (nyepa), seven bodily constituents or physical strengths (lu zung) and three waste products (dri-ma). Since these act as the root of the birth, existence, and disintegration of the body, the body is called lu (depend upon or leave behind).⁵

When physical energies, bodily constituents, and waste products function properly and are in balanced state it is considered healthy. A state of dysfunction or imbalance is unhealthy. Sicknesses arise from three sources: disturbances of the physical energies of this lifetime, ripening of the past karmic imprint, and the combination of physical energies disturbances and past karmic imprint.⁶

If someone loses their outer, inner, and vital life constituents or force (namely the function of the muscles, leaving them unable to eat food and become malnourished) and channels functions, one will certainly die. The aggravation of the physical energies, bodily constituents, and waste products disturbs their balance and destroys each other’s force, causing the deterioration and death of the human body.⁷

The four elements of earth, air, water, and fire form the bodies of sentient beings. Disorders also derive from the four elements. The antidote, called medicines, have the four elements. Thus, the body, disorders, and antidotes are all linked to the same nature.⁸

The innate desire of sentient beings is to avoid suffering and achieve happiness. Hence, people engage in all sorts of activities to find comfort and contentment. Yet without a proper approach, happiness itself can become the cause of suffering. Therefore, every effort must be made to seek guidance to have happiness and comfort in this and future lives.⁹