The Theory of the Three Factors—derived from the "Chinese Medical Encyclopedia—Tibetan Medicine"

　　The Three Factors—Lung, Tripa, and Bkra-shis—are the three fundamental elements in Tibetan medical theory. According to Tibetan medicine, these three factors are the three energetic substances that underpin all life activities in the human body and also serve as the three primary causes of disease. Under normal physiological conditions, these three factors maintain a certain volume and fixed locations within the body, existing in a state of mutual dependence and restraint, thereby preserving balance and harmony and ensuring the smooth functioning of bodily life processes and overall health. However, when pathological conditions arise—under the influence of various internal and external pathogenic factors—the volumes and positions of these three factors undergo changes. This leads to imbalances, with some factors becoming excessively dominant while others become deficient, disrupting the original state of equilibrium and coordination. As a result, the seven vital essences (including subtle essence, blood, flesh, fat, bones, marrow, and semen) and the three impurities (feces, urine, and sweat) are affected, turning them into pathogenic agents and throwing the body out of balance. The Lung, Tripa, and Bkra-shis that have caused disease are referred to as the "Three Evils," which is why the Three-Factor Theory is also known as the Three-Evil Theory. In a physiological state, Lung corresponds roughly to the "Qi" of Traditional Chinese Medicine, though the two are not entirely identical. Its primary functions include promoting blood circulation, regulating respiration, and governing bodily movement—it serves as the driving force behind all life activities in the human body. Tripa corresponds to "Fire," providing thermal energy to the body and facilitating digestion. Bkra-shis possesses properties of both water and earth, playing a role in supplying bodily fluids and maintaining moisture. The terms Lung, Tripa, and Bkra-shis are transliterations from Tibetan; some scholars render them as "Wind, Bile, Phlegm" or "Qi, Fire, Mucus," while others translate them as "Wind, Fire, Water, Earth." However, compared to the Chinese terms such as Wind, Qi, Fire, Phlegm, and Bile, the Tibetan concepts encompass a broader range of phenomena and carry deeper meanings, though their exact conceptual parallels are not entirely identical. In a physiological state, the Three Factors exhibit numerous attributes and characteristics, notably their cold and hot natures: Tripa is hot, Bkra-shis is cold, and Lung is also cold. Tripa and Bkra-shis have an antagonistic relationship, while Lung displays a dual nature—when it encounters Tripa, it becomes even hotter; when it encounters Bkra-shis, it becomes even colder. In the "Great Commentary on Purity and Clarity," this relationship is vividly illustrated by comparing it to the interplay among the sun, moon, and stars. When the Three Factors undergo pathological changes, they give rise to Lung Disorders, Tripa Disorders, and Bkra-shis Disorders, respectively. Corresponding therapeutic remedies are classified according to their elemental nature: earth medicines for Bkra-shis disorders, water medicines for Tripa disorders, and fire medicines for Lung disorders ("Great Commentary on Purity and Clarity": "Lung disorders are treated with nourishing medicines; Tripa disorders with cooling medicines; Bkra-shis disorders with warming medicines"). In the body, Lung, Tripa, and Bkra-shis occupy the upper, middle, and lower regions, respectively. The seasons most commonly associated with these disorders are summer (hot season), winter (cold season), and rainy season. The age groups most susceptible to these disorders are the elderly, young adults, and children—specifically, the elderly tend to develop Lung Disorders, young adults are prone to Tripa Disorders, and children are more likely to suffer from Bkra-shis Disorders. The times of day when these disorders typically manifest are morning, noon, and dusk, respectively; at night, they appear in the early hours, midnight, and dawn. Within the Three Factors, there are specific subtypes: "So-chen Lung" (the sustaining Lung), "Jen-gyu Lung" (the ascending Lung), "Chab-chi Lung" (the pervasive Lung), "Me-nyan Lung" (the accompanying-fire Lung), and "Thu-she Lung" (the descending Lung); "Tripa-gyu-shi" (the eliminating Tripa), "Tripa-dang-gyu" (the transforming Tripa), "Tripa-jhu-shi" (the making Tripa), "Tripa-do-se" (the brightening Tripa), and "Tripa-thong-shi" (the seeing Tripa); "Bkra-shis-dan-shi" (the relying Bkra-shis), "Bkra-shis-ne-shi" (the breaking Bkra-shis), "Bkra-shis-ngang-shi" (the tasting Bkra-shis), "Bkra-shis-leng-shi" (the grounding Bkra-shis), and "Bkra-shis-gyu-shi" (the combining Bkra-shis)—altogether comprising 15 distinct subtypes.

