The Doctor Is WithinBy Pico Iyer
Associated Press/Ashwini Bhatia
“Dream ”” nothing!” is one of the many things I’ve heard the 14th Dalai Lama say to large audiences that seem to startle the unprepared. Just before I began an onstage conversation with him at New York Town’s Hall in May, he told me, “If I had magical powers, I’d never need an operation!” and broke into guffaws as he thought of the three-hour gallbladder operation he’d been through last October, weeks after being in hospital for another ailment. For a Buddhist, after all, our power lies nowhere but ourselves.
We can’t change the world except insofar as we change the way we look at the world ”” and, in fact, any one of us can make that change, in any direction, at any moment. The point of life, in the view of the Dalai Lama, is happiness, and that lies within our grasp, our untapped potential, with every breath.
Easy for him to say, you might scoff. He’s a monk, he meditates for four hours as soon as he wakes up and he’s believed by his flock to be an incarnation of a god. Yet when you think back on his circumstances, you recall that he was made ruler of a large and fractious nation when he was only 4 years old. He was facing a civil war of sorts in Lhasa when he was just 11, and when he was 15, he was made full political leader and had to start protecting his country against Mao Zedong and Zhou Enlai, leaders of the world’s largest (and sometimes least tractable) nation.
This spring marked the completion of half a century for him in exile, trying to guide and serve 6 million Tibetans he hasn’t seen in 50 years, and to rally 150,000 or so exiled Tibetans who have in most cases never seen Tibet. This isn’t an obvious recipe for producing a vividly contagious optimism.
Yet in 35 years of talking to the Dalai Lama, and covering him everywhere from Zurich to Hiroshima, as a non-Buddhist, skeptical journalist, I’ve found him to be as deeply confident, and therefore sunny, as anyone I’ve met. And I’ve begun to think that his almost visible glow does not come from any mysterious or unique source. Indeed, mysteries and rumors of his own uniqueness are two of the things that cause him most instantly to erupt into warm laughter. The Dalai Lama I’ve seen is a realist (which is what makes his optimism the more impressive and persuasive). And he’s as practical as the man he calls his “boss.”
The Buddha generally presented himself as more physician than metaphysician: if an arrow is sticking out of your side, he famously said, don’t argue about where it came from or who made it; just pull it out. You make your way to happiness not by fretting about it or trafficking in New Age affirmations, but simply by finding the cause of your suffering, and then attending to it, as any doctor (of mind or body) might do.
The first words the Dalai Lama reportedly said when he came into exile, I learned not long ago, were “Now we are free.” He had just lost his homeland, his seeming destiny, contact with the people he had been chosen to rule; he had been forced to undergo a harrowing flight for 14 days across the highest mountains in the world. But his first instinct ”” the result of training and teaching, no doubt, as much as of temperament ”” was to look at what he could do better. Now.
He could bring democratic and modern reforms to the Tibetan people that he might not so easily have done in old Tibet. He and his compatriots could learn from Western science and other religions, and give something back to them. He could create a new, improved Tibet ”” global and contemporary ”” outside Tibet. The very condition that most of us would see as loss, severance and confinement, he saw as possibility.
Not all Tibetans can be quite so sanguine and far-sighted, of course, and in terms of a resolution of Tibet’s political predicament with China, the Dalai Lama has made no visible progress in 50 years. Beijing is only coming down harder and harder on Tibet, as he frankly admits. But when I watch him around the world, I see that he’s visiting other countries and traditions in part to offer concrete, practical tips for happiness, or inner health, the way any physician might when making a house call. Think in terms of enemies, he suggests, and the only loser is yourself.
Concentrate on external wealth, he said at Town Hall, and at some point you realize it has limits ”” and you’re still feeling discontented. Take his word as law, he constantly implies, and you’re doing him ”” as well as yourself ”” a disservice, as you do when assuming that any physician is infallible, or can protect his patients from death in the end.
None of these are Buddhist laws as such ”” though in his case they arise from Buddhist teaching ”” any more than the law of universal gravitation is Christian, just because it happened to be formulated by Isaac Newton (who said, “God created everything by number, weight and measure”). I’ve been spending time for 18 years in a Benedictine monastery, and the monks I know there have likewise found out how to be delighted by the smallest birthday cake. Happiness is not pleasure, they know, and unhappiness, as the Buddhists say, is not the same as suffering. Suffering ”” in the sense of old age, sickness and death ”” is the law of life; unhappiness is just the position we choose ”” or can not choose ”” to bring to it.
