Mountains in Tibet

Causative Factors of Illness

There are two main divisions in the causative factors of illness – long term causative factors and short term causative factors. This chapter also looks at how the disease enters our body and accumulates, and how it manifests and causes illnesses.

Inner circle of the Wheel of Life

Inner circle of the Wheel of Life

Long Term Causes

In the Tibetan medical texts it states that the main cause of every type of suffering or illness, is Ma-Rig-Pa or ignorance. They say that just as a bird is unable to escape it’s shadow no matter how high it flies, so are we unable to lose our ignorance which has been with us since our birth. Our basic ignorance generates the three poisons of desire, anger and delusion; this shows us clearly how Tibetan medicine is closely connected with Buddhist philosophy.


Desire is like salted water, as we drink more we need more; we are never satisfied with what we have. We have got so many wishes to fulfil and we are always seeking something which we believe will give us permanent happiness. However, lasting happiness is not something which can be gained only through material comforts, if this was the case we in the West would have no problems and in comparison to people in the East we would always be happy.

The teachings of Buddhism tell us that everything is impermanent. The Tibetans, for example, have lost their country and when the first exiles escaped across the Himalayas they were unable to bring a single family heirloom, even after so many generations of them living in Tibet. This shows how it is foolish to keep on planning for the distant future when we do not know what will happen the very next day. My mother always used to tell me that one day we have to leave our bodies behind and go into the next world empty handed and alone.

This sort of basic belief helps Tibetans to appreciate the little comforts which we have and to be contented with them. One of my father’s friends used to say that as long as we are not in debt we are rich. So basic simplicity in our lives is best. Desire generates greed, and when our wishes are not fulfilled we become restless and suffer from sleeplessness. This causes further anxiety and tension which can disrupt the subtle flow of Loong and in some extreme cases it can cause madness. In the Tibetan medical texts desire is symbolised by a bird which is the creature most associated with sex in the animal kingdom.


Anger is the most destructive inner enemy both for ourselves and others. It is generated by feelings such as envy, jealousy, pride, selfishness and the mental attitude which states “I am right and you all are wrong.” A person who is angry has no patience and no time to think clearly what it is they want to do, they will try instead to do everything on the spot, and this can often lead to misfortune and failure. When this happens they will blame others for their mistakes and they might even become abusive and physically violent, leading to further actions which harm and kill.

When we are angry it feels like the anger is coming from the middle of our body from around the region of our liver and gall bladder. In English we say when we are angry, “My blood is boiling”. It changes the colour of our face and increases our bodily temperature. Constant anger can disrupt our heat energy and cause disorders related to mKhris-pa. Anger is symbolised in the medical texts by a snake. It is helpful when you feel angry to visualise that you are standing in front of a snow capped mountain which is able to melt the fire-like anger; it is also helpful to visualise how ugly anger can be by picturing someone whose face is distorted by anger. And if, for example, we have feelings of anger towards our parents we should visualise them as old, grey and full of wrinkles; how can we then feel angry towards someone who is so obviously no threat to us?


Delusion is like a fog which permeates our mind and body; it generates laziness. Due to laziness we leave everything to the last minute, we don’t want to do much physical activities like exercise or cooking proper food, and sometimes we don’t even want to think. Because of this we wish to do everything in the easiest, cheapest and quickest way. This behaviour can lead to us becoming overweight and mentally dull, which in turn disrupts our bodily fluids and causes Bad-Kan disorders. In the medical texts delusion is symbolised by a pig and also in English we have the expression “pig ignorant”.

Short Term Causes

These are –

  1. Improper diet and lifestyle
  2. Seasonal factors
  3. Spirits

1. Improper Diet & Lifestyle

In the West scientists are still investigating whether there is a connection between illness and diet, however in Tibetan medicine it has already been confirmed that improper diet and lifestyle can cause physical and mental illnesses. From my experience of three different kinds of society - Tibetan, Indian and Western - I can say that different countries have different illnesses connected with their peoples’ eating habits and the way the people lead their lives.

In the Tibetan community people drink butter tea (a combination of butter, salt, milk and tea churned together) in excessive amounts, much more, for example, than the amounts of tea which the English drink. As refugees the generation to which my parents belong have led strenuous physical lives, performing such work as quarrying, demolishing rocks through the use of explosives, and road construction in North India often in extreme climates of heat and cold. Therefore the biggest problems within the Tibetan community are hypertension which is caused through taking in too much salt, and arthritis, eye, hearing and back problems which have been caused by a life of physical hardship.

