Interview with Neeshee Pandit, part 2
Theory and Practice across Three Asian Medical Systems
Read part 1 of the interview for an introduction to Neeshee Pandit, Ayurvedic, Chinese and Tibetan Medicine practitioner and astrologer. And be sure to check out Somaraja here on Substack, where Neeshee-ji writes on many topics of likely interest to Seeds readers.
JE: Tell us more about your Ayurvedic teacher Vaidya Mishra's lineage: what's distinctive about it, what are some of the hallmarks?
NP: Vaidya Mishra referred to his family lineage as the "Shaka Vansya Ayurveda" lineage. He traces it back to Lord Krishna, but this is likely just mythology. There are several hallmarks of his approach which could be summarized as "sutra to science" and "pulse and marma." Vaidya was an amazing herbalist and after coming to the United States, he noticed that Western patients were not metabolizing herbal medicines properly, due to conditions of toxicity. In response to this, he formulated transdermal herbal applications that allowed for absorption via the skin rather than through the already-burdened digestive system of most patients. He also created "herbal memory nectar drops," in which only the vibrational imprint of the herb remained in a base of vegetable glycerin. This approach was rather homeopathic, as there was no detectable physical herb, but only its energetic "memory." He referred to his unique herbal delivery system as the "transdermal marma system," as the transdermal herbs would be clinically applied to marma points. This treatment style he referred to as "pulse and marma”––emphasizing a complex pulse diagnosis system and marma therapy as a primary treatment paradigm. Suśruta describes 107 marma points––Vaidya's lineage expanded on this and had preserved many additional point locations not found in classical texts.
Other interesting aspects of Vaidya's teaching include his emphasis on the four types of toxins (ama, amavisha, garvisha, indravajravijanavisha). The first (ama) is familiar to all Ayurvedic practitioners, but the remaining three less so. Amavisha is a development of long-standing ama––it refers to a "hot" (or acidic) toxin. Garvisha refers to environmental toxins of all kinds, a significant issue in today's world. And indravajravijanavisha was seen by Vaidya as a reference to electromagnetic frequencies. He was unique in considering EMFs a major etiological factor that could interfere with effective treatment.
JE: Regarding Tibetan Medicine, I’ve always been curious about how it accomplishes its synthesis (or reconciliation, if that's a better word) of two quite disparate sets of roots—Ayurvedic and Chinese—plus a third set, really, in Vajrayana Buddhism. For instance, do practitioners use the five phases and the 12 organ networks (i.e. Chinese Medicine theory) some of the time and the three doshas (Ayurvedic theory) at other times, or is there a broader framework that integrates all of the above?
NP: Tibetan Medicine is the original "integrative medicine" of the world. While Ayurveda and Chinese medicine are major influences, Tibetan medicine also incorporates aspects of Greek and Persio-Arabic medicine, alongside indigenous Tibetan shamanism. Tibetan medicine developed its synthesis over many centuries by inviting physicians from neighboring cultures to share their medical systems. One such example was Galen, who is said to have become a resident physician in the Tibetan courts. In terms of Ayurvedic influence, the Astanga Hridayam was a primary textual transmission from India to Tibet, because Vagbhata was a Buddhist. Significant aspects of Ayurvedic medicine are now preserved in Tibetan medicine due to the transmission of Buddhism from India to Tibet. In this sense, we could see Tibetan medicine as a "Buddhist" stream of Ayurveda. However, the Tibetans also preserved and perfected rasa shastra, and have clear influences from the South Indian Siddha tradition. The "precious pills" of Tibetan medicine still use mercury [note: always in a purified, stable form as mercury sulphide -JE], and I had the honor of meeting a Tibetan herbalist once who was renowned for his alchemical preparations.
The Tibetans use tridosha to evaluate the compositional quality of things––constitution and materia medica––as these are seen as having "fixed" natures. Thus, when classifying foods, herbs, and constitutional types, tridosha remains the reigning paradigm. Yet, the Tibetans use Chinese five-phase theory to examine the pulse and to account for a number of astrological / divinatory factors. These are seen as having a more dynamic and present-time value where the cyclical phases become relevant. I always found the Tibetans' contextual application of these theories to be fascinating.