Not long ago, I was traveling with the Dalai Lama across Japan and another journalist came into our bullet-train compartment for an interview. “Your Holiness,” he said, “you have seen so much sorrow and loss in your life. Your people have been killed and your country has been occupied. You have had to worry about the welfare of Tibet every day since you were four years old. How can you always remain so happy and smiling?”
”My profession,” said the Dalai Lama instantly, as if he hardly had to think about it. His answer could mean many things, but one of the better things it meant to me was that that kind of happiness is within the reach of almost anyone. We can work on it as we work on our backhands, our soufflÃ©s or our muscles in the gym. True happiness, in that sense, doesn’t mean trying to acquire things, so much as letting go of things (our illusions and attachments). It’s only the clouds of short-sightedness or ignorance, the teachers from the Dalai Lama’s tradition suggest, that prevent us from seeing that our essential nature, whether we’re Buddhist or not, is blue sky.
Efficacy of Tibetan Medicine as an Adjunct in the Treatment of Type 2 Diabetes
- Tenzin Namdul, BTMS,
- Ajay Sood, DM,
- Lakshmy Ramakrishnan, PHD,
- Ravindra M. Pandey, PHD and
- Denish Moorthy, MBBS
From the Department of Research and Development (T.N.), the Tibetan Medical and Astrological Institute (TMAI), Dharamsala, Himachal Pradesh; and the Departments of Endocrinology and Metabolism (A.S., D.M.), Cardiology (L.R.), and Biostatistics (R.M.P.), All India Institute of Medical Sciences, New Delhi, India.
- Address correspondence to Dr. R.M. Pandey, Department of Biostatistics, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India. E-mail: firstname.lastname@example.org .
Diabetes is the most frequently seen chronic disease in Tibetan medical clinics (1). Ancient texts of Tibetan medicine outline the successful management of diabetes (2). However, there is a paucity of systematic research studies using modern scientific tools to evaluate the efficacy of Tibetan medicine. Therefore, we undertook a study to assess the efficacy of Tibetan medicine when combined with a diet and exercise regimen compared with a diet and exercise regimen alone in controlling the blood glucose and glycated hemoglobin (GHb) in newly diagnosed or untreated type 2 diabetes.
A total of 200 newly diagnosed or untreated type 2 diabetic patients, who were eligible and consented to participate in the trial, were recruited from two branch clinics of the Tibetan Medical and Astrological Institute (TMAI), the Bangalore Branch Clinic in South India and the New Delhi Branch Clinic in north India, from April 1997 to April 2000. The subjects were aged 30-65 years, with a fasting venous plasma glucose (FPG) value between 140 and 250 mg/dl and a postprandial plasma glucose (PPG) value of â‰¥200 mg/dl. The subjects were willing to follow dietary and lifestyle guidelines. Patients who had an FPG >250 mg/dl, who had a BMI <19 kg/m2, or who were insulin dependent, were not included in the study. The other criteria for exclusion were hypertension, heart disease, kidney failure, pregnancy, a period of lactation <6 months, history of a blackout episode, or any complaint of vision loss.
At each center, all of the 200 subjects, 136 men and 64 women, were randomized into two groups, the treatment group and the control group. The treatment group was treated with Tibetan medication in the form of powder or pills, as prescribed by a practitioner of Tibetan medicine, in addition to the modification of diet and lifestyle recommended by the American Diabetes Association (3). At least two of four Tibetan medicines (Kyura-6, Aru-18, Yungwa-4, and Sugmel-19) were administered based on each patient’s age, sex, personality, pulse, and urine characteristics. Subjects in the control group were treated only with the dietary and lifestyle modification. The study was not blind, and the subjects gave their informed consent. The TMAI Ethics Committee approved the study.
A predesigned proforma was created for each patient. FPG, 2-h PPG, and GHb levels were estimated at baseline, 12 weeks, and 24 weeks. Of the 200 subjects, 136 patients completed 12 weeks of follow-up and 112 patients completed 24 weeks of follow-up. The age, sex, BMI, FPG, PPG, serum cholesterol, serum triglycerides, serum HDL, and GHb of the subjects who withdrew at 12 and 24 weeks were similar in both groups at the baseline. Therefore, an intention-to-treat analysis was performed. A Student’s t test was used to compare the mean values between the two groups. Ï‡2 test was applied to assess the association between the two groups and the other categorical variables. The STATA 6.0 intercooled version (STATA, Houston, Texas) was used to analyze data.