By contrast to the Tibetans, Indians love sweets, hot spicy foods, they drink too much iced water in the summer months, chew too much pan (a mixture of beetle leaf, beetle nut, slaked lime and other herbs and spices) and they smoke too many beedis (a very popular cheap Indian cigarette). In the large cities where the populations can be huge, there is also not too many facilities for them to do much physical exercise, therefore people are unfit. Due to hese factors the main health problems in India are diabetes, asthma, ulcers, mouth and throat cancer and obesity.

In the West people eat too much sugar such as in sweets, chocolate and fizzy drinks, fatty and starchy foods, and drink too much tea, coffee and alcohol and smoke too much. The lifestyle is generally very fast with people constantly rushing around and having little time to relax. In the cities the majority of people are employed in jobs which involve sitting at a desk and therefore they do not do too much physical exercise; Many people also drive to work and can therefore quite easily spend their working day doing very little walking at all. These factors lead to problems such as heart disease, cancer, insomnia, depression, tooth decay, digestive, skin and weight problems to name but a few.

These above examples show us that improper diet and unwholesome lifestyle can cause mental and physical illnesses.

Causes and conditions which imbalance the Nyipa-Sum.

We have already discussed the type, location and function of Loong, mKhris-pa and Bad-Kan within the body, here we will see the effects of them being disrupted.

Loong is one of the three principal energies of the body which has the nature of the air element. It is characterised by being movable, light, cold, subtle, hard and rough. The subtle flow of Loong is disrupted if we take in excess food and drink which have the same characteristics as itself, such as coffee, tea, pork, goats milk, yoghurt, white and black peppers, white bread, coca cola, chocolate, grapefruit, lemon, lime. Loong is disrupted when we perform actions such as fasting and giving ourselves too much mental stress, or if we suffer excess blood loss from the body either through accident or labour, have too much sexual activity, skip meals and do not eat at the appropriate times. The natural flow of Loong will also be disrupted if we suffer from chronic diarrhoea and vomiting, grieve too much for loved ones we have lost, talk excessively, try to repress the normal eliminating functions of the body, physically strain ourselves too much on an empty stomach, cry until we collapse and work long hours without rest.

MKhris-pa has the same nature as the fire element. It is characterised by being hot, sharp, oily, of strong odour, purgative and fluid. Our bodily heat is increased and mKhris-pa is disrupted if we take in excess food and drink with similar characteristics to it, such as alcohol, (especially spirits like whisky), lamb, duck, eggs, garlic, chilli, butter, milk, full fat cheese and cream, nuts, seeds. Wrong actions such as doing too much strenuous physical exercise in the heat, constantly being full of anger, sleeping in the middle of the day, doing excess physical labour such as digging when gardening, can also lead to mKhris-pa disorders.

Bad-Kan has the same nature as the water and earth elements. The characteristics of Bad-Kan are that it is heavy, smooth, blunt, oily, cool, firm and sticky. Bad-Kan energy is disrupted if we take in excess food and drink with the same characteristics as it, such as sugar, potatoes, raw milk, raw vegetables, cold foods, half cooked meats, chilled drinks. Wrong actions such as sleeping on a full stomach, eating late at night, eating too fast, exposing our bodies to the cold weather by wearing inadequate clothing, eating before the food eaten previously has been properly digested and not performing enough physical exercise can all lead to Bad-Kan disorders such as indigestion and water retention.

Loong and Bad-Kan disorders are very common in the west whilst mKhris-pa disorders are common in countries such as India which has a hot climate.

Illnesses caused through misuse of the five senses

With regard to the five senses, the eyes for example, can become strained from sitting at computers for hours and hours, watching too much television, reading continuously, or straining the eyes by focusing on an object which is either too big or too small; if you sit in a dark place which has no natural light eye problems can also occur. In some cases the visual effect from seeing something repulsive such as vomit, faeces or blood can cause people to be sick and also in some cases illness can be caused merely by seeing something such as a snake slivering in the grass. These example give some indication of the power of the sense of sight.

Illnesses caused through misuse of mind body and speech

The body can be strained by physical activities, and in professions such as nursing and gardening the most common problems are back related, due to lifting patients and digging the ground, varicose veins can also be a problem for people whose work involves a lot of standing. Physical strains can also occur in jobs which require less heavy labour.

