Bhutanese Medical System: The Bhutanese medical system goes well beyond the notion of medicine in the narrow western sense. It forms a part of their culture and tradition, in which "Buddhism" is the prevailing influence. Health and spirituality are inseparable and together they reveal the true origin of any sickness. The art of healing is, therefore, a dimension of the sacred life style of Bhutanese people. The system of medicine used in Bhutan is known as "Sowa Rigpa". Today, this medical system is practiced in many countries, but owing to its origin and development in ancient Tibet, it is, currently, known throughout the world as Tibetan Medicine. It is believed that at the beginning of time, the art of healing was a prerogative of the Gods, and it was not until "Kashiraja Dewadas", an ancient Indian king, went to heaven to learn medicine from them, that it could be offered to man as a means to fight suffering. He taught his progeny the principles and the practice of healing, and this knowledge was spread and perpetuated as an oral tradition until Lord Buddha appeared and gave specific written teachings on medicine. These were recorded in Sanskrit and became part of early Buddhist sacred writings. When Buddhism was first brought into Tibet in the 8th century by Guru Rimpoche, some of these medicinal texts were translated into Tibetan language and enlightened rulers of that country became interested in the subject. They started promoting the development of the art of healing by organising meetings on medicine to which they invited healers not only from the whole of Tibet and surrounding Himalayan countries, but also from China, India and the Muslim world. It is reported that at these conferences all the different systems were examined and the best practices adopted and incorporated into the newly born Sowa Rigpa, which was then handed down from one generation to the next. This tradition was further enriched by the contribution of great Tibetan doctors, including Gyuthog "The Elder," in the 8th century, and one of his descendents, Gyuthog "the younger", who lived in the 11th century. The later made a notable contribution in spreading the celebrated Gyu-shi or "Four Medical Tantras" and its commentary, the "Vaidurya Ngonpo". The four medical tantras, which were originally Sanskrit texts dating perhaps from the 4th century, are unanimously considered to be the basic work of Tibetan medicine. It was under the reign of the 5th Dalai Lama that the Chagpori medical school, soon to become a famous centre of healing, was found at Lhasa. Sowa Rigpa in Bhutan : When shabdrung Ngawang Namgyal came to Bhutan in 1616, his Minister of Religion, Tenzin Drukey, who was also an esteemed physician, started the spread and teaching of Sowa Rigpa. Although, there were sporadic instances of Bhutanese being sent by their patrons to study this art in Tibet before, it was only after 1616 that Sowa Rigpa was established permanently in Bhutan. Since then the Bhutanese tradition of Sowa Rigpa has developed independently of its Tibetan origins and although the basic texts used are the same, some differences in practice make it a tradition peculiar to the country. The specific knowledge and experience gained by the Bhutanese over the centuries, are still very much alive in this medical tradition that originated in Tibet. The natural environment, with its exceptionally rich flora, also enabled the development of a pharmacopaeia, of which there is no equivalent anywhere in the world. Source of Medical Tradition : Though it took shape in Tibet, the traditional medicine, which is still practiced in Bhutan, has always been characterised by the diversity of its origins. It is based on the Indian and Chinese traditions and has incorporated ancient medical practices connected with magic and religion. However, in essence, it is based on the great principles of Buddhism and provides a comprehensive way of understanding the universe, mood and sickness. Indian sources, including Ayurvedic medicine, were the most important. They provided the majority of theoretical bases of the medical tradition, revealed to mankind through the channel of Vedic sages. In this tradition, man can be understood by analog with the universe, the physics laws and the matter which serve as a model of elementary physiology. There is, thus, an identity of nature between the solid parts of man and the earth, his fluids and water, his body heat and fire and his breadth and the wind. These parallels gave birth to the so-called theory of "humours", one of the fundamental principles of the medicine now practised in Bhutan. Chinese sources also played a decisive role. Here again, physiology and physiopathology are based on a close relation between the human microcosm and the universal macrocosm. For Chinese philosophers and doctors, these two worlds are governed by the same law, derived from an immutable and eternal principle, "Tao", of which there are two aspects : "Yin" or rest and "Yang" or movement. The entire universe, including human beings, thus goes forward rhythmically in accordance with the movements of Yin and Yang. In the medical spheres the balance or imbalance of this fundamental energy will result in health or sickness. In addition, the system of channels running through the body and enabling energy to circulate and the distinction between full and empty organs, are both taken from the middle kingdom. However, the most important contribution of Chinese medicine to the art of healing is the examination of the pulse which indicate, in particular, any disorder connected with an excess or shortage of Yin and Yang. These two great systems of thought inspired Bhutanese medicine, but there were also local influences. In many ancient accounts, sickness is usually attributed to demonic causes. Local gods, demons and spirit of all kings could be considered as responsible for certain illness. To, obtain healing, it was necessary to practice particular ritual and only monks or magicians were in a position to do so. This medical practise, thus, involved much divination as the means of diagnosing and recognising the spells causing the illness, and exorcism as the way of treating the patient. Even though medical techniques in Bhutan developed subsequently, observation, experience, study, knowledge and popular local beliefs had a definite influence on the way the traditional medicine evolved. Over and above these various influences, "Buddhism" itself is at the heart of Tibetan and Bhutanese medical traditions. Buddhism teaches that the existence of phenomena and suffering (Sickness, old age and death) have a single origin that prevents man from reaching Enlightement, namely the ignorance. This is the origin of the three moral poisons - desire, aggressiveness and mental darkness. General Principles of Bhutanese Medicine The theory of the three humours is one of the fundamental principles of traditional medicine. As has been mentioned above, Ayurvedic theories draw an analogy with the universe, the physics of which serves as a model for an elementary physiology. Comparatively speaking, one may say that the bile (Thripa) corresponds to fire, the phelgm (Beken) to water and the air (Lung) to the wind of the universe. Each humour has its own function in this general system. - Air is responsible for respiration and bodily activity, speech and the mind. It controls blood circulation. It is dry and light. - Bile stimulates and appetite, is responsible for digestion and maintains the normal temperature of the body. It is also claimed to confer bravery and wisdom. It is intimately connected with blood and body temperature. It represents organic fire and is essentially active. It is hot. - Phlegm sustains the body and procures sleep. It is responsible for the movements of joints, muscle development, and confers patience. It is the aqueous element associated with bodily fluids. It is passive, cold and heavy. These three fundamental humours have complementary activities. When their respective quantities are not modified, they help to maintain a normal state. Good health is thus the result of a harmonious balance between these three humours. But this balance can also be slightly modifed in non-pathological proportions, depending on general criteria, such as the seasonal cycles for example, or particular criteria such as individual temperament. At the same time, the predominance of one or another can lead to imbalance and indispositions of various kinds, and results in sickness. The three humours are, therefore, both physiological elements of the body that are vital for its existence and potentially pathogenic elements. Various causes can trigger an imbalance in the three humours. These include eating habits, life-style, living conditions and environment. Under their influence, the humour can be aggravated and become a pathology. Spells cast by evil spirits and the consequences of one's own karma or bad actions from the past, are other triggering causes. The specific symptoms of these modifications in the humours are then, clearly apparent in the pulse, urine and on the surface of the body. In the event of sickness, pathological imbalances in the air, bile and phlegm are treated with antagonistic elements, namely drugs based respectively on earth, water and fire elements. Given the magical and religious aspects of certain disorders, prayer and virtuous practices may also be associated with conventional treatment.