— Appendix Five —

Expedition Medicine – A Personal View

Ch’i Po said: ‘The utmost in the art of healing can be achieved when there is unity.’

The Emperor enquired: ‘What is meant by unity?’

Ch’i Po answered: ‘When the minds of the people are closed and wisdom is locked out they remain tied to disease. Yet their feelings and desires should be investigated and made known, their wishes and ideas should be followed; and then it becomes apparent that those who have attained spirit and energy are flourishing and prosperous, while those perish who lose their spirit and energy.’

The Emperor exclaimed: ‘Excellent indeed!’

(From The Yellow Emperor’s Classic of Internal Medicine)

It is said that the doctors in ancient China were paid to keep their patients healthy. If they became ill payments were suspended, and if the illness became serious the doctor had to pay out for expenses. Prevention, obviously better than cure, was achieved by a holistic approach, for it was known intuitively that man is more than the sum of his parts. They endeavoured to bring order and balance into all facets of their patients’ lives so that the Chi energy – the breath of life – could pass through them without interruption. This life force and its power often becomes apparent, spontaneously, during or after severe illness, after emotional trauma, when letting go of attachments, when falling in love, or when a break has been made in habitual routines which may occur through great physical exertion and facing one’s fears – as on a demanding mountaineering expedition. It is made manifest through conscious efforts to work on oneself by following any of the many paths mapped out by esoteric doctrines and oral traditions. Anyone who has received traditional Chinese acupuncture will be aware of the vital energy once it has been allowed to run its course through the body.

The Tao, or the way to nurture this life force, is easier for those who live close to nature since they can more easily steer a middle course, avoiding both deprivation and excesses of sensory perception, and can strike a balance between the ‘normal’ conscious self and the inner voices that reveal themselves in dreams and flashes of intuition. In ancient times the doctor helped his patients to control desire and avoid attachments, all in an effort to let the Chi energy flow. He also paid particular attention to the patient’s food, just as in modern times Rudolf Steiner realized that man could more easily make contact again with cosmic energies if the food he ate was grown with the emanations from the cosmos in mind.

On a mountaineering expedition we are isolated for long periods of time and are able to face up to our problems without the usual diversionary constraints of family life and earning a living. Absent are the distractions of TV, spectator sports and the safety valves offered by the pub and weekend crag climbing or participation in other sports and pastimes. It is unlikely there will ever be the perfect mountaineering expedition but each expedition can move in the general direction of understanding and self-awareness at a personal level and can break down the barriers to greater physical achievement.

What follows is a personal view of this two-sided approach to inner and outer freedom on the mountain.

Overwhelming Ambition
Anyone setting off for an 8,000-metre peak is ambitious and, on the face of it, there is nothing wrong in that. Problems only arise if one or more of the team is so attached to the idea of ‘success’ that negative emotions creep in. To be hooked on the need to impress the rest of the world that you are the hard man of the trip invariably means that petty jealousies, uncontrolled anger, fear, and frustration will prevent a true rapport, to the detriment of the flow of energy (love). Energy goes down the drain and the team down with it. Expedition morale plummets. The attempt is a wash-out, the excuses: weather conditions, snow conditions, illness – anything but the real reason: no love flowing, team going down! Ambition feeds on itself and can never be satisfied. You can only let go of it but it is hard to get off the treadmill.

Going Public
It would take a very advanced team to remain unaffected by the expedition becoming a public event. So often the image we have of ourselves does not match up with the image we feel is being portrayed in the film clips for News at Ten, articles going off for serialization in The Times or the Observer, tape recordings for the expedition book, interviews for the expedition film. With the right team and a bit of common sense it is possible to have your cake and eat it too, providing there is free discussion about these potential pitfalls both during the course of the expedition and afterwards. If we do set off with problems unresolved they will only be magnified at altitude. There are individuals who are hardly affected at all by the commercial side of expeditions but the majority of us find it a problem to some extent.

The root of the trouble lies in our great need to be liked, but in reality the emotion invoked on winning the race or climbing ever steeper Himalayan peaks is not love but jealousy.