Recently I saw a woman patient in her late forties who is an estate agent and who spends many hours on the telephone talking to clients. As a result of this her neck was bent towards the right and, due to it being stiff, she was unable to straighten it. I prescribed herbal medicines to relax the muscles and nerves in her neck and on a practical level I advised her to buy a telephone with headphones so that this problem would not re-occur.

In another case a patient of mine who is in his early forties and who does a lot of computer work as a book editor, strained his wrist and arm to such an extent that he had to take a long rest from his work in order to recover. This shows how repetitive actions can lead to physical strains. In the same way if we do very little physical activity problems might occur, such as gaining too much weight, obesity, listlessness.

The mind can be strained by such things as continually focusing on one subject, worrying over something such as money, the possibility of losing a job or a partner, grieving for a loved one, being consumed by desire for promotion at work, or even worrying about one’s age. All these factors can contribute to suffering from complaints such as blood pressure, heart disease and insomnia.

When the mind is underused, it can forget what it knows. In my own case when I was working at the Tibetan Medical & Astro Institute branch clinic in New Delhi where the majority of patients are Indian, it was necessary for me to learn Hindi in order to communicate with them. During that time I was able to speak Hindi quite well and I was able to use the relevant medical terms, however since being in England for some years, where I do not need to speak Hindi, I have now forgotten a great deal of this.

Speech can be strained by such activities as continually shouting, screaming and even singing. To a lesser extent people in professions such as teaching, lecturing, politics and entertainment can get very exhausted through having to talk all day. It can also be the case that when some people talk continually even the people listening to them can become exhausted!

From the above examples we can see it is important to be moderate in our use of the five senses and our body, speech and mind.

2. Seasonal Factors

The Tibetan lunar calendar is divided into 6 seasons - late winter, spring, dry summer, wet summer, autumn and early winter.

It is very important for each season to occur at the right time, otherwise when it is too hot, too wet or too cold the external imbalance of the season will lead to internal imbalance of the three principal energies of Loong, mKhris-pa and Bad-Kan.

During the dry summer which in the Western calendar corresponds to months May and June, the environmental qualities become light and dry. These have the same characteristics as Loong, therefore if you are Loong nature and if you eat lots of non – nutritious light and rough food, along with having mental stress, Loong will accumulate in your body.

During the wet summer which corresponds to the months July and August, the environment becomes cooler due to rain and wind. This aggravates Loong and it becomes manifest, leading to illness, this is shown by the fact that breathing problems such as asthma, bronchitis and joint problems worsen during this time.

During autumn which corresponds to September and October when the environment qualities become warm and oily, they counteract and pacify Loong.

For mKhris-pa during wet summer (July and August) the environmental qualities become cool and oily. If you are mKhris-pa nature and you eat lots of hot, sharp and sour potency food and you perform lots of strenuous physical activity mKhris-pa accumulates in the body.

In the autumn (September and October) the environmental qualities become warm and oily which aggravates mKhris-pa and therefore mKhris-pa disorders become manifest, leading to illnesses such as the flaring up of skin diseases, headaches, high blood pressure.

In early winter which corresponds to November and December the environmental qualities become cold which counteract and pacify mKhris-pa.

In late winter which corresponds to January and February, the environmental qualities are cold, heavy, blunt and oily. If your body nature is Bad-Kan and you eat lots of cold and raw food and do little exercise Bad-Kan accumulates.

In the spring which corresponds to March and April the environmental qualities are warm and Bad-Kan disorders manifest such as digestive problems, asthma, colds, flu and weight problems.

In the dry summer (May and June) the environmental qualities become light and dry which counteract the Bad-Kan and pacify it.

Table Showing the Relationship Between Disease and Seasonal Factors

Tibetan Month Western Month Seasons Environmental Qualities Accumulation in the Body Manifestation of Disorder Pacification of Imbalance
12, 1 1,2 Late Winter Cold, heavy, oily Bad-Kan - -
2, 3 3,4 Spring Warm - Bad-Kan -
4, 5 5,6 Dry Summer Light, dry Loong - Bad-Kan
6, 7 7,8 Wet Summer Oily, cool MKhris-pa Loong -
8, 9 9,10 Autumn Warm, oily - MKhris-pa Loong
10, 11 11,12 Early Winter Cold - - MKhris-pa