　　The Origin of the Three Factors: Tibetan medicine holds that the three root causes—greed, anger, and ignorance—are the fundamental sources of the three factors. These three factors are inherently present in the father’s essence and the mother’s blood. Consequently, the embryo formed through conception from these essences already possesses the three factors at birth—just as a worm that lives in association with a poisonous substance is itself inherently toxic. Depending on the relative proportions of the three factors present in the father’s essence and mother’s blood, as well as the varying amounts of the elements Lung, Trika, and Phakpa that the mother ingests through her diet and lifestyle after conception, the human body can manifest in seven distinct types. Individuals whose father’s essence contains relatively more Lung elements, or whose mothers consume more coarse and light Lung elements through their diet and daily routines, tend to be short in stature and belong to the Lung type. Similarly, individuals whose father’s essence and mothers’ diets contain relatively more Trika elements tend to have an average build and belong to the Trika type. Those whose father’s essence and mothers’ diets are rich in Phakpa elements tend to be tall and physically strong, belonging to the Phakpa type. The above three types are known as “simple types.” If the three elements—Lung, Trika, and Phakpa—are present in equal proportions, the resulting individual belongs to the “three-combination type,” whose physique, strength, and temperament are considered optimal. Likewise, if two of the three elements—Lung and Trika—are relatively more abundant, the individual is classified as a “Lung-Trika type”; if two elements—Phakpa and Trika—are relatively more abundant, the individual is a “Phakpa-Trika type”; and if two elements—Phakpa and Lung—are relatively more abundant, the individual is a “Phakpa-Lung type.” Such “two-combination types” are superior to simple types but inferior to the three-combination type.

　　The relationship between the Three Factors and Stomach Fire

　　The relative magnitudes of the three constituent elements in the human body directly influence the strength of stomach fire. This effect can be categorized into four scenarios: When the Fire-Lung component is relatively large, the stomach fire in the body may sometimes be strong and sometimes weak, exhibiting uneven intensity; when the Neng-Xiao-Chi-Ba component is dominant, the stomach fire becomes exceptionally vigorous; when the Neng-Sui-Peng component is dominant, the stomach fire is relatively weak; and when the Fire-Lung, Neng-Xiao-Chi-Ba, and Neng-Sui-Peng components are all equally balanced, the stomach fire maintains a stable and moderate intensity. Additionally, the relative magnitudes of the following three pairwise combinations—Fire-Lung and Neng-Xiao-Chi-Ba, Fire-Lung and Neng-Sui-Peng, and Neng-Xiao-Chi-Ba and Neng-Sui-Peng—also affect the strength of the stomach fire.

