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CHANNELS    This is one of the most interesting and discussed aspects of TTM and one must be cautious when reading one or another author's interpretation. Some very eminent people have made (and continue to make) startling mistakes concerning this topic. The explanation here is based upon long discussions held with Prof. Khenpo Tsenam, who is in an exceptional position to comment being both one of (if not the) finest TTM physicians and also a most eminent Buddhist scholar.

The channels are an abstract description of physical realities. Let us take an example. A flowchart on an engineer's wall may show a series of lines and boxes indicating how raw materials are transformed into the end product in a factory. Out in the factory itself, there are not lines and boxes but crushing plants, piles and barrels of faw materials, boilers, stills, conveyor belts, tubes and a plethora of all sorts of things. The engineer's flowchart is an abstract simplification of all that but one which nevertheless enables a skilled person to understand exactly how slow-downs and faults in one part of the system will have repercussions elsewhere.

Likewise, the 'channels' are a simplified way of representing the main processes which keep the body alive. The reality of these processes is made of nerves, muscles, tissues, blood, bodily fluids, the complex chemistry in and between organs and so on and so forth. It is particularly concerned with relating one area of bodily activity to another, to show their interdependence. These channels are not something other than the processes. Thus TTM may speak of a channel between the liver and the eyes. It does not mean that there is some invisible channel between the two but simply that the one affects the other, through complex chemical and physical processes. For example, we know these days that the hypothalamus controls urination through the hormones it secretes and which are carried circuitously to the top of the kidneys through the blood stream. There is no direct 'tube' from the hypothalamus to the kidneys but that is just how TTM might have portrayed it to show the link between the two and to establish a mechanism. The channels are a schematic map of bodily relations, not an anatomical chart. This having been said, many of the main channels do correspond to major vascular, nervous and endocrine canals of the body, as these are its major highways of communication.

Not aware of this schematic nature of the channels, there are still many people these days who take the channels - as they are expressed in TTM - to be 'psychic channels', since there is no direct physical counterpart found in the dissected corpse. Others simply and erroneously equate the channels to branches of the central nervous system. It is not entirely their fault that such people miss the point when it comes to TTM. Buddhist practice uses similar stylised maps of the body in meditation and has developed a system whereby advanced meditation using them can sufficiently influence the brain to produce useful changes in the yogin's body. Furthermore, the stylised maps bear a relationship to the purified, divine body described in vajrayana Buddhism. One should take great pains not to confuse the medical and meditational systems. Doctors and meditators alike recommend this. To understand the relationship between the medcial and meditational channels requires considerable understanding and experience of meditation, as well as knowledge of the Buddhist concept of the universe. It needs the intelligence which can discern what applies to physical reality and what applies to mental exercise.

The texts describe four main types of channels. These are not four different types but the same channels discussed from four points of view, according to their function. They are:

   Generative channels, which give rise to the body and the three biodynamics
   Existence channels, which sustain the body, keep the senses clear, the mind alert etc.
   Connecting channels, which are mainly described through the activities of some 700 blood vessels and 19 main nerves and their ramifications.
   Life-supporting channels

Some of these channels are described as critical, inasmuch as their malfunction can be life-threatening.

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CRITICAL POINTS     These are important points in the body which are particularly vulnerable and injury to which may lead to grave injury or death. The texts describe some 302 of them, related to the flesh, adipose tissue, bones, tendons and ligaments, 'full' organs (spleen, liver, kidneys, heart and lungs), 'hollow' organs (stomach, gall bladder, bladder, small intestine and large intestine) and channels.

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PATHWAYS    These are the main pathways through which the body is sustained. Some are external while others are internal. The internal ones are primarily concerned with the sevenfold process of metabolism (more fully described below in physiology) which at each stage produces both nutrients and wastes. The 9 external ones common to both sexes are the eyes, ears, nostrils, mouth, urethra and anus. Women also have the two nipples and the vagina.

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PHYSIOLOGY

THE TARGETS OF PATHOGENIC AGGRESSION    Appropriate diet and sensorial nourishment, efficient digestion and a subsequent efficient metabolism, along with the correct production and evacuation of wastes, is central to TTM's notion of what is needed for the maintainence of good health. The overall metabolic process (described in the next sections) starts from the intake of nourishment and follows catabolic and anabolic processes from the intestines through the whole digestive tract to the liver and on, step by step, to the production of other bodily tissues up to the final 'glow' of good health. Each stage produces certain nutrients, required by the body, and certain by-products, which mainly need to be eliminated. It is evident that anything which goes wrong in this vital chain is going to have important repercussions on health. The physician needs to understand these processes intimately and to know how to use behaviour, diet, medicines or more radical treatments to correct any disorders that occur.

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METABOLIC FIRE    This topic concerns the production of energy from nutrients. "The "metabolic fire " is the basis of digestion but is also the energy component present in the three main biodynamics, in the body constituents and in the excreta. The texts say:

" It makes one free from sickness, able to be active, and it gives radiance and glow, longevity, and strengthens the metabolic heat of the body constituents."

A certain amount of metabolic fire, generated by:

... proper mastication and production of phlegm,
... a proper production of bile and
... proper transit of foodstuffs and the 'wind' biodynamic,

is needed to break food down into what will produce both energy and vital bodily nutrients. If this initial fire is insufficient, nutrients will not be properly processed and will either be wasted, eliminated as excreta, or else they will create harmful residues. Weakness and depletion, with various sequela, may ensue. Thus a healthy diet -described as one which is not too heavy and one which is warming by nature (giving energy to the body rather than taking it from it) - is needed and this diet should match the person's digestive ability.

An important part of TTM is to ensure that the patient is getting the maximum energy out of his/her diet and to see that the diet suits his or her needs and lifestyle. In TTM, good diet and good digestion hold a prime place in prophylactic medicine as well as being a vital adjunct to the various therapeutic means employed.

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THE METABOLIC CHAIN    

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THE ORIGINS OF PATHOGENIC AGGRESSION  TTM looks at pathogenesis on three timescales. The first harks back to a distant past and is related to the psychology of the person. Being a Buddhist medicine, this past also includes the mind and actions of the person in past lives. Be it in this life or previous ones, the psychological capital of a person is seen as having an overall influence on their biology. This influence is key in the generation of the three main biodynamics, which are such an important topic in TTM that they will not be treated here but on their own page. Desire and attachment is intimately connected with the Vata biodynamic. Anger and rejection is intimately connected with the Pitta biodynamic and confusion and ignorance intimately related to the Kapha biodynamic.

On a second timescale, one has the resultant physiology of the person, with its strengths and weaknessnes and in which the three biodynamics are the vectors of both health and sickness. When they are functioning as they ought ('each in their own place') and not 'modified' they bring good and balanced health. When they fall out of balance through depletion, excess or conflict, they can harm one or more of the seven stages of metabolism (or the processes of excretion) and sickness results. There is a third, very immediate stage of pathogenesis, which concerns the immediate circumstances which have triggered the malady. To give an over-simplified example to show this point:

... the person's psychological capital from the past may be highly characterised by desire
... this causes one of the three biodynamics to outweigh the others and make for an oversensitive person, quite vulnerable and easily depleted of energy when they cannot control their environment
... the person being too lightly dressed one day and exposed to harsh noises and mental stress may crack up suddenly - have a mini breakdown - much more quickly than someone else would.

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