Competition
Those of us who see our climbing for what it is – a personal pilgrimage along a path potentially as valid as any other – will act modestly, and even be modest. Which of us can say from our hearts that this need to impress has not been a problem at some time during our climbing careers? It is certainly a fact of life that has to be faced wherever human beings join together and enter the rat race, where the competitors are brought to a standstill in the swamp of institutional boredom and pain as is seen today in all the professions – legal, educational, medical for starters but also at ‘grass roots’ level – among housing associations, community action groups and wherever hierarchies develop amongst people who join together. So why should we who climb expect it to be different for us?

Age-old Problem
There is another age-old problem, a continuing trend down the years whereby generation after generation of climbers, seven years apart, have snapped and snarled at each other: the younger ones at those who are in the way and those of the older generation at the young energy close on their heels. The ‘old farts’ should know better, relishing the breath of fresh air, and the younger element must realize that once they have replaced (become) the old guard they can expect the same from the next generation following them. There was one 90-year-old climber still greatly troubled by events which had taken place 50 years before in the Alps – muttering dark thoughts about his rope-mates of the 1930s, and he is not alone in this. Clearly, these problems do not always go away with time, nor is old age a guarantee of equanimity. At such moments it is wise to recall the early days when a healthy spirit of spontaneous curiosity first tempted us to step out into the hills. All of us must have memories of exhilaration and discovery in good company which nothing can tarnish, and which give us the strength to check the rot more effectively, otherwise the whole rotten show will stay on the road forever or at least make it difficult to attain that spirit and energy needed to enjoy our climbing and everything else to boot.

Mixed Expeditions
Women, by nature or nurture, tend to be less aggressive and ambitious than one’s fellow climbers, seem to be intuitively more in touch with their environment and sensitive to emotions. They can help. Recognize the spiritual qualities of a woman and she will help you develop the other side of your nature, but don’t become blinded by her beauty – claws of attachment strangle the flow of vital energy. Instead of softening the atmosphere of an expedition, attachments will only arouse negative emotions. Mixed expeditions can be quite interesting.

Homesickness
Overcoming homesickness is to overcome a kind of illness in which feelings of insecurity linger on from childhood pulling us back to the nest for the love and affection that cannot be found out of it. With too many problems left unresolved at home homesickness may be impossible to cure. Is anyone entirely immune from this limiting factor, when even the spirit of the hills may be temporarily dead to the beholder? There are various ways to overcome the depression that results from homesickness – or rather the general insecurity of which homesickness is but a symptom. The usual ways are to hide from it by overwhelming it with ambition, by reaching out for material security, take to alcohol, become a workaholic, sleep around, smoke, eat, escape into books, become a heavy leader, follow some Freudian father figure, take up a ‘cause’, become ‘religious’, etc. Some four or five weeks into a well-matched expedition, pangs of homesickness usually subside as the team settle down to share in the common objective and become aware that we are ‘but river arks on the ocean brine’ until such time as we can feel genuine love for each other.

When this particular sickness has passed the real difficulties of leaving family and friends for two to three months can be faced positively by realizing that it was in their love that they made sacrifices to manage without the breadwinner, father and lover, so that he might do as he had to do. We must do it without useless self-pity and worry, accepting the penalty that they will move on for a time without us. How stupid it is that climbers wish to be away climbing when in the comfort of home, and to be home when uncomfortable on the mountain. To enjoy the mountains fully we must join our bodies in being there. If my thoughts are for ever wandering off out of control it is as if I am blinkered. But we do have the advantage in the mountains that the unexpected continues to shake us out of our routines.

Food
Cicero thought that we ‘should eat to live, not live to eat’ which is a point of view appropriate to expeditions and particularly on expeditions to China in the spring, when fresh foodstuffs are difficult to come by locally and freight charges make the carriage of all foodstuffs a very expensive item. Unfortunately, food assumes an unusual importance on expeditions, owing to the physical effort requiring sustenance which is interspersed by quite long periods of inactivity acclimatizing, weathering storms or resting between climbs, when there is little else to divert attention.