　　The relationship between the Three Factors and the abdomen

　　People with a predominant "Lung" constitution have a harder abdomen, meaning they are less likely to experience bowel movements. Even when consuming foods and beverages with laxative properties—such as earth- or water-based diets—as well as potent laxatives, they still find it difficult to have a bowel movement. On the other hand, people with a predominant "Cholera" constitution (because Cholera is sharp, purgative, and moist) have a softer abdomen, making them more prone to bowel movements. They can easily have a bowel movement even after taking mild laxatives, and sometimes even just by consuming small amounts of liquid separated from cheese or similar foods. People with a predominant "Bile" constitution (Bile belongs to earth and water, and has a dull nature) have an abdomen that is moderately hard or soft. Individuals whose constitutions of Lung, Bile, and Cholera are equally balanced have an abdomen that is appropriately hard yet soft; although they may not respond well to weaker laxatives or certain foods, they can still achieve a bowel movement when given standard laxative prescriptions. Moreover, although there are differences in abdominal hardness and softness among the three mixed-type individuals, these differences are not as pronounced as those seen in pure-type individuals. The five sources of Lung belong to wind (air), have a cold and hot nature (cold in particular), and are inherited from the parents' essence and blood. After birth, Lung grows and develops through the vital essence derived from food and the lifestyle practices during both prenatal and postnatal periods. Lung is the driving force behind all life activities in the human body, distributed throughout the body's subtle tissues, primarily residing below the navel in areas such as the iliac bones and large intestine. In a normal physiological state, Lung governs respiration, controls the body, speech, and mind—thus regulating physical activity, language, and thought. It digests and breaks down food, transports the seven essences along their respective channels, and then spreads them throughout the body, promoting blood circulation, nourishing the entire body, sustaining life functions, and prolonging life. It also eliminates waste products like feces, urine, and nasal mucus, thereby facilitating metabolism. Furthermore, it keeps the sensory organs—such as the eyes—highly sensitive to sight, hearing, smell, taste, and touch, and maintains clarity of consciousness. Additionally, Lung plays a role in sexual desire, ejaculation, reproduction, and passing on one’s lineage. Lung possesses six key characteristics: coarse, light, cold (as stated in “The Great Commentary: Pure and Bright”: “Lung’s nature is not very hot, thus it is classified as cold. However, when mixed with the other two factors, it exhibits neither cold nor hot characteristics”; and in “The Lexicon: Sun”: “The so-called ‘cold’ refers to a property that is not hot but displays symptoms of coolness, treated with warming medicines”), subtle, firm, and mobile. Notably, Lung is characterized by its mobility. Coarse means lacking smoothness, opposite to greasy and soft; it manifests as stubbornness of mood, rough skin and tongue coating, and rapid onset of illness. Light means rising and floating upward, opposite to heavy and dull; it shows up as restlessness, lightness of body, agility of movement, and quick reactions. Cold means cool and chilly, opposite to hot; it manifests as sensitivity to cold, intolerance to cold weather, preference for sunny places and warmth, and a liking for hot foods. Subtle means fine and minute, opposite to soft and greasy; Lung can pass through any tiny channel, permeating every part of the body without obstruction, reaching everywhere. Firm means hard and solid, opposite to soft and greasy; it manifests as skin that is resistant to friction, hard lumps that do not easily suppurate, a distended and hard abdomen that is difficult to empty. Mobile means floating or moving erratically, opposite to stable; it shows up as hyperactivity, mental restlessness, forgetfulness, and frequent vivid dreams. Lung mainly resides below the navel, yet it also extends to the head, chest, heart, stomach, genital region, and all other parts of the body. Depending on where Lung resides in the body and its specific functions, it is further divided into five subtypes.

　　The Zhiming Long primarily resides in the three vital organs—muscle, bone, and brain—and gathers at the Baihui point on the top of the head. It flows through the throat and chest cavity. Its functions include swallowing food and drink, breathing air, spitting out saliva, sneezing, and generating warmth. Additionally, it sharpens mental clarity, enhances memory, and heightens sensory perception, such as keen hearing and vision. It also helps to stabilize and retain spiritual awareness within the body, thereby strengthening consciousness.

　　The Shangxing Long primarily resides in the chest region of the human body and flows through areas such as the nose, tongue, Adam’s apple, esophagus, and trachea. Its functions include governing speech, enhancing vitality, revitalizing the complexion and radiance of the skin, promoting diligence and ambition, bolstering endurance and stamina, and enabling one to think clearly and creatively. It also improves memory.

　　Vijnana Lung resides in the heart, one of the five most important organs in the human body. It circulates through the vessels that connect the upper and lower parts of the body, as well as its internal and external regions, and through the channels that facilitate the transportation of the seven vital essences. Its primary function is to carry the seven vital essences—such as blood and other dietary metabolites—throughout the entire body, thereby promoting circulation. It governs the movements of the limbs, including flexion, extension, and walking; it opens and closes orifices such as the mouth and eyes; and it oversees speech and thought. In short, the body’s movements fundamentally depend on the action of Vijnana Lung.