The treatment and control groups were comparable with regard to age, sex, blood pressure, body weight, BMI, serum creatinine, and urine albuminuria. However, despite randomization, the treatment group had worse symptoms, including significantly higher FPG and PPG values (178.2 ± 34.1 and 284.4 ± 65.3 mg/dl vs. 166.4 ± 35.5 and 260.2 ± 71.1 mg/dl, P < 0.05), as well as a higher GHb value (9.4 ± 3.0 vs. 8.5 ± 2.3%, P < 0.01), indicating poorer glycemic control at the start of the study in the treatment group. The treatment group also had a higher serum cholesterol level.
The percentage change in the levels of these parameters was calculated from the baseline of the treatment group, because the baseline plasma glucose values were different between the two groups (Fig. 1). Fasting blood glucose levels decreased by 12.2 ± 30.5% at 12 weeks and by 23.4 ± 20.0% at 24 weeks in the treatment group compared with 7.4 ± 30 and 6.4 ± 27.7% in the control group (t = 0.94, P = 0.35 at 12 weeks; t = 3.76, P = 0.0003 at 24 weeks). The PPG measurement was significantly lower in the treatment group at 12 and 24 weeks (decrease of 18.0 ± 31.2 and 23.4 ± 27.1%) compared with the control group (decrease of 5.5 ± 32.9 and 10.0 ± 41.2%) (t = 2.21, P = 0.02 at 12 weeks; t = 1.98, P = 0.05 at 24 weeks). At 12 weeks, the percentage decrease in the GHb levels was 1.9 ± 35.8% in the control group compared with 17.5 ± 31.3% in the treatment group (t = 2.58, P = 0.011). At 24 weeks, the decrease in GHb was 21.8 ± 30.1% in the treatment group compared with 6.7 ± 29.3% in the control group (t = 2.44, P = 0.02). There was no significant change in body weight, blood pressure, or serum lipids in either group.
””Change in fasting plasma glucose (A), postprandial plasma glucose (B), and GHb (C), after treatment with Tibetan medicine. â–µ, Control; â–¡, treatment. *P < 0.05.
Previous studies have reported that when used alone or in conjunction with sulfonylureas, traditional Chinese medicine decreases the fasting and postprandial blood glucose levels in diabetic patients (4,5). Chinese medicine has been reported to improve the symptoms of diabetes and insulin and glucose blood levels (5). However, there are no published reports in English medical literature regarding the effectiveness of Tibetan medicine in the treatment of diabetes. We report a significant improvement in glycemic control with the use of Tibetan medicine in patients with a recent onset of type 2 diabetes compared with patients treated only with diet and exercise. The improvement in glycemic control was observed at 3 and 6 months after the start of the treatment. We have not measured insulin or C-peptide levels in our patients.
One of the limitations of this study was a high drop-out rate during follow-up. However, the characteristics of the subjects who dropped out from the two groups were similar and therefore should not alter the conclusions. Further evaluation of the Tibetan medical system in patients with diabetes will require blinded placebo controlled trials and comparisons of this system with other available oral hypoglycemic agents.
We would like to express our heartfelt gratitude to His Holiness the Dalai Lama for his immutable guidance and encouragement in initiating this project. We gratefully acknowledge the constant advice and pivotal role played by Dr. Tenzin Chodak and Dr. Lobsang Wangyal. We give our sincere thanks to Dr. Namgyal Qusar, Dr. Namgyal Tenzin, Mrs. Saroj, Ms. Indira, the Men-Tsee-Khang administration, the senior participating doctors (T. Tamdin, N. Tsering, S. Lhamo, D. Rabten, Y. Dorjee, T. Tsephel, T. Gyaltsen, P. Yangchen, P. Lhamo, T. Kyizom, T. Kyipa, and L. Chodhar), the junior participating doctors (K. Dorjee, T. Sangmo, D. Sangmo, S. Dolma, T. Lhamo, P. Dhondup, and T. Norbu), and last, but by no means the least, our grateful thanks to all of the patients for participating in the study.
- by the American Diabetes Association, Inc.