Whilst it is right to take into account the real and imagined terror of there not being the appropriate food for each team member, it might be worthwhile pointing out the advantages of a vegetarian diet. I do not wish to press the issue too far, knowing that amongst meat eaters vegetarian food is the butt of every upset stomach going. The Masai in Africa and the Eskimo of Baffin Island subsist on a diet almost exclusively of meat and have done so for generations. Clearly, however, one man’s meat is another man’s poison, for there are people who are extremely sensitive to the food they eat. I myself witnessed an arthritis sufferer, who had been confined to her wheelchair, but six months after a radical change of diet was walking normally and full of zest for living. This suggests to me the importance of the food we eat. Since turning to a diet largely free of additives – vegetarian except for occasional fish – I have found that aches and pains from broken and dislocated limbs and fingers no longer ache and are not as stiff as when I was sustained on a ‘normal’ diet. Whilst this was my motive for a change of diet, I have noticed that at an age (41) when I might have expected my energy levels to drop the opposite is the case. In fact the Latin origin of vegetarian, vegetus, means active and vigorous. Vegetarians claim that the diet helps them sleep more soundly and think more clearly, and I certainly find insomnia is not a problem. Each year since 1978, when I turned to this diet, I find myself more easily adapting to high-altitude climbing. This is a very subjective assessment of complex physiological changes, in which other factors may be involved such as the residual acclimatization from going high twice a year and knowing more about the problems of being high. Hindu pilgrims have recognized that a meatless diet helps them to reduce the effects of ‘mountain sickness’ whilst travelling over the high passes of the Himalaya. Buddhists and Hindus do not eat meat as they believe that to eat animal flesh will enhance instinctual and animal-like behaviour to the detriment of their spiritual goals. (The boxing profession realize the value of meat not only in building up large muscles but also in making the boxer more aggressive.)

Whether or not meat is taken, chewing garlic is supposed to help acclimatization, as is smoking tobacco! In Tibet garlic was given to animals affected by ‘pass poison’, according to Rockhill (Land of the Lamas). The Sherpas of Nepal favour garlic and chillis for this and other ailments, such as the common cold. Western medicine recognizes that garlic helps strengthen the elasticity of the blood vessels which could presumably be an advantage in acclimatizing to the lack of oxygen. There are many vegetables and herbs that may assist in the acclimatization and general health of an expedition working at great altitudes. The application of homoeopathic medicine for the prevention and cure of ailments merits attention – but not here, as I do not know enough about it yet.

Acclimatization
If, despite applying the suggestions outlined above, expedition members do lose vital energy and succumb to illness, then Dr Peter Steel’s handbook on expedition medicine should be consulted. This covers ailments of the digestive and circulatory systems that expeditions may suffer from on the approach march and those of the respiratory system that may arise on the mountain; it is also useful for general first aid. Peter Hackett’s book, Mountain Sickness, published by the American Alpine Club, is an excellent up-to-date account of the prevention, recognition and treatment of mountain sickness. Further information is to be gleaned from the appendices of the many expedition books produced each year. The main problem of course is acclimatization. There is no substitute for a very slow build-up to enable the body to adapt itself to the lack of oxygen. This is absolutely essential for Alpine-style ascents. To climb on any of the 8,000-metre peaks means we have to be fit and acclimatized from having climbed on lesser peaks first. It is during this period that not only physiological adjustments take place but also psychological factors are put to the test. It is not just a ‘Sherpa physiology’ we have to work towards but also a ‘Sherpa psychology’ to survive at great altitudes. They are content to lead uncluttered lives doing a few things well rather than a lot badly. They are economical not only in their actions but also in their thoughts and speech. They usually appear emotionally tranquil, thoughtful and full of grace and good humour.

To some it may seem like a luxury to await the time when all the team experience deep within themselves that intuitive feeling that the time is ‘now’ to go for it. It is a matter of life and death that we do not go before this moment has arrived. The moment there is unity on which line to take and how this should be followed, when there is agreement that the weather and conditions on the mountain are reasonable, that acclimatization has been achieved and the team members are in complete harmony with each other – then and only then should they commit themselves to the mountain.

(most of this chapter was reproduced in The Doctor magazine, Autumn, 1982)

References

Traditional Aquapuncture: The Law of the Five Elements, Dianne M.Connelly
Tao: The Watercourse Way, Alan Watts
Buddhism, Alexandra David-Neel
The writings of Carlos Castenada , Richard Bach, Rudolf Steiner, G.I. Gurdjieff and others