　　Banhuo Long primarily resides in the lower part of the stomach region, circulates through the large and small intestines, and transports nutrients to all the vessels. It is one of the Three Stomach Fires. Its functions include enhancing gastrointestinal motility, regulating digestion of food, breaking down essence and waste products, and transporting them to their respective biochemical and storage sites, where they mature and are transformed into the Seven Essences and Three Impurities.

　　The Xia Xie Long primarily resides around the anus and runs along the large intestine, bladder, genital region, and inner thighs. Its functions include controlling and facilitating the excretion of semen, menstrual blood in women, and both bowel movements and urination, as well as assisting in childbirth, delivering the placenta, and eliminating postpartum residual ailments.

　　The "Chiba" element belongs to the fire category and has a hot nature. Its innate origin stems from the father’s essence and the mother’s blood; in the postnatal stage, it develops through the absorption of the essence of food and drink as well as the vital energy derived from daily life and living conditions. Chiba is the thermal energy that sustains all life activities in the human body. Its functions include promoting digestion of food, generating appetite and feelings of hunger and thirst, absorbing fine nutrients and medicinal substances, facilitating the maturation and biochemical processes of the seven essential fluids, maintaining body temperature, enhancing radiance, giving the skin a rosy and fair complexion, and bolstering courage and ambition. (As stated in the “Great Commentary on Pure Clarity”: “The heart is characterized by combativeness, competitiveness, and bravery—though physically weak, it knows no fear, just as a tiny spark of fire can burn down even a mountain-sized haystack.”) It also governs strategic thinking. (As noted in the “Great Commentary on Pure Clarity”: “A strategist is wise, deeply calculating, quick-witted, meticulous, clear-headed, and decisive.”) In terms of emotional and psychological traits, Chiba manifests as intelligence, decisiveness, pride, and irritability. Chiba possesses seven primary characteristics: heat, sharpness, lightness, pungency, diarrhea, dampness, and greasiness. Heat is the opposite of cold, referring to elevated body temperature and excessive stomach fire. Individuals with abundant Chiba tend to be cold-resistant, easily feel hungry and thirsty, have radiant complexions, experience fever during illness, and prefer cool foods. Sharpness is the opposite of dullness, indicating keen intellect, intelligence, impatience, pride, combativeness, and hyperactivity. Additionally, they are prone to developing abscesses that easily become suppurative and often experience sudden onset of illness. Lightness is the opposite of heaviness, meaning being fleeting and uplifting; it contrasts with heaviness by making one’s emotions easily agitated, rash, changeable, and lacking focus. Moreover, illnesses caused by Chiba tend to be easier to treat. Pungency refers to strong odors, the opposite of mildness; it describes the intense stench produced by heat, such as the strong smell of sweat or urine. Diarrhea means being prone to loose stools. It is the opposite of dryness and reflects the effects of dampness and sharpness; individuals with abundant Chiba often have soft abdomens and are prone to diarrhea. Dampness is the opposite of dryness, manifesting as easy sweating and frequent bowel movements, as well as excessive phlegm production. (As explained in the “Great Commentary on Pure Clarity”: “Chiba belongs to the fire element; thus, its essence and residues, once melted by fire, tend to cause diarrhea. The moist substances—such as the essence, semen, and sweat—that have been melted by fire seep out of the body, and this characteristic is referred to as diarrhea. The properties of diarrhea and dampness apply specifically to the effects of Chiba, rather than being inherent qualities of Chiba itself.”) Chiba is distributed throughout the entire body, but it primarily resides in the liver and gallbladder region—the central part of the body extending from the heart to the navel. Depending on the specific location and function of Chiba within the body, it is further divided into five subtypes.

　　The chief of the five subtypes of Chibas, known as “Nengxiao Chibas,” is located at the pylorus—the junction where food is about to be digested and still remains undigested. It is the most important of the three gastric fires. Its functions include generating thermal energy, fermenting and digesting food, initially breaking down food into its essence and waste products, maintaining body temperature, and assisting the other four types of Chibas—including the color-changing Chiba—in performing their respective functions while enhancing their strength. Additionally, it has the function of warming and drying the body’s fluids.