Tibetan medicine does place more emphasis on the twelve organs than Ayurveda does, a clear Chinese influence. But the twelve organs are not connected to each other via a functional network of meridians. There is channel theory in Tibetan medicine, but it is based on Indian and Tibetan tantric traditions, rather than Chinese meridian theory. Given how much the Tibetans incorporated from China, the lack of a meridian paradigm still surprises me.
JE: I’ve marveled at times at the efficacy of the Tibetan herbal tradition and how much it manages to rely on sui generis medicinals and high-elevation Himalayan plants (though I recognize that they do import triphala, spices, etc. from India, and presumably some things from China as well). I'm curious about the history of their herbal formulas - do we know you wrote them, and how they emerged? Was there a (mythical or historical) Shennong-like figure in Tibet?
NP: As for herbs, you are right––they use materia medica unique to the Tibetan plateau and import Ayurvedic medicinals / spices. There is also some significant crossover with Chinese materia medica, suggesting a clear influence from Chinese herbalism as well. Most of the herbal formulas in Tibetan medicine have mythological origins––they were revealed in dreams as a kind of hidden treasure (terma) to great Masters. Nagarjuna, for example, is credited with writing (or "revealing") a number of such formulas. This topic has been well-studied by anthropologist Barbara Gerke in "The Signature of Recipes: Authorship, Intertextuality, and the Epistemic Genre of Tibetan Formulas."
JE: I love seeing this reference to Barbara Gerke’s work—she was part of my earliest exposure to these traditions when my undergrad study abroad program visited her then-center in the Darjeeling Hills of India. Small world department. Now, zooming back out for a moment, it's rare to meet someone versed as you are in all three of these great Asian medicine traditions (we might need to add Unani to the list of great Asian medicine traditions, too). From your unique perspective as a student/practitioner of these three, would you share a little about what you see as the respective strengths of Ayurveda, Chinese Medicine and Tibetan Medicine? What unique contributions does each tradition bring? And how might a prospective patient go about deciding which kind of practitioner to visit?
NP: Each system certainly has its strengths, which I think of as emphases. Ayurveda is largely a diet and lifestyle medicine––it is primarily oriented to counseling patients in appropriate diet and healthy routines. This focus comes from the Vedic tradition which relied on a highly ritualized form of life to receive the favor of the gods––everything is thus "timed" to enact a harmony between microcosm and macrocosm. If we look at Ayurveda, we see that it can keep us busy all day with lifestyle practices! Ayurveda has re-emerged in the West via "spa therapies", but its main strength is as a diet and lifestyle medicine, and therefore as a preventative paradigm. Ayurveda's unique theoretical contribution is likely its constitutional paradigm––its emphasis on understanding the unique individual constitution and the importance of living in accordance with it. I also find that Ayurveda's ability to differentiate constitution from imbalances (or prakriti from vikriti) is very helpful, and not as strongly delineated in other traditions. For example, in Chinese medicine, constitutional ideas do exist [editor’s note: see recent post on Dr Huang Huang’s new book and constitutional approach to Chinese herbal medicine - JE] but they are less defined, and are not as clinically significant as they are in Ayurvedic practice. Ayurveda also has a unique therapeutic paradigm in panchakarma, its traditional detoxification regimen, and in its emphasis on rejuvenation (rasāyana).
Chinese medicine gives us a unique physiological framework with the twelve meridians and organ networks. While Ayurveda has marma therapy, the Chinese are the ones who have truly developed an energy medicine. The Chinese application of acupuncture and moxibustion on points and meridians has no real parallel in Ayurveda or Tibetan medicine, and it is a remarkably powerful clinical therapy. Ayurveda and Tibetan medicine have rich anatomical paradigms, but the Chinese have observed the esoteric anatomy of the human being in unique detail, and formulated a clinical approach in relation to it. I think it is essential for Ayurvedic and Tibetan medicine practitioners to at least gain some knowledge of acupuncture, though this can be challenging in the climate of licensure / accreditation in America. Acupuncture stands out as the unique contribution, but the Chinese herbal tradition is also quite rich and sophisticated. Chinese five-phase theory, as first expounded in the Nan Jing, is also an indispensable contribution to medicine as a whole.