　　The Color-Changing Chiba resides in the liver—the base of fire among the five zang organs—and circulates among the body’s seven essences. Its function is to alter the colors of these essences: for example, turning blood and muscles red, fat white, and bone marrow grayish-white. In short, it has the ability to change the colors of the seven essences, the three impurities, and even certain fine substances within the body, including hair.

　　The “Chiba” resides in the heart and is responsible for safeguarding one’s mental clarity, governing consciousness and thought. It enables individuals to develop a sense of pride and self-assuredness—such as the conviction that their insights and understanding are uniquely their own. It also enhances courage, fosters strategic thinking, fuels desire, and inspires diligence and hard work.

　　The Nengshi Chiba is located within the pupil of the eye and the vessels that transmit visual signals. It governs vision and has the function of clearly distinguishing all aspects of external objects, including their shapes, sizes, thicknesses, and colors.

　　Mingse Chiba is located in the skin and functions to make the skin rosy and fair, imparting luster and radiance.

　　Pakken’s five elements—water and earth—possess a cold nature. Its innate origin stems from the father’s essence and the mother’s blood, while its acquired essence depends on the nourishment derived from food and the vitality gained through daily routines and physical activities. Under physiological conditions, Pakken plays a vital role in promoting human growth, prolonging life, regulating bodily fluids, and fostering their production. In particular, it confers focused concentration, emotional stability, and resilience against panic; it instills courage when facing danger, strengthens willpower, promotes sleep, lubricates and fortifies joints, enhances resistance to hunger, thirst, and drought, and endows the skin with moisture, softness, and elasticity. In terms of mental state, Pakken primarily manifests as strong willpower, steadiness, single-mindedness, and endurance. Pakken exhibits seven key characteristics: greasy, cool, heavy, dull, soft, stable, and sticky. Greasy refers to oiliness and moisture, contrasting with dryness, stagnation, and roughness; it is characterized by a plump physique with abundant oils, as well as viscous vomitus, diarrhea, and blood discharge. Cool signifies coldness, the opposite of heat; it is manifested by low body temperature and a preference for warm foods. Heavy implies heaviness and dullness, the opposite of lightness; it is marked by a sense of bodily weight, slow movements, introverted personality, sluggish thinking and speech, excessive sleepiness, and difficulty in fully recovering from illness. Dull denotes slowness and lack of sharpness, contrasting with keenness; it is reflected in slow movements, sluggish thinking, gradual disease progression, and difficulty in transforming into other illnesses. Soft refers to tenderness and flexibility, contrasting with coarseness; it is characterized by a smooth tongue coating and supple skin, gentle temperament, and mild pain sensations. Stable contrasts with dynamic; it is expressed through a steady and persistent personality, with relatively little change in health conditions. Sticky, in contrast to rough, has strong adhesive properties; it is evident in viscous vomitus and diarrhea. In the human body, Pakken predominantly resides in areas above the chest, such as the head and lungs. Depending on the specific organs it relies upon and its distinct functions, Pakken is further divided into five subtypes.

　　The sternocostal cartilage, located in the chest among the bones including the sternum and the costal cartilages, serves as the foundational base upon which four other types of bacon—such as tenderloin bacon—depend. It also assists other types of bacon in performing their functions. In particular, it regulates the body’s moisture levels and facilitates the smooth circulation of body fluids.

　　The gastric lipase is present in the undigested portion of food in the upper part of the stomach; its function is to grind and ferment the food in the stomach, preparing it for digestion.

　　The sense of bacon flavor depends on the tongue, which is responsible for taste perception and distinguishes the six basic tastes: sour, sweet, salty, and others.

　　The Shenfu acupoint is located at the top of the head and primarily governs the sensory functions of organs such as the eyes and ears. It enables one to experience external stimuli—such as colors, sounds, and tastes—and thus fosters a sense of contentment.

　　Can be paired with bacon

　　Located between the joints throughout the body, it connects and lubricates the joints, enabling them to bend and extend.

　　In a pathological state, under the influence of both internal and external factors, the locations and quantities upon which the physiological entities—Lung, Chik-ba, and Phe-gan—depend undergo changes and disturbances. The original state of balance and coordination is disrupted, giving rise to disease. At this point, Lung, Chik-ba, and Phe-gan not only fail to perform their normal physiological functions but also begin to harm the seven dhatus and three humors, transforming into pathogenic conditions harmful to the body. Due to these characteristics of the diseased Lung, Chik-ba, and Phe-gan, they are commonly referred to as the "three evils," "three pathogens," or simply "disease." Lung evil is light and unstable; it follows cold when encountering cold and heat when encountering heat. Cold intensifies with the presence of Lung evil, while heat becomes even more intense in its company. For example, Chik-ba evil is of a hot nature: when accompanied by Lung evil, the heat becomes even more pronounced; Phe-gan evil is of a cold nature, and when combined with Lung evil, the cold becomes even more severe. Lung evil is light and buoyant, capable of stirring up excess moisture and dampness, thereby exacerbating edema. Moreover, due to its vigorous nature, Lung evil can cause stagnation and obstruction of qi and blood, leading to the accumulation and formation of masses and tumors. In short, Lung evil is mobile and frequently changing; all diseases in the body originate with Lung evil as their precursor. Furthermore, during the recovery phase, diseases often relapse precisely because they are stirred up again by residual Lung evil. Thus, throughout the entire process of disease onset, progression, and outcome, Lung evil consistently plays a dominant role. Generally, Lung evil resides in areas where food is digested—in the small intestine, large intestine, hip joints, lumbar region, most of the body’s bones and joints, as well as sensory organs such as the skin, pores, eyes, and other parts of the body, with the large intestine being its primary site. When disease occurs, these areas manifest various symptoms characteristic of Lung evil itself. The properties of Lung evil include roughness, lightness, coldness, subtlety, firmness, and mobility—six distinct qualities. It is best treated with herbs possessing five complementary properties: softness, heaviness, warmth, greasiness, and stability. Chik-ba evil typically resides between the sites of food digestion and non-digestion—specifically, between the stomach and the navel. It depends on the blood, sweat, refined essence of food, yellow bile, and also affects the eyes and skin. Its main location is between the large intestine (where food is digested) and the stomach (where food remains undigested). When disease occurs, these areas exhibit various symptoms characteristic of Chik-ba evil itself. The properties of Chik-ba evil include greasiness, sharpness, heat, lightness, stench, diarrhea, and dampness—seven distinct qualities. It belongs to the fire element and manifests as a hot nature. It is best treated with herbs possessing six complementary properties: coldness, dullness, coolness, softness, mildness, and dryness. Phe-gan evil typically resides in the thoracic cavity, neck, lungs, head, refined essence of food, muscles, fat, bone marrow, semen (in men) or menstrual blood (in women), and the two excretions—urine and feces—as well as in sensory organs such as the nose and tongue. Its primary location is in the stomach—the site where food remains undigested. When disease occurs, these areas display various symptoms characteristic of Phe-gan evil itself. The properties of Phe-gan evil include greasiness, coolness, heaviness, dullness, softness, stickiness, and stability—seven distinct qualities. It belongs to the water and earth elements and manifests as a cold nature. It is best treated with herbs possessing six complementary properties: astringency, heat, lightness, sharpness, roughness, and mobility.

　　In summary, the three factors—Lung, Chik-ba, and Phe-gan—each occupy their proper place within the human body, maintaining constant levels and achieving a balanced harmony that complements and reinforces one another. When these factors function normally and in equilibrium, the physiological functions of all tissues and organs are robust, the body remains healthy and free from illness, and one is full of vitality. However, once external factors disrupt this balance, causing an excess or deficiency in any of the three factors, leading to an imbalance and disharmony among them, pathological changes occur. These pathological changes then give rise to various diseases, becoming the root cause of illness. The process of treating disease, therefore, essentially involves regulating the three pathogenic factors—Lung, Chik-ba, and Phe-gan—that have become imbalanced. Consequently, the theory of the three factors permeates every aspect of Tibetan medicine, encompassing physiology, pathology, and treatment. Indeed, Tibetan physiology, pathology, and treatment all rely on the theory of the three factors as their theoretical foundation; the theory of the three factors is the very essence and core of Tibetan medicine.

　　(Compiled by Cuoru Cilang and Shanmudan, translated by Xing Quanzhang)