Tibetan medicine is an integrative system, because it functions as an umbrella for so many other medical systems, all elegantly synthesized in its theory and praxis. This gives Tibetan medicine an historical wholeness that other traditions sometimes lack. For example, Tibetan medicine still utilizes demonological concepts that stem from its indigenous (and animistic) worldview. This "eco-demonology" is a significant emphasis in Tibetan medicine, where the human relationship to the non-human world is regarded with great importance, and where human disturbance of the natural world is tied to complex etiologies of illness. Tibetan medicine has its holism intact, it offers a complete worldview without eschewing older ideas, and offers a framework where differing worldviews can comfortably co-exist. In contrast, Chinese medicine has been moving away from demonological ideas since the Han dynasty, favoring an agrarian framework that was conceived as being more rational and empirical than ideas of spirit-caused illness.
In terms of unique contributions, Tibetan medicine has a very sophisticated approach to bloodletting, not found in the same way as Ayurveda or Chinese medicine. There is good reason to accept moxibustion as an indigenous Tibetan practice, making this an interesting contribution––we do also see a highly developed approach to moxibustion in Chinese medicine and in Japanese styles of acupuncture. Medicinal baths (lums) are another unique contribution from Tibetan medicine, with many types of baths described and employed in treatment. As we can see, Tibetan medicine has a rich array of external therapies!
As for which system to choose, some patients have their natural inclinations. Many who are interested in Indian philosophy and yoga gravitate toward Ayurveda as a compatible paradigm. Buddhist practitioners, especially Tibetan Buddhists, will find Tibetan medicine more appropriate for their worldview and spiritual practice. Practitioners of Qigong, martial arts, and Daoist alchemy in general will appreciate Chinese medicine as a continuation of these practices and ideas. All three medical systems are rooted in unique worldviews, spiritual traditions, and cultural paradigms––it is for the patient to discover which resonates. We can also examine this more clinically: patients who are interested in nutritional counseling, detoxification, and rejuvenation will find Ayurveda quite useful; patients seeking a directly energetic and even psychotherapeutic approach to healing will find it satisfied in Chinese medicine and five-phase based approaches in general; and patients who desire a spiritually-informed medicine will find these principles most active in Tibetan medicine.
That being said, patients often come to see without a clear preference for a system. They know that I specialize in traditional Asian medicine and are looking for help with their concerns. In these cases, I become naturally eclectic. I think my intake style is most influenced by the "traditional diagnosis" of J.R. Worsley, and I use his system of pulse-taking as well. I will typically make dietary and lifestyle recommendations based on Ayurveda, because it just has so much to offer. People need to learn about the benefits of ghee, tongue scraping, abhyanga, neti, nasya––and these pearls are rather unique to Ayurveda. If I'm going to recommend herbs, then I will use Tibetan herbs. I gravitate to Tibetan herbs because the formulas are beautifully designed and the herbs are very high quality–– the plants are grown in a pristine environment, processed according to seasonal and astrological factors, and ritually empowered. Tibetan formulas also tend to "fit." In other words, I can listen to a patient and a classical formula can come to mind that fits their clinical portrait. I think we have to use whatever tools give us that sense of resonance, matching the patient as closely as possible. In terms of an external therapy, I make moxibustion a cornerstone of my sessions, and find it adequate in addressing a spectrum of concerns.
JE: There are so many threads here we could follow further here—I’m especially interested in the animist roots and ritual aspects of Tibetan Medicine, something that has indeed been largely lost in perhaps all but the most Daoist-influenced of Chinese medicine lineages—and we’ve barely touched on Jyotish and astrology! But we’ll wrap it up here for today. Thanks so much for sharing with us from your theoretical, academic and clinical expertise. It’s been a pleasure.